There is a study to prove everything.
Even the large respected “unbiased” publications in places like “Lancet” or “New England J”, or “Nature” include unpublished, non-peer reviewed, drug company trials at times.
This is despite listing “no disclosures” prominently in the heading. Reading the abstract alone would not reveal this. Below are some ideas as to J Chronicle recommendations, and short blurbs as to why.
Sertraline is the best first line antiD. Less sexual side effects and less weight gain.
I am also a huge fan of the atypical tetra Mirtazapine. But do not let your doctor start you at 7.5 or 15mg. This will be highly sedating. For reasons you won’t care about, it has a biphasic curve effect such that higher doses are actually less sedating. Probably less weight gain as well. In Europe many trails start at 60mgs: out patient.
Perhaps try 45mg, or even 30mg. The only reason I put it second is because of weight gain and sedation, but these aren’t a guarantee. And the h1 mediated sedation will down regulate to zero over time.
And all the AntiD’s probably do cause some weight gain. As they will headaches and GI upset, nausea, hot flushes, sleep disturbance; at least for a time (THAT is predominantly serotonin for you. For reasons that wouldn’t interest you, 5ht is cause of most of the general SFX. There are more serotonin receptors in your gut then in your brain, as only one example as to why. There are more).
Also, I’m a slight fellow, and a boy – weight gain doesn’t register to me if I
do not make a point to think about it.
That being said, a large Lancet meta-study ranks Mirtazapine number 1 for efficacy, of the top 12 “new generation” prescriptions . It also has analgesic effects similar to the TCAs. All the AntiD’s probably do, to some degree. But this is recognised.
Often when a patent is due to expire, a company will churn out an enatimer; this often is either no different, or not better, or flat out no good – they just want to sell it.
That being said, escitalopram does out perform its racemate in nearly every recent trial. Less side effects too. More blood restriction to fear attention areas. But people like new things. Bear that in mind when considering these studies.
Often these new compounds come out here and the States, but get banned in Europe as being too similar to the original to be marketed under law as a “new product”.
Venlafaxine should be avoided, due to addiction. Paroxitine is similar, and Fluvoxamine.
Though some detox without incident.
Some make the flouroxitine shift with success and taper from there.
And some end up counting beads out of capsules and tearing the car door off to get a missed pill they think they dropped in their hand bag- with “electric shocks” in their brain the whole time, among other things.
This is represented as “vertigo” or “dizziness” in the side effect list, just by the way.
Lithium isn’t the “gold standard” of anything. Alprozalam is a “gold standard” too, apparently. When I hear this kind of thing, I realise that there truly is a good reason we got rid of the gold standard.
Lithium is a chalky, big, multi daily dose, cardio toxic, salt that requires
blood monitoring and is not necessarily preferred to some of the new atypical neurolepts at all. It depends what you are treating. It could be a miracle.
Try anything, but treat symptoms, not diagnoses.
And do not follow diagnoses from doctor to doctor: seek a second and third opinion. Let them work it out if it is so obvious to a medical certainty. Do not lead them. This will show you the art in medical science.
And most importantly, get rid of doctors who do not treat you individually.
As a rule, everything cycles. Remember that. And children all have imaginary friends and are in a constant cycle; for at least 22 years.
Neuroleptics and stabilizers should be a last port of call when you have been up for a month and sold a business that didn’t belong to you while camping on John Farnham’s lawn.
Or if Satan has been calling off the hook for weeks now, trying to sell you real-estate in hell; and you don’t even have a phone.
These are definite exceptions. There is little evidence for pre-treatment. And how would you even get it?
Early treatment, maybe. Maybe.
The schizi-polar diagnoses are burdensome.
I think when there is some undeniable truth, like you wake up somewhere in some hospital, bankrupt, with a clump of a police officers hair in your fist; you’ll know in a moment of clarity. And will likely face little choice in the matter anyhow.
On the contrary, when some GP is telling you have bipolar of any kind, or even cyclothymia- demand to see their 12 month, minimum, report of your cycles.
How else did they form this theory? They must be really attentive in that 15 mins before the next patient comes in. That or they really really are not.
Otherwise, don’t even ask what they are talking about: just leave.
That goes triple for anything being diagnosed on children. Their cells are dividing too fast, but that would take too long. Be hesitant. I’ll leave it at that.
And again, go for treatment, not diagnosis. Outcome focus.
If the two happen to go together today, fine. But do not assume they always will. People are ever evolving, everyone is different in their constitution and most of all, no matter how arrogant or forceful a specialist happens to be: doctors make mistakes.
And form baseless habits.
The stimulants all have great long-term safety, even cardiovascular, as well as efficacy, for their respective conditions. Unless you look up the same dose of the same compound in the addiction literature, of course, where the position is starkly reversed.
For this reason, the data for neither can be trusted. However, the long-term cohorts are sound in the medication populations. Take long-term by necessity only or under advisement. That ideally applies to any medication.
But function does have to come first.
Daily aspirin seems amazing for too many reasons, such that I don’t trust it. But if it has been prescribed, the benefits are legion. On paper. Including nootropic, with caffeine; which is why it gets a mention here with psychotropics.
Use pseudoephidrine, not phenylephrine, to stop hay-fever and severe general allergies.
Noone really needs to be told that. But I’ve seen people with severe allergies taking prescription antihistamines to no effect. No one can think clearly like that.
If nothing else works for you, try psedoephidrine. It will be monitored, and you will have to ask for it directly. But I’ve seen some miricle revivals. Also, the alternative is ineffective.
For flu though, a decongestant nasal spray and Ventolin with some antiemetics/pyretics will be fine. codeine to suppress cough.
Never take less than 30mg of codeine; that is subclinical. And paracetamol (acetaminophen)/ibuprofin, both, are dangerous if you are in pain and taking them with some frequently.
All opiods have stimulant and antidepressant effects, even prodrugs. But it is temporary and the addiction/withdrawal is, of course, no trade. And as bad as bezodiazapine withdrawal, according to some. And vice versa. That it is worthy of note I think.
BZ’s can also be causal in aggression and depression. It is the same receptor as alcohol that does it, and associated adaptations. Watch that, the Z drugs too, for similar reasons.
Keep an eye on this. Because doctors won’t.
To finish, there is a round up and some top 5 lists to follow with “The Crux”.
JR. (2013). What Psychiatric Medication I Should Take? -Top 5, J Chron. Lett. & Sci (1), Sept, Jaded Medicine Collection, Ed 5.
Follows to : “The Crux”