Posted by SLS on April 22, 2011, at 7:56:37
In reply to Re: the only way out » SLS, posted by 49er on April 22, 2011, at 7:06:42
> Hi Scott,
>
> The problem with saying that depressive rebound can best be treated by medication or psychotherapy is that it could be due to so many reasons that might not be conducive to those treatments.I agree with you. I guess I did not word my post efficiently enough. Withdrawal depressive rebound is by definition a feature of acute withdrawal and not of chronic presentation. I would not advocate reinstating an antidepressant during the period of withdrawal if there are no compelling reasons to do so. However, I believe that chronic depression persisting beyond this acute phase of withdrawal argues for continued treatment.
The point at which we differ substantially is the interpretation of post-withdrawal depression. Is it relapse? I tend to think so.
> This is not a one size fits all type of deal.
I agree. In psychiatry, few things do fit all.
> For example, if someone has suffered vestibular damage as the result of being on psych meds and is depressed from that, reinstating the drugs that caused the problems would be very cruel.That's just common sense. Why would you think I would argue for such a thing?
> Regarding psychotherapy, if that person can't even sit up straight without getting dizzy, then it would be useless.I disagree about the worth of psychotherapy in this situation. I think CBT can work to help the patient recognize spontaneous negative or intrusive thoughts as the illness warps perceptions. It is a form of reality testing. If, however, you are suggesting that MDD is a biological illness that can prevent people from functioning effectively, I think we have a deal.
One of the problems I see with the extended taper you advocate is that it extends the period that one is to suffer from chronic withdrawal. Although I would not recommend an abrupt discontinuation, I think a schema that requires more than a year to reach discontinuation is counterproductive.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.
poster:SLS
thread:983009
URL: http://www.dr-bob.org/babble/20110418/msgs/983500.html