The Freedman Archives: Part II

The following is a collection of letters written by Gary Freedman to his imagined friend.

Friday, May 14, 2004

Pharmacological Fulminations


Hey, buddy. How's it goin'?
No long Joycean letter today, replete with interminable ruminations and reflective free-associative introspection.
Just wanted to let you know that I'm free this weekend. My girlfriend is out of town. If you want to get together, just ring me up, buddy. You know I'm always here for you. Though, in truth, I may not be all there for you.
Maybe you could get some of your buddies together, and we could play some softball. Tim Norton, the front-desk manager in my building, plays softball; he's always a reliable ringer. Warning though -- you'll have a lot of explaining to do with your friends when they see that I throw like a girl.
I wanted to advise you of something about my medication. I started taking anti-psychotic medication on March 17, St. Patrick's Day. Dr. Cooper, my psychiatrist, prescribed Zyprexa (Olanzapine) after my psychotic breakdown the day before (March 16th) (Pat Nixon's birthday).
Dr. Cooper didn't prescribe any refills. The medication ran out. So I'm not on any anti-psychotic medication. I know I told you I had stopped taking the medication just before my "arrest," on April 21, 2004. And indeed that was true. But the evening of the arrest, I was so hyped-up that I started taking the medication again -- until a day ago.
The thing is I'd like to undergo evaluation before I start up on anti-psychotic medication again. There are assessment protocols that are used to evaluate the indications and effectiveness of anti-psychotic medication. As you probably can guess, psychotic thinking is characterized by specific, identifiable warps in thinking. The effectiveness of any anti-psychotic medication can be evaluated by looking at the amelioration of those specific and typical warps in thinking.
I was reading that in the clinical evaluation of Zyprexa, the following protocols (see below) were used to obtain a baseline of psychotic thinking (in the test subject's unmedicated state) and comparison readings at various dose levels of the drug.
I thought it would be useful if I were to take the very same tests that were administered in the clinical trials of Zyprexa. Even Dr. Henry Barbot, my current treating psychiatrist, said to me at my last consultation that I need psychiatric evaluation of my current mental state.
Be that as it may.
The following are the tests that were deemed useful in evaluating the psychotic thinking and amelioration of psychotic symptoms in the clinical trial of Zyprexa, the anti-psychotic medication that I had been taking. See Physicians Desk Reference, 57th ed., 2003 edition. Entry for "Zyprexa" at page 1877.
1. Brief Psychiatric Rating Scale (BPRS)
2. Clinical Global Impression (CGI)
3. Positive and Negative Symptoms Scale (PANSS)
4. Scale for Assessing Negative Symptoms (SANS)
Subjects who were tested after medication showed a statistically-significant improvement over baseline measurements, using the above protocol.
Personally, I suspect that the protocol would show no improvement in my case upon administration of Zyprexa. I have never shown any improvement in delusional thinking. And in fact it is recognized that antipsychotic medication tends not to affect fixed delusional systems of longstanding duration.
There was no change in my psychological, or ideational, preoccupations while I was on the Zyprexa. If you review documents that I've written, such as my letters to you, I think you would agree that you can see no difference in the letters when I'm on the medication as compared to when I'm not on the medication.
Now, my view of the other meds I'm on is totally different. I'm also on antidepressant medication: Effexor. It's very effective in maintaining my mood; it increases my anger threshold (I can take a lot more crap and not get angry while I'm on the med); and it decreases my ruminations and my obsessive thinking. Believe me, buddy, when medication works, I can see that it works, and I'm enthusiastic about taking the med. I have nothing but positive things to report about the various anti-depressants (SSRI's) I've taken since 1999.
Same goes for the minor tranquilizer I'm on: Xanax. Xanax--like Ativan, another drug of the class benzodiazepine--is effective as a hypnotic and also at reducing my level of agitation. I get very good results with the benzodiazepines and am enthusiastic about them.
But the Zyprexa just doesn't do anything for me. Plus, it makes me very fatigued. I feel like I have congestive heart disease when I'm on Zyprexa; even walking is a strain. And you know how important physical exercise is for me.
I think psychological testing (see above) would bear out my point of view that there's no objective evidence that Zyprexa (or Abilify or Risperdal--the drug William takes) has any therapeutic effect on me.
In any event, give me a call buddy. We can get together and talk about the Indian elections. Gandhi's back, baby, she's back!!
Or we can talk about my current thinking; my current strategic thinking. I was pondering the possibility of talking to your supervisor, Barbara Webb. Or Grace Lyons, The Americans With Disabilities Act Coordinator. But to tell you the truth, as Gandhi would say, I'm thinking it's best to keep this grievance I've got against you going at full throttle. I now have a rationalization to send letters now and then to the D.C. Police, keeping them apprised of the issues that you, my friend, placed in controversy about my mental health and stability. If I got my library privileges back, I'd have no legitimate reason to stay in communication with the good officers who saved you from possible carnage and mayhem (I'm being literary, of course).
Here's the thing, buddy. The Police can protect you from violence, but who will protect you from non-violence. That's Gandhi's Truth.
See ya.


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