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Bidding Goodbye to the Patch

Posted by Adam on March 16, 2000, at 19:41:06

Well, all good things must come to an end, as they say.

Roughly six months ago I entered into a clinical trial testing transdermal selegiline hydrochloride as an antidepressant therapy. For me, it was a huge success. I meant I could take an MAOI at a dose that inhibited both isoforms of MAO without having to adhere to any dietary restrictions. It also meant, in all probability, fewer side effects than would be felt than with the drug taken orally, since first-pass metabolism to l-methamphetamine and l-amphetamine was largely eliminated.

The study ended yesterday, and now I must get used to a few changes, and am somewhat uncertain of what will happen next.

It was my hope that I could continue to see the doctor who oversaw me during my participation in the study. My insurance company won't allow that, though, since he isn't in "the plan" under any circumstances, so I have to find a new doc, and fast. I had a psychopharmacologist before I entered the study, but he is uncomfortable taking me back. His official reasoning is he has no experience with selegiline, and is uncomfortable prescribing it. My suspicion is that, since I made the decision to enter the study without first consulting him, thus irritating him and my psychotherapist, he views me as non-compliant and would prefer not to work with me any longer. Others, who shall remain unnamed, share this suspicion as well. Such is life. Chances are I will get into the outpatient clinic at McLean hospital until next December, when it's "Open Season" and I can get into a plan that is bit more flexible.

Be that as it may, my other concern is weather or not my plan (Tufts PPO, for those curious) will go for the idea of me on selegiline at all. They have thus far been so uncooperative, I would not be the least suprised to be told that I will not be insured for upwards of 60mg/day selegiline, since this is an off-label use of the drug and a massively larger dose than the FDA-approved indication of Parkinson's Disease. It's interesting, because, say it cost them about $8,000 a year to keep me on selegiline (not an unreasonable figure, unfortunately), that's still way less than it cost them to keep me in the hospital getting ECT and loads of group therapy ($125/session/patient, and who knows what ECT costs/treatment, not to mention the $20 aspirins and mashed potatoes, etc.). If selegiline worked for me so wonderfully, you would think a simple cost-benefit analysis would bring them to the conclusion that, hey, it's cheaper for us to help this guy out than have him wind up in the hospital again, so why not?

What I have learned about managed care is that even such intelligent decisions based on financials are beyond some administrators, and forget about's the bottom line, folks.

Luckily, the doctors in the study are wonderful people, have assured me they will not leave me dangling, and will make sure I'm all set up and stable, pro bono if necessary. That's what this world needs, you know? People like that, who actually care. So I'm not too worried, though I must admit the future does scare me a little.

For those who are curious, I'll relate my insurance stories, as well as how well I am adjusting to oral selegiline, if that becomes available. I'm paying out-of-pocket right now for a relatively low dose (15mg/day) which the head of the study, suprisingly to me, won't rule out as an adequate dose for my depression. If that's the case, dietary restrictions, or even drug restrictions, are something of a judgement call, though I don't think I'm going to do anything like go out and take ecstacy just to see what happens. The first sign of depression, though, and I'm upping the dose or heading for tranylcypromine, if need be. No fooling around any more, if I can help it.





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