Fibromyalgia Drugs

Drug Class Review: Drugs for Fibromyalgia: Final Original Report [Internet].

Smith B, Peterson K, Fu R, McDonagh M, Thakurta S.

Portland (OR): Oregon Health & Science University; 2011 Apr.
Drug Class Reviews.

"We compared the effectiveness and harms of tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, noradrenergic and specific serotonergic reuptake inhibitor, norepinephrine and dopamine reuptake inhibitor, serotonin receptor antagonist, antiepileptic drugs, and skeletal muscle relaxants in adults with fibromyalgia."

Abstract and conclusions online via PubMed.

Mephedrone and the number 25

This is how the saga played out in the news.

• 17 March BBC: How has mephedrone affected users?
• 17 March BBC: Review of mephedrone drug pledged.
• 29 March Guardian: Mephedrone to be banned and made class B drug after link to 25 deaths.
• 2 April Guardian: Mephedrone ban prompts latest drugs council resignation.
• 7 April BBC: Mephedrone ban backed by Commons.
• 16 April BBC: Drugs: The facts.
• 16 April BBC: Mephedrone ban comes into effect

Then this today from the BBC:

Teenagers' deaths 'not caused by mephedrone'

Back in March hue and cry over the possibility that 25 people might have died as a result of taking mephedrone, and another of the Govt drug advisers resigned in disgust at their advice being ignored by a Govt keen to curry favour with a disaffected public. Now it turns out that at least two of them had not taken the drug, but the law has still been changed.

• 23 July (Guardian) Mephedrone not to blame for death of teenager, say Cumbria police.

Let's compare with other mortality stats in the UK. The Office for national statistics tells us:

The number of alcohol-related deaths in the United Kingdom has consistently increased since the early 1990s, rising from the lowest figure of 4,023 (6.7 per 100,000) in 1992 to the highest of 9,031 (13.6 per 100,000) in 2008. http://www.statistics.gov.uk/cci/nugget.asp?id=1091

That's 9,000 in 2008. That's actually 25 deaths definitely from alcohol per day, every day. And rising, having doubled in the last 16 years.

By contrast there were 2075 drug related deaths in 2008: some details include 897 deaths from heroin, 378 from methadone, 242 from paracetamol. On the face of it paracetamol is far more likely to kill you than mephedrone, but you need to take into account the vast quantities of it that are consumed each year. (Still it can kill you).

Deaths from road accidents:

The total number of deaths in road accidents fell by 7 per cent to 2,946 in 2007 from 3,172 in 2006. However, the number of fatalities has remained fairly constant over the last ten years.

That's almost 250 per month, or about 25 every 3 days.

The Office for National Statistics doesn't publish tobacco death rates on it's website but the NHS reckons the deaths attributable to tobacco in England in 2008 was 84,000. That's about 236 a day, or 10 per hour! So 25 in 2.5 hours. Assuming the same smoking patterns in the rest of the UK that's about 98,000 for the UK, giving 268 per day, 11 per hour, and 25 in 136 minutes.

So to summarise, in the UK, according to official statistics:

• Tobacco kills 25 people every 135 minutes.
• Alcohol kills 25 people a day.
• Road accidents kill 25 people every 3 days.
• Heroin kills 25 people every 10 days.
• Paracetamol kills about 25 people a month.

Maybe we need to reassess our priorities? The question for the new government is given the policy on drugs which do much less harm to the population: why are tobacco, alcohol still legal? (Indeed given how many deaths are caused by cars, why are they still legal?) Why is there such a fuss about these small time party drugs which we have yet to prove harmful, when 11 people an hour, almost 1 every 5 minutes are dying from tobacco.

BTW I do not endorse drug use. I think taking drugs is stupid unless you have to for medical reasons, and even then they are problematic. But I also think it is stupid for taking drugs to be a criminal offence. Two stupids don't make a smart.

Antidepressants may change your personality

paxil aka paroxetine aka aropax aka seroxat

Tweeted by CognitiveTherap

Same story in the LA Times; in the Guardian.

No one talks about the way that depression changes your personality. No one asks how relevant personality tests are, nor what they measure, nor how seriously we should take them. This is a one off study of just 240 people which has not, as far as I can tell, been repeated. No one seems to measure personality before as well as after the onset of depression and treatment with drugs. This story should not be in the news at all. Medical journalism is a crock of shit. The Guardian article is slightly better written, the LA Times article is reprehensible and irresponsible.

Did you know that the information on Anti-depressant medications all say something like: "the action of this drug is presumed to be due to its effect on the levels of serotonin." [my italics] Actually they don't know, they certainly don't know why the side-effects come on within 30 minutes, and the mood effects take 2-4 weeks. They just don't know.

I take drugs!

In my youth I used to take illicit drugs. But in 1992 I gave all that up as a dead-loss. Drugs never made me happier, and if anything made me more unhappy by causing me to take poor decisions and covering up the underlying unhappiness. However over about three decades now I have taken a variety of prescriptions drugs (or meds as we veterans of the mental health system tend to call them), not all of which I can remember. Drugs are the first and often the only line of treatment for my several ailments: depression, anxiety, pain, migraine.

Depression

Anti-depressants form by far the largest category of drugs I've taken. These drugs all affect different people differently - sometimes oppositely for instance you might lose/gain weight or feel drowsy/hyper-alert (I get fat and dopey). I'm hyper-sensitive to dose changes and could be badly affected by such things as when the chemist changed brands.

amitriptyline. This is one of the earliest ADs and still a front line drug in many places. It is soporific to some extent (a large extent for me) and so goes well with insomnia. In lower doses it is widely prescribed for pain (which how I first started on it). I would not go so far as to say this drug ruined my life, but I do think it cost me my marriage, and about ten years of my life lived in a daze. As I overdosed on it 10 years ago it did nearly cost me my life in that sense. It is still offered to me whenever I see someone new.

Various tri-cyclics with much the same effect: imipramine, prothioden (aka dosulepin), trazodone, plus a couple I don't recall the names of.

paroxetine. Took this for several years. Quite useful. Main side effect was delayed orgasm which the Mrs enjoyed (before she left me). However getting off this shit is tough. The withdrawal effects are savage! Massive headaches and nausea - it goes on and on! Smallest pill is 20mg, but you really need 1 mg steps to easy off it. 20 > 0 would be unthinkable, and I was cutting these bastard oval pills into 4ths and 8ths!

fluoxetine (aka Prozac). Sent me to sleep - supposed to be stimulant! Was dozy for a few weeks before deciding I'd rather be depressed.

citalopram. snooze...

I've never been able to afford St John's Wort, as it is fucking expensive. Currently I don't take depression meds, though with the English winter coming on I'm thinking about it again. I was often on two ADs such as Paroxetine and Amitriptyline.

Anxiety

stellazine - used as an antipsychotic, but in smaller doses for anxiety. To be honest I have no recall of how effective this was, but I did overdose around that time, so perhaps not very.

thioridazine. Also sometimes used as an anti-psychotic, but given to me for anxiety. I remember that it dried out my mucus membranes, made me constipated and caused me to suffer because I had haemorrhoids at the time! But it also made me dopey. The psychiatrist lied about the side-effects and then got indignant when I told her she was a fucking bitch (she got her own back in my records by saying I had "unrealistic expectations" - fucking bitch).

(These more serious anti-X drugs come with powerful side-effects that make them extremely unpleasant for me to take. Really not worth it for anything short of psychosis - which I don't suffer from, despite what people think!)

diazapam (aka Valium) one of the benzo-diazapines which are bit like opiates. This is wonderful for anxiety, but hideously addictive. Hard to get Drs to prescribe this stuff - much harder than temazapam (see below). Usually take this for going to the Dentist to stave off panic attacks. Love this stuff, and thank goodness I never got access to it in my recreational days!

Insomnia

temazapam - gets me off to sleep when nothing else works, although not always. Sometimes I'm just too wound up to sleep and even these don't work. Quite addictive so I try to keep the dose low and spread them out. Also a bad hangover. Some time back had another benzo called clonazepam (aka klonopin) - much the same (though I was taking more than prescribed so the Psychiatrist stopped them - probably just as well!)

Herbs. Things like hops, passion-flower, and valerian root do actually work as soporifics, though in my experience all cause a hangover if I take enough to get a noticeable effect. Kava kava used to work quite well and was freely available in NZ, but has been banned in the UK because one person in Europe had a bad reaction.

Pain

Various over-the-counter combinations of ibuprofen, paracetamol and codeine. These are helpful on minor pain days.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).

diclofenac being my current poison. Long term kidney damage a bit of a downside. One per day max or bad stomach problems.

naproxine and similar drugs depending on what the NHS are buying at the time.

brufen - basically slow release ibuprofen. Haven't used it for a while.

Nerve-agents (aka anti-seizure drugs) These are prescribed on the basis that my pain nerves are over active (fucking A). They work by reducing the electric potential of nerve cells and dampening nerve activity.

gabbapentin. Specific to pain nerves so less likely to cause overall drowsiness etc. For me caused unpleasant hallucinations a bit like a bad trip on magic mushrooms. Not good, not something I enjoyed even in the bad old days.

carbamazepine. Good pain relief but completely fucked me up - could barely remember my name! Three months in the twilight zone. For a long time after I stopped I did not need painkillers - my longest stint in years. If only I could adjust to having 50% of my present IQ and no particular ambitions this would be the thing for me!

The weirdest pain treatment I had was injections of local anaesthetic into the affect area (i.e. the back of my neck) I nearly passed out - there's something very un-natural about being injected in the neck! Didn't do much else though.

In conclusion

I also take migraine medication (maxalt) occasionally. And of course I eat a shit load of dark chocolate (containing anandamide, theobromine, phenylethylamine and tryptophan) - fortunately my migraines are not food related! Had one today - take a pill, head to bed, and when I wake up it's all over. Grateful for this stuff.

On the whole I've found that most drugs just fuck me up, and I'm better off without them - I try to take the minimum, and I'm better at handling the pain now anyway. The alternatives are all expensive and although I'm grateful to the NHS they don't pay for the things I find most useful like ongoing psychotherapy. I could do with some physio as well, but I can't get the Docs to agree to it. Don't even fucking talk to me about alternative medicine - I've never felt the slightest effect from homeopathy, or any other 'alternative'. The best I could say is that they seem to be harmless - if pointless and expensive.

One of the best things for all of the above is laughing. So now I try to see and hear as much comedy as I can. This means that the BBC is as important to me as the NHS. I love the News Quiz, I'm sorry I haven't a clue, the Unbelievable Truth, Mitchell and Webb; and Have I Got News for You, Never Mind the Buzzcocks, Mock the Week. The BBC fosters so much comedic talent. Jeremy Hardy is my laughter physician. He'll most likely never read this, but I salute you Jeremy. Laughter helps with pain, it helps with anxiety and depression. It just helps.