Psycho-Babble Medication | about biological treatments | Framed
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Re: Are maximum doses more effective?

Posted by sowhysosad on April 23, 2009, at 19:00:36

In reply to Re: Are maximum doses more effective?, posted by bleauberry on April 23, 2009, at 16:36:57

> I like my doctor's way of doing it. That is, start very conservative, judge what has happened, and don't make any plans on anything until then. If he were to start me on Lexapro for example, and him knowing my history, I know his strategy would be 2.5mg every other day for a couple weeks. He would not even speculate on what to do after that until he had assessed every detail of that two weeks. And we would have no preconceived notion whether the final dose I end up on being well is that same dose or 40mg per day or anything inbetween.

That sounds like a really sensible strategy. Some 8 months on I'm still suffering a rebound depression from ramping sertraline too quickly, which also had the added downside of preventing me tolerating other serotonergic meds. I regret my doc and I underestimating how powerful SSRI's can be. We only allowed a week before assessing the dose increase, which wasn't nearly enough,

> I tend to agree wtih Dr Gillmans beliefs that in really severe depression, ssris and snris should be avoided completely, unless combined with a TCA. He just has not seen them having enough power or staying power to treat severe depression. Patients get somewhat better, but hardly ever really well (on ssris/snris). That's his take, his experience, not mine, though I do tend to agree. It takes a ssri+tca, or an maoi, to get the job done.

I agree with Ken Gillman's opinion's on the lack of efficacy of "dual action" drugs, and he's a great champion of MAOI's which, I agree, are certainly under-used in this day and age.

But I think perhaps he overstates the role of norepinephrine in "severe" depression. Mine's been pretty "severe" but noradrenergic meds have just made me worse. Depression is undoubtedly a wide range of similar conditions where different neurotransmitters play distinct roles in each person, which is why we none of us respond identically to the same meds.




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