“Think outside the fuckin’ white box.”

http://10yearsasinglemom.com/2015/04/12/racism-in-america/

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As a chronic pain patient, how many times have I been abandoned?

My pain became constant in the 1980s, and instead of opioids, it was treated with antidepressants.  Lots and lots of antidepressants.  Prozac was one of the first antidepressants that I was prescribed, and although it did nothing for my pain, it made me feel very strange — as if I was living outside of my body.

Let me make it clear that I’ve never been diagnosed with depression.

I was also prescribed Elavil and Lexapro for chronic pain, titrating up to the maximum dosage on both drugs with no benefit whatsoever.  And then there were the antidepressants that made me sad… and ironically, depressed.

Then came the 1990s and the use of antidepressants exploded.  After I had jaw surgery in the early 90s, I went through months of harrowing and painful physical therapy on my jaw.  During that time, I was still allowed to have pain medications, but when my money ran out and I couldn’t afford any more physical therapy, I was abandoned by all of my doctors.

“We’ve done everything we can.  We can’t help you.”  (Yeah?  Well in that case, I want all my money back.)

I had the oral surgery in Austin and moved back to Houston shortly thereafter.  I was broke and in pain, and I couldn’t find even one doctor to help me in the large city of Houston, Texas.

I don’t usually suffer from colds, and I’ve only had the flu once, but that year I came down with the worst cold I had ever experienced.  It seemed like nothing helped the symptoms, even though I tried every other-the-counter drug I could afford.  Obviously, the congestion and achiness made my facial and jaw pain worse, so I was in pretty bad shape.

As a pain patient, I was prescribed many medications that didn’t help — did I throw them all away?  No, in fact, I found an old bottle of antidepressants in my bathroom closet, and I thought, why not try again?  But the antidepressant was a very strong one, an MAOI inhibitor. At that time, there wasn’t a warning about taking cold medications and MAOIs, although I believe there is one now.

Basically, I was looking for some kind of pain relief — any relief, I didn’t care where it came from. How many of those pills did I take before becoming unconscious?  I don’t know, but looking back on it now, I don’t recall ever thinking about suicide.  I didn’t want to die, I just wanted some relief, and those pills were my only option at the time.

When I came to, I was in the hospital.  The doctors and my family told me that my heart had stopped and that I had been dead.  While I was unconscious, the doctors told my family that there wasn’t a very good chance of me waking up, and if I did, I would undoubtedly suffer from brain damage.

Yes, there was some confusion for the first couple of hours after I awoke, but that’s about it. And yet, I was trapped inside that hospital room for 5 days.  I begged them to release me — told them I couldn’t afford to pay — all to no avail.

The hospital would not allow me to have street clothes, so I talked my boyfriend at the time into bringing me some, along with my car. And then I was able to escape, thankfully for my own sanity.

To treat my chronic pain in the hospital, the doctors prescribed massage, and I really wish it had helped.  Not too long after I escaped, I was lucky enough to find a connection to some marijuana.  Pot found in Texas was not the best, and sometimes not even mediocre, but these connections got me through the next 6 or 7 years so I could work and see my son.

But these underground connections were not very reliable, and eventually, I ceased to have any. Which then forced me back into finding pain relief within the medical industry.  By that time, the pain had traveled into my neck and shoulders, and I finally decided to try opioid therapy.  Let me say that before I had surgery, I was required to try every other available treatment, including biofeedback and acupuncture, so opioid therapy was the only option left.

Texas was the first state to pass an Intractable Pain Act to protect doctors who prescribed opioids, so I was able to find one who did (see my post on Dr. Joel Hochman).  When Dr. Hochman suddenly passed away, on the day of my scheduled monthly appointment, I was abandoned again.  His office referred a handful of favored patients to another pain doctor, but I was left out in the cold, without even a way to get my patient file. I finally ended up seeing Dr. Forest Tennant in California, who also ended up abandoning me.

After being abandoned by Dr. Tennant, I did think about suicide.  This time, I also ended up in a hospital, but this one was a mental hospital.  For 7 days I was locked up against my will because I was unable to manage my pain and the medical industry was not interested in doing so.  I was finally released, with a referral to a pain doctor, who was only interested in prescribing a low dose of opioids, if that.  And that’s when I finally gave up on doctors, saved enough money to move, and ended up here in New Mexico because of its Medical Cannabis Program.

Unfortunately, I’ve also been abandoned by New Mexico’s Medical Cannabis Program because I cannot afford both the cost to renew and the ridiculously expensive cost of marijuana at the legal dispensaries. The co-pay for 180 hydrocodone per month was about $10.  I calculated my monthly cost for an adequate supply of medical cannabis to be about $1,800.

My chronic pain is never-ending, but support from doctors hinges on many things that I have no control over, like insurance companies and the drug war. The moral of this story is that chronic pain patients should never rely on the medical industry and doctors — or anyone else for that matter — they will support you one minute, and then the next, dump you like a sack of rotting potatoes infected with Ebola.

Antidepressants and Chronic Pain

http://www.mayoclinic.org/pain-medications/art-20045647

Antidepressants: Another weapon against chronic pain
Antidepressants are a mainstay in the treatment of many chronic pain conditions — even when depression isn’t a factor.

And even though they haven’t been proven to work unless you actually suffer from Major Depression.

Antidepressants seem to work best for pain caused by:

  • Arthritis
  • Nerve damage from diabetes (diabetic neuropathy)
  • Nerve damage from shingles (postherpetic neuralgia)
  • Nerve pain from other causes (peripheral neuropathy, spinal cord injury, stroke, radiculopathy)
  • Tension headache
  • Migraine
  • Facial pain
  • Fibromyalgia
  • Low back pain
  • Pelvic pain

The painkilling mechanism of these drugs still isn’t fully understood…

http://chroniccare.rehab.washington.edu/chronicpain/resources/antidepressantsforthetreatmentofchronicpain.pdf

(2008)

In summary, evidence supports the use of tricyclic antidepressants in neuropathic pain, headaches, low back pain, fibromyalgia and IBS. The efficacy of the newer serotonin and norepinephrine reuptake inhibitors is less supported by evidence, but can be recommended in neuropathic pain, migraines and fibromyalgia. To date, evidence does not support an analgesic effect of serotonin reuptake inhibitors, but beneficial effects on well-being were reported in several chronic pain conditions…

http://www.pbs.org/newshour/updates/one-woman-manages-chronic-pain-invisible-affliction/

Janice Lynch Schuster was the kind of person who never got sick, because she “didn’t have the time.” A writer for a health research institute, mom to six kids and a boxing hobbyist, Schuster considered herself a healthy 51-year-old. But in January 2013, she developed a sudden throbbing pain in her tongue. When topical treatments failed to relieve her swollen salivary glands, her dentist referred her to an oral surgeon who suggested a lingual frenectomy, a procedure to remove the band of tissue between the tongue and floor of the mouth. It was described as “just a snip,” but the result was so painful that even after the stitches healed, the pain remained unbearable, transforming into an entirely new injury. On bad days, Schuster can’t talk or eat…

SCHUSTER: One emergency room doctor asked if I was depressed, because he had never met a pain patient who wasn’t depressed. [ER doctors diagnosing depression?]  The experience of just constantly being in pain, it just saps your energy, saps your joy of experience in your life. It narrows the scope of what you’re able to do.

I have had a lifelong history of depression…

http://theacpa.org/faqlisting.aspx

Why did my doctor give me an antidepressant for my pain? I’m in pain, not depressed! Can’t he see that the only problem is my pain? I need help now!
It is a little confusing, but a number of antidepressants have actually been found to help ease chronic pain. The effect these medicines have on pain is separate from their effect on mood. There are many things about chronic pain that we do not understand. However, it seems that imbalances in chemicals involved in pain perception and transmission may play a role. In low doses antidepressants seem to adjust these chemicals. As a result, they are a common and useful way to treat chronic pain…

Common?  Yes.  Useful?  Extremely doubtful, unless you suffer from Major Depressive Disorder.

http://www.health.harvard.edu/mind-and-mood/depression_and_pain

Almost every drug used in psychiatry can also serve as a pain medication. Relieving anxiety, fatigue, depression, or insomnia with mood stabilizers, benzodiazepines, or anticonvulsants will also ease any related pain. The most versatile of all psychiatric drugs, the antidepressants have an analgesic effect that may be at least partly independent of their effect on depression since it seems to occur at a lower dose.

The two major types of antidepressants, tricyclics and selective serotonin reuptake inhibitors (SSRIs), may have different roles in the treatment of pain. Amitriptyline (Elavil), a tricyclic, is one of the antidepressants most often recommended as an analgesic, partly because its sedative qualities can be helpful for people in pain. SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft) may not be quite so effective as pain relievers, but their side effects are usually better tolerated, and they are less risky than tricyclic drugs. Some physicians prescribe an SSRI during the day and amitriptyline at bedtime for pain patients.

Both drug classes act in brain pathways that regulate mood and the perception of pain. Tricyclics heighten the activity of the neurotransmitters norepinephrine and serotonin; SSRIs act more selectively on serotonin. Some researchers and clinicians believe that a newer antidepressant which acts strongly on both neurotransmitters, the so-called dual action drug venlafaxine (Effexor), is superior to both tricyclics and SSRIs for treating pain. So far, the evidence is inconclusive.

Physicians and psychiatrists are also considering the uncertain potential of the anticonvulsant drug gabapentin (Neurontin) and drugs that block the activity of substance P, another neurotransmitter involved in the regulation of both pain and depression. Electroconvulsive therapy, a standard treatment for severe depression, may have independent analgesic effects...

http://arthritis.about.com/od/arthritismedications/f/antidepressants.htm

Patients with chronic diseases such as rheumatoid arthritis, lupus, and fibromyalgia
can experience depression — it’s not uncommon. For many patients, the depression is temporary or even brief, but others with recurring symptoms may benefit from a visit to a counselor, psychologist, or psychiatrist. Medication is often prescribed to help with the symptoms of depression, too…

http://www.drugs.com/lexapro.html

Do not use Lexapro if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. After you stop taking Lexapro, you must wait at least 14 days before you start taking an MAOI.

To make sure Lexapro is safe for you, tell your doctor if you have:

liver or kidney disease;
seizures or epilepsy;
diabetes;
narrow-angle glaucoma;
heart disease;
bipolar disorder (manic depression); or
a history of drug abuse or suicidal thoughts.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with escitalopram may cause you to bruise or bleed easily.

Drinking alcohol can increase certain side effects of Lexapro.

Lexapro may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert…

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Lexapro, especially:

  • any other antidepressant;
  • buspirone;
  • lithium;
  • St. John’s wort;
  • tryptophan (sometimes called L-tryptophan);
  • a blood thinner such as warfarin, Coumadin;
  • migraine headache medication – sumatriptan, rizatriptan, and others; or
  • narcotic pain medication – fentanyl or tramadol.

———————–

Although Lyrica is listed as a Schedule V drug on the DEA’s drug scheduling list, I cannot find any other antidepressants which are included.  Antidepressants appear to be Schedule N drugs, meaning they’re not a controlled drug.  Yes, antidepressants must be prescribed by a doctor, but the DEA believes there’s no risk of abuse.  And when a prescription drug isn’t controlled by the DEA, doctors have no fear in prescribing it.  So, as a chronic pain patient, if your doctor keeps pushing you to take antidepressants, this is why.

The history of antidepressants

Wikipedia:  A 2012 international review article states that the idea that antidepressants might contribute to suicide in depressed patients was first raised in 1958. For 30 years antidepressants were primarily used in severely depressed and often hospitalized patients. The issue of suicidality on selective serotonin reuptake inhibitors (SSRIs) became one of public concern with reports in 1990 that Prozac could lead to suicidality in patients. Fourteen years later, warning labels were put on antidepressants suggesting particular difficulties “during the early phase of treatment, during treatment discontinuation, and when the dose of treatment is being changed, and that treatment related risks may be present in patients being treated for syndromes other than depression, such as anxiety or smoking cessation.”

People under the age of 24 who suffer from depression are warned that the use of antidepressants could increase the risk of suicidal thoughts and behaviour. Federal health officials unveiled proposed changes to the labels on antidepressant drugs in December 2006 to warn people of this danger.  The FDA warns against the use of Paxil for children and teens depression in favor of Prozac.

SSRI prescriptions for children and adolescents decreased after U.S. and European regulatory agencies issued warnings about a possible suicide risk with antidepressant use in pediatric patients, and these decreases were associated with increases in suicide rates in children and adolescents in both the United States with a 14% increase, and 50% increase in the Netherlands.

A 2009 study showed increased risk of suicide after initiation, titration, and discontinuation of medication. A study of 159,810 users of either amytriptyline, fluoxetine, paroxetine or dothiepin found that the risk of suicidal behavior is increased in the first month after starting antidepressants, especially during the first 1 to 9 days.

http://www.sntp.net/prozac/breggin_prozac_1.htm

(1999)

One antidepressant, Prozac, recently generated a Newsweek cover story, leaped to the top of the drug charts, and then ran into a storm of controversy. Sales figures for August, September, and October 1990 show that more than 400,000 new prescriptions for Prozac are being written each month in the United States. Total sales in 1991 are expected to reach one billion dollars…

Antidepressants are very much in vogue, but they have been around for a long time. Elavil (amitriptyline) and Parnate (tranylcypromine), for example, have been in use for three decades. In 1984, thirty-four million prescriptions were written for antidepressants, placing them a distant second behind the minor tranquilizers; but the Prozac craze is narrowing the lead. More than two-thirds of antidepressant prescriptions are for women.

The great majority of antidepressant prescriptions are written by nonpsychiatric physicians. Psychiatrists, however, set the tone for the widespread use of these agents. Right now psychiatrists are advocating their use for a variety of disorders, from depression and anxiety to eating problems, premenstrual tension, phobias, and obsessions and compulsions. They have become a jack-of-all-trades drug. This in itself should warn us not to trust the claims being made…

http://content.time.com/time/health/article/0,8599,1895672,00.html

5/6/2009, Why Antidepressants Don’t Live Up to the Hype

But in the past few years, researchers have challenged the effectiveness of Prozac and other SSRIs in several studies. For instance, a review published in the Journal of Affective Disorders in February attributed 68% of the benefit from antidepressants to the placebo effect. Likewise, a paper published in PLoS Medicine a year earlier suggested that widely used SSRIs, including Prozac, Effexor and Paxil, offer no clinically significant benefit over placebos for patients with moderate or severe depression.

Now a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients — those with a limited range of psychological problems. People whose depression is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs — which is unfortunate for the 45% to 60% of patients in the U.S. who have been diagnosed with a common mental disorder like depression and also meet the criteria for at least one other disorder, like substance abuse.

http://guardianlv.com/2014/02/antidepressants-finally-deciphered/

Data from the Center for Disease Control and Prevention from 2011 shows that antidepressants prescriptions increased by nearly 400 percent between the early 90’s and 2005-2008 in the United States. Antidepressants are the third most commonly prescribed medication in the US, used by roughly one in ten people over the age of 12…

In the wake of the FDA warning, SSRI’s were demonized, and SNRI’s, serotonin- norepinephrine re-uptake inhibitors, were advocated in their place. Now, a study published in the journal Pediatrics shows that SNRI’s are no more effective at preventing suicide than SSRI’s…

According to the CDC, less than one third of those on antidepressants have seen a mental health professional in the last year…

http://www.theguardian.com/society/2008/feb/27/mentalhealth.health1

2/26/2008, The creation of the Prozac myth

In the 20 years since its launch, 40m people worldwide have taken the so-called wonder drug – but research revealed this week shows that Prozac, and similar antidepressants, are no more effective than a sugar pill. So how was the myth created? Psychoanalyst Darian Leader traces the irrepressible rise of the multibillion dollar depression industry, while others explore the clinical and cultural impact of Prozac, its perceived personal benefits – and sometimes terrible costs…

The new research, published in the Public Library of Science Journal, found that a placebo was just as effective as the drugs – excepting in some cases of severe depression, where it was not the drugs that did well, but the placebos that did worse…

The new negative results might seem to promise a change of direction. But they may just be the other side of the industry coin. What remains unchallenged is the diagnosis of depression itself. GPs diagnose it every minute of the day, celebrities reveal they suffer from it and soap opera characters wrestle with it. Yet 40 years ago depression was hardly anywhere. A tiny percentage of the population were deemed to suffer from it. So what happened?

These developments actually followed a surprising course. The story of depression cannot be dissociated from the story of its supposed remedies. And these, like nearly all psychotropic drugs, were not the result of targeted research, but of chance association. The first drugs had in fact been used as antihistamines, yet they seemed to have effects on mood, energy and anxiety…

Where depression had been rated at 50 per million in the early 60s, by the 90s this had jumped to 100,000. These remarkable changes coincided with the crisis in the market for minor tranquilisers such as Librium and Valium, prescribed for anxiety. As these widely used drugs were found to be highly addictive, it looked as if a substantial market was about to collapse…

Reining in payday loans falls by wayside in New Mexico

http://www.kob.com/

ALBUQUERQUE, N.M. (AP) — Attempts to rein in payday loans in New Mexico fell by the wayside during the recent 60-day legislative session. While the small loans industry says it helps people in need, consumer advocates say a fix is sorely needed.

According to a 2014 study by the Pew Charitable Trusts, 14 states and the District of Columbia either ban payday loans or cap interest rates at 36 percent. Nine states have some restrictions, while 27 allow single-repayment loans with rates 391 percent or higher.

In my opinion, a 36 percent interest rate should be considered usury.  And since it’s the Big Banks and Wall Street who own these payday loan stores, it appears they are still in charge.

Predatory lending practices have been a target of consumer advocates for decades in New Mexico, one of the poorest states in the country. Bills that would have capped interest rates at 36 percent went nowhere. Industry members say businesses would be forced to shut down at that rate.

Google:  Usury, noun, the illegal action or practice of lending money at unreasonably high rates of interest.

Wikipedia:  A loan shark is a person or body who offers loans at extremely high interest rates.

Ferguson police one of many law enforcement agencies facing federal reforms

http://www.latimes.com/nation/nationnow/la-na-nn-ferguson-police-one-of-many-reform-20150303-story.html#page=1

Police departments in Cleveland, Albuquerque and Newark, N.J., were the subject of scathing federal investigations last year…

Nineteen departments have been placed under some form of federal monitoring since 2000, according to a 2013 report by the Police Executive Research Forum.  In 2012 alone, five major city police departments were placed under some form of federal monitoring, the report said…

Here is a look at some of the other federal investigations…

Albuquerque Police Department, October 2014

Federal officials and Albuquerque police leaders announced a settlement that would revise the department’s use-of-force policy and disband a problematic SWAT unit.

From 2010 to 2014, Albuquerque police shot 37 people, 27 of them fatally, according to the federal report. The department was also ordered to drastically change the way it handled confrontations with the mentally ill, after the fatal shooting of a homeless man sparked a string of protests in the city…