Posted by blueberry on June 4, 2005, at 5:38:05
In reply to Re: How is it... » yesac, posted by SLS on June 3, 2005, at 14:22:55
That is one of the most powerful drug combinations I've ever seen here. Why only 15% improvement is a painful puzzle. I have thought about your situation and came up with a few theories. Just opinions, and just theories.
Contrary to what most people believe, I believe that the closer a med is to targeting whatever is wrong, the lower the dose is required to do that. The further away a med is from targeting the real problem, the higher the dose needed. If that theory was true, then it would indicate to me that increasing serotonin and NE levels a lot is not targeting the actual underlying problem in your case.
You clearly have the bases covered in terms of increased serotonin, NE, and DA. But that doesn't seem to be helping much. What has been left out? The GABA system is left out. The opioid system is left out. I've known people in your situation who experienced quick and almost miraculous recovery with either a benzo or an opioid after failing everything else. If there is a malfunction in one of those circuits, the meds you are currently taking will only affect them slightly and indirectly.
Your current meds are creating a huge buildup of serotonin, NE, and dopamine. But that isn't helping much. Think of a dam blocking a river...it results in a huge buildup of water. But what if that river is only a trickle? It won't matter how large the dam is, there won't be enough buildup in water at the dam because there is hardly any water coming in. With that in mind, maybe some meds that will stimulate neurotransmitter production and release. Like stimulants. Maybe the huge buildup of neuros from your current meds has shut down production, or maybe production has been the actual problem all along.
Basically, no matter how I look at it, I tend to feel that your symptoms are not directly or even indirectly related to low serotonin, NE, or DA levels. It's something else. In your shoes, I would be very suspect of any neurotransmitter circuit that has not already been addressed, like GABA or opioid. Going forward, I would toss out all theories you have been going on for years, because they are clearly off base. The clues and the evidence are striking. At least, to me anyway.
Just my thoughts. Psychiatry is so hard. Symptoms can be caused by any malfunction in any one of the brain's circuits. Trying to figure out which one of those circuits is primarily at fault is difficult, because only trial and error of different meds will give the needed clues. In your case, and it is just my opinion, all the clues seem to point to something else besides serotonin, NE, or DA. My top theories for your situation would be the GABA circuits, opioid circuits, or neuro stimulation and production. I could be way off base, but those are my thoughts.
poster:blueberry
thread:507285
URL: http://www.dr-bob.org/babble/20050601/msgs/507550.html