because Kraepelin followed the same patient for decades [ in the days before medication] and found that they all had periods of spontaneous recovery, although it might take decades. They never became permanently demented. Since patients spontaneously remitted, he also understood that treatments might be invented in the future to help them recover faster and more effectively.
Paula is proof of this.
We used Paula’s sudden but chronic loss of personal details as a marker; specifically- we tested her every day, at different times of the day to see if she could remember her own address.
The doctor started her on Paxil [Paroxetine]. It took more than 2 months to begin to work. We did not know what to expect, but she began to remember her own address some of the time, so we took this as a good sign.
Our main concern was getting her personal memory back.
The Paxil was helpful, but her memory for her address [and her thoughts ] would come and go during the week. Still, we tracked it often. She was not normal but she was better. She progressively and slowly improved.
She had to be given lithium when, after a year or so, she suddenly became manic, as a result of the Paxil. In retrospect, she could feel the mania coming on rapidly and her breathing rate increase naturally. We learnt to decrease the dose of the lithium in order to maintain her stability and keep improving her memory.
We had no other tools besides the Paxil and then the lithium, and of course-our Marker.
The doctor tried her on other medications but they did not work and her memory worsened.
Every time she went off the Paxil to try something else, she relapsed and went back on the Paxil, which took 2 months to begin working once more.
Paxil was the only medication which began to return her personal memory to her.
It took 10 years [of Paxil] to stabilize her personal memory [using her address as a Marker] and her baseline intellect [they seemed related] to her baseline level of mental function.
It took 10 years to get her mental function as good as it was before her illness. As her body adjusted to the Paxil, over the 10 years, she no longer became manic or even hypomanic and did not need the lithium .
We could not have accomplished this without tracking her intellect and memory using a marker in order to understand which medication could help.
We think that recovery of memory and mind is possible with medication such as Paxil and with better understanding of long episodes of respiratory failure due to ventilatory limitations.
Paula and I had Kraepelin’s studies to help us understand the pattern of physical signs- including the mental dullness and the depressed respiration. Paula and I had Kraepelin’s studies to help us understand that patients could recover their mental capabilities [and mood] completely, which is all patient’s really care about.
We think that it is possible that with additional research and supportive medical support of ventilation [breathing] , reversible mental dullness and dyspnea [internal sense difficulty breathing] and depression [anguish and distress] can be treated much more quickly.
This can be accomplished the way Paula and I did, by identifying a significant memory marker to evaluate treatments.
And we can also medically evaluate patients more completely in order to identify difficult to spot features such as spontaneously depressed breathing [no yoga, no opioids] , episodes of respiratory failure and hypercapnia/hypocapnia [with normal lungs, regular blood tests will be normal] and sensations of difficulty breathing or shortness of breathe [difficult to see if breathing is also depressed].
It is time to take depression more seriously as a medical syndrome, despite the temptation to explore it as a psychological problem.
It is also time to look at unknown undiscovered and unlooked for physical stressors more carefully and to realize that chronic stress is always due to organ dysfunction of one kind of another and organ dysfunction takes decades often, to appear on regular blood tests.
Chronic stress and especially mental dullness and mental confusion [cognitive deficits] are a signal to begin examining the pattern of vital signs in search of physical illness, blood loss, undernutrition and deficiencies, muscle weakness and atrophy and other non specific but important signs of poor health.
If the doctors refuse to listen and refuse to look for the underlying physical signs and symptoms of major depression, bipolar depression, and even what we assume to be dementia instead of a possible treatable chronic delirium [including episodes of manic depressive insanity] than we, as concerned friends and family, should begin to obtain the patient’s vital signs, including respiratory rate at rest, geriatric history, medical history and should start thinking about treatable conditions which often accompany ill health, undernutrition and injury.
This is what I did when Paula could not do it for herself.
And I am nobody, simply a concerned friend, who likes detective stories and scientific puzzles .