Psycho-Babble Medication Thread 890874

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SLS: Can you give us examples?

Posted by Zana on April 15, 2009, at 11:37:07

I would be really interested to hear some examples of how you plan treatment options for yourself. It sounds really sensible. More than that. It sounds like you have found a way to take charge of your treatment. Please explain. I always feel like I am on the receiving end of a boat load of meds loosing aimed at my presenting symptoms. Depression and anxiety with a history of poop out and agitation with ADs, mood stabilizers too dulling, too agitation. Atypicals not much help. Am now on Pristiq, Remeron for sleep, Seroquel for depression, klonopin for sleep and anxiety, gabapentin for anxiety, respiral to help clear my thinking (I'm in a fog not disoriented or anything more major) and provigil for energy and mood brightening. Seems like too much even though I am feeling better. But maybe I'd feel even better without some of these. Who knows ? It seems like its all trial and error to me.

Thanks for your thoughts.

Zana

 

Re: SLS: Can you give us examples? » Zana

Posted by Phillipa on April 15, 2009, at 12:45:09

In reply to SLS: Can you give us examples?, posted by Zana on April 15, 2009, at 11:37:07

Zana heh I'm not Scott but you're right all trial and error unfortunately. Sometimes too many meds leave one wondering what the cause of a problem is. Hope Scott gets back to you. Good luck with the pdoc today right? Phillipa

 

Re: SLS: Can you give us examples? » Zana

Posted by SLS on April 15, 2009, at 12:58:39

In reply to SLS: Can you give us examples?, posted by Zana on April 15, 2009, at 11:37:07

It is really hard to determine for someone else what treatment choices make the most sense without knowing their treatment history. It sounds like you have seen a lot of drugs and drug combinations.

For me, I decided to try and break through a point of stagnation (plateau)
by:

1. Switch from Nardil to Parnate. If worse, return to Nardil.

2. Switch from nortriptyline to desipramine. If worse or no better, return to nortriptyline to avoid genotoxicity.

3. If a plateau is reached after 6 weeks, add memantine.

4. If no improvement, add Topamax.

5. If no improvement, discontinue memantine and Topamax.

6. Add Trileptal.

7. If no improvement, add Geodon 40mg.

8. If no improvement, discontinue Trileptal and Geodon.

9. Add amphetamine.

10. If no improvement after 2 weeks, add T4 (thyroxine)

11. If no improvement after 2 weeks, disontinue amphetamine and T4.

12. Keep thinking.


For you, I think it would be worthwhile to document your treatment history by making lists of drugs and drug combinations for those that:

1. Produced an improvement, no matter for how long.
2. Produced an exacerbation.
3. Had no discernable effect.
4. Produced intolerable side effects (with descriptions).

How long do you generally give startup side effects to dissipate when starting a new treatment?

It sounds as if you might wind up taking a drug combination that includes the remediation of anxiety or agitation that are produced by an otherwise effective treatment.

For instance, sometimes the only way to treat a refractory case is to allow a drug to produce a mania and then treat the mania without discontinuing the precipitating drug. For you, it might mean that you can choose the drug that had the best antidepressant response, and then treat the anxiety and agitation with an anxiolytic / antimanic, which might be something like Klonopin, Depakote, or Zyprexa.


- Scott

 

Re: SLS: Can you give us examples?

Posted by Zana on April 15, 2009, at 18:09:56

In reply to Re: SLS: Can you give us examples? » Zana, posted by SLS on April 15, 2009, at 12:58:39

Thank you Scott. I have been struggling with this melange of meds to find a way to sort out what's helping and what's hurting. I do understand what you are saying about creating and then treating "side effects." That's why I am taking Provigil and gabapentin. The Provigil revs me up; the gabapentin takea the edge off. I do need to find a more systematic way of writing down what I'm taking and how I'm feeling. For some reason I can't get a good, clean format in mind.
Thanks again.

Zana

 

Re: SLS: Can you give us examples?

Posted by bleauberry on April 15, 2009, at 19:19:22

In reply to SLS: Can you give us examples?, posted by Zana on April 15, 2009, at 11:37:07

I think the overall strategy SLS demonstrates is this:

1. Have preplanned backup plans of what the next move is if the current move doesn't work. Have a plan in advance.

2. Don't pile more meds on top of meds that aren't doing a lot of good...get rid of them before adding new ones.

I moan and groan when I see someone on 4, 5, 6, 7 meds, and they are still in bad shape and wondering what new med to add to the list. Get rid of the non-performing meds first so other good meds might have a decent chance without being drowned out in the noise.


 

Re: SLS: Can you give us examples?

Posted by desolationrower on April 16, 2009, at 0:43:46

In reply to SLS: Can you give us examples?, posted by Zana on April 15, 2009, at 11:37:07

I'm not scott but i generally agree with his approach; i do think its important to optimize diet/nutrional factors, especially if one is displaying some treatment resistance. in part because its adding treatments which don't have side effects (unless 'improving health' is a side effect)

Zana - it might help to try to clarify (not necessarily to the board, just to yourself) what 'agitation' and 'dulling' mean fo ryou, to better identify treatments that improve one w/o causing the other.

its trial and error, espeically 'guess and test' kind

-d/r

 

Re: SLS: Can you give us examples?

Posted by Sigismund on April 16, 2009, at 17:27:57

In reply to Re: SLS: Can you give us examples?, posted by bleauberry on April 15, 2009, at 19:19:22

>I moan and groan when I see someone on 4, 5, 6, 7 meds, and they are still in bad shape and wondering what new med to add to the list.

Yeah, I wonder how they do it.

Being young might give you a bit more strength.

No way could I do that now.

 

Re: SLS: Can you give us examples? » Sigismund

Posted by Phillipa on April 16, 2009, at 19:26:39

In reply to Re: SLS: Can you give us examples?, posted by Sigismund on April 16, 2009, at 17:27:57

Sigi me either. Being young sure helps Love Pj


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