Switching between the same group of medication

[AmZ]

Hi,

I was wondering something.

If, say, someone is taking an SSRI medication and it doesn't seem to be helping them, could the answer be to switch them to another SSRI medication which could then work for them?

Thanks.

 

[Daniel E.]

At least for depeession, switching SSRIs can be as effective as trying medications from other classes:

http://forum.psychlinks.ca/prescrip...esistant-depression-findings-from-star-d.html

Of course, I tend to see medication more as like one piece of "the answer," with other pieces being like exercise, socialization, mindfulness, behavior therapy, etc. Even in lab rats, just changing the environment helps them do better mentally.

 

[Retired]

If, say, someone is taking an SSRI medication and it doesn't seem to be helping them, could the answer be to switch them to another SSRI

This is precisely how the medication / patient match is achieved.

There is no one size fits all in anti depressants, and finding the one that works for a given individual often involves trial and error over a period of time.

Sometimes a compound that was ineffective or not well tolerated earlier might even be effective or better tolerated at a later date.

The only consideration could be the half life of the current medication and the half life of the new med, where the doctor would calculate the appropriate delay between the discontinued compound and the replacement compound, if necessary.

When switching between different classes of medications, however, there may be a "washout period" depending on the combination of medications involved, where the discontinued medication must be completely eliminated before starting the replacement.

Physicians, especially psychiatrists or other specialists working with psychotropic medications should be well versed in replacement protocols.

 

[Daniel E.]

And there are so many me-too SSRIs and other psych medications now, that it would take many lifetimes to try all of them in different combinations of two or more, at least since there are always new psych meds coming out.

 

[AmZ]

Thank you for the replies. Much appreciated.

I don't know what my psychiatrists plans are with me - I am on Lexapro 20mg, Lithium 900mg and Abilify 10mg. When I spoke with her yesterday she said "you are on 10mg of Abilify, correct?", so I wonder if she has some plans to adjust that medication. From what I read online, the maximum dosage is usually 20mg but that is for people with Bipolar. I saw that usually the treatment for Major Depression is 2.5mg-5mg.

My problems right now isn't the BPD or OCD it seems. The OCD is mild, at least the physical one of counting on my hands and teeth. My thoughts are perhaps a little obsessive and could do with some calming down I guess.
With the BPD, the hospital have refused to say that I have it and say that if I had it, it would be much more 'obvious' such as me resisting treatment and arguing with the nurses and staff. That's what they say anyway. My psychologist and psychiatrist outside both say that I have BPD. I can go on as I am with not knowing really whether I have it or not, but I still find it to be confusing and unhelpful. i.e. If I have BPD, then maybe DBT would be good for me and once I am out of the hospital, or some time in the future, maybe I could find a psychologist that specialises in DBT and BPD. Anyway, I shall go on as I am for now like this I guess.

The thing I am suffering with is the depression. My mood is very low. Again, more confusion, as it is often once I am triggered by something and then my mood changes. I don't really know what the deal is with me and me and the medications and what to do there.

 

[David Baxter PhD]

1. Stop going online and second-guessing your medications. Your psychiatrist is doing that job.

2. Stop second-guessing your diagnoses. If you wonder about a specific approach like DBT, ask your psychiatrist and psychologist what they think of the idea. For one thing, the use of DBT is not limited to BPD so it's not diagnosis-specific.

 

[AmZ]

I'm just expanding my knowledge so that I know what the deal is. i.e. my question about switching between SSRIs.

Which diagnoses shall I second-guess? That I have BPD or that I don't? I don't have one diagnosis here.

 

[Daniel E.]

BTW:

Why is DBT proving helpful with multiple disorders? It seems clear that emotion dysregulation is the driving force behind many problems, not just borderline personality disorder, and treating it can make a huge difference in people's lives. A pattern of over-intense emotional response, whether learned or hardwired, can be replaced with more effective coping skills. These skills are both specific (see the four DBT skills above) and highly learnable.

More and more, psychology will be moving from specific treatment protocols for each disorder to modular treatments that target the underlying driving factors that create most symptoms. DBT's focus on treating emotion dysregulation is an excellent example of where we are heading?a single treatment process that successfully impacts multiple problems.

http://forum.psychlinks.ca/dialecti...y-is-so-effective-for-multiple-disorders.html

 

[David Baxter PhD]

I'm just expanding my knowledge so that I know what the deal is. i.e. my question about switching between SSRIs.

Which diagnoses shall I second-guess? That I have BPD or that I don't? I don't have one diagnosis here.

How is that helping you? As far as I can see, it just gives you more to worry and obsess about.

 

[AmZ]

Not really Dr Baxter. I think it's good for me to know about the medications and how they work - to be an informed consumer. I'm not going against my psychiatrist or anything, it's just that communication is difficult so why not ask knowledgeable people on here?

About the diagnoses - it's frustrating but I am prepared and have been good about it and only brought it up once many months ago with the psychologist and psychiatrist. I think it's best to leave it and when I leave the hospital to the full time program, that psychologist and psychiatrist can be my third people to diagnose me - maybe then I'll just go with what they say.