Posted by JohnL on January 31, 2003, at 16:56:50
In reply to Anyone hear have the bipolar II/depression mixup, posted by jumpy on January 30, 2003, at 21:22:22
Though doctors are trained to draw boundary lines between symptom clusters and to give them names, and then to match certain drugs to those symptom names, from what I have seen over the years that provides limited benefit in actually getting the patient well. It provides a starting point, but that's about it. Often what happens is that a drug not really intended for the symptoms worked better than anything. We see that for example with Zyprexa as an antidepressant instead of its intended use as an antipsychotic.
After someone has already tried several meds, I think it makes a lot of sense to venture outside the immediate class of drugs and do some short term trials from other classes. For example, someone with resistant depression and anxiety might end up with a small amount of an SSRI and a small amount of Zyprexa. Or some other AP.
We know something is wrong in the brain. But we don't know what. Did SSRIs help? No? They made things numb? Then obviously boosting serotonin was not the desired tweeking. They did help, but just a little? Then maybe it will be part of a combo. The serotonin component is only part of it, there's more. Keep exploring for clues.
One patient who suffered anxiety their whole life had given up on all drugs. As a last resort, there was only one thing left, and it was lithium. The patient was totally cured in less than 24 hours with small dose lithium. Another similar case with Depakote. And Neurontin.
When treatment isn't working, and when the diagnosis is tricky, it makes sense I think to do some exploring to gather clues and find out what class of medication to spend time on. Way too often the appropriate drugs for the symptoms don't work, while other drugs do work, and so the effort at trying to label those symptoms with names is tricky and not always useful.
JohnL
> Hey Everyone,
>
> After 7 years of depression and panic attacks, I still (and my docs) can't agree upon whether I have bipolar spectrum or plain depression. Anyone know any good ways to tell the difference?
>
> Thanks
>
> Jumpy
poster:JohnL
thread:138453
URL: http://www.dr-bob.org/babble/20030130/msgs/138595.html