It's a GAD GAD World
Saturday, September 20, 2003
What Price Sleep?

Terrific. My last few days of being able to sleep in before I start my new job, & I'm up at 6am. Actually, I woke up around 4:45, tossed & turned until 5:30, then said, "the hell with it, I'm hungry" & got up.

Welcome to the wonderful world of GAD, where insomnia rules...

Although I have to admit things aren't as bad for me as they were a few months ago. Back in April/May my anxiety was so bad that I would just lie awake until 3:30am. It didn't matter how physically exhausted I was. As soon as my head would hit the pillow, I'd be wide awake.

But things are slightly better now. In May I participated in a study at a major university which studied the effects of a drug called riluzole on treating GAD. Riluzole is normally used for treating patients with ALS (Lou Gehrig's disease). It works by inhibiting a brain chemical called glutamate. The brain makes glutamate when you're anxious or nervous. However, too much glutamate can literally excite your brain cells to death. Therefore, when a person is under a chronically stressful situation, it can literally cause brain damage.

The study required me to be on riluzole for 8 weeks, during which time my symptoms improved. Riluzole didn't make me well, but it made me better. In return for my participation in the study I've been entitled to 3 months of follow-up treatment. I continued to take riluzole after completing the study. Unfortunately, 3 weeks into the follow-up phase I started to have an adverse reaction to the drug. One of riluzole's potentially dangerous side effects is that it can cause liver damage. I had to have blood work done routinely while I was participating in the study. One day my blood work came back & my liver enzymes were up. That's a sign of impending liver damage, so I had to stop taking the drug.

So then the question was which drug should I start on now that I can't take riluzole? I absolutely refused to take an SSRI (more on that in another post), so that sort of limited my options. My doctor wanted me to go on Wellbutrin, but after I did some research on Wellbutrin I wanted to ask my doctor what kind of drugs he was using. Wellbutrin is a drug commonly used to treat depression. I'm dysthymic, so that was logical. It's also common for some antidepressants to be used as anti-anxiety medication, so that was logical, too. The problem was that 2 of the common side effects of Wellbutrin are anxiety and insomnia. As I said to my doctor, "Why don't we just find an alcoholic with a head cold and give them Nyquil?"

A side rant here: If you're receiving medical treatment, whether it's for mental illness or anything else, it is CRITICAL that you take responsibility for your own treatment!! NEVER just blindly accept whatever your doctor tells you! While it's true that there are many doctors out there who are just plain idiots, even the gifted and competent doctors can make mistakes. And even if they're not prone to making mistakes, YOU know your own body better than any doctor does. A doctor can prescribe treatment, but you're the one who has to undergo the treatment. If it doesn't make sense or it isn't working for you, SPEAK UP!! Again, you MUST take responsibility for your own treatment. If your doctor has a problem with that, find another doctor. You're the one paying the medical bills--that means your doctor works for YOU, not the other way around. If your doctor seems threatened by you taking an active role in your treatment, take your business (and your insurance money) elsewhere.

Having said all this, I do need to say that my doctor is not an idiot. I like him, and there aren't too many people in the medical profession about whom I can honestly say that. There are many reasons why I like him, but the biggest reason is that he is not afraid to be challenged. He not only accepts my taking an active role in my treatment, he welcomes it.

Anyway, back to my treatment. We ended up deciding that I would go on Effexor. DISASTER!!! It made me so loopy that I couldn't function properly. I was a zombie. I couldn't walk a straight line. It was like I was drunk. And it made me a weepy mess. So as I sat in the clinic blubbering to my doctor, I asked if there were any other drugs out there that inhibited glutamate. He said that there were, & to make a long story short we decided on Lamictal. Lamictal is typically used to treat epilepsy and is currently being tested on patients with bi-polar depression. However, since it's a glutamate inhibitor and since I responded to riluzole, which is also a glutamate inhibitor, we both felt this would be a good way to go.

I've been on Lamictal for almost 3 weeks (25 mg/day), and it's working well. I'm not completely asymptomatic, but I'm better than I was while on riluzole, and a hell of a lot better than I was when I first started the study.

As I said before, I start my new job on Monday. I'm going to be a receptionist at a VERY prestigious financial firm. It's a temp to perm job, but I already know I don't want it permanently because the hours are 8-6. That's a 10-hour day, folks. That's not a job, that's jail. I'm a World Trade Center survivor. Life is too short to slave it away at a job. So I'm going to try & ride out this job till January. If I don't have something else lined up by then, I'll go back to the tax firm where I was working up until yesterday.

8-6...this means I'm going to have to get up at the crack of ass every morning. Thank God for Dave Price. I have a feeling he'll be the only good thing about this whole job aside from the paycheck. (For those who don't know, Dave Price is the weather guy for the graveyard shift newscast on Channel 2. He's funny, he's smart, and he's a cutie patootie. ;) )

Actually, that last take on the job isn't entirely accurate. My boss seems cool, the work isn't going to be that difficult (all I'll be doing is answering the phone), and it's a friendly environment from what I've been told. I'm just not liking the thought of not seeing daylght for the next few months.

I think I'm going to try to go back to sleep now...

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