John Melville, MD wrote:
I feel compelled to mention that just about all the advice about drugs in the prior post is extremely poor medical advice.  The reason he can't find a doctor to implement it is thay any doctor who did would (and should) lose his or her medical license.

The only thing on the list for which you couldn't find a willing doc is the ketamine thing. It's something supposedly worth paying attention to, but I was bringing it up as something to think about. I wasn't giving advice - I was telling him to go find a ketamine hookup.

As for the rest of the meds, I feel compelled to mention that the vast majority of the docs I've seen for depression have engaged in this fire-and-forget medicating, and that it absolutely wasn't just limited to me.

I've gone through quite a few doctors over the years, and I've learned just how excited they are to prescribe SSRIs for depression. Fine, they work for some people, but for many others they barely score higher than placebo. CBT is practically on the level with the therapeutic effect of SSRIs. And, yeah, I'm generalizing about SSRIs when there are many, but - without exception - the docs who've prescribed them for me have always told me they're basically the same. If they want to generalize, I might as well, too. It makes me immature, but what else is new.

Before I go any further, I should ask about what kind of an MD you are. There are plenty of cars that can be serviced at any old garage, but there are more and more nowadays that require specialized service from a specific dealership. My car is like that - just had to drive it an hour and a half in traffic to get the oil changed.

So, are you the garage where any car can park it and get a general sort of repair, or are you the dealership that takes only specific cars?

In other words, do you treat burns, scrapes, and cuts, or do you specialize in treating mental illness?

Would you want a PHP coder working on a C# project?

The information I get from my GP - whos fantastic, by the way - is worlds apart from the information I get from the shrinks I've seen. I don't think it's a stretch to say that my shrink is going to be a bit ahead regarding mental illness than a GP (I don't mean to imply that you're a GP - it's just a generic guess).

Another way to think about it - would you want my shrink treating burns, scrapes, and cuts? Or setting broken bones? Or doing prostate exams?

I don't think so.

Now, moving on, everything that I wrote above I wrote with things like this in mind. Regardless of what you believe, there *are* docs out there who will prescribe various seemingly inappropriate meds for treatment of depression. Hydrocodone, for example - I've been spoken to a few times about it as a possible means of getting through a particularly bad episode. 'Course, after self-medicating for depression with morphine for a little too long, I no longer have the hydrocodone discussion. I didn't think I'd want it, but it turns out I wanted it a bit too much.

So, I'm reporting based on my experiences. Whatever the ethical considerations, I've been a patient for this stuff for well over a decade, and I've learned a little along the way. There are *so many* message boards dedicated to people swapping this kind of information after receiving year after year of useless treatments. When you're desparate, you don't care about anything but getting better. Sometimes - like I did - you'll make stupid decisions, but other times you'll just get nailed without little fault of your own. That's the stuff you pass on.

I'm not telling him what to do. I'm not pretending to be a doctor. I'm someone who spent years feeling miserable when it probably didn't need to be that way.

In the end, how is he going to make his decision? Is he going to read my email and then start prescribing meds to himself? Is he going to take my note to the pharmacy? Is he going to hypnotize his doctor?

Well, these things are all possible, but I think it's far more likely that, were he to act on it (and, fortunately, it sounds like he's improving), then he'd go to a doc or a shrink with a few notes in the back of his head about what to avoid. Like, Effexor. That'd be a good word to have in the Avoid pile.

Anyway, he's safe now.