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NYT article on autoimmune neurology

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whopper

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I have a segment of patients, however small, that I'm convinced has a strong autoimmune component to their mental illness. The problem is I don't have enough training to start an autoimmune med on my own, the physicians that do don't want to do it because psych is outside their field, and the meds usually cost big money and their insurance won't pay.

E.g. I got a guy with depression, tried ECT, TMS, literally all antidepressants made since 1980, and he has many criteria of SLE, has Sjogrens, and has several other autoimmune problems. Whenever he tried an antidepressant it either worked temporarily but he then within months developed an allergy to it, or it didn't work.

I got a theory his immune system is just way too active and if calmed down he would be able to tolerate the prior antidepressants that previously worked but no other physician will work with me on this to prescribe an autoimmune med.

The guy's system is so over-active that supplements that calm immune response such as tumeric-he's had allergic reactions to them too! Plus their response is no where on the order of an actual autoimmune med. It's like a spitball vs an assault rifle.

So far I've had maybe about a dozen patients where the autoimmune thing IMHO is likely very much the main problem.
 
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nitemagi

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I have a segment of patients, however small, that I'm convinced has a strong autoimmune component to their mental illness. The problem is I don't have enough training to start an autoimmune med on my own, the physicians that do don't want to do it because psych is outside their field, and the meds usually cost big money and their insurance won't pay.

E.g. I got a guy with depression, tried ECT, TMS, literally all antidepressants made since 1980, and he has many criteria of SLE, has Sjogrens, and has several other autoimmune problems. Whenever he tried an antidepressant it either worked temporarily but he then within months developed an allergy to it, or it didn't work.

I got a theory his immune system is just way too active and if calmed down he would be able to tolerate the prior antidepressants that previously worked but no other physician will work with me on this to prescribe an autoimmune med.

The guy's system is so over-active that supplements that calm immune response such as tumeric-he's had allergic reactions to them too! Plus their response is no where on the order of an actual autoimmune med. It's like a spitball vs an assault rifle.

So far I've had maybe about a dozen patients where the autoimmune thing IMHO is likely very much the main problem.
I think having an active immune system doesn't say what's happening. Generalized inflammation, or autoimmune condition attacking some aspect of the brain might explain (like anti-nmda), but overactive immune system seems nonspecific to me. Which is a problem with a lot of the psychoneuroimmunology literature as a whole.
 

whopper

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I don't disagree with you but there is more and more emerging data showing in many cases a core component of the depression (or other mental health problem) could be the immune system.

That's why I'd only push for considering it with some type of manipulative treatment if the patient tried the conventional (multiple antidepressants, ECT, TMS) with no to little success as was in the case I mentioned.
 
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