Posted by Questionmark on May 17, 2009, at 7:55:24
In reply to Re: Questions about Nardil Experience, posted by stargazer2 on May 12, 2009, at 23:17:14
I completely agree with you. This is a very good and important observation. I strongly believe that most doctors frequently prescribe psychiatric drugs in doses that are too high-- often way too high-- for the individual. I'm especially referring to maintenance doses, as opposed to start-up doses (before reaching the maintenance dose), although the start-up doses are probably often too high as well. This is partially a consequence of many drugs not being available in lower doses-- which is relevant with start-up doses, individuals who are overly sensitive or slow metabolizers of the drug or substances in general, and when a drug is being used to augment another drug/s. But i don't think these are usually even the case when this excessive-dose prescribing occurs. Most doctors prescribing psychiatric drugs seem to be entirely ignorant and-- at times, seemingly apathetic even-- to the extreme importance of using what is, as i like to call it, the minimum sufficiently effective dose. This is important for many reasons-- and far more than for just limiting direct side effects, which is extremely important in itself.
{{ The most recent example i have witnessed is the following-- which you can ignore if uninterested. A friend of mine, whom i know quite well, just started on an antidepressant recently-- her only trial besides a ~6 month SSRI + Wellbutrin stint several years ago. After a brief start (about a week or so) on Requip, she requested, at my urging (since... she noticed nothing whatsoever except nausea; she is without insurance and Requip is on patent and therefore significantly more expensive; i do not consider Requip to be generally any more superior to any of the SSRIs) an alternative, preferably a generic SSRI.So what does he do? He writes a Rx for 40mg generic citalopram (brand name Celexa for those unaware). Now mind you my friend did not like her only previous SSRI trial because she felt too.. well of flat affect basically. Most of you experienced and observant enough with this stuff realize that, for an individual susceptible to that effct, it's more likely to occur the higher the dose. But my guess would be that he probably didn't ask about any of this. Regardless, I did think she should be on something, probably an SSRI (she was/is quite often very depressed-- an extremely emotional "Atypical"-type depression) and I was happy with the choice of citalopram. But 40 mg?? Come on! For some people that [or more] may be necessary. But to basically start her off on that high of a dose? There was no good reason for it. ... And numerous potentially bad reasons not to.
Granted this involved her general practitioner and not a psychiatrist, but it is still ridiculous and, in my opinion, unacceptably & irresponsibly haphazard (note i am NOT saying it is law-suit worthy by any means-- just so there are no assumptions or misunderstandings). Also i know from experience that many psychiatrists (not just GPs) often do this sort of thing as well.
... So i was very angry upon hearing this (not at my friend of course), and i strongly suggested that she split the pills in half and only take 20mg/day-- and to even seriously consider 10mg, at least to start-- and explained all the reasons why. Many of you, *very* many others, and probably almost every single medical doctor in the country, would criticize this and say things like "but you're not a doctor" and "but she needs to discuss this with her doctor" and various other such cliche lines. The fact of the matter is i trust my judgment on these matters more than i do the average doctor-- certainly the average general practitioner-- and certainly this guy. I am largely ignorant about drug metabolism and all the liver enzyme involvement and what not-- and hence various drug interactions. But as far as... well, everything else related to all this (at least regarding the classes of psychiatric drugs of which i'm knowledgeable), i trust myself more. I also know my friend and her situation well, and had time to talk with her about many of the relevant details. U.S. Medical System Guy gets what 10, 15 mins to talk to her and decide on a prescription? He obviously is also far less concerned than i am. And it is obvious he knows very little about the complexities of antidepressant use. I, on the other hand, through *first hand* experience and years of too much analyzing and obsessing and discussing, and "PsychoBabble: Medications" reading/conversing-- etcetera-- know quite a lot about these complexities. I am no scholar-- of course. But my knowledge, and ability to use that knowledge most effectively, far exceeds that of many if not most medical doctors.
So please: Spare me your cliches. }}(That's my rant and i'm sticking to it.)
> Hi Courtney,
>
> Perhaps the starting dose is too high for you. Although everyone here seems to aim for higher doses, I am on Nardil and started on 15 mg and gradually increased to 45 where I am holding for right now. So you may not be able to tolerate that level right away. I am someone that believes in slower starts on meds, at least that is what have learned in 20 years on meds for depression. I have tried most meds with the exception of the newest ones.
>
> That would be my recommendation anyway.
>
> I wouldn't give up yet, but I would not go to a higher dose first. Ask your pdoc if a lower dose might be what you need.
>
> SG
poster:Questionmark
thread:894892
URL: http://www.dr-bob.org/babble/20090515/msgs/896204.html