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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 63. Go back in thread:
Posted by sukarno on April 2, 2010, at 19:29:06
In reply to Re: Bravo (nm) » bleauberry, posted by conundrum on April 2, 2010, at 17:52:07
Do any other folks feel the same way? I use light therapy as my main treatment to ward off depression and it is very effective, but it too seems to decrease my libido. When I am feeling down and depressed, I have more interest in sex. Perhaps it is because we think sex might help raise our mood? And when we are in a normal mood we don't desire sex as much because we don't desire a reward as much as when we are depressed? After all, we feel good enough when "normal", so we don't need any extra "kicks".
Does that sound about right?
Light therapy should not affect sexual function, but I feel almost no libido (3 hours/day light therapy). I read thought that it boosts serotonin and antagonizes melatonin production.
Posted by Phillipa on April 2, 2010, at 19:44:16
In reply to higher sex drive when depressed, posted by sukarno on April 2, 2010, at 19:29:06
Meds have done nothing for me it's me and getting out and doing things that have worked the best for me. I'm permanently tolerant to benzos at low doses and will continue to take them why not at age 64? Phillipa
Posted by linkadge on April 2, 2010, at 20:07:16
In reply to Re: I doubt I will ever fully recover, posted by bulldog2 on April 2, 2010, at 16:52:43
>The awful truth is that many of us are born with >mental illness that will not heal on its own and >the meds out there are a bit archaic and behind >the rest of modern medicine
Maybe maybe not. We don't really know what is causing our problems so we don't really know what might make them better.
I am not saying bad genes don't exist, but theres not a lot of proof (yet?) that the drugs are really addressing any fundamental disease process.
Linkadge
Posted by ace on April 2, 2010, at 20:08:59
In reply to to ace, posted by Jeroen on April 2, 2010, at 17:18:57
> you kidding me brother? from what?
It's not clear in his question, and some of the answers, whether it be psychiatric syndromes or possible medication side-effects posing the problem. Many people complain of the medications causing problems themselves especially when used over long periods of time.
> psychosis, depression, autims, whatever, same thing
>
> i have same doubts that linkadge has :(
Posted by linkadge on April 2, 2010, at 20:09:36
In reply to Re: I doubt I will ever fully recover » linkadge, posted by conundrum on April 2, 2010, at 17:40:08
Well, when TCA's were around, they were not prescribed as liberally as the SSRI's are. So you might have a ratio of like 10 people who have tried an SSRI vs. one who has tried a TCA.
I agree about the serotonin transporters. They are there for a reason. Your bran can (and does) regulate them on its own in response to low levels of neurotransmitters.
Linkadge
Posted by linkadge on April 2, 2010, at 20:11:44
In reply to Re: I doubt I will ever fully recover, posted by bleauberry on April 2, 2010, at 17:42:50
Yeah, but I've been battling this off and on for 10 years trying this or that med. My brother had a depressive episode (probably worse than mine) which he did not medicate. He recovered and is doing much better than I could dream.
Linkadge
Posted by linkadge on April 2, 2010, at 20:13:46
In reply to higher sex drive when depressed, posted by sukarno on April 2, 2010, at 19:29:06
Perhaps your depression is associtated with high dopamine and low serotonin. Serotonin puts the breaks on obsessions (including sexual obsessions).
I know when I am depressed I want everything but like (or am satisfied) with nothing.
Linkadge
Posted by linkadge on April 2, 2010, at 20:16:56
In reply to Re: higher sex drive when depressed, posted by linkadge on April 2, 2010, at 20:13:46
I think my whole obsession with medications is just an attempt to get (or feel) more control over my life.
Instead of just letting go, and not being such a control freak, I loom on pages like this for the wrong answers.
Linkadge
Posted by sukarno on April 2, 2010, at 20:39:43
In reply to I think I just want control..., posted by linkadge on April 2, 2010, at 20:16:56
It's interesting that you mentioned that about high dopamine activity when depressed. I think you hit the nail right on the head. I have OCPD (Obsessive Compulsive Personality Disorder), which is basically (or should be better known as) Perfectionistic Personality Disorder. I read a medical abstract that showed high dopamine activity in the dopamine D2 and D3 receptors in folks with OCPD. The D3 receptor is associated with compulsions.
Seventy percent of people with OCPD suffer from depression too and anxiety.
Posted by SLS on April 3, 2010, at 6:21:34
In reply to Re: I doubt I will ever fully recover, posted by bleauberry on April 2, 2010, at 17:42:50
I think there is a conundrum when it comes to using the word "depression" to label various human conditions. Perhaps the majority of people who complain of depression will see their discomfort ease with time, but I don't think the same can be said of recurrent or chronic MDD and BD. The latter two conditions are most likely being driven by anomalous brain neural and, perhaps, endocrine activity. They tend to get worse if left untreated.
- Scott
Posted by SLS on April 3, 2010, at 10:16:49
In reply to Re: higher sex drive when depressed, posted by linkadge on April 2, 2010, at 20:13:46
> Perhaps your depression is associtated with high dopamine and low serotonin. Serotonin puts the breaks on obsessions (including sexual obsessions).
Ah. Makes sense.
- Scott
Posted by julie1977 on April 3, 2010, at 14:09:19
In reply to higher sex drive when depressed, posted by sukarno on April 2, 2010, at 19:29:06
maybe its because our primitive brain is activated so we have a higher sex drive. I'm the same.
Posted by bulldog2 on April 3, 2010, at 14:30:52
In reply to I think I just want control..., posted by linkadge on April 2, 2010, at 20:16:56
> I think my whole obsession with medications is just an attempt to get (or feel) more control over my life.
>
> Instead of just letting go, and not being such a control freak, I loom on pages like this for the wrong answers.
>
> LinkadgeI think at least for me, pursuit of the magic med combo that will bring remission ,brings about remission or at least a partial remission from the depression. I find a sense of happiness and excitement at times when reading about the meds or med that will about a remission from depression. So finally I put my combo together and start it and usually the combo works for a while until I stop it for some reason. Now I start the pursuit of the magic med combo again. Ah the chase is so exciting.
Posted by Dr. Bob on April 3, 2010, at 15:00:44
In reply to OCPD and overactivity of dopamine D2/D3 receptors, posted by sukarno on April 2, 2010, at 20:39:43
> It's interesting that you mentioned that about high dopamine activity when depressed.
Sorry to interrupt, but I'd like to redirect follow-ups regarding dopamine D2/D3 receptors to Psycho-Babble Neurotransmitters. Here's a link:
http://www.dr-bob.org/babble/neuro/20100223/msgs/942019.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there. Thanks,
Bob
Posted by bulldog2 on April 3, 2010, at 18:06:58
In reply to Re: I doubt I will ever fully recover, posted by linkadge on April 2, 2010, at 16:22:47
> This is not a radical statement. This idea has been suggested (and studied to some extent) before.
>
> Most depression gets better on its own within 6-12 months. But, people these days are taking SSRI's almost indefinately (on the assumption that they need them to prevent future episodes). The truth is more likely that they can't get off them.
>
> Linkadge
>
>
>
>
>I don't contest the statement. But in our society having a doc tell his patients you'll probably get better in 6-12 months would guarantee no following...Maybe ask people to wait several weeks may be tolerable but not 6-12 months...So what happens you wait 6-12 months and if you don't get better than ask for meds...Your brain has now been battered by depression for a half a year...I don't think that's a reasonable statrategy..
Posted by bulldog2 on April 3, 2010, at 18:09:59
In reply to Re: I doubt I will ever fully recover, posted by bleauberry on April 2, 2010, at 17:42:50
> There are countless syndromes, diseases, and symptoms that millions of people suffer from that just do not ever fully recover. Many in fact continue to progress. The best many can do is to slow the progression and ease the symptoms.
>
> We're talking diabetes, fibromyalgia, MS, parkinson's, chronic late lyme, kidney or liver pathology, heart disease, blood pressure, on and on and on. From the most common names to the most complicated.
>
> How is it that the syndrome or disease of MDD is any different? Because a minority of people experience temporary improvement or remission on a psych drug? When has it ever been a total cure that lasted a lifetime? I think rarely. It is a chronic condition with many possible causes. Even if we found the cause and removed it, how do we know that permanent damage has not already been done?
>
> For many people with longstanding depression and long histories of drug treatments, I think expecting a total cure is unrealistic. I do not however think the battle to attain it should stop. But it should be put into perspective. Expectations for the short term (the next 3 years) should be lowered, while longterm expectations remain high. If the next 3 years there is no improvement, then the short term goal for the next 3 years stays the same, but the longterm goal is still very high. The bar keeps moving.
>
> This allows us to live here and now. We aren't wasting a life by chasing someting that may never happen. It prevents frustration, disappointment, and further succumbing to the seductive power of the disease which would love to see us retreat to a couch or a bedroom forever.
>
> There needs to be acceptance that life is not a promised rose garden. From the day of birth we are destined to deteriorate little by little.
>
> To long for the good ole days is probably not a healthy thing. To accept the here and now for what it is and to make the best of it is healthy.
>
> Some of the happiest or most productive or most creative people I've ever witnessed were those with heavy crutches. But, and it's a big but, it only pertains to those who said, "Ok screw it, I got this heavy monster for the rest of my life but it aint gonna keep me on the couch any longer. I am stronger than this thing."
>
> That's hard in depression. It means forcing oneself out of the comfort zone. It means forcing oneself to do things that are so hard they are almost impossible. A new hobby. Entering a church on a Sunday for the first time. Starting a job hunt. Exercising. Making dramatic changes in food choices. Playing mind exercise games. Hikes. All the stuff that totally sucks when depressed. Actually, the harder it is to do, probably the more we need to do it! The only thing stopping us is ourselves, not the depression.
>
> Over time we score enough wins that the brain partially recovers. We aren't as ill as we used to be. And it happened without drugs. Something healed with the right prodding.
>
> I think of people like Ace who scored a big and apparently permanent cure with Nardil. Others have stories of 8 years on zoloft, or 10 years on prozac. I know one person who went years on antipsychotics and everyone gave up on her. She started a whole new family of friends at a church, weaned off her drugs, and is basically normal now. Those stories are so rare though, that it reminds me of the rare Las Vegas jackpot winners, or the rare lottery winners, that makes all the rest of us thing we are next in line to be the next big winner. Very seductive thinking.
>
> Everyone's journey is different. But I think for many of us, our expectations are too high. We are not exempt from dealing with the troubles of life anymore than millions of other people with their diseases and syndromes. We are in fact probably much more fortunate than many of them who have already accepted their disease and moved on to more productive lives despite it.
>
> Don't get me wrong. I want a total cure. I will never give up fighting for it. But until then, beginning about 2 years ago, I did lower my short-term expectations because it allowed me to open a new chapter and say, "ok then, let's move forward despite it all, other people of lesser strength than me did it, so can I, life is too short for a couch of dreams."
>
> Since then I have discovered:
>
> I can go to work feeling like death, yet come home feeling like I won something...it was hard, I did it, I feel better than I did.
>
> My best music came from those times I was so depressed I had to force myself to hold the guitar. I had to force myself to stay with it for hours. Never during my good times did I make music that good. The music I made during good times didn't "touch" people as much. But the music I made when I would have rather committed suicide gives people goosebumps, and they certainly feel spiritual emotion in it.
>
> For someone else they would experience the same spiritual gift, except in some other way not a guitar.
>
> So there are actually good sides to depression. We see things others don't see. We can create things others can't. We can experinece bigger wins than others. We can help others in ways no one else can. There are unseen gifts.
>
> But it sucks. As does any disease. I keep fighting. I've scored enough wins over the monster I lost count a long time ago. I rule the monster now, it doesn't rule me. As long as it is with me, I am the boss, not it.
>Its the side effects of any illness that eventually kill us...so the better you manage illness side effects the less damage to the body even if theirs no cure
Posted by linkadge on April 3, 2010, at 18:13:50
In reply to Re: I doubt I will ever fully recover, posted by bulldog2 on April 3, 2010, at 18:06:58
>So what happens you wait 6-12 months and if you >don't get better than ask for meds...Your brain >has now been battered by depression for a half a >year...I don't think that's a reasonable >statrategy..
I do think its a reasonable strategy. The suicide rate has not dropped since the introduction of antidepressants. Sure, the good old fashoned way may be harder in the short term, but if most people recover without meds (which statistically they did), then you wouldn't have millions of people dependant on psychiatric drugs (which permanaently alter brain chemistry in their own right)
Linkadge
Posted by conundrum on April 3, 2010, at 19:01:56
In reply to Re: I doubt I will ever fully recover, posted by linkadge on April 3, 2010, at 18:13:50
Chemistry? Try physiology. Your number of transporters, receptors, and brain cells change from taking these drugs. Some would call structural changes brain damage.
Posted by Zyprexa on April 3, 2010, at 21:58:01
In reply to Re: I doubt I will ever fully recover, posted by bleauberry on April 2, 2010, at 17:42:50
I use to take the meds thinking some day i will be better. Little did I know it would never happen. You just keep taking the drugs as long as you want to be better. Its not a cure, and you will never recover and stop the meds. Unless you are realy lucky. I don't fool myself any more I just keep taking the drugs.
Posted by Justherself54 on April 3, 2010, at 22:28:03
In reply to I think I just want control..., posted by linkadge on April 2, 2010, at 20:16:56
I wish there was a right answer. I too would like some control over my mood.
Posted by SLS on April 3, 2010, at 23:25:53
In reply to Re: I think I just want control... » linkadge, posted by Justherself54 on April 3, 2010, at 22:28:03
> I wish there was a right answer. I too would like some control over my mood.
I have no doubt that the exposure to many antidepressants produces changes in brain structure and function that may be irreversible. One indication that this occurs is the observation that many drugs display the phenomenon of "poop-out". People often develop a refractoriness to the therapeutic effects of a drug once that drug is discontinued and later restarted. Something must be different.
I am not sure what better choices there are but to take a risk and try the psychiatric drugs that currently exist and hope that we respond to them in ways that are observed to reduce pain and suffering in a great many people.
Statistics have a habit of changing depending on who presents them. I have read that the rate of suicide in some countries has decreased since the advent of the SSRIs in 1987. It is suggested that the media attention paid to Prozac and the epidemiology of depression produced an increase in the number of people seeking treatment, and thus a decrease in the number of suicides. I guess the question worth asking is what the rate of suicide would be in the absence of antidepressant treatment. It had already been increasing prior to the inventions of phenelzine and imipramine. Thereafter, it remained static and later decreased.
I cherry-picked this one:
http://www.suicide.org/suicide-statistics.html#death-rates
- Scott
Posted by sukarno on April 3, 2010, at 23:54:59
In reply to Re: I think I just want control..., posted by SLS on April 3, 2010, at 23:25:53
I'm not sure if this would belong here or in alternative since it is more accepted these days as a standard form of treatment, but have any of you tried light therapy (using a light box)?
It has been proven in double-blind studies to help depression, not only seasonal affective disorder.
Sometimes severely depressed inpatients are forced to wake up after 5 hours of sleep and then are administered light therapy. The combination of sleep deprivation and light therapy brings about a rapid improvement in relief of depression.. much quicker than drugs or ECT.
Posted by SLS on April 4, 2010, at 0:16:09
In reply to Re: I think I just want control..., posted by sukarno on April 3, 2010, at 23:54:59
Hi.
Thanks for the suggestion. I will keep it in mind.
- Scott
> I'm not sure if this would belong here or in alternative since it is more accepted these days as a standard form of treatment, but have any of you tried light therapy (using a light box)?
>
> It has been proven in double-blind studies to help depression, not only seasonal affective disorder.
>
> Sometimes severely depressed inpatients are forced to wake up after 5 hours of sleep and then are administered light therapy. The combination of sleep deprivation and light therapy brings about a rapid improvement in relief of depression.. much quicker than drugs or ECT.
Posted by bulldog2 on April 4, 2010, at 11:40:22
In reply to Re: I doubt I will ever fully recover, posted by linkadge on April 3, 2010, at 18:13:50
> >So what happens you wait 6-12 months and if you >don't get better than ask for meds...Your brain >has now been battered by depression for a half a >year...I don't think that's a reasonable >statrategy..
>
> I do think its a reasonable strategy. The suicide rate has not dropped since the introduction of antidepressants. Sure, the good old fashoned way may be harder in the short term, but if most people recover without meds (which statistically they did), then you wouldn't have millions of people dependant on psychiatric drugs (which permanaently alter brain chemistry in their own right)
>
> LinkadgeA couple questions to clarify your post. There's a bit of confusion here.
1. Do you have a link to this study or the name of the study?
2. What criteria did they use for determining who would participate in this study?
3. I believe your study said most get better. Define most as I guess that could mean anywhere from 51% to 99%.
4. Was this I guess what is termed double blind study? If so what were the results on both sides.
Now just some of my own opinions. You said most get better and therefore some don't get better. This means someone has waited 6-12 months to get better and hasn't gotten better and now its a year later. So now the doctor will dispense meds?
I don't think you understood what I was getting at. Even if your study turns out to be correct I don't think most patients would put up with a doctor who practiced that way. I go to my doc and have been in the blackest depression for several months and I'm looking for some relief. My doc pats me on the back and tells me that this mental anquish will most likely subside after 6 to 12 months. Now he tells me that if I don't feel better after a year to come back again and we'll look at some meds to help me out. Now hang in there he smiles at me. Now after the nurses have pried my hands off Dr. X's throat I would start going to other doctors who would medicate me immediately.
Just an observation of human nature. Many will not wait a week for a cold to go away before asking for antibiotics which do not even work on a cold. (let alone wait 6-12 months )
Most doctors also will not practice this way if they wish to keep people coming to them for treatment.NOW!! if science can figure out which depressive types will resolve on their own and which will not than we have a statistic that is meaningful. That way those who will not resolve on their own can get started now on treatment.
Right now to many symptoms are lumped under depression and treated in a standard way which I believe creates many failures. I believe depression is a group of diseases that probably requires a group of different treatments and in some cases no meds but psycotherapy.Myth No 1. Antidepressants are addictive. They may be for some and I am not questioning that. But I have cold turkeyed my ads many times without a problem. I continue to try new med combos in pursuit of that elusive remission. I also have had friends and acquaintences stop their ads after they were no longer needed without any withdrawal issues.
Myth No 2. Suicide rate. I personally don't believe you can take one statistic and use that to determine wether meds are effective or not effective. You need a myriad of personality measurements before and after to see if the med is effective. There could be other factors in one's life that could lead to suicide. Chronic debiliting disease, chronic pain etc. It is a myth that depression is the only reason one would committ suicide.
So let's look at your comments.In my opinion they're really more opinion than hard science which is okay.
1. It may be a reasonable strategy for you but a 6-12 month waiting period would not be a reasonable for me or many others. I guess it's a matter of choice.
2. The statement about the suicide rate not dropping. That's a hard one to prove. As I stated above you can't take this one meaurement and judge antidepressants based on that. Depression is to complex to be judged on one thing and we can't be sure how accurate the measurements were from the 1950's. More than likely they were undercounted in the 1950s.
3. You mention the old fashioned way. You really could make that statement about modern medicine in general. Probably the majority of symptoms that we go to the doctor about would resolve on their own and in far shorter time than 6 to 12 months. If you think about it maybe we should withhold medical treatment on most illnesses and just wait and see if the sick person becomes well on their own. If the person dies, while that may be tragic there is an upside. Only the strongest survive and live to breed and we end up with a more robust society.
So you may have come up with a strategy that is better for society in general but we just have to expand it to include all illness and in the process weed out the physically and mentally unfit.
> I do think its a reasonable strategy. The suicide rate has not dropped since the introduction of antidepressants. Sure, the good old fashoned way may be harder in the short term, but if most people recover without meds (which statistically they did), then you wouldn't have millions of people dependant on psychiatric drugs (which permanaently alter brain chemistry in their own right)
Posted by sukarno on April 4, 2010, at 13:20:25
In reply to Re: I doubt I will ever fully recover » linkadge, posted by bulldog2 on April 4, 2010, at 11:40:22
I guess the good thing I can report is that - in the days when I wasn't couped up at home and had a car and would drive everyday - getting exposure to plenty of natural sunlight and social activities pretty much eliminated any depressive symptoms I had. Even if I felt bad at night, a long drive (200 miles round-trip) with the sunroof open at night and nice music playing would also bring relief. I loved to be on the road. Staying in one place tends to trigger my depression.
The best relief I ever obtained without drugs was when I was delivering newspapers early in the morning as the sun was rising. It was about an hour of physical activity and that exercise along with the early morning sun markedly reduced my anxious and depressive symptoms. I felt like a new person and it only got better the longer I kept doing that. I had to give it up though when the weather became far too cold (sub-zero).
So, thinking of this, even though this was back in the 1990s when I had a car (which I don't now and haven't had one for 9 years), gives me hope that I don't really _need_ drugs to overcome my depression.
It is just that this situation is driving me nuts and I need pills to get through it. (living in a dark house.. weather too hot to venture outside... not knowing the local language enough to develop social bonds with people... no car... stuck inside all the time on my computer)
I hope that someday I can get out of this country or at least find a higher elevation where the weather is far cooler (unfortunately those areas are populated by the wealthy expatriates so I can't afford to live there).
I have my mind set on a country more affordable to travel to such as Australia or New Zealand. New Zealand would be preferable due to its relatively cool climate year round (especially in the southern part). I could then venture out, make friends since we all speak English and get better without drugs.This is the thought that keeps me going. I feel though that light therapy is the only thing that has kept me going. Stablon is far too weak on its own when living in a dark house and also being isolated from society. I'm sure Stablon would be efficacious if one was able to venture out and socialise with others.
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Dr. Bob is Robert Hsiung, MD,
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