Commentáby Marybeth, Muskegon, Michigan
I don't have a question. However, I would like to make a comment. I found the antidepressant Lamictal to be a godsend. I feel like a new person since I've been taking it. I also take Neurontin, which really takes the edge off. I feel for the person who can't find the right medicine. Don't give up, keep trying new drugs.
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
I agree so completely with your sentiments that I thought we'd post your comment as a little source of encouragement for all the folks struggling with medications that aren't quite doing the job, and also so that I might expand a little on your thoughts.
First, you are not the only person who has found Lamictal (generic: lamotrigine) to be a godsend. I know many people whose lives were helped incredibly when it was added to their antidepressant regimen. In fact, I often tell people that if they have either unipolar or bipolar depression, they shouldn't come near giving up hope until they have tried it. Note, however, that many studies now show that it neither treats nor protects against manic episodes. Like all good medications, it has its limitations.
Here is the larger point: I have spent several decades both prescribing and doing studies on medications designed to address the biology of depression, and this is what the experience has convinced me of: Any given person's response to a medication is a crapshoot. I have seen people have a complete response to the first medication they try. I have seen people fail 10 medications and then experience a miracle cure on the 11th. I have seen depressed people fail antidepressants and respond to antipsychotics. I have seen psychotic people whose lives were turned around by an antidepressant. I have seen people who never found a drug that worked do well with therapy.
What we lack is a crystal ball to predict who needs what. Many people are studying the issue as I write, and it might be that in a few years, someone will find the magic formula, but I doubt it. Here's why: Although psychiatrists have literally hundreds of different diagnoses in their diagnostic manual, increasing data suggest that many of these diagnoses share underlying biological abnormalities. This, of course, is why antidepressants work for depression, but also work for anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder, eating disorders, etc. So I think it is very unlikely that we will ever find medications that are specific for specific problems. The brain doesn't work that way.
On the other hand, within any given diagnosis -- say depression -- there is huge variability between individuals. Although in general, depression is characterized by a series of abnormalities in the brain and body, every individual with depression is a little different, with a body and brain that tell the sad story of woe in a slightly different way. The differences between people with depression can be as large as the differences between the varying psychiatric disorders themselves.
If we can't even find a medication specific for a particular diagnosis, what are the odds we will be able to know ahead of time which medication will work for any given patient? If any given medication is just as likely to help one person with panic disorder and another person with depression as it is to help two people with depression, you can see that we've got a long way to go before the crystal ball is worth taking out of the closet. In fact, my sense of the emerging science of mood and anxiety disorders suggests to me that we will probably never be able to do this because the disorders themselves are inherently probabilistic because of the huge complexity of the systems involved in their production.
In the name of fair balance, I should tell you that many scientists would disagree with what I've been saying, and they may be right. Perhaps we will in the future develop technology that will allow us to look beyond diagnostic labels and into the actual neurobiological abnormalities of each individual to see what they specifically need. Maybe -- but if it ever happens, it's a long way in the future.
I have a very good buddy who is one of the world's leading brain tumor researchers, and he is just now beginning to get a handle on how to treat each tumor individually. My head spins when he talks to me, because the process is so complicated. And a tumor pales in comparison to the human heart, soul and brain when it comes to complexity.
So what is the practical upshot of all this? Maintain hope, even if you have tried medications to no good effect. It is easy to get discouraged when medications don't work or when they come with unbearable side effects. But many people give up too soon, not realizing that there is a medication with their name on it, if only they will patiently persist in trying all options.
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