Samstag, 23. Februar 2008

Medikamentation: Psychopharmaka und "life drugs" (akt. 22.02.2008)

Die erste Säule der Depressions-Behandlung: Medikamentation. Folgend meine Erfahrungen mit den diversen Psychopharmaka, die ich im Laufe der Zeit im "trial and error"-Verfahren gesammelt habe.

1. "Tevilor" (Wirkstoff: Venlafaxin): Ein sehr effektives Psychopharmaka, welches ich - in angepassten Tagesdosen von 35 mg bis 300 mg Venlafaxin - über mehrere Jahre genommen habe. Sehr gute emotionale Verbesserung und Stabilisierung auf relativ hohem Niveau, mit geringen Schwankungen. Ich fühlte mich wie "in weiche rosarote Watte gepackt".
Ein riesiges Problem ist die intellektuelle Beeinträchtigung, ich nenne es - in Anlehnung an den emotionalen Zustand - bildlich gesprochen ein "rosa Rauschen", welches im Kopf vorherrscht, und stark Lernen und Konzentration behindert. Insofern war es für meine Situation (Studium) ungeeignet, was ich viel zu spät gemerkt habe. Im Nachhinein muss ich sagen, dass ich während der Verabreichungszeit von Trevilor wie in einem leichten Rausch lebte, Probleme - aber auch das Leben! - gingen an mir vorüber. Senil grinsend trieb ich durch die Zeit. Insofern ist es eher für Menschen geeignet, die nichts mehr tun müssen und einfach nur "glücklich" sein wollen.
Nebenwirkungen: Benommenheit, Verwirrung, Vergesslichkeit, Erektionsprobleme, starkes Schwitzen und stechender Schweiß- und Uringeruch, erhöhter Puls, schnelle Erschöpfung (beim Sport).

2. 12 mg Reboxitin ("Solvex") zusammen mit 100 mg Modafinil ("Vigil"), letzteres anfangs off-label verschrieben, da es in Deutschland zur Depressionsbehandlung noch nicht zugelassen war: das war ein radikaler Wechsel nach "Trevilor". Ca. 1 Woche nach der Umstellung kam der schlimmste Zusammenbruch, den ich bisher erlebt habe. Und eine beeindruckende Verbesserung der intellektuellen Fähigkeiten, wie ein Erwachen, und als wäre man (wieder) intelligent geworden. Die Beklemmungen gingen leider nicht weg.
Nebenwirkungen: Dauermüdigkeit, was keine unmittelbare Nebenwirkung ist, denn ich schlafe nachts tief und fest - aber zu kurz. Ich springe um fünf Uhr hellwach aus dem Bett und weiß dann nicht so recht, was ich tun soll. Selten gelingt das erneute Einschlafen nach dem Umzug auf das Sofa.

3. Bupropion ("Elontril") wurde in fortschrittlicheren Ländern als Deutschland bereits seit Jahren als Antidepressivum eingesetzt, hier ist es dafür erst seit Frühjahr 2007 zugelassen.
Es zeigt wohl auch unterstützende Wirkung bei Raucherbeendigung und Gewichtsabnahme und ist deshalb - in gleicher Dosierung! - auch als "life-drug" im Handel. Das zeigt wiederum, wie wenig tatsächlich über Depression als Botenstoffstörung bekannt ist. Amüsiert las ich auf dem Beipackzettel: "Es wird vermutet, dass es im Gehirn mit den chemischen Substanzen Noradrenalin und Dopamin in Wechselwirkung tritt. Diese Substanzen werden mit der Entstehung von Depressionen in Verbindung gebracht".
Der gleiche Wirkstoff in derselben Dosierung als Luxusdroge für Raucher, die damit aufhören wollen. Sehr unspezifisch. Also bin ich so etwas wie ein biochemisches Versuchskaninchen; besser aber das als Nichtstun.

4. Mit "Elontril" zusammen mit "Vigil" (Wirkstoff: Modafinil, s. o.) nehme ich nun zwei Medikamente, die auch als "life drugs" eingesetzt bzw. abgesetzt werden. In der "Wirtschaftswoche" stand, daß Manager "Vigil" nähmen, um eine Nacht durchzuarbeiten. Meine Meinung: Was für Weicheier, das geht auch ohne Drogen. Und es ist ein unsportliches Verhalten, weil sie sich dadurch besser machen, als sie sind, während ich es nehme, um "normal" zu sein.
Und von den US-Streitkräften heisst es, sie hätten es an ihre Kampfflieger beim Desert Storm verfüttert. Das wiederum finde ich sehr fortschrittlich. Derartige Maßnahmen würden bei uns zu zahllosen Beschwerden von Soldaten, Anhörung des entsprechendem Beauftragtem im Bundestag und zu einem "Spiegel"-Titelthema führen.
Vergleichlich auch unter Wissen: "Die Pathologie des Normalen" (Neuro-Enhancement)
Mit jeweils 1 Tablette morgen ergab sich keine signifkante positive Wirkung, die Bekemmung war zwar nicht mehr dauerhaft, aber präsent, und ich war emotional sehr unstabil (Verzweiflungs- oder Angstschübe).
Ich habe daraufhin auf die Höchstdosis erhöht (jew. 2 Tabletten), was regelmäßige abendliche Verzweiflungsschübe inkl. Selbstmordgedanken mit sich brachte. Daraufhin Reduzierung auf 2x Tabl. "Elontril" und 1,5 Tabl. "Vigil". Dadurch deutliche Besserung.
Nebenwirkungen ("Vigil" zusammen mit "Elondril"): die ersten vier Wochen dauerhafte - aber nur leichte - Kopfschmerzen flächig im Stirnbereich, manchmal stark und fokussiert auf Nasenwurzelbereich, weiterhin: leichtes Zittern, leichte Übelkeit, pelziges (taubes) Gefühl in der Nase- und Mundpartie, Sehstörungen (Augenschmerzen, Verschwommenheit in der Nähe, "Sternchen" vor blassen Hintergründen), starker Schweiss- und Uringeruch.
- bei hoher Dosierung (s.o.): wie oben, plus Einschlafstörungen, erhöhter Puls und Blutdruck, stärkeres Zittern der Hände, Hände u. Füße "schlafen" schnell ein. Ca. 6 Std. nach Einnahme leichte Hitzewallungen. Selbstmordgedanken.

5. "Tavor" (Wirkstoff: Lorazepam): zur fallweisen Anwendung bei starken Angstschüben (also nur für Notfälle). Ich nehme dann 1/4 bis 1/2 Tablette, meines Wissens entspricht das 0,25 (0,50) mg Lorazepam. Wirkt sehr schnell. Ich vermeide wenn möglich die Einnahme (arg.: BtmG-Medikament, Suchtgefahr, kognitive Beeinträchtigung). Mußte und muß ich jedoch vereinzelt während der Einnahme von "Solvex" und "Elondril", jeweils in Verbindung mit "Vigil", nehmen, auch bei der erhöhten Dosis.

Fazit: eine hilflos anmutende Medikamentation durch ständiges Ausprobieren, was Wirkstoff und Dosierung betrifft, angepasst/variiert zudem an wechselnde Lebenssituationen. Die beste Wirkung wird mit einem Lifestyle-Medikament zur Raucherentwöhnung erreicht. Da muß noch viel geforscht werden.



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