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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 27 to 51 of 95. Go back in thread:
Posted by gardenergirl on August 4, 2008, at 19:30:35
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
If y'all are going to go down the same road with the same outcome, have you considered taking it outside? I like having you both around, not blocked.
Respectfully,
gg
Posted by linkadge on August 4, 2008, at 19:34:32
In reply to Re: You are refering to me? | No. » linkadge, posted by SLS on August 4, 2008, at 18:43:47
>How so?
Well, for somebody who has been miraculously and gloriously affected by the workings of these drugs, it doesn't seem like you have had any form of sustained efficacy from any one drug. You're periodically talking about how things aren't working for you the way they once did, and how your brain has adapted to the effects of many of the medications you take. It just seems to me that when you feel good, you start to jump into this "idealization mode" where you seem to overassert the efficacy of these meds and the extent to which modern psychiatry can help any one individual. When you're not feeling so hot, it seems that you start to doubt the overall utility of many of these meds and talk in (what appears to me) to be a more grounded mannor about the benifits and drawbacks of meds. On the one hand you unequivically and liberally advocate the use of the genotoxic TCA's and on the other you write posts that makes me think you are concerned about the possable genetic dammage that you yourself may have sustained.
You don't often tell people about the psychotic/ manic reaction you had to drugs like nortyptaline in the past. Wonder drugs don't make people manic and/or psychotic. Yet, I don't think you consider yourself bipolar as you are not taking maintainance doses of any mood stabilizer. As such, I don't know how you could be convinved about your diagnosis and subsequently I don't know how you could be so convinved that you really are being treated optimally.
Everybody's got a story to tell and nobody who frequents this board is perfectly well IMHO. Perhaps you think that if you can convince others that medications work, you can convince yourself?
Linkadge
Posted by linkadge on August 4, 2008, at 19:35:30
In reply to Re: Some people don't want to believe. Linkage/SLS » Justherself54, posted by SLS on August 4, 2008, at 18:48:29
>The hostility is unfortunate, and it is very >uncomfortable to witness.
Oh boo-hoo, I'm so insulted.
Linkadge
Posted by linkadge on August 4, 2008, at 19:40:28
In reply to Re: Some people don't want to believe., posted by Sigismund on August 4, 2008, at 19:29:42
>It may be that psych drugs have to be unpleasant >to discourage drug abuse/malingering/etcetc.
That makes no sense to me because in other disorders, there is a liberal use of drugs which have abuse potential. Stimulants are highly abusable but that doesn't discourage their use in ADHD. The same is true for pain meds. Perhaps depression isn't seen as a hard-core disorder requiring hardcore treatment.
Linkadge
Posted by Sigismund on August 4, 2008, at 20:11:38
In reply to Re: Some people don't want to believe., posted by linkadge on August 4, 2008, at 19:40:28
Do you have ADHD in Canada?
I thought the British Commonwealth was free of itPain? I suppose sometimes it gets treated.
Posted by bleauberry on August 4, 2008, at 20:23:28
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
> Some people here don't want to believe that medication can adequately treat mental illness and argue vehemently their position.
What is even more perplexing is when someone gets well on meds....what do they want to do then?....get off the meds! There is some strange stigma attached to taking medications that affect the mind. Those stigmas do not apply to diabetes, blood pressure, heart disease, arthritis, or anything else. But if it has to do with the mind, oh, it's all in the attitude and healthy living. No need for meds. Give me a break. While things can malfunction in other organs, that doesn't apply to the brain. It is infallable and off limits. Cough.
I think the biggest hurdle for many are the side effects. To get well means living with some new burden. Not always, but often enough. Those side effects usually diminish or disappear in several months, but that is too much time for many to tolerate.
Frustration when a couple meds haven't worked also gets in the way. Hope fades, faith fades, and the enthusiasm to stick to the plan fades.
Posted by SLS on August 4, 2008, at 20:35:08
In reply to Re: Some people don't want to believe., posted by bleauberry on August 4, 2008, at 20:23:28
> Frustration when a couple meds haven't worked also gets in the way. Hope fades, faith fades, and the enthusiasm to stick to the plan fades.
Yes. Furthermore, the fading hope, faith, and vigilance are influenced or manufactured as a result of the depressive symptomology itself. It is so hard to separate the biological from the psychological at times.
- Scott
Posted by Deputy 10derHeart on August 4, 2008, at 20:37:16
In reply to Re: Some people don't want to believe., posted by bleauberry on August 4, 2008, at 20:23:28
I ask that everyone keep the board guidelines in mind, and not post anything that could lead others to feel accused or put down, as well as refraining from sarcasm, overgeneralizations and jumping to conclusions about others.
I've chosen this blanket reminder for now, but there are several posts on this thread that I am concerned about. I might also mention apologies usually go a long way. And, I do thank those who have already made them, and those who have tried to engage and caution their fellow posters in supportive ways. We appreciate that - a lot.
A spirited debate is definitely encouraged by admin, but there are limits on *how* that's done here, as I believe most posters know.
If you do wish to review the guidelines, they can be found at:
http://www.dr-bob.org/babble/faq.html#civil
10derHeart, acting as deputy to Dr. Bob
Posted by SLS on August 4, 2008, at 20:42:50
In reply to Re: You are refering to me? | No. » SLS, posted by linkadge on August 4, 2008, at 19:34:32
> >How so?
>
> Well, for somebody who has been miraculously and gloriously affected by the workings of these drugs, it doesn't seem like you have had any form of sustained efficacy from any one drug. You're periodically talking about how things aren't working for you the way they once did, and how your brain has adapted to the effects of many of the medications you take. It just seems to me that when you feel good, you start to jump into this "idealization mode" where you seem to overassert the efficacy of these meds and the extent to which modern psychiatry can help any one individual. When you're not feeling so hot, it seems that you start to doubt the overall utility of many of these meds and talk in (what appears to me) to be a more grounded mannor about the benifits and drawbacks of meds. On the one hand you unequivically and liberally advocate the use of the genotoxic TCA's and on the other you write posts that makes me think you are concerned about the possable genetic dammage that you yourself may have sustained.
>
> You don't often tell people about the psychotic/ manic reaction you had to drugs like nortyptaline in the past. Wonder drugs don't make people manic and/or psychotic. Yet, I don't think you consider yourself bipolar as you are not taking maintainance doses of any mood stabilizer. As such, I don't know how you could be convinved about your diagnosis and subsequently I don't know how you could be so convinved that you really are being treated optimally.
>
> Everybody's got a story to tell and nobody who frequents this board is perfectly well IMHO. Perhaps you think that if you can convince others that medications work, you can convince yourself?I am fascinated that you are so focused on my condition. I would have preferred that you get the story right, though.
- Scott
Posted by Bob on August 4, 2008, at 21:51:54
In reply to Re: Some people don't want to believe., posted by linkadge on August 4, 2008, at 17:20:50
>
> You keep quoting these institutions as if its supposed to mean something. Sure they're smart that doesn't mean that they're always right or that they're in hot presuit of anything that will amount to anything. If your claim to fame is coming into contact with a bunch of people that their entire day studying monoamine uptake mechanisms then its time to move on.
>
> I got to meet David Healy, so whats your point?
>
> Linkadge
Granted researchers can be out of touch sometimes, or misguirded maybe, but if we don't have these groups of people looking for answers, then how will any progress ever be made?
Posted by Bob on August 4, 2008, at 21:57:19
In reply to Re: Some people don't want to believe., posted by bleauberry on August 4, 2008, at 20:23:28
>
> I think the biggest hurdle for many are the side effects. To get well means living with some new burden. Not always, but often enough. Those side effects usually diminish or disappear in several months, but that is too much time for many to tolerate.>
Maybe sometimes, but I've been on multiple drugs where some side effects faded, while others became more insidious. I call weight gain, sexual dysfunction, and fatigue some nasty side effects, and for me these often just got worse over time.
Posted by gardenergirl on August 4, 2008, at 22:23:48
In reply to Re: Some people don't want to believe., posted by gardenergirl on August 4, 2008, at 19:30:35
Posted by Sigismund on August 4, 2008, at 23:35:01
In reply to Re: Some people don't want to believe. » linkadge, posted by Bob on August 4, 2008, at 21:51:54
>then how will any progress ever be made?
Quite touching, such faith.
Posted by yxibow on August 5, 2008, at 1:43:30
In reply to Re: You are refering to me? | No. » SLS, posted by linkadge on August 4, 2008, at 19:34:32
> >How so?
>
> Well, for somebody who has been miraculously and gloriously affected by the workings of these drugs, it doesn't seem like you have had any form of sustained efficacy from any one drug. You're periodically talking about how things aren't working for you the way they once did, and how your brain has adapted to the effects of many of the medications you take. It just seems to me that when you feel good, you start to jump into this "idealization mode" where you seem to overassert the efficacy of these meds and the extent to which modern psychiatry can help any one individual. When you're not feeling so hot, it seems that you start to doubt the overall utility of many of these meds and talk in (what appears to me) to be a more grounded mannor about the benifits and drawbacks of meds. On the one hand you unequivically and liberally advocate the use of the genotoxic TCA's and on the other you write posts that makes me think you are concerned about the possable genetic dammage that you yourself may have sustained.
I don't know where this ideology about TCAs being any more cancer causing than other newer antidepressants haven't had years of use and articles written about possible new finds in lab rats.Second of all, would you rather have someone commit suicide, or possibly have a nth degree risk of cancer later in life?
I can't see the logic in it.
Posted by yxibow on August 5, 2008, at 1:56:19
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
> Some people here don't want to believe that medication can adequately treat mental illness and argue vehemently their position. Yet, professional neuroscientists state otherwise and produce conclusive results of investigations supporting the utility of psychotropics. Why is this?
>
> Anger?
>
> It seems to me that having such an attitude is counterproductive to successful treatment. It can cause people to fail to commit themselves to trials of different medications. One consequence might be that such an unbelieving person tends to abort drug trials prematurely, and never get the answer they are looking for - remission. Holding on to melancholic and negative thoughts can only work against treatment and prevent the changes in the brain from taking place to produce a therapeutic response. There is power in positive thinking.I have to concur in this topic -- but with a caveat, remission may not be what one thinks it will be -- there may be no such thing as complete remission of any disorder that is biologically and biochemically governed and is always changing.
Remission is making mental illness akin to the years spent away from cancer. A disorder under control would be something I would say is a better way of describing it.
The best of chemical "cocktails" for an anxiety-depression spectrum disorder is not a chemotherapy regime. If you stop taking your medication, there is a good chance it will come back if you have a particularly hard to treat disorder.
Some people are lucky and have mild disorders such as dysthymia for a short period of time and take medication and then upon stopping it after having completed some therapy in the meanwhile don't need their medication.
Unfortunately for a lot of us, medication is a continual need -- but not the only need in a condition.There are social needs, there are therapy and psychological needs, and there is the need, yes, to believe, but not just to believe in the power of medication --- its there in the background to help you, but what is missing in our mental health system a lot is goal, task, CBT oriented therapy to accompany a medication regime.
Most psychiatrists are trained in some form of talk therapy but not a lot invest much time in this. There are psychopharmacologists who also hold double degrees in psychotherapy as well.
And then there's the concept of mixing two doctors, a psychiatrist and a psychologist -- but I think it would be a mistake if there wasn't some communication between the two at some point. That's your privacy though and how you view it, its your right.
-- Jay
Posted by yxibow on August 5, 2008, at 2:09:54
In reply to Re: Some people don't want to believe., posted by dcruik518 on August 4, 2008, at 8:48:12
> It seems to me that most people here believe that meds can be helpful. That said, however, I think many people here have difficult or treatment resistant cases and they come here to seek advice above and beyond the easy first-year-resident kind of "ssri's work for everything" crap. If there's anger, it's anger at the large number of incompetent dopes who call themselves psychiatrists. We therefore have to educate ourselves and sometimes take matters into our own hands. More than any other of the medical specialities, psychiatry needs to be done democratically, not autocratically, and I think it's this need for dominance among the p-docs that leads to patient frustration as much as anything else. The top down model is bunk.
>
> ~DRC
>
>
First of all that's a vast generalization of psychiatrists. I'm sure there are good ones and bad ones. Most states have licensing boards where you can check up on the status of their license and any license restrictions.
Second of all, while I agree that its a democratic concept -- well its a consumer concept really... you are a consumer (as NAMI calls patients now) and you come to someone for help -- "taking matters into your own hands" I assume means making responsible choices about who you see for a psychiatrist and not buying medicine willy nilly off the cuff and the black market.
I also see this vitriol against medicine sometimes and against psychiatry right on the medicine board -- if you don't want to be treated, why go? Its like asking a dog to bark and then bark yourself. Now, this is distinctly different from sitting passive at a psychiatrist's session and saying uh-huh to everything and not bringing your own views -- I tell people if they're afraid of forgetting everything then why not bring a pad of paper and their views and also write down some notes at the session.Also nobody is shoving medication down your mouth -- you can refuse to take the medication suggested. Enough refusals of course and the psychiatrist may run out of ideas, but there's always a second opinion and yes, a second doctor.
Remember, retaining a psychiatrist is or should be a relationship -- if you dont both invest time into it, it wont nurture, and the converse is the "dump your doctor" threads I see when people don't necessarily know how many months someone has invested in someone. Its that many more months till you get somewhere else. Maybe its necessary -- maybe it isn't.
-- Jay
Posted by SLS on August 5, 2008, at 5:37:00
In reply to Re: Some people don't want to believe., posted by dcruik518 on August 4, 2008, at 8:48:12
Hi.
> The top down model...
What is a "top down" model?
Thanks.
- Scott
Posted by linkadge on August 5, 2008, at 6:48:21
In reply to Re: Some people don't want to believe. » linkadge, posted by Sigismund on August 4, 2008, at 20:11:38
>Do you have ADHD in Canada
Canada is a mirror image of the US. Its very easy for people to get an ADHD diagnosis.
Linkadge
Posted by linkadge on August 5, 2008, at 6:50:38
In reply to Re: You are refering to me? | No. » linkadge, posted by SLS on August 4, 2008, at 20:42:50
>I am fascinated that you are so focused on my >condition. I would have preferred that you get >the story right, though.
Cute. Although, I am not fascinated.
Linkadge
Posted by linkadge on August 5, 2008, at 6:53:18
In reply to Re: Some people don't want to believe. » linkadge, posted by Bob on August 4, 2008, at 21:51:54
>Granted researchers can be out of touch >sometimes, or misguirded maybe, but if we don't >have these groups of people looking for answers, >then how will any progress ever be made?
I've got nothing wrong with these people. I just don't see the point of listing institutions as if their prestige is somehow proof of the validity of the ideas they assert.
Linkadge
Posted by linkadge on August 5, 2008, at 7:10:25
In reply to Re: Some people don't want to believe. » bleauberry, posted by Bob on August 4, 2008, at 21:57:19
>Maybe sometimes, but I've been on multiple drugs >where some side effects faded, while others >became more insidious. I call weight gain, >sexual dysfunction, and fatigue some nasty side >effects, and for me these often just got worse >over time.
Exactly. The notion that side effects diminish and effect increases over time is just a framework of how it occurs in some people or how it would occur more ideally.
The reality is that the facts about many of these substances are readily downplayed. Weight gain, permanant sexual side effects, phospholipidosis, neuroendocrine changes, metabolic changes, cardiac side effects, genotoxicity, apathy, suicidal ideaion, other cognitive side effects.
The whole system could be supported by a system not dissimilar to the emperors new cloths.
Medications could be affecting the majority of people in this way. They could be pooping out, they could be causing unbearable side effects. If you only trust the 3 month studies of safety and efficiacy of these meds how could you possably be getting an idea of how safe/effective they are over time in the population as a whole.
When you just accept that the meds work like certain studies suggest then nobody speaks up and says, hey this medication isn't all that great. Sure it seemed to work for the first little while, but now all I do is sit around. I'm so apathetic and have no interest in anything. I still don't feel well, I just feel numb and medicated.
Linkadge
Posted by linkadge on August 5, 2008, at 7:12:52
In reply to Re: You are refering to me? | No. » linkadge, posted by yxibow on August 5, 2008, at 1:43:30
>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
Posted by linkadge on August 5, 2008, at 7:24:35
In reply to Re: Some people don't want to believe. » dcruik518, posted by SLS on August 5, 2008, at 5:37:00
I guess all I am saying with this thread is that:
"Some people don't want to believe." is correct.
Some people don't want to believe that the majority of studies find antidepressants no better than placebo. Some people don't want to believe that there is no proof that antidepressants actually reduce suicide. Some people don't want to believe that antidepressants often poop out. Some people don't want to believe that antidepressants can induce mania in certain patients. Some people don't want to believe that antidepressants may infact be responsable for certain suivides. Some people don't want to believe that there is no conlcusive proof that serotonin levels are low in depression. Some people don't want to believe that the serotonin transporter tends to already be decreased in depression. Some people don't want to believe that tianeptine is an effective antidepressant. Some people don't want to believe that antipsychotics can cause diabeties. Some people don't want to believe that ECT can cause memory loss or that more than 80% of patients relapse within one year of having it. Some people don't want to believe that they may just be experiencing a placebo effect. Some people don't want to believe that scientists have little idea of how SSRI's work when they do. Some people don't want to believe that the drug industry is the single greatest predictive factor for the outcome of any published psychiatric medication trial. Some people don't want to believe that antidepressants may infact make depression a more chronic disorder etc. etc.
Linkadge
Posted by Jamal Spelling on August 5, 2008, at 8:18:32
In reply to Re: Some people don't want to believe., posted by linkadge on August 5, 2008, at 7:24:35
Posted by dcruik518 on August 5, 2008, at 8:29:47
In reply to Re: Some people don't want to believe. » dcruik518, posted by SLS on August 5, 2008, at 5:37:00
The phrase "top down model" is used for all sorts of organizations to describe a situation in which authority is structured in the traditional hierarchical patriarchy. Most work settings are like this but many newer companies have started to run themselves in less hierarchical ways. Apple for instance. A "bottom up model" refers to decisions that come, for instance from the grassroots in politics, or from the factory floor in factories. The idea is that the people themselves often know what is needed better than the detached, out of touch managers up their towers. Japan uses a bottom up approach in their manufacturing--instead of dictating what should be done, managers ask the people on the floor to make as many suggestions for improvement as possible. this empowers people and leads to greater productivity. I'm not saying psychiatry should be completely "bottom up". I'm saying it should be democratic, by which I mean both parties work together, essentially as equals, to find the right treatment. OF course, psychiatrists are experts and the average patient cannot be equal to them in knowledge, but the patient does come with something the doctor does not have--namely their own personal experience.
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