Tag Archives: medication

Guest Post: Progress with Prozac

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The following is a piece written by fellow advocate, Justin Birckbichler. I had the privilege of meeting Justin recently at an incredible conference for online advocates of chronic illnesses, HealtheVoices. The conference was sponsored by Janssen, the pharmaceutical division of Johnson and Johnson, as a way for them to give back to the communities for whom they serve. Justin advocates for testicular cancer. He is an incredible advocate who is knowledgeable, funny, supportive, and caring. He helped me further the work of my own advocacy, as well. Justin also happens to be a teacher!

Read more about Justin at the bottom of this post.

Please note: if you are a man, please consider taking his very short survey for his research on the topic of testicular cancer. A link for the survey is included in his bio.

For now, enjoy this intriguing piece of writing:

Progress with Prozac 

Around the five month mark post chemo, I realized something was not quite right. It wasn’t my new fascination with discussing balls at every opportunity; it was more than that – my mood was not what it should have been. At first, I thought it was just the stress of returning to work and transitioning back to being a normal person instead of a cancer patient.

Upon closer inspection, I realized I was still feeling down, but it was summer, so the job reason didn’t make sense. If you’re not at regular reader of A Ballsy Sense of Tumor, I am a teacher, and teachers don’t work in the summer – that’s the main reason we chose this, duh. (If you’re my principal and you’re reading this, please understand that this is a joke.)

However, a new school year began, and I noticed that I was feeling off and just not as enthusiastic as I once was about teaching. It wasn’t that I hated my job; it was that something internally wasn’t quite right, and it was having an impact on my ability to teach to the best of my abilities. My students were still learning, growing, and seemingly enjoying themselves, so they didn’t appear to notice my internal struggle. Nor did my administrators, who are awesome and amazingly supportive of me, or my co-workers, who are also pretty great and put up with endless ball puns during team meetings. Regrettably, we don’t teach about spheres during the geometry unit.

In addition to feeling slightly off at work, I also realized I was feeling irritable and was much quicker to get angry at home. In October, I experienced a full on panic attack while watching an episode of Stranger Things on Netflix on the eve of my orchiectomyversary. Overall, hobbies like reading and cooking didn’t bring me as much pleasure as they once did, and I just felt generally pretty flat.

As I’ve alluded to numerous times through my writing on ABSOT, I battled with depression in high school. However, since my only job at that point in my life was to be a student (and school had never been a struggle for me, since I was in the gifted program), it didn’t have an impact on my “job.” It dawned on me that I was now feeling some of the same effects I did back them.

Knowing that having depression at a young age puts me at risk for a recurrence later in life, I decided to look into research about cancer survivors and PTSD/depression to fully understand just how stacked the cards were against me. It didn’t bode well when I first typed “cancer survivors and…” into Google, and “PTSD” and “depression” popped up as the first two suggested results (followed by “alcohol”).

As I researched more, I found this study from 2017 that said about 20% of cancer survivors experience PTSD symptoms within six months of diagnosis. The CDC also reports that cancer survivors take anxiety and depression medication at almost twice the rate of the general population.

After finding this information, I decided to ask for help, specifically in the form of antidepressants at my follow up visit in December. Dr. Maurer agreed to prescribe them, and I thought it would be all pretty rainbows and fluffy unicorns immediately.

However, about four weeks later, I felt no different. I knew antidepressants could take up to six weeks to show major changes, but I wasn’t feeling even slightly better. Perhaps I even felt worse, as I had these “happy pills” and I still felt down. Maybe something was just wrong with me – beyond the missing testicle.

I’ve learned to be open with my health and feelings, so at my med check up with NP Sullivan, I basically said, “Hey, I don’t think these are working.” Since I am obviously super medically qualified (read as: not qualified at all), I supported my theorem by saying I was on the same dosage I was in high school, and High School Justin was about fifty pounds lighter and ten years younger (and had a terrible taste in hairstyles and girls, but that’s a different story for another day).

NP Sullivan actually agreed with me and decided to increase my dosage. I wish I could say that this was the end of my frustration, but it wasn’t.

However, this new struggle wasn’t internal – it was externally driven towards insurance companies and American healthcare in general. If you’re an international reader (and I know you’re out there, since according to Blogger’s data I have readers on every continent, except Antarctica, which is a shame since it’s cold as ball(s) there), appreciate it if you have a better healthcare system.

When Dr. Maurer first prescribed the pills in December, my prescription was denied, since the pharmacy needed to get “pre-authorization” because apparently, a doctor’s orders aren’t enough. This wouldn’t have been a huge deal, but I was going out of town for a week and wanted to start the pills immediately. Out of desperation, I ended up paying out of pocket for that first fill. About two weeks after starting the pills, the pre-authorization came through, just in time for my dosage increase.

And just in time for another claim denial. Apparently, my original pre-auth covered me only for the original dose. The fact that insurance claims can be denied through an automated system by non-medical professionals is ridiculous to me. Insurance companies, do better.

Long story short, the insurance claim handlers at Dr. Maurer’s office are awesome, and I got pre-authorized for the new dose. (Maybe my mini-rant on Instagram story helped too!) This new pre-auth lasts for a year, and hopefully, I won’t need any more increases.

To be honest, I don’t think I will need it. I’m not really sure when I noticed that I was feeling better, but when I wrote my “12 Months Later” post in late-January, things were definitely looking up. I was getting more into the swing of lesson planning and teaching, minor things didn’t bother me as much, and I didn’t find myself complaining as often. I wish I could say that colors were suddenly more vivid, but I’m colorblind and colors don’t ever look bright.

It’s now the end of February, and I feel so much better than I did in September. (Side note – I really feel like Christopher Nolan with the amount of time jumps in this post. My bad.) While I would never say I hated work, I definitely have a better attitude when I walk through the doors of Room 31. Exercise, writing, reading, and cooking have become more enjoyable again. While writing this post, I realized that this one has a better feel and tone, as compared to some of the posts I wrote between September to January, even though it’s about depression, I feel more like myself on a day-to-day basis. I haven’t resumed any sort of formal therapy program, but I know that is definitely recommended while on these pills. It’s on my to-do list to look into in the future.

My biggest takeaway from this all is to ask for help if you feel you need it. There seems to be such a stigma around mental health and this post is an effort to be open and transparent to help dispel it. Sometimes, mental health isn’t even viewed as a necessary thing to take care of or treat as a serious matter. We treat our bodies and help them to heal when we are sick or injured; why should our mental health and brains be different?

The debacle with the insurance company and preauthorization helps to underscore this issue. When I had “probable strep” in January, although the test came back negative, the company had no problem approving amoxicillin, even though it probably wasn’t necessary. Any other prescription for my myriad of side effects during chemo was filled without an issue. But needing antidepressants? I had to jump through hoops to get those.

I recently saw a Tweet that said, “Depressed people don’t need Prozac. They need running shoes and fresh air.”

That’s a damaging narrative. I tried that, and continue to exercise, but it wasn’t that simple for me. If that’s your opinion, fine. Go run or whatever else works for you. But don’t shame other people for trying what might work for them. Just as I’m not going to fault you for trying homeopathic medicine, don’t go throwing crystals at me for what I’ve chosen. Positive thinking just isn’t enough sometimes.

I hope that this dosage continues to keep my mood elevated and on the upswing. I have no idea how long I’ll need to be on the antidepressants, but I’m not worried about it. What matters to me is that my emotional healing is beginning to catch up to my physical healing, the disparity between the two being something that has been nagging at me since I was cleared for remission.

However, this is something that I should have seen coming. They removed half of my “lower brain” and left my upper brain fully intact… no wonder it’s taking twice as long to heal!

About the Author: Justin Birckbichler is a fourth grade teacher, men’s health activist, testicular cancer survivor, and the founder of aBallsySenseofTumor.com. From being diagnosed in November 2016 at the age of 25, to finishing chemo in January 2017, to being cleared in remission in March, he has been passionate about sharing his story to spread awareness and promote open conversation about men’s health. Connect with him on Instagram (@aballsysenseoftumor), on Twitter (@absotTC), on Facebook (Facebook.com/aballsysenseoftumor) or via email (justin@aballsysenseoftumor.com).

Currently, Justin is running a research study based on males of any age who have had a physical exam done by a doctor and their experiences related to testicular exams. I

This six-question survey is brief. All responses are anonymous, and all information is kept completely confidential.

If you’re a male, please visit bit.ly/absotdoctorsurvey to help further the research. If you’re not an owner of testicles yourself, please share the link to help maximize the reach. Thank you in advance!

The Challenges of Medications for Mental Illness

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Medications and mental illness. This is a topic that seems to quite controversial at times; so much so that I considered not writing on the topic. However, I believe that multiple perspectives are crucial and that is what I provide here…another perspective. I also want to be clear that this post includes my opinions and thoughts. I am not a doctor and do not claim to be one.  There seem to be two very distinct camps when it comes to medications for mental illnesses: 1) Those who are very opposed to medications and even consider them to be detrimental to one’s health, and 2) Those who believe the medications are beneficial and a necessary component to regaining one’s mental health through the challenges of a mental illness. I would imagine there may be a third camp consisting of those who neither strongly support nor strongly oppose the meds, yet these are the voices seldom heard. I would classify myself in this camp for several reasons. I do not believe medications are for everybody, I believe strongly that they work for some people, I believe there should be more research conducted, and I believe that the business of pharmaceuticals and the amount of money in the industry can certainly allow for questioning the ethics and morals of those in the business.

I have heard some horror stories from people on medications and I have heard some stories that attribute the medications to successful recoveries. In my own case, one medication that had worked in the past did not seem to be working any longer. The psychiatric PA switched me to another medication in the same family (both were SSRIs). I began to have general thoughts of suicide on my new medication. I asked the psychiatric PA if my thoughts of suicide could be due to the medication, as antidepressants have a known possible side effect of causing suicidal ideations. In fact, in 2004, the FDA required manufacturers of all antidepressant medications to add a black-box warning to their drugs stating that they may increase suicidality in children and adolescents (drug watch.com). How ironic…antidepressants that cause suicidal thoughts? I guess this speaks to part of the complexities of mental illness medications.  After I had asked the question, the doctor responded exactly as I was expecting, “It could be the medication or it could be the depression.” He increased the dosage of my new medication, something I should have questioned at the time. A psychiatrist I was to meet with later told me that he never would have increased the medication that I had been taking, as there was no evidence of any further efficacy with a higher dose than what I was taking. My once general thoughts of suicide now became very detailed. I developed a plan and thought of it often throughout the day. It felt as though the thought was invading my brain. It would come out of nowhere and, at times, I could not stop thinking about it. It really began to frighten me after having a dream about the plan one evening. I found myself looking in a mirror, thankfully only with my finger and thumb acting as a gun, determining the angle I would need to hold the real gun at against my temple. Suddenly, I broke down into tears (uncontrollable crying bouts had become an evening ritual by this point), shocked at what I was doing. I became very fearful that suicide was going to become a reality.

Due to this overwhelming feeling of fear, I shared with my wife that I needed more support.  She and my sister joined me for an appointment with the psychiatric PA and we all shared that I needed more support. I made the decision, with the help of my sister and wife, to take time off from work in order to enter a partial hospitalization program.

At my intake meeting, I met with another psychiatrist (the one who had suggested that he never would have increased my previous medication). This psychiatrist spoke with my wife and me at length and, together, we came up with a new medication to try. This was based partly on what had worked for family members and partly based on the medications that I had previously tried. These medications seemed to work like magic. I had the significant side effects that the doctor had mentioned for the first few days; dry mouth, increased anxiety, slight dizziness. However, the side effects subsided within the first few days, never to return again. We had to discuss other medications, as well. My previous psychiatrist had me on sleep medication. I had mentioned that I seemed to sleep well once I fell asleep, but I was still struggling initially falling asleep.  I took this doctor’s suggestion and began to take a prescription antihistamine to get me to fall asleep, while continuing the other medication to keep me asleep (reminder that I believe all meds are different for all patients and this is not necessarily best for all-consult your doctor if you think this may be helpful for you).  Sleep medications, I discovered the hard way, are also something to be concerned about. Have a conversation. While it’s important to get proper sleep while recovering from depression, it’s also important not to overmedicate. While I was in the partial hospitalization program, I would return home in the evenings and my wife was kind enough to allow me to sleep through the nights. Once I had made it through the three-week partial hospitalization program and was on my way towards recovery, my wife (rightfully so) decided that I could wake at night to help with our crying three-year old twins. Due to the large amount of sleep medication, combined with the prescription antihistamine, I fainted soon after getting out of bed in the middle of the night. The first night, I fainted three times when I got out of bed. Two nights later I fainted again after getting out of bed in the middle of the night. This time, we decided to call 911 and I was taken to the Emergency Room for evaluation. After checking my blood and heart, the doctor was quite certain that my fainting spells were due to the medications. He casually informed me, “You can leave things the same…no need to change your medications…the only risk you would have to worry about is that of accidental death from banging your head from another fall after fainting.”  Still being depressed, the sarcasm of his comment didn’t sink in until I was in the parking lot. Working with my psychiatrist, I quickly weaned off my sleep medications.

I believe it is absolutely critical to discuss one’s medications with their doctor. Ask questions. If on multiple medications, what is the purpose for each of the medications and how might they interact with one another? What are the side effects? How long might I need to be on these medications? If your doctor does not seem to value you or your questions, if his/her answers do not satisfy you, seek another opinion. It’s very common to get second opinions for other serious diseases and I believe that if you do not have trust in your current psychiatrist or family doctor, one should seek another opinion.  I would also highly recommend, if at all possible, to bring a loved one to any appointment in which you think a change in medications may be discussed. As I had mentioned, I was too depressed to question the doctor, too depressed to answer questions accurately and probably would have left the appointment eating dog food if that was what the doctor had suggested.

Another issue to be sure to consult with one’s doctor is the weaning of medication.  I have heard of many people who, because they were feeling so much better, stopped their medication too soon. I believe it is absolutely essential to work with your doctor if you plan to stop your medication. Together, you would come up with a plan to wean. I believe it is common practice to wean most medications that are given for mental illnesses, rather than to stop abruptly.

As a final note, while some people may believe in the medications and others may not, I believe it is very important not to judge people for the choices they make. Mental illnesses and their medications are very complex and complicated. People faced with a mental illness have enough on their plate. They do not need to be judged, they need to be supported.

As always, I welcome, and encourage, comments and thoughts to this post.  Thank you.