Posted by JohnL on February 28, 2000, at 5:01:21
In reply to The results of following advice..., posted by janet on February 27, 2000, at 21:28:18
I find that when I print out my research for the pdoc to read in black and white, it makes my case much stronger. It's hard for the pdoc to argue against what other physician's are having success with. Dr Bob's Tips are loaded with printable ammunition to support your case. Look up stimulants in 'Tips', print out what you find. I also print testimonials of patient success stories. WayneR and Naltrexone for example. There are other testimonials here of stimulant success stories.I think it's worth noting that suggestions and advice on this board are sometimes helpful, but sometimes not. It's ultimately up to the patient and the doc to weigh pros and cons. Each patient has unique chemistry. What works for one won't work for another. But I find it helpful to accept advice from others, especially when I'm up against a dead-end. It never ceases to amaze me that there was something else I hadn't thought of. Advice and suggestions give me hope. Many times simply having hope restored is the magic link that allows me to get through another day when it otherwise seemed impossible.
Too often I think many pdocs become entrenched in treating depression with antidepressants. They think too much in terms of symptoms and diagnosis, but not enough in terms of understanding the unique underlying chemical imbalance of the patient. What those pdocs fail to realize is that the depression might not have anything to do with low serotonin. Identical symptoms can be caused by a variety of chemical imbalances, some of which have nothing at all to do with serotonin. My pdoc explained to me how stimulants closely resemble NE/dopamine in molecular structure, and he thus views stimulant treatment as NE/dopamine replacement. That's how the body interprets it. He explained how Tegretal closely resembles the tricyclics. If someone does poorly on a tricyclic, he can predict fairly that Tegretal would not be a good match for that patient.
In the old days we had few drugs to choose from, and thus it became reality to wait 6 weeks for a trickle down effect. Today we have many choices to more directly target the unique chemistry of each patient. The purpose of quick trials is to identify superior matches in a drug class and to weed out inferior ones. Once the superior drug has been found, then we can continue with a longer trial. We want to be sure the patient is on the best match within a drug class. The best match makes itself known by quick response and minimal side effects. The body likes it at a molecular level.
We've seen patients experience profound improvement in a short amount of time. Clearly their drug was on target. We've seen people get well in longer trials. Clearly their med was off target, working indirectly through a trickle down process. Rarely do we see someone who has a minimal improvement in the first couple weeks get a miraculous improvement at 6 weeks. It happens, but not very often. If the drug is off target, it can still work, but not as well and not as fast as one that is on target. Quick trials allow us to weed out inferior matches before committing to longer trials.
Sorry to go so long here. Basically I just wanted to reiterate that stimulants do have a valid role in treating depression, as they have since even before the first antidepressants were invented, and that printing out research helps me make my case to my pdoc. He can doubt me, but it's a lot harder to doubt dozens of other physicians in black and white. JohnL
poster:JohnL
thread:24453
URL: http://www.dr-bob.org/babble/20000220/msgs/24536.html