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Re: these days are med mixing testing grounds.... SLS

Posted by zeugma on May 22, 2004, at 13:01:40

In reply to Re: these days are med mixing testing grounds...., posted by SLS on May 22, 2004, at 11:33:02

> > It is almost as if they are giving up on the science of it all and just giving people temporary hope in a placebo effect.
> I guess when it comes to psychopharmacology, there must be a balance struck between evidence-based medicine and anecdotal clinical experience.
> It would be instructive to query the doctors you refer to as to their exact reasons for choosing a particular polypharmaceutical strategy.
> - Scott

When things go bad, that's the time I query my doctor for reasons for his particular med choices. But the polypharmacy I have had for the past year and a half has been very much an empirical matter. On my first visit to him, he gave me samples of Buspar (I suppose the drug company was making a last-ditch attempt to promote this drug before it went off patent). I was finding nortriptyline unsatisfactory in the treatment of anxiety, and I decided i was going to try the samples regardless of what he said, unless there was a definite contraindication, which there wasn't. It did nothing for anxiety, but had an AD effect, so I got him to provide scripts for me without any problem. It was stictly my decision to try the Buspar.

Then I needed more help for my ADD, and he made the pharmacologically redundant choice of Strattera to add to the nortriptyline. It did work (Strattera is a much more powerful inhibitor of the NE transporter than nortriptyline and has no sedating effect, for me at least) so I was happy to use the two concurrently as I was getting relief from depression and ADD for about the 1st time in my life (the nortriptyline at that time had the depression in near-remission). As I've described elsewhere, I was able to convince his colleague to intercede for me to get a script for Klonopin after a disaster with CBT and a major change in life circumstances that would have made my previous level of social phobia an insurmountable obstacle. He had no desire to add the K even though I regularly complained of anxiety/social phobia. This is unfortunately standard practice for pdocs to think of SP as a 'minor' problem that can be handled with therapy.

My last visit, I had an episode of depression that was provoked by an exogeneous circumstance, and I was determined to get answers from him as to what med combos made sense and what didn't. We decided to slowly discontinue the nortriptyline, and I am going to ask him to let me try Provigil since it seems to work on noradrenergic systems in a synergistic (not redundant) way with Strattera. It will also target the symptoms of fatigue and desire for social isolation that may be consequent on fatigue in a more 'rational' way than anything that has been done so far with him. The truth is that I feel obligated as a patient to research as thoroughly as I can and listen to others' experiences as closely as possible so I can 'rationalize' my treatment. Unfortunately, no pdoc has had a global understanding of how the parts of my various disorders fit together (ADD, melancholic depression, social phobia and severe generalized anxiety, narcolepsy) and what i consider to be mere prejudices- against benzos, for example- also interfere with optimal treatment. It has been frustrating as h*ll, but then I am also functional to a degree I have never come to in my more than three and a half decades of life. So I trust him to help me, but many of the decisions seem to be mine. Maybe that's why i consider him to be the first pdoc who has helped me at all.




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