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Performing your drug trials - some suggestions.

Posted by SLS on December 10, 2022, at 13:55:29


This is a repost of something I wrote to another member of the Psycho-Babble community along their thread. Names were changed to protect the guilty.


> All in all the trial is off to a good start.


I'm happy to hear that. I'll say a prayer or two for you. Even if there's no God, I don't see how it could hurt.

I hope this stuff helps. I think it is a healthy posture to take. It might bring you closer to discovering a successful, and possibly unique treatment. It should help to optimize your treatment trials in order to search for remission.


1. Just take the pill for a minimum of 4 weeks. If you feel even a mild, but discernible improvement at 4 weeks, go at least 2 more. If not, consider adding adjunctive medications.

2. Stop looking microscopically at how [Drug] is affecting you day by day - or even hour by hour. You will only obsess - and perhaps abort the trial prematurely. Just take the pill and forget about it. Spend your time doing normal stuff that has nothing to do with your mental illness. Reduce your visits to Psycho-Babble. Doing normal stuff is the only way you can truly evaluate your degree of improvement in mood and function.

3. Increase your brain stimulation frequently by changing your environment and performing varied - and especially novel - tasks.

4. Go for walks.

5. Perform 20 minutes of aerobic exercise at least a few days per week. Anaerobic exercise helps too, but only minimally.

6. Don't worry about the pharmacology of [Drug]. You will only obsess - and perhaps abort the trial prematurely.

7. Take the pills and live your life as best you can while in your ill state.

8. During your drug trials, use the palliative tricks that you have learned over the years to lessen the magnitude of your symptoms. Here, it IS helpful to take into consideration the pharmacology of these adjuncts and to be aware of any contraindications or important interactions with your treatment regime.

9. Be aware that starting a new drug / treatment can produce startup side effects that eventually disappear or mitigate.


* The only reasons to stop taking [Drug] that I can think of, other than for lack of efficacy, is if significant treatment-emergent adverse events (side-effects) appear that do not show a trend towards dissipating. Don't do *anything* without talking to your doctor first unless there is an urgency to act. Grit your teeth and allow your doctor to be the doctor. You are the patient, regardless of how much you think you know. Share your information with your doctor, and then take your pills.

* If you are going to perform any research at all to improve your chances of getting well, change your focus. Spend less time researching pure neuroscience and more time researching the clinical application of psychiatry. Research various treatment modalities, including medication. Study the statistics arrived at when treating a population of real people. Look for anecdotes especially those reported by authors you have confidence in.

* Just take the pills and don't give it another thought unless side effects become problematic.

Good luck!!!

- Scott


> I finally initiated [Drug] today at 5 mg/day.

> I've noticed a definite, but still modest, effect. I feel a slight improvement in mood, cognition, and attention. I am less certain about a stimulant-like effect with regard to amelioration of apathy.

I've tried to find research on the effects of [Drug] on dopamine. I did not find anything intriguing, only comments in passing about an increase in the release of dopamine and several other neurotransmitters (at least serotonin, noradrenaline, acetylcholine, and histamine).
> I found this interesting citation:
> --quote--
... Antidepressants had a positive effect on psychomotor speed ...
Of note, after removal of [Drug] from the analysis, statistical
significance was lost for psychomotor speed.


That is an EXCELLENT article, and it absolutely describes what happens to me as I approach remission. However, I might relapse by the time I finish typing this sentence. Nothing is guaranteed to work forever. Nardil often stops working after 10 years of remission. It appears outwardly as being a spontaneous relapse. However, this might actually be a result of stressing a vulnerable brain too much. It is CRITICAL that one remove as much psychosocial stress and anxiety as possible. This often requires psychotherapy. Otherwise, one may experience a "medication breakthrough" relapse.

I told the research staff at the NIH that I wanted to go to medical school. I was 33 at the time. My doctor was quite emphatic in recommending that I not try. He said that it would be too much stress on the brain. This is particularly true when a regular circadian rhythm is not maintained. Performing an internship at a hospital can require very long hours and includes swing-shifts. He said that all of this combined would almost guarantee that I suffer a medication-breakthrough relapse at some point. Remember, if you achieve remission, it will be under the conditions that you achieved it.


> All in all the trial is off to a good start.


I am glad that your initial reaction was an almost instant improvement in depression. This is what the National Institutes of Health (NIH) calls a "blip" improvement. They considered a TEMPORARY blip-improvement early in the course of a drug trial to be an optimistic sign of ultimate treatment success - although not necessarily remission.

Keep taking your pills, despite any brief blip-improvement that appears and then disappears during the first 2 week of treatment. You might have to wait 4-6 weeks to see the beginnings of a true clinical response.


- 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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