A number of years ago, I was post surgery for a sports related injury. Woozy, they rolled me back to my hospital room and hooked me up to an IV drip, an EKG monitor, and a machine to give me morphine if the pain got too bad. As soon as the nurse left the room I needed to get up.
“What are you doing?” my wife said, startled that I was trying to stand.
“I have to get up,” I said.
“Stop it you’re being crazy. You’re going to pull the IV out.”
I ignored her, pulled off the EKG wires, pulled out the morphine drip, and started rolling the IV bottle towards the bathroom. I knew I was being crazy, but couldn’t stop it.
“Going to the bathroom,” I said, lying because I knew she was right, but I just had to get up and move around .
I stood in the bathroom and looked at my diaphoretic, unshaven face. I couldn’t just lay there. Something weird was happening to me. I waited 5 maybe 10 minutes and got back in bed.
“Are you okay?” my wife asked’
“I’m fine.”
Ten minutes later the same thing happened again, and ten minutes after that again, and again… It was a nightmare. It felt like I had lost my mind, and like a dog with a ball on the other side of a very high fence would never retrieve it. I begged my wife to go home. She wouldn’t leave. I didn’t want her to see me this way. The nurses didn’t know what was happening and kept suggesting that I take more morphine. Four long hours later, when the surgeon finally finished his next two operations and came in to see me, I was finally back to normal.
The next day I figured out what happened. The anesthetic, Droperidol, triggered an akithesia, an abnormal, uncontrollable movement disorder that originated in the extrapyramidal part of my brain. Droperidol is from the same family as Haloperidol, a major tranquilizer to treat schizophrenia, bipolar disorders etc. Haloperidol can cause the same symptoms that I experienced. Until this happened, I never imagined the hell my poor patients were going through when they had side effects from the medication I was giving them.
Not being able to control oneself is a horrible experience. Imagine having voices that try to control you, or a delusion that people are trying to kill you, or panic attacks so bad that you’re sweating, your heart’s pounding, you can’t think straight, and you’ll do almost ANYTHING to get it to stop.
For anyone to ever minimize the pain of mental illness is a travesty, yet insurance companies almost always separate treatment for “medical” problems with treatment for “psychological” problems. For the millionth time, let me remind them that the brain is connected to the rest of our bodies.
Any thoughts about being out of control or how our medical care system works or doesn’t work?
Art Smukler, MD - Books & Thoughts 
Debra,
I’m glad the Paxil helps.
Do purchase one of Art’s novels. I have both Chasing Backwards and Skin Dance. They’re really well written. I loved the end of Skin Dance and can visualize it in a movie. Art is a mult-talented guy who really cares about people.
Mike
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Thanks Mike!
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I was diagnosed with Akithesia when I was on my second Antidepressant of the last 5 years. It was Cymbalta. After telling my psychiatrist that I felt like I couldn’t control my thoughts, I had weird terrible thoughts that would pop into my head which I felt were not of my own choosing. This was really scary. They weren’t voices, but it was like my mind had lost the plot, I felt like I didn’t want to think these things, but they popped into my mind all of a sudden. My Psychiatrist decided to augment my treatment with a mild antipsychotic. I refused because I really thought aside from that, the treatment was going well, my mood was quite improved. After the ‘honey moon’ period was over (3 months), I went slowly back into a worse depression than before. I had many suicidal thoughts, self harmed, and my life seemed to fall to pieces around me. It took me 2 years to realise that the drugs were doing no good, (a new psychiatrist told me to get off them), so I quit. I then had the worst withdrawals ever, and lost my mind for a complete week- it was so horrible. 2 months later now, I am feeling a lot better, I feel a lot less crazy. Although I know that my memory and emotional responses are going to take some time to return to normal. I hope I get my memory back, it really feels like there are giant black holes inside it.
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Don’t give up on therapy or psychiatrists. Like in all professions there are good ones and obviously some terrible ones. I’m glad you’re doing better!
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Not exactly the same thing, but I recall what my wife went through when she was switched from a low dose of Cymbalta to another anti-depressant. Just Google Cymbalta withdrawal, and you’ll read all sorts or horror stories of what people experienced. Now you see ads on TV promoting Cymbalta for relieving pain. It is a great anti-depressant, however, the TV ads may lull many unsuspecting folks dealing with physical pain into something they won’t know how to deal with at a later time.
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mike, you made a very important point. when I saw the tv ads promoting Cymbalta for pain relief, being that it was Cymbalta, knowing it was an anti depressant, I assumed the pain the ad referred to was mental pain. I am sure you are aware of the mental pain which occurs when you wake up in the morning and are so racked with anxiety, your stomach is somewhere between your chest and your throat making you feel as though you want to vomit.
I promptly asked my psychiatrist if I might try Cymbalta. she wrote me a scrip. I took it and waited in anxious anticipation for many days for this wonderful pain reliever to take my mental pain away. needless to say, this never happened, heck it didn’t take away my back pain either. the drug made me angry and frustrated and by the time I saw my doc again I was in a terrible state. I had been punching my pillow at night as though a knife were in my hand and I pretended my pillow was a person who I could safely stab with out killing someone. doc relieved me of this terrible drug which I thought would relax me and take from me severe mental pain.
I never touched it again, and I am once again on the paxil which I thought wasn’t working, but now I know paxil is the best thing since sliced bread and one of the best out of the many anti depressants I have been taking for almost fourty five years. the Cymbalta pain ads are disingenuous , and false advertising… and I believe there are more people who believed the way I did, praying it would take away mental pain.
I feel the ads take advantage of us who are searching for a way out of the pain of depression, in other words the mentally ill who want some p eace and nothing else…
shame on these people…
thank you dr. art for this blog and the chance to speak about the many aspects of ‘ our relationship between our brain and our body… I like that phrase it is genius.
by the by, I intend to buy your psychological thrillers, one of my favorite genres.
debra
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Thanks for your comments Debra. The problem with all antidepressants is that we can’t predict which will work and which won ‘t. Obviously, Cymbalta wasn’t ‘t for you. Paxil works very well for some people and not for others. Cymbalta does have an FDA approved niche for pain( physical). Sorry it wasn’t helpful. Best Wishes
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My sister told me my mother went through something similar, after surgery for a burst, infected colon. Something about a strange reaction to the morphine. She did the same thing, getting up and pulling out her IV’s, and tearing off her nightgown! It must have had to do with the medication during surgery, because she was in rehab and on pain meds for months, but that was a one-time experience as far as I’m aware!
In my experience you can never underestimate the severity or the weirdness of possible side effects from new medications – I’ve had terrible reactions to Lyrica, Cymbalta, and Wellbutrin. I think anyone who’s taken Ambien for any length of time knows that it makes you do weird things, and then you don’t remember them very well! If for some reason I don’t go to sleep when I first get groggy, I will raid the refrigerator, or re-arrange the cans in the pantry! And when I eat something, I’m very messy for some reason, and spill stuff everywhere! And the next morning I wake up and say – Did I really do that?!
It really must be awful for people when they have some kind of compulsive behavior that they can’t stop, but at the same time another part of the brain knows that something is out-of-control and yet can do nothing to stop it! People assume that if you are aware of it, then you can stop it, but apparently that’s not always so! I think good physicians are the ones who listen to their patients, and aren’t dismissive of their observations. Nothing like taking a walk in someone else’s shoes, to have a better understanding of their experience.
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Being diagnosed with manic/depressive disorder in the mid 1970’s; furthermore being prescribed Haldol, Lithium Carbonate, Cogentin, I almost lost my mind, I did loose the ability to void fecal matter, I did loose the ability to sit still; my $50.00 an hour psychiatrist was as about useful as a brick wall; I would tell him I could not void fecal matter, as I violently rocked back and forth in his office, week after week; after having enough of that, I made my descision to take all my med’s and end the misery. My step mother caught me and decide to take me to the state hospital; as I sat in the directors offfice and explained my distress, he commented that I was experiencing all the standard side-effects of the drug cock-tail that I had been taking. As I lived and learned, and as I interact with others who have taken, some, or all of these same medications; I have come to the conclusion that their is so much more to learn about behaviors and medications.
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I have an adult daughter who is bi-polar with schizoaffective disorder. Although I do not know the common name for haloperidol there are many medications which she has been given which cause unusual reactions. Unfortunately, because she has a mental disability the psychiatrists don’t listen when she tells them the medication isn’t working correctly or causes odd side affects. She is highly intelligent and when the medications are correct she is fine. But too often, for some strange reason they will decide she can’t be on the med that is working well too long and change it. I can tell immediately and have her go back and let them know. But they tell her to try it a while longer. Why won’t they listen? Now that you know first hand what these medications can do, perhaps you can advocate for psychiatrists to be more aware of these odd side affects. When one is already having a problem, they certainly don’t need more strange behavior added on.
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Having fibro I was assumed to be depressed by my gp who didn’t actually bother to ask about my mental state but since I was in pain I must be depressed right? She put me on a course of SSRI’s and I got my prescription and went home. Then I took a tablet… just the one very small white thing. A few hours later I was giggling like a drunk schoolgirl, all by myself, an hour or so after that I got hubby up (he was on night shifts) No way could I drive to get the kids from school. All this time I was waiting for my gp to phone back after I called and said ‘This doesn’t seem right’.
By 4 in the afternoon I was running round the house and garden, I cleaned all the kitchen tiles and pulled up every weed I could see. I was also talking so fast it was hard to understand me. When I ran out of things to do I started punching myself in the head to try and get the feelings out. If I ran anywhere I was punching the walls as I went. It felt like my brain was on fast forward and was about to explode from the strain.
The gp phoned back and said ‘Don’t ake any more’ !!!!! Well DUH! Hubby took me to A&E where the triage nurse couldn’t stop laughing at me (nice man!) the doctor then said ‘Never seen anything like it, I’ll go and ask’ came back with ‘Can you stay in so the other docs can come and look at you’… Exibit A… A nutter, weird isn’t she.
I went home and it wore off after about 18 hours. I NEVER want to be like that again!
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