Posted by Pfinstegg on December 21, 2002, at 13:21:13
In reply to Re: next steps - Anna Laura - waiting, posted by Anna Laura on December 21, 2002, at 4:25:03
Hi Ana Laura..I think bupropion was the best choice you could have made, for its boosting of dopamine and nor-epinephrine levels. It's so good to hear that you can feel a small spark of aliveness again.
I do remember now that you told me that your 24-hour cortisols were normal, even low normal, I think you said; that's very good news, as it means you aren't anywhere near a melancholic or psychotic depression( if you were, you probably would be feeling too ill to even post). I asked about the DST non-suppression, even though it is considered a bit unreliable- influenced by what your estrogen levels may be on a given day, among other things- because, if you turn out to be a consistent non-suppressor, this would make you a candidate for one of the few treatments available for that: TMS and mefipristone. These are being used for both bipolar and monopolar here in clinical trials, with favorable reports for both. The TMS is given daily for 2 weeks, sometimes a bit longer, and the mefipristone is given for 7-10 days. The complete remission rate is around 65% for both (why are all psychiatric treatment 65% effective?!), all the patients were also continued on low to moderate doses of various AD's and mood-stabilizers afterwards to prevent relapse. In addition to clinical remission, about half of the patients in both groups reverted to being DST suppressors, although it could take as long as a year for this to occur. When that happens, it is such good news, as it means, of course, that you no longer have HPA axis dysregulation, and that your brain is once again handling stress normally.
I didn't mention ECT here, although it is just as effective: it's just my bias, but I know you are young and brilliant, and there is always the small chance that you could be one of the relatively few people who develop cognitive deficits after it. From everything I have read, there is no risk of that from the other two treatments.
Anyway, I'm so glad to hear there is a tiny improvement- I hope it continues to become stronger and that you have a very good holiday.
with best wishes!
Pfinstegg
P.S. You can have the CRH-DST test done instead of the ordinary DST; it is much more accurate in detecting axis dysregulation
poster:Pfinstegg
thread:33204
URL: http://www.dr-bob.org/babble/social/20021218/msgs/33733.html