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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Tom Twilight on April 16, 2006, at 16:21:19
Hi everyone
Not going to write at great length, because I feel terrible.......
Anyway I live in the UK
My GP told me that I have to be on an AD for over six months (preferably longer!) to know whether it will work or not
Surely this is wrong
I would have thought that twelve weeks at Max dosage would be sufficient?
Also if a patient isn't improving after a reasonable length of time then it might be more dangerous to not change their medication
These are just my thoughts
Any opinions?
Posted by blueberry on April 16, 2006, at 17:15:12
In reply to How Long is a Fair Trial for an AD? Please Advise, posted by Tom Twilight on April 16, 2006, at 16:21:19
Tom, I feel so bad for how you are feeling. Just know that you are not the only one who feels trapped. I just prayed to God for you.
The most recent scientific data on antidepressant trial times...
Studies are now showing that those patients who show a decent response in the first 2 weeks are the ones that have the highest probability of reaching remission. The others can also improve with longer time, but the odds are strongly in favor of the early responders versus the non-early responders.
On the other hand, a recent 6 year study of thousands of patients showed that 12 weeks was the optimum time to judge effectiveness. Many patients who had not responded at 8 weeks did respond by 12 weeks. One of the major findings of the study was that doctors give up too quickly at 4 - 6 weeks.
But when your doctor says 6 months, that is just plain not backed up. I mean, sure, you would probably be better at 6 months than at 12 weeks, assuming a decent response was already underway. If you get to 12 weeks and things are bad, it is time for a switch or an add-on.
What meds have you already tried? What was good or bad about them? What choices are on your mind right now?
Posted by bipolarspectrum on April 16, 2006, at 17:17:49
In reply to How Long is a Fair Trial for an AD? Please Advise, posted by Tom Twilight on April 16, 2006, at 16:21:19
Hi,
I could not agree with u more... it may be helpful to know exactly what medication your on.. but in general, for ssris and the like, i think its somewhere in the range of 6-8 weeks is a great trial... whereas this is lower for the bipolar medications, like lithium, and what have you... but I'm in full agreement that leaving a patient on a non-useful medication for a long period of time is doing nothing but prolonging suffering... I think the issue here is that ur being treated by a GP.. My mom is a GP and i know for a fact that she does have an adequate knowledge of psychiatric medications... Find yourself a good pdoc!
bps> Hi everyone
>
> Not going to write at great length, because I feel terrible.......
>
> Anyway I live in the UK
>
> My GP told me that I have to be on an AD for over six months (preferably longer!) to know whether it will work or not
>
> Surely this is wrong
>
> I would have thought that twelve weeks at Max dosage would be sufficient?
>
> Also if a patient isn't improving after a reasonable length of time then it might be more dangerous to not change their medication
>
> These are just my thoughts
> Any opinions?
Posted by Racer on April 16, 2006, at 18:14:25
In reply to Re: How Long is a Fair Trial for an AD? Please Advise, posted by bipolarspectrum on April 16, 2006, at 17:17:49
First, I think Tom Twilight is seeing a GP because the NHS has a ridiculously long wait to see a pdoc. I'm doubting that he's seeing a GP by choice. (And my understading is that it's very, very difficult to see a pdoc self-pay over there, too, as well as very expensive.)
Anyway, I'm in total agreement with everyone else: 6 months is absurd.
What I've read, which isn't as up to date as what blueberry seems to have found, is that there should be *some* benefit within about 3 to 4 weeks. That doesn't have to mean full remission, it just means that something good should be happening to continue the trial. Even minor benefit in that time frame should mean giving it a longer trial.
At that point, if there's any benefit whatsoever, either increasing the dosage or augmenting with another medication are probably appropriate.
And it's probably only worth sticking it out for six months if there is significant improvement.
So, Tom, how long have you been on what? And I'm very sorry you're having such a rough time of it.
Posted by ed_uk on April 16, 2006, at 18:37:28
In reply to How Long is a Fair Trial for an AD? Please Advise, posted by Tom Twilight on April 16, 2006, at 16:21:19
Hi Tom,
In the treatment of depressive illness, I would not recommend continuing an antidepressant if there had been *no* benefit after 6 *weeks* at a *reasonable dose*.
If there had been *no benefit at all* after 4 weeks (at a high dose), I would consider trying a different medication. If there had been some benefit, waiting a couple more weeks could be a good idea.
In the treatment of anxiety, response to ADs can take longer. 8 weeks at an appropriate dose may be required to obtain substantial benefit.
In the treatment of OCD, up to 12 weeks at a *high* dose of an SSRI may be necessary to assess the benefit.
>My GP told me that I have to be on an AD for over six months (preferably longer!) to know whether it will work or not
That sounds dumb to me. UK docs tend to say things like this because they can't think of anything else to prescribe. Of course, if you wait long enough, many people will spontaneously get better! :)
>I would have thought that twelve weeks at Max dosage would be sufficient?
Definitely. Waiting longer than 12 weeks would not be appropriate in your case. I am certain of that.
Warm regards
Ed
Posted by Phillipa on April 16, 2006, at 23:18:34
In reply to The joys of NHS, huh?, posted by Racer on April 16, 2006, at 18:14:25
I've been told from 4-6 weeks should show improvement and startup effects to be gone. Love Phillipa
Posted by bipolarspectrum on April 17, 2006, at 10:55:59
In reply to Re: How Long is a Fair Trial for an AD? Please Advise, posted by bipolarspectrum on April 16, 2006, at 17:17:49
Sorry everyone,
I meant to say that my Mom the GP (in Canada) does NOT NOT NO WAY have an adequate clinical background and knowledge in psychiatric medications...> Hi,
> I could not agree with u more... it may be helpful to know exactly what medication your on.. but in general, for ssris and the like, i think its somewhere in the range of 6-8 weeks is a great trial... whereas this is lower for the bipolar medications, like lithium, and what have you... but I'm in full agreement that leaving a patient on a non-useful medication for a long period of time is doing nothing but prolonging suffering... I think the issue here is that ur being treated by a GP.. My mom is a GP and i know for a fact that she does have an adequate knowledge of psychiatric medications... Find yourself a good pdoc!
> bps
>
> > Hi everyone
> >
> > Not going to write at great length, because I feel terrible.......
> >
> > Anyway I live in the UK
> >
> > My GP told me that I have to be on an AD for over six months (preferably longer!) to know whether it will work or not
> >
> > Surely this is wrong
> >
> > I would have thought that twelve weeks at Max dosage would be sufficient?
> >
> > Also if a patient isn't improving after a reasonable length of time then it might be more dangerous to not change their medication
> >
> > These are just my thoughts
> > Any opinions?
>
>
Posted by Tom Twilight on April 17, 2006, at 16:59:04
In reply to The joys of NHS, huh?, posted by Racer on April 16, 2006, at 18:14:25
Hey everyone
Excuse the language
Firstly I'm really grateful to all who responded!
Does anyone have any clinical evidence I could use to back up my arguments that 12 weeks at Max dosage is a fair trial for an AD?
Unfortunatly Racer is absolutely right I'm seeing my GP who is good by UK standards, but knows little about mental health care.
You have to wait months to see a Pdoc on the NHS
When you do see them their usually no good anyway.....
> Anyway, I'm in total agreement with everyone else: 6 months is absurd.
>
> What I've read, which isn't as up to date as what blueberry seems to have found, is that there should be *some* benefit within about 3 to 4 weeks. That doesn't have to mean full remission, it just means that something good should be happening to continue the trial. Even minor benefit in that time frame should mean giving it a longer trial.
>
> At that point, if there's any benefit whatsoever, either increasing the dosage or augmenting with another medication are probably appropriate.
>
> And it's probably only worth sticking it out for six months if there is significant improvement.
>
> So, Tom, how long have you been on what? And I'm very sorry you're having such a rough time of it.
Posted by Racer on April 17, 2006, at 20:57:26
In reply to The joys of NHS, huh? Damn Right!-Thanks All!, posted by Tom Twilight on April 17, 2006, at 16:59:04
>
> Does anyone have any clinical evidence I could use to back up my arguments that 12 weeks at Max dosage is a fair trial for an AD?
>I know I've come across some articles in professional journals about drug protocols... I just spent a few minutes looking to see if I'd saved the one that looked best to me, but no joy. Try looking on the NHS site, or the British psychiatric association (I don't know what it's called). One of them might have a protocol for how long to stay on a drug before making changes. I know I looked at places like Psychiatric Times, and other journals with some free articles, and I found what I think is exactly what you want: a step by step protocol for trying drugs.
I'm sorry I couldn't help more, but it does exist. Maybe that helps motivate you to look for it? I'll google it later, if I get some energy together.
Posted by ed_uk on April 18, 2006, at 16:50:02
In reply to The joys of NHS, huh? Damn Right!-Thanks All!, posted by Tom Twilight on April 17, 2006, at 16:59:04
>Does anyone have any clinical evidence I could use to back up my arguments that 12 weeks at Max dosage is a fair trial for an AD?
Just tell him to look in the BNF :) He will have one on his desk. It suggests that young adults respond in 4-6 weeks, but the elderly may take a bit longer.
Regards
Ed
This is the end of the thread.
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