I had two conversations last week with Dr. Levin regarding titration protocol and managing SEs. I’ll recount them as best I can. Where I've quoted him, I wrote down exactly what he said during our phone calls.
He described the switch as ‘noticing after 3 weeks that you haven’t thought about having a drink.’
Regarding titration after the switch he said:
“If I understand Olivier’s directive you are to stay at the switch dose indefinitely.”
If you don’t have [debilitating] side effects, it’s better to stay where you are and wait and see if they subside.
Side effects:
Obviously concerned I asked about the SEs and what to do if they are debilitating at that level. He said that the body will adjust, and that it’s important to keep a steady level in the blood stream, that the body will correct for the amount in due time by excreting what is unnecessary.
“If you have significant side effects it’s understandable to make a change and becomes a good idea to lower it down and …to go down slowly.” He feels strongly, as I shared on another thread, that the goal is success. So titration up, or down, should be based on being able to manage life. (my interpretation, I suppose.)
“The way to manage SEs is to take at least 3 doses, or sometimes 4 or even 5, so the amount that goes into your blood stream is [consistent.]
That’s worked a number of times with patients of mine…”
He also thinks that SEs might be related to underlying physical issues, to titrating too quickly or because of other meds.
(He recommends using epocrates.com in order to find out about contraindications. I was able to register using the free 3 month subscription. The list of contraindications is rather long. It seems to mostly include CNS depressants. Also included are muscle relaxants—acetaminophen, aspirin and ibuprofen used in conjunction with some other med can result in psychomotor impairment. Lots of other things I’ve heard mentioned around here from chamomile (german) and some ADs to topa… please check it out if you can.)
He repeatedly emphasized that discontinuing bac suddenly could have dire consequences. (Seizure is one he mentioned.) And that if a doctor were to recommend discontinuing I should call him immediately. He was very clear with me that doctors don't know much about bac, much less high dose bac. Though he didn't say it that way, ftr.
He said that 140mg/day, 240mg/day and 340/mg/day are ‘important’ levels in regards to the switch.
Dr. Ameisen was recently a guest in Dr. Levin's home in Chicago. He was there at the invitation of the chair of psychiatry, Dr John Csernansky.
He gave the lecture "Addiction: a cure at last" that he had also given as inaugural grand rounds at St-Lukes Roosevelt (Columbia University), at Bellevue/New York University and more recently at Harvard Medical School among other universities in the US and in Europe. The talks are very well received and physicians who attend them often start treating patients according to the protocol he has discovered.
There's more and I'll follow up with another post. But this is everything we talked about re. titration and SEs. I think.
He described the switch as ‘noticing after 3 weeks that you haven’t thought about having a drink.’
Regarding titration after the switch he said:
“If I understand Olivier’s directive you are to stay at the switch dose indefinitely.”
If you don’t have [debilitating] side effects, it’s better to stay where you are and wait and see if they subside.
Side effects:
Obviously concerned I asked about the SEs and what to do if they are debilitating at that level. He said that the body will adjust, and that it’s important to keep a steady level in the blood stream, that the body will correct for the amount in due time by excreting what is unnecessary.
“If you have significant side effects it’s understandable to make a change and becomes a good idea to lower it down and …to go down slowly.” He feels strongly, as I shared on another thread, that the goal is success. So titration up, or down, should be based on being able to manage life. (my interpretation, I suppose.)
“The way to manage SEs is to take at least 3 doses, or sometimes 4 or even 5, so the amount that goes into your blood stream is [consistent.]
That’s worked a number of times with patients of mine…”
He also thinks that SEs might be related to underlying physical issues, to titrating too quickly or because of other meds.
(He recommends using epocrates.com in order to find out about contraindications. I was able to register using the free 3 month subscription. The list of contraindications is rather long. It seems to mostly include CNS depressants. Also included are muscle relaxants—acetaminophen, aspirin and ibuprofen used in conjunction with some other med can result in psychomotor impairment. Lots of other things I’ve heard mentioned around here from chamomile (german) and some ADs to topa… please check it out if you can.)
He repeatedly emphasized that discontinuing bac suddenly could have dire consequences. (Seizure is one he mentioned.) And that if a doctor were to recommend discontinuing I should call him immediately. He was very clear with me that doctors don't know much about bac, much less high dose bac. Though he didn't say it that way, ftr.
He said that 140mg/day, 240mg/day and 340/mg/day are ‘important’ levels in regards to the switch.
Dr. Ameisen was recently a guest in Dr. Levin's home in Chicago. He was there at the invitation of the chair of psychiatry, Dr John Csernansky.
He gave the lecture "Addiction: a cure at last" that he had also given as inaugural grand rounds at St-Lukes Roosevelt (Columbia University), at Bellevue/New York University and more recently at Harvard Medical School among other universities in the US and in Europe. The talks are very well received and physicians who attend them often start treating patients according to the protocol he has discovered.
There's more and I'll follow up with another post. But this is everything we talked about re. titration and SEs. I think.
, to check my inbox.
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