![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 39 to 63 of 488. Go back in thread:
Posted by djmmm on January 20, 2002, at 0:31:33
In reply to Re: MAOI diet short list and Zyvox , posted by fran on January 19, 2002, at 23:17:44
> I'm on Effexor for depression, but do know a
> little about MAOI and that they require diet
> restrictions which are not necessary for SSRIs.
> But now I've been started on Zyvox,which is a new
> antibiotic which has been out only about 2 months.
> It's used for serious infections with "super-bugs",
> i.e. bacteria that are resistant to all other
> existing antibiotics. Amazingly, it requires
> adherence to an MAOI diet, but I found this out
> only by looking it up in the new PDR. My doctor
> (an infectious diseases specialist) didn't tell me
> and there was no warning on the prescription
> bottle. *UNBELIEVABLE!!!*
> So, I'm very grateful to all of you for having
> already shared your experiences on-line. I had
> been following the old MAOI recommendations
> (sloppily provided even by my recently trained
> pharmacist), and was just resigned to a month or
> two of those restrictions (I totally admire all of
> you who have been doing this long-term). But even
> there, I had a ton of unanswered questions. Now
> I'm a much happier camper!
> BTW, I did read in a reputable (I think) article
> that, if you stop an MAOI, you have to continue
> the diet restrictions for an additional 4 weeks.
> Have any of you come across any information like
> this, or to the contrary?
> Thanks again, to all of you!an irreversible covalent bond is formed by conventional MAOIs (non-reversible) so if discontinued, a new MAO enzyme must be resynthesized before "normal" MAO activity resumes... 4 weeks, seems a little excessive, but Im not a doctor.
also..Zyvox interacts with MAOIs because it is a MAOI itself,--so it also has potential interactions with SSRIs, TCAs, bupropion, and Buspar
Posted by Seamus2 on January 20, 2002, at 9:37:49
In reply to Re: MAOI dose and dizziness-Seamus, posted by Lisa01 on January 19, 2002, at 9:11:31
> Seamus, how long before you reduced to a maintenance dose? I haven't gone to 20 mg. yet. but plan to start next week. Also, do you do, or have you done, any CBT? < <
I'll probably drop back at the start of my sixth week.No CBT. I think my brain IS screwed up already, and look on the Parnate as a vitamin to keep it working well.
Seamus
Posted by Krazy Kat on January 20, 2002, at 18:13:42
In reply to Re: MAOI dose and dizziness-Seamus, posted by Lisa01 on January 19, 2002, at 9:11:31
Lisa:
Sorry I'm jumping in here - my understanding is that you can't mess with your brain chemistry - the effects of drugs, legal or otherwise, are fleeting.
Perhaps if we Could change our "chemistries", we could take a med once and then be cured. That Would be nice.
- KK
Posted by djmmm on January 20, 2002, at 18:47:33
In reply to Re: MAOI dose and dizziness-Seamus » Lisa01, posted by Krazy Kat on January 20, 2002, at 18:13:42
> Lisa:
>
> Sorry I'm jumping in here - my understanding is that you can't mess with your brain chemistry - the effects of drugs, legal or otherwise, are fleeting.
>
> Perhaps if we Could change our "chemistries", we could take a med once and then be cured. That Would be nice.
>
> - KKwell, not exactly...the problem is we do mess with our brain chemistry, and the greater problem is, for many, the effect is not fleeting...
many drugs are neurotoxins...drugs like MDMA (Ecstasy) and the popular diet drug Pondomin have the potential to "manipulate" the serotonin system, by destroying axon terminals, and even the very neurons that contain the mitochondria which produce the serotonin.
SSRI, TCAs and all other Psychiatric drugs seem to change brain chemistry, too. They too manipulate the serotonin system, perhaps not to the extent that MDMA does, but the result would be considered long-term downregulation of specific serotonin (or norepineprine) receptor sites.
Posted by Lisa01 on January 20, 2002, at 19:02:47
In reply to Re: MAOI dose and dizziness-Seamus, posted by djmmm on January 20, 2002, at 18:47:33
> > Sorry I'm jumping in here - my understanding is that you can't mess with your brain chemistry - the effects of drugs, legal or otherwise, are fleeting.
> > Perhaps if we Could change our "chemistries", we could take a med once and then be cured. That Would be nice.
> >
That certainly seems to be true in the sense that, once meds are out of our systmes, the original symptoms re-emerge.> well, not exactly...the problem is we do mess with our brain chemistry, and the greater problem is, for many, the effect is not fleeting...
>
> many drugs are neurotoxins...drugs like MDMA (Ecstasy) and the popular diet drug Pondomin have the potential to "manipulate" the serotonin system, by destroying axon terminals, and even the very neurons that contain the mitochondria which produce the serotonin.
>
> SSRI, TCAs and all other Psychiatric drugs seem to change brain chemistry, too. They too manipulate the serotonin system, perhaps not to the extent that MDMA does, but the result would be considered long-term downregulation of specific serotonin (or norepineprine) receptor sites.I can't attest the technical accuracy of these statements but I'll take your word on it!! What I'm simply thinking of is the strange things that occur when beginning a med. When I began Parnate, for example, I had twitching in my left eye, pulsing temples, and a mild, on and off headache. I just kept thinking: what is this doing to me?? It shows you how desperate we are for relief from symptoms--of Social Anxiety in my case--that we will put up with such things. I just sometimes wonder what the long-term result will be.
Best to all of you, and thanks for your input.
Lisa
Posted by Rick on January 21, 2002, at 3:40:48
In reply to Re: MAOI dose and dizziness-Seamus, posted by Lisa01 on January 20, 2002, at 19:02:47
> It shows you how desperate we are for relief from symptoms--of Social Anxiety in my case--that we will put up with such things. I just sometimes wonder what the long-term result will be.
The general wisdom -- and I'm not saying it's 100% correct -- is that medication changes brain chemistry temporarily; while successful CBT can effect permanent changes.
On the other hand, the continuation vs. discontinuation summarized study below shows clear evidence of maintained post-treatment benefit from Klonopin (clonazepam), the med which has demonstrated the highest level of controlled-study efficacy to-date for SP. Despite the overblown fears of dependence, addiction (HUGELY exaggerated), and tolerance (excuse me, why have I been able to REDUCE my theraputic dose from 3mg to 1mg over two years??), this med is physically safer than AD's and generally a lot more tolerable. But I digress...I'd imagine the kinds of post-treatment Social Phobia benefits described here would likely apply to MAOI responders as well.
P.S. Despite my Klonopin boosterism I think if you stick it out you have a great chance of doing well with Parnate. And if even if not, there are quite a few meds than can help, with some promising new ones in development.
Rick
-----J Clin Psychopharmacol 1998 Oct;18(5):373-8
Discontinuation of clonazepam in the treatment of social phobia.
Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.
Posted by spike4848 on January 21, 2002, at 9:47:56
In reply to Brain Chemistry/Lasting Social Phobia Benefits » Lisa01, posted by Rick on January 21, 2002, at 3:40:48
> The general wisdom -- and I'm not saying it's 100% correct -- is that medication changes brain chemistry temporarily; while successful CBT can effect permanent changes.
responders as well.Hey Rick,
I think we are pretty much in agreement. As I understand it, *any* active treatment *modified* brain chemistry. With medication, active treatment last only as long as the duration you take it. With CBT, you retrain behavior, and thus "treating" the brain for as long as the behavioral changes last. Often these changes can be life long. So if we are able to correct any maladaptive behavior contributing to our illness, and maintain that behavior, we can in a sense permenently change brain chemistry.
I am not sure if an "imbalance" in brain neurotransmiters levels is the etilogy of mood disorders. These imbalances we see may just be secondary to the real pathologic process. We simply just don't know enough about the brain.
We know the human brain in the most complex of all the organs. Many scientists believe we will never completely understand how it works. We need something "smarter" than our own brains to figure out the inner workings of the brain. Thus, we may never fully realize the pathology of mood disorders.
Spike
PS Rick ... I alway enjoy reading your posts ... they are very informative and insightful
Posted by Lorraine on January 21, 2002, at 11:40:32
In reply to Brain Chemistry/Lasting Social Phobia Benefits » Lisa01, posted by Rick on January 21, 2002, at 3:40:48
> > It shows you how desperate we are for relief from symptoms--of Social Anxiety in my case--that we will put up with such things. I just sometimes wonder what the long-term result will be.
>
> The general wisdom -- and I'm not saying it's 100% correct -- is that medication changes brain chemistry temporarily; while successful CBT can effect permanent changes.
>
> On the other hand, the continuation vs. discontinuation summarized study below shows clear evidence of maintained post-treatment benefit from Klonopin (clonazepam), the med which has demonstrated the highest level of controlled-study efficacy to-date for SP. Despite the overblown fears of dependence, addiction (HUGELY exaggerated), and tolerance (excuse me, why have I been able to REDUCE my theraputic dose from 3mg to 1mg over two years??), this med is physically safer than AD's and generally a lot more tolerable. But I digress...I'd imagine the kinds of post-treatment Social Phobia benefits described here would likely apply to MAOI responders as well.
>
> P.S. Despite my Klonopin boosterism I think if you stick it out you have a great chance of doing well with Parnate. And if even if not, there are quite a few meds than can help, with some promising new ones in development.
>
> Rick
> -----
>
> J Clin Psychopharmacol 1998 Oct;18(5):373-8
>
> Discontinuation of clonazepam in the treatment of social phobia.
>
> Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F.
>
> Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
>
> Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.
Posted by Rick on January 21, 2002, at 13:00:37
In reply to Re: Brain Chemistry/Lasting Social Phobia Benefits » Rick, posted by spike4848 on January 21, 2002, at 9:47:56
Posted by Rick on January 21, 2002, at 13:22:46
In reply to Re: Great info of enormous usefulness nm » Rick, posted by Lorraine on January 21, 2002, at 11:40:32
Lorraine -
Glad you found it useful!
BTW, anything by Duke's JR (Jonathan RT) Davidson on anxiety -- especially social phobia -- is worth reading. He was listed as the second author in the Klonopin/clonazepam discontinuation abstract, and was the lead researcher for the original placebo-controlled study that demonstrated the med's appx 70% response rate in social phobia. Those just scratch the surface of the work he's done on SP etiology, measurement, and treatment.
Rick
Posted by Lorraine on January 21, 2002, at 19:25:28
In reply to Re: Great info of enormous usefulness nm » Lorraine, posted by Rick on January 21, 2002, at 13:22:46
Rick:
You may have seen this
http://www.psychiatrist.com/supplenet/59s17/59s17toc.htm
> Lorraine -
>
> Glad you found it useful!
>
> BTW, anything by Duke's JR (Jonathan RT) Davidson on anxiety -- especially social phobia -- is worth reading. He was listed as the second author in the Klonopin/clonazepam discontinuation abstract, and was the lead researcher for the original placebo-controlled study that demonstrated the med's appx 70% response rate in social phobia. Those just scratch the surface of the work he's done on SP etiology, measurement, and treatment.
>
> Rick
Posted by Rick on January 21, 2002, at 21:45:43
In reply to Re: Some links » Rick, posted by Lorraine on January 21, 2002, at 19:25:28
Lorraine -
Yes I've seen it, and it's nice that the Journal of Psychiatry (or Glaxxo Smith Kline??) has made that supplement available electronically for free.
The same journal also published an updated supplement on Social Anxiety in 2001. I had to order the hardcopy, purchased online from the Orders section at http://www.psychiatrist.com , but it was well worth the $10. (Don't know if that would be possible at the moment though, because I just visited the site to verify that this price still applies, and the Orders link doesn't seem to be functioning properly.)
I've pasted the table of contents for the 2001 supplement below.
Volume 62 2001 Supplement 1
Advances and Emerging Treatments in Social Phobia
3 Disclosure Statements.
4 Introduction: Advances and Emerging Treatments in Social Phobia. Jonathan R. T. Davidson
5 Social Phobia: Prevalence and Diagnostic Threshold. Ariel J. Lang and Murray B. Stein
11 Social Anxiety Disorder: An Unrecognized Problem in Primary Care. David J. Katzelnick and John H. Greist
17 Social Anxiety Disorder: Comorbidity and Its Implications. R. Bruce Lydiard
25 Social Phobia: Etiology, Neurobiology, and Treatment. Nicholas J. Coupland
36 Current Status of Psychotherapeutic Interventions for Social Phobia. Richard G. Heimberg
43 Treatment of Social Phobia With Antidepressants. Franklin R. Schneier
50 Benzodiazepines and Anticonvulsants for Social Phobia (Social Anxiety Disorder). James W. Jefferson
Rick> Rick:
>
> You may have seen this
>
> http://www.psychiatrist.com/supplenet/59s17/59s17toc.htm
>
> > Lorraine -
> >
> > Glad you found it useful!
> >
> > BTW, anything by Duke's JR (Jonathan RT) Davidson on anxiety -- especially social phobia -- is worth reading. He was listed as the second author in the Klonopin/clonazepam discontinuation abstract, and was the lead researcher for the original placebo-controlled study that demonstrated the med's appx 70% response rate in social phobia. Those just scratch the surface of the work he's done on SP etiology, measurement, and treatment.
> >
> > Rick
Posted by Elizabeth on January 22, 2002, at 23:30:23
In reply to Brain Chemistry/Lasting Social Phobia Benefits » Lisa01, posted by Rick on January 21, 2002, at 3:40:48
Lisa:
Medications typically work as long as you're taking them (sometimes people develop tolerance, but this doesn't generally happen with most common psychiatric drugs). The evidence regarding talk therapies (mainly CBT, although other talk therapies are now being studied too) is less clear. Advocates of CBT and other nonmedical therapies have claimed that these therapies get to the "root of the problem" and therefore can permanently cure mental disorders (medications that are used presently constitute "treatment" rather than a "cure"). On the other hand, some studies show that people who don't remain in therapy frequently relapse.
Personally, I didn't have much luck with CBT, but I think that each person is different. Another type of talk therapy, interpersonal therapy (IPT), seems promising for social phobia, and I think that group therapy can be helpful too (there are lots of CBT and IPT groups, some of which are specifically intended for people with SP).
I do think that, if you can afford it and if you can find a therapist who you "click" with, it's nice to be in *some* sort of talk therapy (depending on what you feel most comfortable with). My impression is that family or marital counseling can be especially helpful for couples or families where one or more members suffer from a mental disorder. On the other hand, I believe that it's usually not prudent to attempt to treat serious mental illness with talk therapy alone. (Social phobia comes in mild forms too, of course.)
Re Parnate dose:
Even many physicians don't know much about using MAOIs. Burns, if I recall, is a psychologist, so while the book you have is supposed to be a great self-help resource, I don't suggest relying on it for medical information.-elizabeth
Posted by OldSchool on January 23, 2002, at 14:33:08
In reply to Re: Brain Chemistry/Lasting Social Phobia Benefits » Rick, posted by Elizabeth on January 22, 2002, at 23:30:23
> Re Parnate dose:
> Even many physicians don't know much about using MAOIs. Burns, if I recall, is a psychologist, so while the book you have is supposed to be a great self-help resource, I don't suggest relying on it for medical information.The above information is totally incorrect. I have David Burns's book Feeling Good right in front of me and it clearly says "David Burns, MD." His credentials are the following according to the book. "Clinical Associate Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine."
Clearly Burns is a psychiatrist, not a psychologist. I have his latest updated Feeling Good and while Im not a big fan of any kind of talk therapy, I found the updated drugs section in the second half of the book to be OUTSTANDING. In fact, the drugs section of Feeling Good is worth the price of the book IMO. Its written in plain English and is clear, concise, useful information about psychiatry drugs used to treat depression. I would rely on this information anyday. One thing I like about Burns is he obviously does not believe in overmedicating his patients and this is clearly obvious in his drugs section of Feeling Good.
His drug information is first class info.
Old School
>
Posted by Lisa01 on January 23, 2002, at 15:13:36
In reply to Re: David Burns is a psychiatrist , posted by OldSchool on January 23, 2002, at 14:33:08
> Clearly Burns is a psychiatrist, not a psychologist. I have his latest updated "Feeling Good" and while Im not a big fan of any kind of talk therapy, I found the updated drugs section in the second half of the book to be OUTSTANDING. In fact, the drugs section of "Feeling Good" is worth the price of the book IMO. Its written in plain English and is clear, concise, useful information about psychiatry drugs used to treat depression. I would rely on this information anyday. One thing I like about Burns is he obviously does not believe in overmedicating his patients and this is clearly obvious in his drugs section of Feeling Good.
>
> His drug information is first class info.
>
> Old SchoolI was quite sure that he could not have prescribed drugs as a psychologist--I believe only M.D.'s and psychiatrists only have this 'power'--and he talks extensively in the book about his prescribing experience with the various drugs and the feedback from his patients.
I would also point out that I did not take the dosage advise from the book alone but also from my family physician, who thought that beginning on the 10 mg. dose would be best. He has since approved a move to twice daily with a close watch on side effects (I still get dizzy and disoriented following the afternoon dose, but am waiting this out hoping for the benefits!)
Lisa
Posted by Cecilia on January 24, 2002, at 3:50:02
In reply to Re: David Burns is a psychiatrist , posted by Lisa01 on January 23, 2002, at 15:13:36
> > Clearly Burns is a psychiatrist, not a psychologist. I have his latest updated "Feeling Good" and while Im not a big fan of any kind of talk therapy, I found the updated drugs section in the second half of the book to be OUTSTANDING. In fact, the drugs section of "Feeling Good" is worth the price of the book IMO. Its written in plain English and is clear, concise, useful information about psychiatry drugs used to treat depression. I would rely on this information anyday. One thing I like about Burns is he obviously does not believe in overmedicating his patients and this is clearly obvious in his drugs section of Feeling Good.
> >
> > His drug information is first class info.
> >
> > Old School
>
> I was quite sure that he could not have prescribed drugs as a psychologist--I believe only M.D.'s and psychiatrists only have this 'power'--and he talks extensively in the book about his prescribing experience with the various drugs and the feedback from his patients.
>
> I would also point out that I did not take the dosage advise from the book alone but also from my family physician, who thought that beginning on the 10 mg. dose would be best. He has since approved a move to twice daily with a close watch on side effects (I still get dizzy and disoriented following the afternoon dose, but am waiting this out hoping for the benefits!)
>
> LisaDoes anyone know if anything happened to Dr. Burns? I used to read his web site (feelinggood.com) in which he would personally answer readers questions, but he stopped writing in it after Sep. 11 and now his web site has disappeared altogether. Dr. Burns is indeed a psychiatrist, but makes it clear in his web site that he has little faith in medication and believes CBT to be much more effective. I guess CBT works well for some people, but I`ve never figured how you make yourself BELIEVE the so-called rational thoughts, especially on an emotional, not just intellectual, level. And some of it is pretty oversimplistic, like the shame-attacking exersises where you do embarrassing things on purpose; for someone with deep rooted shame issues this makes about as much sense as curing broken bones by breaking a few more. Cecilia
Posted by Cecilia on January 24, 2002, at 4:32:09
In reply to Re: David Burns is a psychiatrist , posted by Lisa01 on January 23, 2002, at 15:13:36
> > Clearly Burns is a psychiatrist, not a psychologist. I have his latest updated "Feeling Good" and while Im not a big fan of any kind of talk therapy, I found the updated drugs section in the second half of the book to be OUTSTANDING. In fact, the drugs section of "Feeling Good" is worth the price of the book IMO. Its written in plain English and is clear, concise, useful information about psychiatry drugs used to treat depression. I would rely on this information anyday. One thing I like about Burns is he obviously does not believe in overmedicating his patients and this is clearly obvious in his drugs section of Feeling Good.
> >
> > His drug information is first class info.
> >
> > Old School
>
> I was quite sure that he could not have prescribed drugs as a psychologist--I believe only M.D.'s and psychiatrists only have this 'power'--and he talks extensively in the book about his prescribing experience with the various drugs and the feedback from his patients.
>
> I would also point out that I did not take the dosage advise from the book alone but also from my family physician, who thought that beginning on the 10 mg. dose would be best. He has since approved a move to twice daily with a close watch on side effects (I still get dizzy and disoriented following the afternoon dose, but am waiting this out hoping for the benefits!)
>
> LisaDoes anyone know if anything happened to Dr. Burns? I used to read his web site (feelinggood.com) in which he would personally answer readers questions, but he stopped writing in it after Sep. 11 and now his web site has disappeared altogether. Dr. Burns is indeed a psychiatrist, but makes it clear in his web site that he has little faith in medication and believes CBT to be much more effective. I guess CBT works well for some people, but I`ve never figured how you make yourself BELIEVE the so-called rational thoughts, especially on an emotional, not just intellectual, level. And some of it is pretty oversimplistic, like the shame-attacking exersises where you do embarrassing things on purpose; for someone with deep rooted shame issues this makes about as much sense as curing broken bones by breaking a few more. Cecilia
Posted by OldSchool on January 24, 2002, at 10:30:56
In reply to Re: David Burns , posted by Cecilia on January 24, 2002, at 3:50:02
>
> Does anyone know if anything happened to Dr. Burns? I used to read his web site (feelinggood.com) in which he would personally answer readers questions, but he stopped writing in it after Sep. 11 and now his web site has disappeared altogether. Dr. Burns is indeed a psychiatrist, but makes it clear in his web site that he has little faith in medication and believes CBT to be much more effective. I guess CBT works well for some people, but I`ve never figured how you make yourself BELIEVE the so-called rational thoughts, especially on an emotional, not just intellectual, level. And some of it is pretty oversimplistic, like the shame-attacking exersises where you do embarrassing things on purpose; for someone with deep rooted shame issues this makes about as much sense as curing broken bones by breaking a few more. Cecilia
I have his book Feeling Good. I dont agree with much of the stuff in it. He criticizes the idea of depression having a chemical imbalance root cause, but then goes onto giving rave reviews of MAOIs. MAOIs are the most potent antidepressants available. What gives with that? What a hypocrite. Its obvious Burns is another idiot who has this mindblock many psychology buffs have to the basic fact that all of your thoughts, moods, feelings, perceptions, etc. are brain based. Everything starts in your brain.He also admits bipolar disorder is heavily biological and genetic, but denies depression is biological. LOL
Old School
Posted by Elizabeth on January 24, 2002, at 12:59:33
In reply to Re: David Burns is a psychiatrist , posted by OldSchool on January 23, 2002, at 14:33:08
> The above information is totally incorrect. I have David Burns's book "Feeling Good" right in front of me and it clearly says "David Burns, MD." His credentials are the following according to the book. "Clinical Associate Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine."
Well, then he doesn't have any excuse, if he did indeed claim that 20 mg of Parnate should be enough for all or most patients. 20 mg of Parnate is a very modest dose, although it may of course be adequate for a few people.
You of all people should know that just because someone is a psychiatrist, that doesn't mean they know what they're talking about! (Not that Burns doesn't know what he's talking about; all I know is that he's wrong about this particular thing.)
-elizabeth
Posted by Elizabeth on January 24, 2002, at 13:07:37
In reply to Re: David Burns is a psychiatrist , posted by Lisa01 on January 23, 2002, at 15:13:36
> I was quite sure that he could not have prescribed drugs as a psychologist--I believe only M.D.'s and psychiatrists only have this 'power'--and he talks extensively in the book about his prescribing experience with the various drugs and the feedback from his patients.
That's right, psychologists can't prescribe drugs (thank goodness). A psychiatrist is an M.D. and as such can prescribe. I haven't read the book; I was going on memory from a discussion about it a very long time ago on Usenet! Sorry about that.
> I would also point out that I did not take the dosage advise from the book alone but also from my family physician, who thought that beginning on the 10 mg. dose would be best.
*Beginning*, sure. That doesn't mean that 10 mg is an effective dose! The 20 mg you're taking is also seldom enough. It is a good idea to increase it slowly (assuming your depression is not serious enough that you need to get to a target dose ASAP) since you seem to be sensitive to the side effects. A good *starting* dose isn't the same as an *effective* dose -- many people have to start at 5 mg/day of Paxil, for example. You might be lucky and find that 20 mg/day is enough Parnate for you, but I wouldn't count on it. You might go back and read Burns again -- I'm guessing that he didn't say that 20 mg is generally a sufficient dose.
-elizabeth
Posted by Lisa01 on January 24, 2002, at 13:14:45
In reply to Re: David Burns and Parnate » Lisa01, posted by Elizabeth on January 24, 2002, at 13:07:37
You might go back and read Burns again -- I'm guessing that he didn't say that 20 mg is generally a sufficient dose.
Hi Elizabeth--thanks for all your input. Burns does say that he will sometimes go to 30 mg. Parnate but very rarely to 40 or more. He emphasized that many respond so well to 10 or 20 that they do not need to go any higher. I was hoping to be one of those people. One thing that is unclear in Burns is how long to give it at 20 mg before determining you need more (my fam. phys. says 2 weeks). At this point I don't even notice partial benefits which makes me wonder if it just needs more time...Lisa
Posted by Elizabeth on January 24, 2002, at 13:24:48
In reply to Re: David Burns , posted by OldSchool on January 24, 2002, at 10:30:56
> I have his book Feeling Good. I dont agree with much of the stuff in it.
I agree, and I'm surprised to hear that you have the book. Any particular reason you got it?
> He criticizes the idea of depression having a chemical imbalance root cause, but then goes onto giving rave reviews of MAOIs. MAOIs are the most potent antidepressants available.
Well, if they are the best ADs, maybe it just means he thinks the other ADs are weak and don't do much. (BTW, I'm guessing that you mean the *strongest* or most *effective*. Potency just means the effective dose is low -- so Parnate is more potent than Nardil, and Paxil is more potent than Zoloft, but MAOIs and other ADs can't really be compared in potency since they do different things.)
> What gives with that? What a hypocrite. Its obvious Burns is another idiot who has this mindblock many psychology buffs have to the basic fact that all of your thoughts, moods, feelings, perceptions, etc. are brain based. Everything starts in your brain.
A lot of people seem to have a hard time grasping this idea. Anyway, that must be why I thought Burns was a psychologist, because he's such a CBT cultist.
Out of curiosity, have you tried CBT or other talk therapy, and if so what did you think of it? (My experience with CBT was much like Cecilia's.)
> He also admits bipolar disorder is heavily biological and genetic, but denies depression is biological. LOL
So he buys the idea of a biological basis for some mental disorders, but denies that depression is one of them, huh? Personally I've never heard of *anyone* with serious depression who was cured by CBT.
Yes, the brain gets sensory input from external experiences, and in the long term these experiences affect what we call "personality," but whether or not a major depressive episode will occur is largely predetermined, probably at least in part by genetics. (There may be other factors, such as autoimmune conditions.) So I don't think that people with depression that has recurred for more than a couple times are likely to benefit from personality or behavior modification (the supposed effect of CBT).
-elizabeth
Posted by OldSchool on January 24, 2002, at 14:25:44
In reply to Re: David Burns is a psychiatrist » OldSchool, posted by Elizabeth on January 24, 2002, at 12:59:33
> > The above information is totally incorrect. I have David Burns's book "Feeling Good" right in front of me and it clearly says "David Burns, MD." His credentials are the following according to the book. "Clinical Associate Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine."
>
> Well, then he doesn't have any excuse, if he did indeed claim that 20 mg of Parnate should be enough for all or most patients. 20 mg of Parnate is a very modest dose, although it may of course be adequate for a few people.
>
> You of all people should know that just because someone is a psychiatrist, that doesn't mean they know what they're talking about! (Not that Burns doesn't know what he's talking about; all I know is that he's wrong about this particular thing.)
>
> -elizabethElizabeth, I agree Burns is biased against meds. Thats obvious from his book. I read in his book that he prefers to "keep the dosage low." I know thats BS. He also criticizes SSRIs, in favor of the older tricyclics. That is BS as well, as the SSRIs are much cleaner drugs with fewer side effects.
All that being said, Burns's book is worth reading. Some of the things he says about meds is true, while some of it is junk. I have the ability to discern the junk from the good stuff.
I dont think CBT, nor any other talk therapy gets to the "root" of severe mental illness.
Old School
Posted by OldSchool on January 24, 2002, at 14:35:19
In reply to Re: David Burns » OldSchool, posted by Elizabeth on January 24, 2002, at 13:24:48
> > I have his book Feeling Good. I dont agree with much of the stuff in it.
>
> I agree, and I'm surprised to hear that you have the book. Any particular reason you got it?Because I read some stuff saying that CBT can be useful for refractory depression. I was skeptical and still am. However I wanted to read the book, which I havent done yet. I have read parts of the meds section in it though. Plus Ive had such a hard time tolerating meds in the last year that I figured I better start doing some things in case someday all I can tolerate is ECT. Although I think the experience with Amantadine recently has explained a lot...it totally "loosened me up" and I found I could add drugs while on Amantadine easily.
> > He criticizes the idea of depression having a chemical imbalance root cause, but then goes onto giving rave reviews of MAOIs. MAOIs are the most potent antidepressants available.
>
> Well, if they are the best ADs, maybe it just means he thinks the other ADs are weak and don't do much. (BTW, I'm guessing that you mean the *strongest* or most *effective*. Potency just means the effective dose is low -- so Parnate is more potent than Nardil, and Paxil is more potent than Zoloft, but MAOIs and other ADs can't really be compared in potency since they do different things.)I think the guy is just full of it to a large extent, although I still liked some of what he writes especially about meds. He believes in being cautious with meds and I agree with that.
>
> > What gives with that? What a hypocrite. Its obvious Burns is another idiot who has this mindblock many psychology buffs have to the basic fact that all of your thoughts, moods, feelings, perceptions, etc. are brain based. Everything starts in your brain.
>
> A lot of people seem to have a hard time grasping this idea. Anyway, that must be why I thought Burns was a psychologist, because he's such a CBT cultist.
>
> Out of curiosity, have you tried CBT or other talk therapy, and if so what did you think of it? (My experience with CBT was much like Cecilia's.)Nope Ive never been in any therapy. The closest to therapy Ive ever been in was my offline support group...it was kind of like a real informal, loose group therapy session. Very informal which I like.
>
> > He also admits bipolar disorder is heavily biological and genetic, but denies depression is biological. LOL
>
> So he buys the idea of a biological basis for some mental disorders, but denies that depression is one of them, huh? Personally I've never heard of *anyone* with serious depression who was cured by CBT.
>Yep...thats exactly what he does. He says bipolar is clearly biological and genetic but rejects these ideas for regular depression. He says many people with bipolar will need to be on lifetime medication, but those with depression "rarely require lifetime drugs." In other words, the guy is an idiot.
> Yes, the brain gets sensory input from external experiences, and in the long term these experiences affect what we call "personality," but whether or not a major depressive episode will occur is largely predetermined, probably at least in part by genetics. (There may be other factors, such as autoimmune conditions.) So I don't think that people with depression that has recurred for more than a couple times are likely to benefit from personality or behavior modification (the supposed effect of CBT).
Me either. This stuff is largely pure neurology in my opinion. Its your brain and CNS. Sometimes the endocrine system has something to do with it or as you mentioned the autoimmune system.
Old School
Posted by Emme on January 24, 2002, at 16:10:59
In reply to Re: David Burns, posted by OldSchool on January 24, 2002, at 14:35:19
Hi Folks,
Funny this thread should come up. I'm partway through the book. I personally find a lot that's objectionable and a lot that's good (besides the thorough medicine listing at the end). First of all, I don't think we should disregard the usefulness of CBT. *Every* human being, mood disordered or not, can use a reality check now and then. To me, CBT is just a formalized system of being aware of how your thoughts and reactions relate to what may or may not actually be going on. When I look at his descriptions of cognitive distortions, I see myself so clearly in some of them. While I'm not big into writing it all down, it doesn't hurt to have my awareness raised. My therapists have used some aspects of CBT (though not in the rigid cultlike manner as Burns prescribes). Although it's certainly not enough to manage my illness without meds, I can't say it hasn't been helpful.
Do I think CBT has or can "cure" my serious mood disorder? No! I *know* that I need careful psychopharmacologic management. Do I think there's a genetic component to my illness? My family history says absolutely. And I can't process any CBT while severly depressed - the meds have to bring me up a bit. I suspect my illness is more "biologically" based than "psychologically" (if we're gonna draw a line between the brain and the mind). But hey, any adjunct tool that can help me manage better can't hurt. I just don't expect CBT to be the magic key.
On the negative side: I do agree the book and techniques have an almost cultlike feel to them. I totally agree that it's ridiculous that he says bipolar is genetic and depression is not. It also sounds a bit hard to believe when he says he has cured suicidal patients in incredibly short periods of time. And that he's rarely had a patient need onoging drug treatment beyond a year or so. I also worry that all his glowing stories might make people who've had CBT feel like failures if they haven't had resounding success with CBT. I worry that the book might encourage folks to abandon their medicine without appropriate discussions and oversight from their doctors, or to not recognize when they need to really think about starting meds. Yeah, I know he puts in caveats about when to call in a professional and all that. But I think his anti-drug stance poses possible dangers.
Oh, and the guy's way too long winded (unlike this post :) He could've made his points in a quarter of the space and his writing style irritates me - he writes as if his audience is a bunch of third-graders. How annoying.
Emme
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