Posted by galtin on September 19, 2001, at 22:27:02
In reply to A Theory. - Comments? » margaret, posted by Cam W. on September 18, 2001, at 21:50:12
> Margaret - I have not seen much on a theory that I am going to talk about now, but I have wondered about this theory for a few years now, and would like anyone to comment on it; perhaps by weakening my argument, or even by strenghthening it.
>
> Many, perhaps most, people who stop a particular antidepressant (any antidepressant) and then restart it after a relapse occurs, end up having the same efficacy from the same dose.
>
> There are however a significant subgroup of people who seem to have recurrent depression, that seems to worsen upon each subsequent episode. These people need to take higher and higher doses of the same antidepressant, as was used in the previous depressive episode.
>
> I would hazard a guess that this occurs with the SSRI class of antidepressantsmore often than with other AD classes (it could be that SSRIs only seem more prevalent in these cases, because they are the ADs that are most prescribed and are used the most.
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> The mechanism that may be occurring in this subgroup of people with depression could be described as being analogous to the "kindling effect" seen in bipolar disorder. The kindling effect theory in bipolar disorder states that with every episode of mania &/or depression, the next episode comes sooner, lasts longer, and is more severe. This can and did continue until the person had to be institutionalized, for their own safety. Lifelong medication is needed in these cases, to ultimately interfere with and decrease the number of lifelong episodes. Breakthrough episodes do occur, even in those who seem to be in perfect control of their treatment modalities (eg. taking combinations medication, cognitive-behavioral therapy, social skills training, and money management courses).
>
> Could something similar be happening in this subgroup of people with depression? Could a "kindling effect" be occuring in this type of depression. I guess, if we assume that this "is" happening, then the treatment would be contiuous maintenance antidepressant therapy (maybe avoiding the SSRIs), with group, interpersonal therapies; as well as other therapy aimed at recognizing the prodromal symptoms of relapse.
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> Just some thoughts. Whaddaya think?
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> Margaret, maybe the reason that you have to take higher doses, may be becase of kindling. Perhaps a switch to Effexor™ (venlafaxine) may be a good choice; ask your doc about this. In fact, print this off for him/her, and take it in to your next appointment.
>
> Remember, at work here is only the rambling mind of Cam.
Hi Cam,The "kindling" theory fits my experience. I experienced my first three depressive episodes in my late 20s. All three were undiagnosed and they remitted on their own after six to ten months. The fourth episode did not self-remit and was eventually properly diagnosed. Over the last 20 years I have tried about a dozen A-Ds and found two--Parnate and Effexor--that work well. The others were useless.
I eventually switched from Parnate after my dosage reached 60 mgs a day. While taking Effexor I have tried to come off medication twice. I have succeeded each time, but in each case I relapsed after three or so months medication free. In addition, I had one relapse while on the meds. After each of these relapses I needed an increase of 75mgs. to recover. Thankfully, once the right dosage was reached, I got better fast--within three or four days.
My doctor believes that I will likely be on A-D meds the rest of my life. At this point, I do not need much convincing. My self-take is that genetics, plus heavy drinking in my younger years, plus several untreated episodes have worn a depressive groove in my brain into which I will always tend to slide in the absence of ongoing pharmacologic treatment. After each such slide, the groove will wear a bit wider and a bit deeper. Since my last episode 30 months inaugerated my first exposure to the local inpatient mental health unit, I have no inclination to challenge my doctor when he asks, grimly, "Why fool around with this stuff?" By which he means both depression and medication.
I am not sure, Cam, but this sounds like kindling in action.
galtin
poster:galtin
thread:79029
URL: http://www.dr-bob.org/babble/20010917/msgs/79122.html