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Re: Marplan success stories?

Posted by Scott L. Schofield on November 18, 1999, at 12:21:05

In reply to Re: Marplan success stories?, posted by Elizabeth on November 18, 1999, at 0:47:02

> > Yes. Although when my depression did not remit satisfactorily, Dr. Quitkin used an interesting term: atypical reactive-type with endogenomorphic characteristics.

> That seems contradictory. I wonder what he meant by it?

At the time, I regarded it as a cop-out. It seemed he was hedging his bets. That way, his diagnosis would be, at worst, partially correct.

Since then, I have begun to see where he was coming from.

> > > What is Quitkin like personally, if you don't mind my asking? I've read some of his work and am a great admirer.

> > Remain an admirer from afar.

> Yes...?

I guess it's a personal thing. You might interact with him very well. Maybe he has changed over these last 16 years. At the time, though, I was not alone in my perception. However, we know how way-off that can be.

He and his team have made some major contributions. Although I haven't read closely any of his more recent work, he may be the only researcher to actually investigate the placebo response. It looked like really good stuff to me.

> > Each successive mania can be worse than the one previous. The damned thing seems to sink its claws deeper and deeper (kindling).

> This is my experience with recurrent depression also: the episodes get worse and closer together.

You have to attack it early and you have to attack it hard.

At least you have periods of remission. I've been stuck since 1982. Every second of every minute of every hour of every day of every...
[sorry for the complaining]

> > Not only that, but the following depression(s) can be more resistant to treatment.

> That happened to me, sorta: I stopped Prozac after taking it for 2 or 3 years, then when I tried it again it no longer worked (and I went through a long succession of meds).

There was some concern a few years ago that a similar thing may happen with lithium. The phenomenon has been labelled "lithium-discontinuation-induced lithium-refractoriness". There are people who have remained free of bipolar episodes for years while taking lithium, only to relapse soon after discontinuing it (especially upon abrupt discontinuation). When the lithium is restarted, there are some for whom it no longer works. I know someone who this happened to.


Just for a start:

Post RM, et al.

Lithium-discontinuation-induced refractoriness: preliminary observations.
Am J Psychiatry. 1992 Dec;149(12):1727-9.
PMID: 1443252; UI: 93072508.

Terao T, et al.

Refractoriness induced by lithium discontinuation.
Am J Psychiatry. 1993 Nov;150(11):1756. No abstract available.
PMID: 8214199; UI: 94027491.

Bauer M.

Refractoriness induced by lithium discontinuation despite adequate serum lithium levels.
Am J Psychiatry. 1994 Oct;151(10):1522. No abstract available.
PMID: 7993489; UI: 94379268.


> > > "As tolerated."

> > And you tolerate this?

Sorry. I meant this to be a play on words for my own amusement.

> But anyway, more specifically, I'm supposed to go up to 30 mg (as tolerated) until I next see my pdoc (Tuesday). This is assuming the pharmacy even gets the stuff by then (as of 6pm today it hadn't come in).

30 mg for me too.

See ya...





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