Posted by jojo on July 17, 2001, at 11:35:05
In reply to How good is good enough?, posted by Else on July 14, 2001, at 14:41:38
> I am beginning to think that no drug in the world is as effective as what I seem to be looking for. My pdoc has finally agreed to prescribe Klonopin (he even asked me how much I thought was O.K. which left me speechless). Now I'm taking 2mg daily and I guess I am doing better because I have the nerve to actually post something here which was not the case last week. But I'm just wondering. How do I know this is as good as it is going to get? I can't help but think I am so neurotic nothing will ever be good enough. But how good is good enough? How do normal people feel? I don't think I'll ever be completely satisfied no matter what and maybe this is nothing a pill can fix. I have had superb but short lived responses to a variety of drugs in the past so I can't help but believe in pills. But I just don't know how much of it is up to me. Anyway, I don't know if what I am saying makes any sense.
Below is the beginning of some thoughts that occurred to me after reading Elizabeth's message that the
AD effects of buprenorphine stop within hours of stopping taking it (failing to take the next dose, {or would the psychodynamiclly oriented say that making the decision to stop taking it is relevant?}). These ideas need a lot of expansion, but I thought I'd toss the first part in here because Else has brought up such
a "pregnant" question.
This raises some interesting philosophical questions. For instance, I always considered an "Antidepressant" to be a drug whose activity occurred in two separate stages. The first, or acute stage,
was generally apparent after the first dose, about the same time as most "side effects", and, although these effects might be therapeutic, they generally appear to be of little interest to the Psychiatrist. The second, or "True Antidepressant" effect, if it does occur, begins after some delay, formerly the standard 3-6 weeks, although a big goal of research has been to shorten this period. With buprenorphine, the rapidity of onset, the "True Antidepressant " effect, appears to have merged with the acute effect of the more usual antidepressants, and appears to act more like the classical "euphoriants", e.g. heroin, except that it doesn't cause "euphoria" as the word has become commonly used, as an abnormal, "heightened" state of mood,
but rather the "euphoria" that follows its etymological roots, i.e. "eu", meaning normal, and "phoria", referring to mood. BTW, my Psychologist friend tells me that "mood" has no scientific definition. How then can one be said to have a "mood disorder"? I guess it's like pornography, 'I can't define it, but I know it when I see it'. I don't know, but would be interested in learning how this word was appropriated by physicians or attorneys or Drug Warriors, to have a "negative" meaning. i.e., PDR, Adderall: Adverse Reactions:…,…, euphoria …One of the questions that this raises is that of Else, "How good is good enough?"
Buprenorphine is not considered a euphoriant. Does it than raise ones "mood" to THE 'Normal'
level and then stop? How does it know when to stop? Is there a "mood thermostat", and the drug brings the "mood" up to that level? If you plot "mood" on the horizontal axis, and amount of drug, or time, on the vertical axis, is the curve smooth, or does it flatten out as one passes through the "Normal" zone?
Morphine, methadone and heroin are said to be "antidepressants". Using the graph suggested above, does one get something approximately like a straight line, slanting upward to the right, mostly at the same angle, or does it flatten out at the "NORMAL PLATEAU", giving us a clue as to "how good is good enough?"
Because of the behavior of Bipolars in the Manic phase, we seem to accept that too much of a good thing (too much "mood"???) is a bad thing, but it's difficult to discuss without a definition of "mood".
With the more "classical" antidepressants, one stopped increasing the dose when the "side effects" became greater that the "therapeutic effects", or the higher doses presented some physical threat."How Good is Good Enough raise many questions which beg for answers.
poster:jojo
thread:70126
URL: http://www.dr-bob.org/babble/20010714/msgs/70483.html