Posted by psychobot5000 on January 15, 2007, at 20:10:50
In reply to Re: Depressives' sensitivity to stimulants! » linkadge, posted by SLS on January 15, 2007, at 19:37:49
> Doctors don't use amphetamine monotherapy to treat MDD and BD because it doesn't work. It tends not to bring one to remission and keep them there for more than a week or two. It is not the best kept secret in psychiatry that it does. It is not some long-lost piece of knowledge that the most dedicated of researchers have neglected to revisit.
>It is known that -some- people lose the mood benefit of stims with tolerance, and that in others it causes depression. Many patients find amphetamine monotherapy inadequate. But I've never seen any evidence indicating, (as many docs and writers manage to suggest) that therefore -everyone- loses the mood-elevating effect of stimulants with time. I think this is a conflation of theories of stimulant abusability (ie, response to downregulation after the initial dose) with a phenomenon experienced in a portion of patients. Many patients in this community seem to find stimulants very useful in the long term, after all--and we tend to be very treatment resistant.
I have read case-reports of people who use them successfully for the long term, even as monotherapy. Many docs will confidently state that amphetamine monotherapy doesn't work in the long term, but I find that these same docs are:
1) Young--fresh out of school, and with relatively limited clinical experience, also freshly indoctrinated with serotonin theory.
2) Refuse to write for stimulants in the first place--thus making it unlikely that they have much experience with their use in depression.
In any case, those of us in this community are not good benchmarks for AD efficacy, I'd say, since we tend to be resistant to everything. In fairness, I note that you were specifically condemning amphetamine -monotherapy-, which seems reasonable. But then...what medication is adequate as monotherapy?Best,
P-bot
poster:psychobot5000
thread:721931
URL: http://www.dr-bob.org/babble/20070113/msgs/722687.html