Posted by JohnL on February 26, 2003, at 7:40:30
In reply to Is diagnosis important ?, posted by White Stone on February 25, 2003, at 15:06:30
This is just my opinion, but I do not believe a diagnosis is all that helpful when it comes to actually choosing medication.
A patient with lifelong anxiety failed every med on the planet. But a small dose of Lithium, as a last resort, completely cured the patient within 24 hours. That was an electrical instability problem that got fixed. Lithium has no place for treating anxiety, but it worked.
Certain populations of depressed patients actually get worse on antidepressants. They get better instead on antipsychotics. In the meantime, they suffered for years because the doctor was only treating them with antidepressants because the diagnosis was depression. The diagnosis and the fix did not jive.
There are hundreds and thousands of such examples. I think a diagnosis is a good place to start, but that's about it.
A better way, in my opinion, is to gather clues from medication trials. For example, someone with anhedonic depression might just remain anhedonic but numb on SSRIs. If that happens to them, then it could be a clue that targeting dopamine and/or norepinephrine might work better than serotonin. And so on.
Obviously brain chemistry is very complicated. But I believe each medication we try gives us important clues that can help decide what the next medication should be, and that this approach will get the patient well faster than trying to stay in a rigid plan where the med has to fit the diagnosis.
> I have definite symptoms from several different disorders; among them are post-traumatic stress syndrome, obsessive-compulsive, bipolar, and GAD. The GP doctor first tried attacking the depression (Effexor and Zoloft) and now has prescribed an antipsychotic (Zyprexa) for the possible bipolar. He hasn't really given me a diagnosis past depression and anxiety. He seems to be trying to arrive at a more conclusive diagnosis based on how the medications effect my symptoms. Is this normal? Is a diagnosis important? Wouldn't it be more helpful to me to have a diagnosis so I could learn everything I could about what he suspects is wrong with me?
>
> Any comments would be appreciated.
poster:JohnL
thread:203746
URL: http://www.dr-bob.org/babble/20030224/msgs/203951.html