Posted by finelinebob on May 9, 2004, at 14:04:51
In reply to Friend with long-term depression, posted by nephron on May 9, 2004, at 9:35:26
Hey nephron
First of all -- good for you, doing this for your friend! You sound like the kind of friend we could all use.
Second of all, let me quote from Dr. Bob's disclaimer statement: "Don't necessarily believe everything you hear. Your mileage may vary." Especially YMMV. Your friend, your friend's doctor and you know more about his situation than we will, and we're speaking from what has and hasn't worked for us. Now...
Panda's comments raise one important question: do you know what his diagnosis is? That could have a big impact on what sort of advice people would want to give.
All the same, I'm another vote for suggesting tricyclics. I've been depressed at least since I was 8, so I fall in the same boat -- long term chronic depression. My pdoc had me go through just about every SSRI, and each of them ripped me apart in their own unique ways. Seems to me that if a med doesn't cure what ails you, then its ALL side effect and NO therapeutic effect. Apparently, my seratonin is doing just fine, thank you.
When he finally had me try nortriptyline, it was like night and day. Apparently, my norepinephrine is NOT doing just fine, thank you very much. I also tried desiprimine for a short time, but my response wasn't nearly as good as it was to nortriptyline.
From what I've read, King Vultan is right about Wellbutrin affecting dopamine, but I've also read it works more on seratonin and norepinephrine. As someone who has had some bad reactions to SSRIs, I'd say try something else. Wellbutrin hit me harder than any SSRI did. But, again, that's my personal experience.
Sounds like his pdoc is ONLY willing to try new things -- tricyclics and MAOIs are older classes of meds ;^). SSRIs are supposed to have such better side effect profiles, I think that can blind people to other choices ... I know MY pdoc was hesitant to try anything else, even though he'd been in practice for 30 years or so. So if your friend's pdoc isn't willing to consider a different class of meds, your friend should probably look for a different doctor. You didn't say how long he's been working with this doctor ... giving up what may otherwise be a good working relationship should not be taken lightly. Has your friend addressed this issue directly? I mean sitting down and saying flat out, "Seratonin-based meds aren't working for me. Look at my response to these meds if you want verification. Isn't it time we took a different approach?" If he doesn't feel that he can, if he doesn't think his doctor will accept this from him, then it IS time to head to someone else. Whether the doctor would actually respond that way or not isn't the issue -- what is the issue is that there's no trust in the relationship.
I see my pdoc more often than I see most of the people I consider my closest friends. I imagine the same may be true for a lot of people around here. It's an important relationship.
One last thing: documentation. Doctors can't make good decisions without reliable data. So, if your friend is having difficulty finding a med that works, try to get him to keep a meds journal, recording what he is taking and how it is affecting him. If he has records of what he has taken in the past, he should try to reconstruct this. For me, it took 2.5 years to finally get around to nortriptyline. That was 2.5 years of various altered states of mind, most of which weren't very pleasant. Of course, I found this out AFTER it all, when it finally occurred to me to chart what I had been through. When a doctor is seeing you once a month and all you have to share is some version of "I don't feel any better", it can be hard for that expert to pull together your reflections and his past session notes and see the big picture -- doctors are only human, too. The more data they have to work with, the better chance they have of coming up with the best course of treatment. It's in your friend's best interests to help his doctor out on this as much as he can.
take care (you and your friend both!)
flb
poster:finelinebob
thread:345044
URL: http://www.dr-bob.org/babble/20040505/msgs/345095.html