Posted by Cam W. on April 21, 2001, at 12:31:21
In reply to Re: how long for effexor relief, posted by JohnL on April 21, 2001, at 5:46:45
•John -
> Yes, definitely Effexor or any med can make things worse. My views on this issue are controversial and somewhat anti-mainstream, so take them with a grain of salt or give them some thought. Your choice.
>
• If Effexor does make things worse, this would seem indicative of a different type of depression or a depression with a breakdown of some neuronal/hormonal system than most depressions. This would mean that if low dose Effexor (basically an SSRI) were to not truly be working (ie not a side effect nor a worsening of the original depression), the next step may be an antidepressant with a different mechanism of action (eg NRI like reboxetine or a noradrenergic TCA like nortriptyline or desipramine). One can prevent kindling from occurring usually by some sort of "mindset" change, by either learning better coping mechanisms or fixing the psychosocial problems that caused the depression in the first place.
>
> Total cure is an achievable goal. The secret is to find the drug that is a superior match for your unique chemistry. The only way to do that is trial and error. From what you have said in your post, Effexor does not qualify as a superior match for you.
>
• The deeper I look into the mechanisms of depression (eg glucocorticoid or second messenger system involvement) the more I am convinced that depression cannot be cured, just controlled into remission. I believe that either: a) once a certain level of stress is acheived a permanent change in the set point for which depression will reoccur is "hardwired" or b) the set point is already there due to genetics and environment and maintainng a stress level above this set point will trigger depression and since the neuronal pathway to that set point has been "laid down", it is easier for stress to reach that set point (ie sort of a kindling effect, in a way, similar to bipolar disorder). Antidepressant or drugs of any type will not "cure" any disorder. There are no cures in pharmacy.
>
> A superior match meets these criteria:
> 1) Few side effects (your body embraces the drug molecule, doesn't view it as some hostile foreign substance)
>
• You are confusing depression with an immunologic response. While immunologic changes do take place in people with depression, it is not of the sort that triggers an immunologic response (ie allergic reaction), where the body sees the drug as an antigen and produces antibodies to it. Quite the opposite happens; the body's immune response is dampened when in a depressed state. The side effects are a result of a body's unique mix of neurotransmitters, neuroreceptors, and especially neuroreceptor subtypes. Most distressing side effects of the newer antidepressants and many of the side effects of the older antidepressants do go away within the first month of use, as neuroreceptor systems are modified by a different mix of neurotransmitters being introduced into the body.
>
> 2) Some hint of good response is noticed within one day to two weeks.
>
• Some hints of good response are noticed in a week, occasionally. In the first week or two sleep and appetite are usually improved; 2 to4 weeks energy and initiative begin to return; and 4 to 8 weeks depressive symptoms begin to resolve. Many of these early effects are overshadowed by the depressive symptoms and may not be apparent to most people.
>
> Inferior matches take longer to work, if they ever work at all, have more side effects, and can actually make you feel worse. Can an inferior match go on to work well if given 8 weeks or longer? Yes it can. But why subject yourself to the torture, especially when there is no guarantee? To me, it is easier to abandon a dud drug at two weeks and start a new one than it is to continue with a dud for months.
>
• I have seen too many cases in which a person maintained on a seemingly ineffective therapy subsequently respond and respond vigorously after 8 to 12 weeks of antidepressant use. I have seen cases of OCD respond to SSRI treatment only after 4 to 5 months of use. I have seen Clozaril control very severe tardive dyskinesia only after 9 months of treamtent. In my opinion, early drug response can happen, but in very, very few cases. The response to a drug depends on how well the body can adapt to the changes the drug is trying to impose on it (ie how well the body can modifying the responsivity and perhaps number or complement of neuroreceptor and neuroreceptor subtypes.
>
> There is ample evidence, anecdotally as well as scientifically, that a portion of patients will experience a robust response in a short time. Sometimes it is a fluke, sometimes it is just misinterpreted side effects, but in most cases it is indicative of a superior match. All of my doctors were quite different, but they all agreed on one thing. That is, those patients who responded well within a short time went on to be the most successful when given more time. Those who did not respond well in a short time went on to be either only partially cured, not cured at all, or worse.
>
• Again, I beg to disagree. I follow 60+ peer-reviewed journals a month for the past 4 years and 10+/mo for 6 years before that (ah, the internet). I have seen no evidenced-based information to substantiate your claims of quick response equals better overall response. There are instances where you see a quick response, but these have not held up to prospective randomized placebo controlled trials, especially those using a placebo lead-in format. Again, I see no evidence of a "cure" but I do see evidence of remission; which, in itself is mulitfactorial, with drugs being only a part of the remission process.
>
> So I look for relatively quick responses as a guiding tool to screen out losers and focus on winners. While a conventional pdoc would have you try one drug for 8 weeks, regardless that you are feeling worse the whole time, I would meanwhile be trying 4 drugs one at a time in that same period and dramatically increase the odds of stumbling onto the superior match I'm looking for.
>
• There is absolutely no evidence for this claim and it is counter productive to the way medications truly work. I have shown photocopies Dr.Jensen's work to some of the top researchers and psychiatrists in our area and they have dismissed his claims with some very valid arguments. For more specifics than I have given above, I would have to consult my notes at work, but I am currently on disability and have been kinda banned from my office :-) . I am supposed to be resting, but that is too hard for me to do.
>
> Mainstream would say to stick it out and give it more time. But to me, Effexor has shown all the traits of an inferior match for you. Yes it can go on to work for you. But the odds for success at this point are lower than the odds would be if you tried something else instead.
>
• I would say, from my clinical experience and from evidenced-based medicine and peer-reviewed journals that the Effexor should be given a chance to work. Increasing the dose of Effexor, under the watchful eye of a good doctor, shows increasing effect over a very wide range of dosages. This is unlike the SSRIs which plateau at a certain dose and little or no more effect is seen by increasing the dose.• The above is my opinion based on my work in the mental health field and will change or be modified as new "scientific" evidence is produced. As of now, I believe that a vast majority of what I have said is how most researchers see the current state of affairs in psychiatry. - Cam
poster:Cam W.
thread:60638
URL: http://www.dr-bob.org/babble/20010417/msgs/60689.html