Posted by policebox on August 18, 2011, at 20:32:17
In reply to What to say to a doctor that avoids medication, posted by rjlockhart04-08 on August 18, 2011, at 17:38:53
Although it can be frustrating for us as a patient, I think it is the correct course of action when beginning anti-depressant drug treatment with someone, to start with the medications that treat the depression and are also the safest (when I use the word "safest" I mean whose side effects are the most tolerable and that taking the medications aren't complicated).
This is going to be the SSRI class of medications most frequently. If one of those doesn't work, it's generally prudent to try another SSRI. If monotherapy on an SSRI fails, then it's generally prudent to try to augment the SSRI with another drug.
If after these trials the depression fails to satisfactorily remit, that's when I'd say it's time to try Wellbutrin as an augment to the SSRI.
Typically after trying a few things involving Wellbutrin, if the depression fails to remit, one of the tricyclic/tetracyclic antidepressants should be tried. Again, as with the SSRIs, there are several tricyclic/tetracyclic drugs to choose from, so you will want to try one or more of these, along with augmenters, to see if you can get the depression to remit.
If that fails, it's appropriate to then begin a trial on one of the MAOis. Again, there are several of these, so it's worthwhile to try one or more.
To jump right into an MAOi is akin to trying to kill a fly with a cannon. Also, wanting to jump right in at a maximum dosage isn't a good idea. "More" does not necessarily translate into "better". There are many drugs which are actually less effective at high doses than lower doses. Plus, increasing the dosage too rapidly can contribute to the medication failing to work or working for a while and then "pooping out".
I understand that when you don't feel well and you feel life kind of slipping away, the urge is to try to fix things as soon as possible. Unfortunately, psychiatric medicine is still in its infancy. It has some powerful tools at its disposal, but much of it, like all branches of medicine, is a guessing game. My advice is to try to be as patient as possible and give every new medication combination a fair trial, meaning at least a month. If the medication helps your depression, but you are experiencing side-effects that are tolerable, then try to stick it out that whole month. Generally the side-effects will go away as your body gets used to the drug. If not, there might be augmenters you can add to treat them. Of course, if you suffer any life threatening or dangerous side-effects, you should consult your doctor immediately.
I wish you all the best.
Policebox
> Alrighty. I think I see my doctor in week or 2 weeks. The strattera she prescibed me is not working. I am still going to give it 2 more weeks but I really am disappointed that I am treatment-resistant with alot of medications. The only ones that do work are Wellbutrin and Stimulants. I'm going for the wellbutrin in this next session and I have to be aware that she may say no. But what should I say to a doctor that believes wellbutrin can give me anxiety and is maybe not the correct medication for my condition in this case.
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> I already her about Parnate and she told me its very old medication that is usally used at the last ends of antidepressants. And it's complicated because you can't eat many foods and it has side effects that are serious. SO...all I have to do is just talk her into it. But I'm not going for Parnate. I'm going for Wellbutrin at its max dose. It's gonna be difficult but what should I say to her? I've been thinking about this for a long time.
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> Just some tips of what I should say in session. Rerember this doctor is stuborn and avoids many medications. Yes, I will dump her in time but she's my doctor right now.
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> Thanks for anything.
>
> Matt
poster:policebox
thread:994232
URL: http://www.dr-bob.org/babble/20110809/msgs/994249.html