Confessions of an Rx Drug Pusher Read online

  The usual chaos ensued. My sister’s drinking got out of hand. The police called me after picking her up one night on a DUI. I was stunned when she attacked me, both physically and verbally, on the drive home. Like a frightened animal, she became wild. She clawed, screamed, and cursed uncontrollably as she lunged at me from the backseat of the car, which forced me into the dash. Once again, I washed my hands of my sister. I could not handle her abuse. My anxiety and migraines were returning. These were a warning sign. Stress has a very detrimental effect on my health. Even for minute stressors, much less than the kind my sister brought into my life, my body always signals a four-alarm fire response. I feared I might have a meltdown if I didn’t protect myself.

  Trying to help a manic, psychotic person (especially an intoxicated one) is like trying to help a wounded badger. In spite of your best intentions to help, you will more than likely get eaten up in the process! A family intervention forced my sister to attend rehab. For a while, she seemed to do better. However, she continued to move indecisively between Indiana and Texas, so Meg went to live with my mother in southern Indiana. That meant starting over at yet another unfamiliar high school, which she did. In spite of it all, she graduated with honors and enrolled at Indiana University, my alma mater, to study premed. Her dream was to become a plastic surgeon and help deformed children.

  2

  My Own Dark Night of the Soul and

  a Case of Déjà Vu

  Don’t Be Afraid of the Dark

  At the blackest ebb of midnight—

  not a single star in sight—

  there’s a still and quiet whisper

  of ebony delight…

  It may appear quite frightening

  to those without true faith,

  but darkness only serves to show

  where light can heal our ways.

  If you listen in the stillness,

  you can hear a voice inside.

  It’s the steward of the lighthouse

  sent to help you through the tide.

  So, don’t tremble as you stumble

  down life’s dark and narrow path.

  Pick up your torch and lantern

  and forge on to greater tasks!

  Take heart in your ability

  to navigate at night,

  and remember that instinctually

  you ‘re headed for the light!

  Gwen Olsen (1992)

  December 2, 2004, was the day Meg committed suicide. It was also her biological father’s birthday. She didn’t leave a note. She didn’t say good-bye. She didn’t get her Christmas gifts, which were still sitting unwrapped on my closet floor. Only two days before that, the last words she said to me were, “I love you, Aunt Gwen.” Then we hung up the phone.

  So why do I feel so guilty? Because I knew the drugs she had been given were destroying her mentally and I had promised her that I would not allow her to be further chemically abused. However, when it came right down to it, I was unable to keep that promise because none of the decision makers would listen to me until it was too late. That’s the problem with becoming overzealous or passionate about a subject. You risk isolating the very audience you seek to educate.

  After fifteen years in the pharmaceutical industry as a sales rep, I have more than an average layman’s knowledge about drugs and pharmacology. In fact, the first part of my pharmaceutical career was spent as a hospital rep, educating resident physicians in teaching hospitals about psychiatric drugs, among others. However, the majority of my career was spent as a specialty rep, calling on specialists in cardiology, psychiatry, neurology, orthopedics, obstetrics/gynecology, endocrinology, and so forth. These are the scholars among physicians, so the training I received to work with these doctors was exceptional. It also included many preceptorships in several prestigious teaching institutions.

  In addition, I had personal experience to back up my book learning. In 1992, following a divorce, my general practitioner encouraged me to try a newly released antidepressant called Zoloft. Prior to that, I was despondent and lethargic, and I had begun losing weight. It seemed like a reasonable suggestion. I was thirty-three years old, and I had never taken antidepressants before. In just a few days, I started having horrendous side effects, including agitation, jitteriness, racing thoughts, and palpitations. I couldn’t drive. I couldn’t think. I certainly couldn’t work and call on doctors. I called my physician. The doctor called me back and assured me these were not side effects associated with Zoloft. He explained that what I was experiencing was known as agitated depression and my condition was worsening before the drug took effect. He suggested we increase the dose. I complied.

  My memory doesn’t serve me as to what happened next, but I fortunately kept a journal of my chemically induced foray into madness. Apparently, after doubling the dose, I began experiencing psychotic delusions. I also noted involuntary muscle spasms and an inability to sit still, which I identified to be the neurological side effect known as akathisia. I had learned about this devastating side effect while selling Haldol (haloperidol) for schizophrenia and senile dementia. At one point, I curled up in a fetal position to hold myself while I shook uncontrollably, searching for relief from the torturous tremor within. Still, my doctor assured me these types of adverse events were not reported with Zoloft. However, at my insistence, he discontinued the Zoloft therapy. No washout period was given.

  He prescribed Prozac next. I stopped journaling two days into my use of Prozac because my hands shook too badly to write and my thoughts raced at lightning speed. The suicidal ideation came in intense and unrelenting urges. I found myself driving up and down Highway 2222 (a curvy, potentially treacherous road), looking for a place to drive off that would appear accidental. I didn’t want to leave Austin, my three-year-old son, without the benefit of my insurance. I played out every detail with obsessive compulsion. My once-sharp, brilliant mind was losing touch with reality, and I couldn’t bear the psychic pain. Nevertheless, I continued believing in the doctors and the magic pill that would fix my brain chemical imbalance. After all, that’s what I was assured the antidepressants would do. Balance my brain chemistry, right?

  The list of drugs I was exposed to next is embarrassing, even to a former, diehard believer of the quick fix. Why I allowed myself to be a guinea pig of that nature is beyond me. However, after three doctors and fourteen pharmaceutical interventions, I had enough! A certain survival instinct kicked in, and I knew my very life was slipping away and my brain was being irreparably damaged. I turned my back on conventional medicine and started an alternative path of healing.

  In therapy, I would later liken my harrowing experience with biochemical psychiatry to that of being mentally gang-raped—repeatedly and brutally by men I respected and trusted—then left to die, feeling broken and ashamed because they had convinced me it was my fault and that somehow I had asked for it.

  The brain becomes distorted in its functioning as it attempts to overcome the effects of psychiatric drugs. Even when the drugs are stopped, it cannot immediately recover its original functions. In some cases, such as my own, the brain may never fully recover (Breggin and Cohen 47).

  After several months on disability and a slow, grueling rehabilitation period, my life returned to some semblance of normalcy. I suffered severe memory loss and decreased cognitive function. This made my profession, much less my daily life, extremely stressful. I lived every moment out of my Franklin Planner. I was fearful I would forget something and fall short of my responsibilities. This created terrible anxiety and social dysfunction, not to mention a negative impact on my self-esteem.

  I felt compelled to share with others what had happened to me. Most folks expressed sympathy, but they became uncomfortable when I talked about it. I soon learned to drop the subject. Nobody really seemed to comprehend I had experienced a serious adverse drug reaction that left me permanently brain-damaged. Once you receive a psychiatric diagnosis, everything one says or does becomes suspect, even with loved ones and coll
eagues.

  I developed a natural distrust of pharmaceuticals for depressive disorders and discouraged everyone I knew who was taking them. I felt there was an inherent risk that could not be proven yet. I didn’t return to the medical literature for answers until nearly twelve years later when I began researching the subject for Meg. My newly formed interest in natural health and alternative healing had been the focus of my recent years’ education, training, and research.

  It took another eight years of transition, but I eventually left the pharmaceutical industry disillusioned and, honestly, a little ashamed. My once high-profile, lucrative career now felt like a sham, much like the snake oil peddlers of history. My conscience was ill at ease.

  Polypharmacy: Prescription for Drug Interactions

  My niece, Meg, then eighteen years old and an honor graduate and premed student at Indiana University, had a similar experience in 2003. Following an automobile accident, Meg was given massive quantities of Vicodin (hydrocodone) and other anti-inflammatory drugs for pain. Her performance at school began waning, and she became depressed.

  During exams, Meg decided to take a natural stimulant called ephedra to counteract the sedative effects of her pain medication. She did not know ephedra could be a dangerous drug and it could potentiate or interact negatively with the pharmaceuticals already in her system. She did what is frequently referred to in college as pulling an all-nighter. At some point, she slipped into manic delusions.

  Her adverse drug reaction landed her in the psychiatric ward of the local hospital where she received a diagnosis of bipolar (manic-depressive) disorder and a cocktail of chemicals that would lead to her ultimate demise. Once you are branded with a serious psychiatric diagnosis, it is nearly impossible to receive treatment that does not involve chemical restraint.

  Before her death, Meg obtained her pharmacy records for me. Judging from the large quantities of hydrocodone and propoxyphene (both central nervous system depressants) she was taking, I feel certain her initial depressive symptoms were more than likely the result of excessive narcotic drug use. However, because of the number of specialists involved, the doctors never related her depression or any of the subsequent withdrawal symptoms to her drug use. So, they prescribed even more drugs.

  The diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM IV) for sedative, hypnotic, or anxiolytic withdrawal (all of which Meg was prescribed long-term following her car accident) reads as follows:

  A. Cessation of (or reduction in) sedative, hypnotic, or anxiolytic use that has been heavy and prolonged.

  B. Two (or more) of the following, developing within several hours to a few days after Criterion A:

  1. autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)

  2. increased hand tremor

  3. insomnia

  4. nausea or vomiting

  5. transient visual, tactile, or auditory hallucinations or illusions

  6. psychomotor agitation

  7. anxiety

  8. grand mal seizures

  C. The symptoms in Criterion B cause clinically significant distress of impairment in social, occupational, or other important areas of functioning.

  D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (DSM-IV 147).

  When Meg described to me what she felt like, at first on the antidepressants and then later on the antipsychotics they gave her, it mirrored what I had gone through in 1992. This time the initial offending drugs were Zoloft, Paxil, and Effexor XR. As Meg began reacting negatively to each antidepressant, she was either immediately switched to another drug, or additional drugs were prescribed to control adverse side effects.

  It is important to elaborate a little here in order to understand how the selective serotonin reuptake inhibitor (SSRI) drugs work in the body. Neurotransmitters are the messengers that relay all of the body’s biochemical information between nerve cells. Serotonin is a specific neurotransmitter that affects both mood and impulse regulation and plays an important role in sleep quality. Low serotonin levels are associated with many psychiatric problems. The newer antidepressant drugs work primarily by shutting down select pathways of the brain that remove and recycle neurotransmitters, particularly serotonin. This allows more serotonin to circulate longer between neurons.

  There is eminent danger in switching immediately from one SSRI to another. One of the differences between the various SSRI antidepressants is the serotonin receptor that each one affects. While one drug may inhibit reuptake of serotonin and metabolism by one receptor, another inhibits reuptake of serotonin and metabolism by yet another receptor. Because of long-term accumulation, blocking of the receptor can continue long after the drug is stopped. That is where the danger lies. If a patient is given one SSRI and that pathway for the reuptake of serotonin is shut down and then receives a second SSRI without the advantage of a drug washout period, the brain shuts down yet another pathway for serotonin metabolism. Multiple blocking of serotonin pathways can lead to agitation, confusion, and other potentially fatal reactions known as serotonin syndrome. In spite of the potential for serious toxicity, this is a common prescribing practice among doctors (Tracy 97-98).

  Meg was simultaneously given narcotic analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, anxiolytics, antibiotics, muscle relaxants, anticonvulsants, and antipsychotic meds. All were prescribed by well- meaning physicians; however, to the trained eye, it is obvious the left hand did not know what the right hand was doing in this case. Even her pharmacist should have questioned the potential interaction between some of these categories of drugs.

  Many of the chemicals she was on are processed through the liver’s same enzyme known as the cytochrome P450 system, which controls the breakdown of drugs in the body and their likelihood to interact with other drugs in the system. When a person takes a variety of drugs that each use a different enzyme system within the liver, then there shouldn’t be a problem. But when a person takes two or more drugs requiring the same enzyme system within the liver to metabolize and eliminate them, then the drugs can be potentiated, that is, made more potent, in the bloodstream and can climb to dangerous levels in their usual doses (Strand 111).

  It is also common practice for doctors to prescribe covering antidotes such as Xanax (alprazolam), Valium (diazepam), and Inderal (propanolol) with SSRIs in order to minimize severe neurological agitation or akathisia reactions. In other words, these drugs are prescribed prophylactically because the doctor anticipates adverse side effects from the SSRI. However, all of these antidotes are metabolized by the same cytochrome P450 enzyme and can be potentiated by any of the

  SSRIs, or vice-versa. SSRI patients have consistently reported serious adverse reactions to benzodiazepines such as Xanax. Not only does this occur when SSRIs are prescribed in conjunction with the benzodiazepines, it sometimes happens long after the discontinuation of the SSRI and benzodiazepines are reintroduced (Tracy 169).

  This partial list of drugs Meg was given within a one-year time frame clearly illustrates the problem at hand: Depakote ER, Seroquel, Vicodin, amoxicillin, penicillin, Desyrel (trazodone), Zoloft, Paxil, Lamictal, Flexeril (cyclobenza- prine), naproxen, Vioxx, Trileptal, Voltaren (diclofenac), Ultram (tramadol), Effexor XR, Phenazopyridine, Tizanidine, Septra DS, ibuprofen (800 mg), Darvocet N- 100 (propoxyphene), Abilify, Zyprexa, Xanaflex (Xanax and Flexeril), and Nabu- metone.

  Several of the drugs’ package inserts (labels) warn of potential drug interactions when used in combination. In fact, all of the following drugs are known to use the cytochrome P450 system in the liver: Darvocet, Effexor, hydrocodone, ibuprofen, naproxen, amoxicillin, Septra DS, penicillin, Paxil, Desyrel, Ultram, Voltaren, Xanax, and Zyprexa (Strand 114).

  Meg was never given washout periods between prescriptions in order to minimize these risks. The addition of more offending chemicals only added insult to injury in a br
ain and body struggling to overcome toxicity. Without adequate support, Meg was set adrift on an inflatable “raft with a hole in it” in the vast, deadly sea known as the American health care system. It was inevitable she would eventually perish.

  Meg continued struggling with mental and emotional issues. She was forced to drop out of school because she was unable to think clearly and function academically. She became despondent. In addition to taking all of these prescribed drugs, she started abusing illicit street drugs. Unable to work or function physically, she floated from one odd job to another in order to support herself. She was referred from one doctor to another and picked up a new diagnosis following another brief psychiatric referral. This time it would be schizophrenia.

  In his consultation letter to the referring physician, the psychiatrist concluded the following:

  Chief complaints and history:

  1. Chronic Pain

  2. History of MVA (motor vehicle accident) 1 lA years ago

  3. Feels depressed

  4. Insomnia

  5. Anxiety

  Examination:

  1. Patient reports of hearing voices and music

  2. Patient reports of feeling depressed and hopeless

  3. Patient’s affect (facial expression) is constricted

  4. Denies any current suicidal or homicidal ideations

  5. Denies any visual hallucinations

  6. Insight and judgment is slightly impaired

  Impression:

  Based on clinical history and exam, patient’s symptoms and signs of the above- altered mental status suggest a possibility of dementia/worsening schizophrenia.

  Plan:

  MRI of the brain to rule out concurrent possibility of new stroke

  1. Zyprexa, 5 mg/PO (by mouth) qhs (one at bedtime) to help with hallucinations and insomnia