Tuesday, October 27, 2009


Due to the post that I wrote on antidepressants a while back, I get emails every so often from gals I don't know contacting me regarding the topic of depression. Emails from women eschewing any bashfulness they might have on the subject and contacting me to say thanks for what I wrote; it sent them to their doctor to remedy a problem long embarrassed of, hidden, and unattended. Emails asking for more information. Or emails telling me that I helped them begin to abolish their shame in medicating for what is truly a common clinical problem.

From time to time I find myself questing this blogging hobby. Isn't it just a useless, fruitless way to spend my time? It's right about then that I receive one of those grateful or inquiring emails and realize that not only do I enjoy maintaining Remarks from Sparks, but from time to time this blog is a conduit, rendering what I consider a valuable service of sorts.

A frequently emailed question is which anti-depressant I take and do I, perhaps, know which one is best? Don't fret, these readers exercise propriety and communicate that they don't want to be nosy and if I'd rather keep that tidbit private they apologize in advance for overstepping their bounds. But if a little bit of information from me will help someone remedy their depression through talking with their healthcare professional, I'm happy to share whatever needs sharing.

Wellbutrin XL. That's what I take. And not the generic version. I gave the generic bupropion a go and unfortunately experienced unreasonable increased adverse events. So back to the branded I happily went. (And the little white branded pill is so much cuter anyhow.)

An FYI-oriented side note: generic medications manufactured not by the original patent owner but a generic company only need to prove 80% bioequivalence to the original branded medication; so when someone tells you that the generic drug is exactly the same as the branded, you should know that they're wrong. For some people, the generic is magnificent, for others--despite the cost benefit--it just ain't.

Is Wellbutrin XL the best anti-depressant? Right now, for me, I couldn't say otherwise. It does its job--helps me get out of bed, helps me be kinder, helps me unfurrow my brow. I was fortunate to hit the helpful pill on my first try, but unfortunately, that makes me the exception rather than the rule.

The anti-depressant drug class is a crowded one, for chemical depression isn't a cut-and-dry disease state; neurotransmitter issues and imbalances vary widely from person to person, and the variance necessitates a broad range of tools in order to correctly personalize therapy. Different drugs act on different neurotransmitters in different ways, meaning that doctors need a wide array of gizmos with which to hack at your depression.

For many, the first or second or even third tool isn't the right tool. I started with Wellbutrin XL and came to know efficacy quickly. However, I have a friend who started with Wellbutrin XL and found that it didn't do the job. Moved onto Lexapro. Found that it didn't work either. And then on to Effexor. And found herself saying, Hey! This is how I used to feel. I'm productive. I have no trouble rousting myself from bed. I like my family. I hate myself less. Effexor was the right tool for her, but it took some trial to discover that.

There are some depression patients that try the first anti-depressant prescribed to them and don't find that they feel any better or they experience unbearable side-effects; and then, their first experience being a bust, they give up on depression medication altogether. Because, duh, it doesn't, like, work. I wish they wouldn't do that. Yes, oh yes, it can take some patience to fall upon the right medication if you're in the trial and error phase of therapy, but it's patience spent on a good cause. For when you land on the right drug, you are likely to feel that every wrong turn was worth the end-result. You get to be you again.

Why let clinical depression win the war? Why die on the first hill you encounter?

Another hill on which patients routinely give up the ghost is the cost hill.

It often goes down like this:
The doctor listens to the patient describe his symptoms and, drawing on her clinical experience and relevant studies, she prescribes a drug that she believes will do the job. Because drug reps are awesome and the doc has samples on hand, she gives the patient a few weeks of the drug to try courtesy of the manufacturer.

The patient starts on the samples and begins to get his life back. When the samples are all gone, the patient heads to Costco to have the script filled only to discover that if he wants the drug that's been doing him favors, he's going have to fork over a tier 3 copay. (Tier 3 often ranges anywhere from $45-$80 depending on your plan). Eighty-friggin'-bucks? They nearly scream. Are you kidding me? There are a ton of anti-depressants out there. I know 'cause I've seen commercials. Gimme one that I can afford, 'cause I'm sure as hell not going to pay that!
Afford is a terrific word to use there.

But it's not a question of what you can afford. It's a question of what you can't. For me, I can't afford to let depression win this round. Every single day I spend mired in the bog of depression is a day I didn't live. A day I didn't enjoy my family or my hobbies. And for life being as short and unpredictable as it is, I simply cannot afford to live that way.

Instead of jumping to the I-can't-afford-it conclusion, maybe ask: Can I afford to going back to feeling the way I did before?

At my last job, my Wellbutrin XL was a prior-auth (a whole other ball of sticky wax) on my insurance plan, so the first time I landed at the pharmacy to fill that script with the new insurance, I discovered that, at my dose, if I wanted the brand-name product that I'd come to rely on and trust, I'd have to shell out $95 every month.

Despite the dirty rumors about pharmaceutical reps' paychecks, I'm not made of money; yet without hesitation I paid seventy-five more dollars than I had been paying before the insurance change. I'm willing to sacrifice pedicures, eating out, more shoes, whatever unnecessary "necessity" I need to give up or enjoy less of in order to keep feeling like me. $95 doesn't sound affordable, but I absolutely couldn't go back to the way things were before or the way things are when I forget my pill for a week.

Funny how it turns out that what seems like an unaffordable price becomes incredibly affordable when I put it in perspective and prioritize. It doesn't matter how many pairs of cute shoes I get to buy or how many times The Husband and I get to have dinner out or how many pedicures I get each month, I will enjoy them less without the medical help that I need right now. I can't afford to let depression win.

It's just something to consider. If you're a depression patient (or oughta be), I'd hate for that to be the hill you die on. An $80 price tag is surely an ugly one, but think of the bang for your buck. You can get out of bed. You can play with your kids. You can care for your spouse. You can do your damn hair, for heaven's sake. Is it worth giving up on a medication that helps for the prize of a few extra dollars in your pocket?

Not for me.

Disclaimer-type thing: Yup, I work in the pharmaceutical industry. Nope, I don't sell an anti-depressant. I never have. I've no ulterior motive in this post. It's of pure intention, for I know what depression feels like before and after medication and it's a difference worth talking about.


it'sliketheweather said...

Meg, great post today! Love the way you characterize the "afford" vs "can't afford" debate of drugs. My hubby's a drug rep, too, I can testify that it's definitely not the gravy train it used to be, especially when you're getting laid off every 18 months. Keep on truckin'!

Sparks said...

Wishes for the best of luck to your husband in pharmaland. I know what the fear of that chopping block feels like. I've not been chopped myself, but I know of so many that have, and I fret for 'em.

Celeste said...

Yay for Wellbutrin XL!!! I was on Prozac for the first year of my drug-taking, and let's just say that it sure didn't help me in my quest to get knocked up. Since starting wellbutrin, I feel like I can see colors again. Prozac was fine for my depression, but everything was more blah than I liked. Particularly sex. (This may be TMI, but I was bawling from sheer joy of enjoying sex the first time after Wellbutrin came into my system.)The generic works just fine for me, but I still get annoyed that I'm paying ten measly dollars instead of the four that it was before. Thanks for putting this into perspective.

rabidrunner said...

Okay, so this is totally unrelated. Well, it is... Government sponsored health care is on the mind these days. You spoke of the preauth problem you had and it made me wonder how health care reform would impact people and andi-depressants. Call me a pessimistic pansy, but I don't see the government intervening as "good."

(Just tell me to drop the whole health care thing, will ya. Just tell me to shut up.)

Megan said...

I don't so much see myself telling you to shut up. Especially on this front. I work with healthcare professionals all day, every day, and, not from the mouths of doctors or from the mouths of anyone else that works in their offices, have I heard a single positive thing about healthcare reform. These are the people that are right there in it.

I had a lunch appointment in an office just this last Friday and that was the topic at hand for the hour I was there. A lot of great doctors are going to retire early if things go as far south as they expect. They want to practice medicine, and with some of the changes on their way down the pike it' ain't gonna happen.

Julie said...

I very sincerely and deeply thank you.

Anonymous said...

I have been battling depression my entire life, resorting to a few unhealthy habits when i was younger. When i met my husband he changed my life by sharing with me his personal experience, just as you have to all of us. Thank you for your insight on the subject that so many people struggle with and find embarrassing to admit it even to family. Finding the right medication really can make a difference in your life and the people you love. Sometimes, as i am finding out now, medication isn't the only solution. Counseling, in any form you decide is best for you, can be very beneficial. For me, it is basic journaling that helps a lot.

Rachel said...

I am in the midst of trying to find out what will make me happy again and am so lucky that I came across your blog. I appreciate your honesty and have found a little more hope that I can be who I used to be.

Megan said...

Rachel, thanks for speaking up. It's not the easiest thing to do. You'll get there. I'm sure of it. It takes time and it's painful, but when you get there, the rush of relief will knock your socks off. Feel free to fire off an email anytime you're feeling like a support group is in order. I'll be the support group.

Natalie said...

I went through a heady bout of seasonal and employment related depression two years ago and it was a scary time. I saw a doctor and discussed treatment options, but because my issues were so situational he recommended therapy instead of pills. I pulled out of it just fine on my own but I will never forget talking to my mother about it before I saw a doctor. She had been on a prescription for a while after suffering PPD and even then - even then! - she had the nerve to tell me that seeing a doctor and accepting medication was showing weakness, and that I should just suck it up and "be happy."

Therapy was, actually, a huge help, and I recommend it.

So it's posts like this that make me want to do a dance and shout praises, because deciding to avoid the problem and "suck it up" is weakness, not strength. It takes guts to take care of yourself, that's what.