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Re: A BIPOLAR (II) EXPERT *PLEASE* (longish)

Posted by JohnL on March 4, 2001, at 4:14:08

In reply to A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by JahL on March 3, 2001, at 10:31:22


Hi,
I'm glad the Lamictal looks promising so far. You have my best wishes that it will continue! Fingers crossed. Like you, I've experienced many drug trials. I know how that goes.

Anyway, I just wanted to put in my two cents. In my experience, the actual diagnosis is important when the patient first seeks treatment, because it helps to narrow down drug choices. However, after three or so drugs have not yielded satisfactory results, I think any diagnosis can be thrown out the window. The more drugs that are tried and failed, the more useless a diagnosis becomes.

There are at least ten general categories of different types of chemical imbalances. Any one of them can cause symptoms identical to another. It becomes more important, in my mind, to sample drugs from totally different classes to increase the odds of hitting the right chemical imbalance. Sooner or later the patient always discovers by accident a drug they really like. Actually, if it is done in an organized manner, it is no accident. In short, I find the actual diagnosis very limited when it comes to drug choice. The best method is to actually try different drugs just for short times.

As an example, one doctor kept records of which medications gave excellent long lasting results for treating anxiety. Everything worked, though it varied from patient to patient. Some patients did very well on SSRIs. With other it was benzos. Others found antipsychotics worked best. Some found Tegretol or Depakote best. Some found beta blockers best. Some experienced robust results in just one day on Lithium. Lithium has no clinical justification for a diagnosis of anxiety. But it worked completely anyway. The diagnosis in all these cases was useless. Sampling different drugs was the only way to discover the ones that really worked, especially when the sampling included drugs that had no clinical justification for the diagnosis.

All too often I think we get caught up in a diagnosis and focus on too few drugs because of it.
John


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poster:JohnL thread:55442
URL: http://www.dr-bob.org/babble/20010302/msgs/55508.html