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B-B-B-Budget: The Cost of Medication. Is It Worth It? 02/10/2011

Budget.

Now there’s a scary word.

Why is it there?

It goes through my mind on a regular basis.  Like – every time I run out of a few medications at once.  And especially on those really special occasions when they all run out at the same time.  You know the ones?  Or perhaps you don’t.

Me – I have what is known as Treatment Resistant Depression.  It means what it says.  It’s a bastard to treat.  It doesn’t respond to the basics and I go to a psychiatrist who is a specialist.  Yay me!  It also means that what works is an interesting combination of meds.  This is complicated by the fact that my depression is the result of surgery that I had in my early 20’s that also left me with a tendency to partial seizures (now controlled – by medication…).  I also have a history of really nasty and persistent migraine that I resisted medication for until the summer when I had them for 4-5 days a week every week for about 5 months and found myself at risk of losing my job over the number of sick days that I was accumulating.  I also have low levels of vitamin D and a back injury that has resulted in the growth of osteophytes (essentially arthritis).

I figure that I am lucky to live in Australia where a large proportion of the cost of most medications is subsidised by Medicare – the government scheme to ensure that health care is affordable for everyone.  It says something that I generally reach the threshold of what people are expected to pay without further subsidy (Medicare’s safety net) by about October or November each calendar year.

My meds for Depression include Lexapro (also known as escitalopram) an SSRI, Edronax – a SNRI, Lamictal (lamotrigin) which works as a mood stabiliser but is also an anti-seizure medication and Valdoxan – which is only new.  I’m taking Valdoxan at a low dose as an augment to my other anti-depressant medication.  I’ve tried to go without an augment several times, but it just isn’t enough to hold me – I relapse with the slightest of triggers.

Valdoxan is expensive however because it is not PBS listed (ie not on the Medicare Pharmaceutical Benefits Scheme list) but is sooo much better than Lithium which is what was what was used as an augment before.  Valdoxan wouldn’t replace Lithium for someone whose primary medication need was for Lithium – but as an augment it has been great.  It helps me sleep at night, doesn’t leave me drowsy through the day, doesn’t put on weight or make my hair dry and frizzy – just costs a lot of money.  But it allows me to function so much better than the Lithium did that I don’t begrudge a cent.  I also take a very small dose of Abilify which has helped with some other weird symptoms that used to come when I was low on sleep.

Next, I take Topamax to prevent migraine.  Much as I hate to admit it – this has proven very worthwhile.  While I still get an occasional breakthrough migraine a few times a year – they are nowhere near as severe, don’t last more than a day and don’t leave behind the ghost migraines for days afterward.  In short – I can function.  On top of this I take Vitamin D supplements and Glucosamine with Chondriatin (and I notice the difference with my back stiffening if I stop taking it).

Finally, one of the fall out effects of my depression has been the decrease in concentration and attention span that has come with it.  This year to see if we can improve that my doctor has been prescribing me a low dose of dexamphetamine – and I think it’s working.  The catch has been that it gave me tremors in my hands and, in the beginning, headaches – I had finally managed to get rid of all antidepressants that caused this – so it was back to the Propanolol for me to get rid of the tremors.  Propanolol also helps with prevention of migraine too, so it adds a bit of reinforcement to the Topamax (not that I would take it if it wasn’t for the tremor!).

That, ladies and gentlemen, totals at eight prescription medications and two over the counter alternative medications.  Not what I would call ideal – but they all serve a specific purpose and thinning them out would leave me very vulnerable to relapse – trust me, I’ve tried – under the supervision of my doctor whom I’ve told point-blank that I won’t take something or other … several times.  One day I hope to successfully reduce them, but I think that it will take a lot more skill in managing my depression on my part, more research time, planning and preparation.

I buy the Vitamin D and Glucosamine at discount pharmacies.

The rest I go to the same pharmacy for all the time.  This helps if I run into any trouble with any scripts or if I’m physically ill – they’ll run it around to my place for me.  Also if I get prescribed something else or go to buy something over the counter – the pharmacists there know what else I take and can tell me if it will cause me any problems.

Recently I had to get all my scripts filled at once.  It cost a lot of money.  At first I cringed.  But really, I’ve done this before and its nothing new.  It’s about four weeks medication that I’m paying for.  I know how much my medication costs.  In the end I just shrugged my shoulders and paid.  I said to the lady who served me the same as I’ll say to you.

“A day’s wages is not a lot to pay in exchange for the ability to function for a month.”
 

10 Responses to “B-B-B-Budget: The Cost of Medication. Is It Worth It?”

  1. I’m really sorry. This really puts each day into perspective. The fact that one finishes each day successfully is a reason to celebrate.

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    • Thanks. I rely on psychological skills as much as medication these days, but like my Doctor says – it’s a very chemically based depression. I love the fact that I can enjoy a normal life. But its not always easy and it doesn’t come without cost.

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  2. Carla Says:

    Thankfully you have a Medicare system to help with all your meds. We have that here in Canada too. It’s great that you have found a combination that is working for you!

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  3. I am on six different medications, and it’s ridiculous what the cash prices are. My Invega at one point was $200 a month with insurance. America really needs to get its health care under control though. It’s ridiculous what some things cost here- even with insurance.

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    • Wow! That’s awful! Even without PBS my Valdoxan isn’t that much! No wonder the mental health system in America is so out of control. How can anyone afford treatment? I will have to look for some more good on-line resources that are accessible for at least starting points for people. How much does it cost to see a therapist? so a counsellor? a psychologist? an OT? a Psychiatrist? Do you have access to any free health care at all? (except in the prison system)

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  4. Els Says:

    Sounds like my experience in Switzerland with medications – luckily the Social Services will pay for them at the moment as my health insurer has stopped paying. I also have treatment resistant depression, just changed meds again (now have Cipralex, Venlafaxine, Lamotrigine and Seroquel). I was reeling off which ones I had tried to my Psychiatrist and he said (only to try and make me smile) that there are another 80 antidepressants to try yet, so there was some hope for me. then he said he wanted to electrocute my brain.

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  5. kenc Says:

    Yes it certainly is – although I do think at times that I should be on the Chemist Christmas card list…
    After over 1 year of seeing a very engaging and thorough psychiatrist, it has come down to “MDD with moderately severe GAD, and presenting with reversed diurnal bipolar depression”. A bit of a mouthful, and something that has taken a lot of mental gymnastics to even acknowledge that I was depressed. You see, I thought it was normal to think this way…
    Before I started with the psych I was originally on an MAOI after adverse side effects with Effexor to “help my mood”. So an old TCA called Doxepin helped to dissuade some of my thoughts, and at least helped me sleep. But the side effects again took over.
    It was only since seeing the psych have I been able to understand what is going on, and why things have to be treated a certain way, and why I have to wait weeks to see how it is working.
    But on top of all of that, I have been through just about every SSRI, augmented with Mirtazipine at times, only to find out that I am one of the 5% or so that have an adverse mental reaction to SSRI in that the serotonin does the opposite of what it sets out to do.
    So a couple of other things were tried (such as an atypical antipsychotic as mono therapy) before the conclusion was made that I appeared to only respond to the norepinephrine/noradrenergic components of certain medicines. So on to Nortriptyline which did work very well except for not addressing the increasing anxiety, for which Diazepam was prescribed daily. Worked for a short time before the (for me overwhelming) side effects of greatly excessive sweating for the SNRI and horrendous nightmares from the benzodiazepine became too much.
    And now on to reboxetine as a singular NSRI augmented with Quetiapine for the bipolar and to assist with the insomnia. So far so good!

    Short answer – was the cost worth it with visits to a psych every 2 weeks and then a new and different prescription plus augmented medicines every few weeks? Certainly! Because without them I dread where my thoughts would have likely taken me.
    We are lucky in Aus with the Medicare Safety Net as I have reached it for the last two years running, and as the dreaded gene pool has passed this disorder to my daughter she too has reached it last year as well, so again I am thankful for the support and the ability to address this at times debilitating illness.

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  6. dekadens Says:

    I’ve just started a treatment with Valdoxan, it’s a pretty new med here in sweden (saw that you wrote this post in-11) and i’m also very happy over the medical system here (you never pay more than 2000SEK – about $280). The valdoxan Medicine cost about $ 60 for 28 days… I am also eating voxra (Bupropion) wich has helped me A LOT.

    Now, to the question, do you still eat valdoxan? do you get good effects? any damage to your liver? I am supposed to take a lots ove liver-tests every third week for about sex months and the evere third month… and i have a very low alcohol consumption and no liver damages to start with.

    Best,
    Therese

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    • Hey Therese.
      Sorry not to get back to you sooner.
      Long Story. Password issues.
      I was on Valdoxan for a while to boost the effects of the escitalipram and Roboxetine that I was taking. It was much better than having Lithium to this as I was taking before that. I changed over to Quetiapine last year instead of Valdoxin for the other med because I was having issues with insomnia. These weren’t because of the valdoxin though. My Dr and I swapped it because a small dose of Quetiapine at night did the job of supporting my other meds and also helped with sleep.
      My doctor has been telling me recently that he thinks that Bupropion would be helpful for me instead some of my current medications, but it is not available in Australia unless you pay a very high amount for it because the government has refused to add it to the pharmaceutical benefits scheme (PBS) eligibility list (these medications are subsidised by the federal government and they are subsidised even more heavily for pensioners and very low income earners/households). There is also an annual limit of how much in total someone pays for medicines that are on the PBS list – after that you a very minimal amount (the same as the pension price).
      The thing that he says is unique about Bupropion is that it is supposed to have an energising/stimulating type of effect, rather than the slowing/dragging type of effect that most antidepressants have. I’m interested in learning more about it because it sounds like a big change from anything I’ve had before. How did you find it?

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