Psycho-Babble Medication | about biological treatments | Framed
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Posted by Toby on January 28, 1999, at 15:13:45

In reply to NB QUESTION FOR TOBY RE MEDS SENSITIVITY, posted by Jeremy on January 26, 1999, at 23:37:32

> I have heard of a strategy of starting the patient on sodium valproate and them on the antidepressant. The antidepressant is supposedly better tolerated then.

I use this often for patients with bipolar disorder, but have not heard of it otherwise. It actually may be a good idea though since you have anxiety and if antidepressants tend to make you more anxious or irritable, valproate may be helpful (it works on GABA in the brain as a calming agent).

> How reliable is the strategy of coadministering a medication like serzone to counteract ssri induced sleep disturbance? Does trazodone also act on the ht2 receptor like serzone?

The reliability of this strategy is varible but can be quite effective. I find that my patients get less hangover with Serzone than Trazodone when using it strictly for sleep, but since it is expensive we can generally use it for only short periods as needed. Trazodone does act on the 5HT2 receptor.

> Is it pharmacokinetically feasible to increase the dose of a tablet but take the extra dose only every three days initially to make upward titration more gradual. Please exclude consideration of liquid medication.

It depends on what the medication's half-life is. If the half-life is 24 hours or greater, generally taking it every other day is a good strategy, but longer than that tend to make the blood levels fluctuate too much and side effects may emerge. If the half-life is less than 24 hours, the dose can be divided up during the day or evening and slowly increased on a daily basis.

Please also see my response to your earlier posting from the 23rd. Good luck.




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