Posted by Sean on February 9, 2000, at 12:02:34
In reply to Re: Mood stabilizers for Unipolar Depression, posted by JohnL on February 9, 2000, at 5:13:38
> Karen,
>
> I think a flaw in general psychiatry is the assumption that an antidepressant should fix depression. And that if one doesn't, another will. This just isn't so in some cases, as I understand it. The reason is because there are many different malfunctions that can cause depression, just as there are many different things that can cause diarrhea, right? Antidepressants won't always target whatever problem is causing the depressive symptoms. And thus multiple failures on antidpressants.
>
> I know a woman who finally found total cure on just Depakote, after failing just about every other drug for 20 years. Ironically, Depakote can make a significant number of other people more depressed. A regular poster we used to see here a lot found total cure with Naltrexone, after decades of failing everything else including ECT. I know a woman who experienced total cure on her very first day of Wellbutrin. As I've said in other posts, and I have come to believe strongly, it all depends on how a particular drug target's the person's unique underlying problem.
>
> The farther a drug is away from targeting the problem, the longer it will take to have a trickle down effect and work, if it ever works at all. The closer the drug, the faster the results with fewer side effects. It is common to get worse on the wrong drug. It would seem apparent with you that raising serotonin and/or norepinephrine does not target the underlying problem. If it did, you would have responded to an AD by now.
>
> So looking at the mood stabilizers makes logical sense. Maybe one of those will target the underlying problem that so far has been missed. But I think there are even better choices for you at this point. It doesn't matter what the actual diagnosis of symptoms is. Some people with unipolar depression for example have found total cure with Lamictal, which is used in epilepsy and bipolar. I believe medication reactions provide important clues to guide treatment. The clues your history suggest are to stay away from antidepressants and focus instead on other psychiatric drug classes.
>
> You sound like a classic case of someone who would respond nicely to a psychostimulant, the same drugs used in ADD or ADHD. Even if you have no symptoms at all of ADD or ADHD, you fit the profile very nicely of someone who will respond to a stimulant. If so, the underlying problem would be NE/dopamine failure, which no antidepressant will fix. But a stimulant will. Like all drugs, if one isn't a best fit, another likely will be. Sometimes stimulants overcompensate and require a small dose of an antipsychotic as well to counterbalance. But doesn't it make sense that if all those antidepressants didn't work, we're barking up the wrong tree? The answer might be something as simple as a child's dose of Ritalin with a tiny dose of Zyprexa. Simple and fast. If a stimulant is going to work, it will do so in 24 to 72 hours. No long wait to find out. They will quickly replace or mimic the failed brain chemicals.
>
> If you respond negatively or neutrally to several stimulant trials, then the mood stabilizers would be the next logical place to look. In your shoes (actually I AM in your shoes) I think the stimulant class should be at the top of your priority list. No ADD or ADHD symptoms needed. With a history almost identical to yours, I responded robustly to Ritalin. Now I just need to explore the alternatives in that class to find a best fit and fine-tune dosing. Stimulants first, with a possible tiny adjunctive dose of an antipsychotic. Mood stabilizers second. That's what I would do if I were you. To hell with the antidepressants. You already know all to well they don't work for you. There are important clues in all those antidepressant failures. JohnLAgreed. There are simply too many pathways capable
of producing the common symptomology of depression
to classify treatments and diagnoses into rigid categories.I think the unipolar/bipolar dichotmoy is oversold.
Kraepelin and many of the early psychiatrists noted
the recurrent nature of "unipolar" depression and
considered it a variant of manic depression. My guess
is that we will eventually tease out pure unipolar
from bipolar, but at least 50% of unipolar people
will be in the bipolar spectrum. For these people,
antidepressants are probably not a good idea and
the treatment of choice will be a mood stabilizer.Speaking of which, my experience with Neurontin
has been good in this respect...I say go for it.
poster:Sean
thread:20861
URL: http://www.dr-bob.org/babble/20000209/msgs/20914.html