Posted by Lorraine on August 24, 2001, at 22:27:02
In reply to Re: martin jensen book - Elizabeth, Lorraine, others?, posted by JohnL on August 24, 2001, at 18:54:12
> > >[John] I like his book a lot. The strategies in it were what saved me from a 10 year stay in a depression dungeon.
Right. The problem with sequential long term trials is that if you are treatment resistent, it could be 25 years before you hit the right combo. If you look at Preskorn's column "Do you feel lucky" (www.preskorn.com/columns/9801.html), he does the math using 600 possible drugs in combinations of 2, 3, 4 and 5. The odds of hitting the right combo is 1 in 179,000; 1 in 35,820,200; 1 in 5,346,164,850 and 1 in 637,262,850,120. My thought when I read this was, well why is he using a universe of 600 drugs? I mean I have eliminated certain classes of drugs (SSRI's) by this time and why not just look at the big players. So I took my remaining drugs to try short list drawing from the categories of stimulants, MAOs and Anticonvulsants. I came up with a list of say 18 drugs to try in various combos (hey, this is already much better than 600, right?). Then I eliminated those drugs on the list that I had already tried unsuccessfully. Now my list is down to 10 drugs to try in various combos--not too many right? Ok, but when you crank out the math, my odds using a two drug combo are 1 in 45 and using a three drug combo are 1 in 240. Well, you get the drift, we could be going through trials a long long long long time if we do "adequate" trials. There is a fallacy in this thinking, but I think it is small. The fallacy is that once you eliminate a drug b/c of side effects, you don't need to include it in combos and Preskorn's formula (which is pure statistics) does not take this into account. However, my use of just 10 drugs is surely too small as well so it all evens out in the wash.
My experience has not been that us treatment resistent folks need longer trials--my n of 1 doesn't--and, frankly, I don't have the life to waste doing my trials "adequately".
Nor do I believe that there is a true or accurate method to the madness of prescribing these drugs. Everyone is throwing darts from what I see. They have to be because we do not know enough now to determine with any degree of accuracy which drugs will work with which people. Different pdocs have theories--some seem more plausible than others--but, really, this prescribing stuff is still at the "art" stage.
[John wrote:]
> > > Both my GP and my psychiatrist found many valid points in Jensen's methods, and some debateable ones too. But like most anything else, it is not a bible. Instead I think it is better used to help one lay out their own unique roadmap. It provides strategy and organization, where otherwise there is not enough of that.This is my point as well. At this juncture in the road, any organizational approach is extremely useful. We like to pooh-pooh new ideas as not backed by enough research or science, but, let's face it, by the time they are we will all be long dead and turning in our graves. The only currency that I have to spend is my time.
> [John wrote:]
> His methods led me through quick trials of the SSRIs I had not yet tried. Then his method had me run through the stimulants. For the first time in my life, I found a hint of something that could work.I have not been using Jensen per se nor have I shared his book with my pdoc. What I have done though is speed up my trials with a pdoc that understands the desirability of doing that. Stimulants and benzos take one or two days to know if they work, if they have bad side effects etc. My experience with mood stabilizers led me to quickly determine whether there was a prayer of hope in them or not quite quickly (5 days to 2 weeks). The MAOs take more time and require a washout between trials. Still, I'm not inclined to give a drug that is not making me feel better pretty quickly an extended trial--life is too short.
> > > [John wrote:] Still though, at least now I knew which drugs worked best. My favorite of the SSRIs was Prozac. It helped. So I voted it in. My favorite stimulant was Adrafinil. It was great, especially with Prozac, so I voted it in. My favorite AP was Zyprexa. It was in. And thus my three way cocktail of minimum doses and I feel better than I ever have in my entire life.Good for you John. You decided to try something different and it worked for you. I'm glad.
> > > It was Jensen's book that made it all happen. I would probably still be stuck back in SSRI land with no hope in sight and a bunch of doctors shrugging their shoulders, if not for the book to give some direction and strategy to the whole thing.
His book made me think differently as well.
> > > I do not agree with his 5 day trial thing though. Personally I think it should be 2 weeks, maybe 3 max. That's what I did. One new drug every two weeks, and then I could go back and choose my favorites. It worked like a charm.Like I said above, I think it depends on the drug. Quick acting drugs can have shorter trials than longer acting drugs.
Lorraine
P.S. by the way, John, it was your earlier posts that caused me to buy his book in the first place and decide for myself notwithstanding the controversy surrounding his methods.
poster:Lorraine
thread:76220
URL: http://www.dr-bob.org/babble/20010822/msgs/76301.html