Aswad
Posts: 9374
Joined: 4/4/2007
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quote:
ORIGINAL: minnetar
Sir i appreciate Your response completely. she has undergone years and years of treatment with basically no relief. i told her it was selfish of me to want her to stick around when she was in so much pain. lol we discussed the best methods after that . i truly appreciate Your thoughtfulness.
Not technically my business, but did she ever try Depakote (sodium valproate + valproic acid), Nardil (phenelzine) or Temgesic / Buprenex / Subutex (buprenorphine) at any point?
If not, I'd check those out.
They're usually way down on the list of things the docs try, but in depression with self-injury, there is a fairly good chance one of them will work.
Approximate minimum doses for therapeutic effect for phenelzine and buprenorphine, respectively, will be on the order of 1 mg per kilogram body weight per day, rounded up to the nearest whole tablet of 15mg (e.g. at 80kg, one would take 90mg per day, diivided over 1-3 doses) for phenelzine, and about 1.2mg per day for buprenorphine; as usual, start low.
It will take up to 2-4 weeks to see an effect at therapeutic dosage; if no effect is apparent, don't bother to try increasing the dose, if some effect is apparent, try increasing it in reasonable increments, if full effect is apparent (stuff stabilizes and starts to improve significantly, though it still takes time to make a full recovery) then stay at that dose.
Upper therapeutic dose limit for buprenorphine for this use appears to be on the order of 16mg per day; at that dose, you will want to divide it into 2-4 smaller doses to avoid significant nausea, constipation and such. If there is sleep apnea, moderate to severe asthma, chronic obstructive lung disease or similar significant problems with breathing, this dose should only be approached very slowly, to avoid respiratory depression; such will not generally be an issue otherwise at any reasonable pace.
I can't recall the upper limit for phenelzine right now, and I'm not entirely sure there is one, except that there should ideally be weekly blood work done the first month after starting or raising the dose, to make sure the liver doesn't go wonky.
I'd reccomend trying them in one of two orders, depending on whether likelyhood of success, or the likelyhood of complications, is to be the guide. For the former, I'd say Nardil, then Temgesic/Subutex, then Depakote. For the latter, I'd say Temgesic/Subutex, then Nardil, then Depakote.
If she hasn't tried this, and still has problems, I'd suggest asking her to take it up with her pdoc. He'll probably wrinkle his nose at all three, and explain why, but it's a viable option for a reasonable likelyhood of significantly improved quality of life.
Hope this helps, and sorry to intrude.
_____________________________
"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do." -- Rorschack, Watchmen.
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RE: Depression revisited - 
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