The Use of Blood or Urine Levels of Anti-Depressants
Why Is This Basic Test So Rare?
I have to be frank. I have a love-hate relationship with large drug companies. At times they give me tools that do save lives, and at other times they treat physicians like dogs, especially European Drug companies. It is one reason I do not explore and research their products. In an hour or two most of the five new options in psychiatry can be read on and in twenty hours mastered intellectually.
But the real use on these agents, is first knowing how they really act, since suggestions fro the maker are almost always nonsense.
For example, internists and family MD's are the main targets of many drug companies, because if you are sad, irritable or moody, you are quickly given no advanced medical testing but an anti-depressant.
While usually started far too high in the first five days, they can be of use.
But what happens when the benefit is lost?
The Cult of the "Right Dose"
Tom was doing great on his medication... for six months. But slowly his mood slipped, and he was 50% back into a depression. His family MD decided this medication was not good enough, and switched him to a medication in one day that had very different ways of acting.
This caused him to experience withdrawal, experience withdrawal with dizziness and immense sadness, and agitation and restlessness from his new antidepressant.
I was called in by his parent and spouse, and we restored the past medicine for two days, stopped the chemical battery dose suggested in drug company literature and the useless PDR, and checked his blood level. Due to collaboration with some exceptional pharmacologists in North America, we had agreed to occasionally check levels in patients losing a good response.
The conclusion was that if you do well, and you have a liver that works, the liver will drop your blood level at least two times. And if your fall and winter is cold and with less intense sun, you are also at risk.
You start of drug y, you get side effects because the prescriber just follows some mill suggestion, and after 7-21 days you may feel better. But if it is a cold winter or 6-9 months pass after your mood is fixed, you can lose this benefit.
OK I am going to show you some serious magic and genius. Einstein is alert with pen and paper in his grave. Ready?
1) Get a blood level of the medication. Or some occasionally can be tested other ways such as urine. If it is in the lower range and at least not in top 25%, increase the dose.
2) Ignore blood levels that take about 3-6 years to be normalized. Simply raise the working medication. Now some of you who still think that Lincoln is our President and that police never lie and are never corrupt in your Mayberry reruns, will be concerned at a high radical dose.
Why is it radical? Because some book for marketing to family MDs and Internists, set a common dose range. Common? Routine? They must be confusing people with lawnmowers that are only mildly complex.
While it is true that antidepressants in the USA since 1988 have been made to be overdosed, it is not that one increases the dose forever to the point of higher risks of seizures and other risks. However, I do mean that people who get a response and lose it, should consider merely raising the dose.
Raising a Dose Is Not an Addiction
Years ago when I taught Karate, an overstated ability, I said if you were only going to attend six sessions. Do not attend my classes. Learn how to run better and try to marry into a family of State Troopers--they are usually smart and ethical. Unless they are from New Jersey, then they are mere revenue generators.
Amazingly, Carol was restored fully to her normal mood and function 80% in five months and 100% in seven months. She did well for two years. At that point her mother died, and they were like best friends. She did not handle it well. She had support, but biological signs drifted in. When she and I discussed her increasing her two medications 25%, her brother, a surgeon working on a medical board, said that was addicting her.
As I said, he was a surgeon, and so knew nothing about real pain care, and picked his drug reps based on looks. Addiction? Do you know what the street value in a drug den is for an antidepressent? If you could get 5.00 for one it would be amazing. He would rather she experience suicidal feelings, lose her job, possibly her marriage, then get better. Because he was a leader in medical politics, he was a master of infinite issues n medicine. Hardly.
HERE ARE THE BASIC QUESTIONS FOR A SUPERIOR AND THINKING PHARMACOLOGIST:
[DR. SCHALLER IS NOT AN EXPERT IN ANYTHING. HE STUDIES VERY PASSIONATELY ABOUT TWENTY TOPICS. OTHERS CAN RATE HIM, BUT THE ONLY ONES REALLY QUALIFIED ARE LONG TERM PATIENTS].