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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 37 to 61 of 95. Go back in thread:
Posted by Bob on August 4, 2008, at 21:57:19
In reply to Re: Some people don't want to believe., posted by bleauberry on August 4, 2008, at 20:23:28
>
> I think the biggest hurdle for many are the side effects. To get well means living with some new burden. Not always, but often enough. Those side effects usually diminish or disappear in several months, but that is too much time for many to tolerate.>
Maybe sometimes, but I've been on multiple drugs where some side effects faded, while others became more insidious. I call weight gain, sexual dysfunction, and fatigue some nasty side effects, and for me these often just got worse over time.
Posted by gardenergirl on August 4, 2008, at 22:23:48
In reply to Re: Some people don't want to believe., posted by gardenergirl on August 4, 2008, at 19:30:35
Posted by Sigismund on August 4, 2008, at 23:35:01
In reply to Re: Some people don't want to believe. » linkadge, posted by Bob on August 4, 2008, at 21:51:54
>then how will any progress ever be made?
Quite touching, such faith.
Posted by yxibow on August 5, 2008, at 1:43:30
In reply to Re: You are refering to me? | No. » SLS, posted by linkadge on August 4, 2008, at 19:34:32
> >How so?
>
> Well, for somebody who has been miraculously and gloriously affected by the workings of these drugs, it doesn't seem like you have had any form of sustained efficacy from any one drug. You're periodically talking about how things aren't working for you the way they once did, and how your brain has adapted to the effects of many of the medications you take. It just seems to me that when you feel good, you start to jump into this "idealization mode" where you seem to overassert the efficacy of these meds and the extent to which modern psychiatry can help any one individual. When you're not feeling so hot, it seems that you start to doubt the overall utility of many of these meds and talk in (what appears to me) to be a more grounded mannor about the benifits and drawbacks of meds. On the one hand you unequivically and liberally advocate the use of the genotoxic TCA's and on the other you write posts that makes me think you are concerned about the possable genetic dammage that you yourself may have sustained.
I don't know where this ideology about TCAs being any more cancer causing than other newer antidepressants haven't had years of use and articles written about possible new finds in lab rats.Second of all, would you rather have someone commit suicide, or possibly have a nth degree risk of cancer later in life?
I can't see the logic in it.
Posted by yxibow on August 5, 2008, at 1:56:19
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
> Some people here don't want to believe that medication can adequately treat mental illness and argue vehemently their position. Yet, professional neuroscientists state otherwise and produce conclusive results of investigations supporting the utility of psychotropics. Why is this?
>
> Anger?
>
> It seems to me that having such an attitude is counterproductive to successful treatment. It can cause people to fail to commit themselves to trials of different medications. One consequence might be that such an unbelieving person tends to abort drug trials prematurely, and never get the answer they are looking for - remission. Holding on to melancholic and negative thoughts can only work against treatment and prevent the changes in the brain from taking place to produce a therapeutic response. There is power in positive thinking.I have to concur in this topic -- but with a caveat, remission may not be what one thinks it will be -- there may be no such thing as complete remission of any disorder that is biologically and biochemically governed and is always changing.
Remission is making mental illness akin to the years spent away from cancer. A disorder under control would be something I would say is a better way of describing it.
The best of chemical "cocktails" for an anxiety-depression spectrum disorder is not a chemotherapy regime. If you stop taking your medication, there is a good chance it will come back if you have a particularly hard to treat disorder.
Some people are lucky and have mild disorders such as dysthymia for a short period of time and take medication and then upon stopping it after having completed some therapy in the meanwhile don't need their medication.
Unfortunately for a lot of us, medication is a continual need -- but not the only need in a condition.There are social needs, there are therapy and psychological needs, and there is the need, yes, to believe, but not just to believe in the power of medication --- its there in the background to help you, but what is missing in our mental health system a lot is goal, task, CBT oriented therapy to accompany a medication regime.
Most psychiatrists are trained in some form of talk therapy but not a lot invest much time in this. There are psychopharmacologists who also hold double degrees in psychotherapy as well.
And then there's the concept of mixing two doctors, a psychiatrist and a psychologist -- but I think it would be a mistake if there wasn't some communication between the two at some point. That's your privacy though and how you view it, its your right.
-- Jay
Posted by yxibow on August 5, 2008, at 2:09:54
In reply to Re: Some people don't want to believe., posted by dcruik518 on August 4, 2008, at 8:48:12
> It seems to me that most people here believe that meds can be helpful. That said, however, I think many people here have difficult or treatment resistant cases and they come here to seek advice above and beyond the easy first-year-resident kind of "ssri's work for everything" crap. If there's anger, it's anger at the large number of incompetent dopes who call themselves psychiatrists. We therefore have to educate ourselves and sometimes take matters into our own hands. More than any other of the medical specialities, psychiatry needs to be done democratically, not autocratically, and I think it's this need for dominance among the p-docs that leads to patient frustration as much as anything else. The top down model is bunk.
>
> ~DRC
>
>
First of all that's a vast generalization of psychiatrists. I'm sure there are good ones and bad ones. Most states have licensing boards where you can check up on the status of their license and any license restrictions.
Second of all, while I agree that its a democratic concept -- well its a consumer concept really... you are a consumer (as NAMI calls patients now) and you come to someone for help -- "taking matters into your own hands" I assume means making responsible choices about who you see for a psychiatrist and not buying medicine willy nilly off the cuff and the black market.
I also see this vitriol against medicine sometimes and against psychiatry right on the medicine board -- if you don't want to be treated, why go? Its like asking a dog to bark and then bark yourself. Now, this is distinctly different from sitting passive at a psychiatrist's session and saying uh-huh to everything and not bringing your own views -- I tell people if they're afraid of forgetting everything then why not bring a pad of paper and their views and also write down some notes at the session.Also nobody is shoving medication down your mouth -- you can refuse to take the medication suggested. Enough refusals of course and the psychiatrist may run out of ideas, but there's always a second opinion and yes, a second doctor.
Remember, retaining a psychiatrist is or should be a relationship -- if you dont both invest time into it, it wont nurture, and the converse is the "dump your doctor" threads I see when people don't necessarily know how many months someone has invested in someone. Its that many more months till you get somewhere else. Maybe its necessary -- maybe it isn't.
-- Jay
Posted by SLS on August 5, 2008, at 5:37:00
In reply to Re: Some people don't want to believe., posted by dcruik518 on August 4, 2008, at 8:48:12
Hi.
> The top down model...
What is a "top down" model?
Thanks.
- Scott
Posted by linkadge on August 5, 2008, at 6:48:21
In reply to Re: Some people don't want to believe. » linkadge, posted by Sigismund on August 4, 2008, at 20:11:38
>Do you have ADHD in Canada
Canada is a mirror image of the US. Its very easy for people to get an ADHD diagnosis.
Linkadge
Posted by linkadge on August 5, 2008, at 6:50:38
In reply to Re: You are refering to me? | No. » linkadge, posted by SLS on August 4, 2008, at 20:42:50
>I am fascinated that you are so focused on my >condition. I would have preferred that you get >the story right, though.
Cute. Although, I am not fascinated.
Linkadge
Posted by linkadge on August 5, 2008, at 6:53:18
In reply to Re: Some people don't want to believe. » linkadge, posted by Bob on August 4, 2008, at 21:51:54
>Granted researchers can be out of touch >sometimes, or misguirded maybe, but if we don't >have these groups of people looking for answers, >then how will any progress ever be made?
I've got nothing wrong with these people. I just don't see the point of listing institutions as if their prestige is somehow proof of the validity of the ideas they assert.
Linkadge
Posted by linkadge on August 5, 2008, at 7:10:25
In reply to Re: Some people don't want to believe. » bleauberry, posted by Bob on August 4, 2008, at 21:57:19
>Maybe sometimes, but I've been on multiple drugs >where some side effects faded, while others >became more insidious. I call weight gain, >sexual dysfunction, and fatigue some nasty side >effects, and for me these often just got worse >over time.
Exactly. The notion that side effects diminish and effect increases over time is just a framework of how it occurs in some people or how it would occur more ideally.
The reality is that the facts about many of these substances are readily downplayed. Weight gain, permanant sexual side effects, phospholipidosis, neuroendocrine changes, metabolic changes, cardiac side effects, genotoxicity, apathy, suicidal ideaion, other cognitive side effects.
The whole system could be supported by a system not dissimilar to the emperors new cloths.
Medications could be affecting the majority of people in this way. They could be pooping out, they could be causing unbearable side effects. If you only trust the 3 month studies of safety and efficiacy of these meds how could you possably be getting an idea of how safe/effective they are over time in the population as a whole.
When you just accept that the meds work like certain studies suggest then nobody speaks up and says, hey this medication isn't all that great. Sure it seemed to work for the first little while, but now all I do is sit around. I'm so apathetic and have no interest in anything. I still don't feel well, I just feel numb and medicated.
Linkadge
Posted by linkadge on August 5, 2008, at 7:12:52
In reply to Re: You are refering to me? | No. » linkadge, posted by yxibow on August 5, 2008, at 1:43:30
>Second of all, would you rather have someone >commit suicide, or possibly have a nth degree >risk of cancer later in life?
There is no proof that antidepressants reduce the risk of suicide. On the contrary there is evidence that antidepressants may increase the risk of suicide in certain patient populations.
Linkadge
Posted by linkadge on August 5, 2008, at 7:24:35
In reply to Re: Some people don't want to believe. » dcruik518, posted by SLS on August 5, 2008, at 5:37:00
I guess all I am saying with this thread is that:
"Some people don't want to believe." is correct.
Some people don't want to believe that the majority of studies find antidepressants no better than placebo. Some people don't want to believe that there is no proof that antidepressants actually reduce suicide. Some people don't want to believe that antidepressants often poop out. Some people don't want to believe that antidepressants can induce mania in certain patients. Some people don't want to believe that antidepressants may infact be responsable for certain suivides. Some people don't want to believe that there is no conlcusive proof that serotonin levels are low in depression. Some people don't want to believe that the serotonin transporter tends to already be decreased in depression. Some people don't want to believe that tianeptine is an effective antidepressant. Some people don't want to believe that antipsychotics can cause diabeties. Some people don't want to believe that ECT can cause memory loss or that more than 80% of patients relapse within one year of having it. Some people don't want to believe that they may just be experiencing a placebo effect. Some people don't want to believe that scientists have little idea of how SSRI's work when they do. Some people don't want to believe that the drug industry is the single greatest predictive factor for the outcome of any published psychiatric medication trial. Some people don't want to believe that antidepressants may infact make depression a more chronic disorder etc. etc.
Linkadge
Posted by Jamal Spelling on August 5, 2008, at 8:18:32
In reply to Re: Some people don't want to believe., posted by linkadge on August 5, 2008, at 7:24:35
Posted by dcruik518 on August 5, 2008, at 8:29:47
In reply to Re: Some people don't want to believe. » dcruik518, posted by SLS on August 5, 2008, at 5:37:00
The phrase "top down model" is used for all sorts of organizations to describe a situation in which authority is structured in the traditional hierarchical patriarchy. Most work settings are like this but many newer companies have started to run themselves in less hierarchical ways. Apple for instance. A "bottom up model" refers to decisions that come, for instance from the grassroots in politics, or from the factory floor in factories. The idea is that the people themselves often know what is needed better than the detached, out of touch managers up their towers. Japan uses a bottom up approach in their manufacturing--instead of dictating what should be done, managers ask the people on the floor to make as many suggestions for improvement as possible. this empowers people and leads to greater productivity. I'm not saying psychiatry should be completely "bottom up". I'm saying it should be democratic, by which I mean both parties work together, essentially as equals, to find the right treatment. OF course, psychiatrists are experts and the average patient cannot be equal to them in knowledge, but the patient does come with something the doctor does not have--namely their own personal experience.
Posted by Deputy Dinah on August 5, 2008, at 10:04:28
In reply to Re: You are refering to me? | No. » SLS, posted by linkadge on August 5, 2008, at 6:50:38
> Cute. Although, I am not fascinated.
Please don't be sarcastic, or post anything that could lead others to feel accused or put down.
You've been warned before, both individually and as part of a general warning by Deputy 10derheart in this thread, to follow the civility guidelines of this site. Here is the link to the guidelines.
http://www.dr-bob.org/babble/faq.html#civil
I'm going to have to block you from posting from one week.
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
Dinah, acting as deputy to Dr. Bob
Posted by Deputy Dinah on August 5, 2008, at 10:09:35
In reply to Re: You are refering to me? | No. » linkadge, posted by SLS on August 4, 2008, at 20:42:50
> I am fascinated that you are so focused on my condition. I would have preferred that you get the story right, though.
Please don't post anything that could lead others to feel accused or put down.
Because of the timing of this post, it is possible that you did not see Deputy 10derheart's warning before this was posted. I'm going to give you the benefit of the doubt and not block you from posting. Please follow the guidelines in the future.
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
Dinah, acting as deputy to Dr. Bob
Posted by Toph on August 5, 2008, at 10:34:36
In reply to Re: Some people don't want to believe. » Toph, posted by SLS on August 4, 2008, at 18:34:44
> Name one FDA approved antidepressant that doesn't work.
While this whole thread may just boil down to semantics Scott there are some people, especially those with treatment-resistive depression, for whom none of the FDA antidepressants work, if by working you mean that the drugs relieve them of their depressive symptoms. And for some patients with Lewy Body dementia and other dementias many psychotropic medications have a paradoxical effect whereby these meds make symptoms worse. They certainly do not work for these patients. But as you have implied the exceptions should not make the rule.
Posted by SLS on August 5, 2008, at 13:24:21
In reply to Re: Some people don't want to believe. » SLS, posted by Toph on August 5, 2008, at 10:34:36
> > Name one FDA approved antidepressant that doesn't work.
> While this whole thread may just boil down to semantics Scott there are some people, especially those with treatment-resistive depression, for whom none of the FDA antidepressants work,
It is more than just semantics. That no one drug helps everyone is manifestly true. However, it is just as true that every drug helps some percentage of people get well. In my saying that drugs work, it was the point of my posting that drugs are effective and can help a much larger percentage of people than is often suggested. I never indicated that drug monotherapy works for everyone.
I am smitten with optimism for others, to be sure. I am not completely objective because I am projecting my own treatment history. It took decades and 73 different drugs to get to where I am today. (I need help with the math here) If we then take combinations of only two drugs from my list of 73, I think that would yield over 1000 permutations. Combinations of 3 drugs equals at least 10,000 permutations - perhaps more. Of course, no one wants to perform 1000 different 6 week drug trials. That would take 100 years. So, how then do you begin choosing drugs?
When do you stop trying?
I think it should infuse hope into some people that even a brief improvement in depression is an indicator that they are treatable. Often, it is the doctor that gets in the way. If no doctor were willing to combine Nardil with nortriptyline, I wouldn't be in this improved condition. The tools are there. Unfortunately, they are too often not used optimally.
Speaking of anger, I get angry when I see people stop pursuing drug treatment. The number of available combinations of drugs that can be used is staggering.
Currently:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.5mg
N-acetylcysteine 1800mg
Omega-3 from fish oil
So, how did I come to find this treatment? Educated guesses and algorithms for combining drugs.I would be curious to know how many of us would find their treatment to achieve remission contained within a single, published, algorithm - STAR*D. The STAR*D investigation is incredibly limited in the number of treatment permutations offered. However, even with so small a number of treatments included, 75%-85% of participants were robustly improved.
In light of these findings and my own experience, it is hard for me to want to qualify my statement that "drugs work". They do.
- Scott
Posted by Toph on August 5, 2008, at 14:09:27
In reply to Re: Some people don't want to believe. » Toph, posted by SLS on August 5, 2008, at 13:24:21
Optimism is a goog thing Scott. And I'm glad that you found drugs that work for you. You should be applauded for perservering. I've always felt fortunate that a simple salt keeps me out of the cycle of psychosis I once suffered. I only wish others were so fortunate as you and I.
Posted by SLS on August 5, 2008, at 16:37:06
In reply to Re: Some people » SLS, posted by Toph on August 5, 2008, at 14:09:27
> Optimism is a goog thing Scott. And I'm glad that you found drugs that work for you. You should be applauded for perservering. I've always felt fortunate that a simple salt keeps me out of the cycle of psychosis I once suffered. I only wish others were so fortunate as you and I.
Me too.
- Scott
Posted by bleauberry on August 5, 2008, at 18:14:43
In reply to Re: Some people don't want to believe. » Toph, posted by SLS on August 5, 2008, at 13:24:21
As a mild departure from the topic of the thread, though still related, I think it deserves mention of how people don't recognize no one approach is perfect, but that a balanced approach yeilds best odds. By that I mean continue with drug trials, especially trying to follow the STARD plan (switch rather than pile tons of meds of top of each other); but also healthy living...reduce or eliminate caffeine, reduce or eliminate sugars, focus on frequent meals of proteins, raw veggies and raw fruits, drink lots of water that has been purified, through diet or supplements get a good balance of the good fats (omega3 and 6), remove any amalgam fillings in the teeth, stick to a regular sleep plan, force oneself to be involved in any capacity with a church or volunteer organization, force oneself to be employed in at least a minimum capacity, walk, exercise in strong sshort bursts 3 times a week if able. If someone really really really wants to get well, they would do well to nurture what is good for the human body as all of the above are. Isolation, amalgam fillings, poor diet, sugar and caffeine...these do not spell healing.
And of course followup doctor testing. For example, it is going to be real hard to get a psych drug to work if there is longterm hidden Lyme disease, just one example. Thyroid needs to be optimal...normal isn't good enough. Body temperature and symptoms tell that story better than lab tests. Nothing will work right if the average body temp is 97.8 instead of 98.6.
Ya know? Drugs, yes. But don't forget the other half. Drugs can't do it all. The mind and body are intricately intertwined in the whole thing.
As to a previous post by Linkadge about meds not much better than placebo, political involvement, and everything else...well, yeah, good points were made. However, it is hard to discount when we see people right here, real people, get amazingly better on their prozac, zoloft, trivastel, milnacipran, zyprexa, depakote, klonopin, nardil, or whatever. It happens. Can't say it doesn't. Those were not placebo.
Posted by dbc on August 5, 2008, at 18:20:30
In reply to Re: Some people » Toph, posted by SLS on August 5, 2008, at 16:37:06
Im disillusioned about big pharm, the rigged studies, the doctors that belive these studies, supporting other people with mental issues, wanting to help.
I generally do not care. Not everything in the world is a disorder. If all abnormal behaviours are a disorder than what is this person were all shooting to become.
There was a thread about internet addiction that really made me ask "are they really this stupid" and sadly the answer was yes. There was all sorts of self diagnostics going on about this being a disorders and what can be done to fight it. This sounds like material for Oprah not a serious psychiatric medicine medical board.
It did make me realize that the reason i read these boards isnt because im not at all interested in any person that ever posts but what they have to say about medicine. "is this a complaint about a side effect" Skip it.
My positive message is total and utter apathy, its therapeutic for me anyway.
Posted by Phillipa on August 5, 2008, at 19:38:46
In reply to Re: Some people don't want to believe., posted by bleauberry on August 5, 2008, at 18:14:43
Well I guess that leaves me out of meds working as do have chronic lymes disease and test as positive each time tested. And hasimotos thyroiditis is not controlled to an optimal number. Just because the endo says 1-2 is what I should be at feel better when it's higher. Had a pdoc that thought I should be a little above the normal somwehere around 6. Does the endo listen to how I feel no and no way do I know how to adjust synthroid. Phillipa
Posted by Deputy 10derHeart on August 6, 2008, at 0:23:57
In reply to Re: Some people, posted by dbc on August 5, 2008, at 18:20:30
>a thread about internet addiction that really made me ask "are they really this stupid" and sadly the answer was yes.
Please don't post anything that could lead others to feel accused or put down, and please respect the feelings and opinions of others even if you don't agree with them.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
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-- 10derHeart, acting as deputy for Dr. Bob
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