Re: Soltice » rjlockhart04-08

Perhaps leaving it to God is to recognize the possibility that God has left it to you. Yes, I believe that He knows all of the answers. Because He leaves so much uncertain and unknown, uncertainty can save you. Perhaps God leaves it to you to use all of the resources he has provided you with to do the rest on your own with hard work and the help of others. Nobody is going to fight as hard for you as you will fight for yourself.

I am not trying to minimize the severity of your condition. I recognize that a great many people with your illness are biologically incapacitated by it. However, to treat the psychological along with the biological would seem very necessary in your case. It would be desirable to make the most of every moment you have left in life, regardless of the severity of your current state. Your current condition is grotesque. If you can experience moments of acceptance of such adversity, you might be able to increase the quality of your life while your brain function remains pathological. There is a tendency while being in midst of depression to take inventory of all of the things that you can't do or feel. Yet, there is still much to be grateful for. Make a list of what you are grateful for, and you will see that there is a great deal that is often not appreciated. In each moment, you might try to recognize how much you do have to work with. This is a positive and productive way to approach life. If, one day, you are fortunate enough to find an effective treatment, you will be very much ahead in your recovery process for having performed so much psychotherapeutic work.

Look less at what you can't do, and more at what you can do. You will go that much further along your road to wellness.

I spent 5 nights a week in the RWJ / Rutgers medical school library during the 1980s, trying to figure out the etiology of MDD and the mechanisms of the drugs known to treat it effectively. I was told by my first set of doctors at Columbia Presbyterian in New York that I would never get well, and that they weren't even sure what I was suffering from. It looked like atypical depression to them, but did not respond to medication like atypical depression should. They demanded that I yet again undergo six months of psychotherapy before they would consider treating me any further. I challenged them to send me anywhere in the city for a psychological evaluation. I dared them to. I told them that I would consent to the psychotherapy, but only if and when the need could be established medically. Besides, there was nothing left for them to try on me. So, for the first time in my life, I questioned the judgment and knowledge base of a doctor. After my spending fifteen minutes describing to the doctor what I experience as depression, and that it is indeed a biological entity for which psychotherapy was of little use, she was left in tears. I must have hit a homerun in that I was able to offer a compelling argument for the existence of a biological diathesis for major depressive disorder. Acceptance of this notion would have set her ahead of her colleagues by 7-10 years.

In 1983, I became suspicious that my case involved dopaminergic dysfunction. (This was at a time when NE was the focus of study, and before the advent of interest in the clinical potential of 5-HT reuptake inhibition). My doctor was amused. When I asked for the then experimental Wellbutrin, she said, "No way". I then asked to try bromocriptine (Parlodel) instead. At this juncture, her amusement turned into condescending laughter as she said, "Sure - if you want to throw up all day." Nowadays, using DA receptor agonists to treat depressive disorders is a strategy used from time to time. Indeed, bromocriptine ended up triggering a brief antidepressant response in me, and I never even got nauseous.

Oh, well. She did the best she could during the treatments administered between 1982 and 1983. Frederick Quitkin (deceased) was the ultimate decision maker on the treatment team, and was the person responsible for denying me an open trial of Wellbutrin. Both of these doctors are smart, and have contribute quite a bit to the field of psychiatry. It is just that they were the prisoners of history.

Article: Efficacy Of Desipramine In Depressed Outpatients. Response According To Research Diagnosis Criteria Diagnoses And Severity Of Illness.

The efficacy of desipramine for mild depression was tested in a double-blind, placebo-controlled study of outpatients with scores below 19 on the Hamilton Rating Scale for Depression (HAM-D). Of 103 such patients, 23 dropped out and 16 improved during a ten-day placebo period. Among 64 patients completing the randomized portion of the study, significantly more improved with desipramine that with placebo. The Research Diagnostic Criteria (RDC) category of major depressive disorder largely accounted for the drug-placebo response difference found for the entire sample. Patients with intermittent depressive disorder improved significantly less frequently with desipramine than patients with major depressive disorder. Independent of RDC diagnosis, severity of illness correlated with outcome. Thus, patients with pretreatment HAM-D scores at or above the median demonstrated significant drug effect, while patients with lower pretreatment HAM-D scores did not.

Why is this so important? For anyone following my string of threads regarding the eligibility requirements and screening methods used in contemporary clinical trials of antidepressants and why the more severe MDD cases fair better on drug therapy than those rated as being mildly to moderately depressed. This effect makes any such study report a smaller separation of active treatment from placebo. Placebo looks better and better the more the less depressed patients are included. Antidepressants are significantly more effective than placebo when severe MDD patients are studied exclusively.

What does all of this have to do with the plight of the original poster? Perhaps it will act as a demonstration of how God has left it to me. So, I did what I could with all of the resources He has afforded me. I therefore leave it up to God the story to unfold with me as an active participant in His plan - whatever that may be. Leaving it to God does not mean giving up and doing nothing.

Speaking of God, He recently gave to man the ability to produce an antidepressant drug called vilazodone (Viibryd). What do you think? Hopefully it will not show itself to carry any dangerous side effects. So far, so good.

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

Re: Soltice » rjlockhart04-08

Thread

Post a new follow-up

Notify the administrators

Start a new thread