Posted by JohnL on August 18, 1999, at 3:33:59
In reply to running out of AD options...Is Lithium next?, posted by yardena on August 17, 1999, at 16:27:01
Yardena, if previous ADs worked but faded, Naltrexone is a new and not yet well-known augmentation to prevent "poop-out". 25mg usually does it. However, it is difficult to tolerate at first, often requiring starting with small pieces of a broken up pill. If it's going to work, it will work great. If not, you'll know that too. Info is available by looking back in the archives of previous months and checking out all posts by WayneR, who is a success story with Naltrexone.
Lithium is a textbook augmentation. It too will either work or it won't, and trying it is the only way to know.
There is a book called Dysthymia, The Spectrum of Chronic Depression, by Agop Akiskal, a noted international researcher/guru. In it he says depression is highly genetic, yet it doesn't breed true. There are so many various forms of psychiatric conditions. If ancestors have one of them, it is likely descendants will get some form too, but not the same form. In addition, he claims depression has various stages, and that at any point in time we are at just one stage of a continuously moving development. As examples, a major depressive bout may turn into a longterm dysthymia. Bipolar may turn into atypical. Or manic-depression may become evident after years of just depression. There may be alternating cycles of psychosis. Intermingling of selected schizophrenia symptoms at times. Though he attempts to draw clear boundaries between different forms of depression using specific symptoms as criteria, it is obvious that there are no clear-cut boundaries, many gray areas, and it is constantly in change anyway.
As far as drug treatment goes, he says when ADs don't work or create other problems, mood stabilizers are the way to go (such as Lithium, Depakote). Newer ones like Neurontin and Lamictal are good choices as well I think. He also believes many difficulties in treatment are due to physicians' underuse of MAOIs. He likes MAOIs.
Having said all this, I haven't really said much to help. The book was like that too. Because after all, we can never predict what will work. Trying to label our type of depression for drug choice is equally difficult. We just never know till we try and try again until something works, using past success stories as guidelines. You ask some tough questions that need a lot of books just to touch on some possible answers. You are a great thinker and seem to know yourself and your history very well, which is a huge plus in seeking treatment that works. Best to you. JohnL.
poster:JohnL
thread:10247
URL: http://www.dr-bob.org/babble/19990814/msgs/10274.html