WHAT HAPPENS WHEN TWO OR MORE CONDITIONS THAT ARE VERY COMMON CO-MORBIDITIES RESULT IN OR REQUIRE POTENTIALLY CONFLICTING TREATMENTS OR DRUG THERAPIES? THIS TAKES AN EXPERT WITH KNOWLEDGE OF THE ENTIRE SPECTRUM TO SORT OUT AND PRIORITIZE.
HERE ARE SOME SELECTED POSTS FROM CONCERNED PATIENTS ILLUSTRATING THIS POINT. THIS FIRST ONE IS FROM THE MAST CELL ACTIVATION DISORDER (MCAD) FACEBOOK GROUP:
“I was just reading through this article and noticed they say not to take any SSRI’s? My daughter has been on them for years so curious if anyone else has problems taking them? This whole illness got so much worse when she weaned and went off Effexor but the Dr.’s dismiss that all the time”
SHE IS REFERRING TO THE FOLLOWING ARTICLE IN WHICH DR.LAWRENCE AFRIN INDICATES THAT SSRIs SHOULD NOT BE USED IN MCAD PATIENTS
http://link.springer.com/article/10.1007/s00210-016-1247-1 Pharmacological Treatment Options for Mast Cell Activation Disease
MY RESPONSE TO THIS IS IN PARTQUESTION IS AS FOLLOWS
“As with all these recommendations, the advice is relative and all things must be taken in context of the individual patient. In his book “OCCAM” Dr Afrin (quoting Dr. Lawrence B. Afrin from the recently published book NEVER BET AGAINST OCCAM – Mast Cell Activation Disease and the Modern Epidemics of Chronic Illness and Medical Complexity) says on page 426 “…whether it’s through stimulating nerve cells which then help settle down hyperactive mast cells, or by directly binding with and inhibiting hyperactive mast cells, it’s not surprising that SSRIs help settle down at least some mast-cell-related symptoms in some MCAD patients.”
SEEMINGLY CONFLICTING RECOMMENDATIONS FROM AN ACKNOWLEGED EXPERT IN THE FIELD. MAY SEEM CONFUSING FOR THOSE THAT ATTEMPT TO PRACTICE MEDICINE FROM A COOKBOOK
THE ASTUTE CLINICIAN WHO IS ALWAYS ASSESSING THE WHOLE PATIENT AND THINKING BOTH INSIDE AND OUTSIDE THE BOX REALIZES THAT THERE ARE VERY FEW ABSOLUTE RULES WHEN TREATING COMPLEX MEDICAL SYMPTOMS IN LIVING HUMAN BEINGS.
RELATIVE CONTRAINDICATIONS ARE A COMMON DENOMINATOR IN MEDICINE AND HAVE TO BE CONSIDERED ACROSS THE BOARD IN EVERY THERAPEUTIC MANEUVER IN EVERY PATIENT. WORKING WITH A PHYSICIAN WHO KNOWS NOT ONLY HIS SUBJECT THOROUGHLY BUT ALSO KNOWS YOU AND CAN CHANGE AND ADAPT APPROPRIATELY AS THE SITUATION DEMANDS IS THE KEY TO FEELING YOUR BEST AND LIVING LIFE TO THE FULLEST EXTENT OF WHICH YOU ARE CAPABLE.