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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by colin wallace on April 1, 2002, at 5:38:59
Dr. Kramer,
Throughout the course of my prolonged episode of major depression, I have experienced severe akathesia/overstimulation on standard therapeutic doses of SSRI's, or a significant decrease in efficacy/cognitive function at standard doses of tricyclics, or the 'newer' anidepressants.
Currently, I take (200mg) Sam-e, which has helped tremendously, and 12.5mg Zoloft (I was prescribed 25mg for ease of administration, but find that dose to cause a 'happy stupor', in which I am clumsy, forgetful and intellectually stunted).This same effect will manifest with or without Sam-e, which I began taking relatively recently.I have to say that I now feel better than I have in years, due to this low dose med regimen.
My question is firstly, that although I feel an undoubted benefit from such a small dose ssri, is this really enough to keep a severe depression in check- or should I grit my teeth and endure the 'happy stupor' at the nominally minimum effective dose of 25mg.I value my mental clarity and require it for my employment.
Secondly, does an antidepressant response to tiny doses suggest an enzyme deficiency/renal-hepatic impairment, or could it be construed as a bonus, ie. less of a likelihood to experience any adverse effects caused at standard doses.
Any opinions much appreciated.Colin.
Posted by Dr. Kramer on April 1, 2002, at 9:06:10
In reply to Kramer: Reasons for subtherapeutic Responses., posted by colin wallace on April 1, 2002, at 5:38:59
Everyone's different - and doses of meds are based on population data, not individuals. You need very little Zoloft (and very little SAMe!) to get better. If it works, it's enough. There's no sense in enduring side effects unless you need to.
As far as your 2nd question, hey, if this is the only hepatic/renal issues you have, then it is a bonus! Doing well is doing well.
Posted by Tye on April 2, 2002, at 21:15:23
In reply to Re: Kramer: Reasons for subtherapeutic Responses., posted by Dr. Kramer on April 1, 2002, at 9:06:10
> Everyone's different - and doses of meds are based on population data, not individuals. You need very little Zoloft (and very little SAMe!) to get better. If it works, it's enough. There's no sense in enduring side effects unless you need to.
>
> As far as your 2nd question, hey, if this is the only hepatic/renal issues you have, then it is a bonus! Doing well is doing well.Dr. Kramer,
Are you a PhD or MD? Medically, the appropriate answer would be for Mr Wallace to get some routine serology which includes renal and liver function tests. This would be include BUN, creatinine, potassium, AST, ALT, GGT, Albumin levels as an initial sample. I think it is carelessly to state, "if this is the only hepatic/renal issues you have, then it is a bonus!" Any hepatic or renal insufficiency is potentially life threatening and should be evaluated. By ordering these simple blood tests and perhaps performing a basic physical exam may help you avoid a lawsuit in the future.
I hope this helped.
Tye
Posted by pharmer on April 2, 2002, at 22:39:04
In reply to Dr Kramer: Are you a medical doctor?, posted by Tye on April 2, 2002, at 21:15:23
> > Everyone's different - and doses of meds are based on population data, not individuals. You need very little Zoloft (and very little SAMe!) to get better. If it works, it's enough. There's no sense in enduring side effects unless you need to.
> >
> > As far as your 2nd question, hey, if this is the only hepatic/renal issues you have, then it is a bonus! Doing well is doing well.
>
> Dr. Kramer,
>
> Are you a PhD or MD? Medically, the appropriate answer would be for Mr Wallace to get some routine serology which includes renal and liver function tests. This would be include BUN, creatinine, potassium, AST, ALT, GGT, Albumin levels as an initial sample. I think it is carelessly to state, "if this is the only hepatic/renal issues you have, then it is a bonus!" Any hepatic or renal insufficiency is potentially life threatening and should be evaluated. By ordering these simple blood tests and perhaps performing a basic physical exam may help you avoid a lawsuit in the future.
>
> I hope this helped.
>
> TyeTye,this site appears to have enough babblers already that believe they possess a M.D. Sounds like you attended the same school as them.
Posted by Zo on April 2, 2002, at 23:57:07
In reply to Re: Dr Kramer: Are you a medical doctor? » Tye, posted by pharmer on April 2, 2002, at 22:39:04
Posted by colin wallace on April 3, 2002, at 5:10:05
In reply to Kramer: Reasons for subtherapeutic Responses., posted by colin wallace on April 1, 2002, at 5:38:59
At this point, I could reiterate what Fachad has said in his 'Be realistic and respect Dr. Kramer's Position' post.I won't, because Fachad has concisely made this point,(almost as well as I would have done!!)the thrust of which ought to have been clear to us all at the outset.
As for my personal post,it is axiomatic here that I accept those (stated and implied) groundrules, and am merely 'bouncing ideas' in an informal setting, and not seeking to obtain a highly personalized diagnosis in preference to a physical consultation in the appropriate setting.
My questions were asked out of inquisitiveness:
Is it possible , I wondered, for an individual to obtain an AD benefit from a tiny, subtherapeutic dose? Answer: Quite clearly you are!Fine.
Secondly,I have absolutely no renal/hepatic concerns, and was merely curious as to why I can get away with such a miniscule med. regimen.
Answer:IF THESE ARE THE ONLY renal/hepatic issues you have.....then yes, you could consider it a bonus.Implicit in that simple answer is " if you had any other worrisome symptoms in this area, I'm sure you would have raised them- in the correct setting, with your own physician".
Of course I would have (and indeed have 'bounced' the same question off my own physician!
Dr. Kramer,please do not let the cynicism and pretentiousness of a few people here taint your opinions of the majority, who are more than grateful for your time and input.
As for(utterly silly) mentions of 'law suits', well, I live in the UK, and I'm glad to say that we, don't yet live in a culture where a person lives in perpetual fear of being legally hamstrung for breathing in public!!
'Dr.Kramer told me to wear those Dr.Bob psychedellic swim-shorts to the Vatican in order to cure my chronic social phobia....LAW SUIT! aaarghh!!
This is the end of the thread.
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