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“Hey doc, I’ll have mine on the rocks with a twist of lime …”

by Andy Behrman

27th April 2004

There have been so many times, in sessions with my psychiatrist, that I've wondered, "Hey, why not throw in a twist of lime; I'm on every other damn medication in the pharmacy - or on the entire planet for that matter."
And that little dark green sliver of lime does pay homage to the fact that most psychiatrists (and psychiatric patients) refer to their combinations of medications (or 'meds' for short) - whether they be anti-depressants, anti-psychotics or mood stabilizers - as 'cocktails'. It's common terminology, albeit a bit cynical and disparaging to the field of psychopharmacology, and I don't know anyone who doesn't know anyone who doesn't call their 'medication regime' by the term 'cocktail'.

I was at a cocktail party (there's that annoying word again) in Los Angeles about a month ago, talking about what seems to be the illness of the decade, manic depression, (which also happens to be mine). Someone came right up to me and asked, "So, what 'cocktail' are you on?" This brings up an entirely different issue about the appropriateness of asking complete strangers at a social function about their medication. But let's put that point aside for the time being.

I made the decision to confront the question directly, responding openly and honestly by telling the questioner (a dead ringer for Johnny Depp) that I was on the 'Hollywood Cocktail'. The Johnny Depp look-alike looked surprised.

"What's in the Hollywood Cocktail?" he asked, with an extremely curious look.

"It's Depakote, Topamax, Geodon, Klonopin and Sonata," I responded, sputtering off a long list of 'meds'.
He looked at me like I was ingesting enough pills and capsules to sedate all of Tinseltown. Little did he know that over the years I had tried more than forty-five different medications to control my manic depression and side effects, and that during some periods I took more than twelve medications at once - sometimes totalling more than thirty pills and capsules throughout the day. Yes, I was a human guinea pig. My own doctor didn't even know exactly what drug was doing what for me and what wasn't. So I was right - it was all guess work after all. But the cocktail was working, and wasn't that all that mattered anyhow?

And that's why psychopharmacology really is - guess work. It's one of those weird sciences (I don't really even consider it a science - it's more like a hobby, like stamp collecting or knitting, except you need a degree and a license to practice it) where I imagine doctors wearing white lab coats, white caps and protective booties while mixing pills and potions. You're in a huge laboratory and there's steam coming out of all kinds of glass flasks and the doctors are feeding these concoctions to innocent rats and rabbits, and teams of scientists are observing their behaviour and taking copious notes while the animals spin around their treadmills. Psychopharmacology is not an exact science at all. Sometimes I fantasize it's much like Italian cooking - some extra spices thrown in here, a splash of wine there. Let's just see how the rats and rabbits like that. It's embarrassing to say, but I got my own doctor to admit that psychopharmacology is a tiny bit like decorating and a lot like bartending.

Let me explain. A decorator chooses paint colours for the walls and fabrics for the couch and chairs, and gets a feel for how his client will feel living in this space. Will the inhabitant feel cosy or too cold? Is the room too uptight? Then the decorator can make changes - he can 'warm up' the paint colour, add some fabrics or some pillows or some antiques to give a different feel to the room. So, ultimately, the 'patient' will be able to live in comfort. A bartender, too, has to get a sense of what his customer wants. Does he just want to drink a few beers through the night and get 'toasted', or does he want to get blasted within the first hour with a strong few shots of a good Mexican tequila?
I've been on my cocktail for about two years and have been relatively even-keeled. Last week, my new doctor thought he'd tinker with the cocktail and upped the dosage of one of my mood stabilizers. In two days, the new mixture had knocked me flat on my ass - almost as if I had downed a whole bottle of gin in one sitting. I couldn't get out of bed. let alone form sentences. Like the old days of being sedated and coming out of recovery after electroshock, I got him on the phone and slurred to him about my need to quickly come off the dosage. I was perfectly happy with my little 'night-cap' and I was going to be the one to make the decision this time.

"I'll have another cocktail," is a common line you'll hear in a bar. But it's also one you'll hear around a psychiatrist's office, because psychopharmacology is a science of trial and error and it takes quite a few attempts to find the right combination of 'meds' - the right cocktail to stabilize people with psychiatric illnesses. In my case, it took nearly seven years to stabilize my manic depression, and by the time we had dealt with that successfully we had a new issue to deal with - an illness referred to as schizoaffective disorder, which required finding the right anti-psychotic that wouldn't leave me with crazy side effects such as shuffling feet and twitching.

But I've finally found my cocktail. I take it once a night, and it's paid for by the American government - that's probably a bigger feat than actually finding the right cocktail. But that's a huge issue. We can talk about that over a drink.
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