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Re: 3Day to 2 Week Responses. Proof, not myth. Shirley

Posted by allisonm on October 28, 2000, at 12:17:08

In reply to Re: 3Day to 2 Week Responses. Proof, not myth., posted by Shirley on October 28, 2000, at 11:02:06


Shirley,
I'm no expert and medicine is not my field, but I believe that -- depending upon the symptoms -- doctors have fairly specific courses of treatment they try, as well as second and third lines of defense. On Dr. Bob's links page you will find a link for the Harvard Algorithms for depression, bipolar and schizophrenia. The Harvard Algorithm is located at:
http://www.mhc.com/Algorithms/

I believe it is written for doctors, but I have answered the series of questions about myself to the best of my ability and found that where I am in my current meds is exactly where I land on the algorithm. You may also choose to look at the flowchart, which shows the overall plan.

I do not believe that doctors pick medication choices "out of a hat" so to speak in trying to treat people. I do not believe that their
choices are so inspecific as to be hit or miss. If a person has depression, it's probably due to a particular chemical imbalance, but there's no way of knowing which one until the different drugs that affect them are tried, one after the other. I think they generally try drugs in a specific order to both find the imbalance and try to rule out the other possible imbalances and eventually come to some hypothesis. From what I can tell, one order seems to be something like SSRIs such as Prozac, Paxil, and Zoloft first, then Effexor or Remeron, then augmentation with lithium or Wellbutrin, maybe tricyclics are somewhere in there and then MAOIs.
Unfortunately in the US, we don't have Reboxetine, an SNRI, as I suspect that because SSRIs were so horrid for me I have an
imbalance having to do with norepinephrine and/or dopamine. The drugs I've taken that have helped the situation affect those two chemicals most.

One last thing: When drug companies test these drugs, the FDA requires that they do six-week trials, ie subjects have to take these drugs for six weeks before any conclusions can be made regarding efficacy. I suspect there is a reason for it. Frankly, I wonder why they don't require a longer trial period since most ADs are taken much longer than six weeks.

Also, from my own experience, if I gave up on Wellbutrin in the first two weeks because the side effects were bothersome and I didn't feel particularly better, just wired, then I would not have experienced the true benefits of the drug, which occurred weeks later.

Allison


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poster:allisonm thread:47596
URL: http://www.dr-bob.org/babble/20001022/msgs/47613.html