Previously, medical science did not have a sufficiently sophisticated understanding of the highly complex interactions of neurotransmitters, hormones, vitamins and other micronutrients, the organs that produce biochemicals in these systems, and the symptoms of improper functioning of these interactions. In the last 20 years, we have learned many things, including that this is more complex than we expected and that we are still largely ignorant about these processes.
From 2007–2014, multiple medical professionals used their training, their experience, and my available patient data to diagnose me as well as they could. Their diagnoses were unanimous: depression, generalized anxiety disorder, PTSD, and panic disorder. Let’s assume that their diagnoses are valid (measure something real); because the diagnoses were unanimous, it’s easy to assume scientific reliability (reproducibility). And let’s assume the diagnoses are accurate. They are not, however, precise.
An accurate diagnosis of depression, for example, doesn’t tell us how to treat the depression. Talk therapy, medicine, and electroconvulsive therapy all work for some patients, but none of them work for all patients. Within medicines, patients might respond to many things, including increased serotonin, increased dopamine, increased micronutrients, or reduced inflammation (seriously). But none of those therapies work for everyone. A depression diagnosis is never sufficient information for finding the treatment. And at the time each doctor diagnosed me, we did not know enough about the human body to make a more precise diagnosis. Furthermore, now that we know more about how things work, we haven’t developed diagnostic tests yet: except for multiple sessions with fMRI, which is obscenely expensive. And even worse, because no one expected total desensitization of 5HT2A, no one has specifically studied a cure. I have only found three medicines known to upregulate 5HT2A. My doctors did an excellent job with the knowledge and diagnostic tools available to them, but it would have been impossible for them to prescribe a cure for me.
Before I had a precise understanding of my medical problems, my doctors helped me find medicines by trial and error. Now, I am able to search for medicines that address a precise problem. My understanding that my dopamine activation is too low (in part because of the 5HT2A problem), for example, caused me to take bupropion again. It has helped. My two horrible experiences running out of alprazolam were informative: alprazolam increases dopamine in the striatum, but the effect is not as large or long lasting as bupropion or modafinil. That told me my dopamine levels are still low enough that a small disruption has large effects. Therefore, I increased bupropion from 150 mg twice a day to three times a day. It helped improve the symptoms I expected, and it improved a symptom I didn’t anticipate: I have an appetite. For years, my appetite has been mostly nonexistent, and that makes it difficult for me to eat properly, which makes almost everything else in my life more difficult.
I am now taking 450 mg of bupropion per day, and that is the maximum dosage because anything higher has risks. I can change other medicines to improve my ability to cope. But there are many obstacles. Increasing bupropion and modafinil is expensive. I want to eliminate venlafaxine, omeprezole, and caffeine, but during the transition away from those medicines, I will have many problems. It would be dangerous for me to change those medicines while homeless. Some excellent supplements, such as three amino acids, are inexpensive but only available by mail order: difficult for homeless people. Caffeine increases dopamine, so I can only stop taking it if I can find other ways to increase my dopamine.
If I want to heal, I need to make larger changes, and the above obstacles are even more problematic.
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