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

Posted by SLS on October 28, 2000, at 19:05:04

In reply to 3Day to 2 Week Responses. Proof, not myth., posted by JohnL on October 28, 2000, at 8:59:45

3-4 (+1) day trials make a whole lot more sense to me than do two week trials. If Jensen is on to something here, and he very well might be, then I believe his protocol is to be followed as he has written it. I'll leave some brainstorming to others to offer thoughts as to why this is probably so. I may find much of what Dr. Jensen has to say to be ludicrous and obviously without scientific foundation, but he is no dummy. 3-4 day trials means 3-4 day trials, not two week trials.

That some people begin to improve before the end of the second week is not, and never has been, a "myth". There is no revelation being uncovered here. I have a hard time understanding why this issue has been perceived as an either-or affair. I have not had too difficult a time recognizing this phenomenon. I responded within an hour of my first dose of Effexor. I responded within 3 hours of my first dose of Dexedrine. I gleaned improvements from Dexedrine and Parlodel for the first three days after adding them to Parnate. A month ago, I experienced a teasingly significant antidepressant effect from Parnate + desipramine on days 5-7 that has since faded. I have experienced the same thing with Parnate by itself. Same with Lamictal. I tend to respond (if you can call it that) a week sooner now than when I was a "virgin". So, I guess I have been fortunate enough to have had this great revelation as early as 17 years ago. Duh.

Medicine, particularly psychiatric medicine, is a clinical discipline. If you are already at two weeks and nothing good and nothing bad is happening, you go one more. It is as simple as that.

Does anyone disagree?

I believe most psychiatrists will attest to the fact that not only have they seen atypical robust responses within a week, but that they have also in a great many cases observed a "lightening" of depressive symptoms that can be seen at about the 6-day mark. It is measurable if it is the practice of the physician to measure it. However, this is usually not apparent to the patient because it is so subtle. In these instances, the patient may not feel substantially better to report such for another two weeks. It's good that such a trial would be allowed to continue beyond 14 days.

Interestingly, in opposition to the inferences of the study cited, the older psychopharmacologists would tell me that the slower and more gradual the course of improvement, the more likely it was to "stick". But they had not thought to use strategies such as the addition of pindolol to SSRIs (of debatable efficacy) to hasten an improvement. Maybe they were 180 degrees wrong. It just so happens that it was true for me. Like JohnL always says, we are all different. 3 days, 7 days, two weeks, six weeks.

As I have said in another thread, a 3-4 day trial protocol for screening for effective antidepressants is an exciting idea that would revolutionize psychiatry if it were true. Hopefully, we can get an answer on this soon. There are reasons why I NEVER said in previous posts that it wasn't true (at least not that I can recall). It has had some appeal to me. From my own experiences with medications and those some of the expert clinicians who I have spoken to, the phenomenon that I think Jensen may be focusing on falls within his time-frame. I think it is presumptuous to be so cavalier as to modify it without understanding it.

As far as the aggressive post that I regret submitting in the previous thread is concerned (I really need to start counting to ten), well, I still see what I see. I can't help it. I'll let it go for now.

JohnL has a much better feel for the character and behaviors of various drugs than do I, has greater exposure to creative polypharmacy than do I, and has successfully helped many more people than have I.

- Scott




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