Posted by Mark H. on April 30, 2000, at 1:36:16
In reply to Re: Not Trying To Start World War III, posted by KarenB on April 29, 2000, at 13:18:03
I'm fascinated that a few of the posters I most respect, and who have some of the greatest knowledge of biochemistry, support the 6-8 week AD trial theory, which has always seemed to me absurdly dangerous and ineffective.
I've said it before, but in my experience anything that makes a depressive worse should be stopped immediately, as the clinician is risking that person's life during the two-month "wait and see" period. To me, it is callous and cavalier and swerves perilously close to malpractice.
Anything that doesn't produce immediate improvement and has troubling or distorting side effects (vision abnormalities, reduced driving or work performance, increased sleep disturbances, etc.) should probably be replaced immediately as well, in as little as a week or two, based on my personal experience.
I'm with Karen B on this -- when my depression has been lifted by medication, the effect is not subtle, questionable, gradual or attributable to something else.
At point "x" I added "this" to the mix, and less than 48 hours later the heavy dark curtain of depression had lifted and I could begin my healing.The effect is so dramatic and sudden that I want to think I have simply and naturally gone into some sort of miraculous remission, but stopping my AD for EVEN ONE OR TWO DAYS a year or two later causes the curtain to fall -- and believe me, I know the difference between depression and withdrawal or rebound symptoms. (And nevermind that the "stabilization" theory would predict I could not possibly begin to crash that fast.)
The quantity of adjunctive meds I need to take fluctuates with my cycle. I'm usually most well in late Nov and all of December, and again in late May and most of June. I'm at my worst usu in late Aug and Sept and again in Feb and March. The other months are transitions up or down and are fairly predictable as well.
I still wonder if the 6-8 week trial period appears to work for some (or even a majority of?) people NOT because SSRIs have stabilized the neurotransmitters, but because the brain itself has found a new equilibium in that time, whether somewhat assisted by the AD or not.
Cam and others, whom I greatly respect, may in fact be right. But if they are, then I suspect some other factor is at work for me and others like me. My depression is refractive and cyclic and long-term. Trials of Prozac, Zoloft, Paxil, Serzone and others were NOT cumulative or helpful for me in any way, regardless of the length -- I remained severely depressed for months and months and months on SSRIs.
I'm classed as Bipolar II, but it would be counter-productive to clip my minor "highs," which is when I do my best work and feel most normal, and I have never responded (except negatively) to any of the so-called mood stabilizers. So much for the idea that being given an AD without a mood stabilizer will supposedly flip us bipolar folk over into mania -- either my diagnosis is incorrect or incomplete, or the "expert guidelines 2000" have made far too broad a generalization in this regard.
So if the 6-8 week theory isn't just an extended "active placebo effect," then I wonder what is going on for those of us who really can tell quickly whether something is going to work or not? Any ideas?
Thank you for your consideration and ideas.
By the way, do two "troughs" and two mild "highs" a year make me a "rapid cycler?"
Is there even such a thing for Bipolar II? I assumed a rapid cycler was someone who either experienced mixed states or vacillated within a few hours or days between states -- but some of what I've read on this site brings this into question. Any clarification will be appreciated.Many thanks,
Mark H.
poster:Mark H.
thread:31659
URL: http://www.dr-bob.org/babble/20000429/msgs/31734.html