Dear all
I have recently got a new patient who is on a prescribed antidepressant medication. She would like to come off but has tried twice unsuccessfully, she gets a severe depression after a few months. She has been on the medication for several years and although she has reduced her dosage over the years, I think she is showing some side-effects of the medication e.g. anxiety, dizziness, nausea, restlessness and insomnia. She would like to come off the medication and is looking for support in doing this.

I guess there is a choice between looking at a purely constitutional picture and recognising all the symptoms as part of her case and prescribing on the TOTALITY or

Recognising that the 'Drug picture' is somehow separate and trying to deal with that separately, but maybe alongside the constitutional remedy.

I am not experienced in this area and would be grateful if any other homeopaths would let me know what their experience has been.

It has been suggested to me that the medication in potency can be helpful in treating side-effects and withdrawal. I know this is technically isopathy but does it work?

Of course, I know that she will have to withdraw very, very slowly and will need a lot of support and encouragement. Also, that it should be done under the supervision of/with the agreement of her GP.

Comments welcome
Therese

In these situations I try to understand what led the person to go on antidepressants in the first place, and what feelings return when they begin to wean themselves off. That is, is the depression related to grief? Suppressed anger? Low self-esteem/self-worth? Then one needs to further individualize with the presence of physical complaints, etc. I don't feel common symptoms such as insomnia, anxiety, etc. will help so much, whether they're related to the antidepressant or not. I also don't use a potentized form of the antidepressant for treatment. After matching the pharmacologically suppressed symptoms with a remedy, I generally use an LM to allow for more flexibility in dosing. Good luck!

[ 04. September 2003, 20:46: Message edited by: David A. Johnson ]

Isopathy is useful in removing a block in a case which may be caused by a specicic toxic agent. It is not best to start treatment of a patient this way, but to consider it when progress stalls and there seems to be no other reason for the lack of progress.

There are two reasons to avoid going this way too quickly.

1. The patient may already be reacting to this specific stimulus, and by giving it in potency will cause and even stronger reaction by the vital force to defend itself. Since the remedy is not being chosen to match the patient's individual response, it will not necessarily help the patient. The reason the law of similars works, is that it creates a similar disease in the person, which takes the place of the natural one, thereby extinguishing it. Since people do not react to a medicine in the same way uniformly, this is unlikely to happen by giving a medicine not prescribed according to similarity.

2. If the medicine does not cover the peculiar and unique aspects of the disease, but only the common and general reactions to the medicine, there is at best a chance to palliate, and at worst a chance to suppress.

In the case of depression, my experience is by prescribing the medicine suited to the peculiar aspects of the person's disease, they are able to withdraw from the drug more easily. I still take it slowly, reducing it in steps. It might be necessary to redose or retake the case as the effects of the drug wear off, revealing symptoms that have been hidden or suppressed. During this process, isopathy might be useful. I have never had to do it though.

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David Kempson.<br />Dip.Homoeopathic Medicine.<br />Lecturer Australian College of Natural Therapies (Brisbane Campus)<br />Member AHA, AROH, HMA<br />Member Australian Homoeopathic Association. Member#0442.

I have got a few people off anti depressants and the knack is slowly slowly!! First find the constitutional remedy . When the person is feeling better then start decreasing the anti depressant slowly - as in halving the dose every other day for a week or so then halving the dose every day. You have play it by ear making sure the person is stabilised before lowering the dose further. If they begin to get withdrawal effects or indeed to prevent withdrawal effects give Avena Sativa MT. I use the herbal tincture because it is cheaper and prescribe 10 -20 drops in warm water 3 x day as needed. It acts very fast to stop trembling. I have never needed to use the anti depressant in potency.

When trying to find the constitutional remedy remember you need to know what the person was like before the anti depressants. If necessary ask relations. I found Lachesis for one woman when she told me that as a child her Mum said that she never stopped talking. With that I started to ask around lachesis and found it fit. I gave the remedy in a 200 to begin with and I think we may be up to 10M now but I am pleased to say she hasn't requested an appointment for months so she must be OK. Before that she always phoned when she felt she was going down again and a dose of Lachesis always did the trick.

[ 04. September 2003, 22:50: Message edited by: Ricky ]

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RSHom - Registered Homeopath

Dear all
Thank you for your descriptions of your experiences and your explanation of why not the drug in potency. It has taken me a while to read and digest this but it's very helpful. You all seem to be saying that it is more important that to prescribe on the picture that has probably been suppressed by the antidepressants than the current one. I will have another talk to her because I have to say I was distracted by her extemely anxious current state. I have given her 'Mimulus' for now and this seems to be helping. Her previous homeopath gave her aconite for panic attacks which does not seem to have helped the underlying state.

Underneath, I think I can see a 'Calc Phos' constitution since childhood but maybe I need to delve deeper to find out the 'masked' depression symptoms before prescribing.

I am very grateful for your support,
Therese

I think it is still important to include the current symptoms, mental and physical. But it is just as important to exclude any symptoms which are known side effects arising directly from the medication, as these are considered common symptoms and are not peculiar to the patient.

However, a patient may have peculiar reactions to a medical drug, and these are also important for prescription.

In any particular case, you should go over the history to see if a picture arises that may have been there all along. A person may be in a remedy state prior to drug treatment, and still be in that same state after treatment, although showing perhaps different symptoms (still covered by the corresponding remedy.)

I am not too keen on the 'layers' idea - that is that we can see underneath a current state. If you can see underneath, it must be part of the state. There cannot exist two states in the one person, just as there cannot be two vital forces in a single organism. I think it is possible to see hints of what state the patient has been previously in, through careful questioning.

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David Kempson.<br />Dip.Homoeopathic Medicine.<br />Lecturer Australian College of Natural Therapies (Brisbane Campus)<br />Member AHA, AROH, HMA<br />Member Australian Homoeopathic Association. Member#0442.

I agree with all the above--so, be sure to ask something along the following lines :

'In the midst of the depression, what are the thoughts and feelings you experience?'

As an example, I saw two people yesterday to whom I asked a similar question--the first immediately said--'I feel as though I'll never be good enough for anyone, that no matter how hard I try I will never be good enough'.

The second person (who is currently taking a high dose of an antidepressant) said--'I just want to withdraw--I just want to go in my house and not talk to anyone'. It's okay at work, but once I get home I just want to sit in front of the TV until I fall asleep'.

The first person's further history included a dominating father with extremely high expectations, anticipatory anxiety, fear of failure, a family history of cancer, etc.,-- the rx was carc. The second's history included strong responsibility, a severe head injury in childhood, warm blooded, worse in damp, hx of gonorrhea, etc.--the rx was nat-s.

The point is, even with suppression, the general conflict which manifests as depression is still 'lurking beneath the surface'. Good luck--

Thank you both for this, it has been very helpful. I have met with her again and think I have a clearer idea of what her particular depression is about.
Best wishes
Therese

Hello,

One thing to keep in mind when looking at a case of depression being treated with antidepressants is a baseline. To be more accurate, you would want to create a baseline with the patient.

What I mean by this is to itemize out all the symptoms that are extant BEFORE the beginning of homeopathic treatment. The ones that are still ocurring despite the antidepressant. What I mean is that it is rare that antidepressants will truly resolve symptoms. There are often places where the underlying symptoms "sneak" through. So those should be discussed and elaborated by both the practioner and the patient.

In addition to those symptoms above, it is a good idea to itemize out all the additional symptoms in the case that should respond to your Rx. For instance, lets say your patient also has sciatica, allergies, and insomnia. So here is how I chart it:

1.) Sciatica - experiences pain, right leg every morning without fail, 4/10 intensity (4 out of a possible 10 in intensity - 10 being worst pain imaginable)
2.) Insomnia - 4 nights out of 7 can't sleep before 3 am
3.) Allergies, consistently to milk - causes diarrhea.
4.) Depression - now (with antidepressant, paxil, celexa, etc.) experience it every morning - sadness and can't stop thinking of brother's death for about 30 minutes.

It might seem anal to take such a "shapshot" of the consistent symptm picture before treatment. But it is an immense help during your assessment later. It also give you a wonderful tool to confidently suggest later (3 - 6 months later) that the patient ask to have there GP titrate them off the antidepressant.

In other words, if you take a comprehensive baseline of the consistent symptoms of the case while on antidepressants and before homeo treatment. You have a beginning measure. Then, while they are remaining on the antidepressant, and you begin the homeo Rx, you will have a concrete baseline to measure from. So as the patient returns for each follow-up, review with them each of the symptoms. On the correct rx, all the above symptoms will be improving.

Then say after several months, both you and your patient are CERTAIN that the homeopathic Rx is working OVER AND ABOVE THE ANTIDEPRESSANT. Then you can confidently and safely suggest tapering off the drugs.

That is the method I've used and it is very reliable. Hope this helps

Sincerely,

Dr. T

__________________
Tim Shannon, ND<br />2610 SE Clinton St. Ste. E<br />Portland, OR 97202<br />503-236-8853<br /><a href="http://www.drtshannon.com" target="_blank">www.drtshannon.com</a><br />drt@drtshannon.com

Dr T
This sounds great. I guess it would be useful with patients on all kinds of medication, not just antidepressants. Thanks for sharing it with us.

Events have overtaken me with my patient. She went to see her GP and has halved her dose of medication, yes every day! I would have liked her to take things more slowly but now I think the best thing to do is to support her on whatever comes up. At the moment, I have just given her 'support' remedies and am keeping in regular contact with her. I have an idea of the deep emotional stuff that may become more obvious, and yes it started way before the antidepressant. However, because she is changing her conventional medication I am reluctant to give her a deep homeopathic prescription until I see how she responds to the withdrawal.

thanks again,
Therese