Psycho-Babble Medication | about biological treatments | Framed
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Re: Toby - help

Posted by Toby on September 10, 1998, at 16:52:48

In reply to Toby - help, posted by Lynn on September 10, 1998, at 10:39:19

Effexor is a good drug for treatment resistant depression. Stick with it and don't quit too early as long as you don't get side effects, go all the way up to the max dose, 225 mg per day. It's the same as an SSRI at 37.5 mg and as the dose increases it begins to take on some norepinephine (energy) effects and then some dopamine (reverses hopelessness) effects.
Regarding the stimulants, refer the doctor to the Journal of Clinical Psychiatry, Feb 1996, "Methylphenidate Augmentation of Serotonin Selective Reuptake Inhibitors: A Case Series." If you do not have a personal history of substance abuse and aren't living with an active substance abuser, the risk of you becoming addicted to a stimulant is practically nonexistant. Discuss making a contract with the doctor regarding lost, stolen or accidental flushing of medication: i.e., attempt a trial of a stimulant and as long as you don't come up short or lose it more than once, you have a right to get your depression treated with what works. If you do have a history of drug use or the doctor just is too uncomfortable (he may have gotten burned by other patients; shrinks have their own neuroticisms to deal with), an alternative is Cylert which is a non-abuseable stimulant that is reported to be a pretty good augmentor of antiderpessants.
One other fairly amazing alternative to stimulants would be Pindolol and there are about 30 new references to that being a dramatic medication for lifting depression (if it's going to work, you will see a difference in 1 week or less, so there's no need to mess around with it for several weeks if you don't see an early and dramatic difference). So far I've seen an incredible improvement in 6 out of 7 patients in less than a week (the seventh was so resistant he had to be admitted for ECT which finally did put him in remission).
In the Greensboro/W-S area I recommend Baptist Hospital where all these treatments are cutting edge and they are very familiar with all these things (not squeamish about trying stimulants but not pushovers, either). In private practice, Dr Farah (in the Greensboro book) is one of the most knowledgeable psychiatrists I know, and in W-S is Dr. Creque who is an expert on bipolar disorder and in High Point is Dr. Collins whose first name escapes me because its late in the day and I'm tired. I'll think of it....
I'm not confident of the fibromyalgia diagnosis. While I think it does exist, some doctors use it as a trashcan for any condition they don't understand or as a way to turf patients who don't respond in the expected way to standard medication treatments. Hope that isn't the case here. Nonetheless, a referral in that direction can at least perhaps rule that diagnosis in or out and frequently, the fibromyalgia expert may have better treatment recommendations than the standard psychiatrist because fibromyalgia is so unconventional and responds so uniquely to unconventional treatments. Sometimes one just gets lucky. If the Effexor is not successful and stimulants (even Cylert) are not an option with this doctor, try to get him to try one more trial with the Pindolol and then take the referral to the fibromyalgia people or try one of the docs above. Best of luck.




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