![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by SLS on August 5, 2008, at 6:26:25
I think that the longer one spends in the depressed state, the longer is the recovery process. This is a generalization. I don't know to what degree this is true.
I am 1 1/2 years into my biological recovery process, and still have some residual depression to watch dissipate. It will take quite awhile for brain tissue to recover. I suspect that my cognitive impairments will take the most time to resolve.
I have added N-acetylcysteine (NAC) and fish oil in an attempt to speed up the recovery process. However, if these substances do not accelerate recovery, I will still glean antioxidant, anti-apoptosis, and anti-hypertriglyceridemia effects. In fact, I had planned on taking NAC well before discovering that a blinded study reported its usefulness as an adjunct treatment for bipolar depression.
My improvement has been substantial and has allowed me to attend school and achieve high marks. I am also just about ready to return to work. That will depend on whether or not I decide to take a few more college courses.
My point is this: I suspect that some people terminate a treatment trial prematurely because they perceive that the treatment is only partially effective. I keep mood charts to aid in my evaluation of my response to treatment. I am better now than I was a month ago. This has been a stable pattern since early on in my recovery. However, the Deplin has accelerated and stabilized further my improvements. Sometime, changes are subtle. They can be subtle enough as to be overlooked. Mood charts can be of great utility in teasing out trends in antidepressant response. Unfortunately, not all partial responses lead to remission. A plateau can usually be seen in the mood chart, though.
Here is the mood chart I use:
http://www.slschofield.com/medicine/mood_chart_beam.pdf
Since my baseline state was of severe chronic depression, I modified my scoring of the chart so that the top score representing severe mania becomes 100% remission of depression. Doing this doubles the resolution of mood tracking.
As usual, I offer no guarantees that a partial response will bloom into a full response. One may plateau instead of ascending. One other thing is critically important in understanding the antidepressant response. It is almost never linear. There are biological ups and downs that sometimes have one believe that a "recession" into depression is, instead, total poop-out. It may not be. I believe that tracking mood using some kind of charting can help tease out the differences between plateau and gradual improvement. Still, I would keep in mind the idea that one may then leave the partially-effective treatment in place and augment it with other drugs that have either shown a partial effectiveness also, or are of a different drug class.
Just a few things to think about.
- Scott
Posted by raisinb on August 5, 2008, at 9:20:33
In reply to Plateau versus Continued Improvement - Charting, posted by SLS on August 5, 2008, at 6:26:25
That's very good advice. I track moods and it helps immensely, because I know that if I'm depressed for even half a day, I immediately decide that my meds have stopped working and I am doomed to be depressed until I die. That's how depression works.
Posted by Phillipa on August 5, 2008, at 10:56:33
In reply to Re: Plateau versus Continued Improvement - Charti » SLS, posted by raisinb on August 5, 2008, at 9:20:33
It's a great idea I did something similar for years but there was never an increase in good feelings so stopped. I'm not even sure I'm depressed anymore. Manybe just apethetic and since no money and aging see no way out of that and there isn't. Seems each time I feel better something bad happens. Scott with all you've tried and been through that looks like a major task and you must be extremely intelligent. BTW what do you mean by cognitive impairment if able to go to school and get good grades? I'd think that would mean it was excellent? Phillipa
Posted by SLS on August 5, 2008, at 12:01:07
In reply to Re: Plateau versus Continued Improvement - Charti, posted by Phillipa on August 5, 2008, at 10:56:33
The classes were inordinately difficult for me. I had to work at it. My ability to read and remember are still not what they should be, though. It was challenging. However, I am healthier now than I was last spring, so I expect things will be easier next semester.
- Scott
Posted by Phillipa on August 5, 2008, at 13:00:44
In reply to Re: Plateau versus Continued Improvement - Charti » Phillipa, posted by SLS on August 5, 2008, at 12:01:07
Scott even before I had any problems I had to read things three times. First time got nothing out of it. Second time a quick read no retaining of facts. Then all the notes took in class I would read them daily. Then third time with book it would make sense. Always found the testing was on the notes. Still same subject? Bet you enjoy it. Phillipa and glad your improvement continues. Oh question off topic think it is possible to be " normal" for 20 years and then have a cycle where you're not well? Love Phillipa
Posted by Marty on August 5, 2008, at 20:27:57
In reply to Re: Plateau versus Continued Improvement - Charti » SLS, posted by Phillipa on August 5, 2008, at 13:00:44
Interesting Scott. Thanks for the chart.
It's the best I've seen so far.I found the analogy between med cocktail/depression and portfolio/stockmarket interesting even if very limited: One need to look at the mid/long term course of his portfolio/cocktail to know if he needs to sell/stop or buy/add something.. not just the last few days. Now the anology pretty much stop there.. especially if you suffer a huge 'crash' -> time to change the cocktail ASAP while you shouldn't touch your portfolio that much. Also if you get to high, rich is a good thing, mania is not. .. maybe that analogy isn't much interesting finally lol
BTW Scott, if you have time I'd like you thoughts on my new post about Prozac and 5-HT2c.
/\/\arty
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.