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Re: Hope and complex drug cocktails Cecilia

Posted by Psydoc on June 2, 2002, at 21:06:01

In reply to Hope, posted by Cecilia on June 2, 2002, at 1:06:21

To give you an example of how a complex "cocktail" of meds can be useful, a few months ago I saw a severely depressed lawyer who had been too depresed to practice law for 2-years. He had been diagnosed with Bipolar-II Disorder. He came to me taking:

Effexor-XR 150 mg 3X a day
Klonopin 1/2 mg 3X a day
Ritalin 5 mg 3X a day
Wellbutrin-XR 150 mg 3X a day
Zyprexa 2.5 mg at bed
Depakote 1500 mg at bed

He had been on this combination for over 3-months without significant benefit. As I usually consider Klonopin to be part of the problem rather than the solution, I gradually stopped it, and I VERY gradually introduced Lamictal which was slowly increased to 100 mg/day. Within three weeks of reaching 100 mg/day his depression remitted sufficiently for him to return to work. Over the next few months he was weaned off of the Depakote, the Zyprexa and the Ritalin. The Lamictal was gradually increased to 200 mg/day.

Best regards . . .

Ivan Goldberg
psydoc@psycom.net
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> I`ve been noticing how people from the UK find that their doctors give up on them after a few trials, whereas in the US they keep trying ever more complicated regimes (at least if the patient has good insurance). Sometimes I wonder which is better, hope is good, sure, but so many people can`t tolerate the side effects of high dose multi-med regimes. Doctors like Dr. Goldberg don`t see them because they finally give up on their own and decide depression without side effects is better than depression with them. I`d be curious to know what percent of people are actually able to tolerate some of these elaborate cocktails-doctors say such and such percentage inprove on such and such regime, but they never say what percent was never able to get to therapeutic doses on said regime. A Discouraged Cecilia


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