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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 Phillipa on September 26, 2009, at 20:00:25
Just a link on success of antidepressants and therphy. Phillipa
http://www.webmd.com/depression/features/unhappy-with-your-antidepressant?ecd=wnl_dep_092509
Posted by sowhysosad on September 27, 2009, at 15:41:40
In reply to Success Rate of Antidepressants And Theraphy, posted by Phillipa on September 26, 2009, at 20:00:25
> Just a link on success of antidepressants and therphy. Phillipa
While I'm sure combining meds and therapy is a perfect fit for some people, I'm very bored of my successive (UK) pdocs banging on about therapy - and in particular CBT.
You'd think it was some kind of magical panacea which will save the entire UK from mental health problems.
They're now so bogged down in this thinking that they deny that purely biochemical depressions exist.
The irony is that the latest pdoc couldn't even offer me CBT on the NHS due to lack of resources. She insisted I contacted a mental health charity instead.
That said, I'm sure combining therapy with the right meds can be a terrific treatment for some types of depression.
Posted by SLS on September 27, 2009, at 20:06:48
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by sowhysosad on September 27, 2009, at 15:41:40
> > Just a link on success of antidepressants and therphy. Phillipa
>
> While I'm sure combining meds and therapy is a perfect fit for some people, I'm very bored of my successive (UK) pdocs banging on about therapy - and in particular CBT.
>
> You'd think it was some kind of magical panacea which will save the entire UK from mental health problems.
>
> They're now so bogged down in this thinking that they deny that purely biochemical depressions exist.
>
> The irony is that the latest pdoc couldn't even offer me CBT on the NHS due to lack of resources. She insisted I contacted a mental health charity instead.
>
> That said, I'm sure combining therapy with the right meds can be a terrific treatment for some types of depression.Psychotherapy does not produce an improvement in my depression. None at all. The depression persists despite my accomplishing the goals that I set out to address in psychotherapy.
For some people, it is crucial to process the psychological issues that contributed to the precipitation of their biological depressive condition. Psychosocial stress can be minimized to allow for a faster recovery and prevent relapse.
I think there might be differences between unipolar atypical depression and bipolar depression with respect to the propensity of psychotherapy to yield meaningful results in reducing symptom severity. I have no data to present, however. I am just trying to account for the results reported in the literature. An alternate hypothesis is that many of the studies reporting success with psychotherapy in depression are not treating the right kind of depression. I am dubious that the majority of these studies accurately diagnose their subjects as having major depressive disorder.
- Scott
Posted by Phillipa on September 27, 2009, at 20:26:10
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by SLS on September 27, 2009, at 20:06:48
Scott good point so far know the therapists and one did have goals seemed worthless to me the others just did nothing for me. Diagnosis? Here I feel the key word is helping to understand. Love Phillipa
Posted by sowhysosad on September 27, 2009, at 20:38:16
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by SLS on September 27, 2009, at 20:06:48
> Psychotherapy does not produce an improvement in my depression. None at all. The depression persists despite my accomplishing the goals that I set out to address in psychotherapy.
A UK health service pdoc would probably still try to convince you otherwise despite your experience!
That said, they may approach bipolar disorder in a different way to unipolar depression. I have no experience in that area - as far as I'm aware I'm not on the bipolar spectrum.
> For some people, it is crucial to process the psychological issues that contributed to the precipitation of their biological depressive condition.
I'm sure you're right, particularly in the case of "situational" depressions that have been precipitated by recent life events or stressors.
Where therapy is helpful, I firmly believe techniques like CBT and Psychology of Mind that are concerned with the "now" and dealing with broken thought processes are probably most effective.
To me, dredging up and analysing negativity from your past is counter-intuitive to getting well. It can only push you deeper into depression whilst making the therapist substantially wealthier.
> I think there might be differences between unipolar atypical depression and bipolar depression with respect to the propensity of psychotherapy to yield meaningful results in reducing symptom severity.
Yeah, I would imagine they have a largely biological basis, in contrast to many unipolar depressions.
My current depression in a weird one. It came after a bout of SSRI-induced akathisia which, in turn, may have been caused by suddenly quitting another SSRI weeks earlier. To me, it's blatantly a biological depression.
It's probably been exacerbated by external stressors since then as my life has come apart at the seams, but I was in a good place before the depression kicked in.
Despite explaining this until I'm blue in the face, I can't get a pdoc to understand the concept.
Posted by SLS on September 28, 2009, at 5:16:30
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by sowhysosad on September 27, 2009, at 20:38:16
> Despite explaining this until I'm blue in the face, I can't get a pdoc to understand the concept.
That is extremely unfortunate. For any professional health care worker that you rely on to help get you well, it is nothing short of sabotage to have them tell you that your depression is anything but biological. I know this from personal experience. In 1982, there weren't too many doctors who were willing to assign the etiology of depression to abnormal biology. Had I acted upon their demands to get psychotherapy instead of somatic treatments, I might not have made it this far.
- Scott
Posted by sowhysosad on September 28, 2009, at 11:23:57
In reply to Re: Success Rate of Antidepressants And Theraphy » sowhysosad, posted by SLS on September 28, 2009, at 5:16:30
> That is extremely unfortunate. For any professional health care worker that you rely on to help get you well, it is nothing short of sabotage to have them tell you that your depression is anything but biological.
The pdocs I see are all juniors and they're a little threatened by the fact I do my homework and don't just blindly accept what they say.
Last week I asked to switch SSRI's because fluoxetine is causing tachycardia (120bpm at rest), agitation and dysphoria.
She told me I was over-medicalising my condition, that switching SSRI's would have a placebo effect at best, and that it's likely no med will be a "golden bullet" for my depression.
> In 1982, there weren't too many doctors who were willing to assign the etiology of depression to abnormal biology. Had I acted upon their demands to get psychotherapy instead of somatic treatments, I might not have made it this far.
That's a worrying thought. I guess I should take a leaf from your book and fight for my mental health. It's just frustrating when we get patronised and dismissed for being more knowledgeable than the average patient.
Posted by number42 on September 28, 2009, at 14:36:42
In reply to Re: Success Rate of Antidepressants And Theraphy » sowhysosad, posted by SLS on September 28, 2009, at 5:16:30
> > Despite explaining this until I'm blue in the face, I can't get a pdoc to understand the concept.
>
> That is extremely unfortunate. For any professional health care worker that you rely on to help get you well, it is nothing short of sabotage to have them tell you that your depression is anything but biological. I know this from personal experience. In 1982, there weren't too many doctors who were willing to assign the etiology of depression to abnormal biology. Had I acted upon their demands to get psychotherapy instead of somatic treatments, I might not have made it this far.
>
>
> - ScottAmen to that!
#42
Posted by letterbox on September 30, 2009, at 2:10:26
In reply to Re: Success Rate of Antidepressants And Theraphy » SLS, posted by sowhysosad on September 28, 2009, at 11:23:57
I agree with all of the above comments. It's so hard to find a good psychiatrist who can give you the right diagnosis and the right meds. A lot of psychiatrists from my experiences have been condescending and act like they hate their job and that I am a huge waste of their time. One psychiatrist told me I would be miserable for the rest of my life. His remedy was to take Paxil and go the the gym and build up some muscle (I am a slender woman). Those were his words, literally! He was convinced that there was just some abuse in my childhood when I told him there was a lot. He didn't hear me; he didn't want to. I took the Paxil and it didn't work for me. I had severe side effects and my panic attacks, anxiety and depression worsened. When I called to make another appointment, I was told he had closed my file and I couldn't get back in to see him without going on the waitlist. Nice. No wonder suicide rates are increasing!
So far my new pyschiatrist seems on the ball, yet she seems rushed, and she is. There is a huge shortage of psychiatrists and mental health practitioners in Canada - I don't know what it's like in the U.S.
The waiting list to see one here is six months to one year, and mosts GPs don't bother referring because it takes too long. And then those people who don't get referred may get poor treatment by the GPs who don't know a lot about these types of meds. My GP knew the basics but not a lot. When I had questions about medications, she had to keep leaving the room to look things up. She finally returned with this big book and looked up several different ones and read the details out loud to me slowly. Then she told me to come back so she could do some research. I knew more about some meds than she did. My GP was going to make me quit Effexor 225 mgs cold turkey, which is the worst thing you can do. Effexor is the most difficult med to get off of - the side effects are many and are very severe which can be life threatening in terms of suicide thoughts. When I told her that, she was baffled. I had done my research, why didn't she know this?
I really had to insist on seeing a psychiatrist. It's a good thing I did because I was lucky to get in immediately because my boss knew my psychiatrist. My psychiatrist would not take me off Effexor because she said my symptoms were to severe and that the side effects from the withdrawal could be dangerous.
There are huge gaps and stigmas in our mental health system. Something needs to be done. The Canadian Medical Association has put out publicity about mental health awareness and how it should be treated like any other disease such as diabetes. There should be no stigma or embarrassment because of it. Doctors and the general public should be more educated. Speaking of which, here in British Columbia, Canada, it Mental Illness Awareness Week from October 4-10 put on by the Canadian Mental Health Association. A lot of organizations are putting on presentations, lectures, public screenings, plays and films throughout B.C. to help increase awareness. Hopefully that will help. I found that over the years the awareness has increased but the amount of help has not.
Wow, they don't call this board Psycho-babble for nothing. I sure am babbling on and on. Thanks for reading.
Posted by 10derHeart on September 30, 2009, at 13:07:41
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by letterbox on September 30, 2009, at 2:10:26
Posted by sowhysosad on September 30, 2009, at 19:36:55
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by letterbox on September 30, 2009, at 2:10:26
Wow! Sounds like the mental health experience in Canada is scarily similar to here in the UK (although your waiting lists are even longer than ours)!
Do you still feel lucky to have access to free healthcare, even after your bad experiences?
I still appreciate having access to a free psychiatrist, even if the quality is much lower than the US.
> The waiting list to see one here is six months to one year, and mosts GPs don't bother referring because it takes too long. And then those people who don't get referred may get poor treatment by the GPs who don't know a lot about these types of meds. My GP knew the basics but not a lot. When I had questions about medications, she had to keep leaving the room to look things up. She finally returned with this big book and looked up several different ones and read the details out loud to me slowly. Then she told me to come back so she could do some research.
Posted by Phillipa on September 30, 2009, at 20:09:32
In reply to Re: Success Rate of Antidepressants And Theraphy » letterbox, posted by sowhysosad on September 30, 2009, at 19:36:55
Where I live it's next to impossible to get a pdoc drive total eight hours and she's been out for over eight months and doubt she'll be back as 72 and bad car accident. Saw her PA that's it. Phillipa
Posted by sowhysosad on September 30, 2009, at 20:33:59
In reply to Re: Success Rate of Antidepressants And Theraphy » sowhysosad, posted by Phillipa on September 30, 2009, at 20:09:32
Ouch! Not good.
Part of me would rather see a bad pdoc than none at all.
That said, some of the GP's I've seen have been better than pdocs. NHS pdocs are unwilling to prescribe anything more powerful or esoteric than an SSRI/SNRI for unipolar and seem more patronising and less sympathetic than many GP's.
> Where I live it's next to impossible to get a pdoc drive total eight hours and she's been out for over eight months and doubt she'll be back as 72 and bad car accident. Saw her PA that's it. Phillipa
Posted by Phillipa on September 30, 2009, at 21:35:44
In reply to Re: Success Rate of Antidepressants And Theraphy » Phillipa, posted by sowhysosad on September 30, 2009, at 20:33:59
Let's play pdoc got a basket of about all the ssri's and ssnri's lamictal, seroquel, deplin, theophylline,pamelor Phillipa
Posted by sowhysosad on September 30, 2009, at 22:40:09
In reply to Re: Success Rate of Antidepressants And Theraphy » sowhysosad, posted by Phillipa on September 30, 2009, at 21:35:44
> Let's play pdoc got a basket of about all the ssri's and ssnri's lamictal, seroquel, deplin, theophylline,pamelor Phillipa
Personally I like to keep it simple and stick to monotherapy, but it's hard enough even to persuade them to switch SSRI's!
I can't imagine them prescribing an MAOI in a million years.
Posted by Phillipa on October 1, 2009, at 19:15:34
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by sowhysosad on September 30, 2009, at 22:40:09
Not in the UK isn' celexa the favorite of docs? Phillipa
Posted by sowhysosad on October 1, 2009, at 22:42:58
In reply to Re: Success Rate of Antidepressants And Theraphy » sowhysosad, posted by Phillipa on October 1, 2009, at 19:15:34
> Not in the UK isn' celexa the favorite of docs? Phillipa
I dunno. It seems fairly common but way less than generic Prozac, for example.
A few more progressive docs started prescribing its sister drug Cipralex (Lexapro) when it first became available here. Unusual because the guidelines favour older drugs available in generic form.
Posted by morganator on October 1, 2009, at 22:47:18
In reply to Re: Success Rate of Antidepressants And Theraphy, posted by SLS on September 27, 2009, at 20:06:48
Scott, have you ever tried group therapy? That is, psychodynamic group therapy. It can be very useful for learning to build postitive relationships. I'm not saying you have issues with this. I just believe that happiness in life has a lot to do with having good relationships. Love and relationships are life, without them, forget about it.
Group therapy is not easy. There is much heavy lifting that has to be done there. Also, it is very difficult to find two quality psychotherapists that conduct a really good group therapy.
This is the end of the thread.
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