Many patients come to Dr. Stefano Pallanti after seeing many doctors in Italy or in their own countries, and many times they have visited doctors in other countries around the world. Patients often travel to the United States, but also to Australia, looking for treatments that work for them. Many patients say they feel worse after visiting multiple neurologists and psychiatrists.
The reasons for not responding to treatment can be multiple and include:
You have been misdiagnosed or partially diagnosed;
The diagnosis may be correct, but you are not responding to therapies, due to peculiarities of drug metabolism that have not been individually considered;
Inappropriate treatment developed a resistance to treatment;
There exist disorders for which there are not yet guidelines; therefore, it may be necessary to undertake "off-label" treatments. Prescribing such treatments requires the doctor to go beyond the standard guidelines and protocols and refer to the latest scientific research;
Coexisting psychiatric and neurological disorders were treated separately, and the treatments interfered with each other (e.g., Tics and cognitive disorders, Bechet and psychiatric disorders);
There still exist unknown diseases.
Having the correct diagnosis provides the first step in formulating a personalized treatment. There are no treatments or medicines that suit everyone!
What commonly happens
Incorrect or Incomplete Diagnosis
Almost all patients who come to Dr. Pallanti arrive with incorrect or incomplete diagnoses.
ADHD, for example, does constitute an important comorbidity of some psychiatric disorders but is commonly ignored. If the ADHD is not treated in Depression, Anxiety, Obsessive-Compulsive Disorder or Parkinson's, no significant improvement can be achieved.
Wrong Choice of Medication
We often see patients taking antidepressants (unsuccessfully) because they felt "depressed," and the doctor then prescribed antidepressants.
The same symptom, as reported by the patient, may be an expression of different mechanisms at its origin, that is, of different disorder. For example, under the umbrella of "Depression," there are at least five subspecies, and each of them has a different cause, that is, the specific malfunctioning brain circuit’s.
So, each patient has to be treated with different medicines or strategies.
There is no one-to-one correspondence between the symptom and the cause. So, too, there is no one-to-one correspondence between the symptom and a medicine. There is no culture of these aspects, yet.
Unfortunately, doctors prescribe medicines using standardized guideline criteria without investigating which brain circuit actually is involved.
Wrong Dose Prescription
A doctor prescribes a patient a low-dose serotonergic antidepressant because he does not know its proper usage. It fails to work; and after two months the patient goes back to the doctor. The doctor changes the medicine and gives another serotonergic at a minimal dose. It, too, does not work, and the third time the patient returns, the doctor administers another serotonergic again at a minimal dose. The patient consults another doctor, but always a minimum dose serotonergic is prescribed, and the clinical picture does not change.
The treatments did not work because they did not reach the minimum therapeutic dose.
Among other factors, physicians cannot jump from one medicine to another because there are interactions, and especially intersections in the mechanisms of action that cannot be disregarded.
The patient continues on with the same therapy that does not work; and, in the meantime, he becomes resistant. Thus, it becomes more difficult for him to respond to treatment because the longer a patient is sick, the more difficult it becomes to treat him. Such a progression commonly occurs in Italy and abroad.
The doctor does not prescribe the most effective, new drugs
Patients can now find out about new drugs on the Internet, but their doctors do not prescribe them because they do not know them or how to use them. Often, those who do not know the new drugs disqualify them. If a physician prescribes them, he does so at a minimal dose, and therefore they do not work.
Personalized care for greater success
The treatments should be personalized: each person should receive a treatment designed specifically for him or her.
The starting point lies always in the diagnosis: it can be under-typed or specified; and, if new aspects emerge during treatment, expanded to include other conditions that require treatment.
Then we must consider the story of each individual person: the story of the family, the story of the external and biological events that exerted an impact on the trajectory of the disorder, and most importantly, the person.
Everyone has physical, medical, immunological, relational, familial, and genetic characteristics that distinguish him or her from everyone else. There are other factors to consider: age, gender, family status, and predisposition for particular treatments. Then, we must consider the relational and communication style, the individual expectations.
For these contributing aspects, the doctor must consider and clarify the therapeutic objective, which must be shared with the patient. A treatment works when all these factors receive appropriate attention, shared between the doctor and the patient. This holistic approach defines the “personalization of care.”
Biennial course on Anxiety Disorders organized by the European College of Neuropsychopharmacology
A unique opportunity to expand your knowledge and experience in the field of Anxiety Disorders.
Dr. Stefano Pallanti will lecture on Neuromodulation Therapies during the 4th module of the course.