Posted by bleauberry on July 20, 2009, at 18:52:55
In reply to Re: to all of you » Jeroen, posted by yxibow on July 20, 2009, at 2:52:29
I totally agree with yxibow.
As I've said several times, I stand behind my insistance that an antipsychotic alone, or even a combination of them, is going to fall way short of the goal line. Spend a few dozen hours roaming through pubmed on this topic and it becomes clear that one of the best family of meds to look at for patients in Jereon's category are the TCAs+antipsychotic. Of course, the TCAs are all quite different. So as with antipsychotics, several need to be tried if a first one goes poorly.
In Jereon's case I think there are three factors of importance at play:
1) Not enough time on any particular medication or combination. Understandable though. If it is going poorly, we often have no choice but to drop out. If it is going so poorly in the early weeks to cause a drop out, either the dose management was too aggressive or the stuff was never going to work anyway. I have never ever seen anyone start off a treatment that went really bad and then it turned into a miracle. Never.
2. Medication choices have been good in the antipsychotic department, but very poor in other categories. The TCAs for example have been completely ignored. Very strange, considering those are the ones in case studies that supplied the missing link.
3. The diagnosis is questionable.
Back to the original thought by yxibow, when someone is ill for as long as Jereon has been, it will take time on a steady med combination to get there. The trick is to first find the medications that can be tolerated, and to use medications that have worked for other people with like histories. And to take a second look at the diagnosis, or even better, get a fresh second opinion from someone else.
> > nothing is going on im still an inpatient, but im affrai to take Sertindole because i might have cardiac disease
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> As I noted, Mellaril is much more likely to cause QTc elongation.
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> Nevertheless, I also said that Sertindole was not approved in the US eventually because it does have some risk of QTc elongation greater than those in its class.
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> Geodon also has QTc elongation risk, but was approved here because the chance was reexamined to be less than 1/4000.
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> Yes, when faced with a choice of a medication it is always a choice whether the benefits will outweigh the risks.
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> Is there any heart disease or defects in your family ? Have you ever had a heart murmur?
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> An EKG should be performed before starting the agent. It should also probably be used periodically (not obsessively... in terms of months perhaps) to check on how it works.
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> But it all comes down to this... and don't think I'm trying to be mean....
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> I know you've been struggling with things for a long time....
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> but with an antipsychotic, even if in some people there is a noticeable difference in as little as a few weeks, it takes several months to really notice a difference...
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> I'm concerned that fears may have led to stopping medications before they had a chance to work. Yes, I know that Clozaril made you extremely lethargic and had some bad effects --- this is common in a lot of patients.
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> The question is... which one to keep an open mind on, at least for a month or two.
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> Now I'm not asking you to endure undue harm or a terrible situation, that would be Schadenfreude... but give things a reasonable chance.
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> -- good luck
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>
> -- tidings
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> Jay
poster:bleauberry
thread:907243
URL: http://www.dr-bob.org/babble/20090709/msgs/907655.html