Posted by bleauberry on October 15, 2010, at 17:23:46
In reply to Re: Thinking of coming off meds » bleauberry, posted by SLS on October 14, 2010, at 5:31:56
> > I think the whole thing sounds reasonable to me.
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> Why?Why not?
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> Do you have some insight into Maxime's condition and history to be able to come to this conclusion?Yes.
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> > I think it needs to be done slowly and carefully. Very tiny changes while dropping dosage. Personally I would probably whittle down the doses of the other meds too in tiny amounts at the same time.
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> Why?Because they are either not doing anything and/or compounding the underlying problem.
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> What should Maxime do should she relapse while performing a slow taper of her medications?There can't be a relapse because the current condition is already miserable.
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> > Maybe it's just me, but I see no logical or justifiable reason to stay on meds that have done little or nothing to improve quality of life.
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> I would agree with this, but I think you should ask questions of Maxime regarding her treatment history before you suggest what is the right thing for her to do.Been following this one a long time.
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> > It boggles my mind, but probably countless people do it.
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> How are you feeling today? Not too bad? Perhaps you don't share the same desperation as others.Failed ECT, a backpack of failed meds, 15 year chronic something, two threats of suicide and a ride handcuffed in the ambulance falls in the category of desperation, especially when trying to fake some sort of sign of life while on the job. Today was just another day in that paradise.
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> > Feeling worsened symptoms while decreasing the dosages will probably happen, and each time it will pass in a few days to a week or two.
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> According to whom?Me.
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> > It's adjustment stuff happening. Many people erroneously think "oh, that means the med was doing something good after all, and I get worse without it"....wrong. It's called withdrawals and readjustments. The true baseline will not be evident for a month to three months after a final dose. Everything up until that time is related to readjustment.
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> Perhaps you should clarify how you would distinguish between withdrawal rebound depression and relapse before suggesting to someone that they commit to continuing to taper medications gradually despite feeling worse.When you're already there before even attempting a taper, what difference does it make? Gotta move forward with a logical plan of action that doesn't repeat previous failures.
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> > Doxycycline has to be tried. No ifs, and, or buts, about it.
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> Why doxycycline? What might its mechanism of action be?It covers a lot of depression causing bases missed by everything else tried thus far. Wide spectrum, relatively safe, very common, intracellular. Worst case scenario....lose appetite and lose some weight. Best case scenario....feel better than in a very long time. Excellent diagnostic tool to rule in or rule out a wide variety of medical mysteries we can't see that all have one thing in common....difficult depression. The other symptoms are highly indicative of this approach.
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> > Again logic comes into play....if a boatload of psych meds have not done the trick, then something else is going on.
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> It does not follow from logic given your supposition that any one drug be indicated over another. Why not try rectal suppositories of bisacodyl? Afterall, antidepressants don't work.I don't know anything about rectal suppositories or bisacody? What is that? Antidepressants do work. From my earlier days I can attest to that. But when they don't, that's when the rules of the game change. Something else is going on. As the game changes, the player refusing to adjust will wonder why he/she continually loses over and over.
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>One definition of insanity is to keep repeating behaviors that keep failing....as in staying on certain meds despite continued deep depression and failure, and a host of other worrisome symptoms those meds are either not addressing or actually causing.
One thing that bothers me about patients piling med on top of med with crossed fingers, when the initial two or so really weren't doing much positive, is that a deep hole is dug that is extremely hard to get out of. Been there done that, several times That's why a taper in very tiny steps. And a fresh look at....what causes depression that does not respond to the most potent psych meds available? The answer to that question might sound like rocket science, but it is really pretty simple. Just completely foreign and bizarre to anyone who has only had experience within the confined limited environment of the four walls of psychiatrist's office.
But wait a minute. Parnate and Nortriptyline has got to be one of the big boy most potent depression busters out there, at least within psychobabble discussions, right? Remember the STAR*D study. Neither Parnate nor Nortriptyline did much better than anything else. Miracle meds for some, miserable failures for others, with no way to predict. With the result at hand with this patient, time to move on. Preferably with wider spectrum glasses that do not repeat previous assumptions.
As you know, Scott, I am more of a real-world guy than a clinical guy. I don't trust the clinical researchers and psychiatrists very much. Why? Because if they had the skill or merit we all pretend they do, we would all be in better shape than we are. They have no more of a clue as to what to do than you or me. We pay them $200 to make their best guess, and yet there is no accountability when we are left in the same misery we started with. No refund. the best the scientific researchers can do is give us chemicals that may or may not do anything positive, with a success rate modestly better than a spoonful of honey. Worse yet, severely compounding the problem, they do nearly zero "meaningful" diagnostic work and severely limit the types of meds to try. If it aint in the psych box, it can't cure depression....wrong wrong wrong.
Real world: When neurotransmitter manipulators of all kinds fail in a patient, that itself is highly diagnostic and provides direction for treatment.
Real world: Something relatively tame and simple like prozac plus ritalin could be a miracle. Not those specifically, but maybe, but back to basics....simpler is often better with a lot of things in life.
Real world: Try vicodin two days, hydrocodone 2 days, codeine 2 days just to see what happens. Not as a cure, but as a diagnostic tool to focus strategies. If treatment is going to be a guess, at least let's have an educated guess with definite repeatable clues pointing the way. Rule it in, rule it out, either way it is a positive.
Real world: A month on Doxy just to see what happens. It will tell a story that covers a wide area. Rule it in, rule it out, either way is positive. Diflucan worth a look too.
Just a few perfectly legitimate directions to go. But, a taper off of failed meds causing bizarre problems has to come first.
poster:bleauberry
thread:965683
URL: http://www.dr-bob.org/babble/20101009/msgs/965868.html