Dr James Schaller
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A SOUTH CAROLINA GUIDE TO
OFFERING POOR DEPRESSION CARE

WHAT YOU DO NOT WANT
WHEN DEPRESSED

I have always loved the Carolina's and when a young boy coming back from the oil fields, a precious family took me in and fixed my car. But now I am taking care of some folks in the Carolina's who fly in, and one poor lady was not enjoying her Carolina experience.

20% of women get biological depression from the age of 14-44. I do not know what it is after the age of 44, but suspect Depression increases from 45 y/o and older, due to many key hormones falling.

Rita came in to see me and said simply, "I am in a very bad place, you better be good, because I am not doing well.

She really could have avoided many problems if she had been getting care from someone with specialization in her areas of trouble. But both her family doctor and a local psychiatrist were not able to help her.

  1. Her treatment started with some Zoloft from her family doctor. She had some anxiety with her depression so he "wanted to start with a good dose." On 50 mg she had a panic attack, perhaps from excess serotonin or a dopamine. And she was very nauseous. He told her to "hang in there." I am not really sure what that was supposed to do. In about nine days she was no longer anxious or nauseous. She felt better for three months until the "holidays." Then she was having trouble with irritability, energy, enjoying things and was restless.
  2. She was then given Xanax for her sleep trouble that started when she was increased to 100 mg. The Xanax helped her fall asleep, but she woke up 4-5 hours later and felt quite restless. He told her to take another Xanax when she woke up, and this only made her sedated when she was driving in the am.
  3. So she was changed over to Paxil because it "works on both depression and anxiety, and she found herself raised up to 25 mg in 2 weeks, at which point she had a panic attack and was also sedated. "How is that even possible?" She asked me.
  4. She insisted on a psychiatric consult, and the family doctor was mad at this request, and sent her a termination letter. He just said, "I cannot help you." And offered the local county medical society for a family doctor referral.
  5. The psychiatrist had a six-week waiting list and was at a respected center. She stayed on Paxil 20 mg because it helped her mood moderately, but she could not increase it due to feeling tired on a higher dose. Taking it at night still did not remove this sedation.
  6. The psychiatrist was "hard to understand and eccentric. "I was concerned, since I am incredibly eccentric. In fact, it is my only virtue.

    He stopped the Paxil and replaced it with Effexor, because it was "stronger and would help anxiety without being so sedating."

    She had insomnia for two weeks on 150 mg in am and 75 mg at night, but that eventually decreased 50%. She was changed over from one medication to another in three days and vomited her first day of the change. Her nausea was likely from excess serotonin stimulation at the brain's nausea center.
  7. She was doing moderately well after six weeks on the Effexor but could not sleep.
  8. She was then tried on small doses of various medications for her insomnia. These included: Trazodone, Elavil, Ambien, Sonata Gabatril and Klonopin. Most helped partially but never fully.
  9. In four months she was depressed again and she did not have a sense her psychiatrist had a handle on her trouble.

*******

THE BOTTOM LINE:
HER CONSULT

First, her family doctor thought he was some kind of Freudian genius and was clearly over his head, and devalued Rita because of his lack of skills. He considered psychiatrists second class in the guild in medicine. In a word, he was a 1960's dinosaur. We promptly flushed his ideas into the great pseudo-intellectual cesspool.

  1. He had started her on widely high doses, when she should have started on fractions of the smallest pill size. You can always increase the dose -- even later the same day! He committed chemical battery with multiple medications. Basically, he was following the PDR and the drug rep instructions.
  2. He did not realize that Zoloft blood levels fall every couple months, because I have not published this yet from our massive collection of levels.
  3. He seemed to not appreciate that in "holiday times" there is certainly stress, but there is also less light or lux intensity in the light and that increases depression.
  4. Xanax has a bad rap with additionologists, but it is useful for airplane flights, needle sticks and rare panic, but is usually not a daily medication, because the blood levels shoot too high and then fall very low in about 4 hours.
  5. The psychiatrist did not appreciate that Effexor and Paxil did not hit the same receptors. So some of Rita's brain chemicals would fall fast, and others would get stimulated fast during a quick 3-4 day conversion of one medication to another.
  6. She vomited because Effexor stimulated her serotonin nausea receptor, located in the back of her head, too fast. This is very preventable. You do not switch medicines so fast or with large doses, no matter what a drug company says!
  7. The medications added for sleep have possible interactions with Effexor, which he never told her about and they were really just band-aids. Why was she having poor quality sleep?

    We found that she had low progesterone, the natural serenity hormone, and replaced her with 200 mg at bed and she slept wonderful.
  8. We also checked her bone chemistry labs and her free testosterone. After adding a tiny 1/2 a mg of natural testosterone, a fraction of what men need, she found her bone growth improving in 3 weeks according to the urine breakdown of bone labs. I suspect the progesterone and low testosterone was growing some bone. The testosterone helped her mod a little also.
  9. The psychiatrist did not appreciate that her lost Effexor benefit was possibly due to a reduced blood level. We did publish about the loss of benefit due to increased metabolism years ago.
  10. We found that she had modest antibodies against her own thyroid, so the routine junk TSH test would not show that some of her thyroid was bound up by antibodies, as if it was a bacteria -- making the hormone unable to do its job. We gave her a low dose of thyroid replacement and explored the cause of her autoimmunity.

In conclusion, I do not hear from Rita much. She is "fully restored" and we are delighted she is her "old self."

Dedicated to Those Willing to Seek Healing
And Seek It with Passion,

Dr. J



Bank Towers, Tamiami Trail, Naples, FL
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