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To: Joel Young, MD You are the first psychiatrist I have seen on this board. I want to welcome you. I am a patient who has been living with PD about 15 years. Prior to this time I would have about two or three really bad periods of depression each year. They could be short periods of 3-5 days or longer periods of 2-3 weeks. When diagnosed with PD, depression in PD was assumed to be due to the drugs and the fact PD is a chronic illness. In the last year or two, depression in PD is finally getting elevated to its rightful place beside bradykinesia, tremor and rigidity. This is creating a new problem. I do not believe neurologists are properly trained to dispense antidepression medication. I know a couple of neruologists who have a psychiatry background, but I would guess they are unique. Less I be quoted as dinging the neruology field, I will add that there are probably fewer psychiatrists with a minor in neurology. I will address that problem later. There is a wealth of information linking reduced levels of serotonin with PD. There is also scientific speculation that reduced serotonin levels may be one possible cause for depression. This all leads up to the use of SSRI drugs in PD. If there is a serotonin depletion in PD, the use of SSRI drugs make a lot of sense. I am taking one 20 mg Paxil daily and find it beneficial. It doesn't significantly change my day, but I am more agreeable, tolerable and maybe likeable because of Paxil. What I do not know is if I would be better off using Prozac or Zoloff. Can you tell us what difference exists between Prozac, Zoloff and Paxil? Is one better than another? I know of one member of this group who is on Zoloff and is fighting fatigue. I looked in the PDR and found fatigue at a 10% experience level. I did not see fatigue on the list for Paxil. If you go along with my comments about neurologists, often what the patient requests is what the neurologist often will prescribe (subject to proper medical practice). Now as to psychiatrists. My only experience with psychiatrists has been when members of the support group have played with illegal drugs such as crack, gotten arrested and put in a drug treatment center. This has been HELL FOR PD PATIENTS. Sinemet (dopamine) can make a normal person look very psychotic. One member was arrested recently for crack possition and placed in a drug rehab center. He normally used 2 50/200 Sinemet CR daily and 1 or 2 25/100 Sinemet with 2 0.25 mg Permax. The drug rehad unit said drugs are given four times daily, that's the rule, no exceptions. So they decided that he should have a 50/200 Sinemet CR and a .25 Permax four times a day. To help him with this change they allowed him to have 12 25/100 Sinemet daily as needed. These rehab units apply much stress as part of their drug rehab program. The net-net was the patient was taking all the meds daily. (4 50/200 CR, 4 0.25 Permax and 12 25/100 Sinemet). Physically he was undermedicated as he had festenation in walking and often went into akineasia. He had almost no dyskinesia. He had belly protrusion and rear extension when he did move. He was in extreme paranoia. He believed everyone was watching him, could read his lips, thoughts, and everything else. I tried to talk to him, but he was so concerned about people standing behind trees or cars or desks listening that he didn't want to talk about anything else. He knew he was over medicating, but claimed he needed it just to move. Most of the time the drugs were doing nothing for him.. He did talk continuously about people listening, so I am not sure he even heard me talk. I will also add that these drug rehab programs do not admit to having any patients. If you were to call and ask about the status of someone, they will tell you they do not know of anyone by that name. This made getting to medical staff almost impossible. I finally wrote a letter to the psychiatrist in charge of the program explaining what might be this man's problem due to such high sinemet levels. I even sent a book on drugs used in PD. I did not get a response from the medical staff. What happened was the patient was transferred out of that rehad unit the day after my letter arrived . He was sent to a new location and program. The staff there actually called me for information about PD and drugs. We talked for about 2 hours as they explained their drug rehab program and I explained stress related reactio ns to a PD patient. The nice thing was that the patient was able to complete the drug rehab program. From this and a couple of similar situations in Southern Ca. I have come be believe that psychiatrists do not understand PD. They will pump us full of their favorite antipsychotic drugs thinking PD is a movement disorder. Actually it is a neurotransmitter disorder. And it is neurotransmitters that psychiatrists, neurologists and anesthesiologists all play with and these are the professionals. Think of us patients, we are just amateurs playi ng with dopamine and serotonin etc. trying to find what works best. We truly need good, fundamental information to properly guide our professionals. That was a lot off my chest. I would appreciate your comments. Regards, Alan Bonander ([log in to unmask]) Past President of Young Parkinson's Support Network of CA.