evgeniy puharev is a douche

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I’ve been splogged again, meaning that the jackass below is using my writing for commercial purposes in violation of my posted copyright notice. Feel free to send him a note.

Hope you like the copyright notice that now starts each of my posts, Evgeniy. Apparently it wasn’t enough to have a entire page devoted to the subject. I hope it screws up your butt ugly site.

domain: VTRANSLIT.RU
type: CORPORATE
nserver: ns1.vtranslit.ru. 213.155.5.40
nserver: ns2.vtranslit.ru. 213.155.5.41
state: REGISTERED, DELEGATED
person: Evgeniy A Puharev
phone: +7 4232 757551
e-mail: ioi@bk.ru
registrar: RUCENTER-REG-RIPN
created: 2006.10.27
paid-till: 2008.10.27
source: TC-RIPN

why getting off depakote is so confusing

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I have learned several important things in my quest to get the hell off of Depakote ER.

1. Depakote (divalproex sodium) is one of three medications in the Valproate family of medications.
2. Depakene (valproic acid) and Depacon (valproate sodium) are the other two.
3. All three convert to the same thing in your brain but take different paths in getting there so side effects can vary from drug to drug. Crazy Meds has a excellent in-depth look at the differences. Yeah, my head hurt too.
4. All Depakote tablets are delayed release, whether they are labeled ER or not. So, they cannot be safely split.
5. This sucks because Depakote tablets only come in 125mg, 250mg and 500mg doses which are too fucking large to use to taper off this medication.
6. There is a 125mg capsule form of Depakote that you can open and sprinkle on food as long as you don’t chew it. How’s the pudding grandpa? There is also a 250mg capsule form of Depakene but again this has different properties than Depakote.
7. There is also a syrup form but it is valproic acid and not Depakote.
8. 125mg (or whatever mg) of Depakote ER does NOT equal 125mg (or whatever mg) of plain old non-ER Depakote because of the extended half-life.
9. The non-ER version of Depakote just recently went generic in the US! I found that out when my pharmacist handed me a bottle of Divalproex DR. She was as surprised as I was.

My psychiatrist and I spent over an hour talking about different ways to safely lower my current dosage with what was available. 20 minutes of that hour was spent writing it down and going back and forth to make sure that I understood the reasoning and the schedule. The schedule is rather complex and I hesitate to post it publicly as it is tailored to my physical and mental needs and takes into account my past experience with tapering off other medications. This doctor has already gotten me off five medications successfully. It helps that we occasionally keep in touch between sessions.

However, I have decided to post the first stage of the taper in the hopes that this can be a talking point with your own psychiatrist. Again, this has been tailored specifically to me. Do not follow this schedule except under the advice of a psychiatrist. I don’t want to hear about how you fucked yourself up.

First, the doc wanted to make sure that I only took divalproex sodium and wasn’t whoring around the valproate family. So, that nixed my idea of the syrup. Second, while he said that he would be willing to prescribe the 125mg sprinkle capsules, he felt that wasn’t necessary because we could do a slow taper by combining Depakote ER and regular old Depakote tablets, which I’ll get into in a minute. Also, and this is going to be potentially controversial for some of you, that I can do bigger tapers with little to no side effects based on my history and lifestyle.

This “lifestyle” includes eating balanced, nutritious mostly organic foods. I have started taking Norwegian cod liver oil that for the price, must be hand pressed by the baby Jesus. I have also ordered (well, will be ordering as I screwed it up the first time) vitamin supplements to take. While I have always equated supplements with snake oil, people who have a lot more experience than I say they work and my doc likes the idea. So I’m going to just shut up about it.

Did I mention my ongoing battle to forgo caffeine? Gods in heaven, I hate my life.

Anyway, after the long disclaimer, here is first part of the taper to get me off 1000mg of Depakote ER:

1. Take two 500mg tablets Depakote ER every other day.
2. Take one 500mg table Depakote ER plus one 125mg Divalproex DR tablet with breakfast and one 125mg Divalproex DR tablet with dinner on opposite days from step 1.
3. Repeat steps 1 and 2 for a minimum of 8 weeks.

The plan is to mix the long half-life of the ER version (17ish hours) with the shorter half-life of the Divalproex DR to keep a steady state. Doc explained the bio-pharmaceutical reasoning behind this but I can’t remember the whole thing. That’s the highlight. The 8 weeks isn’t a magic number. It is simply a reasonable amount of time to make sure that my mood remains stable considering that I experienced withdrawal last time (with a larger taper) after four weeks. This first taper also gives me the option of adding an additional 125mg Divalproex DR tablet with dinner in step 2 if withdrawal does occur.

I also have the option of jumping back to 1000mg of Depakote ER and meeting with my doctor again to reassess.

I can already tell you that Divalproex DR is harder on the stomach. Be sure to take it with a meal.

Wish me well.

Update May 10, 2009:

As of a few weeks ago I am totally off Depakote. A few things that I have learned going down from a high of 1,500 mg. First 250 mg is too much to taper if you’ve been on the drug for 5+ years. I would suggest 125 mg as the largest taper, preferably much smaller to avoid withdrawal symptoms. Approximately 2 – 4 weeks after each taper I experienced a major depression and in one case hypomania. This passed within a few days but in a couple of cases I had suicidal ideation. I strongly suggest that you only taper off this drug under the care of a knowledgeable psychiatrist and have friends and family help monitor your moods as tapering can be extremely dangerous. I experienced other withdrawal symptoms such as nausea, sleeplessness, loss of depth perception, flu like symptoms, mild seizure like feelings in my head, muscle cramps, exhaustion and anxiety. I believe that had I been able to taper at a slower rate that I could have minimized these symptoms. However, I lost my health insurance and could not afford a slower taper. The further you get in the taper the smaller the taper amounts need to be as the withdrawal symptoms become stronger. I suggest using a pediatric syrup towards the end if at all possible. I could not have done this had I been working full time.

I hope that this additional information is helpful.

avoidance

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I am avoiding writing on my blog. Not sure why but I am. I have updates on the depakote taper which I will post soon. Otherwise I am doing well and feeling good. A friend helped me clean my living room and it is very nice to come home to. I sit and look around and see nothing that needs to be done in here. It’s very relaxing.

Peace.

how to destroy a friendship

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I ran into a guy today that I haven’t seen in years. We will call him Matt. Maybe it’s fate rubbing my nose in past failures at a time when I am attempting to reconcile issues with the men that have touched my life.

Matt and I met in college at a time when I was in denial about being gay. He was one of the first that I came out to. We grew to be friends and stayed in contact afterward, at one time living together as roommates. Around this time I was going through my second major breakdown and was taking Paxil for depression. One night Matt and I spent an evening talking and drinking a bottle of wine. We’d done this countless times before but I was not familiar with the affect alcohol would have on me while taking the drug. I blacked out, waking up in the morning in Matt’s bed with him sleeping elsewhere. Apparently I had gotten very drunk, came on to him then threw up. Classy. He took care of me and put me to bed. I have no memory of any of this.

First, let me just say that I have never blacked out before from drinking. Second, I will admit that I had grown to have feelings for Matt but not in some grand romantic sense. More of a harmless crush really. I mean, he’s straight, I’m not stupid and while I have always tended to be ruled by my emotions I have also had clear boundaries. But that was before alcohol and Paxil got involved.

Our friendship was ruined. I could see how hurt he was and I was just downright ashamed. Matt didn’t want to talk to me after that and I couldn’t face him so we haven’t spoken in maybe ten years. Seeing him today was bittersweet as it was nice to see the old him even if it was brief but the shame burned the back of my eyes the entire time. Why is it so hard to say you’re sorry? Maybe that would have just been selfish. Maybe it’s best to leave things well enough alone. So much has changed with me in the past ten years and this has to be the same for him.

Whoever said that time heals all wounds is an idiot.

Editor’s update: rereading this it sounds like seeing Matt again was more melodramatic than it actually was. A friend of mine and I were talking about this and she made a good observation. Why is it that when shit like this happens it’s always with someone you don’t  have a thing for? He walks away thinking I’ve been carrying this torch for him and all I get is shame for something that I don’t remember that I did while under the influence of drugs!