Yeah, short of genetic screening processes becoming far more selective and specific, it's impossible to predict the exact pharmacological imbalance responsible for the depressive phase. Plus, even should that come to pass, it would be a short-sighted clinician who relies purely on pharmacotherapy alone for management of depression. It's a far more complex condition than simple brain chemistry, encompassing a variety of factors like social and physical stressors, with the need for a multimodal approach to properly address. Medications are just one of the supports that hold the entire structure together, and if you throw the entire weight of treatment on that one area, it's going to collapse eventually. Similarly, using a treatment ineffectively will do just as much harm.
It's amusing to boot up my copy of the latest update to the Australian Therapeutic Guidelines and take a refresher look at the treatment protocols for bipolar depression. It specifically calls out SNRIs as well as any other antidepressants with noradrenergic activity (or MAOIs, god forbid you ever have to go there) as more likely to provoke a rapid manic cycling pattern than SSRIs, but of course they're still first line treatment due to their efficacy. It's an ugly truth that we simply don't have sufficient tools to adequately tailor treatment to the individual short of trial and error.
I'm actually surprised to see you list aripiprazole as your doctor's choice of prophylactic therapy. Around here, the absolute most common prophylactic would be quetiapine, followed closely by olanzapine. I definitely wouldn't be second guessing your treating specialist, just expressing my own observations based on my own clinical experience.
One last question: Have you talked about the cost of the medicines you take with your pharmacist? If there's one health professional that knows every last method of squeezing down the cost of prescriptions, it would the them.
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Topic: Should I go back on anti-depressants and how? (Read 7888 times)