new drugs! new drugzzz!

[baratron]

I have now been to the doctor, and am somewhat manic. Not clinically manic, you understand - just happy and bouncy. I'm still depressed, don't think that's gone away, but I saw a good doctor who listened to me and tried to understand my situation. I have seen enough crap doctors in my life that I am always pleasantly surprised to find a good one. The one I saw today not only understood what 225mg of Efexor XL means (in terms of dosage and what my depression must be like to warrant it), she even managed to prescribe another antidepressant to use with it that doesn't contraindicate it. This might not sound like much, but you would not believe how many times I have been prescribed two drugs that should not be used together - even for something as simple as asthma, let alone psych stuff. And she wrote a note to the receptionists to get me bumped up the queue to see my usual doctor - I've got an appointment to see him tomorrow! That's a vast improvement on June 11th, don't you think?


I've been told to take 500 micrograms of fluanxol and 15mg of mirtazapine along with 225mg of Efexor for the time being, and see how I get on with that. Fluanxol I've had before - in large doses (20mg+) it's an antipsychotic, used for treatment of schizophrenia, but in tiny doses it's useful for anxiety along with depression. It's good stuff, but unlicensed in the US, which means it's a pain in the arse to get information about it online. It doesn't help that "they" have decided to change the spelling of the drug from "flupenthixol" to "flupentixol" - bloody IUPAC! Mirtazapine I haven't had before, but it's also known as Remeron if that means anything to anyone. Apparently it was only licensed in the last couple of years, and it is used primarily for "polytherapy". In my current state, the thought of me, being polyamorous and having polytherapy is ridiculously funny. Of course, it just means treatment with more than one drug for the same thing at the same time.

Scary organic chemistry:
Efexor is venlafaxine hydrochloride, also known as (R/S)-1-[2-(dimethylamino)-1-(4 methoxyphenyl)ethyl] cyclohexanol hydrochloride or (±)-1-[a [(dimethylamino)methyl] p-methoxybenzyl] cyclohexanol hydrochloride and has the empirical formula of C₁₇H₂₇NO₂ HCl. Its molecular weight is 313.87.
("Meep!" says meeping)

Mirtazapine belongs to the piperazino-azepine group of compounds. It is designated 1,2,3,4,10,14b-hexahydro-2-methylpyrazino[2,1-a] pyrido [2,3-c] benzazepine and has the empirical formula of C₁₇H₁₉N₃. Its molecular weight is 265.36.

Fluanxol is 2-{4-[3-(2-Trifluoromethylthioxanthen-9-ylidene)propyl]- piperazin-1-yl}-ethanol dihydrochloride, or C₂₃H₂₅F₃N₂OS.2HCl. Its molecular weight is 507.4.

And now prepare to meep most ferociously:
Flupenthixol is wholly synthetic. Thioxanthone is converted to an activated butadiene by a Grignard reaction followed by dehydration. Flupenthixol is formed by 1,4 addition to the activated butadiene followed by heating or treatment with strong alkali (Petersen et al., 1977).

The really scary thing is that I understand that! I have distinct memories of nearly blowing up the Perkin lab whilst attempting a Grignard reaction...

Comments

[kyte.livejournal.com]

Ooh - I spy progress :>

Huzzah :>

[mjl]

"(R/S)-1-[2-(dimethylamino)-1-(4 methoxyphenyl)ethyl] cyclohexanol hydrochloride"? I'm beginning to see the need for brand names. personally I never managed to get my head around the A level organic stuff and bloody benzene rings (and then of course most of our bloody chemistry paper was about 2,4,6-trichlorophenol and chloromethyl benzene - now of course that's the only stuff I remember...)... your understanding of that stuff is both impressive and scary.

anyway, what I was going to say (before I clicked the link and started having A-level flashbacks...) was that I was glad you got to see a good doctor and got new drugs. *hugs*

[slinkr.livejournal.com]

Wow. That's an awful lot of chemistry. But yay for getting a good doctor and a reasonably scheduled appointment.

*scratches head*

[kixie.livejournal.com]

Fluxanol is intriguing - very new? There is little out there about it and I'm curious.

Mirtazepine (sp - I'll call it Remeron, brand name) is interesting. Another one of a kind med - if anything it should put you to sleep for awhile. Certainly did for me - I took it while taking paroxetine, but all it really managed to do for me was to put on weight (it does mostly when taken in 30mg or more a day) and make me very...paranoid. So the doc gave me thorazine to chill that out.

Remeron is apparently brilliant for anxiety - it was kind of a dud with me, but then at that point in time nothing was working and I should have been in hospital cleaning out from a klonopin addiction - and is pretty good with depression. I have a friend whose doctor gave it to her for a sudden bout of agoraphobia and it helped. Takes a short while to work though.

G'luck - I found a site about Fluxanol if you want me to send the url to you. Med adjustments are a bitch, but sometimes really worth the annoyance.

[lcohen]

i'm really glad that you found someone who listened to you and understood what was going on with you--makes quite the difference! i understood not a word of the chemistry part--i just hope that it helps.

[nitoda]

Hmmm - understanding the chemistry is most certainly beyond me! But am glad you felt heard and are getting a change in treatment - hope it works out for you!

[narenek.livejournal.com]

"Meep!" says narenek, I now remember why I became a sysadmin.