A GOOD doctor will work out what sort of depression you have based on your answers to complicated mood surveys, and prescribe an antidepressant accordingly. Prozac is great for melancholic depressives, but it may do nothing at all for atypical depressives. All I experienced from it was occasional physical numbness and a bit of dizziness, it didn't help me sleep or stop worrying. Efexor is fantastic for me, because it works on norepinephrine as well as serotonin, so helps with the anxiety and gives you energy to DO THINGS. When I first went on it, it worked quite literally within days - at least until my body got used to the dose and went "uh, this isn't enough anymore". One of the first "symptoms" of me forgetting a dose is that I become irrationally and disproportionately bad-tempered. However, Efexor may be utterly lousy for some depressives, because it can give them the energy they're lacking without actually making them feel any better - which can cause them to have enough energy to seriously hurt or kill themselves. And of course, people are complicated and biochemistry isn't this simple.
A really good doctor will be able to tailor make a cocktail of psychoactive drugs to sort you out. At one point I was on Efexor, Fluanxol and Mirtazapine all at the same time, along with megadose folic acid (15 mg per day). Efexor (venlafaxine) is an SNRI, Fluanxol (flupenthixol/flupentixol) is an antipsychotic given in low dose to treat psychotic depression, and Zispin (mirtazapine) is a NASSA drug which works on noradrenaline as well as serotonin, used in combination with venlafaxine and duloxetine for treatment-resistant depression. Folic acid is a mood stabiliser which is much safer than lithium for monopolar depressives. I used to take it around the dangerous time of the month, and it stopped me going completely deranged.
Often GPs are maligned for being allowed to prescribe antidepressants without the correct knowledge. I'll allow that GPs can be utterly bloody clueless - I ended up with treatment-resistant depression and suffered for four years because of the woman who only knew about melancholic type when mine was atypical, and said when Prozac didn't work "oh, then you don't have biochemical depression". And GPs may well not know which antidepressant is best for patients manifesting with a particular symptom set, or know how frequently patients need monitoring - "come back in 14 days" is NOT appropriate for someone who feels suicidal who's gone onto a new drug. The irony is, it was my own GP who worked out the treatment for me, and I've never seen a psychiatrist who I've trusted to know more about biochemistry and drugs than I myself do. (The last psychiatrist I saw actually argued with me that I'd made up one of my diagnoses for attention because she'd never heard of it. I pointed out that she had access to all of my medical notes and told her to make a quick phone call to my GP and confirm it with him. GAH!!!) The difference is that my GP is a medical researcher as well as a doctor, and reads all the psychiatry literature.
[comment STILL too long - continued in yet another post!]
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about doctors and drugzzz
Date: 2008-03-05 11:18 pm (UTC)A really good doctor will be able to tailor make a cocktail of psychoactive drugs to sort you out. At one point I was on Efexor, Fluanxol and Mirtazapine all at the same time, along with megadose folic acid (15 mg per day). Efexor (venlafaxine) is an SNRI, Fluanxol (flupenthixol/flupentixol) is an antipsychotic given in low dose to treat psychotic depression, and Zispin (mirtazapine) is a NASSA drug which works on noradrenaline as well as serotonin, used in combination with venlafaxine and duloxetine for treatment-resistant depression. Folic acid is a mood stabiliser which is much safer than lithium for monopolar depressives. I used to take it around the dangerous time of the month, and it stopped me going completely deranged.
Often GPs are maligned for being allowed to prescribe antidepressants without the correct knowledge. I'll allow that GPs can be utterly bloody clueless - I ended up with treatment-resistant depression and suffered for four years because of the woman who only knew about melancholic type when mine was atypical, and said when Prozac didn't work "oh, then you don't have biochemical depression". And GPs may well not know which antidepressant is best for patients manifesting with a particular symptom set, or know how frequently patients need monitoring - "come back in 14 days" is NOT appropriate for someone who feels suicidal who's gone onto a new drug. The irony is, it was my own GP who worked out the treatment for me, and I've never seen a psychiatrist who I've trusted to know more about biochemistry and drugs than I myself do. (The last psychiatrist I saw actually argued with me that I'd made up one of my diagnoses for attention because she'd never heard of it. I pointed out that she had access to all of my medical notes and told her to make a quick phone call to my GP and confirm it with him. GAH!!!) The difference is that my GP is a medical researcher as well as a doctor, and reads all the psychiatry literature.
[comment STILL too long - continued in yet another post!]