Posted by SLS on April 15, 2009, at 12:58:39
In reply to SLS: Can you give us examples?, posted by Zana on April 15, 2009, at 11:37:07
It is really hard to determine for someone else what treatment choices make the most sense without knowing their treatment history. It sounds like you have seen a lot of drugs and drug combinations.
For me, I decided to try and break through a point of stagnation (plateau)
by:1. Switch from Nardil to Parnate. If worse, return to Nardil.
2. Switch from nortriptyline to desipramine. If worse or no better, return to nortriptyline to avoid genotoxicity.
3. If a plateau is reached after 6 weeks, add memantine.
4. If no improvement, add Topamax.
5. If no improvement, discontinue memantine and Topamax.
6. Add Trileptal.
7. If no improvement, add Geodon 40mg.
8. If no improvement, discontinue Trileptal and Geodon.
9. Add amphetamine.
10. If no improvement after 2 weeks, add T4 (thyroxine)
11. If no improvement after 2 weeks, disontinue amphetamine and T4.
12. Keep thinking.
For you, I think it would be worthwhile to document your treatment history by making lists of drugs and drug combinations for those that:1. Produced an improvement, no matter for how long.
2. Produced an exacerbation.
3. Had no discernable effect.
4. Produced intolerable side effects (with descriptions).How long do you generally give startup side effects to dissipate when starting a new treatment?
It sounds as if you might wind up taking a drug combination that includes the remediation of anxiety or agitation that are produced by an otherwise effective treatment.
For instance, sometimes the only way to treat a refractory case is to allow a drug to produce a mania and then treat the mania without discontinuing the precipitating drug. For you, it might mean that you can choose the drug that had the best antidepressant response, and then treat the anxiety and agitation with an anxiolytic / antimanic, which might be something like Klonopin, Depakote, or Zyprexa.
- Scott
poster:SLS
thread:890874
URL: http://www.dr-bob.org/babble/20090408/msgs/890888.html