What’s a doctor to do without acamprosate? Drama and irony, alcoholism and manic-depression, and strength versus resilience


When you stop to add up the score

My day is never a bore.

    It was my impression

    That manic-depression

Affected patients one out of four.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  On sabbatical and back from the brink of burnout, while my one-year non-compete clause ticks away I’m having adventures and working in out-of-the-way places.  Currently I’m finishing an assignment in Matakana and Wellsford, north of Auckland, on the North Island of New Zealand.

I have a touchstone question to diagnose bipolar disease, which used to be called manic-depression.  I ask, “Have you ever had an episode lasting at least four days during which you felt great, got a lot done, slept less than four hours a night and didn’t miss the sleep?”

I find the disease equally common, under-diagnosed, and hard to treat.  Those affected tend to reject medication, because doing away with their depression means doing away with their euphoria; people don’t want to exorcise the devil if it means they can’t dance with the angel.

Doctors talking amongst themselves will shake their heads and talk about the co-morbidities of bipolarity, especially alcoholism, drug abuse, and schizophrenia.

Alcoholism romping through a family by itself causes enough damage, linking it to Richter-scale mood swings shatters family structures and warps children’s personalities.

One quarter of the patients I cared for today came to me because of the direct or indirect effects of bipolar illness.  If you want to understand something, you have to understand its context; though one patient at a time has an appointment, each exists in a family.  The best treatment I can recommend frequently comes down to Alcoholics Anonymous, Alanon, and Alateen.

“Strong” children, the ones who can hold a family together before the age of fourteen, alarm me because strength acquired early comes at the expense of resilience.  Those children who take on the super-responsibility of keeping things together in the face of chaos in later life tend to snap rather than bounce back from life’s inevitable traumas.

Until recently, AA stood as the best, most-tested treatment for alcoholism.  In the US, Campral (acamprosate) has shown itself safe and effective for a number of addictive disorders, including gambling.  Best if used with a support group like Alcoholics Anonymous, it established itself as the drug of choice.  It does not exist in New Zealand, and I had to discuss that with more than one patient.

The absence of Campral as a therapeutic alternative constitutes my sole disagreement with New Zealand’s formulary.

I cannot recommend people get the medication outside the country, and Internet pharmacies are notorious for inaccuracies and counterfeits; I do not know of a single reliable one.  Yet I found myself listening to my patients talk, and saying that I couldn’t imagine a jury convicting someone for trying to bring Campral in illegally.

Throughout the morning I watched the agony caused by self-destructive behavior, dramatic in a family member and ironic in the patient.

But I had energy left over when I finished my clinic; my schedule permitted me enough time to talk with patients.  I drove away with Bethany in the afternoon to visit the Kauri Museum, dedicated to the spectacular tree that dominated the north part of New Zealand before logging destroyed the forests.

I’m working on my resilience.

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3 Responses to “What’s a doctor to do without acamprosate? Drama and irony, alcoholism and manic-depression, and strength versus resilience”

  1. milwaukee psychiatrist Says:

    milwaukee psychiatrist…

    […]What’s a doctor to do without acamprosate? Drama and irony, alcoholism and manic-depression, and strength versus resilience « Walkaboutdoc's Blog[…]…

  2. jeannie Says:

    Hi there. I understand your frustration.I am curious about anything that is availableto help with addictive disease. I wondered if you were aware that the majority of alcoholics present to their gpswith depressionThey are often prescribed antidepressants but continue drinking. I had 15 uears of really good recovery however in 2010 alot of awful things happened and i pickedup that obe drink. What a nightmare. I came to Auckland to a rehab and while here my marriagr dissolved. I relocated leaving son with his dad. It broke my heart but i had lost legal custody of him. Another consequence. During my journey i have relapsed 6 timesthe last time i was in a pschiatric hospital for three months. I am nearlt a year sober and i take antabuse daily. I haf seizures with naltrexone so it is no longer n option. Antabuse is ok but it doesnt always stop the demons visiting. I dont want an easy fix….i have tried that but drinking scares me so much.Do you know if this medication is distributed in Australia?. I would be most intetested. Good luck with your work. It sounds very interesting. Cheers Jeannie

    • walkaboutdoc Says:

      Jeannie:

      Most successful treatments involve both pills and skills. Certainly with alcoholism 12 step programs stand as the best trainers of skills, and in my experience Campral is the best of the pills. Alternatives to Campral include naltrexone in the form of Revia, an injection that lasts a month, but you had a negative experience with it. Which brings us to Topamax (topiramate); it’s a medication approved by the FDA for seizures and migraines. The most common side effect is weight loss, and I prescribe it for that reason from time to time. But I have seen a good number of folk lose interest in not only alcohol but tobacco with it. For those who binge drink or binge eat it seems to work, but it’s not 100%. Seizure medication tend to help bipolar illness, and I suspect that might be one of your problems.

      I do believe acamprosate is distributed in Australia.

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