Are We To Blame For Our Depression?

Someone in a group I belong to recently posed the question “Is it my fault I’m depressed?”.

People immediately began chiming in on both sides of the fence, with the overwhelming majority stating a firm and clear “absolutely not”.  I hesitated to answer because I don’t think there is such a clear cut yes or no answer.  Life is rarely simply black and white.  There are many shades of gray.

I spent many years struggling with my own mental illness.  I saw many doctors, took a multitude of medications in all different dosages and combinations.  I tried changing my diet, exercising more, busying myself with arts and crafts, talking long nature-filled walks, everything anyone had suggested might work.  In my case, nothing helped.

Last year, my newest doctor sent me for a genetic test and we discovered that I had a genetic mutation that prevented my body from breaking down a specific vitamin my brain needed to function properly.  That broken-down vitamin is used by the brain to transport the chemicals, whether made naturally or in the form of antidepressants, where they are needed. Because my brain never received that substance, nothing my body made, no pill I took, even had a chance to work.

There is a pill version of that broken-down vitamin on the market.  My doctor prescribed it.  It took almost a year of fighting my insurance company to get it covered.  Now that I have it, there is a noticeable difference.  It is not a panacea, my depression is still here, but it is a start.  I have a long road ahead of me but at least I am finally on the right track.

It brings to mind a quote from Maya Angelou:

“Do the best you can until you know better. Then when you know better, do better.”

For years, I tried again and again to get help even though nothing worked.  I cannot blame myself for not knowing that, on a genetic level, my body was incapable of making what it needed in order for any treatment to work.  But now that I know better, I am doing better.

I do not believe we can blame ourselves when our bodies malfunction.  When someone is diabetic, their pancreas is not making the proper amounts of insulin and glucose.  People go to a doctor and get treatment so they can live a healthier life.  They are not to blame for their organ ceasing to work.  With mental illness, the only difference is the organ involved.  No one has any control over their brain not working properly.

But everyone does have control over whether or not they get the treatment they need.

I know some people will play devil’s advocate and say a diabetic wouldn’t have gotten diabetes if they hadn’t eaten so much sugar and likewise, someone who is mentally ill may have made poor life choices that put them in their predicament, as well.  However, that is not how it works.  Millions of people drink soda and other sugary drinks every day, yet not all of them have become diabetics.  Likewise, many people struggle with everything from drinking, drugs, bad relationships and dead-end jobs without experiencing depression.

There are many known hereditary and biological causes for mental illness.  Many people are predisposed to depression, having been passed through their family line.  For others, it can be caused on a genetic level from mutations.  In some cases, the onset is caused by an unforeseen tragedy or event that shakes a person to the core.  With me, it is a combination of them all.

Living a rough life does not guarantee depression any more than drinking a soda guarantees diabetes.  On the contrary, people from all walks of life, all socio-economic backgrounds, different races, religions, sexual orientations, upbringings all struggle with their mental health.  A hard life might contribute to a person’s mental illness but it does not cause it, much like drinking sugary drinks are a contributing factor to diabetes.  There is a big difference between causation, though, and a contributing factor.

Though we have no control over whether any of our organs are working properly, I believe there is a clear line here where we need to accept personal responsibility.  As Maya Angelou said “..when you know better, do better”.  Once we realize something is not working correctly in our bodies, it is our responsibility to take steps to fix the problem.  We need to do what we can to be healthier, live healthier.

Once a person has realized they are struggling with a mental illness, they need to at least attempt to get help.  I understand the frustration all too well when nothing seems to work, but we need to at least try.  Again, to quote Maya, “Do the best you can until you know better”.  Try therapy, meditation, medication, homeopathic remedies.  Something.  Anything.  Embrace whatever works for you.  But at least DO something.  Don’t suffer needlessly.  Take care of yourself the best you can. Then “..when you know better, do better”.

Nobody asks to be depressed.  No one has any control over whether or not they are diagnosed with a mental illness.  But you do have control over whether or not you treat your illness and you ARE to blame if you knowingly neglect yourself and your well-being.

Please take care of yourself the best that you can.  Get help when you need it.  Don’t let the judgment or stigma from anyone else prevent you from taking care of your mental health.  It is okay to need help, especially when your body is not working like it should be.  There is no shame in having a mental illness.  The only shame is in not getting the treatment you need.

Victory is Mine! Fighting for & Winning Coverage is Possible!

I was recently contacted by someone from My Patient Rights. They are a nonprofit helping patients learn their rights, navigate their health plan and ultimately how to become their own advocate.  They had read my story about fighting for coverage when it had been republished on The Mighty and contacted me, interested in hearing how my battle was going.  When I informed them that I had won my fight against the insurance for coverage, they asked me to write a piece, sharing my story.  The following piece was written exclusively for My Patient Rights in hope that sharing my story might give others the courage and strength to fight for the coverage they need, as well.

I’ve spent my entire life struggling with severe depression.  I felt broken.  Others treated me like I was unbalanced, unhinged and crazy.  No treatment or medication I had tried worked.  While the majority of people suffering from depression could pinpoint the event or period in their lives that was the catalyst for their illness, mine had always been there and nothing seemed to help.

Everything changed for me when my doctor discovered that I was born with a genetic mutation.  This mutation renders my liver incapable of breaking down folic acid to any usable degree.  Though this genetic mutation exists in varying degrees, mine is an extreme case, where my liver is working at approximately 20% of its potential.  Broken down folic acid is what the brain uses to help transport the chemicals needed for functions such as balancing moods.  Without it, no amount of chemicals, whether naturally made or taken in the form of an antidepressant, could get where they were needed.  At best, my brain was receiving 20% of what it required.  My lifelong depression was a result of my brain being literally starved of the nutrients it needed.

This changed everything for me.  I wasn’t crazy after all.  My mental illness had a definitive biological cause.  Even more importantly, there was a treatment available, capsules of broken down folic acid, called l-methylfolate.  There was a company that manufactured capsules of already broken down folic acid under the name Deplin.  For the first time in my life, there was actual hope.  With this medication, my brain could finally get what it has been missing.  While the medication I needed wasn’t extremely expensive, it was beyond my financial means.  It was a medication I would need for the rest of my life and it would cost thousands of dollars every year.  The only way I would be able to afford the continued medication I needed would be for my health insurance to cover the majority of the cost.

My doctor started me on some samples of Deplin while we waited to hear back from the insurance company that my medication would be covered.  While it was not a panacea, I could feel a distinct difference inside almost immediately.  While my condition would not be cured by taking this prescription, it would be greatly improved and would open the door for other treatments to be used successfully for the first time ever.  With Deplin, my depression was feeling more manageable, my moods higher and more stable than they had ever been.

It seemed like a simple fix, cut and dry.  The brain needs broken down folic acid in order to balance moods and combat depression.  My body, on a genetic level, was incapable of breaking down folic acid in any usable amount.  A pharmaceutical company made a capsule of broken down folic acid that would provide my brain with what my body could not make on its own.  You can imagine my surprise when the insurance company denied my coverage.  Positive that it was an error, my doctor and I resubmitted my claim.  Again, it was denied.

The reasons for the denials were ludicrous.  The first denial stated there was a “less expensive, alternative treatment”.  More specifically, folic acid tablets.  The folic acid tablets that my body was incapable of metabolizing due to my genetic mutation.  The second denial was even more ridiculous.  CDPHP denied coverage of the medication deemed necessary by my genetic test because they questioned the validity of the test itself.  The insurance company had covered the genetic testing because they believed it to be necessary to my treatment, yet refused to acknowledge the results of the test or the treatment deemed necessary based on the test results.

My first appeal was rather informal.  Speaking on the phone to an in-house doctor, explaining why I felt they had made an error.  During the conversation, the doctor I was speaking to seemed both sympathetic and understanding.  They understood why the folic acid tablets suggested would not be a viable option.  Once again, I thought it was cut and dry, easily resolved.  After all, the doctor seemed to not only understand, but to agree with all I was saying, as well.  When the second denial came back questioning the validity of my genetic testing itself, I knew I had to step up my game.

I contacted the lab that did the genetic testing and spoke directly to technicians, gathering information about the testing itself.  They provided me with case studies showing the benefits of their testing in mental health treatment, as well.  I also contacted the pharmaceutical company that manufactures the broken down folic acid tablets.  With their help, I gathered multiple articles discussing not only my specific diagnosis but the use of their product in treating it, as well.  Altogether, I submitted over one hundred pages of research to CDPHP for my second appeal.  It took less than three hours from the point that the last paper was faxed to their office for me to get the phone call from CDPHP.  Denied again.

I was beside myself.  There was no way that anyone at CDPHP could have reviewed even a portion of the material I had faxed in before issuing their denial.  There was no alternative treatment available.  My depression would not go away on its own.  No antidepressant could work because, without the broken down folic acid, there was no way it could get where it was needed.  Meanwhile, my doctor’s supply of samples was quickly running out.

I was in an absolute panic.  My last ditch effort was a final appeal with the state.  Turns out, health insurance companies are monitored by the government.  A final no by the insurance company is NOT the final no.  You can go above the heads of the insurance company and have your state review their decision.  And that is precisely what I did.

Once again, I faxed out all the research I had compiled, both on my own and with the assistance of both the lab and pharmaceutical companies involved with my case, over one hundred pages.  In addition, my doctor found medical journals that addressed my specific condition and treatment in detail to submit on my behalf.  I was cautiously optimistic.  After all, I had submitted the majority of this before, believing it was all cut and dry,  only to have it denied.

It took weeks to hear the result because it was not considered a life or death situation so the appeal could not be expedited.  My supply of samples had run out.  I could feel my depression spiraling back down into the darkness that had succumbed me for years.  This final appeal was my last and only hope.

After what felt like an eternity, I received a huge packet in the mail from New York State Department of Financial Services, the government agency that oversees external appeals.  My appeal had been sent out to Maryland for review.  An independent doctor, with a long list of credentials and no affiliation with either my insurance company or my state, had deemed inequitably that my prescription for Deplin was not only medically necessary but the only treatment currently available for my condition.  CDPHP’s denial was overruled.  They would have to cover my medication.

It felt like a miracle.  All in all, it took approximately one year’s time from the discovery of my genetic mutation to the results of my final appeal arrived in my mailbox.  It took almost three months longer before CDPHP began finally actually paying for my medication.  In the grand scheme of things, my entire fight took a little under a year and a half.  In reality, it should never have happened.  It should have been a cut and dry case of my receiving the only treatment available on the market for my condition.  It is devastating to think that our insurance coverage often comes down to keeping their costs down and not what is best for our health.  But if I have learned one thing from this experience, it is that we do still have power.  The story does not end when our insurance company tells us no, that they will not provide necessary treatments.  Insurance companies have to answer to outside government agencies with more power and the authority to overrule their decisions.

We can fight.  And we can win.

Don’t lose hope.  Don’t take no for an answer.  If you need treatment and your insurance company refuses to cover it, that is not the end.

Fight for your health.  Fight for your right to have the treatments you need covered.

It may just be the most important fight of your life.

mypatientrights

Written Exclusively for My Patient Rights on 11/3/17.

Previous pieces written about my fight for coverage include: Fighting for My Mental HealthThe Meds Crash.. and The New York State Appeals Process: Apparently Not Everyone Who The State Certifies To Prescribe Medication Is Considered ‘Educated Enough’ To Defend Their Patients’ Prescriptions During An Appeal.

Life Happens..

They say life happens, whether it happens while we’re making other plans or it happens so we must deal with it or one of many other overused cliches meant to help usher us into reality.  I’m not quite sure who “they” are but they definitely hit the nail on the head with this one.  Life happens without a doubt.

My writing has been put on a back burner for a couple months now.  Both my ongoing blogs and the books I have in the works have been delayed.  It is not that I have lost interest or my passion or that I have run out of topics to write about.  Far from it. My mental health and my journey towards mental wellness are still very much a priority and are nothing I would ever give up.  Life just happened.

On a high note – after almost a year battling my insurance company over covering my Deplin, I finally won my last external appeal.  CDPHP has yet to start paying for it, but it has been deemed medically necessary by outside sources with the ability to overrule their decision.  It is a huge victory and more than worthy of a large celebratory post, but again, life happened.

On a very low and tragic note, I have hit some painfully rough waters with the man I love.  There is no need for anyone to prepare themselves for the drama or heartache of a love grown sour for we are still very much together.  Our relationship is truly one of the best things in my life right now.  It was a different sort of heartache.

His father had been ill.  Terminally ill.  We understood he did not have much more time with us, but we had expected much more than what we had been given.  It went so quickly from an untimely fall to a trip to the emergency room to the intensive care unit to hospice.  No one was ready.  I know that no one is ever truly ready for such a loss but it all happened so quickly.  Too quickly.

I’ve spent the last year deconstructing and reconstructing myself piece by piece.  I’m by no means back together quite yet.  I am a work in progress in every way.  But everything going on with myself was cast aside on the back burner so that I could be there for the man I love.  There wasn’t even a question in my mind.  I had to be there.

The man I love is a good man.  Beyond good, in my opinion, but I’m far from impartial. He has been through a lot in his life – we are kindred spirits in that sense.  He has such a warm, loving and compassionate heart.  And life had torn it clear in two.  Nothing, not my writing nor even my own well-being, was as important to me as being there however I could for him.

This was his Dad.  He had already lost his mother a few years ago and was still recovering from that.  Losing both parents leaves a hole, an emptiness that nothing else can ever truly fill.  Life had rendered him an orphan.  I knew that feeling all too well and I could not leave him to face it alone.

Hospice itself was beyond agonizing.  Nothing in life can prepare you for watching someone who was once larger than life slowly fade away.  I’ve been there myself, as well. Hospice is where my father spent his final days as his cancer ate him alive.  Though every moment of the days in hospice with his father held me in a death grip, threatening to pull me back into the past with my father, there was nowhere else I could be but at his side while he spent his final days with his own.

Next came going through the motions of the final preparations and the flurry of condolences that come with a great loss.  Though the words are heartfelt and well-meaning, they cannot even begin to penetrate the numbness that comes with the realization that someone who has always been there is truly gone.  I understood completely how he felt and where he was mentally and emotionally because I have been there myself.  It is a feeling you never forget.

As they often say – “When it rains, it pours”.  Life was not satisfied with dealing that one large heart-wrenching blow.  The last couple months provided a steady barrage of ill-timed hardships to rival even the most depressing country or blues song.  His truck – the last vehicle his mother had driven – needed work to pass inspection and stay on the road. His boat – left to him by his father as a reminder of better days and a multitude of fishing trips together – wouldn’t start and needed repairs.  His cat – given to him by his parents to help him through rough times in his past – was injured and needed to go to the vet.  It was as if every aspect of his life that was tied to his parents was collapsing and crumbling under the weight of the tragedy of his father.

Add to the mix us scrambling to find a place together.  Neither of us could continue to stay where we have each been nor did we honestly want to live separately any longer. One of the only truths we have embraced during these very uncertain times is that we not only wanted but that we NEEDED to be together.  In the short time we’ve been a couple, we’ve become a rock for each other, that light we each cling to when trying to find our way out of the darkness. We understand each other in ways no one else ever has and find a comfort in one another that has been lacking from our lives.  We belong together.

We eventually found a place in his old stomping ground out in the country, literally next door to where he had lived a few years prior.  It is a small place and I’m honestly not sure how we will fit everything into it, but we will manage.  It is familiar territory for him and we are together.  It is home.

Since moving in, we honestly have not been as productive as we probably should have striven to be, but we both needed some downtime to catch our breath, recuperate and heal.  Life has been overwhelming and we both honestly needed a break.  Some avenues of our life have suffered a bit but we have been doing our best to keep going, take care of ourselves and each other.

Life happens.  I’m numb to it at this point.  I’m honestly not sure how I have managed to not crumble into a million tiny pieces by now but somehow I’m still going.  I have to keep going because he needs me there.  Like me, he is an orphan now.  I have to keep going because I need to take care of myself, as well.  We will be okay, though.  We HAVE to be okay because in each other we have finally found what we’ve both been missing in our lives.  We are both seriously overdue for our happily ever after.

We are going to get through this, get past it.  We are going to find some way to heal and to keep going.  We are going to be okay.  We will survive and we will be okay.

They say to fake it until you make it, to keep telling yourself things until you believe it and it becomes truth.  Again, I don’t know who “they” are, but they’ve been right about everything else so I’m hoping this pans out as well.  I shall embrace my hopes for future wellness as my mantra, repeating them in the hope that in time they become reality. Because life has definitely happened and we need more than anything to be okay again.

A Realistic Way To Look At Mental Illness

Mental illness carries a lot of stigma.  People often hide their diagnosis or minimize their symptoms because they are afraid of the judgment that will follow.  It seems easier for many to suffer in silence than to have everyone else look at them as broken or crazy, as something to be feared or pitied.  Many people would rather struggle every day to function than to become a pariah or a joke.

Realistically, there is no shame in having a mental illness.  A mental illness is, in the simplest terms, an illness of the brain.  Our brain is just one of many organs in our body.  When another organ isn’t working properly, we see a doctor and get treatment.  No one is shamed for it because we understand that the body is a machine and that all machines have issues now and then.  The more pieces to a machine and the more functions it performs, the more likely that the machine might have an issue or break down from time to time.

Take the pancreas for example.  It is the organ that maintains the glucose levels in the body.  When the pancreas isn’t working properly, a person can become hypoglycemic, hypoglycemic, or diabetic.  All those conditions can be treated.  Nobody is shamed for having these conditions because we understand that sometimes organs do not work properly.  People go to a doctor and are given medications and treatments that will help improve their quality of life.

Take the heart. There are many conditions that affect the heart.  Heart disease is an umbrella term that includes all the disorders of the heart much like mental illness describes all the illnesses that affect the brain.  Yet there is no shame in talking about heart disease.  Food packaging proudly advertises that food is “heart healthy” and people are reminded regularly to take care of their heart so they can live a longer, healthier life.

The approximate overall cost of heart disease in the United States is 207 billion dollars every year.  That total includes the direct cost of treatment & medications, as well as the indirect cost of lost productivity.

(Based on: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm )

In comparison, the combined direct and indirect cost of only SERIOUS mental illness every year is over 300 billion. That total does not even take into account moderate or mild mental illness, JUST the serious cases.

(Based on: https://www.nimh.nih.gov/health/statistics/cost/index.shtml )

Yet when it comes to mental illness, the room becomes so quiet that you could hear a pin drop.  You don’t see cereal boxes displaying that they contain nutrients for a healthy brain though so many of them do.  You don’t see advertisements recommending meditation to strengthen your brain like you do ones recommending walking and jogging to strengthen your heart.  The fact is – WE SHOULD.  The only advertisements we see regarding mental illness are the occasional commercial for a prescription illustrating that if a person feels broken, their medication might fix them.

The brain is just another organ in our body.  Like the heart, it is needed to survive.  The brain is the most complex organ in our body.  It controls so many things, from basic tasks to thoughts and emotions.  As the most complex organ in the body, it also has the highest chance to develop an issue.  According to the latest statistics from the National Alliance on Mental Health, “1 in 5 adults in the U.S. —43.8 million, or 18.5%— experiences mental illness in a given year”.  Those numbers are staggering.  When you consider how many others are suffering in silence and haven’t spoken out or received treatment, you can only imagine how much higher those numbers might go.

(You can find NAMI’s mental health statistics at: http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers )

With that many people affected, and so much money being spent on mental health treatment, it is clear that mental illness has become a crisis of epic proportions.  When the number of people affected by heart disease skyrocketed, it became clear that something had to be said and done.  Change was needed.  It is no different with mental illness.

Mental illness is the umbrella term to describe conditions that occur in the brain.  No more, no less.  There should be no shame when someone has a mental illness because it is no different than if they had diabetes or heart disease – only the organ affected is different.  No more, no less.

Mental illness needs to stop being that dirty little secret we are afraid to talk about.  The stigma needs to end.  We need to rally behind those with mental illness like we do other health conditions, encouraging them to speak up, speak out and receive help.  We need to stop letting stigma label those who are suffering.  We need to educate and to encourage wellness.

Like many other conditions that affect a person’s body and organs, mental illness can be treated.  It is ridiculous that so many people are untreated or undertreated because stigma has turned mental illness into a dirty word.

selfgrowth

Republished on SelfGrowth.com on 10/17/17.

The New York State Appeals Process: Apparently Not Everyone Who The State Certifies To Prescribe Medication Is Considered ‘Educated Enough’ To Defend Their Patients’ Prescriptions During An Appeal

Government Red Tape & Legal Loopholes At Their Finest

After forty years of struggling with treatment-resistant depression, I finally found a clinic and team of doctors that have not only helped pinpoint genetic causes of my depression but that have also helped create a wonderful multi-pronged treatment plan that is actually helping me.

The person I see for the medication portion of my treatment plan was the one who first sent me for my Genesight test that discovered my genetic mutation.

(The full story explaining my genetic mutation and how it relates to my depression can be found HERE.)

He prescribed me a medication called Deplin, which provides my brain with a key substance my body is incapable of making on its own in any useful amount due to my aforementioned genetic mutation.  He started me on samples of Deplin right away and there was an immediate and extremely positive result.  For the first time in 40 years, I felt actual hope that I could have a life above and beyond my depression.

My insurance company, CDPHP, denied coverage of the prescription and my long battle began.  When I was called by the insurance company about the first denial and I explained my case further, it was suggested we re-apply for coverage, only to be met with yet another denial.

Meanwhile, I kept taking my samples, though the supply began to dwindle.

I spoke both with Assurex Labs who make the Genesight test that discovered my gene mutation, and PamLabs, which is the company that makes Deplin, about my ongoing battle for coverage and they both offered to help.  For my internal expedited appeal, I included not only approximately 50 pages of data showing the validity of genetic testing in the treatment of depression, but another approximately 50 pages specifically explaining my genetic mutation and the use of Deplin in its treatment.  Altogether, the paperwork I sent in alone, not even counting what my clinic sent in on my behalf, totaled well over a hundred pages.

Despite all the work put in by everyone involved, the internal appeal was denied.  Ironically, though CDPHP had over a hundred pages of paperwork faxed in, they rendered their opinion a few hours after the faxes were sent in, well short of the 72 hour time frame they had to review everything.  There was no possible way they could have reviewed everything before calling with their decision.  I’m honestly not sure they reviewed any of it at all.

I don’t believe it was ever a matter of the best interest of the patient with CDPHP.  From the beginning, their only concern has been saving money and avoiding adding another medication to their list of things they had to cover.  All explanations about how this medication was the only possible treatment available to me fell on deaf ears.

(My journey within the appeals process has been documented HERE.)

Meanwhile, my supply of samples of Deplin has been exhausted and I have found myself back where I once was, drowning in a sea of treatment-resistant depression that nothing seems to touch.

(The Explanation of the meds crash that followed can be found HERE.)

We began the process of filing for an external appeal with the state because, in New York state, even if an insurance company denies coverage, the state can overrule it if they see fit.  Unfortunately, as it has been explained to me by my treatment staff, appeals don’t always go well because insurance companies and the section of the government that oversees their decisions usually work in tandem, proverbially washing each other’s backs.

I began correspondence with a local newscaster, as well, who was well-known for her health advocacy work.  She advised me that, in her experience, external appeals tend to go 50/50 and to please let her know how it turns out because she was interested in the story.

Meanwhile, the gentleman in my treatment team who was in charge of my medication prescriptions began the lengthy process of formatting a detailed external appeal for the state, explaining once again that there is no alternative medication for my condition and including multiple articles from approved medical journals based on their guidelines that support his diagnosis and prescription of Deplin.  He sent in his portion of the 72 hour expedited external appeal last Thursday, 3/16/2017.

I heard back from a reviewer from the consumer assistance unit of New York State Department of Financial Services today, Tuesday, 3/21/2017, that they have not yet assigned an examiner and cannot do so until they receive an attestation from a doctor, specifically someone with an MD or DO after their name.

The gentleman who has been doing my medication management for two-thirds of a year now is licensed to prescribe medication in New York State.  He has a multitude of letters after his name, including CAQ & PA-C, however, though New York State AUTHORIZES him to prescribe to patients, he apparently is not allowed to assist in their medication appeals because he does not have an MD or DO after his name.

As explained by the reviewer, “The law says the attestation has to be completed by a physician.  The education law defines a physician and an MD or DO.  So in order for this to go external you will need to have the attestation completed by a physician.”  This means that, though New York State allows people with other degrees to PRESCRIBE medication, their appeals department uses a specifically restrictive and exclusionary definition as a legal loophole to mark as invalid and discard any appeals sent in by the treating physician unless they have one of two specific abbreviations after their name.

It does not matter that, according to the Merriam-Webster dictionary, physician is defined as “a person skilled in the art of healing; specifically :  one educated, clinically experienced, and licensed to practice medicine as usually distinguished from surgery”.  Speaking from a legal perspective, the Law Dictionary defines a physician as “A practitioner of medicine; a person duly authorized or licensed to treat diseases; one lawfully engaged in the practice of medicine, without reference to any particular school.”  Speaking from a medical perspective with regards to the term physician, the Medical Dictionary states “In the UK it refers to a specialist in internal or general medicine. In the USA it is a more general term for a medical doctor.”  Despite the seemingly broader and unified consensus of this definition, New York State has its own much smaller and less inclusive definition of physician which they apparently use to disregard and nullify otherwise valid patient appeals.

My mind is beyond blown at the loopholes this department is using to prolong this appeal.  In my disgust, I went so far as to ask them if I am supposed to see yet another doctor beyond my treatment team and to please explain to me how the state can certify someone to treat patients and prescribe medications one moment and then in their next breath deem them unqualified to speak on a patient’s behalf as to why they need that prescription.  It’s irrational to the point of being ludicrous.

Thankfully, when I spoke to both the director of the clinic where I am in treatment and the gentleman in charge of my medication management and they both assured me there was a supervising psychiatrist who would be in the office tomorrow who can assist me further.  This supervising psychiatrist apparently has the correct letters after his name to re-submit paperwork on my behalf.

I am beside myself with disbelief at this whole fiasco.  None of this should be THIS hard.  It’s a matter of simple facts.

FACT: I have a gene mutation that renders my liver incapable of breaking down a nutrient my brain needs in order to treat my depression.  Without this broken down nutrient, the neurotransmitters in my brain cannot function properly.

FACT: There is a synthetic version of this nutrient on the market called Deplin.  I have tried it for months and it works for me.

FACT: There is no other alternative on the market and no other possible treatment that could give my brain what it needs.  This is the ONLY treatment available for my genetic mutation and the ONLY way that any other antidepressants or anti-anxiety medications prescribed would work for me in the treatment of my depression.

Those three facts alone should be enough reason to approve this medication for me.  Yet the insurance company has denied it multiple times and now the state is dragging its heels, refusing to even assign an examiner until someone with the correct letters after their name signs and submits the same forms that have already been submitted.

You would honestly think that anyone who can prescribe medications in this state could defend their prescriptions in the appeals process on behalf of their patients.  It makes perfect sense.

Except to New York State.

It is complete insanity.  The people making health coverage decisions need to start considering the lives and the health of the people involved instead of worrying about saving a few dollars here and there.  They need to start considering doing what is in the best interest of the patient and not worry about “winning” or “proving points”.  This is NOT a game.  I’m fighting for my life and my mental health here.  I’m fighting for the ability to get the treatment I desperately need so that I can get better.

My heart goes out to everyone out there fighting the appeals process, trying to get their treatment or medication covered.  It should NOT be like this.  Doctors, therapists and insurance companies should be working hand in hand to do what is best for the patient, not denying coverage just to save a buck.  I am blessed to have an amazing treatment team that has been standing behind me every step of the way and assisting wherever they can, yet most days, I am still overwhelmed and frustrated beyond belief trying to deal with this lunacy.  My appeals process has been ongoing for over half a year now and it is becoming harder and harder each day to keep fighting and not just roll up in a ball and cry.  Some days, there is no fight left, only tears.  I cannot imagine having to deal with something like this on my own yet unfortunately many people do.  My heart sincerely goes out to each of you.  Stay strong, keep fighting and please don’t lose hope.

 

The Meds Crash..

What Happens When Your Insurance Company Won’t Cover the Medications Needed for Your Mental Health

In the last year, I have made so many positive strides in my ongoing fight to get in front of my mental illness and to be in a healthier place.  I not only have begun finally opening up, writing and talking about my struggles with depression, anxiety and p.t.s.d., I have begun therapy at a wonderful facility that uses a multi-pronged treatment plan to combat mental illness, involving not only traditional treatments such as therapy and medication management but also incorporating unconventional tools such as yoga, meditation and art into the mix to help people heal mind, body and soul.  Perhaps the greatest stride forward I have made, however, happened thanks to a genetic test my new doctors gave me that identified a genetic mutation I possessed that has been the linchpin blocking all previous attempts at medication and treatment.  Due to this genetic mutation, my liver is incapable of metabolizing folic acid, a simple b vitamin used by the brain to help transport the chemicals needed to help moderate my moods and depression.  It is a fairly simple fix because there is an already broken-down version of folic acid on the market, a synthetic version that can help my brain to function properly – something it has never been able to do on it’s own, due to my genetic mutation.  However, the simple yet life-changing fix has been completely derailed by my insurance company, CDPHP, that refuses to cover it.

My doctor had been providing me with samples of the broken-down folic acid, also known as l-methylfolate or by the prescription name Deplin, for the last seven months.  While it is in no way a panacea that would make my mental illness disappear, it made a world of a difference.  I had more clarity, was able to focus better and function more.  I was able to fight back tears and move forward, face fears and be productive in ways I previously never imagined possible.  I found myself able to genuinely smile and experience happiness.  Despite the fact that I was going through one of the rockiest times in my life, I had real hope.  It was the beginning of a new life, a new world for me.

Yet despite how much of a breakthrough I had achieved on many levels thanks to this medication, CDPHP continues to refuse to cover it, deeming it unnecessary.  My doctor had a drawer full of samples to keep me going while we began our fight for coverage.  I had been filing appeals, reaching out for help, fighting with every ounce of energy and courage that I could muster, completely due to the Deplin helping my antidepressants and anti-anxiety medications get where they were needed in my brain, something they could never do on their own because I had always been medication resistant due to my genetic mutation.

…And then the samples ran out.

…And my internal appeal for coverage by CDPHP was denied.

It has been a week since I have had any Deplin in my system.  Where I was previously up before seven in the morning every day, up for breakfast and ready to start my day, I can’t seem to pull myself up out of bed again.  Today, it was almost eleven before I even got out of bed.  Less than twenty minutes later, I was back in bed, wrapped in my blanket, wondering why I was even bothering.  Each day, it becomes increasingly harder to do anything at all.

Even the simplest conflicts feel unbearable again.  I find myself panicking and breaking down into tears over even the smallest bumps in the road.  Where previously I was convinced that I could somehow figure things out and find a way, I don’t feel like I can deal with anything right now.  I’m afraid to go out, to leave my room, because I have no control over my emotions or my tears anymore.  My mind is racing again, I cannot focus, I cannot sleep, I have no desire to eat, no desire to do anything.  I feel like I’m in a constant panic, one word away from breaking down into tears again.

It is like I had entered a Renaissance, a beautiful world full of progress and hope, only to be kicked back into the darkness of the stone age.

I have an external appeal yet to file with the state but I don’t know if I can do it.  I don’t know if I have the strength.  My mind keeps asking me why bother?  Everything feels hopeless.  The battle feels lost.  All I want to do is climb back in bed and cry.  That other world, that one where I was smiling, where I felt hopeful, feels like another world, another life, just a dream.  I’m terrified I’ll never find my way back to that person again.  Sitting out in public, typing this out, I cannot stop the tears from flowing, cannot find my way back to the person I was even a week ago when I believed that things were going to be okay, when I believed in hope.

This story began with Fighting for My Mental Health on 1/13/17.

mightylogoRepublished on The Mighty on 5/11/17.

Fighting for My Mental Health

Battling my Insurance Company for Coverage

I have struggled with depression my entire life.  Before I even knew what mental illness was, back in a time when it was the gorilla in the room that nobody talked about, I knew something was different within myself.  Off.  Wrong.  Unlike many people suffering from depression that can pinpoint a specific period in their life that marked the onset of their illness, mine seemed to always be present, lingering and lurking in the shadows for as long as I could remember.  Though years of abuse, trauma and dysfunction contributed to its intensity, those demons of depression have always been there, tormenting me.

Throughout my childhood, my mother struggled with often untreated, always under-treated bipolar disorder.  It was a dark shadow that hung over our family.  Mental illness was not something spoken about in our house.  Appearances were everything and it was a dirty little secret, our family legacy, that we all knew was there but no one ever discussed.  When I was a teenager, she shot my father.  When her secret was revealed, I saw firsthand the stigma of mental illness.  Friends and neighbors who once sang her praises ostracized her.  She simultaneously became a punchline to laugh at and a monster to fear.  Back then, I never spoke out openly about my own struggles because I knew all too well how people reacted to mental illness.

In my twenties, the weight of my depression became to heavy to bear.  I began having breakdowns, unable to fully cope with the pressures of life on my own.  On and off throughout my adult life, I have tried reaching out for professional help.  Doctors prescribed a wide variety of antidepressants and anti-anxiety medications in different dosages and combinations with no apparent rhyme or reason, as if they were playing whack-a-mole with my mental health.  Nothing seemed to help.  Time and again, I would become so discouraged with the waves of prescriptions with horrific side effects and no beneficial progress that I would stop treatment, retreating back into the shadows to suffer again in silence.

This past year, an angel appeared to help me battle my demons.  I was blessed to find a new doctor who actually listened to my past struggles instead of going through the motions of standard mental health treatment by continuing with the painful game of whack-a-mole that had been my previous experience.  He thought outside the box, wanting to run tests to better understand why I had been so resistant to medications and to help pinpoint which drugs might be a better choice for me.

He arranged for me to take a genesight test.  A cheek swab and a few vials of blood later, the lab had my complete genetic makeup on file.  Based on my genetic markers, this test could determine which medications my body could and could not metabolize and which were likely to cause moderate to severe interactions.  I had never heard of such a test before, but my insurance covered it and I was at the end of my rope, with very little hope, willing to try anything.

The results of this test were mind-blowing.  Not only did the test identify that many of the prescriptions my previous doctors had prescribed would cause moderate to severe interactions and should never be given to me, the test also revealed something completely unexpected.  I have a rare genetic abnormality.  Due to this genetic mutation, my liver is unable to break down folic acid.  The broken down version of folic acid, l-methylfolate, is used by the brain as a conduit to help the brain transfer the chemicals needed to regulate and moderate moods.

Finally, my lifelong struggle with depression made perfect sense.  Because my body could never break down folic acid into l-methylfolate, my brain was never able to properly regulate my moods.  No matter what my body could make on its own or what doctors had prescribed, it was unable to get to the part of my brain that needed it because the l-methylfolate was never present to transport it where it was needed.  Because my liver genetically was unable to break down this vitamin, my brain had literally been starving for a basic b vitamin my entire life.  It was an easy solution, though.  There is a prescription form of the broken down version of folic acid, l-methylfolate, on the market.  It is called Deplin.

This discovery was a life-changer for me.  I finally had hope where previously there was none.  With Deplin, my brain would finally be able to regulate and moderate my moods.  Prescriptions that previously were unable to get where they needed in my brain would finally have a chance to work.  I was given a ray of hope for a semblance of a normal life where I was not struggling to battle the demons of my depression every moment of every single day.  My doctor, my angel of hope, began me on samples of Deplin, six to a box, as we applied for coverage from my insurance company, CDPHP.

It seemed a clear cut and dry request.  CDPHP had fully covered my genesight lab work.  The lab work identified that, due to a genetic abnormality, my liver was incapable of metabolizing and breaking down folic acid into l-methylfolate, a substance needed by my brain to combat my depression and regulate my moods.  A pharmaceutical company manufactured a pill form of the broken down version of folic acid that I needed.  It wasn’t an experimental or new substance.  It had been thoroughly tested, approved and was readily available on the market to be prescribed for those who needed it.  It was even less expensive than many of the previous antidepressants and anti-anxiety medications that I had tried without success, though still more than I could afford to pay out of pocket.

However, much to my doctor’s and my surprise, CDPHP refused to cover my Deplin.  The first time it was rejected, we were told that they had determined there was a cheaper alternative available.  Their “cheaper alternative” was folic acid tablets.  Folic acid that my liver was incapable of breaking down on its own.  I called up CDPHP’s 800 number provided on my denial letter and pleaded my case, explaining the lab results, why I so desperately needed the Deplin covered and why the cheaper alternative would not work for me.  They suggested we resubmit the claim, assuring me that, based on my explanation, it should indeed be covered.

Yet again, the next claim was denied.  I was told that CDPHP does not recognize the results of the genesight test so they could not cover any medication determined necessary based on the results of the test.  My mind was blown.  CDPHP fully covered this lab work being done, yet refused to acknowledge the results of the very test they had paid for.  Because of this, Deplin was considered not medically necessary.  Furthermore, they refused to acknowledge the list of prescriptions to avoid determined by the genesight test as likely to cause moderate to severe interactions.  CDPHP refused to cover the antidepressants deemed safe for me based on my genetics because “other anti-depressants were available”, regardless of the fact that the prescriptions they were referring to were all either on my genesight list of prescriptions to avoid or they had been previously tried with adverse effects.

Meanwhile, I am living off of sample boxes of both my Deplin and my antidepressant.  There is a noticeable difference in the last few months.  My depression is by no means cured but I have an easier time coping, I find myself genuinely smiling sometimes, I have real hope where previously there was none.  Yet, there looms anxiety and stress over my ongoing battle to get my prescriptions covered.  I am currently drafting both an internal and external appeal to get my prescriptions covered, though my doctor, my guardian angel, has informed me there’s little hope for a positive outcome.  He has dealt with this system for years, explaining that the insurance companies and the government work hand in hand and never want to pay for anything more than they absolutely have to pay for, regardless of whether or not it is needed.

I’m honestly at a loss.  I want to hold onto hope because I desperately want to get better.  I want to fight this depression, to heal and have a chance at a semblance of a normal life.  Yet I find myself anxiety-ridden every time my doctor opens his sample drawer, fearful of the day when his sample supply runs out.  I’ve been living off of those sample boxes, six pills, six days to a box, for months now.  I know his supply won’t last forever.  I dread the day when he runs out and I have to go back to that life without hope, drowning in a depression that nothing could touch, all because my insurance company refuses to cover the medication that a test they covered says I need.  I’m battling for my life here.  I’m fighting for my mental health.

 

Status Update 2/2/17:

I was informed this week by my doctor that his supply of samples of Deplin has come to an end.  The news was bittersweet.  As he handed me the last of his supply of the medication I desperately need to treat my mental illness, I calculated that I barely have enough to last another week and a half.  He suggested I try to stretch out the last pills by taking the remainders on alternate days to keep some in my system as long as possible before they run out.  Yesterday was my first day without one and I could honestly feel a distinct difference – less energy and pep, less motivation to even do basic tasks.  I found myself crying more easily and my mind drifting back down into that darkness more easily than it had in months.  I’m genuinely scared.

I consider it bittersweet for two reasons.  The first being the obvious fact that I have finally found something that genuinely helps with my depression.  While it is far from a panacea, the difference is clear and vast.  The end to his supply of samples also means that instead of filing a long, drawn out appeal to have this medication covered, I can file for an expedited appeal, which is decided within 72 hours.

I began the process today.  My first call was to CDPHP itself, to begin the expedited appeal process.  My next call was to Assurex Health, the company that conducted my Genesight test that identified my gene mutation that determined I needed Deplin.  I spent a good hour on the phone with different departments as they suggested everything from reports and information packets to clinical data from their genetic studies to submit for my appeal.  My next call was to Pam Labs, the pharmaceutical company that makes Deplin, who offered to send me whatever information I needed to help fight for drug coverage.

After speaking to both companies, I received a call back from CDPHP’s appeals department to inform me that they received my expedited appeals request and that I will receive a decision by tomorrow afternoon.  The woman I spoke to also claimed that CDPHP never approved nor covered my Genesight test, a claim I found very fishy.  Every single other time CDPHP has denied coverage for anything, not only did my doctor receive a packet explaining their decision to deny coverage, but I was notified, as well, with a decision number in case we decided to dispute it.  Six months after the test was completed, I have received no notification that it was supposedly not covered, nor has my doctor ever mentioned such a thing to me.  I spent over an hour on the phone today with the company that did the testing themselves, as well, and though I spoke directly with the billing department who needed my order number to pull up my test before the lab technicians could speak to me, not a single person at Assurex Health even offhandedly mentioned anything about not being reimbursed for the labwork, nor in the last six months has that lab ever attempted to contact me regarding payment.  I have never been one for conspiracy theories but I cannot help but question the validity of CDPHP’s appeals department claim that they never approved nor paid for the test.

I am thoroughly prepared to fight for my medication to be covered through whatever channels I must in order to get it covered.  It has been recommended, as well, that I contact a local reporter who specializes in stories about health coverage since I already have a relationship with that station after doing a story with them this past fall.  My flight response has always been high but this is one fight I cannot allow myself to run from because my mental health is too important – I must continue my fight for coverage through every and any avenue available until I get the medication I need.

Status Update 2/7/17:

My expedited internal appeal was denied, despite sending CDPHP almost one hundred pages of paperwork, between clinical study data provided by Assurex Labs and multiple articles both about my specific gene mutation and the use of l-methylfolate to treat it when a patient is treatment and medication-resistant.  My next step is to file an expedited external appeal with the state who oversees the healthcare plans.  I am down to five more days of Deplin and have begun trying to space them out, alternating days, in order to keep some in my system for as long as I can.

selfgrowth

Republished on SelfGrowth on 1/13/17.

empowher
Republished on EmpowHER on 1/13/17.

The Mental Illness Epidemic

Mental illness is the gorilla in the room that nobody wants to talk about.  It is that dirty secret that everyone knows but never openly acknowledges, instead whispering about it in dark corners where others cannot hear.  It has become an epidemic of catastrophic proportions, yet it is still regarded with fear because those who have never been there do not understand it and those who are suffering have been beaten down so badly by their inner demons that they often no longer have the will to speak up.

The mentally ill are stigmatized by society and the media to believe there is a great indignity and shame in our diagnosis.  Those with mental illnesses are looked upon as broken, damaged, looney, flawed, crazy and mental.  We have become a joke.  Worse yet, we are seen as dangerous, to ourselves and others.  Regardless of the broad range of mental illnesses, we are all painted with the same broad brush.

It doesn’t matter that mental illness has bona fide physical and genetic causations.  It is an invisible illness.  Since the pain cannot be seen, it is doubted.  We are treated like it must be all in our head.  We are told we should just try to be happy.  We are made out to be drama kings and queens, just looking for attention.  Though no one would dare to accuse a cancer patient of faking their pain or suggest someone with a broken leg just try walking, we’re left afraid to speak out because we don’t want to be judged or be forced to justify our pain worthy of validation.

It does not matter that millions of people suffer from some type of mental illness in their lifetime, with depression and anxiety being at the top of the list.  It doesn’t matter that it affects people all over the world from all walks of life.  Mental illness does not discriminate.  It affects the rich and the poor, people of all races, religions, ages, sexes and sexual orientations.  Even though mental illness is a global crisis, talking about it is still often taboo.

Anyone who doubts the far-reaching impact of mental illness today need only spend five minutes doing internet searches.  Take a look at larger sites that share stories of people faced with mental illness like The Mighty.  Every single day, dozens of new stories are posted by people whose lives have been impacted by mental illness.  Those are just the people who were brave enough to speak out that day and whose stories were chosen to be published.  A drop in the bucket.  Pick any large blogging site, such as this one WordPress, and do a search for “mental illness” or “depression”.  You could spend hours reading page upon page of personal stories and blogs written from the last couple weeks alone by people suffering themselves.  Celebrities are even beginning to come out more and more to say that they, too, are struggling and suffering from their own battles with mental illness.

And yet, those of us suffering still cling to that shame and that fear.  It has become so ingrained into our psyche that we pause each time we go to speak out, weighing the consequences.  Often we minimalize our suffering to avoid judgment or pity.  We don’t want pity.  We want, no we DESERVE applause for living through all that we have, struggling to get up, live and function each day while battling our own minds.

I have been called brave and inspirational for speaking out about my own journey and battles with mental illness.  I honestly feel neither brave nor inspirational.  Those of us who are speaking up are honestly fed up.  We are tired of suffering and struggling every single day.  Even more so, we are tired of seeing others walking that path, as well.  We can spot our own kind.  We know that empty, pained look hidden behind that too tight smile and those encouraging lies that you’re “hanging in there” and are alright.  Our heart goes out to each and every one of our kind we see because we’ve all walked that path and wouldn’t wish it on our worst enemies.

We speak up not thinking that we can change the world but because we are exasperated by it.  We cannot believe that anyone could stand in a field surrounded by landmines, denying their existence even as explosions ring out around them on all sides.  People are dying from this illness.  Lives are lost every single day.  Families are destroyed.  Millions of people are not faking this, hoping for attention.  It is an epidemic of global proportions.

I see stories and comments every day on social media that turn my stomach.  Stories of mothers losing children because they fell through the cracks of the mental healthcare system and died.  The truth is that the mental healthcare system as a whole in this country is broken and flawed.  There are so many people suffering that facilities and agencies do not have the manpower to handle it all.  The laws and regulations surrounding many aspects of mental healthcare are outdated and archaic.  Mental hospitals are overcrowded, understaffed and have become corrals and waystations in many cases, where people are held until other options can be found.  Drugs are being pushed in many cases above therapy and treatment.  People are falling through the cracks.

I see stories about violent crimes being committed by people with a history of mental illness, followed by an outcry about the need to lock up the mentally ill for the safety of all others, and to take away some of our basic rights because of the actions of a select few.  It does not matter that studies have shown that those suffering from mental illness are more likely to be victims of a crime than perpetrators.  The fact that some mentally ill people have been violent apparently means that we are all dangerous, loaded guns just waiting to go off.

I see stories about celebrities killing themselves after losing a lifelong battle with their own minds.  There’s such compassion in those brief moments after a beloved icon has died.  Yet it is fleeting.  It leaves me bewildered because when the average person shares their own struggles, they are faced with judgment and stigma.  If a larger than life entity has suffered, it must be true and it is heartbreaking.  The rest of the populace, however, must be faking it.

I see ignorant comments suggesting that the rise in mental health diagnosis has to do with it’s increased presence in the media, as if people are choosing to be mentally ill because it is trendy.  The truth is that people are hearing more and more about mental illness in the media because more and more people are getting fed up of being lost in the system, fed up of being treated like they are crazy and broken, fed up of struggling and suffering every single day.  We need help.  Society says the squeaky wheel gets the grease so we’re ready to squeak, scream and yell if that’s what it takes to get help.

There is hope, though.  More and more people are speaking up, adding their voices to the collective.  Some celebrities are braving the stigma, as well, hoping their faces and names might bring added attention to the cause.  We are beginning to get organized, to create a unified front and to stand together and fight.  We have a very real chance to make a difference together and to see real change.  We must be diligent, though, and keep speaking out.  Do not fall silent.  Do not give in or give up.  This is a battle worth fighting and one we can win if we maintain our united front.

Enough with the stigma.  Enough with the judgment.  We are tired of suffering, of struggling, of crying out and receiving little to no help.  We are tired of fighting the system and society.  We are your mothers, fathers, sisters, brothers, husbands, wives, children, co-workers, bosses, teachers, classmates and friends.  We are millions strong.  We deserve to be heard.  We deserve to be helped.  We deserve to be healthy.

Whenever there is an epidemic facing even a portion of the world, people rise up in droves to help resolve the situation and help those suffering regain their lives with dignity and compassion.  Mental illness has become an epidemic on a global scale.  Stop pretending it doesn’t exist because you cannot see it.  Look around you.  Truly look.  Look at the tears in our eyes.  Look at the gravestones in our cemeteries.  Mental illness is real.  It needs to be addressed.  We all cannot keep living this way.

selfgrowth

Republished on SelfGrowth on 10/17/16.

mightylogoRepublished on The Mighty on 10/25/16.

helpmindsheal

Republished via The Mighty on Help Minds Heal on 10/26/16.

inner_battle_logo

Republished via The Mighty at The Inner Battle on 11/13/16.

Depression & Genetics

Please note: I don’t often write about the technical side of my treatment because I know that it is a very personal thing and what works for one person may not work for another.  I do not want to appear to be endorsing a specific path for anyone else because I am not a medical professional by any means.  What I am sharing is not a recommendation for anyone else but rather my own personal experiences.  Please talk to your doctor before making any changes in your mental health routine.

——————————

I have had a lifelong struggle with depression, anxiety and ptsd.  Not too long ago, I was asked to write a piece about when I first realized I was suffering from a mental illness.  I honestly just laughed because I cannot remember a time I have not.  Throughout the years, I have tried prescription medications on and off to help balance my moods and alleviate the symptoms.  Again and again, it felt like the doctors were playing whack a mole with my health, randomly trying different drugs in varying strengths and combinations until I was a drugged up mess.  I had pills to wake myself up, pills to drag me throughout the day and pills to put me to sleep.  Each time, I felt like I was becoming a mindless zombie.  Each time, I would take myself off the medications because I would rather endure all my pain than to lose myself completely.

When I recently reached out for help again, I was adamant about my stance on drugs.  I never again wanted to return to that state with horrible side effects and a comatose-type demeanor where every day blended into the next in a drug-induced stupor.  Looking over my medical history, my new doctor could find no rhyme or reason to my long list of past medications prescribed by others.  Instead of prescribing something purely on a hit or miss basis, he opted to send me out for genetic testing through a company called Genesight.

Apparently, there are genetic tests now that can determine which drugs your body will be able to metabolize based on your genes.  This test can also determine which medications are likely to cause side effects and even rank the severity from mild to moderate to severe.  When the test results came back, ironically the majority of the medications previous doctors have put me on were listed under moderate to severe side effects.  No matter how much they increased the dose, they were never going to help me because my body had always been unable to break them down.  My new doctor had done a full panel so now I knew what medications would and would not work in my body.

The most exciting result, however, was not among the medication listings, but on the cover of my packet itself.  According to the lab:

This individual is homozygous for the T allele of the C677T polymorphism in the MTHFR gene.  This genotype is associated with significantly reduced folic acid metabolism, significantly decreased serum folate levels, and significantly increased homocysteine levels.

In layman’s terms, it means I have a gene abnormality that affects my liver’s ability to break down folic acid.  In normal, healthy livers, folic acid is broken down into a compound called L-methylfolate.  L-methylfolate is used by the brain to regulate the hormones associated with emotions.  Without that compound present in my brain, it would be near impossible to thoroughly treat my depression and my own body was incapable of producing it in any meaningful quantity.

It turns out that genetic test was a godsend.  Normal lab tests would not pick this up.  A blood test would show the levels of folic acid in my blood and doctors would infer my levels must be fine, not realizing that my liver was incapable of processing it.  Only by looking at the genetic level could they see that my liver was not able to convert any of that folic acid into anything useful.

What makes this an even bigger deal is that a pharmaceutical company has found a way to break down folic acid into L-methylfolate and put it in pill form.  Getting what my brain needs and my body has never been able to provide will be as simple as having a prescription written.  I honestly felt excited.

My doctor was very clear that this is just a big first step, not a cure-all.  This prescription is by no means a panacea.  It, however, is a stepping stone.  It means that antidepressants will finally be able to work because the L-methylfolate will be able to help get them where they are needed.  It means that if my brain actually attempts to regulate my own moods, there is at least a very real possibility of success where previously there was absolutely none.

I took my first pill yesterday and admittedly felt a noticeable difference right out of the gate.  I had more energy and a greater sense of calm.  The depression is by no means gone or even diminished but the fact that I felt anything noteworthy at all on the very first day was enormous for me.  For the first time in a long time, I truthfully am hopeful when it comes to my medication.