While yesterday was a rough day for me, there clearly was a silver lining to the sordid affair and I like to be able to find something positive, even in dark times. I had my bi-weekly Zoom session with my psychiatrist where we were discusssing medication changes and options. Unfortunately, I am a Type 2 diabetic and my endocrinologist really wanted me to have the discussion of getting off of Remeron, a drug known to exacerbate metabolic syndrome and cause blood sugar increases. So the discussion started off with me raising the spectre of getting off of Remeron because my A1C is trending upward again. For those unfamiliar, A1C is a measurement of the average blood glucose in a 3 month period of time and is considered a reliable marker of the advancement of diabetic complication. We agreed that once things stabilize mentally, we will begin to titrate me off of Remeron.
During the discussion with my psychiatrist, I was feeling especially down and hopeless because it feels as if we have tried absolutely everything in the book and nothing is working. In my depressed state, I heard (or thought I heard) my doctor mention Imipramine as an option so I asked her what that was and she mentioned that it is a tricyclic-class antidepressant. I know that a tricyclic called Nortryptaline was tried in 1992 and did nothing so I mentioned that and we did not discuss it any further. For the life of me I cannot remember what we discussed after that but I am guessing it was nothing of any significance really.
It would not be until several hours later in the day, while chatting with my mom about what I had discussed with my psychiatrist and how I believed that most, if not all, of the affordable treatment options had been exhausted that a spark of hope would develop. I mentioned to my mom that we had discussed Imi* something or other and I really could not remember but I knew I remembered that it was some kind of tricyclic antidepressant. This jogged my mom’s memory and she said that it was Imipramine that she had taken. I basically have a really good memory and I had no recollection of mom ever taking any kind of drug by that name. So I quickly googled Imipramine and came up with the brand name of Tofranil. Ah ha! Now that I did remember and I remember it worked very well for her. My mom even confirmed that my memory was correct and that Tofranil did work very well for about 10 years.
At that point, I became pretty certain that my psychiatrist did indeed mention Imipramine and armed with the knowledge that it is essentially Tofranil, I sent a message to her via the hospital system’s patient portal. I even did some of my own cursory research and was encouraged to learn that most patients see real therapeutic benefits after 2 week’s time. Furthermore, there seemed to be strong indications that when Imipramine works for one immediate family member, it has a high probability of working for another. The latest uses of Tofranil are as an augmentation strategy to an SSRI/SNRI which even furthers the argument for its trial. My psychiatrist had a really good idea and she is clearly barking up the wrong tree.
My mood basically swung from weepy to hopeful in the span of maybe 30 minutes. The huge mood swing, while mostly welcome, left me utterly drained by 6:00PM. I had to fight to stay awake because that is just too late in the day to fall asleep for any length of time and sleep through the night. Yesterday reminded me that life in America requires one to be their own self-advocate and that there are virtually no advocacy services available for somebody that is struggling with mental and physical health. While I take no small measure of pride that I was able to do my own research and my own learning, I cannot help but feel that this simply should not be. Having to be my own mental health advocate while in the throes of my own illness is not life. If I had not had the discussion with my mom, I would most likely have discounted an option that could potentially be a life changer. Part of me is asking myself why my doctor was not more insistent on trying Imipramine if she brought it up in the first place. I do not know the answer to that one.
My recent struggles with mental illness leave me believing that the only real freedom of life in America is the freedom to struggle against a machine dedicated to deny one assistance at every possible opportunity. If this is freedom, I not only want nothing of it but am convinced it is completely the wrong approach to life. I feel that if we as Americans stopped being so self-centered and started to care about the wellbeing of others as well, we would be happier and better adjusted people ourselves. There is plenty of research with both strong correlation and causation to suggest that doing positive things for other people improves our own mood and enriches our own lives. Why then is it so difficult for us to take care of others and so difficult for us to be less self-centered? That remains one of the quintessential questions.