Posted by bob on January 12, 2002, at 2:22:10
In reply to Why I think we all need our heads examined » bob, posted by manowar on January 12, 2002, at 1:40:35
Tim:
I don't disagree for one moment that brain imaging is a valuable tool that will one day may lead to accurate *diagnoses* of depressive subtypes. However, I'm still not convinced at this point that going to the AMEN clinic and having my brain scanned will matter a hill of beans in my *treatment*. I've tried many, many, many med combos, and there are many more that I could try. I don't see where there is a one to one correlation between an abnormal brain scan, and what medecine(s) to prescribe for a certain individual to make it normal. There would still be trial and error, because we don't understand the underlying mechanisms by which the meds work, and what they are actually doing to the brain. I don't see a very black and white relationship between brain scans, and what medecines to pick, except in certain cases. I still think, however, that brain scan research is heading in the right direction.
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> First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.I realize that scans don't treat depression, and I don't believe I stated that. How does a brain scan tell you why a person is not responding to a treatment if they've tried, say, 20 different combos of meds and haven't achieved satisfaction. Many on this board have been through the pharmacological ringer.
>> BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
I agree, it's pathetic that mental disorders have no diagnostic tests. I don't think brain scans are there yet though. They can help, but what we would eventually need is a distinct scan pattern for every subtype, an **understanding** of the subtypes, and then we would have to know how to fix it. Our ability to treat mental illness in many individuals falls far short of satisfaction. The fact that we can diagnose things like MS, haven't really improved the treatments much, if at all.
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> Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.I wholeheartedly agree.
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> In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.If your case was treatment resistant, I don't know why that didn't lead your doctors to try different approaches before the scans. My doctors have tried many approaches, and the only limit to my treatment has been my increasing inablility to go on and off of these meds.
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> For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
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> My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.It sounds to me like your pdoc was somewhat timid with the treatments before the scans, and that the scans gave him the impetus to be more creative.
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> >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
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> Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.I said refractory to meds, not "all therapies". I realize there are things like ECT available also. "Refractory depression" does exist, and is characterized by a lack of response to available treatments. All you have to do is type the phrase in any internet search engine, and all kinds of info will come up. There are also many situations where people cannot physically tolerate the meds for one reason or another. Say, for example, you only got a temporary response from your pstims, and then it faded?
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> Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)It sounds to me like the doctor had was very narrow minded in his treatments. I don't think my doctor would resist much of anything I suggested, as long as it was available here in the US. If I wanted to try Microcurrent Stimulation, I don't think he'd have any problem with it.
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> Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.I'm definitely not among the popular believers then, because it has severely impaired my existence. I agree.
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It seems that you've found a suitable solution to your problems with a med combo, and I'm glad to hear that.Again, brain scans are definitely useful, and I wouldn't mind having them done... I'm just not sure at this point for me that it would change my treatment. There would still be trial and error inherent in the med trials.
Bob
poster:bob
thread:88953
URL: http://www.dr-bob.org/babble/20020110/msgs/89810.html