![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 39 to 63 of 102. Go back in thread:
Posted by Lou Pilder on July 24, 2010, at 17:10:53
In reply to Lou's request-dhafax-Kolz, posted by Lou Pilder on July 24, 2010, at 15:58:47
> > > > > If the side effects are the problem, every one of us has side effects for almost every drug we take. Talk about that and stop trying to scare people off nortriptyline by talking about BBB effects that only happen at toxic levels anyway. At least by talking about the real side effects, people can look at them and say they do/don't have them, could/could not tolerate and do/do not believe that they would be worth it to feel better re depression. You have the luxury of using drugs to make you better from time to time when you feel down. There are some of us whose lives are not worth living without these drugs. I know that some of my drugs and especially the combinations of some of my drugs are making me decidedly less healthy but I also know that I either wouldn't be alive or would wish I weren't if I stopped taking them, so I don't have the same luxury you do of only taking what makes me feel "healthy." Just remember that the people that you may be scaring off trying drugs with posts like this may or may not truly *need* that drug for basic quality of life.
> > > >
> > > >
> > > > You know, I really feel that there should be another site on here for posters to talk toxic tantrum crap to each other. You know, my great grandmother didn't have the luxury of medication and she died in a mental institution. My mother never got to know her. It's very sad. I am so thankful for medication to be able to FUNCTION normally in daily life and not live in a vegetated state.
> > > >
> > > > I have patients that have been on tricyclics since they were on the market that don't have any ADVERSE side effects. I took Imipramine for years before Effexor came on the market.
> > > >
> > > > And to Inanimate Peanut, kudos to your response, I'm right there with ya.
> > >
> > > pb206,
> > > I am unsure as to what you are wanting to mean here. Ifyou could post answers to the following, then I could have the opportunity to respond accordingly.
> > > A. In,[...I have patients..]
> > > 1a. Are you someone that has the authority to prescribe drugs by law?
> > > 2a. If so, what is yur title?
> > > B. In,[...been on tricyclics (for 50 years?)and do not have any ADVERSE side effects..]
> > > 1b. redacted by respondent
> > > 2b. is there a journal report of these people that you could post a link to here?
> > > C.In, [...I took (a tricyclic) for years...]
> > > 1c. Assuming that you are not one of the paitients that you refer to as taking these drugs for (50?) years without adverse effects, but you could be a patient of another prescriber of psychotropic drugs, are you included or not included in those that {don't have any AVERSE side effects?
> > > D. In,[...before Effexor came on the market...]
> > > 1d. If you are substituting Effexor for the tricyclic,what was the primary reason you discontinued the tricyclic, if you did so?
> > > 2d. If I find out the reason, if any, then I could ask if you advise others to substitute Effexor for a tricyclic, if you did so. If so, what could be the reason for that advice and if not, what was your reason for the substitution if there was one?
> > > E. In,[...for posters to talk xxxx yyyyyy zzzz...]
> > > e1. My research shows that about 36,000 people die yearly from psychotropic drugs in one way or another. This statistic is unkniwn to me if it is or is not just in the U.S. If not, then interpolation could mean that about 500,000 people die each year from psychotropic drugs. If that is so, then milllions of people will die fromn psychotropic drugs in the future.
> > > e1. Could you post your rationale here for stateing that you want another site for those that you consider to be xxxxx yyyyy zzzz?
> > > e2. there is now a warning about the possibility of many psychotropic drugs to induce a mind-alterd state that could cause the one taking the drug to want to kill thenmselves.
> > > (redacted by respondent) If one was posting here about that, would that content be (redacted by respondent)
> > > Lou
> >
> > Friends,
> > If you are considering being a discussant in this thread or paralle thead, I would like for you to look at the video here to discuss facts.
> > Lou
> > You can view this video by:
> > A. bring up google
> > B. Key in
> > [youtube, fatal overdose with effexor]
> > you will see a woman with a red dress on
>
> Friends,
> There are facts concerning taking psychoactive chemicals. Here is a video that is from a doctor thatI would like for you to view so that we could incorporate any facts into this discussion.
> Lou
> You could view this video by:
> A. bring up google
> B. key in:
> [youtube, Dr. Gary Kohls, SSRI Drugs are]
> if you see a picture of Dr. Kohles, it could be the first one. He will be talking about what could happen to a person that takes those drugs from a doctors perspective.Friends,
Another video that I would like for you to see so that the facts in the video could be used in thiis dicussion.
Lou
You can view this video by
A.bring up google
B.type in
[Psychotropic Drugs: The Hidden, D. Gary Kohls]
Posted by linkadge on July 24, 2010, at 19:46:48
In reply to Re: toxic crap » linkadge, posted by SLS on July 24, 2010, at 16:35:30
>You are a very frustrating man to deal with,
Then don't deal with me.
>However, it looks to me like you are abandoning >a rare opportunity to attain remission by using >a treatment that has been deemed safe by the >medical community for decades.
The medical community? Are you certain that what they've done to you is Kosher?
Linkadge
Posted by morgan miller on July 24, 2010, at 19:54:07
In reply to Re: toxic crap » morgan miller, posted by SLS on July 24, 2010, at 5:19:17
> > Ya know, after re-reading that study I think I will still consider Nortriptyline as an adjunct therapy.
>
> One important fact to note is that barbiturate anesthesias by themselves alter BBB function. This complicates the interpretation of the results of the study. It is possible that nortriptyline has no BBB effects in the absence of barbiturate.
>
>
> - ScottI was thinking the same thing.
Posted by morgan miller on July 24, 2010, at 20:08:11
In reply to Re: toxic crap » SLS, posted by linkadge on July 24, 2010, at 19:46:48
Linkage, your illness is most likely more toxic to the health of your mind, body, and soul than any medication that might help you feel better. If you feel well on a regular basis, you can socialize in a healthy way(promotes healing and neurogenesis), you can get proper exercise regularly(promotes neurogenesis, increases levels of key neurotransmitters, and then there are all those other wonderful health benefits), you can get on with your life and live!!! So what is it? Maybe live 5 more years in your old boring as hell age where you can't do much anyway? Or, do whatever it takes to feel great now and live life to it's fullest while you are still young?
Dude, in 2 or 3 weeks you may have really started feeling good on Nortriptyline and whatever mild side effects you were experiencing may have subsided or disappeared completely. Now I guess you will never know.
Please try not to take this the wrong way, but you not only sound angry but super stubborn? Maybe there is a part of you that does not want to feel really good after feeling bad for so long.
Are you sure some form of therapy with the right therapist wouldn't help? It could take 2 or 3 years before you really start to benefit from it. It's a long hard process but well worth it in the end.
Posted by ed_uk2010 on July 24, 2010, at 20:55:57
In reply to Re: toxic crap » SLS, posted by linkadge on July 24, 2010, at 19:46:48
>Then don't deal with me.
Aww Link, Scott only wants to help you.
My opinion is this...
You are clearly extremely concerned about the potential for toxic effects from psychiatric medication. This anxiety is likely to cancel out the benefits (if any) of the medication which you are prescribed. You have posted previously about the potential toxic effects of SSRIs, TCAs and many other medications. So... in your opinion, are there any psychiatric medications which are extremely unlikely to produce toxic effects in the short-term and in the long-term? If so, what are they? And assuming that you've tried them, how do you respond to them?
Ed
Posted by linkadge on July 24, 2010, at 21:53:53
In reply to Re: toxic crap, posted by morgan miller on July 24, 2010, at 19:54:07
>This complicates the interpretation of the >results of the study. It is possible that >nortriptyline has no BBB effects in the absence >of barbiturate.
No, because in a separate reference to this study, they compared nortriptyline and cloropromazine with the barbituate to various doses of diphenhyramine with barbituate. The diphenhydramine (a bicyclic) had no effect at any dose tested, with the barbituate.
See p 33
Linkadge
Posted by morgan miller on July 24, 2010, at 22:03:36
In reply to Re: toxic crap » morgan miller, posted by linkadge on July 24, 2010, at 21:53:53
> >This complicates the interpretation of the >results of the study. It is possible that >nortriptyline has no BBB effects in the absence >of barbiturate.
>
> No, because in a separate reference to this study, they compared nortriptyline and cloropromazine with the barbituate to various doses of diphenhyramine with barbituate. The diphenhydramine (a bicyclic) had no effect at any dose tested, with the barbituate.
>
> See p 33
>
> http://books.google.ca/books?id=9ykQOkpFFuEC&pg=PA33&lpg=PA33&dq=micellar+drugs+%2B+chlorpromazine+%2B+nortriptyline&source=bl&ots=53da_ifB39&sig=sU02PQmATTVB5BOohvSXgnwf60o&hl=en&ei=_qZLTMeJGoL_8Ab1tYk1&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBQQ6AEwAA#v=onepage&q=micellar%20drugs%20%2B%20chlorpromazine%20%2B%20nortriptyline&f=false
>
> Linkadge
>Sure, but you can't just assume that long term use will eventually lead to increased BBB permeability. Like Scott said, there is no proof for this. Plus, is there any medication does not carry some risk for some type of negative effect in the long run. The way I see it, feel good and take care of yourself, and you may be able to somewhat offset any long term ill effects of meds. Then there is that possibility that a little toxicity may in some way be good for via hormesis. Just trying to look on the bright side.
Posted by SLS on July 25, 2010, at 4:39:28
In reply to Re: toxic crap » morgan miller, posted by linkadge on July 24, 2010, at 21:53:53
> > This complicates the interpretation of the results of the study. It is possible that nortriptyline has no BBB effects in the absence of barbiturate.
> No, because in a separate reference to this study, they compared nortriptyline and cloropromazine with the barbituate to various doses of diphenhyramine with barbituate. The diphenhydramine (a bicyclic) had no effect at any dose tested, with the barbituate.I'm sorry, but I must be missing something. I don't see how the possibility I suggested is logically precluded by what you have written here. If I understand you, the barbiturate was given in conjunction with all of the drugs tested. In any event, you still haven't offered an explanation as to what you are worried about. Even if my suggestion is inconsistent with reality, what are the negative consequences of the effects on the BBB that you suspect nortriptyline might have?
- Scott
Posted by SLS on July 25, 2010, at 4:49:19
In reply to Re: toxic crap » SLS, posted by linkadge on July 24, 2010, at 19:46:48
> The medical community? Are you certain that what they've done to you is Kosher?
What they have done to me through the well-intentioned misapplication of drugs is to very likely produce permanent treatment resistance. This is a reality that I must deal with every day. Somehow, I do. It may not be logical, but it seems to be rather human.
- Scott
Posted by 49er on July 25, 2010, at 5:38:02
In reply to Re: toxic crap » linkadge, posted by ed_uk2010 on July 23, 2010, at 16:50:07
> Link, I've noticed that whatever meds(s) you take, you always report unusual side effects or worry about toxicity. I don't think you will ever be comfortable with taking medication because you are too worried about adverse effects... either now or potential adverse effects in the future. Perhaps you should take no medication at all?
Hi Linkage,
I agree with this.
As some who used to be on psych meds, here is what I am sensing and you can tell me if I am right or wrong.
I sense that even though you are very concerned about side effects, you see yourself as not having any other choice but to stay on meds. If this is an issue and again, I realize I could be off base, I am here to tell you that it is possible to live med free and do well.
And when I say this, this is not meant as a criticism of people who chose to take meds. I am just saying this is not an either or situation.
If you want to babble me to discuss it further, I would be happy to talk with you.
I have nothing to sell as an FYI.
49er
Posted by SLS on July 25, 2010, at 6:03:21
In reply to Re: toxic crap » ed_uk2010, posted by 49er on July 25, 2010, at 5:38:02
> If this is an issue and again, I realize I could be off base, I am here to tell you that it is possible to live med free and do well.
That sounds like an all inclusive statement. Is it?
- Scott
Posted by 49er on July 25, 2010, at 6:37:41
In reply to Re: toxic crap » 49er, posted by SLS on July 25, 2010, at 6:03:21
> > If this is an issue and again, I realize I could be off base, I am here to tell you that it is possible to live med free and do well.
>
> That sounds like an all inclusive statement. Is it?
>
>
> - ScottHi Scott,
I am not sure what you're getting at.
49er
Posted by chujoe on July 25, 2010, at 6:56:14
In reply to Re: toxic crap » SLS, posted by 49er on July 25, 2010, at 6:37:41
When you say "it is possible to live med-free," are you making a global statement? If so, what evidence have you got to support such a statement? Or are you saying, "I have found that it is possible for me to live med-free"?
Posted by 49er on July 25, 2010, at 7:16:52
In reply to Re: toxic crap » 49er, posted by chujoe on July 25, 2010, at 6:56:14
> When you say "it is possible to live med-free," are you making a global statement? If so, what evidence have you got to support such a statement? Or are you saying, "I have found that it is possible for me to live med-free"?
Hmm, this is what I find interesting about communicating on an Internet board. I thought I did my best to make a controversy free statement but obviously, I didn't.
It seems that meds aren't working for Link and I wanted him to see that he has med free options if he chooses to pursue that route. Therefore, when I said it is possible to live med free, it was not meant as a global statement.
49er
Posted by SLS on July 25, 2010, at 8:46:16
In reply to Re: toxic crap » chujoe, posted by 49er on July 25, 2010, at 7:16:52
> > When you say "it is possible to live med-free," are you making a global statement? If so, what evidence have you got to support such a statement? Or are you saying, "I have found that it is possible for me to live med-free"?
> Hmm, this is what I find interesting about communicating on an Internet board. I thought I did my best to make a controversy free statement but obviously, I didn't.
I feel the need to be vigilant against a resurgence of the idea that the mentally ill are in control of the way they think, feel, and function. For many people, medication seems to be the best currently available alternative that effectively treats their abnormal state of consciousness. I want to make sure that these alternatives remain available and that the biological nature of my illness is acknowledged. Your statement lacked a specificity for whom other options are effective. Without any qualification, it appears that you are generalizing your thesis to everyone. Too often, such statements are used by those who would have others believe that mental illness is psychological weakness, and that biological psychiatry is corrupt and ineffective.
> It seems that meds aren't working for Link and I wanted him to see that he has med free options if he chooses to pursue that route.Hopefully, Linkadge will find resolution of his depression soon. I think it would be a great learning tool for everyone at Psycho-Babble to watch this occur without drug intervention. Perhaps you can help make this happen.
- Scott
Posted by 49er on July 25, 2010, at 9:38:27
In reply to Re: toxic crap » 49er, posted by SLS on July 25, 2010, at 8:46:16
> > > When you say "it is possible to live med-free," are you making a global statement? If so, what evidence have you got to support such a statement? Or are you saying, "I have found that it is possible for me to live med-free"?
>
> > Hmm, this is what I find interesting about communicating on an Internet board. I thought I did my best to make a controversy free statement but obviously, I didn't.
>
> I feel the need to be vigilant against a resurgence of the idea that the mentally ill are in control of the way they think, feel, and function. For many people, medication seems to be the best currently available alternative that effectively treats their abnormal state of consciousness. I want to make sure that these alternatives remain available and that the biological nature of my illness is acknowledged. Your statement lacked a specificity for whom other options are effective. Without any qualification, it appears that you are generalizing your thesis to everyone. Too often, such statements are used by those who would have others believe that mental illness is psychological weakness, and that biological psychiatry is corrupt and ineffective.
>
> > It seems that meds aren't working for Link and I wanted him to see that he has med free options if he chooses to pursue that route.
>
> Hopefully, Linkadge will find resolution of his depression soon. I think it would be a great learning tool for everyone at Psycho-Babble to watch this occur without drug intervention. Perhaps you can help make this happen.
>
>
> - ScottScott,
This is the reason why I almost decided to babblemail Linkage directly instead of posting on this board.
I try very hard to qualify what I say and I think if you have read my previous postings on this board, you know darn right well that I don't think people are weak because they chose to take drugs
I really wasn't looking to turn this thread into a drugs vs. no drugs type of discussion. I was only responding to Link's concerns.
I have tried very hard to be respectful and frankly, I am very disappointed that you responded this way.
49er
Posted by violette on July 25, 2010, at 9:58:07
In reply to Re: toxic crap » 49er, posted by SLS on July 25, 2010, at 8:46:16
"For many people, medication seems to be the best currently available alternative that effectively treats their abnormal state of consciousness."
It's also true that some don't recognize the extent of or don't even know their emotionally-based problems until finding the right therapist as many therapists these days practice according to orientations that only scratch the surface, only addressing symptomology rather than the core issues that cause the symptoms.
Posted by ed_uk2010 on July 25, 2010, at 10:46:30
In reply to Re: toxic crap » ed_uk2010, posted by 49er on July 25, 2010, at 5:38:02
>I sense that even though you are very concerned about side effects, you see yourself as not having any other choice but to stay on meds.
I don't want to speak for Linkadge, but I think you could be right. I think Linkadge has three main medication options.....
1. To try to manage without medication and to look at non-medication treatment options.
2. To restrict his med choices to the meds which he feels are the least toxic.
3. To learn to accept the possibility that adverse reactions may occur, and to continue treatment in spite of it (assuming that a drug is producing beneficial effects).
I think it would be helpful for Linkadge to keep a 'mood/med diary', if he doesn't already. I've noticed that he often reports substantial changes in mood which may or may not be related to medication. Keeping a diary could help him to better establish the effects of individual meds over a longer period. Most of us suffer fluctuations in symptoms with or without medication, a diary could help Link to see the 'bigger picture', if that makes sense.
What do you think Linkadge?
Posted by SLS on July 25, 2010, at 11:08:32
In reply to Re: toxic crap » SLS, posted by 49er on July 25, 2010, at 9:38:27
> I try very hard to qualify what I say and I think if you have read my previous postings on this board, you know darn right well that I don't think people are weak because they chose to take drugs.
I apologize if my post sounded like an attack on you personally. It was not meant to be. I find you to be a very fair and responsible poster. I was trying to convey to you some of what motivates me to be so vigilant in my wanting to challenge certain statements and ideas. I was attempting to explain my behavior and not yours.
I am genuinely interested in knowing what alternatives you might suggest for people who suffer from Axis I mental illnesses that exclude drug treatment.
Again, I apologize for not composing my previous post in such a way that would make it clear that I was not referring to you personally in my references to the behavior of others.
- Scott
Posted by SLS on July 25, 2010, at 11:13:56
In reply to Re: toxic crap, posted by violette on July 25, 2010, at 9:58:07
> > "For many people, medication seems to be the best currently available alternative that effectively treats their abnormal state of consciousness."
> It's also true that some don't recognize the extent of or don't even know their emotionally-based problems until finding the right therapist
I agree.
> as many therapists these days practice according to orientations that only scratch the surface, only addressing symptomology rather than the core issues that cause the symptoms.
Does this include CBT? I guess that question is for another forum.
- Scott
Posted by 49er on July 25, 2010, at 11:43:22
In reply to Re: toxic crap » 49er, posted by SLS on July 25, 2010, at 11:08:32
>
> I apologize if my post sounded like an attack on you personally. It was not meant to be. I find you to be a very fair and responsible poster. I was trying to convey to you some of what motivates me to be so vigilant in my wanting to challenge certain statements and ideas. I was attempting to explain my behavior and not yours.
>
> I am genuinely interested in knowing what alternatives you might suggest for people who suffer from Axis I mental illnesses that exclude drug treatment.
>
> Again, I apologize for not composing my previous post in such a way that would make it clear that I was not referring to you personally in my references to the behavior of others.
>
>
> - ScottThanks Scott, I greatly appreciate what you said.
Depression non med alternatives
Supplements - Fish Oil, vitamin D, magnesium. I know I am leaving out many things and of course, you mileage will vary
Self Acceptance - It doesn't mean you like the situation but you accept what has occurred. For example, I greatly angered someone significant due to being forgetful.
Initially, I became very depressed. In the past, that would have led to a downward spiral. But I said that I had to accept what happened including any ramifications and move on.
What enabled me to move on is I downloaded this neat computer outlining program in which I am inputting various ideas that come to mind as alternatives. So when I want to ruminate on this situation, looking at this outline makes me focus and move forward.
I am not saying this is easy because it sure isn't. And again, your mileage will vary.
Oh and make sure I implemented procedures so that I don't forget something important again.
Thanks for asking.
49er
Posted by violette on July 25, 2010, at 11:51:59
In reply to Re: toxic crap » 49er, posted by SLS on July 25, 2010, at 11:08:32
"I am genuinely interested in knowing what alternatives you might suggest for people who suffer from Axis I mental illnesses that exclude drug treatment."
Another factor relevant to successful medication outcomes is that psychiatrists often don't account for Axis II traits (evidenced by prescribing medications as they do w/o adminstering psychological tests), which are very interlaced or overlap with Axis I issues; this is more relevant to the treatment resistant population as noted by literature. Anxiety and depression and psychosis are all symptoms that can be related to Axis I and Axis II issues. However, the Axis II criteria, or so it says, is only relevant to long-standing symptomology.
This is where the mental health system is deficient for those who have experienced mental illness for X number of years.
Really, I couldn't think of anyone who does not have some Axis II 'traits'..it's like astrology, the sun sign descriptions...though few, I'd suppose, would qualify for the actual Axis II 'disorders'. The DSM descriptions of those disorders only describe the extreme version of someone who'd be diagnosed as Axix II, and despite the continum, psychiatrist today ostensibly ignore Axis II issues if only medications are prescribed and a psychodynamic formulation is ommitted for the treatment plan.
Many insurance companies will not pay for treatment of Axis II disorders, therefore, people who have strong Axis II traits are given Axis I diagnoses by mental health professionals, which might adversely affect treatment. This system and stigma is truly a disserve to patients although well meaning on the part of psychiatrists.
Mental illness is mental illness regardless of the defining Axis. IMO, it's incredibly stupid (for the system) to segregate or differentiate the two and it is very stigmatizing.
No one really knows what PROPORTION of one's illness is 'biological' or 'psychological'. No one (does anyone know of how this can be proven by science today-how can anyone prove even with brain scans what proportion of the illness is caused by emotion??) At least I've never heard of the various scientists or psychological schools of thought agree on this or prove their particular conclusion in terms of disproving other views.
Posted by morgan miller on July 25, 2010, at 12:11:12
In reply to Re: toxic crap, posted by violette on July 25, 2010, at 9:58:07
> "For many people, medication seems to be the best currently available alternative that effectively treats their abnormal state of consciousness."
>
> It's also true that some don't recognize the extent of or don't even know their emotionally-based problems until finding the right therapist as many therapists these days practice according to orientations that only scratch the surface, only addressing symptomology rather than the core issues that cause the symptoms.I agree. I do believe as many of you already know that the majority of mental illness is rooted in both biology and psyche.
Posted by morgan miller on July 25, 2010, at 12:13:41
In reply to Re: toxic crap » 49er, posted by ed_uk2010 on July 25, 2010, at 10:46:30
> >I sense that even though you are very concerned about side effects, you see yourself as not having any other choice but to stay on meds.
>
> I don't want to speak for Linkadge, but I think you could be right. I think Linkadge has three main medication options.....
>
> 1. To try to manage without medication and to look at non-medication treatment options.
>
> 2. To restrict his med choices to the meds which he feels are the least toxic.
>
> 3. To learn to accept the possibility that adverse reactions may occur, and to continue treatment in spite of it (assuming that a drug is producing beneficial effects).
>
> I think it would be helpful for Linkadge to keep a 'mood/med diary', if he doesn't already. I've noticed that he often reports substantial changes in mood which may or may not be related to medication. Keeping a diary could help him to better establish the effects of individual meds over a longer period. Most of us suffer fluctuations in symptoms with or without medication, a diary could help Link to see the 'bigger picture', if that makes sense.
>
> What do you think Linkadge?I think those are the best 3 options to explore for Linkage and many of us.
Posted by violette on July 25, 2010, at 12:26:02
In reply to Re: toxic crap, posted by violette on July 25, 2010, at 11:51:59
Anyway, this article considers some things I'm trying to say here...I think the exclusion of psychology by psychiatrists is detrimental to medication outcomes for many people, and that psychodynamic formulations that include looking at the psychological side as opposed to only biological means, can improve treatment outcomes.
http://jppr.psychiatryonline.org/cgi/content/full/7/1/35
For my situation, I was able to repress and adapt to my childhood trauma for a considerable portion of my adult years. When my ego could no longer contain the emotional trauma-I got depression and anxiety symptomology, which basically matched the description of PTSD with a delayed onset, which was triggered by events-one of which I never would have connected to my illness if I had continued meds instead of reading about psychology. This was because, in part, psychiatrists only prescribed me medications, which delayed my recovery.
And this leaves me wondering how traumatic events during childhood or teen years, even seemingly non-traumatic events such as the intrusive parent, effect others here whose treatment plans only include medications?
Even though this article is geared towards PTSD, PTSD from childhood issues was not defined until after the Vietnam War--when it was recognized that from orphanages had higher rates PTSD than vets, with the same symptomology as those Vietnam Vets, while having lower recovery rates (see Wiki on that one). And 'PTSD' can manifest as a continum...like any symptomology.
=================================
"Currently, the symptom-oriented organization of the Diagnostic and Statistical Manual13 and the increasing availability of medications and behavioral approaches to treat symptoms directly may deflect clinicians from exploring the meaning of recent precipitating events and the complex relationship of such events to their patients' symptoms. Pharmacologic treatments, while often very helpful, are limited by side effects, incomplete results, and lack of acceptance by those patients who prefer to solve problems more definitively in psychotherapy.14 Cognitive-behavioral therapies, although reported to be efficacious in Vietnam veterans and rape victims,15 consist of discrete treatments for specific symptoms and do not easily lend themselves to application in more complex clinical situations. In addition, there has been little systematic investigation of what works best in whom.16 As with pharmacotherapy,some patients refuse to participate, and others may find such treatments ineffective or insufficient. At the other end of the spectrum, inexperienced clinicians armed with the PTSD diagnosis may overzealously explore traumas psychodynamically without adequate attention to the vulnerable state of the patient's ego functioning,17 thus overwhelming the patient's capacity to cope."
"Initial psychodynamic assessment usually takes place during approximately three 1-hour sessions. While exploring the patient's current problems, past treatment, early development, and social relationships, the interviewer also assesses mental status both indirectly and, when necessary, by asking direct questions. Although keeping in mind areas to cover, the interviewer is not limited in advance to prestructured questions and leaves time for problems and reactions to emerge spontaneously. In addition to focusing on specific symptoms or behaviors such as those listed in DSM-IV, the interviewer attends to patterns of symptom occurrence and recurrence. Using this information, as well as concurrent observations of the patient's behavior and affects, the interviewer evaluates the patient's past and current ego functioning. When the symptom picture suggests acute regression from a relatively high level of functioning but the relationship of symptoms to recent events remains obscure, an extended evaluation, combined with a trial of psychodynamic therapy, may be necessary for more definitive diagnosis and treatment."
"Despite difficulties studying psychodynamic treatments, a controlled study demonstrated that psychodynamic psychotherapy was as effective as hypnotherapy and trauma desensitization for PTSD when treated patients were compared with wait-listed control subjects.18 Patients treated with psychodynamic psychotherapy showed symptomatic improvement somewhat later than other treated patients, but they showed unexpected, and comparably greater, beneficial changes in personality traits."
"Recent reports document that posttraumatic reactions may be long lasting if not treated effectively. Rose,19 surveying the literature, found that brief supportive psychotherapy for adult survivors of sexual assault had frequently been inadequate to deal with persistent symptoms, even in patients with no preexisting psychopathology. Nader et al.20 described the considerable degree to which children remained symptomatic 14 months following an acute disaster. Terr21 prospectively studied children exposed to a day-long schoolbus kidnapping that involved no physical harm. The children showed symptoms of posttraumatic stress 4 years later, despite brief psychotherapy. Kessler et al.22 found that although treated patients fared better than others initially, one-third of all people with an index episode of PTSD failed to recover even after many years. These data suggest a pressing need for further research into the efficacy and methodology of psychodynamic psychotherapy with traumatized patients.
In this article I will focus on patients who come to treatment with acute symptoms following specific recent experiences and who have functioned at a relatively high level prior to the onset of these symptoms. Although the ego psychological approach to treating patients who complain of severe, chronic symptoms is beyond the scope of this article, the same approach can be clinically useful in understanding such patients.
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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