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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 64 to 88 of 95. Go back in thread:
Posted by Jamal Spelling on August 6, 2008, at 6:56:22
In reply to Re: Some people don't want to believe., posted by bleauberry on August 5, 2008, at 18:14:43
I agree that a multi-disciplinary approach is best.
Don't forget THERAPY. I personally have benefited hugely from therapy, probably more so than from drugs.
By this I am not trying to discount the benefit that many people get from drugs.
The way I see it, drugs address the hardware issues and therapy the software issues.
In my case, I have both hardware and software issues, although I think my software issues are bigger.
There are also studies which show that the combination of drugs with therapy yields better results than either modality used alone.
> 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 UGottaHaveHope on August 6, 2008, at 15:25:36
In reply to Please be civil » SLS, posted by Deputy Dinah on August 5, 2008, at 10:09:35
You all do a wonderful job of monitoring this board, along with taking all sides into consideration, which is commendable.
However, as a longtime member of this board, I must point out that SLS is one of the most helpful people ever on this board. Now there are a lot of other helpful people too, so many, but SLS is definitely one of them.
Posted by Dinah on August 6, 2008, at 17:50:38
In reply to SLS one of most helpful ppl ever/Please be civil » Deputy Dinah, posted by UGottaHaveHope on August 6, 2008, at 15:25:36
I'm certainly not going to disagree. I hope that Scott is well aware of the high esteem I hold for him and his contributions to Babble.
Posted by Dinah on August 6, 2008, at 17:51:46
In reply to Re: SLS one of most helpful ppl ever » UGottaHaveHope, posted by Dinah on August 6, 2008, at 17:50:38
I don't think I worded that strongly enough. I agree wholeheartedly.
Posted by yxibow on August 6, 2008, at 19:43:08
In reply to Re: You are refering to me? | No. » yxibow, posted by linkadge on August 5, 2008, at 7:12:52
> >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
Oh good lord -- the *ss protection that the FDA slapped on all anti-depressants; I personally believe that was a terrible mistake because it discourages the people that need them the most from taking it.
It vilifies all anti-depressants, furthering the agenda of the anti-psychiatry camp, which, does include Scientology, religious groups --- its true, so I'm not going to say that it doesn't exist in reality as my opinion to satisfy board guidelines because that doesn't make sense.
Certain "religions", valid ones or potentially cults, which I have to say because Scientology unfortunately received 501 (c) protection in the US, do have strong stances against psychiatry.Brand name Luvox was withdrawn partly because of Columbinism and partly because of low sales, only recently returned as Luvox CR.
Yes, there are people susceptible to unexplained reasons of anti-depressant suicide -- but a majority of that population would have jumped out of a window anyhow, if I must be crass, because they were suicidal in the first place. Of course you can't interview them afterward, sadly.
My point was that it was, purely in my opinion, such a blurry shade of worry about possible cancer in 30 years when the benefits clearly outweigh those risks and other risks in patients with risk of high suicide.
Lithium is also one of the fastest ways of reducing suicide for some people. Antipsychotics are others.
But if a theoretical patient is stabilized on a tricyclic because it works and other things don't, and they're not feeling like killing themselves, I consider that a triumph, and the worry about future risk of cancer way below what has happened.
There's no guarantee of anything in life. You or any of us could be struck with cancer in life, just from exposure to the air or living long enough. If you don't die of some horrible gardening accident, you'll likely die of a heart attack or cancer. We all hope we will just pass in our sleep, I think, anyhow. But this is getting morbid.
-- tidingsJay
Posted by Phillipa on August 6, 2008, at 19:52:10
In reply to Re: Some people don't want to believe., posted by annabamma on August 6, 2008, at 2:02:56
Oh I see how you misunderstood my apologies as I meant no meds but yes to synthroid. Oops sometimes don't word things correctly. Yes it's for life the synthroid and probably reality wise something else as well. Phillipa
Posted by coral on August 6, 2008, at 21:11:32
In reply to Re: You are refering to me? | No. » linkadge, posted by yxibow on August 6, 2008, at 19:43:08
In full agreement. Speaking only for myself, I flat-out know that Zoloft saved my life.
Posted by linkadge on August 12, 2008, at 16:13:45
In reply to Re: You are refering to me? | No. » linkadge, posted by yxibow on August 6, 2008, at 19:43:08
>Oh good lord -- the *ss protection that the FDA >slapped on all anti-depressants; I personally >believe that was a terrible mistake because it >discourages the people that need them the most >from taking it.
What it does is give people a more detailed profile of possible side effects. Some people would rather patients not hear about potential side effects, but when you're dealing with medications that are on average statistically no better than placebo, it becomes very important that people know about potential risks.
>It vilifies all anti-depressants, furthering the >agenda of the anti-psychiatry camp, which, does >include Scientology, religious groupsIt gives a warning. How the information is used is a separate issue.
>Yes, there are people susceptible to unexplained >reasons of anti-depressant suicide -- but a >majority of that population would have jumped >out of a window anyhow, if I must be crass, >because they were suicidal in the first place. >Of course you can't interview them afterward, >sadly.
The FDA panel that voted for this decsion are intellegent people taking a relatively unbiased decision. People have the right to know about what clinical trial data suggests.
>My point was that it was, purely in my opinion, >such a blurry shade of worry about possible >cancer in 30 years when the benefits clearly >outweigh those risks and other risks in patients >with risk of high suicide.
Theres no proof that antidepressants reduce the risk of suicide.
>Lithium is also one of the fastest ways of >reducing suicide for some people. Antipsychotics >are others.
Antipsychotics as a class do not have demonstrated antisuicide effect. Clozapine does, but this effect has not been demonstrated with other AP agents. Based on the data, those at high risk of suicide should be put on lithium or clozapine (for which there are no black box warnings of increased risk of suicide).
>But if a theoretical patient is stabilized on a >tricyclic because it works and other things >don't, and they're not feeling like killing >themselves, I consider that a triumph, and the >worry about future risk of cancer way below what >has happened.
Research suggests that depression and suicide are two separate things. Self reports of suicidal ideation do not readily correlate with actual risk of suicide. So, just because a patient reports that "drug x saved their life" does not necessarily make it so.
Linkadge
Posted by linkadge on August 12, 2008, at 16:29:27
In reply to Re: You are refering to me? | No., posted by coral on August 6, 2008, at 21:11:32
>In full agreement. Speaking only for myself, I >flat-out know that Zoloft saved my life.
The only way you would know for 100% sure that zoloft save your life is if we had a time machine and we went back and took the drug away from you and you did end up killing yourself.
Of course its not really possible for me to say, "I am skeptical" without insulting you, but that is indeed my intention.
People become very attached to, and convinced about the efficacy of the agents that they believe help them. Whether it be rabbits feet, religion or the Q-Ray bracelet.
People who respond to placebos in general, show no smaller degree of conviction about their beliefs regarding the efficacy of the drug they have been ingesting than those who have recieve an active drug.
People take the notion that they may have repsonded to placebo as a personal insult. Its just like everbody believes they have higher than average IQ. Nobody wants to believe they have lower than average I.Q.
Obviously something changes when people recieve the placebo. Perhaps it is hope placed in the medication, improved recognigition of their problems or a feeling of hope that is associated with medical care. All of these things can lead to real biochemical changes in the brain and body.
I am not saying that your responce is necessarily a placebo responce, all I am saying is that I remain skeptical and from a scientific standpoint I am not persuaded by you personal convicion.
Linkadge
Posted by Bob on August 12, 2008, at 16:37:11
In reply to Re: You are refering to me? | No. » coral, posted by linkadge on August 12, 2008, at 16:29:27
> >In full agreement. Speaking only for myself, I >flat-out know that Zoloft saved my life.
>
> The only way you would know for 100% sure that zoloft save your life is if we had a time machine and we went back and took the drug away from you and you did end up killing yourself.
>
> Of course its not really possible for me to say, "I am skeptical" without insulting you, but that is indeed my intention.
>
> People become very attached to, and convinced about the efficacy of the agents that they believe help them. Whether it be rabbits feet, religion or the Q-Ray bracelet.
>
> People who respond to placebos in general, show no smaller degree of conviction about their beliefs regarding the efficacy of the drug they have been ingesting than those who have recieve an active drug.
>
> People take the notion that they may have repsonded to placebo as a personal insult. Its just like everbody believes they have higher than average IQ. Nobody wants to believe they have lower than average I.Q.
>
> Obviously something changes when people recieve the placebo. Perhaps it is hope placed in the medication, improved recognigition of their problems or a feeling of hope that is associated with medical care. All of these things can lead to real biochemical changes in the brain and body.
>
> I am not saying that your responce is necessarily a placebo responce, all I am saying is that I remain skeptical and from a scientific standpoint I am not persuaded by you personal convicion.
>
>
>
>
> Linkadge
>
>
>Linkage,
Do you believe there is anything that can help people with mental illness, or do you feel that we are meddling with something that will forever be beyond our grasp?
Bob
Posted by SLS on August 12, 2008, at 17:36:17
In reply to Re: You are refering to me? | No., posted by coral on August 6, 2008, at 21:11:32
> In full agreement. Speaking only for myself, I flat-out know that Zoloft saved my life.
Your experience with Zoloft is a reflection of how the majority of other people diagnosed with major depressive disorder respond to antidepressant treatment. This has been demonstrated by the STAR*D study.
- Scott
Posted by linkadge on August 12, 2008, at 19:02:53
In reply to Re: You are refering to me? | No. » linkadge, posted by Bob on August 12, 2008, at 16:37:11
I am not saying the medications cannot or do not help some people to some degree.
It just seems strange to me when people turn what is still a psudoscience into some sort of rigorously established airtight doctrine of medical fact (and then appear to bask in it).
Linkadge
Posted by linkadge on August 12, 2008, at 19:03:44
In reply to Re: You are refering to me? | No. » coral, posted by SLS on August 12, 2008, at 17:36:17
>Your experience with Zoloft is a reflection of >how the majority of other people diagnosed with >major depressive disorder respond to >antidepressant treatment. This has been >demonstrated by the STAR*D study.
Ok, thats not even worth my time responding to.
Linkadge
Posted by elanor roosevelt on August 13, 2008, at 0:14:50
In reply to Re: You are refering to me? | No., posted by coral on August 6, 2008, at 21:11:32
for those of us who have been on meds for a many years--we must remember that when we started, the theory was that ADs would stabilize our brain chemistry and allow us long breaks from the meds
i do think that most of the members of this board believe or at least hope meds will help them get "better"
Posted by SLS on August 13, 2008, at 7:07:52
In reply to meds and belief systems, posted by elanor roosevelt on August 13, 2008, at 0:14:50
> for those of us who have been on meds for a many years--we must remember that when we started, the theory was that ADs would stabilize our brain chemistry and allow us long breaks from the meds
>
> i do think that most of the members of this board believe or at least hope meds will help them get "better"I hope so. Sometimes, I have my doubts.
Psycho-Babble probably contains a greater percentage of people deemed to have treatment resistant depression (TRD) than the general population of people suffering from an affective disorder. Many of these TRD people have performed numerous failed drug trials with attendant untoward side effects.
I think some people grow to become skeptical and cynical regarding the usage of antidepressants. People develop true anger at, and hatred of, these drugs. I can certainly empathize with people placed in this position. Thankfully, "treatment resistant" is not equivalent to "treatment refractory". Interestingly, every investigational group has their own definition of TRD. Is someone TRD if, after trying 10 individual drugs sequentially, goes on to respond to the 11th? What about combination drug treatments? The number of possible psychotropic combinations is in the thousands. If this is not reason enough to instill hope, one might consider that there are several novel drugs close to being submitted for FDA approval:
http://www.neurotransmitter.net/newdrugs.html
One must be aggressive, persistent, and creative to treat the most stubborn of cases. Such a proposition is much more likely to end in success rather than failure.
It takes more courage to maintain hope than it does to lose it.
- Scott
Posted by Bob on August 13, 2008, at 11:44:26
In reply to Re: meds and belief systems » elanor roosevelt, posted by SLS on August 13, 2008, at 7:07:52
Thankfully, "treatment resistant" is not equivalent to "treatment refractory". Interestingly, every investigational group has their own definition of TRD.
> - Scott
>
What is the difference?
Posted by Bob on August 13, 2008, at 11:46:40
In reply to Re: meds and belief systems » elanor roosevelt, posted by SLS on August 13, 2008, at 7:07:52
Is someone TRD if, after trying 10 individual drugs sequentially, goes on to respond to the 11th? What about combination drug treatments? The number of possible psychotropic combinations is in the thousands. If this is not reason enough to instill hope, one might consider that there are several novel drugs close to being submitted for FDA approval:
>
> http://www.neurotransmitter.net/newdrugs.html
>
> One must be aggressive, persistent, and creative to treat the most stubborn of cases. Such a proposition is much more likely to end in success rather than failure.
>
> It takes more courage to maintain hope than it does to lose it.
>
>
> - Scott
>
Scott,What are your thoughts on the somatic treatments like TMS, DBS, and ECT?
- Bob
Posted by SLS on August 13, 2008, at 13:01:36
In reply to Re: meds and belief systems » SLS, posted by Bob on August 13, 2008, at 11:44:26
> Thankfully, "treatment resistant" is not equivalent to "treatment refractory". Interestingly, every investigational group has their own definition of TRD.
> What is the difference?As I understand the term, "refractory" means being incapable of responding to treatment. I guess the difference is subtle.
- Scott
Posted by SLS on August 13, 2008, at 13:26:16
In reply to Re: meds and belief systems » SLS, posted by Bob on August 13, 2008, at 11:46:40
>
> Is someone TRD if, after trying 10 individual drugs sequentially, goes on to respond to the 11th? What about combination drug treatments? The number of possible psychotropic combinations is in the thousands. If this is not reason enough to instill hope, one might consider that there are several novel drugs close to being submitted for FDA approval:
> >
> > http://www.neurotransmitter.net/newdrugs.html
> >
> > One must be aggressive, persistent, and creative to treat the most stubborn of cases. Such a proposition is much more likely to end in success rather than failure.
> >
> > It takes more courage to maintain hope than it does to lose it.
> >
> Scott,
>
> What are your thoughts on the somatic treatments like TMS, DBS, and ECT?
I think rTMS is becoming a more viable treatment, now that more is known about how to apply it. It has been shown that antidepressant response is produced by applying a magnetic flux on the left side of the forehead at a frequency of 20Hz. Interestingly, applying the same parameters to the right side of the head actually produces depression. If, however, a low frequency of 1Hz is applied on the left side, one sees an antidepressant effect. This has encouraged some practitioners to combine 20Hz left with 1Hz right. Results are superior to what was seen early in the development of the treatment.ECT can work. I think it is obvious that as practiced now, too many people are hurt by ECT as well. I think it still has a place. People whose psychotic mania is resistant to pharmacotherapy might have no better choice than to go with ECT, so long as lithium is not being used. I had a series of 6 unilateral left followed by 8 bilateral as a treatment for depression. It didn't work. I experienced cognitive and memory disturbances for about a month afterwards.
DBS is a fascinating procedure. The idea is to disrupt the circuits in Brodmann's Area 25 of the anterior cingulate cortex. Blocking neurotransmission in this region produces an immediate change of state. Depression can clear up within seconds. In fact, the way they determine the precise location to place the electrodes depends on the patient being awake to report the effects of differential application of current.
Generally speaking, rTMS is rather benign; the most troublesome side effect being headache. I would recommend trying it before considering ECT. I would be scared to go with DBS without knowing more about it.
- Scott
Posted by linkadge on August 13, 2008, at 16:00:09
In reply to Re: meds and belief systems » elanor roosevelt, posted by SLS on August 13, 2008, at 7:07:52
I would say that psychobabble has a higher percentage of people who believe in the general effiacy of medications.
Don't go to a church and expect to find a high percentage of atheiests.
Linkadge
Posted by linkadge on August 13, 2008, at 16:14:25
In reply to Re: meds and belief systems » Bob, posted by SLS on August 13, 2008, at 13:26:16
I would think that DBS is a cleaner procedure than rTMS of ECT.
The hyperactivity of area 25 may be a result of lack of ability of the prefrontal cortex to inhibit activity in this region. The atrophy seen in the prfrontal cortex in many familial lines of depression may result in a poor ability to restrain these limbic regions. By enhacing activity in the prefrontal cortex, rTMS may be doing the same as DBS. Like SLS said, DBS can work almost imediately. There may be a depression region, i.e. hyperactivity in a certain region generates depressive thoughts and feelings.
Responce to things like sleep deprivation are also associated with blood flow changes i.e. reduced activity in area 25, increased bloodflow to the right parietal lobe etc.
This study shows that a few weeks of venlafaxine therapy are needed to intiate the same reduction in activity in these regions.
http://biopsychiatry.com/venlafaxine-brain.htm
So, all the monoamine crap may just be a dirty method of dampening hyperactive bloodflow to a certain region.
I don't know about you, but I'd rather have a small implant that does the same thing than have to take high doses of drugs which can negatively effect multiple areas of the brain and body.
DBS IMHO may actually be an overal safer approach.
Linkadge
Posted by Phillipa on August 13, 2008, at 20:24:04
In reply to Re: meds and belief systems » Bob, posted by SLS on August 13, 2008, at 13:01:36
So incapible means no hope and depression forever? Phillipa
Posted by Phillipa on August 13, 2008, at 20:32:43
In reply to Re: meds and belief systems, posted by linkadge on August 13, 2008, at 16:14:25
Link because you still need meds after rTMS and don't after DBS? Phillipa
Posted by SLS on August 13, 2008, at 21:36:25
In reply to Re: meds and belief systems » SLS, posted by Phillipa on August 13, 2008, at 20:24:04
> So incapible means no hope and depression forever? Phillipa
Refractory was always a scary word for me.
- Scott
Posted by Phillipa on August 13, 2008, at 21:58:49
In reply to Re: meds and belief systems » Phillipa, posted by SLS on August 13, 2008, at 21:36:25
Scott I've never heard you say you were afraid. Love Phillipa
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