Posted by SLS on October 19, 2005, at 9:03:23
In reply to To SLS, posted by denise1966 on October 19, 2005, at 4:44:37
> Thanks for your advice but I'm not prepared to stick out 6 weeks of a drug only to find it doesn't work and then switch to another.
I'm afraid that this is the nature of the beast.
Without a crystal ball or some other assurance that you will always respond to all drugs in the future the way you had to a few in the past, I'm afraid that 4-8 week trials are indicated as the only sure way to properly evaluate the efficacy of a drug and what the persistent side effects will be.
> In my experience when drugs have worked they've worked within a couple of weeks at least.
This had been my experience also up until I experienced my only true remission. At this time, I would say that it took a minimum of 3 weeks to begin to notice a subtle improvement and another 6-8 weeks to reach a state of remission. Despite this, I was only willing to give drugs 2-3 weeks each to work subsequently after I relapsed. This was illogical. However, my impatience and the pretentious and mistaken notion that I had figured out my own biological constitution and response pattern impelled me to continue with 2-3 week trials, despite encouragement by my doctors to extend them to 6 weeks.
> When I first ever took prothiaden it worked within a couple of days, same with Seroxat. Two years ago when I went straight onto a higher dose of Seroxat it started to work within about 4 days although not as well.
It might be true for you that every drug that you will go on to respond to shows evidence of therapeutic effect within 2 weeks. I have no real way of knowing. The deal is this: with each drug that you try, fewer and fewer remain as alternatives. The fewer that remain as alternatives, the more compelled you will be to give each drug more time to work. The closer you get to exhausting the remaining drug alternatives, the more you will be compelled to go back and retry some of them for an extended period of time at higher dosages. It is possible that you will need spend only another 2 weeks in a state of depression to get well with the next drug chosen. On the other hand, it is possible that you are skipping over drugs that would take 4 weeks to be effective, and you would never know which ones. If this is true, it might take you years before you get around to trying them again for the 4-6 week trials they require.
If you decide to go with it, I would recommend that you give Wellbutrin at least 6 weeks. I would also recommend that you give any one dosage a minimum of 3 weeks to evaluate for efficacy and side effects. I try to use this as a guideline for any antidepressant I try.
You might want to titrate Wellbutrin to 300mg over the course of two weeks to obviate startup side effects like anxiety, irritability, cognitive fogginess, or even dysphoria. You would then complete another 3 weeks at 300mg and be prepared to evaluate your progress during week 5. If there is ANY improvement, you could then justify another 3 weeks.
My guess is that you are resistent to these suggestions and the therapeutic logic behind them. You might even be defensive and angry at me right now. However, I feel strongly enough about this so as to implore you to give Wellbutrin a truly adequate trial.
It looks like I'll be trying dexamethasone in a few days. Thanks for the kind words of encouragement.
:-)
- Scott
poster:SLS
thread:566744
URL: http://www.dr-bob.org/babble/20051017/msgs/568804.html