Posted by fido on February 23, 2015, at 15:39:36
Hi,
I read a book written by a psychiatrist about treatment resistant cases. The book contains all kind of reports from hard cases which the author (Swiss Psychiatrist) treated as patients.
I actually thought that this book would be encouraging cause the title said that it's about supposedly treatment resistant cases.Anyway, what really dragged me down is that the author described the diagnosis of the patients, the drugs which were being tried out and what doses was used and also how they progressed. And many of the patients basically went from one antidepressant to the next one. All the time they were adjusting doses and raising doses and measuring the serum concentration of the antidepressant. The psychiatrist kept these patients in very close touch and he intervened much more often than a normal psychiatrist would do it.
This is already discouraging cause my psychiatrist tells me to take a certain dose and then I see him again in 8 weeks. But this is a very long time and if I don't make progress then he will say raise the dosage further and then I see him in another 8 weeks.
But the author raised dosages much faster and always kept track of wether the patient improved or not.
Many times the serum levels of the antidepressants were so low that he had to use ultra high doses, like for example one patient was on 2000mg fluvoxamine!!!Anyway, what really got to me was that many of the patients ultimatively did not really get well. It was always an up and down. Many times it seemed like the patient was doing much better only to get a relapse a few months later and suddenly the old drugs didn't work anymore!
This is really discouraging. I dont know how often this happens but when I think about that even IF you find a drug which actually works (which is already very difficult) and then it might only work for a short time then this is totally discouraging. :(What also really surprised me is that the author almost in all cases used mood stabilizers like lithium even in patients without bipolar depression!
It sounded like without mood stabilizer it's not possible to stay stable over a longer period.Now I'm unsure what to think. Does this mean everybody with strong unipolar depression should take an antidepressant and mood stabilizer?
What was also interesting is that the author also frequently used ritalin in patients without adhd which had low energy as a side effect of antidepressants. This seems very uncommon.
poster:fido
thread:1077033
URL: http://www.dr-bob.org/babble/20150223/msgs/1077033.html