![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 32 to 56 of 81. Go back in thread:
Posted by Maxime on December 20, 2010, at 18:49:03
In reply to Re: Sorry: stupid question for this group of (course), posted by SLS on December 20, 2010, at 5:51:55
> > My depression is so bad that my pdoc has requested that I contact him *every day* to give him an update.
>
> What is it about your current mental state that worries your doctor?He is worried because when I am not at work, I now go into a trance state for several hours at night. I don't know how to describe than a trance. This is new for me (new for me lately, I once spent 4 months in that state). He is trying to figure out what triggers it so when I get home from work I send him an email about my day and what I am feeling at that exact moment. He also knows that my job have finished now until January and that I will get worse even depression wise.
I know it will sound strange, but the more depressed I get, the less thoughts of suicide I will have. I also become unable to plan a suicide attempt. He is not worried right now about suicide.
I am still in my PJs and I spent most of the day in bed because getting up was too much for me. I cried a lot. My body hurts more than usual today as well. I have no idea what I will be like tomorrow.
You brought up so many excellent and I would like to comment on them, but I can't right now. It's too much. It always intrigues me when you talk about having cognitive dulling yet you can write very eleborate and intelligent posts. I can only imagine what you could write if you didn't have the cognitive dulling. Are there parts of the day when your cognitive skills are better?
Maxime
Posted by linkadge on December 21, 2010, at 8:48:13
In reply to Re: *Not* Thinking in terms of meds, posted by Alexanderfromdenmark on December 20, 2010, at 10:22:30
I am just saying that, with depression you have to continually battle it from all sides.
It seems like, when some new fancy medication comes out, people get wished away in the magical world of neurotransmitters, where any frame of mind is achievable with the right medication coctail.
Linkadge
Posted by linkadge on December 21, 2010, at 9:08:39
In reply to Re: *Not* Thinking in terms of meds » SLS, posted by bleauberry on December 20, 2010, at 17:44:11
>but I don't see that as a disorder in any way
It becomes a disorder when it is maladaptive. This behavior that many of us engage in *is* maladaptive. We are just simply in denial. I've seen people who are quite satisfied with their medication regiment one day, calling up the doctor demanding a medication change the next. Why?
We don't realize how innapropriate it is for us to sit around here and chat about medications, when
a) nobody has a clue how they work
b) few / none of us can prescribe them
c) they rarely work in the same way for two individuals
d) we hear bad things that discourage us from continuing a single treatment
e) we become convinced about the efficacy or lack therof of particular medicationsWhat the hell does this board actually do for anybody? Seriously. It provides the illusion that we are more in control of our medical treatment then we are. The board just breeds dissatisfaction.
I liken this board to a hobbiest site, say model airplanes. We just sit around and talk, and sooner or later, the user just has to buy a new model airplane.
Or, my father watches all sort of home renovation shows. Every time he does, he's got to buy a new tool, or rip apart a new part of the house. The show produces dissatisfaction.
Lets be honest here. This board is just an excuse for a bunch of people to sit around and talk about something that interests us. Its rarely going to lead to any form of healing (other than a place for social interaction around a common theme).
Linkadge
Posted by linkadge on December 21, 2010, at 9:22:45
In reply to Re: Sorry: stupid question for this group of (course), posted by morgan miller on December 19, 2010, at 21:03:31
>for the first time in my life, no matter what I >try or do, I feel like complete sh*t half of the >time. I now truly understand fatigue.
>When fatigue comes from a physiological source, >when your body simply is not functioning >properly, there is not much you can do except to >try to get to the bottom of the cause and treat >it.
Whatever.
I'm not saying that people can't be fatigued. However, fatigue is all relative.
Nomatter what you do on this board, there will always be people working infinately harder to establish that they are sicker than what you realize. You really can't do anything with these people, because when people are in the state of mind that they are working extremely hard to establish how ill they are, there mind is not working very hard to find ways to get better.
I've seen people with extreme fatigue due to clinical depression, have remission from a single night of sleep deprivation. These people are able to get up and go about their normal routiene during the short period of remission. How could a night of lack of sleep actually improve fatigue? Because its their mind telling them they are fatigued.
Its like my brother when he was younger. He always used to get ill and have "no energy to do anything". He said his legs were to *way* weak to even get out of bed. It tricked him one day by putting a $20 bill on the other side of the hall.
Its all relative. Your fatigue will never be so great as when you conclude that your fatigue is so great. And like I said above, theres not much point in arguing with people who are out to establish how sick they are.
Linkadge
Posted by bleauberry on December 21, 2010, at 17:30:28
In reply to Re: *Not* Thinking in terms of meds » bleauberry, posted by linkadge on December 21, 2010, at 9:08:39
Link, your comments to me and others in this thread are some of the most profound wisdom I've ever encountered on this board. Man you hit a home run the way I see it.
I do believe that when we pin all our hopes on pills, we are indeed engaging in maladaptive behavior that is destined to lose the war against depression. Depression has too many causes and impacts every corner of the body. It indeed requires a wide ranging comprehensive approach, of which a pill is only one piece of the whole pie. To ignore the whole pie is, as you said, maladaptive.
imo
Posted by SLS on December 22, 2010, at 4:45:36
In reply to Re: *Not* Thinking in terms of meds » bleauberry, posted by linkadge on December 21, 2010, at 9:08:39
Hi Linkadge.
> What the hell does this board actually do for anybody?
I think that depends on the person.
You present some very insightful points. For me, this website helps give me hope in the face of desperation. Are we all non-reponders to all available treatments? I doubt it, but the percentage of people here who meet any accepted definition of TRD must surely be higher than what is found in the total population of people being treated for depression. Without firm data, this point is open to debate, I guess. However, I am willing to bet on it. There are too few success stories among the myriad of treatments being applied. To me, it appears that the rate of response to antidepressant treatment on Psycho-Babble is actually lower than one would predict if one were to compare it to more recent estimations of the rate of placebo response.
In light of these assumptions, a thorough evaluation of all possible treatments for depression is warranted. Therefore, this board promises education to these treatments in order to first become aware of them. To me, it seems that people are very supportive of others here as they struggle to remain alive.
- Scott
Posted by SLS on December 22, 2010, at 12:05:24
In reply to Re: *Not* Thinking in terms of meds » linkadge, posted by bleauberry on December 21, 2010, at 17:30:28
> I do believe that when we pin all our hopes on pills, we are indeed engaging in maladaptive behavior...
Who is "we"?
Perhaps you could describe your personal experiences with depressive illness and take ownership of them rather than to generalize them to everyone else. You might have a better chance of uncovering your own truth.
I think that habitually speaking for everyone else is maladaptive.
But that's just me.
- Scott
Posted by jerryTRD on December 22, 2010, at 22:39:32
In reply to Re: Sorry: stupid question for this group of (course), posted by linkadge on December 19, 2010, at 19:01:25
> Did you know that stress increases the level of a chemcal called isatin? Isatin is a highly potent monoamine oxidase A/B inhibitor. It also inhibits acetycholinsterase!
>
> Hmm, when you push / stress yourself, your brain releases an MAOI! (with potentially procognative effects) What an interesting concept? MAOIs......yes, the most potent class of chemical antidepressants currently known to man..... Adversity boosts the production of natural antidepresants.
>
> Thats all I am saying here. If you sit around expecting the energy and motivation to just magically come to you, you may be sitting around forever. Put yourself in a situation which gets you out of your comfort zone, and your brain might actually suprise you.
>
>
> Linkadge
>I've tried allowing my brain to surprise me - but all it does is let me down. Drive me out to the middle of nowhere and I'll sit there until I die.
So sue me if I have even the slightest bit of hope that a medication could end the suffering.
I've also been in therapy for about 20 years - and has it helped me any better than a drug? not at all. So - are you saying that we're all a bunch of mislead med obsessed depressives? Would you say the same thing to someone with cancer??? I doubt it.
I'm feel as tho your "Stupid question for this group" post was condescending and demeaning. Not that you intended that to be I don't know.
Glad you're doing well. Also remember that YOU are a part of "this group." Again I ask - would you be questioning "us" on "this forum" if it were for MS, HIV or Cancer? Would it be OK in your eyes if I had HIV and hoped and prayed for a drug to keep me alive?
- Jerry
Posted by jerryTRD on December 22, 2010, at 22:42:50
In reply to Re: I'm not saying 'snap out of it', posted by linkadge on December 21, 2010, at 8:48:13
> I am just saying that, with depression you have to continually battle it from all sides.
>
> It seems like, when some new fancy medication comes out, people get wished away in the magical world of neurotransmitters, where any frame of mind is achievable with the right medication coctail.
>
> Linkadge
>I think it's called hope. Something you need more than a med cocktail.
Posted by jerryTRD on December 22, 2010, at 22:43:52
In reply to Re: *Not* Thinking in terms of meds » linkadge, posted by SLS on December 22, 2010, at 4:45:36
> Hi Linkadge.
>
> > What the hell does this board actually do for anybody?
>
> I think that depends on the person.
>
> You present some very insightful points. For me, this website helps give me hope in the face of desperation. Are we all non-reponders to all available treatments? I doubt it, but the percentage of people here who meet any accepted definition of TRD must surely be higher than what is found in the total population of people being treated for depression. Without firm data, this point is open to debate, I guess. However, I am willing to bet on it. There are too few success stories among the myriad of treatments being applied. To me, it appears that the rate of response to antidepressant treatment on Psycho-Babble is actually lower than one would predict if one were to compare it to more recent estimations of the rate of placebo response.
>
> In light of these assumptions, a thorough evaluation of all possible treatments for depression is warranted. Therefore, this board promises education to these treatments in order to first become aware of them. To me, it seems that people are very supportive of others here as they struggle to remain alive.
>
>
> - Scott
>
>Thank you Scott. Great post.
Posted by jerryTRD on December 22, 2010, at 22:56:21
In reply to Re: *Not* Thinking in terms of meds » linkadge, posted by bleauberry on December 21, 2010, at 17:30:28
> Link, your comments to me and others in this thread are some of the most profound wisdom I've ever encountered on this board. Man you hit a home run the way I see it.
>
> I do believe that when we pin all our hopes on pills, we are indeed engaging in maladaptive behavior that is destined to lose the war against depression. Depression has too many causes and impacts every corner of the body. It indeed requires a wide ranging comprehensive approach, of which a pill is only one piece of the whole pie. To ignore the whole pie is, as you said, maladaptive.
>
> imo
>
>I agree thinking that one pill will cure everything. But hoping for a med that might just help in the battle is no where near maladaptive. That generalization is - to me - somewhat offensive.
You would never call someone with Cancer, MS, HIV, Dementia, Alzheimer's, etc maladaptive for hoping for a new and better medication to keep them alive longer - how is depression different? So, are you saying that we - on this forum -and in general who have mental illness basically have behavior disorders as well? It's all in our heads right? But if I had a broken bone that would be OK since that is "real?"
Excuse me if I come off as a bit disturbed by yours and others' comments - but for some of us - like me who has gone through ECT, numerous meds/cocktails, supplements, exercise programs, support groups, therapy, Vegal Nerve Stimulator trials and anything else you can think of - I think I should be allowed to have some hope for a new med when it comes out. To me this just adds to the stigma WITHIN our own community. Pretty soon we'll all be telling each other to snap out of it.
When you've tried EVERYTHING that covers the WHOLE "pie" - what do you think we should do then? Don't damn us for educating and supporting each other when it comes to medication. Like I said - you wouldn't be saying the same thing to someone with cancer, etc.
-Jerry.
Posted by jerryTRD on December 23, 2010, at 1:19:12
In reply to Re: *Not* Thinking in terms of meds, posted by linkadge on December 19, 2010, at 18:44:40
> >The problem is, when we go out to the coffee >shop and feel so uncomfortable that we can't >really fully enjoy it and get the most out of >the experience, we then start to say, "Damn, no >matter what efforts I make, I don't seem to feel >right without the right medication".
>
> It doesn't matter if you fully enjoy it or not. We are so focused on needing to enjoying things. Its all about me, what will this do for me? I was feeling miserable last week and wanted to take the day off. I didn't take the day off, I went to work and felt miserable most of the day. But, after I was done I felt great. I didn't just give up and call it quits on the day.
>
> I do believe there is something wrong with depressed individuals, but I believe we feed the illness. When we are told that "it is all in our heads", part of us dies. When we believe this, we stop working on trying to feel better and want to sit back and expect the medications do all the work (which they never will). And when something small goes wrong, we have to "change medications" or augment with this or that.
>
> >I think most people here are hyper-focused on >medication because they have tried getting out, >exercising, and doing other positive things >without a consistent positive response and >consistent relief of symptoms.
>
> Nothing will being consistent symptom relief.
>
> >Linkage, have you ever thought that maybe the >things you struggle with are not as severe as >many people here?
>
> I don't think that is anything you are qualified (me being here, and you being there) to question.
>
> I think that I have had some severe problems, but I think that there are beneficial brain regions that can be strenthened, if you care to strenthen them.
>
> Did you know that practicing juggling for a month significantly increases grey matter volume in certain areas of the brain? Even the process of "acting" well, when you are not feeling well, probably helps to strenthen the circuits involved in normal emotional function. I think the worst thing you can do is *give up* on engaging potentially adverse situations just because you don't like the way they make you feel.
>
> If you continue to throw yourself in situations that put you outside of your comfort zone, your brain will grow, adapt and respond. If you sit around and expect drugs to fix all your problems, your brain will atrophy.
>
> >Still, I have heard you speak of being able to >go run and get relief, something I and many >others here cannot do.
>
> B*llsh*t. You don't want to do it. If there was a crazy axe murderer chasing you, you'd move. Quit thinking about what makes you feel good. Just do it, and watch yourself respond.
>
> Linkadge
I feel this post to be offensive to those who have tried everything not just medications to battle their mental illness. I'm all for treatment that includes the whole and not just bits here and there. You say everyone can get out and jog? I have asthma - so even if I were running from an axe murderer I'd die anyway.I do agree with some of what you're saying, however I feel you're over generalizing. Who knows what we've all tried - minus medications - to help our brains keep order? I don't know - do you?
I just feel it's demeaning to generalize that people on a medication message board are ONLY focused on pills. I would ask to give us some credit.
Jerry
Posted by jhj on December 23, 2010, at 3:33:09
In reply to Re: *Not* Thinking in terms of meds » linkadge, posted by jerryTRD on December 23, 2010, at 1:19:12
I wonder whether those who have strength and motivation to run or do any other excercise are depressed enough.
Regards,
Jatin
Posted by SLS on December 23, 2010, at 4:43:03
In reply to *Not* Thinking in terms of meds, posted by linkadge on December 17, 2010, at 18:19:43
> Does anybody here find themselves continually thinking about all of their problems in terms of medications?
I find myself continually thinking about the way depression pervades my existence - not medications. Every conscious experience is tainted or muted by depression, so it is difficult not to focus all of one's energies on searching for a cure. I don't think focus equates to obsession.
Where I think you are correct is in describing a scenario in which someone becomes obsessed with self-medicating and evaluating the results minute-by-minute instead of week by week. It is a nasty ride. However, never-ending pain and desperation can lead people to behave in ways that had not been characteristic of them in the past.
For at least some people, all that is needed to facilitate the recovery process from MDD or BD is a single pill. The effects of depression are profound. They can make someone feel dead inside. Equally profound in magnitude are the effects of successful antidepressant treatment. One becomes alive inside. It is an awakening. The resolution of depression leaves available to one their full potential to deal with issues and even live happily ever after.
I experienced a complete remission of my depressive disorder for nine months as the consequence of taking a combination of two pills. I might have been well for the last two decades had my doctor not elected to discontinue treatment. It is hard not to notice when a world of black-and-white becomes a magnificent kaleidoscope of color. However, to make sense out of so much color when one knows only black-and-white can take quite a bit of work, but this process is far easier than continually trying to survive and function while living in the altered state of consciousness that is depression.
Maybe the most successful treatment for MDD and BD will come from a biological intervention other than administering drugs.
- Scott
Posted by bleauberry on December 23, 2010, at 8:04:23
In reply to Re: *Not* Thinking in terms of meds » bleauberry, posted by SLS on December 22, 2010, at 12:05:24
> > I do believe that when we pin all our hopes on pills, we are indeed engaging in maladaptive behavior...
>
> Who is "we"?
>
> Perhaps you could describe your personal experiences with depressive illness and take ownership of them rather than to generalize them to everyone else. You might have a better chance of uncovering your own truth.
>Who is we? Well, all of us. If someone doesn't fit into that, they can say so. Show me someone here who is not relying 99% on some medication to end their suffering and I'll change the word "we" to "some".
I do not see that as maladaptive, but rather reality and literalville. Maladaptive is when we reject reality.
> I think that habitually speaking for everyone else is maladaptive.
>
> But that's just me.
>
>
> - Scott
Posted by SLS on December 23, 2010, at 11:39:36
In reply to Re: *Not* Thinking in terms of meds » SLS, posted by bleauberry on December 23, 2010, at 8:04:23
> > > I do believe that when we pin all our hopes on pills, we are indeed engaging in maladaptive behavior...
> > Who is "we"?
> Well, all of us.
Want a bet?
> If someone doesn't fit into that, they can say so.
So.
> Show me someone here who is not relying 99% on some medication to end their suffering and I'll change the word "we" to "some".
What is your point?
What is the significance that the majority of the membership of an Internet forum about mental illness should choose to treat that illness? Isn't it maladaptive for someone to choose not to treat their illness when doing so offers the possibility of ending suffering and returning function?
> I do not see that as maladaptive,...
You don't see what as being maladaptive? I am confused.
> Maladaptive is when we reject reality.
There is that word "we" again. I reject that your presumptions to ascertain reality includes me.
I think maladaptive is when "we" reject medical treatment in favor of abstractions in philosophy.
> > I think that habitually speaking for everyone else is maladaptive.
> >
> > But that's just me.
> >
> >
> > - Scott
- Scott
Posted by jerryTRD on December 23, 2010, at 12:53:13
In reply to Re: *Not* Thinking in terms of meds » linkadge, posted by SLS on December 23, 2010, at 4:43:03
> > Does anybody here find themselves continually thinking about all of their problems in terms of medications?
>
> I find myself continually thinking about the way depression pervades my existence - not medications. Every conscious experience is tainted or muted by depression, so it is difficult not to focus all of one's energies on searching for a cure. I don't think focus equates to obsession.
>
> Where I think you are correct is in describing a scenario in which someone becomes obsessed with self-medicating and evaluating the results minute-by-minute instead of week by week. It is a nasty ride. However, never-ending pain and desperation can lead people to behave in ways that had not been characteristic of them in the past.
>
> For at least some people, all that is needed to facilitate the recovery process from MDD or BD is a single pill. The effects of depression are profound. They can make someone feel dead inside. Equally profound in magnitude are the effects of successful antidepressant treatment. One becomes alive inside. It is an awakening. The resolution of depression leaves available to one their full potential to deal with issues and even live happily ever after.
>
> I experienced a complete remission of my depressive disorder for nine months as the consequence of taking a combination of two pills. I might have been well for the last two decades had my doctor not elected to discontinue treatment. It is hard not to notice when a world of black-and-white becomes a magnificent kaleidoscope of color. However, to make sense out of so much color when one knows only black-and-white can take quite a bit of work, but this process is far easier than continually trying to survive and function while living in the altered state of consciousness that is depression.
>
> Maybe the most successful treatment for MDD and BD will come from a biological intervention other than administering drugs.
>
>
> - Scott
>
>Scott I totally agree with you. When I was first diagnosed with MDD 20 years ago my doc put me on 75mg of Trazadone. Within 2 weeks I was alive again and I just keept thinking - this is the way I SHOULD be feeling and hsould have been feeling my entire life. I fell in love that summer and had the greatest outlook on life. However, I complained one time to my doc that the med was causing too much drowsiness and he said "You're back on track so just stop the trazadone." So I did.
Two weeks later I was deep in depression again. We started the Trazadone again but no effect - upped the dose to 300mg and nothing. From then on nothing worked for me.
So I have no problem hoping a new medication will come out that will get me back the way I was that summer and give me my life back. I admit I was obsessed for a time that just a pill would cure all -but now I don't - but I do believe that it's a great part of helping me to get out of this darkness and pain.
Also, since the dawn of the internet, we're much more informed about our illnesses and their treatments. I can see though, with all the info on the internet and TV commercials - how someone could become hyper-focused on medication as a cure-all. But do I blame them? I can't - because at one point in my life a single medication DID cure my depression. How can I damn someone who has hopes the same will happen for them?
Medications and therapy and a handful of alternative treatments are all we have to hold on to until they figure out the brain. People in mental anguish have every right in my opinion to put there hopes into medication and therapy - it's all we have.
Link said he just walked into a coffeshop and started conversing with people and now regularly continues to visit this spot and it's helping him great deal. I am happy for him - very happy. But I feel his message to "us" is an overgeneralization and when you get right down to it - just because something works for you doesn't mean it'll work for everyone else.
I understand his point, however I believe he could have presented it in a less demeaning manner to the members of this message board.
Posted by jerryTRD on December 23, 2010, at 13:00:38
In reply to Re: *Not* Thinking in terms of meds » bleauberry, posted by SLS on December 23, 2010, at 11:39:36
> > > > I do believe that when we pin all our hopes on pills, we are indeed engaging in maladaptive behavior...
>
> > > Who is "we"?
>
> > Well, all of us.
>
> Want a bet?
>
> > If someone doesn't fit into that, they can say so.
>
> So.
>
> > Show me someone here who is not relying 99% on some medication to end their suffering and I'll change the word "we" to "some".
>
> What is your point?
>
> What is the significance that the majority of the membership of an Internet forum about mental illness should choose to treat that illness? Isn't it maladaptive for someone to choose not to treat their illness when doing so offers the possibility of ending suffering and returning function?
>
> > I do not see that as maladaptive,...
>
> You don't see what as being maladaptive? I am confused.
>
> > Maladaptive is when we reject reality.
>
> There is that word "we" again. I reject that your presumptions to ascertain reality includes me.
>
> I think maladaptive is when "we" reject medical treatment in favor of abstractions in philosophy.
>
> > > I think that habitually speaking for everyone else is maladaptive.
> > >
> > > But that's just me.
> > >
> > >
> > > - Scott
>
>
> - ScottExactly Scott. As i stated in some earlier posts, I don't think some members here who are labeling "us" as "maladaptive" would label cancer patients, those with HIV, Asthma, diabetes, Alzheimer's, COPD, et ,etc as maladaptive for relying on their medications to survive. Why are people with depression any different? This just ignites more stigma within our community and really saddens me to know there are people with mental illnesses who think others in the same situation should snap out of it because it's all in our heads. Just sad.
Posted by morgan miller on December 23, 2010, at 21:44:35
In reply to Re: *Not* Thinking in terms of meds » bleauberry, posted by SLS on December 23, 2010, at 11:39:36
>> Show me someone here who is not relying 99% on some medication to end their suffering and I'll change the word "we" to "some".
Here meaning the medication board? I'm assuming so. I go to therapy. I'm taking action to try to get to the bottom of whether I may have some condition causing my fatigue. I take supplements and have a VERY good diet. I will be exercising more when I am not feeling so F*CK*D up. I go to the steam room, stretch, then hit a freezing cold shower 3 to 4 times a week. I will be getting massage therapy and seeing a chiropractor and other specialists to try to heal my musculoskeletal issues.
I believe there are several others that I know of that have talked of their comprehensive and integrative approach to getting better, three of them being Thomatheus, Hombre, and Bleauberry.
Posted by morgan miller on December 23, 2010, at 21:48:41
In reply to Re: *Not* Thinking in terms of meds, posted by morgan miller on December 23, 2010, at 21:44:35
I forgot to mention, I've dated two girls who I met at work in the last 6 months, one of them I'm currently dating. They know what's going on with me and spend time with me even when I am feeling really bad. I could totally isolate myself but I don't. Despite spending time with someone I enjoy the presence of, I still am depressed and feel like utter sh*t. I will admit there are times where spending time with someone has helped, but only temporarily.
Posted by linkadge on December 24, 2010, at 13:07:15
In reply to Are cancer patients maladaptive too? Dble standard, posted by jerryTRD on December 23, 2010, at 13:00:38
>As i stated in some earlier posts, I don't think >some members here who are labeling "us" >as "maladaptive" would label cancer patients, >those with HIV, Asthma, diabetes, Alzheimer's, >COPD, et ,etc as maladaptive for relying on >their medications to survive. Why are people >with depression any different?
Depression is different because it is not as well understood as these other disorders. Asthama, diabetes, HIV etc. do not have high rates of sponanious remission. With these diseases, there is no evidence that psychological intervention does much of anything for the core disease. With depression it is very different. No body organ is more responsive to a patient's own willpower than the brain. For many patients there is evidence to suggest that psychotherapy is as/more effective at treating and preventing future episodes of depression then medications (yeah yeah, I know - gimme the drugs cause that CBT crap doesn't do anything for me). I guess thats what I am trying to say here. If your own will power is eroded by the belief that medications will solve all your problems than you really have destroyed your most powerful asset.
Its about external vs. internal locus of self control. Many of us here have resolved that we simply do not have the faculties necessary to ever feel well on our own. We resolve that becuase our brains are so inherently dysfunctional, medication is the only way to improve.
An asthama patient cannot will their lungs back into proper function. However a depressed patient can, to varying extents, change their brain through willpower. Again, I am not telling patients they can just "snap out of it". What I am saying is that when you put all of your hope in medications; when you come to this board religiously expecting all forms of mental and emotional pain to be abolished with the submissive ingestion of a drug, you don't do much to strengthen the connections that can derive hope and pleasure from other aspects of life.
- Do you find yourself deriving more pleasure from the anticipation of trying a new medication than you actually feel satisfied or relieved by actually taking the medication?
- Do you find yourself needing to continually change your medication simply because you get bored and want to try something new?
I personally think that this behavior is exclusive to psychiatric patients. You never hear of a patient getting bored with their current blood pressure medication and want to try something new. With psychiatric medications, the allure is that you are affecting the mind, the very organ that assigns meaning to every other aspect of life. The idea that you can entirely change your life by chaning a medication is very seductive.
If it were as simple as somebody taking a antidepressant and getting back to their life, then there would be no issue. The problem is that these medications affect subtle aspects of judgment, motivation, reward, personality etc. As soon as you put a drug into the equation, you dramatically change the equation.
Even if there is a gene, or genes invovled in the developement of depression, current research is finding an incredable epigenic componenet to the manifestation of disease. Through environmental manipulation, you can literally change the way that genes express themselves. Sure, maybe you do have a depression gene. But maybe, given the right conditions, protective genes become more dominant.
Let me respond to "are cancer patients maladaptive too".
This is not a double standard. While there is a plethora of evidence on the lifestyle interventions that are capable of preventing cancer, there is little conclusive research that such non drug interventions are capable of treating cancer. As such, as far as cancer goes, once you have it, following the doctors orders may be your best bet.
However, if a cancer patient was spending most of his or her time obsessively researching new treatments for cancer - convincing himself that he more completely understands the disease mechanisms than his doctor, going against the doctor's recomendations to obtain such treatments and thus neglecting to spend time getting healthful exercise, relaxation and social interaction then yes this cancer patient's strategy would be maladaptive.
Linkadge
Posted by SLS on December 25, 2010, at 8:10:04
In reply to Re: Are cancer patients maladaptive too? Dble standard, posted by linkadge on December 24, 2010, at 13:07:15
Hi Linkadge.
That was a well-conceived post. I wish that it were all true. I have worked my butt off in various psychotherapies, and have applied the lessons learned to my everyday life. Because of this, I believe that I am maximizing my quality of life despite the lack of improvement in my depressive illness.
I do think that we need to refine our nomenclature when the word "depression" is used without any further qualifications. When you speak of depression, what exactly is the condition that you are describing? Is there a difference among its uses in our conversations? What, precisely, is your description of major depressive disorder MDD? In what ways is it the same or different from the depression that you refer to?
- Scott
Posted by violette on December 26, 2010, at 9:17:54
In reply to Are cancer patients maladaptive too? Dble standard, posted by jerryTRD on December 23, 2010, at 13:00:38
> Maladaptive is when we reject reality.
That's where it gets problematic and why these types of discussions can be fruitful. Someone who is in denial does not know (and thus will not admit to themself) they have maladaptive behavior to begin with.
Stating that a person may be in denial is not saying that a person is *refuting* they may have an emotional source of their mental illness. In psychologcial terms, denial does not mean, but it can, that one is cognitively 'denying' the existence of something such as emotional problems; it means that someone is consciously unaware of the existence of something-the correct technical term is disavow...People in psychotherapy can still be in 'denial' about emotions.
And someone in denial can become upset when their view of reality is threatened. It can also be *dangerous* when things said or pointed out by another threaten the sustainment of that person's (disavowment of) reality, depending on how severe a person's pathology is. Expecially if they live alone, have aggressive tendencies, have no doctor...people have been known to get violent when this happens, such as when a spouse might call them on it. Others can regress etc.
BUT sometimes a psychotic breakthrough happens when someone is coming out of denial, which lets previously disavowed emotions back into their reality, and sets them on a road to recovery. If a person is under proper care, a psychotic breakthrough can br a *good* thing.....its best to let disavowed emotions slowly seep into consciousness, with the safety of a therapist, but it doesn't always happen that way.
Also, a person can merge their identity with their illness after time, which is what Linkadge described earlier.... The illness becomes part of them, and it cannot be seperated from their sense of self. In this case, someone who is no longer able to for example 'search for medications over and over' will lose their identity, their sense of self-the brain will tirelessly protect its sense of self-it is instinctual; sometimes compulsive behavior (not necessarily OCPD) is how it does this (the amygdala is involved in preserving the self). Loss of sense of self can be viewed as psychosis. In cases like this, I believe, psychoanalytic therapy is the *only* way to treat it, unless the person ultimately has a psychotic breakthrough. People can be in psychotherapy and still be in denial but it is nearly impossible to do this in psychoanalytic therapy. And psychoanalytic therapy can be more dangereous than medication trials if mistakes are made.
There is much less stigma, less pain, and it is less threatening to the psyche to think of mental illness in the context of biology only. People search for medications to get better-to end the pain--but sometimes it can actually be prolonging the pain. It is definitely a very intelligent and appropriate question to ask at a place like this. Especially if you've had mental health problems for years and years.
I am saying it could be possible for some people, and thinking in terms of those i've seen this happen to in real life and also case studies i've read in psychodynamic manuals and literature. (The psychodynamic/psychoanalytic approach treats patients holistically rather than treating only symptoms as many biological-only psychiatrists are trained to do).
I also agree that cancer patients can have maladaptive behavior, anyone can for any illness. But there seems to be more incentives for the psyche to develop maladaptive behavior in terms of mental illness.
Posted by SLS on December 26, 2010, at 11:49:33
In reply to Re: Are cancer patients maladaptive too? Dble standard, posted by violette on December 26, 2010, at 9:17:54
> > Maladaptive is when we reject reality.
> That's where it gets problematic and why these types of discussions can be fruitful.
Is it possible that any one person can understand reality enough to reject it?
> Someone who is in denial does not know (and thus will not admit to themself) they have maladaptive behavior to begin with.
How do you know when someone is in denial?
> And someone in denial can become upset when their view of reality is threatened.
I know this isn't about me, but I am curious, as you have read enough of my stuff, do you feel that I am in denial since I know that a single pill is capable of bringing someone into remission from MDD? This is my reality. It is also the reality of a great many other sufferers.
Is there something about the existence of a primary brain malfunction manifesting as MDD that you find unappealing? I do not find anything unappealing about treating depression using psychological methods - especially when it works. For me, this is not an either-or debate about what we colloquially describe as depression and how it is best treated. There are different subtypes of depression as there are different types of cancer. Each type will be amenable to different treatments.
> Also, a person can merge their identity with their illness after time
Certainly. I did this for at least 20 years.
> The illness becomes part of them, and it cannot be seperated from their sense of self.
Not even with the application of psychotherapeutics?
> In this case, someone who is no longer able to for example 'search for medications over and over' will lose their identity,
Or perhaps rediscover it.
My posture is very defensive when people try to apply a schema of psychological pathology to every case of depression. This is a very dangerous falsehood that can lead to suicide. I am quick to become defensive on behalf of those people with biological mental illnesses whom are told otherwise. My being defensive is NOT the result of a perceived assault on my reality. The disease I suffer from is hideously painful and functionally debilitating. It is actually a form of mental suppression or mental oppression rather than mental depression. I just want to get well. I am using every precious thought to facilitate this. For people who are unwilling to embrace the existence of subtypes of depression that are caused by abnormalities in brain function and that are treatable with biological interventions, I am sad. I remember what it was like near the beginning of the establishment of biological psychiatry and psychopharmacology. I had to defend myself not only against the stigma and misconception of the illness, but of its phenomenology and treatment. In the 1980's, some very smart research clinicians could not commit to diagnosing anyone as having a predominantly biological mental illness, despite what their eyes witnessed right in front of them. Drugs can work. ECT can work. Sleep deprivation can work. Insulin shock can work. How does ECT penetrate the psyche to change the dynamics of denial such that it disappears? Does the ECT machinery have to know what the patient's issues are in order for it to work for them? What is true is that the remission of MDD accomplished through biological interventions can finally allow a patient to attack their previously refractory issues with success, whether it be with or without a professional psychotherapist.
- Scott
Posted by morgan miller on December 26, 2010, at 12:55:30
In reply to Re: Are cancer patients maladaptive too? Dble standard » violette, posted by SLS on December 26, 2010, at 11:49:33
>How do you know when someone is in denial?
I'm sure Violette will have a good answer, but I'm going to also take a stab at this one. I believe many people that are close to someone start to realize they are in denial. In the case of a therapist/patient relationship, the therapist realizes the extent of denial their patient is in as the patient reveals more and more about their life and childhood. The therapist has the expertise to know that we just do not escape certain inadequacies or traumas during developmental periods of life without them having some kind of detrimental lasting effect on our psyche and brain chemistry(Scott, I know you and I have discussed this before). It becomes very evident that when the patient either is not fully aware of the impact these things had on them or the completely deny the impact, they are in denial. Then there are friends and family that have personal knowledge of the person they are close to, that know there is something wrong in this person's life, that know this person could be more aware of their own reality, but continue to deny anything these realities.
There are certainly cases where it may not be very clear that someone is in denial. I think this is when no one is sure if there is really anything to be in denial of. In terms of what is being talked about in this thread, if there is no reason to believe that something else besides biology is at the root of one's depression, than there is no reason to believe that one might be in denial of the possibility that there may be other contributing factors than biology. Sorry Scott, I'm not talking about you here, just thought it was a pertinent example for the discussion : ) I also may have stated the obvious to everyone. If I did, sorry if you find yourself saying, "Ah, yeah, daah".
I believe there are levels of denial, some much deeper than others.
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