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Rick Saldan is an excellent
inspirational speaker who tailored the seminar to the needs of the
individual students being instructed. This office thanks the Mayors Office
of Information Services for having such a vendor.
Timothy K. Lynch
Office of Fleet Management
City of Philadelphia
Rick has a magical approach that provides a clear and
concise message specifically designed to the needs of his
audience. Rick will provide all the motivational magic you
will ever need, propelling your organization to the next
level of greater success.
Thomas Mulhern
Frontier Communications
Rick Saldan is a compelling and absorbing motivational speaker and
magician.I have been to five of his
Motivational Magic presentations and it is amazing how he keeps our
college audiences on the edge of their seats.
A highly entertaining performer with great comedy flair. Rich content to
increase students' productivity, peak performance and motivation. If you
need an outstanding motivational speaker for colleges, Rick is definitely
one of the world's greatest speakers and magicians!
Dr. Rob Gilbert, Sport Psychologist,
Montclair State University
Rick Saldan has the wit, wisdom and sorcery of a wizard. He
has a dynamic personality, and all will enjoy his
captivating stories, comedy and magic!
Dennis Slaughter
Credit Suisse First Boston
Rick Saldan delivers a first-class show! A pro in every
sense of the word. Funny, unique, entertaining and polished.
Brian Letscher, Actor
Hawaii Five-O, NCIS, Cold Case, Law & Order and The Mentalist.
Rick Saldan is a wonderful combination of master magician, comic
improviser and first class speaker. The audience loved his program, which
was music to our ears. If you love celebrity motivational speakers such as
Tom Hopkins, Dale Carnegie and Zig Ziglar, then you'll love Rick!
Dottie Burman, President
Burtley Productions, Inc.
Rick Saldan
is an incredibly talented performer and motivational speaker with great insight. He shares many powerful
motivational messages that will enhance your life for the better!
Jack Murray, President
Dream Illusions
Rick is one of the best inspirational speakers on
the scene today. Funny, fun loving and highly energetic. If you want to
make your next event into an extraordinary one, then invite professional
speaker Rick Saldan and his amazing Motivational Magic.
Andres Lara, President
Inspiration Times Magazine
Depression Series (Part 2): My Antidepressant Doesn’t Work. What Can My Psychiatrist Do? Author: Michael G. Rayel, MD
Maria has been increasingly depressed for the past few years. She has tried at least four newer antidepressants but so far, she doesn’t seem to respond. Unable to work, she’s now feeling helpless and hopeless. Likewise, her family is discouraged. Frustrated and baffled by Maria’s lack of progress, the family doctor refers her to a psychiatrist.
What can the psychiatrist do to help Maria?
The psychiatrist has several options in dealing with a treatment-resistant or refractory depression. First, Maria’s psychiatrist can optimize the dose of her antidepressant. Maria has been taking low doses of antidepressants. In spite of her lack of response, the medication dosage has not been increased. To obtain a clinical response, her psychiatrist should increase the dose every two to three weeks. The antidepressant can be adjusted up to the maximum allowable dose if no or only partial response is observed.
Second, her psychiatrist can choose to augment the effect of her antidepressant with another medication such as lithium, triiodothyronine (T3), or buspirone. Among augmenters, lithium and triiodothyronine have the best support from the literature. Despite lithium’s efficacy, some doctors avoid this drug because it requires regular blood monitoring and has unfavorable side effect profile such as acne, tremors, and thyroid and renal dysfunction.
Recently, studies have shown atypical neuroleptics such as olanzapine and risperidone to be good augmenters. In my opinion, further studies are necessary to establish these two drugs as standard augmenter. Indeed, research studies and clinical experience have found augmentation strategy to be effective.
Third, combination strategy is worthwhile to try. Maria’s psychiatrist can add another antidepressant to boost the effect of her current antidepressant. For instance, trazodone can be added to an SSRI (serotonin reuptake inhibitor e.g. citalopram). Literature suggests that combining two drugs with different mechanisms of action and drugs that involve several brain chemicals has resulted in clinical improvement. In this scenario, one antidepressant plus another antidepressant is equal to three, or four or even ten, not two.
Fourth, the psychiatrist can switch from one antidepressant to another. Previous studies have shown that when making a switch, a drug should be replaced by a drug from a different class e.g. from SSRI to SNRI (serotonin and norepinephrine reuptake inhibitor e.g. venlafaxine), or from TCA (tricyclic agent e.g. nortriptyline) to SSRI. But recent studies show that switching drugs within the same class (e.g. SSRI to another SSRI) is just as effective.
Fifth, Maria’s psychiatrist can also treat other ongoing symptoms or drug-related problems that further complicate her depression. If she is anxious and agitated, then her psychiatrist should prescribe antianxiety drug (e.g. lorazepam) or if Maria is psychotic then adding an antipsychotic drug should help. Moreover, medication side effects (such as insomnia, dryness of mouth, constipation, etc.) that negatively affect Maria’s compliance to the drug should be addressed promptly.
Lastly, if despite above measures Maria doesn’t respond to antidepressants, then electroconvulsive therapy should be entertained. Of course, this procedure should be done with her consent.
In summary, Maria’s psychiatrist can optimize the dose, augment or combine treatment, switch the medication, treat side effects and ongoing symptoms, or use electroconvulsive therapy for treatment-resistant or refractory depression.
