Posted by JohnL on February 26, 2000, at 4:35:23
In reply to To JohnL, posted by medlib on February 25, 2000, at 20:57:43
> JohnL-
> I really like the idea of your "bang-bang-bang" approach to new Rx initiation and would like very much to take some documentation to my pdoc next week that might convince him to try it with me. Waiting a month between mistakes is the PITS! Do you have any citations you could share with me? I would search Medline myself, but I can't think what to call such an approach. It doesn't correspond to any MeSH term, that's for sure. Any help would be much appreciated.
> Thanks!
> medlibMedlib, we won't find any documentation on this method. It is a rather new approach. It is being taught in several medical schools however. There are some basic assumptions to this method:
1. The drug that most closely targets the underlying chemical imbalance will produce results fast, often the very first day, or within a week. The doctor I'm seeing is having tremendous success. Six week trials do not occur in his practice, except in rare cases where this method doesn't work and he must revert back to traditional psychiatry. He is getting excellent results with nearly all patients in a maximum of 8 visits. No stone is left unturned.
2. Patients often have a favorite drug within a class of drugs, and this allows comparison of each before committing to any one of them. Superior matches are found, inferior matches are weeded out. The doc routinely expects and gets 4 day responses. It's an organized way of probing for that magic molecule.
3. This approach looks for a bullseye, and tries to avoid the typical time consuming trickle down effect that may or may not ever happen. The longer the wait, the farther the drug is from the real problem.
4. Drugs from different classes often work better than the ones we expect to work (again, depending on the unknown underlying chemical problem), and this method probes all possibilities.
5. Drug reactions, whether good or bad, provide clues as to what the underlying chemical imbalance(s) are.
6. This method is not appropriate for someone who is in the midst of suicidal depression or psychosis. The patient must be somewhat stable to probe different drugs quickly.
7. In case of bad reactions, either Xanax and/or Stelazine are given to the patient as antidotes. Negative reactions are discontinued immediately.
8. A psychiatrist in California has published a book on this approach, called "The Successful Treatment of Brain Chemical Imbalance". It can be reviewed at www.drjensen.com. I was, at first, this book's strongest critic.We are so deeply entrenched in the traditional theories of 6 week trials that it's hard to accept new possibilites. Again, no one objected to this approach more than me. But now that I have a real life doctor who uses this approach with incredible success, I find it nearly impossible to blow any holes in the theory. In the old days we only had a limited number of drugs and often had to wait for a trickle down effect. Nowadays there are so many more choices, of which one will likely target the underlying chemical imblance more directly. It's very hard to accept at first, but when the magic molecule is discovered, long trials become archaic.
When the bangbangbang approach fails (VERY rare), reverting back to traditional 6 week trials and/or MAOIs is the next step. But that hardly ever happens. Somewhere in the quick trials the magic molecule is found. It just takes an open mind on the part of the doc and the patient to probe all possibilities in short order. The ultimate goal is getting the patient well in the shortest amount of time.
Following this post, I'll submit another post of what my pdoc wrote to my family doc about me. It is a real life realtime example of this approach in action. JohnL
poster:JohnL
thread:23875
URL: http://www.dr-bob.org/babble/20000220/msgs/23974.html