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Re: antidepressant options? - For everyone...

Posted by SLS on August 18, 2022, at 9:26:45

In reply to antidepressant options?, posted by Christ_empowered on August 17, 2022, at 20:48:43

I am reposting here what I wrote to Linkadge yesterday. I am becoming more and more convinced that too many people on Psycho-Babble are approaching treatment of mental illness too cavalierly. Antidepressants are not PRNs. Yet, many people use them that way. The time scale of PRN usage that I see is measured in weeks rather than in hours. People expect instant improvements rather than recognize that a true remission is achieved only through establishing a new, functional homeostasis with new set-points. This is a process that often takes months rather than weeks to occur. Just because one doesn't experience a perceptible improvement in response to a treatment within 3 weeks doesn't indicate that the treatment won't ultimately produce a robust, long-term healing.

Once you settle on a treatment, try to be patient while you are evaluating its value. If you give each drug trial less than 4 weeks, you will have effectively wasted years without testing a single treatment.


"I used to push an idea here over the years that different is different. It is a simple concept, but too often ignored. Many people make treatment decisions based upon the faulty notion that all SSRIs are alike and interchangeable. We now know that this is not true.

Another consideration is that humankind has likely not yet elucidated all of the pharmacological properties of every psychotropic drug. Scientists discover new properties of old drugs all the time, as is demonstrated by the repurposing of old drugs for new indications.

I made it a general rule for myself that I not be too smart and predict my reactions to drugs based upon what little man understands about the brain, pharmacology, and physiology in general. For the most part, I did not eliminate any drug from consideration based upon what I believed to be true about its properties. Even if I had, I would still not be able to account for the interindividual differences in the responsiveness to the same drug. Without the ability to explain this, we prove to ourselves that we simply don't know enough to anticipate how we will react to each drug we try. There is simply too little known to be able to predict anything.

If Paxil and Zoloft were identical simply because some human being dubbed both drugs as being "SSRIs", then why will someone respond to one and not the other? That's all you need to know in order to make rational treatment decisions if your mental illness is difficult to treat.

Different is different.

Don't exclude any possibilities by being "too smart". Linkadge, you are plenty smart, but scientists have not provided you with sufficient information to put the puzzle together.

Two last thoughts...

1. Don't "pulse" antidepressants.Your brain doesn't know what the hell is going on. It can't find anything resembling homeostasis from which to navigate gradually towards a true and persistent remission. Your brain is lost. It has no familiar starting point from which to begin its journey. I think you would be better off to no longer make frequent and abrupt changes to what you are assaulting the brain with. That includes herbs and nutriceuticals. Stop taking them. They will only confound the biological dynamics between drug and brain. Besides, they don't do sh*t for you. Try to find a combination of drugs that leaves you with a bearable depression as you give the brain time to establish a homeostasis - any kind of homeostasis. It would be great if you can do this without using an antidepressant in the interim. Taking a "drug holiday" for perhaps 2-3 months might make you much more responsive to the same drugs that had failed to produce an improvement previously.

2. You should expect that the journey from baseline depression to remission will be frustratingly gradual. Expect the journey to take a year or more once you begin to feel the beginnings of an improvement. Give a treatment 3 months to demonstrate the robustness of a response after you begin to improve. If you feel no improvement at all - zero - after 1 month, or you feel worse and can't tolerate side effects, you might be better off aborting the trial at that point. Wait at least two weeks before beginning a new treatment.



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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