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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by SLS on February 10, 2007, at 9:17:03
I've noticed that many people here observe themselves on an hourly or daily basis and evaluate a treatment's worth based upon such short trial periods. I think it is often advantageous to think in terms of weeks and even months. The first two to four weeks are throw-aways, anyway. They involve titration to a therapeutic dosage and include also the 2 weeks that seem to be necessary for the biological response to antidepressant drug treatment.
Patience is most difficult when one is in constant pain, but the road to remission lies in knowing how to use the tools available.
- Scott
Posted by Phillipa on February 10, 2007, at 10:58:58
In reply to Patience..., posted by SLS on February 10, 2007, at 9:17:03
Scott where do you get the patience when you're unable to go out or stay alone due to anxiety? If I could just lie there or read I would gladly. I wish I knew your secret. Love Phillipa
Posted by Crazy Horse on February 10, 2007, at 12:03:41
In reply to Patience..., posted by SLS on February 10, 2007, at 9:17:03
> I've noticed that many people here observe themselves on an hourly or daily basis and evaluate a treatment's worth based upon such short trial periods. I think it is often advantageous to think in terms of weeks and even months. The first two to four weeks are throw-aways, anyway. They involve titration to a therapeutic dosage and include also the 2 weeks that seem to be necessary for the biological response to antidepressant drug treatment.
>
> Patience is most difficult when one is in constant pain, but the road to remission lies in knowing how to use the tools available.
>
>
> - ScottI AM PATIENT, DAMN IT!!!!!!!! ;)
-Monte
Posted by lcat10 on February 10, 2007, at 13:10:59
In reply to Patience..., posted by SLS on February 10, 2007, at 9:17:03
> I've noticed that many people here observe themselves on an hourly or daily basis and evaluate a treatment's worth based upon such short trial periods. I think it is often advantageous to think in terms of weeks and even months. The first two to four weeks are throw-aways, anyway. They involve titration to a therapeutic dosage and include also the 2 weeks that seem to be necessary for the biological response to antidepressant drug treatment.
>
> Patience is most difficult when one is in constant pain, but the road to remission lies in knowing how to use the tools available.
>
>
> - Scott
I could not agree with you more. Right now I am on Emsam patch, 12 mg. and have been for around two and one-half weeks (on the dosage). I am still feeling profoundly depressed most days, but I am now having some half-way decent days as well. We don't know yet (pdoc and me) if this is the med's starting to work or not. Time will tell, and if not, then I will go ahead with the ECT on March 5th. I go from profound to severe depression and at best a moderate-severe depression. Don't know yet if the meds will help to alleviate depression to at least a more mild state.
Posted by notfred on February 10, 2007, at 13:27:30
In reply to Patience..., posted by SLS on February 10, 2007, at 9:17:03
"I've noticed that many people here observe themselves on an hourly or daily basis and evaluate a treatment's worth based upon such short trial periods."
I agree and think the same applies to long term treatment that has suddenly stopped working. I would not start makeing changes untill at least a week has passed.
Posted by lymom3 on February 10, 2007, at 13:37:17
In reply to Patience..., posted by SLS on February 10, 2007, at 9:17:03
Your words couldn't come at a more appropriate time for me. I have even avoided reading here because I am so far down that it just makes things worse. Today might be wishful thinking, but I at least am doing laundry and mopped the house. That's a minor miracle given the last few months.
So thanks Scott for the words of encouragement. It was just what I needed today.
Lisa
Posted by SLS on February 10, 2007, at 15:41:31
In reply to Re: Patience... » SLS, posted by lcat10 on February 10, 2007, at 13:10:59
> > I've noticed that many people here observe themselves on an hourly or daily basis and evaluate a treatment's worth based upon such short trial periods. I think it is often advantageous to think in terms of weeks and even months. The first two to four weeks are throw-aways, anyway. They involve titration to a therapeutic dosage and include also the 2 weeks that seem to be necessary for the biological response to antidepressant drug treatment.
> >
> > Patience is most difficult when one is in constant pain, but the road to remission lies in knowing how to use the tools available.
> >
> >
> > - Scott
>
>
> I could not agree with you more. Right now I am on Emsam patch, 12 mg. and have been for around two and one-half weeks (on the dosage). I am still feeling profoundly depressed most days, but I am now having some half-way decent days as well. We don't know yet (pdoc and me) if this is the med's starting to work or not. Time will tell, and if not, then I will go ahead with the ECT on March 5th. I go from profound to severe depression and at best a moderate-severe depression. Don't know yet if the meds will help to alleviate depression to at least a more mild state.
>
I am not terribly impressed with Emsam. If you are even mildly improved on it, I would say that this indicates that trials of Nardil or Parnate might be warranted before continuing on to ECT.It is difficult to determine how long is too long to spend on a single treatment.
The wisdom of patience comes in knowing that one must give Time time to work. (Said the pot to the kettle). :-)
Personally, I find that I am still too impatient to be as methodical as I would like to be. There is a tendency to want to do anything to bring about immediate relief without regard for the long term strategy and the biological characteristics of the delayed antidepressant process.
- Scott
Posted by SLS on February 10, 2007, at 15:51:39
In reply to Re: Patience... » SLS, posted by lymom3 on February 10, 2007, at 13:37:17
> I have even avoided reading here because I am so far down that it just makes things worse.
I find this worrisome, and I do understand. Would you care to perhaps elaborate on what it is about Psycho-Babble that makes it necessary for you to avoid it when you are feeling particularly bad?
> Today might be wishful thinking, but I at least am doing laundry and mopped the house. That's a minor miracle given the last few months.
Very often, at the beginning of an antidepressant response, one sees a difference in what one does before what one feels. I, too, hope that this small "miracle" for you is representative of a much larger one to come.
- Scott
Posted by lcat10 on February 10, 2007, at 16:50:26
In reply to Re: Patience... » lcat10, posted by SLS on February 10, 2007, at 15:41:31
From SLS: I am not terribly impressed with Emsam. If you are even mildly improved on it, I would say that this indicates that trials of Nardil or Parnate might be warranted before continuing on to ECT.
Scott - already tried Parnate. It worked some 20 years ago and then on no antidepressant meds for over 10 years. Didn't need them. In the past two years, with depression coming back, amongst other med's, I tried Parnate again. This time, only minimal improvement as with the Emsam. Maybe Nardil is a possibility. I will ask my pdoc, but I am in such a bad way now a days, that I am not sure I can continue to work and function through another trial of medications. I will see next Wednesday when I see my pdoc. Also seeing the ECT doc that day to get things more in place with him and anesthesiology. Thanks for your ideas.
Posted by chiron on February 10, 2007, at 17:01:08
In reply to Patience..., posted by SLS on February 10, 2007, at 9:17:03
Thanks for the words of encouragement.
Do you know if 'stabilizers' can make your destabilization worse in the initiation phase?
Posted by Phillipa on February 10, 2007, at 20:37:41
In reply to Re: Patience... » lcat10, posted by SLS on February 10, 2007, at 15:41:31
God grant me the serenity to accept the things I can't change, the courage to change the things I can, and the wisdom to know the difference. I think it fits here. Love Phillipa
Posted by rovers95 on February 10, 2007, at 21:00:55
In reply to Re: Patience..., posted by Phillipa on February 10, 2007, at 20:37:41
Yeah, your probably right.......im jus so desperate for things too work for me (and to be back to "normal" is like!!!)
With my current trial im gona giv it time, but i honestly will be so dissapointed if it doesnt work out (thought riluzole could be the "magic bullet")- as i no longer no where to turn.....apart from take ket Long term!
mark
Posted by elanor roosevelt on February 10, 2007, at 22:38:54
In reply to Re: Patience..., posted by rovers95 on February 10, 2007, at 21:00:55
there are side effects and there is life
patience is what i need and patience is what many meds take from me
perhaps the posts on this board seem like we are all bouncing about
a variable to consider: when we are level and well we don't post as often
Posted by Phillipa on February 10, 2007, at 22:56:14
In reply to Re: Patience..., posted by elanor roosevelt on February 10, 2007, at 22:38:54
Hence why I'm always here never better. Love Phillipa
Posted by SLS on February 11, 2007, at 0:03:15
In reply to Re: Patience..., posted by chiron on February 10, 2007, at 17:01:08
> Thanks for the words of encouragement.
> Do you know if 'stabilizers' can make your destabilization worse in the initiation phase?I have certainly seen people react negatively to specific mood-stabilizers that have been tried on them. However, I can't say that I have seen a general pattern of getting worse before getting better. It's possible, I guess. Gabitril is one drug that comes to mind. Keppra is another, but for different reasons. It seems to have a biphasic response curve. Lower dosages can have an antidepressant effect while higher dosages are needed for a stabilizing or anti-manic effect. However, if you go too high in dosage when depression is the predominant mood state, it can make things worse. So, some people go on to feel better on Keppra later as they reduce the dosage, preparing to discontinue it. With Depakote, things can start out good and end up worse thereafter. However, this can be a miracle drug for some people.
For the most part, I would have to say that if a mood-stabilizer makes you feel worse, it probably is not the right drug for you. As alway, though, there are going to be instances that deviate from the norm, so, I wouldn't want to assert that these generalizations are true in 100% of cases.
- Scott
Posted by blueberry1 on February 11, 2007, at 14:11:53
In reply to Patience..., posted by SLS on February 10, 2007, at 9:17:03
Patience is indeed a requirement for treatment of depression. Sad. Those who are already stripped of strength and endurance must somehow invent superhuman patience.
I am guilty of monitoring myself on an hourly and daily basis. But it is good. I can see when a trend is beginning, whether it be good or bad. In a another week or two, whichever way the trend went, I can look back and see what the telltale signs were when it started.
My history with meds is that anything that was good for me in the long run showed itself to be good from day 2 to day 14. I've gone many weeks and months on meds that did not show anything in that first 2 weeks and they never did later either. So my history is, if it don't work in 2 weeks, the odds of it working later are slim. Existent, but slim.
I don't remember where they were, I think at pubmed, but a couple studies looked at early response predicting long term response. In general, a hint of improvement in 2 weeks is highly predictive of further improvement. Some people without improvement at 2 weeks do get better long term, but fewer of them. If it were a poker game, the odds are stacked in favor of the early responder to win.
Another study evaluated the time course of response to patients who did respond to zoloft. It went like this. Anti-anxiety day 1 to day 7. Antidepression from day 7 to day 30. Anti-anhedonia from day 30 to day 54. So if someone were starting zoloft and they did not fit this pattern at say maybe day 25, that doesn't mean they won't improve, it just means that the statistics are not in their favor, compared to people who have responded to zoloft.
One problem with almost all clinical studies is they only show the end result at week 6 or 8 or 12. They don't mention how many people started to improve at week 1, week 2, etc. They don't mention how many people who didn't improve at week 2 did improve at week 8. They just say that it takes 8 weeks. Which I think is incomplete an misleading.
Anyway, yeah, patience. From those least able to have it. Weekly an monthly improvement is what really matters, but I do watch it on an hourly and daily basis as well.
Posted by rjlockhart on February 11, 2007, at 19:46:23
In reply to Re: Patience..., posted by notfred on February 10, 2007, at 13:27:30
I try to be patient, this isnet with any of antidepressant stuff working, i am a car with 5 wheels. i cant stop thinking, ill go nuts.
I dont nkow why i posted. I just posted because i want everone to know im back.
Rj
Posted by Phillipa on February 11, 2007, at 21:37:22
In reply to Re: racing thoughts, posted by rjlockhart on February 11, 2007, at 19:46:23
Glad you're back. Now patience. Love Phillipa
This is the end of the thread.
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