Psycho-Babble Medication | about biological treatments | Framed
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I am reposting something I wrote to Linkadge.

Posted by SLS on July 9, 2021, at 22:21:03

> Yeah, I could never get that high on venlafaxine. I found 75mg very hard to tolerate. Interestingly, I found nortriptyline helpful too. Unfortunately, I stopped it (for some stupid reason and relapsed).

I am SO sorry, Linkadge. You couldn't have known.

So many psychiatrists still adhere to a protocol of a time-limited course of antidepressant therapy. Some psychiatrists change someone's treatment regime on the patient's very first visit, even if they are doing well. I'm not sure that adhering to a "school of thought" is always in the patient's best interests. Both diagnosis and treatment need to be flexible in mental illness. The brain is just too complex to be treated by a monolithic school of thought. "Life charting" sometimes finds a pattern.

A friend of mine who suffered from chronic depression for years finally achieved remission and remained well for about 8 years. The only drug she was taking was lithium. When she moved from North Carolina to California, she found a local psychiatrist. The first thing he said was that she was on lithium long enough and that he wanted her to discontinue it. She did. Three weeks later, she relapsed. When the lithium was restarted, it didn't work at all. It couldn't "recapture" the antidepressant response. She descended into a severe and treatment resistant depression that has lasted for 32 years so far. My guess is that she has a bipolar diathesis, despite her unipolar presentation. Some diagnostic models include depression-only as a subtype of bipolar disorder. With all of the focus and advertisements for Latuda to treat bipolar depression, they never mention mania. I wonder just how common depression-only bipolar disorder really is - where not a single manic episode has occurred.

My presentation is of a chronic severe (treatment-resistant) depression with no history of spontaneous mania. However, I have been severely delusionally and/or psychotically manic as a reaction to taking medication on a handful of occasions. All of them were in association with an MAOI - both Parnate and Nardil. This presentation is described in the DSM-5 as being bipolar with drug-induced mania as a qualifier.

Right now, I'm having trouble maintaining an optimal antidepressant response to Nardil at any one dosage. I might be forced to take 90 mg/day on most days with taking 105 mg/day twice a week. My doctor has another patient that did this with. I have never read nor heard anything indicating that there was a dosage window for Nardil as there is for nortriptyline. I actually lose a qualitatively robust response when I remain at 105 mg/day for longer than 5 consecutive days. Overall, my conscious experience is dramatically different in some ways and very familiar in others. It has changed my life. It is now fun to participate with others and be in control in almost all situations. I don't really have that many years left at this point. I know 61 sounds young by modern standards, but my adolescence and adulthood were stolen from me. They didn't exist but for both pain and numbness every waking moment. Your stories are probably not much different.

At age 61, I am absolutely blessed to be able to spend any time at all in my life experiencing a normal human state of conscious. For some reason, no one uses the phrase "an altered state of consciousness" to describe mental illness. I have for quite awhile. My doctor hasn't warmed up to the idea yet. I have become adamant in my use of this phrase. It adds a realness to how the mentally ill experience existence. Being intoxicated with alcohol is a purposeful alteration in one's state of consciousness. It is manifestly true. The strategic use of words can help mitigate stigma and promote understanding.

Does anyone else find the phrase "altered state of consciousness" to be an accurate characterization of their illness?

I think I can now live out my years with intellectual and emotional exploration, adventure, and lots of sex. However, this does not come without a sense of guilt. I wish I could take you all along with me.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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