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Posted: 20 July 2007 05:58 PM   [ Ignore ]
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I am very nervous. It prohibits me from concentrating. When I talked to ADHD specialists, they said that it is probably due to emotional problems. It makes sense, since it has not been the case always.


When I take medicines like Vaben(Oxazepam) and Lorivan(Lorazepam), it causes me to relax much more and to feel much better. Once I used to take even Nocturno (Zopiclone) just to relax.


I want to take some long-effect pill, perhaps SSRI\SNRI\NASSA\NRI\other . I am bit scared, since it takes a month at least until they start to have effect, and if the choice of the medicine
is a wrong one, the time will be lost. Morever, if the pills do have a positive effect - it is hard to know whether the effect is caused by the pills, or by something else.

 


It would help me a lot if you could give me an informal advice, or refer me to some
helpful literature if there is a way to know which medicine would be good for me, based on the specific given list of medicines that do help me?

[ Edited: 20 July 2007 06:02 PM by someone1 ]
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Posted: 20 July 2007 06:32 PM   [ Ignore ]   [ # 1 ]
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Wow. I’m not a doctor, and even if I were (or knew of others on this site) I would encourage them not to give informal advice to someone without a proper checkup. I would suggest going to your doctor and asking him or her the same questions.

I expect you are here because for some reason you aren’t willing to take your doctor seriously ... but really, you should take him or her MUCH more seriously than us nincompoops here.

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Posted: 20 July 2007 07:22 PM   [ Ignore ]   [ # 2 ]
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I appreciate it, Doug. However, the previous doctor I went to did not really give me good reasons for choosing one long-term medicine over another.  The attitude was ‘they are more or less the same, try and we will see if it helps’. Which is weird, because it is hard to tell if a certain long-term drug helps or the other factors do.

I am asking not for an advice on a drug, but for some explanation of the possibility to make a prediction on long-term antidepressants which would be good for me, based on the short-term drugs that I took.  I want to understand the reasons for myself .

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Posted: 20 July 2007 08:25 PM   [ Ignore ]   [ # 3 ]
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By coincidence I heard a program interviewing researchers on depression this morning on public radio.  They indicated that while a great deal of knowledge has been developed, they still don’t know which drug will work on which patient, and that there are other unknown factors that seem to account for the fact that 30% of depressed people improve when given placebos. 

You might want to find a university research hospital that has a number of medical scientists working on projects related to depression and go there.  They may be able to give you answers that you would find more useful than those given by your doctors so far.

Occam

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Posted: 21 July 2007 09:42 AM   [ Ignore ]   [ # 4 ]
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The problem is that, as Occam suggests, actually your previous doctor seems to have been pretty much on the mark with his/her advice. The various medicines are (at least to my very limited knowledge, and I am no MD) “more or less the same”, and the extent to which they are different, nobody is precisely sure how they will affect any given person differently.

I expect you will continue looking around the internet for info on these drugs. If so, BE VERY CAREFUL OF THE SOURCE. There is an enormous amount of misinformation around. Sometimes wikipedia is a good place to start ... not always, but anyhow give it a look, and also look through the materials they link to.

Or, better, go back to your doctor with the same questions; ask him/her for more detailed info.

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Posted: 21 July 2007 11:14 AM   [ Ignore ]   [ # 5 ]
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I agree with what’s been said so far. People often have the idea that medicine is far more exact and precise a science than it truly is, and if their doctor acknowledges significant uncertainty that they are incompetant or uncaring. The reality is that while our knowledge grows all the time, there’s a lot we don’t know. I work with animals, not people, but for your doctor’s comments about these medications would certainly be true for my patients. While we know a great deal about what they do at the biochemical level, we have a very poor understanding about how that translates into changes in behavior and internal mental states. A trial and error approach in such an important area is scary, and only you can decide, with input from your doctor, whether you want to go that route. Lots of people experience significant benefits from treatment for anxiety disorders, but anything that has a beneficial effect also has the possibility of unwanted effects. My advice is to get as much advice and information from your doctors as you can and make as informed as decision as you can, remembering that nothing is perfectly predictable. Good luck!

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Posted: 21 July 2007 03:55 PM   [ Ignore ]   [ # 6 ]
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If so, how is it possible to understand if a drug has effect on me?

I cannot imagine how can I isolate all the other myriad factors that have effect, and decide whether a certain drug does or does not have an effect on me. Did not work in the past.

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Posted: 21 July 2007 10:05 PM   [ Ignore ]   [ # 7 ]
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As I see it, you will have two possible outcomes if you take a given medication:  1. You will feel better and the side effects won’t be particularly annoying.  2.  There is no improvement and/or the side effects are worse than the improvement.

You are looking for improvement.  If the first is the case, why bother worrying about whether or not the medication is causing the improvement.  Be happy that you are feeling better.

I don’t know the dynamics of your demand to know whether or not you can be certain the particular medication is actually the cause of the improvement, but that desire, it itself, doesn’t seem too reasonable.

Occam

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Posted: 22 July 2007 08:20 AM   [ Ignore ]   [ # 8 ]
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The other thing is they do not know how your own specific biochemistry will work. So while all those medicines do the same basic thing (relieve anxiety), they use different mechanisms and have different side effects, and they react better or worse in part depending on the biochemistry of the individual.

Few years ago I took an SNRI that gave me insomnia then I took an SSRI and did not have the side effects. My case was an attempt to solve stomach pain, which due to lack of knowledge is assumed to be from stress. Sadly none of the drugs have worked for that problem.

The point being, they can not know how well you will react to a medicine or what side effects you may have, until they have tried.

http://en.wikipedia.org/wiki/Antidepressant

Efficacy limitations and strategies

Between 30% and 50% of individuals treated with a given antidepressant do not show a response.[55][56] Even where there has been a robust response, significant continuing depression and dysfunction is common, with relapse rates 3 to 6 times higher in such cases.[57] In addition, antidepressant drugs tend to lose efficacy over the course of treatment[58] A number of strategies are used in clinical practice to try to overcome these limits and variations.[59]

[edit] “Trial and error” switching

The American Psychiatric Association 2000 Practice Guideline advises that where no response is achieved following six to eight weeks of treatment with an antidepressant, to switch to an antidepressant in the same class, then to a different class of antidepressant.

A recent meta-analysis review found wide variation in the findings of prior studies; for patients who had failed to respond to an SSRI antidepressant, between 12% and 86% showed a response to a new drug, with between 5% and 39% ending treatment due to adverse effects. The more antidepressants an individual had already tried, the less likely they were to benefit from a new antidepressant trial.[56]

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Posted: 22 July 2007 10:12 AM   [ Ignore ]   [ # 9 ]
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Lots of good advice and info for you here, someone1. Re. the question as to how you can know if the particular drug is the cause of your improvement, this is basically an impossibility, as Occam suggests. The only way you can know for sure about the causal efficacy of a drug is in a distributed, random, double-blind trial, up against a placebo. You will know if the drug has an effect if there is statistically significant improvement of those taking the drug as versus those taking the placebo.

The problem with single cases (e.g., your case, or my case) is that there is too much noise; there are too many additional factors in any given case to be sure of what’s doing the causal work. Causation is something you determine in aggregate, in a large trial. It can’t be determined in a single case, since the effects are subtle and can be masked by other phenomena.

That said, every drug allowed for use by the FDA has been shown more effective than a placebo in just such a large trial. So we know they are at least somewhat effective in some people. However, this additional effect over placebo may be rather small, and may be different in people with different genetic makeups. So, for example, such a drug may be very effective in certain people, and totally ineffective in others. The same is true with side effects.

All you can do is start a trial run with a drug your doctor feels is a good first candidate, and in close consultation, determine if you like what’s going on or not. This isn’t a perfect solution, but unfortunately there are no perfect solutions yet.

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Posted: 31 July 2007 09:06 AM   [ Ignore ]   [ # 10 ]
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Making the decision to take a drug is not an easy one. 

It seems that taking the drug makes me “less me”. I am a person, an individual, with a character. Taking a drug that effects my brain makes me feel that I am not one hundred percent myself, that I am affected by merely a drug.


Since those drugs can change my behaviour, I am afraid that my relationship with people will be different only because of the drugs. I can wonder if some people will like me only because I am taking drugs which affect me.


So, making the decision to take drugs is not an easy one, but it becomes more complicated because I will not be able to determine whether the drugs help or not.
I would be very glad to receive some advice.

Someone1

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Posted: 31 July 2007 09:44 AM   [ Ignore ]   [ # 11 ]
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Unfortunately, someone1, the best advisor in this situation is you yourself: how you feel day-to-day when taking the drug. Only you can know if the benefits it provides you are worth the side-effects. Not being “you on the inside”, I really don’t feel at all qualified to comment.

The only person I believe could be of use in this situation (assuming you’re already on some course of treatment) is the doctor who prescribed the drug—he or she may have a better idea about how long you need to be taking it before seeing whether it really works, for example. IIRC many SSRI drugs need several weeks in the bloodstream to start having any appreciable benefit.

If you aren’t yet on any course of treatment, then once again, it is impossible to give advice without knowing how the particular treatment would effect you. But as we said before, this isn’t a perfect science. Often the only way to really gauge the effect is to start treatment under a doctor’s supervision and see how it goes. Sometimes dosages need to be altered midway through treatment, etc.

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Posted: 31 July 2007 09:57 AM   [ Ignore ]   [ # 12 ]
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And remember, if you are putting a drug into your body, you are doing it for you.

Not for your family, friends, colleagues and certainly not for your doctor.

You might like to try answering these…

What problem have I identified?
What solutions can I see?
Which do I think is the best?
Are there any risks or side-effects to me?
Can I live with these?
How will I know if my solution is working?
How will I know if it isn’t?
How do I control what is happening?
Who can (and more importantly, will) help me?

Remember. YOU are the most important person.

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Those who understand binary numbers and those who do not.

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Posted: 31 July 2007 11:35 AM   [ Ignore ]   [ # 13 ]
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someone1 - 31 July 2007 09:06 AM

It seems that taking the drug makes me “less me”. I am a person, an individual, with a character. Taking a drug that effects my brain makes me feel that I am not one hundred percent myself, that I am affected by merely a drug.

It is a chemical compound. Eat any fruit? Or Bread/pasta/rice? Or any vegetables or meat? Ever drink a caffeinated beverage? An alcoholic beverage, or just plain ole water?

Every one of those is also just a chemical compound. You don’t want to stop ingesting those do you? But if you stop eating and drinking it will also change your mood and behavior, so eating and drinking normal food and water changes your chemistry and to some extent your behavior.

My own experience with anti anxiety and anti depressants were pretty tame. In both cases the mood enhancement was slow and subtle. Certainly I had no loss of anything I had before. The anxiety meds made me feel generally but slightly more satisfied with things, the antidepressants actually made me feel more ... nervous. But that could be because I wasn’t (apparently) depressed, but have some sort of uncertain stomach thing. The attempt was to treat what was guessed to be a stress related illness, not specifically depression.

Anyway, don’t worry, be happy. The you that you are, both chemically and emotionally is always changing anyway, so just as proper diet or exercise can improve your makeup so can food, drink and even medicine.

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Posted: 31 July 2007 01:14 PM   [ Ignore ]   [ # 14 ]
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Not sure how valid it is, but I heard somewhere that there is evidence to show that taking some form of regular exercise particularly of a type that involves being in a group (anything from aerobics class to team sports) has a beneficial effect on people with depression, self esteem issues or stress related illnesses.  You might like to check that out.

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Posted: 31 July 2007 01:34 PM   [ Ignore ]   [ # 15 ]
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I think Chris and Narwhol’s point is an important one. Many things influence our physiology in a way that impacts our mood and behavior. Food, exercise, social support network, work stress and satisfaction, meditation. And, of course, all of these impact brain chemistry, since that is what mood and behavior is (unless you buy into dualism). The problem is we don’t have much understanding yet of how neurochemistry generates subjective experience and behavior, so it’s largley trial and error when coming up with pharmacological approaches, and to a lesser extent when treating individual pateints. I don’t think there’s any way around that, so any therapy is a bit of guesswork, but it’s educated guesswork (as opposed to most alternative medicine, which is pure guesswork unadulterated by empirical analysis). And nothing is benign. The situation is complex, and you may have to accept a degree of uncertainty and risk if you feel the current situation and the potential benefits justify it.

FWIW, the people I now who have taken SSRIs and other antidepressants have had both good and bad results, but none of them have felt their fundamental self endangered. Oliver Sacks talks about patients with some neurologic conditions (e.g. Touretts) who did feel the price in terms of identity of treating their disease wasn’t always worth it, so everyone’s experience is in some sense unique. But everything you do is part of the process of changing who and what you are, and if you feel strongly enough that how things are now is not ok, a rational attempt to change with as good an understanding of the pros and cons as you can get seems reasonable.

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