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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Phillipa on April 7, 2010, at 12:29:47
What do you think of this seems to be the new trend too. But what if your're already on an ad? Even if it's lower dose think this will work? It's very short. Please respond. I feel others would benefit as well as myself with this Phillipa
How should doctors dose antidepressants? Thomas Schwartz, MD N/A posted:
You can also advocate for yourself once you know this.
1- start at a dose lower than that usually advocated by the FDA. Do this for a few days to get your body and brain used to it in order to hopefully lower your side effect risks
2- increase and take the lowest FDA dose for 4-6 weeks
3- if you are not better increase to the middle dose for 4-6 weeks
4- if you are not better increase to the highest FDA dose for 4-6 weeks.if you and your doctor accomplish this then you have had a 'full trial' of the antidepressant. If the full trial has failed, ask your doctor for another similar trial ideally of an antidepressant to works on a different set of neurotransmitters. Do not stay on the same low dosed antidepressant for several months if it is not helping....
Posted by manic666 on April 7, 2010, at 13:32:48
In reply to Start AD's at lower than FDA starting Dose, posted by Phillipa on April 7, 2010, at 12:29:47
thats an 18 week trial //even i dont go father than 12weeks
Posted by tensor on April 7, 2010, at 16:46:08
In reply to Start AD's at lower than FDA starting Dose, posted by Phillipa on April 7, 2010, at 12:29:47
> What do you think of this seems to be the new trend too. But what if your're already on an ad? Even if it's lower dose think this will work? It's very short. Please respond. I feel others would benefit as well as myself with this Phillipa
>
> How should doctors dose antidepressants? Thomas Schwartz, MD N/A posted:
> You can also advocate for yourself once you know this.
> 1- start at a dose lower than that usually advocated by the FDA. Do this for a few days to get your body and brain used to it in order to hopefully lower your side effect risks
> 2- increase and take the lowest FDA dose for 4-6 weeks
> 3- if you are not better increase to the middle dose for 4-6 weeks
> 4- if you are not better increase to the highest FDA dose for 4-6 weeks.
>
> if you and your doctor accomplish this then you have had a 'full trial' of the antidepressant. If the full trial has failed, ask your doctor for another similar trial ideally of an antidepressant to works on a different set of neurotransmitters. Do not stay on the same low dosed antidepressant for several months if it is not helping....Overkill and overgeneralization. Fluoxetine and reboxetine don't need same startup time, for instance. Side effects are useful indicators in my opinion if you're going too slow or too fast.
/Mattias
Posted by linkadge on April 7, 2010, at 16:52:57
In reply to Start AD's at lower than FDA starting Dose, posted by Phillipa on April 7, 2010, at 12:29:47
Yes, I recomend half (or less) of the usual theaputic dose. Some studies show that half doing in clinical trials lead to virtually identical remission rates (a wee bit lower), without many of the side effects.
Linkadge
Posted by bleauberry on April 7, 2010, at 17:01:12
In reply to Start AD's at lower than FDA starting Dose, posted by Phillipa on April 7, 2010, at 12:29:47
I disagree with two views shown in this:
1. That the FDA is somehow some kind of god that knows best. It isn't.
2. That there is any kind of predetermined dosing schedule appropriate for general use. There isn't.
In general, side effects are a good guide.
I've said it many times, but it deserves repeating once again just in case anyone missed it. My doctor has patients doing well on mere drops of lexapro liquid. One drop is 1/10th of a milligram. Other patients maybe on 1mg to 5mg, all starting with one drop per day, increasing as tolerated by taking multiple drops throughout a day. The ending dose is not known and no pretense is made to try to predict a target dose. Can't be done.
Everyone is different and everyone needs to do whatever schedule suits them the best. For some it will be extremely conservative, some inline with the norm, and some very aggrressive. It all depends on different factors involved with that person's life and biochemical response to that medicine.
Posted by ed_uk2010 on April 7, 2010, at 17:20:39
In reply to Re: Start AD's at lower than FDA starting Dose » Phillipa, posted by tensor on April 7, 2010, at 16:46:08
I think that low initial doses are useful for people who've not taken ADs before eg. if someone has never taken an SSRI, I would suggest a low starting dose. Some people suffer severe reactions. For someone who has previously tolerated the same (or a different) SSRI, I would recommend the standard starting dose.
Posted by Katgirl on April 7, 2010, at 17:32:42
In reply to Re: Start AD's at lower than FDA starting Dose, posted by bleauberry on April 7, 2010, at 17:01:12
I totally agree with this. Years ago I was started on a full dose of Paxil, when it turned out I could function just fine on 5mg or less and lived for years on much less than 2mg of the liquid while tapering off. (I even had to water down the liquid!!)
I am now exceedingly sensitive to medication side effects, but it also doesn't take much to treat me if I could find something I tolerate.
bleauberry, I'm astounded you have found a pdoc that will treat people at those low levels. I get treated like a crazy hypochondriac by both regular and pdocs when I try to explain my sensitivity to drugs and the low doses I want to try. I am always asking if things come in liquid form so I can lower the dose. You must have a really good doc!!!!!!
Posted by Phillipa on April 7, 2010, at 20:02:57
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Katgirl on April 7, 2010, at 17:32:42
I have noticed my pdoc always prescribes a low dose of an ad now and in the past she didn't. Hence the question. I too feel sometimes lower doses help a patient stick to a med if they are not suffering with side effects. My past history I became med phobic from pdocs giving to high of doses the recommended started doses. So many trials aborted due to this. Phillipa
Posted by Zyprexa on April 8, 2010, at 0:48:56
In reply to Start AD's at lower than FDA starting Dose, posted by Phillipa on April 7, 2010, at 12:29:47
I agree with not taking it for a long time if its not helping fairly quickly. But don't agree with starting at a very low dose.
Posted by manic666 on April 8, 2010, at 3:18:49
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Zyprexa on April 8, 2010, at 0:48:56
yes i remember my first ad just ///prozac at 20mg an i was ill but i stuck it out an it worked //but i never went higher than the 20 mg so if they had started me on 10mg for the fist week would have helped instead of turning me into a wreck even more for 10 weeks///have i read this wrong but the thread to me is a trail of 18 weeks far to long a slow biuld up.
Posted by tensor on April 8, 2010, at 3:20:42
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Phillipa on April 7, 2010, at 20:02:57
> I have noticed my pdoc always prescribes a low dose of an ad now and in the past she didn't. Hence the question. I too feel sometimes lower doses help a patient stick to a med if they are not suffering with side effects. My past history I became med phobic from pdocs giving to high of doses the recommended started doses. So many trials aborted due to this. Phillipa
This is why it is important to educate yourself in the subject. Too many people are just taking whatever the doc is prescribing without a question, one need to propose own ideas and be allowed to participate in the process of med choices and their doses. Recently read about a girl in Sweden who had been prescribed antipsychotics for many years for mild insomnia, she now has possibly permanent movement disorders for something that could have been treated with a BZD. Now, when she has read about insomnia and its treatments she is of course very angry and upset.
Unfortunately not everybody can educate themselves due to the nature of the illness./Mattias
Posted by Katgirl on April 8, 2010, at 8:13:44
In reply to Re: Start AD's at lower than FDA starting Dose, posted by manic666 on April 8, 2010, at 3:18:49
Phillipa- I'm glad you have a pdoc who is taking your needs into consideration!
Posted by manic666 on April 8, 2010, at 13:05:38
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Katgirl on April 8, 2010, at 8:13:44
thats why in the nhs //it is rare to get a real slant on your illness //your given 1 med a time to try//its to complicated for the under educated third world p.docs who have the basic of info at disposal//a lot are locoms that chase the money an never stay long enough to get to no a patient//that an a 3year waiting list to see the nobs//your gp is as far better bet in england//i mean i had hundreds of glareing probs when young that were never followed up //,to this day no one has sat me down an said you have this or that illness, //not even after hospital mental ward inmate where i was treated as invisable.if your not trying to jump out a window, you left to fend for yourself/// 2 days after overdoseing i was aloud out on my own to walk half a mile to a superstore //there has been a lot that never came back an i dont mean went home
Posted by bleauberry on April 8, 2010, at 17:18:26
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Katgirl on April 7, 2010, at 17:32:42
> bleauberry, I'm astounded you have found a pdoc that will treat people at those low levels. I get treated like a crazy hypochondriac by both regular and pdocs when I try to explain my sensitivity to drugs and the low doses I want to try. I am always asking if things come in liquid form so I can lower the dose. You must have a really good doc!!!!!!
Well, he isn't an antidepressant specialist or a pdoc. He deals with a specific patient group where drug sensitivity, bizarre reactions, and depression happen to be the norm. In his office, everyone is like you and me.
Most doctors would view me or you as weirdos, lightweights, or hypochondriacs as their only way to defend against their own ignorance. Ya know, point the finger at someone else rather than admit you don't know or admit you aren't on the cutting edge.
They should be better versed on depression-related diseases than they are, and what some of the tell-tale clues are. It isn't rocket science. There are pamphlets and magazines readily available with all this kind of information for them.
Who are these patients? They all have Lyme disease. Exquisite sensitivities are the norm in this group, to drugs, herbs, vitamins, and yes even certain foods. This doc is not a depression specialist, but a Lyme specialist. It just so happens that he sees and recognizes things that would otherwise confound a pdoc who should be well versed on Lyme, but isn't.
There is a pamphlet titled "What Every Psychiatrist Should Know About Lyme Disease." I wonder how many are familiar with that disease or any other that causes depression? Probably very few. Sad. To be paid so much money and to be so out-of-the-loop with their field.
I should mention that Lyme is certainly not the only cause for "bizarreness" you, me, and others' experience in our drug trials. There is previous ssri usage, candida issues, intestinal wall issues, and a few others.
Off the topic, but another interesting note about him is that in his experience he has had a great deal of trouble with generics. So in most cases he will not even prescribe them. He is a brand-only doc and will go to bat with the insurance provider to make it happen if they refuse.
Posted by Phillipa on April 8, 2010, at 19:20:10
In reply to Re: Start AD's at lower than FDA starting Dose, posted by manic666 on April 8, 2010, at 3:18:49
Manic no you read it right. I'm assuming the docs were confident that the med would work and maybe the patient had some positives from the lower dose and was upping to find the right dose. But that is a long time. Phillipa
Posted by Katgirl on April 10, 2010, at 9:43:09
In reply to Re: Start AD's at lower than FDA starting Dose » manic666, posted by Phillipa on April 8, 2010, at 19:20:10
Very interesting Bleauberry. (Although it doesn't surprise me that this wasn't a pdoc!) I have been tested for Lyme's disease, and it came up negative. I was almost relieved, because I don't know how I would have made it through treatment with doxycycline (or whatever big gun antibiotic they use). And YES I have sensitivities to vitamins. I actually haven't been able to take them even before paxil withdrawal, mainly due to stomach upset. Now that I am gluten free, I am hoping my GI improves enough to try different things again.
Posted by Laney on April 10, 2010, at 13:02:20
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Katgirl on April 10, 2010, at 9:43:09
Kat,
I would love to chat with you about your experiences with paxil and it's withdrawl and what you've done that's made the biggest difference. And what this treatment is that you've done? Can't remember right now what you called it.
Thanks,
Laney
Posted by Katgirl on April 10, 2010, at 13:56:14
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Laney on April 10, 2010, at 13:02:20
Hey Laney-
I babbled you about how I went about my final taper.
Unfortunately, my best advice for you would be to stay on the Paxil. I certainly wish I had. I have lost the last six years of my life to the consequences of stopping the medication.
Take care! Kat
Posted by bleauberry on April 10, 2010, at 14:39:39
In reply to Re: Start AD's at lower than FDA starting Dose, posted by Katgirl on April 10, 2010, at 9:43:09
> Very interesting Bleauberry. (Although it doesn't surprise me that this wasn't a pdoc!) I have been tested for Lyme's disease, and it came up negative. I was almost relieved, because I don't know how I would have made it through treatment with doxycycline (or whatever big gun antibiotic they use). And YES I have sensitivities to vitamins. I actually haven't been able to take them even before paxil withdrawal, mainly due to stomach upset. Now that I am gluten free, I am hoping my GI improves enough to try different things again.
Hi Kat,
I hate to spoil the party. It pains me. But it has to be said. Your negative test for Lyme means NOTHING. Absolutely nothing. It doesn't mean you don't have lyme and it doesn't mean you do. It is a worthless indicator. Long story. Trust me. Lyme disease is a clinical diagnosis...history, symptoms, and presentation. It is not a lab diagnosis because there are no lab tests that are accurate. The lab tests we use were designed by the CDC for regional surveillance (where error will not hurt the overall picture very much), not for individual diagnosis (where error will impact your life like a nuclear bomb.)
No way to know at this point. The symptom profile and history seems to fit. In my humble opinion, the chapter on Lyme disease in your life is still open.
I can't tell you how many thousands of people went on to suffer grueling lives of MS, arthritis, depression, ill health of all kinds, because one single lab test said "Lyme-negative".
It reminds me of a judge sentencing an innocent prisoner to a life of solitairy confinement based on one piece of disputable evidence that is falsely assumed to be authentic fact.
Those same people went on to recover amazingly when for one reason or another (usually a different doctor) they were put on antibiotics or herbs.
Just throwin it out there. People should know, regardless of what they do with the knowledge. Awareness is key.
Posted by Dr. Bob on April 11, 2010, at 7:41:42
In reply to Re: Start AD's at lower than FDA starting Dose, posted by bleauberry on April 10, 2010, at 14:39:39
> No way to know at this point. The symptom profile and history seems to fit. In my humble opinion, the chapter on Lyme disease in your life is still open.
Sorry to interrupt, but I'd like to redirect follow-ups regarding Lyme disease to Psycho-Babble Health. Here's a link:
http://www.dr-bob.org/babble/health/20100104/msgs/943048.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there. Thanks,
Bob
This is the end of the thread.
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