Posted by JohnL on December 4, 2000, at 4:47:19
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
Shar,
Believe me, I know right down to the core exactly how you feel. Every emotion, confusion and frustration you're dealing with I have lived with every moment of every day for what seems like an eternity. The good news is that there is an answer. There is a drug(s) that will work. No ifs, and, or buts about it. One must grasp this truth with blind faith and set into motion an organized strategy to find what drug it might be.I too had a psychiatrist for a short while just like the one you just saw. Not very encouraging. It amazes me how some doctors can go through a decade of grueling study and dedication and yet end up displaying such impotence and lack of confidence at ending one's suffering.
Like most any psychiatric condition, dysthymia has a root cause. There is a chemical imbalance; or dysfunctional receptors that aren't working properly; or an electrical or chemical instability. A wide variety of underlying problems could cause your symptoms. The trick is to target that problem head-on. The trick is to find the drug that will do that, since we don't know in advance what the underlying problem is.
Of course it is more complicated than this, but basically one can categorize chemistry problems into groups. These include low serotonin, low or elevated noradrenaline, low or elevated dopamine, low GABA, noradrenaline/dopamiine failure (neuro levels are fine, but receptors aren't working right), chemical instability, and electrical instability. There are a handful of drugs appropriate for each chemistry.
To this point your treatment has primarily been restricted to neuro reputake inhibition of serotonin and/or NE and/or dopamine and GABA. This approach would work if the levels of these neuros were low. Since they aren't helping you much, there's a good chance the underlying problem doesn't have much to do with low neuro levels. There's probably something else going on. Though this is overly simplified, I think that when three drugs of similar mechanisms have failed, then it becomes a high priority to try drugs of different mechanisms.
What if it's a dopamine/NE/serotonin problem, and yet increasing their levels doesn't help? Then perhaps a different approach would include things like Zyprexa, Risperdal, Remeron, Amisulpride, which stimulate or modulate these neuros instead of preventing their reuptake. If it's chemical instability, Lithium. If it's electrical instability, then Depakote or Tegretol. If it's dopamine/NE failure, then Ritalin, Adderal, Adrafinil, or Modafinil.
It makes sense to try a couple drugs from each class. For example, try Zyprexa for a couple weeks, then Risperdal for a couple weeks. Try Ritalin for a week, then Adderall for a week. Lithium, Depakote, and Tegretol for about two weeks each. Clearly none of these will provide a total cure in that short time, but if one is to be a promising candidate for a longer trial it will likely give you some kind of hint within a couple weeks. When all is said and done, you can then return to the ones you liked for longer trials and tweeking.
The above process led me to Amisulpride+Adrafinil, which have nearly completely wiped out my longstanding dysthymia and anhedonia, which I had thought was untreatable (since I had failed so many more common drugs like SSRIs and Wellbutrin). So really, there is an answer, but one needs an organized 'probing' strategy to identify superior drugs for you. Obviously that will involve a doctor who is willing to do the same. If your doc says two weeks isn't long enough, say, "I know. I want to see what it can do in two weeks. If it's going to be good for me, I'll know fairly quickly. We have nothing to lose and everything to gain. Please cooperate with me on this." The whole process is to do two things: 1)treat all the different possible chemistry problems, knowing that with one of them we'll hit a bullseye; 2)find which drug in each class is preferred by your unique body and chemistry.
Hang in there. Someone once told me there are two ways to do things. One can work smart, or one can work hard. Develop a plan, a strategy, to probe different drugs and different chemistries. That's working smart. It increases the odds you will find a good drug in less than 6 months, versus the path you're on which will be a lot of work and may never yield a good drug ever.
Johnps...the drugs you are currently taking could confuse results. You might have to reduce or stop them so you can tell what a new drug is doing. I once tried Amisulpride and Adrafinil while I was also taking a normal dose of Prozac. The Prozac sort of numbed the good parts of the other drugs, so I couldn't really feel how well they were actually working. When I reduced Prozac, the other drugs began to shine through. It's hard to tell what a new drug will do if it is either drowned out or numbed by high doses of a current drug. If the current drugs aren't helping that much any way, I don't see much sense in continuing with them. If they help a little, then a reduced dosage could work just as well and sometimes even better (less numbing).
poster:JohnL
thread:49856
URL: http://www.dr-bob.org/babble/20001130/msgs/49880.html