Posted by bleauberry on January 5, 2008, at 17:34:10
In reply to What have we learned from the STAR*D study?, posted by SLS on January 4, 2008, at 5:42:45
Thank you Scott for your presence. Everyone I know of misses you a lot here. Thanks too for the powerful topic of discussion.
What these studies tell me is...
1) Whatever med is chosen, a patient needs to be able to tolerate to get to a decent dose. If intolerable, or if depression worsens, the deal is off. But the program is still on. Move on to another that can be tolerated.
2) If a med is working partially, don't discard it. Add to it.
3) No matter what the med is, it needs 8 weeks.My only comment on the study is that they maybe could have subgrouped patients into categories depending on their symptom clusters. For example, anorexic insomniac depression would start with Drug A. Withdrawn fatigued anhedonic depression would start with Drug B. Crying sobbing worthless guilty depression would start with Drug C. Sure, most of the symptoms of the entire depression cluster are probably evident, but there are certain clusters much stronger than others that pinpoint a different type of depression and hint toward which neurochemistries might be more likely involved.
For me the biggest problem is just finding something tolerable. I can't do 8 weeks if I can't get to a reasonable dose, which can't happen if I have side effects that incapacitate my ability to be my family's wage earner or make me feel considerably worse than I started. If I get past those hurdles, I'm following the STAR protocol. My one advantage is that I am not afraid to access all available meds, FDA or not.
poster:bleauberry
thread:804126
URL: http://www.dr-bob.org/babble/20080105/msgs/804499.html