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Re: Remeron + Wellbutrin - Remeron + Neurontin = ? JohnL

Posted by SLS on October 21, 2000, at 10:42:01

In reply to Re: Remeron + Wellbutrin - Remeron + Neurontin = ?, posted by JohnL on October 21, 2000, at 5:44:27

Dear John,


> If a drug isn't showing considerable promise in 2 weeks, it is totally senseless to stay on it 3 months or 6 months.

This sentence is a bit deceptive when read.

1. I disagree that it is senseless to remain on a drug regimen for more that two weeks if it isn't showing "considerable promise".

2. I agree that for most currently used antidepressant drug treatments, it is not indicated to continue on them if they haven't produced adequate results by 3 months.

I find this statement to be an unnecessary exaggeration without sufficient foundation in fact to recommend. Martin Jensen's notions regarding trials of less than one week to find a "best match" is, of course, an appealing one. The clinical experience of too many other successful physicians yields the contrary. The fact that researchers have, for over twenty years, been vigilantly pursuing treatments that work more quickly than two weeks demonstrates the recognition that the ones we have right now don't. Let's at least give people three weeks. Maybe four. There are always exceptions.

The problem with casting aside most antidepressants so quickly is that perhaps it is the drug that takes three or four weeks to work for an individual that IS the best match for them. Can you guarantee with 100% confidence that for any one person, there is always a drug that will work within the first 14 days, and that will be the one that also produces the best long-term remission? Is this 14-day recommendation the same regardless of severity or previous treatment-resistance? Doesn't Dr. Jensen advocate only a 7-day trial of each drug?

I think your examples serve well to underscore how much time is often wasted lingering on regimens that don't work adequately. However, I find the one-week trial period (somehow became extended to two weeks) is at this point in time, counterproductive. I really do hope that clinical psychiatry discovers that the premise and methodology expounded by Martin Jensen are valid. It would save a great deal of heartache and misery - not to mention preventing suicides. I don't think there is a conspiracy on the part of the whole scientific community to refuse the recognition of a clinical method that prevents suicide.

Can you refresh my memory as to how long it took for *you* to respond to adrafinil? How did you measure "considerable promise", and on which of the first 7 days did you see it? I guess we'll just make an exception for adrafinil.

I still don't understand how you can deduce the specific neurochemistry of an individual's disorder when affective disorder has yet to be explained in general. We are certainly beyond the point of random trial-and-error. Treatment algorithms exist based upon reactions to sequential trials of drugs with decisions made based upon these reactions. Yes, drugs are often chosen based upon their putative mechanisms of action. There are several different rationales for doing so. However, this is a far cry from choosing drugs and eliminating drugs from consideration by first determining the neurophysiology of each particular case. One day soon.

For example, I know of someone who had terribly negative experiences with noradrenergic (NE) drugs. They made him feel worse. I recall reboxetine being one of the more recent ones. Yet, he did not feel confident enough in his ability to determine that his problem must lie outside the NE system, and that any NE drug would produce a similarly negative reaction. But rather, he chose to try a drug that he believed was a NE alpha-1 agonist. It is a good thing he didn't know as much then as he does now. He seems to have chosen the right drug for himself. I think it was his idea. He gave it more than two weeks and his choice was not the product of a consultation with Dr. Jensen. Lucky.

- Scott




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