Posted by SLS on April 7, 2006, at 7:42:21
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 6, 2006, at 18:17:23
> > I went from therapist to therapist >without success until I properly identified >myself as having an affective disorder.
> But have you found the right drug either?
Yes. On several occasions. Parnate + desipramine produced a dramatic remission that lasted for 6 months before mania began to emerge. Unfortunately, my doctor at the time chose to avoid this treatment upon my relapse into depression. I have also had tricyclics bring me into a state of euthymia. Unfortunately, this response lasts for less than a week. I have had similar, although less robust responses to several SSRIs, memantine, and a few other drugs that I can't now remember. I also experience partial responses to MAOI monotherapy. Unfortunately, the Parnate + TCA combination no longer works.
> There are others who have found the right therapist after a few trials, and some who give up right away, so results vary just like with drugs.
Yes. I think this is an important point.
> >It was when one did work that I became convinced >of the biological nature of my particular case. >Actually, I was convinced prior to that because >I was an ultra-rapid cycler. Once I read "Mood >Swing" by Ronald Fieve, MD, I was able to >observe and interpret my cycling; 3 days up, 8 >days down. The switch from one state to the >other took place within the time period of 30-45 >minutes. It was quite dramatic and regular. I >learned that I could keep a social calendar >based upon the 11-day cycle.
> Not really trying to dismiss the biological nature of the illness.
I am convinced that a huge number of people who complain of depression do not have a biological illness.
> >What is fair is to be able to identify in >advance who will respond to biological >interventions and who will respond to >psychological interventions. Of course, to >combine the two offers an enhanced chance of >successful treatment and prophylaxis.
> Another thing to consider is exercise.
Been there. No dice. Not for me. Not for many others either.
> >Perhaps the reason we don't agree here is that >we see depression from the perspectives of >dissimilar illnesses. My depression is the >result of bipolar disorder. Perhaps there is a >bipolar spectrum affective disorder that is >driven by biological perterbations, one that is >most treatable using biological interventions; >depressions that do not belong to this spectrum >are treatable using psychotherapy. The problem >would then lie in the inability to tell the >difference. I think a good psychiatrist can, >though.
> I see what you are saying. But I think that it is not really fair to restrict certain diseases to certain treatments.I don't think that is what I wrote. What do you mean?
> Thats not to say that the disease isn't biological, it just says that biology can be altered in ways other than drugs.
I used the term "biological interventions" on purpose. Drugs are only one type of somatic treatment.
I think you will find that when psychomotor retardation is used as a gauge of the severity of depressive illness, drugs work much better than psychotherapy. I believe that there should be more focus on improving diagnostics. Not all people complaining of depression have MDD or BD. Not all people complaining of depression should be treated with drugs.
- Scott
poster:SLS
thread:629584
URL: http://www.dr-bob.org/babble/20060403/msgs/630002.html