Posted by blueberry1 on January 15, 2007, at 16:10:20
In reply to Stims vs conventional ADs, no crashing, AD theory » laima, posted by psychobot5000 on January 15, 2007, at 15:12:56
I say give the patient a stimulant sooner rather than later. It offers the potential of immediate benefit vs a 6 week wait. If it doesn't work in 1 week, forget it. No big loss of time compared to switching or starting antidepressants.
It also takes the whole overlap theory stuff between ADHD, ADD, anxiety, and depression off the table. Either the stim will help the patient or it won't, plain and simple. Most important, win or lose, it is a FAST trial. Even the most ill patients can afford one week. But 6 weeks can be an eternity.
In the fear of abuse, that is easy for doctors to monitor with careful prescribing practices (for example, instructions to the pharmacy to only issue one week's worth of the prescription at a time). In terms of tolerance or poopout, that happens with some people and not others. Just like every other conventional med on the market. For a very skeptical fearful doctor, they could at least let a patient who likes a stimulant use it at first while starting an antidepressant and slowly withdraw it as the antidepressant takes over. In the end if the antidepressant alone doesn't do the job, at least everyone knows what will.
Mileage obviously varies. Some people get horribly depressed on stimulants. Go figure.
poster:blueberry1
thread:721931
URL: http://www.dr-bob.org/babble/20070113/msgs/722592.html