Physicians often combine medications for the treatment of depression, but this should not be done by simply matching the sum of symptoms to the sum of medications. Particularly in the elderly, the interactions and side effects become incalculable, and it becomes necessary to reduce medications rather than to increase them.
We must all remember that the goal of treatment means to improve and lengthen life, and not merely to aim at the symptoms reduction. The two goals do not always coincide.
Minimum Therapeutic Dose
After the choice of the right medicines, it is important to individualize the achievement of the minimum therapeutic dose, which will be defined specifically for each person. The guidelines, on this aspect, do not report valid data for every subject. We know that there exist countless variables that determine the metabolic change from the absorption of a particular medicine: without the ability to administer a consistent dosage of any medicine’s absorption levels into the blood, we can only attend to what the patient tells us, as the guide to identify the right treatment.
Each person responds in a specific way to each medication.
If the medicine does not reach the minimum therapeutic dose, it fails to work. Moreover, this could make the person intolerant to that medicine, which implies the person will no longer be able to take it, even if it turned out to be the right one with a different dosage.
Modern medicine and psychiatry propose a personalized approach that goes beyond the strict guidelines and standardized treatments.
Therefore, in addition to providing any useful information on the effects of new medicines, whenever possible, Dr. Pallanti prefers that the patient not be left alone to experience the effects of a treatment, but that any effects take place in the controlled environment ― our Day-Center.
Dr. Pallanti tries, with a method validated by his experience, to arrive at the personalization of the treatment that achieves the minimum sufficient to correct the disorder and no more. The dosage proves fundamental because in some cases a different dose of the same medicine corresponds to different functioning: today, in fact, these medicines are defined as “multifunctional.”
Three different medicines in the same molecule, if employed using different dosages.
It is an art, measured.
Duration of Treatment
Once the condition has improved, why do we have to continue taking the medications or perform the follow-up, neuromodulation treatments? Why must we do the checkup visits very frequently if the treatment works?
Because we know that behind every disorder there lurks a vulnerability in the system that only by maintaining adequate protection over time, can be controlled, and even canceled.
The appearance of therapeutic effects varies from person to person: in some cases, we might observe an improvement after a few days, but sometimes, it can take months. Effective therapies modify the functioning of brain circuits, thus improving the condition; but even after the appearance of therapeutic effects, it remains necessary to maintain what has been restored.
The brain exists as a “plastic,” adaptive organ, and the medicine and the neuromodulation will allow it to adapt in the best possible way, to use its plasticity well: but for these salutary modifications to happen without the symptoms’ recurring, it will be necessary to continue and to balance the dosage according to the circumstances and the environment.
In this way, it will be possible to avoid or at least minimize the risk and severity of relapses.