Posted by JohnL on January 10, 2001, at 18:01:13
In reply to Re: Stuff., posted by JahL on January 10, 2001, at 16:50:14
> > 2. My doc, at the signs of 1-2 SSRI non-response will go to multi-drug therapies blanketing what the failed drugs do not affect, and to a high dose in order to elicit the fastest response. The components with intolerable or undesireable side effects as noted while titrating up can be dropped or substituted. Provided a response occurs, eliminating non-contributing drugs (usually starting with the one's least tolerated) then reducing dosage can be done until response declines. Shoot first and ask questions later when finesse' fails.
>
> I like this approach if the patient is informed & consensenting. Particularly if, as in my case, only meds will provide relief from a lifetime of chronic depression (& there are no 'issues' involved).
>
> I only wish this sort of approach (where appropriate) was practised more widely over here in Britain. There's just NO sense of urgency.
>
> Jah.Yeah Jah, it's not just Britain, but everywhere. I don't understand the complacency of phsycians when dealing with depressed patients. I mean, here take this and hopefully you'll feel better in 6 weeks. What?!? Six weeks? Six hours is long enough, six days seems like an eternity, but six weeks? And it might not even work? You're kidding me, right? Geez. Yikes.
Seriously, 1 out of 10 depressed patients take their own lives. 10%. That doesn't sound too too bad. But 10% is 10 out of 100 people. Or how about 100 out of 1000 people. Yowee. Now it's looking serious. Depression is so bad people literally kill themselves on purpose. Second only to car accidents it is a leading cause of death for teens and early twenties. Depression is major serious stuff and I feel doctors and psychiatrists approach it way too lightly. I've only had the good fortune of knowing two who were very aggressive. With one, if a med didn't show promise in 5 days, forget it. Move on. With the other, his window was in the 2 to 4 week range. Both were very aware that without showing aggressiveness in my treatment, the next time they saw me might be on the obituary page.
And of course chronic depressions like yours and mine are just as harmful, ending lives, ending marriages, ending careers, destroying finances, stopping all progress in life, on and on. Serious stuff that can't wait.
I wish all doctors would attack depression with vigor and a sense of urgency. Because after all, it is an urgent situation. Lots of things have been shown to speed the onset of antidepressants, including benzos and stimulants. I think patients would be much better started off on day one with both an antidepressant and small safe sample packet of Ritalin as well as a small safe sample packet of Xanax. They could take whatever helps them feel better quickest, as needed. Meanwhile, when the antidepressant starts to kick in, then they can withdraw or modify the other drugs. In any case, every possible trick in the book should be used right from day one, in my opinion, not just after someone has been disappointed with one or more drug trials. After all, a hundred out of a thousand of those people are going to be six feet underground by then.
I like the way Mark phrased it, shoot first and ask questions later, something like that.
John
poster:JohnL
thread:51307
URL: http://www.dr-bob.org/babble/20001231/msgs/51395.html