I would like to start by thanking all of those readers who responded about my previous post ‘Tis the Season. As you may imagine it was not an easy decision to make public such a personal post on depression. But after hearing from so many people who have similar problems and concerns but have been afraid to talk to anyone about it, I am glad that I posted it.
Several of you have emailed or messaged me asking for an update, so since it is now four weeks since my doctor visit I thought it would be a good time to write something about the results and any progress.
First of all, DISCLAIMER: I will be discussing a couple of prescription drugs in this post. This is not to be construed as a recommendation or endorsement in any way. You should never begin any treatment plan involving drugs of any type unless you are under the care of a medical professional.
For those of you who did not read the previous article, a quick recap: towards the end of 2019 I found myself experiencing depression, which for the past ten to twelve years has been worse during the holiday seasons.
The previous year, in November of 2018, I sought help from my doctor and she prescribed bupropion, which is marketed under the brand name Wellbutrin. It is also sometimes given to patients who are trying to quit smoking. In grossly simplified terms, it can cause a small release of endorphins (a class of neurotransmitters your body naturally produces) which then can block some of the opioid receptors in the brain. This can have the effect of lessening pain or worry, and promoting an overall positive feeling.
I found that it did in fact help a little – especially with the added life event of my mother passing away at Thanksgiving time that year – by taking the edge off of things. I still might feel upset about an event for example, but I wouldn’t take it personally and go into a depressive spiral. But after a couple of months I was no longer sure it was making much of a difference.
Part of that may have been because of the passing of winter and return of spring, new positive activities coming up like a trip to the Galápagos, and so on. In any event, after confirming with my doctor that there was no problem with stopping the medication cold turkey, I decided not to renew the three-month prescription.
Then this same cycle started up again as the holidays approached in 2019. Although I had even fewer reasons to feel that way, I was slipping into depression and feelings of self-loathing. Worse, I began abusing alcohol and putting on weight.
This lead me to consider contacting my doctor once again about pharmacological help. Before doing so, I did a little research on my own. I was curious to see if there were any drugs that could also help with the alcohol abuse.
I found several options online, including a drug (disulfiram) that causes violent nausea and vomiting if you drink alcohol. This seemed a little extreme, especially when I found that there have been a few deaths associated with this treatment. One of those I have since learned was Keith Moon, former drummer for The Who, who drank while on the medication and choked on his own vomit in his sleep.
That seemed like an adverse side effect.
Then I found another interesting option in my research, a drug called naltrexone. This is another opioid blocker but it goes a step further. It will actively strip away and replace anything currently on the receptors. It does this so well, addicts checking into clinics cannot take the drug until they have been clean for two to three weeks, since the stripping effect can cause them to immediately suffer cold turkey withdrawal symptoms. It is even used in some out-patient treatment centers for opioid abuse to confirm the patient is clean; clients must take a dose under supervision, and are then watched to see if they become ill.
For those who drink alcohol under the medication, they do not become ill. However, they will experience only the gross body sensations of drunkenness – slurred speech, loss of balance, etc. – and none of the emotional component. In other words, the naltrexone keeps them from getting any sort of “high” from drinking.
What really caught my eye was a description of a combination of bupropion and naltrexone marketed (rather aggressively) under the brand name Contrave. Specifically, in addition to help with depression and alcohol abuse, it has also been tied to weight loss in patients when combined with exercise and a reasonable diet.
I know what you’re thinking, if you exercise and have a reasonable diet, you should lose weight anyway. But the reports suggested some had experienced accelerated weight loss under this treatment.
The connection between the neurochemical results and weight loss are not fully understood, but I was intrigued enough to bring this up to my doctor. During our discussion of my situation, she pointed out that Contrave currently sells for about $3 a pill – a bit pricey. However, comments on the medical sites suggested simply prescribing the two active ingredients separately, and take one of each every morning.
Since I had already shown no adverse effects from bupropion, she agreed we could try the combination. If I had any negative reactions to the naltrexone, it would mean simply reverting to only bupropion.
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Interlude: A Short Rant on Prescription Drug Prices:
I’ve already mentioned that Contrave sells for about $3 a pill, and that they market it aggressively. You can go to their website, and get around the need for a prescription by having an online chat or call from one of their doctors, who will make the decision on whether or not to write the ‘script. Wonder how many they reject?
As for going the generic route and taking one of each pill, it all depends on your health care plan. I have the same plan that the US Congress has – you know, the one you can’t have because it would make you lazy. Under my plan, a 90-day supply of both pills cost me a total of $45, so 50 cents a day.
If I did not have a health plan however, the same prescriptions would total $662.98, or $22/day.
Not to mention, my co-pay for the doctor visit to consult and get the prescriptions was $25, where the standard office rate is listed at $373.95.
It’s almost as if there should be some type of Universal Health Care, or at least some sort of control over drug prices. If you can’t afford health care, you don’t deserve good mental health?
End of Rant
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When I started taking the pair almost four weeks ago, the main reaction I noticed was I felt slightly stoned for the first couple of days. So no negative reaction. That was short-lived unfortunately, and since then the only side effect has been a tendency to light constipation (sorry, but this is in the name of science, right?).
The good news is that I have noticed a tremendous change in my mental attitude and my habits. Little things have not been getting to me, and while I am not sitting around with a blissful smile on my face, neither am I mired in bad feelings. I would say that what I feel most is a general acceptance of things around me and my place in the world, and more patience with my ability to affect any positive changes. Even better, as of today (1/17) I have lost 17 pounds since beginning treatment. I also have not had any alcohol for 33 days, and have not had any urges to drink at all. To top things off, I’m also sleeping better.
Once more let me say I do not mean this as an endorsement, nor do I encourage anyone else to do anything without their doctor’s involvement. I’m just reporting on my experience so far, yours may differ – and honestly, never underestimate the placebo effect. It may be working for me simply because I believe it works.
That said, here are some of my observations for the way this seems to be working for me. First of all, alcohol adds a lot of calories to your diet, so it stands to reason if you drink less you may lose weight. So it is significant that I have not had any desire to drink. In fact, after about a week I conducted a little experiment. I took the caps off both a bottle of rum and one of tequila in our pantry, and took a big whiff of each.
Nada. No reaction of any kind, where previously there would have been a strong urge to have just a little taste, then another, then a gulp or three, and so on. I recognized the smell, it just had no emotional impact on me.
The same thing is happening with between-meal and late-night snacks. The thought of getting some chips, making some popcorn, a little cheese and crackers – again, just thoughts that have no emotional pull. I can take it or leave it, and I feel just fine with leaving it. Hunger pangs are having less of an impact on my consciousness.
I’m no expert of course, but this is consistent with my limited understanding of how the combination works. The opioid receptors in my brain are simply registering as “full”, and not demanding any stimulation in the form of cravings. This also promotes a sense of satisfaction, or at least an absence of anxiety.
With better sleep, better diet, and a better mental attitude, it has also been easier to get back into a regular exercise routine. In addition to our walking, we have been hitting the gym more frequently. On evenings we don’t walk, I’ve been able to spend 40 minutes on our exercise bike. We’re had our first of what will be regular ballroom dancing lessons yesterday, and Lord Help Us All we even took a Pickleball class this week and signed up for more (alas, my descent into senior-hood is complete).
I’m starting to write again, which will help me work through some of the tragedies and dysfunctional childhood events that have plagued me. I am making time for enjoying my music room which in itself has a very soothing effect, and we are already making some travel plans for the spring.
Now I am not a person who advocates a pill for every problem, and a tablet for every symptom. Quite the opposite; while watching my first wife’s struggle with cancer, I saw her med list grow and grow. One pill was to counter the side effects of an infusion, then another to counter the effects of that pill, something for the nausea caused by that combination … it went on until I thought she would be better off dropping everything and dealing with the original problem.
So after living vicariously through that nightmare, I’ve always been cautious about treating the symptoms chemically instead of rooting out the causes.
But if you or someone you know is dealing with SAD, general depression, anxiety attacks, or anything similar, don’t rule out medical intervention as a first step. There is no shame in seeking professional help, and I encourage you to start with an open and honest conversation with your general practitioner. The honesty part is very important – don’t sugar-coat anything, or try to make yourself look better – your doctor needs to know the whole truth to help you.
For myself, the bottom line after one month is that I am cautiously optimistic about the future. It does seem like seeking medical help has resulted in not just a prescription for medication, but a prescription for a more balanced and enjoyable life.
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If you or someone you know suffers from SAD or any other form of depression, don’t wait for them to “cheer up”. Help is available, and there is no shame in seeking it out. For SAD, here’s a link for more information and suggestions to cope: https://www.helpguide.org/articles/depression/seasonal-affective-disorder-sad.htm
For general depression issues, this article https://www.healthline.com/health/depression/help-for-depression has information and lists of how to get help, including three hotlines.
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