![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by wcfrench on November 21, 2002, at 0:32:50
OK I know this title is a little off-the-wall.
Hi, I wanted to write and see how people felt about the use of caffeine as an antidepressant (among other things). I've heard that it's not good in the long run? I think it was from Shawn T., who is the king of that department. I take a cup of coffee (as if it were medicine :)) everyday in beginning of work, and drink 1-2 diet sodas throughout the day, seems to keep me going fine. I also use 1mg Klonopin for anti-anxiety at work, but not at home. I'm pretty sure the caffeine has an antidepressing effect, but if I'm trying to get better for good, and maybe eventually be off of medication, what should I do in that respect? I've heard to cut all stimulants, exercise, and go hardcore on self-therapy, but I'm not sure if I could work to the point of not needing medicine, as we all fear.
To make this more related, I take Lithium+Zoloft+Wellbutrin with little avail, as I have posted a few times before, and I'm looking for alternatives. I'm not deep in the hole, but I'm not out... at least I have the drive to do something to feel better.
CBT? I know already that it has been (cognitive behavioral therapy -- sorry if you didn't know that! Don't you hate reading acronyms all the time that you don't know?)... already know that it works wonders for many. There is a self-course going around that's about 400 dollars and is an 11-week course, and I'm thinking of giving it a shot. It's tapes, a relaxation tape, and workbook exercises. It takes some commitment, but the results have been outstanding and it's been going on for 14 years. Has anyone tried it?
Supplements... What do you think about supplements? I tried augmenting my combination with omega-3 fish oil, nothing. Tried, 5HTP and St. John's wart (despite warnings) and they didn't seem to have an effect. Someone told me to try SAM-E? They say it's like a "natural prozac?" (not that Prozac would work for me anyway), so I'm considering trying that. Anyone feel a certain way about it? Good, bad, dangerous, useless? Thx.
Take care all,
Yours,
Charlie
Posted by joy on November 21, 2002, at 9:50:25
In reply to Caffeine/CBT/Supplements/Self-help/What WORKS????, posted by wcfrench on November 21, 2002, at 0:32:50
Charlie, You can buy David Burns book on cognitive therapy called 'Feeling Good'. It is the gold standard. You don't have to spend the $400 unless you need a group for support. There is a workbook also by Burns which is part of the cognitve therapy program. Men seem to do better at cognitive therapy than women though it definitely can benefit everyone. I think your caffeine intake is adequate, I would not overuse caffeine. One cup of coffee and two sodas a day are enough caffeine [in my opinion]. Never stop all caffeine abruptly, or you would most likely get severe
headaches. I personally have not tried SAM-E, but St. John's Wort did nothing for me. I'm not sure it would be too helpful. You might want to reduce your caffeine intake a little gradually, like cutting to one soda instead of two and replacing it with something without caffeine. This tends to help anxiety. I think you are on the right track with cognitive therapy. It is very helpful when practiced consciously. I am not a psychologist or doctor and this is just my humble opinion. Good luck.
Joy
Posted by wcfrench on November 21, 2002, at 13:44:47
In reply to Re: Caffeine/CBT/Supplements/Self-help/What WORKS????, posted by joy on November 21, 2002, at 9:50:25
Thanks Joy.
I was looking at the books, and there seems to be a "Feeling Good Handbook" as well as a "Feeling Good: The New Mood Therapy" with the latter being cheaper. They both seem to have good reviews, but according to some reviewers, Burns bashes the idea that depression and anxiety have to do with anything physical, which I think is ignorant. They both/either seem to be worth buying, according to reviews on Amazon, but many say that it's not a cure-all, or that clinically depressed patients might not benefit greatly. There's a "Ten Days to Self Esteem" by Burns that looks very promising. Have you ever heard or read about that one?Yes, the SJW did nothing for me, or made me feel worse, if anything. I'm going to try SAM-E, which has been said to work fairly quickly, I'll let you know. The $400 thing I was talking about is a self-course, with several tapes, that takes about 11 weeks to do, and has remarkable success. I'm not really in a great position to spend 400 dollars, so a friend is letting me copy the tapes, and you can buy the workbook separately. Anyway thanks for your input.
-Charlie
Posted by Dr. Bob on November 21, 2002, at 18:42:02
In reply to Re: Caffeine/CBT/Supplements/Self-help/What WORKS????, posted by joy on November 21, 2002, at 9:50:25
> You can buy David Burns book on cognitive therapy called 'Feeling Good'. It is the gold standard.
I'd just like to plug the new double double quotes feature:
http://www.dr-bob.org/babble/faq.html#amazon
But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at PBA:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by joy on November 22, 2002, at 8:35:29
In reply to Re: Caffeine/CBT/Supplements/Self-help/What WORKS???? » joy, posted by wcfrench on November 21, 2002, at 13:44:47
Hi Charlie,
I don't remember David Burns bashing medication. It's just that many people who are not severely deressed enough go the medication route [the SSRIs are over prescribed] and the side effects often outweigh the benefits. When I was in a 'black hole' for a time, Paxil pulled me out. However, the side effects were terrible so I weaned off. Some people combine medication and the cognitive therapy. If a person is only mildly depressed, foregoing the medication and starting with Cognitive Behavioral Therapy is a good way to go. Thanks for mentioning to Dr. Bob about the double quotes; I had no idea what he meant and I did contact him on the administrative board. Regards.
Joy
Posted by mattDDS on November 22, 2002, at 23:45:42
In reply to Caffeine/CBT/Supplements/Self-help/What WORKS????, posted by wcfrench on November 21, 2002, at 0:32:50
Charlie,
Burns doesn’t “bash” meds. Nor does he ignore that depression and anxiety involve physiological changes in the brain. He actually started his career doing full-time research on serotonin metabolism, for which he won a prestigious award.
I think he has voiced his concern that antidepressants do not seem very effective, or at least not as effective as most people believe. But doesn’t this mirror the experience of many on this site? Regardless, he said in one of his books that he treated about half of his patients with some sort of medication, usually antidepressants. He is also a big proponent of using mood-stabilizers for mania and neuroleptics for schizophrenia. All his treatment is very much evidence-based, and scientific.
CBT has helped me tremendously for **severe** anxiety and depression. You can look up some of my old posts to see my story if you’re interested. I sometimes wonder why so many people overlook this or fail to integrate it into their treatment plan. Especially when it is basically free (when done as self-help) and has been shown to be as effective as meds with better long-term outcome. Not to mention, there are presumably no side-effects and you “can raise the dose” as much as you want!
Good luck!
Matt
“”Feeling Good”” -- helpful for depression / bipolar
“”The Feeling Good Handbook”” -- covers phobias, anxiety, panic, depression, SP
“”Intimate connections”” -- helpful for social phobia
Posted by wcfrench on November 23, 2002, at 1:19:03
In reply to Burns NOT a med-basher » wcfrench, posted by mattDDS on November 22, 2002, at 23:45:42
You may be right. I am just basing this off of what I read from a reviewer, I'll share it with you. This is a review of "Feeling Good The New Mood Therapy", perhaps you read a different one? Anyway, the reviewer writes...
Having had severe clinical depression for years, I had scoffed at "talk therapies" and never investigated them. I bought "Feeling Good" because I was curious about it and had read several psychiatrists rave about it. Overall, I feel that this book is a good one worth reading by any depressive. However I also believe, from personal experience, that some of the material in "Feeling Good" is incorrect. Dr. Burns obviously does not believe that depression is a biological, brain based disease but more of a "psychological" issue amenable to psychology based therapies. He poo poos the whole notion of depression being "physically based." I had a major problem with that portion of the book. And then later on, in the drugs section of "Feeling Good" Dr. Burns gives the MAOIs a glowing review. The MAOIs are the most potent antidepressants in the psychiatrist's arsenal and frequently work when nothing else works. I find it odd that Dr. Burns refuses to admit depression has a genetic and biological basis, but then goes on and raves about the MAOIs...the strongest antidepressants you can take. That doesnt quite make sense to me.
--So it didn't seem so terrible, it just made me feel like Burns was a little close-minded, but perhaps I should give him more credit. If the double quotes shenanigans pull through, you should be able to link to the Amazon page where the book appears, and read the full review, done by LostBoyinNC (who I've seen somewhere else.. but can't remember.. here?) It is a respectable, thorough review. Either way, I may buy the book just based off of what I've heard so far. I personally think getting to the point where you take steps to improve your quality of life, IE beginning self-therapy or a training course or reading, is the hardest part of the ordeal. I'm happy to begin it, but am weary about my commitment. However, it's the one (and only) thing you can say in all of mental illness that has only positive benefits and no side effects. Unfortunately, it takes a little more commitment than taking a pill, but the end result gives you an improved quality of life and coping skills that last a lifetime.
Take care,
Charlie
Posted by mattdds on November 23, 2002, at 12:10:13
In reply to Re: Burns NOT a med-basher » mattDDS, posted by wcfrench on November 23, 2002, at 1:19:03
Hey Charlie,
This is an interesting exchange. I appreciate your comments on it. I have actually done a lot of thinking about this subject.
The message that I am getting from Burns when I read his work is a bit more subtle than I think you may have interpreted. I am afraid you may have missed his point.
I understood that he, in fact, **does** believe there is genetic susceptibility for depression / anxiety / mania, etc. He is especially convinced that this is the case in schizophrenia and mania, for which he strongly encourages neuroleptics and mood-stabilizers as part of the treatment.
But wait! Just because something is “biologically based”, why does it logically follow that there must be some drug treatment involved to treat it? Keep in mind this is not an anti-med position; in fact Burns used antidepressants in roughly 50% of his patients (although he had better luck clinically with MAOI’s, and fared poorly with SSRI’s). It just means that there are other ways of “rewiring” your brain. For example, blood phobias are very much inherited, and “biological”, as you put it. But people who get exposure to blood eventually can overcome this extreme fear. The treatment of choice for this is not “cranking up the serotonin” with meds, but merely getting more exposure to the feared stimulus.
Burns used the analogy of a computer to illustrate what may be going on in depression and anxiety. The brain is more of an electrical system than a chemical one. The neurotransmitters are essentially there to complete circuits, as in a computer. But perhaps the problem is more the “software” than the “hardware”, so to speak. I believe this is the case, and feel there is little, if any evidence of any neural pathology (at least the obvious traditional pathology) in depression. We can “rewire” our brains through experience. For example, there was a study done at UCLA where one group got CBT and the other got fluvoxamine for OCD. They did PET scans and fMRI’s for the responders of both groups at the outcome. Guess what? The changes in glucose metabolism in the orbitofrontal cortex (the part thought to be involved in OCD) were *identical*, suggesting that CBT causes actual physical changes in the brain! So, the point being, yes there may be a biological anomaly; but that changing the way you think about things can change your brain.
You see, if thinking is a biological phenomenon, with neural counterparts, why could we not use thinking as a way to (directly) access the problem?
Does any of this make sense? Sorry so rambly, but this is an interesting subject to me!
Take care,
Matt
Posted by Peter S. on November 23, 2002, at 23:09:52
In reply to Re: Burns NOT a med-basher » wcfrench, posted by mattdds on November 23, 2002, at 12:10:13
Hey Matt and CharlieI've used cognitive psychology for years. I've also gone to a cognitive therapist for a number of years. What I've found is that the techniques Burns describes are extremely useful in dealing with mild depression as well as anxiety. A major result of depression is distorted thinking- the cognitive approach directly challenges these thoughts. I think it is much more effective than going to an insight oriented or other kind of therapist for depression. Of course for some people this may not be true.
The problem with this approach is that I don't think it has much validity or use with more severe depression. I've done tons of cognitive exercises (writing down all my distortions and challenging them) and have had very little results. It's like water off a duck's back.
The idea that cognitive therapy is the answer to dealing with depression is very far off the mark. It's true David Burns leaves room for meds, but I still get the feeling that he believes if you try hard enough to do the exercises then you can beat any kind of depression. I completely disagree.
Peter
> Hey Charlie,
>
> This is an interesting exchange. I appreciate your comments on it. I have actually done a lot of thinking about this subject.
>
> The message that I am getting from Burns when I read his work is a bit more subtle than I think you may have interpreted. I am afraid you may have missed his point.
>
> I understood that he, in fact, **does** believe there is genetic susceptibility for depression / anxiety / mania, etc. He is especially convinced that this is the case in schizophrenia and mania, for which he strongly encourages neuroleptics and mood-stabilizers as part of the treatment.
>
> But wait! Just because something is “biologically based”, why does it logically follow that there must be some drug treatment involved to treat it? Keep in mind this is not an anti-med position; in fact Burns used antidepressants in roughly 50% of his patients (although he had better luck clinically with MAOI’s, and fared poorly with SSRI’s). It just means that there are other ways of “rewiring” your brain. For example, blood phobias are very much inherited, and “biological”, as you put it. But people who get exposure to blood eventually can overcome this extreme fear. The treatment of choice for this is not “cranking up the serotonin” with meds, but merely getting more exposure to the feared stimulus.
>
> Burns used the analogy of a computer to illustrate what may be going on in depression and anxiety. The brain is more of an electrical system than a chemical one. The neurotransmitters are essentially there to complete circuits, as in a computer. But perhaps the problem is more the “software” than the “hardware”, so to speak. I believe this is the case, and feel there is little, if any evidence of any neural pathology (at least the obvious traditional pathology) in depression. We can “rewire” our brains through experience. For example, there was a study done at UCLA where one group got CBT and the other got fluvoxamine for OCD. They did PET scans and fMRI’s for the responders of both groups at the outcome. Guess what? The changes in glucose metabolism in the orbitofrontal cortex (the part thought to be involved in OCD) were *identical*, suggesting that CBT causes actual physical changes in the brain! So, the point being, yes there may be a biological anomaly; but that changing the way you think about things can change your brain.
>
> You see, if thinking is a biological phenomenon, with neural counterparts, why could we not use thinking as a way to (directly) access the problem?
>
> Does any of this make sense? Sorry so rambly, but this is an interesting subject to me!
>
> Take care,
>
> Matt
>
Posted by wcfrench on November 24, 2002, at 0:30:04
In reply to Re: Burns NOT a med-basher, posted by Peter S. on November 23, 2002, at 23:09:52
I was going to write more at some point, but I just have some small thoughts for now.
I think, at least from what I have felt so far, that anxiety is perhaps a better candidate for CBT than depression. Perhaps mild depression can be redirected to positive thoughts, or at least helped, but severe depression, for me the melancholia/loss of interest, etc, seems like it would be very difficult to undo. For my anxieties, I find the mind to be a powerful and effective tool, and with good training and dedication great results can be had. I'm skeptical, however, about major depression, as Peter said. Of course, I've not given my course the time and dedication it requires, and it spans nearly three months, so I will definitely give it a full chance. For now, I tend to think that deep-down depression is very difficult to correct without the *help* of medicine. I guess I'm hoping that though medicine is helping me now, perhaps one day I'll be ready to stop it and handle myself in a healthy, assured manner. I wish this so much for everyone, because as much as medicine does good, it can do bad. It can wear out, it can cause side effects.. I have no stigma about it, but I don't want to be on it my whole life. I was good at one point, and believe I could be good again.
-Charlie
Posted by mattdds on November 24, 2002, at 1:32:54
In reply to Re: Burns NOT a med-basher, posted by Peter S. on November 23, 2002, at 23:09:52
Peter,
CBT, like all treatment for depression, is not a panacea. However you are incorrect to say that it is only effective for mild depression and anxiety. I realize that CBT may not have worked on severe depression *for you*, but to generalize this to the rest of the population flies in the face of a lot of good evidence.
Many new studies have found the following:
1. CBT is indeed just as effective as antidepressant medication for SEVERE depression, as well as mild to moderate depression.
2. It has better long term outcome, in terms of fewer relapses
3. It may be less expensive if one considers that, since relapse usually follows discontinuation of a medication, they must be continued indefinitely.Keep in mind, that just because CBT did not work for your (severe) depression, which is unfortunate, it is poor logic to say that this is how it is for everyone. Here is a link to a study performed at the U. Penn psychiatry department:
http://www.upenn.edu/pennnews/releases/2002/Q2/derubeis.html
CBT is not for everyone, and it is not easy work; definitely much more difficult than taking medication. This is where proper patient selection comes into play. There was a study done that showed positive correlations between the self-efficacy trait and good outcome with CBT. People who had lower self-efficacy did not fare as well.
I have noticed that bringing up CBT on this board usually elicits the following typical responses:
1. It is only good for mild depression (simply not true)
2. It ignores the “biological basis” or “chemical imbalance” aspect of depression (this seems to *really* hit a raw nerve, like we have this need for our illness to be legitimately “medical”)You wrote:
“I still get the feeling that he believes if you try hard enough to do the exercises then you can beat any kind of depression. I completely disagree.”
I certainly did not get that from reading his stuff. But, conversely, some people (many on this board, apparently) have a go with nearly every conceivable med combo, and still no results. Why is this never brought up? Yet we’re so quick to bring up CBT’s shortcomings.
Bottom line: Get well, using whatever method works! (CBT or otherwise!)
Matt
Posted by joy on November 24, 2002, at 7:59:25
In reply to Re: Burns NOT a med-basher, posted by wcfrench on November 24, 2002, at 0:30:04
Charlie, I used both medication and CBT. I think severe to moderate/heavy depression requires medication in most cases; but CBT is then easier to accomplish. In time hopefully for many, medication will no longer be a necessity, but CBT may be practiced for live.Regards.
Joy
Posted by Dinah on November 24, 2002, at 9:19:15
In reply to Re: Burns NOT a med-basher, posted by wcfrench on November 24, 2002, at 0:30:04
My trouble with CBT and anxiety is that it's like whack the mole. If I deal with one area of anxiety, another one pops up, and so on... If I manage to deal with anxiety completely, something even more unpleasant (agitation and urges to self harm) pops up. I think that sometimes anxiety about this or that is more than anxiety about this or that, it is a discharge of some sort. And if that avenue of discharge is blocked, another will form. Like damming a river.
So I started out with a severe phobia about vomit, channeled all my fear etc into that. Successfully diminished that fear with CBT. Several fears later, I wish I had that d*mn phobia about vomiting back. It was the least harmful of any of them. My mind had long ago chosen a relatively benign (relatively I must confess) way of focusing the fear. I shouldn't have messed with it.
Posted by Dr. Bob on November 24, 2002, at 12:28:42
In reply to Burns NOT a med-basher » wcfrench, posted by mattDDS on November 22, 2002, at 23:45:42
> "Feeling Good" -- helpful for depression / bipolar
> "The Feeling Good Handbook" -- covers phobias, anxiety, panic, depression, SP
> "Intimate connections" -- helpful for social phobiaSorry, the server didn't recognize the "curly" quotes, but that should be fixed now (they'll be changed into "straight" quotes).
Bob
Posted by Peter S. on November 25, 2002, at 16:11:24
In reply to Re: Burns NOT a med-basher, posted by mattdds on November 24, 2002, at 1:32:54
Matt,
You are correct. Generalizing my experience to everyone's response is not helpful in that it may discourage others from trying this treatment. My statement comes from a sense of anger and frustration that in spite of spending years in CBT therapy, reading David Burns books, and doing the exercises many times, it has done very little to alleviate the fundamental depression. People can do millions of studies that show that CBT is God's gift to mankind, but that doesn't effect my experience. I'm not saying it hasn't been helpful, and if I were going to recommend therapy for depression CBT would be first on my list.
Peter
> Peter,
>
> CBT, like all treatment for depression, is not a panacea. However you are incorrect to say that it is only effective for mild depression and anxiety. I realize that CBT may not have worked on severe depression *for you*, but to generalize this to the rest of the population flies in the face of a lot of good evidence.
>
> Many new studies have found the following:
>
> 1. CBT is indeed just as effective as antidepressant medication for SEVERE depression, as well as mild to moderate depression.
> 2. It has better long term outcome, in terms of fewer relapses
> 3. It may be less expensive if one considers that, since relapse usually follows discontinuation of a medication, they must be continued indefinitely.
>
> Keep in mind, that just because CBT did not work for your (severe) depression, which is unfortunate, it is poor logic to say that this is how it is for everyone. Here is a link to a study performed at the U. Penn psychiatry department:
>
> http://www.upenn.edu/pennnews/releases/2002/Q2/derubeis.html
>
> CBT is not for everyone, and it is not easy work; definitely much more difficult than taking medication. This is where proper patient selection comes into play. There was a study done that showed positive correlations between the self-efficacy trait and good outcome with CBT. People who had lower self-efficacy did not fare as well.
>
> I have noticed that bringing up CBT on this board usually elicits the following typical responses:
>
> 1. It is only good for mild depression (simply not true)
> 2. It ignores the “biological basis” or “chemical imbalance” aspect of depression (this seems to *really* hit a raw nerve, like we have this need for our illness to be legitimately “medical”)
>
> You wrote:
>
> “I still get the feeling that he believes if you try hard enough to do the exercises then you can beat any kind of depression. I completely disagree.”
>
> I certainly did not get that from reading his stuff. But, conversely, some people (many on this board, apparently) have a go with nearly every conceivable med combo, and still no results. Why is this never brought up? Yet we’re so quick to bring up CBT’s shortcomings.
>
> Bottom line: Get well, using whatever method works! (CBT or otherwise!)
>
> Matt
>
Posted by mattdds on November 25, 2002, at 23:40:48
In reply to Re: Burns NOT a med-basher, posted by Peter S. on November 25, 2002, at 16:11:24
Peter,
Perhaps I misunderstood what you were saying. I apologize. I can imagine your frustration after years of trying CBT and (although getting pretty good results) not reaching all your goals.
I didn't reach ALL mine either! CBT gave me about a 80-85% reduction in symptoms of severe anxiety and resultant depression. Klonopin has been wonderful p.r.n. for symptoms that seem nonresponsive to CBT. There is always that residual "crap" leftover, even after intense CBT. At least that is my experience. For me, Klonopin and CBT together has yielded a great synergy, even though some CBT researchers might think benzos go against CBT philosophy.
Anyway, sorry if I came across as preachy, or overzealous.
Best wishes,
Matt
Posted by Peter S. on November 26, 2002, at 12:37:10
In reply to Re: Burns NOT a med-basher » Peter S., posted by mattdds on November 25, 2002, at 23:40:48
All forgiven Matt!
It's really easy to get emotional when discussing issues like these. Unfortunately in matters of the mind there is very little black and white, no categorical truths. I wish there was one treatment that was effective for everyone and it did not involve drugs. Perhaps there is such a treatment- I've spent many years searching...
One thing I really believe helps all mental health is a sense of community and being part of a group (not a therapy group). This society's structure tends to lead to isolation. For me when I'm depressed it is much more difficult to reach out but I know making the effort pays off.
Best,
Peter
> Peter,
>
> Perhaps I misunderstood what you were saying. I apologize. I can imagine your frustration after years of trying CBT and (although getting pretty good results) not reaching all your goals.
>
> I didn't reach ALL mine either! CBT gave me about a 80-85% reduction in symptoms of severe anxiety and resultant depression. Klonopin has been wonderful p.r.n. for symptoms that seem nonresponsive to CBT. There is always that residual "crap" leftover, even after intense CBT. At least that is my experience. For me, Klonopin and CBT together has yielded a great synergy, even though some CBT researchers might think benzos go against CBT philosophy.
>
> Anyway, sorry if I came across as preachy, or overzealous.
>
> Best wishes,
>
> Matt
Posted by wcfrench on December 1, 2002, at 15:25:50
In reply to Re: Burns NOT a med-basher, posted by Peter S. on November 26, 2002, at 12:37:10
Hey guys
Thanks for all the great talks on the issue. I am still in search of a doctor in the Raleigh/Durham area (if anyone knows a good one let me know) so for now I've been using the 1 refill of the meds I have left, which is quickly dwindling, and working on some anxiety programs.
I tried (am trying) SAMe and after 7 days I feel worse than when I started, more depressed, is this a likely outcome? (I am already taking an SSRI) If so, I should stop it right away. Also I've been doing a relaxation tape that comes with the program I was talking about and it really seems to relax the body and give my mind some ease, but unfortunately did not brighten my mood too much. But it doesn't happen overnight, and I will continue to work on it.
Any comments appreciated.
Take care all,
Charlie
This is the end of the thread.
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