Posted by hyperfocus on June 2, 2010, at 6:34:20
In reply to Don't know what to believe, posted by linkadge on May 31, 2010, at 17:36:22
I agree with bleauberry that the most important sources of info are communities like PB and having good PCPs who actually care about their patients. These are some of the things I believe wrt depression:
There are three major classes of depressive illness: First you have typical' depression which can develop following a traumatic experience or chronic stress or simply for no reason at all.
The 2nd class contains so-called TRD, major depression, bipolar depression, double depression, psychotic depression et.al.
In the third class you have depression co-morbid with anxiety, social anxiety, OCD, Body Dysmorphic Disorder, Dissociation, etc.
Of course these things can occur without depression but in the majority of cases they do appear together.Practically all empirical results are screwed up because they group the first set of patients together with the 2nd and 3rd like there's no difference between them. This is why studies on meds give false results on med response and seem to contradict each other.
In the first case the best result you can get from the data is that meds work, but they are only as effective as other methods - counselling, psychotherapy, exercise, diet changes, and plain old-fashioned time to heal.
The other two groups show a marked decrease in response rate to meds and practically zero response to alternative therapies. These people need new and innovative treatment that goes beyond traditional med strategies. Again the only place to discover what works are communities like PB.
SSRIs are very effective for the first group. And yes you could say that they're all the same when dealing with this type of depression, as there doesn't seem to be any marked difference in response among the SSRIs. Prozac is just as likely to work as Lexapro or any of the SSRIs
People in the 2nd and third class typically don't respond to SSRIs or SNRIs. The treatments that have been shown to work for some of these people are:
TCAs
MAOIs (except Marplan)
atypicals like Stablon or Valdoxan
Augmentation of a AD with an AP like Abilify or Risperdal
Augmenation of an AD with a mood-stabiliser like Lamictal
Augmentation of an AD with a stimulant like ritalinTCAs have heavy-to-moderate sideeffects but generally work better than SSRIs MAOIs can have the most dramatic response but a lot of people can't tolerate the SEs
Benzos are controversial but they can help a lot of people.
The truth is nobody knows how these drugs work. Nor does anybody know how mental illness develops. You can talk about neurotransmitters all you want but as BB keeps telling us people can take a course of antibiotics and find their mental illness improving drastically. The only solution is to collect as much empirical data and observations as you can and try to formulate a strategy. You need a good PCP who understands the vagaries and contradictions of psych meds and is willing to go beyond what is in the PDR.
poster:hyperfocus
thread:949655
URL: http://www.dr-bob.org/babble/20100524/msgs/949759.html