Posted by BarbaraCat on January 31, 2002, at 2:10:13
In reply to Re: SSRI's, BPD, OCD, posted by Dinah on January 25, 2002, at 9:15:27
Dinah,
Have to agree with you on all fronts. I can say from personal experience how flattening high doses of SSRI's are. But even on 300 mg of zoloft the depression still broke through plus I was having very unapathetic panic attacks. All SSRI's had the same effect - massive doses that did zip for the depression and left me feeling like a sexless brain fried malingerer. I have a huge beef with the current state of affairs in psychiatric medicine. I have one of the large HMO's as my insurance carrier and get to see my pdoc every 6-8 weeks if I'm lucky. I have been in his office and on the phone to him in states of utter desperation. I have let him know in every way possible that the meds were not working, I was one hurting unit and please help. "Well let's just increase the amount or try another SSRI', suggests he. It has only been through this board that I've gained the info that I have been misdiagnosed and am now assuming complete responsibility for my own treatment. I use him mainly as a drug procurer, someone who wields the prescription pad, nothing more. I don't really blame him. It's not possible for any human with a massive patient case load to have any extra bandwidth to 'care' about me and my suffering, but how unfortunate we have to not only put up with this treatment but PAY for it as well. -- Barbara Cat>
> I have mixed feelings about this topic. People with OCD and BPD are in a lot of pain and do need help. High does of SSRI's flatten moods, increase apathy, and reduce cognitive function (especially memory). So of course high doses of SSRI's work for BPD. By making you numb emotionally and apathetic, many of the behaviors will disappear. Those around you are happier because you are behaving better. The same holds true for OCD. SSRI's cause apathy and reduce your ability to remember what you might have done to cause disaster. So naturally the symptoms are less too and you aren't so much trouble to those around you.
> But what is the cost? Extremely high doses of SSRI's rob you of your motivation and to a certain extent your humanity. (I'm talking about extremely high doses here, so don't flame me over this.) I was on Luvox at up to 300mg for four years, and I'm not sure I've fully recovered yet my ability to love and laugh and feel fully engaged in life.
> Wouldn't it be worth the additional time and expense to combine lower doses of SSRI's with really good therapy programs like Linehan's DBT or CBT and then follow-up long term supportive therapy? I know health care dollars are short, but for those who have the money and the motivation to change, I would think that this would be first line treatment for both OCD and BPD. Both disorders have shown themselves extremely well suited to these therapies.
> Of course, not everyone has the motivation to change, and everyone is different and have different degrees of these disorders, but I have to agree with Elizabeth here. Treatment should be more personalized to the individual. And I also agree with her that BPD is an umbrella diagnosis that probably covers a lot of different underlying problems. Just because high dose SSRI's routinely work with BPD doesn't change that fact.
> Just my opinion based on my personal experience, put out mainly for the purpose of discussion.
> Dinah
poster:BarbaraCat
thread:91182
URL: http://www.dr-bob.org/babble/20020124/msgs/92327.html