A Psychiatrist's Toxic Shock to Antidepressant_NYT

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FYI

Buried on the last page of the New York Times magazine, is personal account

by a seasoned psychiatrist who describes her own toxic shock after taking

bupropion (a.k.a. welbutrin, zyban) an antidepressant she had often

prescribed

to patients. Within 10 days she developed insomnia, agitation and tremors.

Her

physical and mental condition severely deteriorated. None of her

colleagues--

psychiatrists whose help she sought--was able to guide her.

" If finding useful information was so difficult even for a physician like

me,

how do most people with antidepressant toxicity fare? In my case, a former

cocaine user was more helpful than books, journals or even colleagues. "

http://www.nytimes.com/2004/01/04/magazine/04LIVES.html?ex=1074243041 & ei=1 & e

n=231e2968f13e9b27

New York Times

Lives: A Doctor's Toxic Shock

January 4, 2004

By NANETTE GARTRELL

How could a psychiatrist in practice for 27 years fail to

recognize an anxiety attack? I was interviewing a new

patient when the first surge of adrenaline hit, but I

couldn't identify the sensation. The patient continued

talking about her lifelong struggle with depression. I

broke into a sweat and wondered whether I was having a hot

flash. I glanced at the clock -- 20 minutes to go. As I

summarized the pros and cons of various antidepressants, my

voice trembled. Did the patient notice? I felt as if I were

disintegrating. I reached for a prescription pad, trying to

steady my shaking hand.

I had never been seriously depressed or anxious before.

Even after my sister's death and my father's suicide, I

hadn't needed drugs to cope. But recently, as a close

friend was dying of liver cancer, I began to dread going to

work. I felt weighed down by my patients and their pain. I

asked myself, Was I in worse shape than they were? My

partner Dee, who is also a psychiatrist, suggested an

antidepressant. She recommended bupropion, since, unlike

some antidepressants, it doesn't cause a sleepy, fuzzy

brain. I had prescribed it frequently -- including to

patients who were physicians themselves -- with favorable

results.

Within 10 days, I developed insomnia, agitation and

tremors. I lost the ability to distinguish between sadness

and the drug's side effects. When the panic attacks

started, I worried I would end up like my father, who took

his life after years of anxiety. Initially, I checked in

with Dee once each day. Soon I was calling her hourly

between patients. I needed every ounce of energy to

concentrate at work.

Usually it takes six weeks for antidepressants to work. I

developed a new appreciation for patients who quietly and

calmly suffer, waiting for their meds to kick in. I was

terrified that I might feel worse if I stopped the

bupropion or changed drugs. I was determined to stick it

out despite my deteriorating physical and mental health; I

was following the advice I had given hundreds of patients.

I forced myself to eat but still lost 10 pounds. Sometimes

I felt paranoid, and I wondered if I was delusional. When I

wasn't working, I was curled in a fetal position,

contemplating whether I should hospitalize myself.

At last, I called a couple of friends who are

psychiatrists. Dee and I couldn't figure out whether the

bupropion was helping or hurting, so I asked for their

input. Their experience prescribing antidepressants was

similar to mine. We had had patients who did poorly on one

medication or another, disliked this or that side effect.

In most cases, we were able to switch to another medication

that worked. I dragged out books and journals and scoured

the Internet for information. I knew that 10 percent of

patients stopped treatment because of intolerable side

effects when bupropion was initially being tested. But

nothing I read helped me compare my experience with those

of other patients who had quit taking it.

So I called another friend. She put me in touch with a

journalist who had taken bupropion after his girlfriend

died. He was a former cocaine user, and he told me he

couldn't stand how bupropion made him feel. His symptoms

were similar to mine. He said it was like coming off a coke

high, that he would choose grief any day over bupropion. I

found something that connected the dots in a press release

about a Stanford study on antidepressant side effects. The

researchers had identified a genetic marker that explained

why some people couldn't tolerate specific medications. I

suspected that I was one of those people.

After four weeks, I had had enough, so I tapered off the

bupropion. My symptoms -- the insomnia, lack of appetite,

agitation and panic attacks -- continued for three weeks

after I took my last tablet. I felt weak for a month, as if

I had just recovered from the flu. Yet for some mysterious

reason, I haven't been depressed since. I don't quite

understand how or why I continued to work through it all. I

had convinced myself that I was just one of many physicians

who went to work every day, in sickness or in health,

upbeat or laid low. I hate to think of how many other

people may be suffering similar side effects without

knowing the cause of their misery. If finding useful

information was so difficult even for a physician like me,

how do most people with antidepressant toxicity fare? In my

case, a former cocaine user was more helpful than books,

journals or even colleagues.

After taking bupropion, I describe potential side effects

to my patients in much greater detail. Even though I

continue to prescribe it, I'm hypervigilant about any signs

of distress. If a patient complains of symptoms similar to

mine, I switch meds immediately. In the past, I would have

encouraged the patient to stick it out, anticipating that

most side effects would eventually pass. I wonder where I'd

be now if I had followed my own advice.

Copyright 2003 The New York Times Company

Nanette Gartrell is an associate clinical professor of

psychiatry at University of California, San Francisco.

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