Posted by SLS on April 1, 2022, at 9:51:45
In reply to Re: combining nardil and parnate ) SLS, posted by Lamdage22 on April 1, 2022, at 2:39:13
> Well, I have basically declared my psychopharmaceutical treatment finished 6 years ago. I told myself all further improvement needs to come from non pharmaceutical measures. Med trials destabilized me and the bottom line is: Meds are just not that good for me.
You are smart to keep your mind open to a diversity in treatment modalities. Just make sure that the presentation of your illness is as accurately diagnosed as is currently possible. I have seen too many people being treated for depression year after year only to find that instituting a regime appropriate for adult ADD changed their lives. For one person, it was Strattera that turned his life around. Within a few weeks, he had cleaned and organized his apartment for the first time in decades.
Some people don't like having to "admit" that the current state of psychiatry offers a diagnostic guideline that more often than not, achieves the goal of choosing those drugs that are *observed* to work for a given symptom cluster and life chart.
Don't buy into nihilism.
.
The following is is a truism that I probably wrote just a few posts upward. It is an example of a rationale to have "sighted" faith. I have witnessed this truism many times in real people with real cases of TRD. I was exposed to a great many people who suffer apparently untreatable mood illnesses.
The truism is strongly advocated by physicians who have made a career of specialize in treating TRD. cases. It provides a rationale for having an inpenetrable "Sighted" Hope" rather than relying on "Blind Hope" or "Blind Faith" The goal is to help reduce the impulse to commit autoeuthanasia.* For every new treatment that becomes available, a certain percentage of previously intractable cases will go on to respond to it.
* Similarly, some people who have used multiple drugs in combination (polypharmacy) take years to find the exact array of drugs at exactly the right dosages. You will never run out of permutations.
I am currently responding to the exact same combination of drugs that I experienced only a partial improvement with 15 years ago. I can't help asking myself where those 15 years went. Happiness was staring at me right in the face. I could have had another 15 years of joy and achievement.
I have no right to ask that question and look for blame when God gifted me with the blessing of having any years of remission at all. My greatest fear, and the one that had plagued me for decades, is that I would die with never having lived.
So what is different now compared to 15 years ago? Right drugs, wrong dosages.
* Nortriptyline was too high at 150 mg/day. Reducing the dosage to 100 mg/day produced blood levels well within the well-known dosage window that nortriptyline demonstrates.
* Lamictal was too low at 200 mg/day. Increasing the dosage to 300 mg/day hit the bullseye.
* Nardil at 90 mg/day is the ONLY dosage that works for me. Again, it acts on me with a dosage window. I was all over the place with Nardil dosage, so I can't recall at what dosage I was at during this period of unsatisfactory results.
Nardil:
75 mg/day=depression
90 mg/day=remission
105 mg/day=functional relapse* I don't recall the dosage of lithium I had been taking, but [for me] the pharmacological action follows a biphasic dose-response curve. At high dosages, lithium yields a reduction of glutamate activity. At lower dosage, the neuronal efflux of glutamate is potentiated. This is reflected in clinical data. High dosages of lithium are necessary to squash mania, but can make depression worse. Conversely, low dosages of lithium can improve depression, but is ineffective for mania. For rapid-cycling presentations, my guess is that only high dosages of lithium will have the desired effect.
I discovered the biphasic dose-response curve of lithium many years ago. Subsequently, I stumbled upon two studies that demonstrated that my observations of myself aligned with what appears in the medical literature. There are no more than three studies with robust and confirming results. The two investigative targets were:
1. Neurobiological
2. Clinical observations of real people.
Even the dosages studied found the same cutoff as I observed in myself. 300-450 mg/day seems to be the "sweet spot".
A very simplistic explanation is that increasing interstitial and synaptic levels of glutamate (low dosages of lithium) improves depression. Decreasing interstitial and synaptic glutamate (high dosages of lithium) treats mania, both acutely and prophylactically.
Finally, while in remission, I tried lowering the dosage of each drug one at a time. I relapsed upon the dosage reduction of all four drugs. I was actually shocked that lithium turned out to be a necessary agent in my treatment regime. Although I experienced a mild improvement immediately after beginning lithium. After a year or so of lithium treatment, I had no idea whether or not lithium was helping with depression. However, I elected to continue lithium at 300 mg/day for the sole purpose of lowering my risk of getting Alzheimer's Dementia. Little did I know that my mother would contract Alzheimer's at age 80.
I am very ware that I have been incredibly blessed to be able to live before I die.
* Try to embrace uncertainty. You are no more certain that you will never find remission than that you will.
Once you *think* that you have run out options to earn sighted hope, this would be the time to rely on blind hope / blind faith instead. This is where uncertainty becomes your best friend.
I hope something here makes sense.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.The only thing necessary for the triumph of evil is that good men do nothing.
poster:SLS
thread:1119086
URL: http://www.dr-bob.org/babble/20220128/msgs/1119208.html