Posted by JohnL on February 12, 2000, at 5:05:20
In reply to Bad solutions, posted by Carolyn on February 11, 2000, at 17:54:47
> I have been moderately depressed for about two months.
> It seems to be getting worse, rather than better. I think I am suffering from SSRI poop-out, but so far my doctor has just tried higher doses of same med (which did work for several years) and the addition of klonipin. In previous depressive episodes I have cut myself, and resorted to alcohol. Now I am having these same urges. Can anyone give me tips on how to deal with that until I am feeling better? Just don't doesn't help. Thanks!
Hi Carolyn. I just wanted to say that I agree with everyone else so far that it is time to communicate thoroughly with the doctor and to try another drug. The typical approach is to prescribe you a different drug from the SSRI class for a 6 week trial. A more novel approach is to try two or three quickly (rather than the drawn-out 6 week trials) to find a best fit. Very often we all have a favorite within the SSRI class. A favorite is recognized by: quick response (often in just days if it is hitting bullseye), few side effects, and a general feeling that we instinctively know it's the right one (again, related to good quick response). The longer it takes and the worse the side effects, the farther we are from targeting the underlying chemical imbalance.One SSRI may work wonders while the others didn't. A long trickle down effect is common when the drug isn't a best fit. It may work in time, or maybe never at all. But the best-fit-drug will usually work fast. You'll know it when it happens. With this in mind, you might try to sell your doc on the idea of trying each of two or three other SSRIs (including Effexor) for two weeks each, with a day or two washout inbetween. Get small sample prescriptions for three. The idea is to find the best fit as quickly as possible. Once a best fit has been found, then we can continue with increased time and dose. The best fit is usually obvious within days. If response in two weeks is neutral or negative, move to the next one. Even if response is good, another might be even better. After trying them all, go back to your favorite. Start with the shortest half-life drug first (Effexor) and go from there. This is a different approach than most doctors practice, but it makes perfect sense to me to look for that best fit before committing to longer term trials. Just a different way to get to the same end result, except a lot faster. In the event that none of the SSRIs are helpful, then the same procedure can be done in other classes of psychiatric drugs. A best fit does indeed exist. You'll know it quickly when it's found. I'm on the sidelines cheering for ya. Hang in there. JohnL
poster:JohnL
thread:21180
URL: http://www.dr-bob.org/babble/20000209/msgs/21246.html