Posted by blueberry1 on February 2, 2007, at 4:49:02
In reply to Re: Do you have to get a lot worse before better? » blueberry1, posted by Quintal on February 1, 2007, at 17:50:59
Thanks for the input. I appreciate it. I have always believed that the closer a drug is to targeting the real problem, the quicker it will work and with less side effects. The farther it is away from the real problem, the longer it takes and more side effects, due to downstream adjustments rather than hitting a bullseye. There are clinical studies that show that. Two of them at pubmed. I just dond't have what it takes right now to go find them.
With paxil and another drug, can't remember what it was, they showed that patients who showed improvement in the first 2 weeks was highly predictive of good response at 6 weeks. About 80% of the responded. If there was no improvement at 2 weeks, only 20% of those folks went on to respond at 6 weeks. No guarantee either way, the odds are significantly in favor of those with early response. Responding with longer trials does exist, and it is of course common philosophy, but the odds are greatly diminished if there is not a hint of improvement in 2 weeks.
You make a good point about bipolar. As I think back, depakote had me feeling significantly better in 24 hours after being on lousy lexapro for a month. Then started zoloft. Worked fast. Was not depressed, but instead just very blah and uninterested in life. When stopped the depakote because I couldn't feel it doing anything, I crashed hard into the emergency room. So zoloft alone was not doing the trick. There was some synergy, perhaps bipolar related.Also saw in clinical studies that depakote+zyprexa (I was still on zyprexa) cause a synergistic increase in dopamine.
Lamictal gave immediate profound antidepressant effect even at just 6mg. Felt very dopaminergic to me. By day 4 I was engulfed in anxiety nervousness beyond belief and depression was very rapidly getting intensely worse. 3.4% of lamictal trial users experience suicidal ideation compared to .3% prozac+zyprexa. I was pretty darn close to that.
Lithium tried it. Again, immediate antidepressant response at just 100mg. Intense confusion, cognitive dulling, rapid heartbeat, and severe hypotension did not allow me to continue. Tried the natural lithium orotate. It was tolerable. Had a slight hint of improvement immediately. AFter that it just seemed to flatten my moods to where I was depressed all the time instead of being depressed all day with some improvement in the evening, which was the pattern I was accustomed to. With lithium orotate the evening improvement was gone and I was just steadily depressed 24/7.
The whole psychiatry thing is so flawed and screwed up. But I have tried going without meds for a month and things were just as screwed or worse. A rock and a hard place.
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