![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Peter on November 29, 2001, at 1:03:02
Hi:
Is anyone out there an ex-addict taking prescribed medications for neurological disorder(s)? The reason I ask is because I am and I'm very disturbed and confused. I stopped taking heroin/cocaine in 1997. I had gone to rehab, programs, etc, but I continued to relapse. When I was still on heroin , right before my last detox, I started going to a respectable pdoc. He immediately diagnosed me as bipolar (though I don't even remember what I told him at the consultation). So, when detox was complete, he placed me on depakote. I've been on depakote ever since, and have found over a few years of being mostly sober that alot of other problems came to the surface(SP, depression, etc.). So, over the years he's placed me on many medications, including AD's, other mood stabilizers, anti-anxiety agents, and even dopamine agonists. At times I felt like a gineau pig. Whenever we tried an SSRI for depression/anxiety, I ended up becoming more impulsive and usually relapsing on cocaine. So, after years of testing and trying, my final med combination that I'm on now is depakote, klonopin, and adderall. Yes, I'm aware of the abuse potential of two of these drugs. I've been sober for a few years and I haven't abused either med. Still, some say that addicts who stop abusing drugs and move to prescribed medication are still doing the same thing they always did - covering up unwanted feelings and avoiding the core issues. Then again, many would say that drug abuse in itself is a common way of self-medicating an unknown underlying neurological disorder. But I must say- that addictive, immediate-gratification side of me is still very active. I really have to watch myself when I'm feeling something I don't want to feel, because next thing I know I'll be begging my doctor for some sort of immediate relief with medication. But he's well aware of my history with drugs, and he still thinks my current med regimen is logical and can be very beneficial to my 'diagnosis', which, I've recently been told, MIGHT include ADD. Even if I don't have ADD, he believes the adderall, in correctly prescribed dosing, can help me with motivation/concentration problems. And it can help with depressive episodes without leading me into increased impulsivity and undesirable side-effects like I got from the SSRI's. But, as an ex-addict, I find that I want to be absolutely sure that his diagnosis of me is accurate, and many very helpful people on this site have suggested brain SPECT scans and complete neuropsychological testing for more accurate verification of my diagnosis. But my doctor claims that those things won't help in the slightest and that he's quite convinced that what we are doing is right. I'm just confused and unsure about everything; I still go through periods thinking about my life and realizing that I've never really spent any time as an adult without substances, either illegal or prescribed (I'm 25). How do I really know I even have a neurological disorder? Well, my doctor agreed to repect my decision a few months ago to taper off of everything to see if I NEED the medication. So I tapered the depakote over a few months. Then all of a sudden sept. 11 happened, and other terrible things occured in my life, and I found myself crawling back to my pdoc asking for relief. So that test didn't work. He decided to try me on Luvox (the only SSRI I hadn't tried), but we decided in light of past SSRI experience and after reconsidering my childhood history, that I would go on adderall. It has helped and I like it, but it's just another substance I depend on, without really knowing if my brain chemically needs it. I'm worried and confused; part of me wants to get off meds to see if I need them, another part wants to just relax and trust the doc and continue to take my medication. But sometimes I perceive medication similarly to how I perceived drugs of abuse - I obsess over them and I try to get the 'perfect' combo to make my life always great, which, as we all know, isn't possible. So I just don't know what to do. Sorry for the lengthiness. Any advice?
Peter
Posted by Mitch on November 29, 2001, at 9:30:04
In reply to ex drug-addicts and psychopharmocology, posted by Peter on November 29, 2001, at 1:03:02
> Hi:
> Is anyone out there an ex-addict taking prescribed medications for neurological disorder(s)? The reason I ask is because I am and I'm very disturbed and confused. I stopped taking heroin/cocaine in 1997. I had gone to rehab, programs, etc, but I continued to relapse. When I was still on heroin , right before my last detox, I started going to a respectable pdoc. He immediately diagnosed me as bipolar (though I don't even remember what I told him at the consultation). So, when detox was complete, he placed me on depakote. I've been on depakote ever since, and have found over a few years of being mostly sober that alot of other problems came to the surface(SP, depression, etc.). So, over the years he's placed me on many medications, including AD's, other mood stabilizers, anti-anxiety agents, and even dopamine agonists. At times I felt like a gineau pig. Whenever we tried an SSRI for depression/anxiety, I ended up becoming more impulsive and usually relapsing on cocaine. So, after years of testing and trying, my final med combination that I'm on now is depakote, klonopin, and adderall. Yes, I'm aware of the abuse potential of two of these drugs. I've been sober for a few years and I haven't abused either med. Still, some say that addicts who stop abusing drugs and move to prescribed medication are still doing the same thing they always did - covering up unwanted feelings and avoiding the core issues. Then again, many would say that drug abuse in itself is a common way of self-medicating an unknown underlying neurological disorder. But I must say- that addictive, immediate-gratification side of me is still very active. I really have to watch myself when I'm feeling something I don't want to feel, because next thing I know I'll be begging my doctor for some sort of immediate relief with medication. But he's well aware of my history with drugs, and he still thinks my current med regimen is logical and can be very beneficial to my 'diagnosis', which, I've recently been told, MIGHT include ADD. Even if I don't have ADD, he believes the adderall, in correctly prescribed dosing, can help me with motivation/concentration problems. And it can help with depressive episodes without leading me into increased impulsivity and undesirable side-effects like I got from the SSRI's. But, as an ex-addict, I find that I want to be absolutely sure that his diagnosis of me is accurate, and many very helpful people on this site have suggested brain SPECT scans and complete neuropsychological testing for more accurate verification of my diagnosis. But my doctor claims that those things won't help in the slightest and that he's quite convinced that what we are doing is right. I'm just confused and unsure about everything; I still go through periods thinking about my life and realizing that I've never really spent any time as an adult without substances, either illegal or prescribed (I'm 25). How do I really know I even have a neurological disorder? Well, my doctor agreed to repect my decision a few months ago to taper off of everything to see if I NEED the medication. So I tapered the depakote over a few months. Then all of a sudden sept. 11 happened, and other terrible things occured in my life, and I found myself crawling back to my pdoc asking for relief. So that test didn't work. He decided to try me on Luvox (the only SSRI I hadn't tried), but we decided in light of past SSRI experience and after reconsidering my childhood history, that I would go on adderall. It has helped and I like it, but it's just another substance I depend on, without really knowing if my brain chemically needs it. I'm worried and confused; part of me wants to get off meds to see if I need them, another part wants to just relax and trust the doc and continue to take my medication. But sometimes I perceive medication similarly to how I perceived drugs of abuse - I obsess over them and I try to get the 'perfect' combo to make my life always great, which, as we all know, isn't possible. So I just don't know what to do. Sorry for the lengthiness. Any advice?
> PeterPeter,
You pretty much already answered your own question. When you stopped the Depakote you started to become unstable. I tried no meds (not intentionally-I just sort of "drifted" off of them) and it was fairly disastrous. I think it is far better to be *dependent* on psych meds than it is to be miserable and *addicted* to heroin and cocaine.
Mitch
Posted by Peter on November 29, 2001, at 11:52:43
In reply to Re: ex drug-addicts and psychopharmocology » Peter, posted by Mitch on November 29, 2001, at 9:30:04
> You pretty much already answered your own question. When you stopped the Depakote you started to become unstable.
Mitch:
This was my doctor's explanation, but I just wonder if my heightened anxiety/instability at the time could have been due to sept.11 and other disturbing things that were happening in my life. I live in Manhattan so I was sort of in the thick of it all. Additionally, around the same time my dermatologist suddenly demanded that I needed a biopsy. These are events that would make anyone unstable (with or without a neurological disorder). Plus, I had been down to a very small dose of depakote during the months leading up to these events and I seemed fine. On the other hand, I'm aware that the events could have triggered or exacerbated a dysphoric manic cycle, requiring my need to restart the medication. But I wasn't out of control; I was just very uncomfortable and anxious. I find it very difficult to discern between psychological reactions and biological imbalances. Finally, there's the additional possibility that my discomfort at the time was a natural, temporary rebound effect of depakote withdrawel (since I'd been taking it continuously for 4 years), which would have dissipated had I 'toughed out' the tapering a bit longer. These are my concerns; I've shared them with my pdoc but he's pretty set in his opinions.
Peter
Posted by medlib on November 29, 2001, at 15:34:41
In reply to ex drug-addicts and psychopharmocology, posted by Peter on November 29, 2001, at 1:03:02
Hi Peter--
At your age, the prospect of having a chronic disease which requires life-long medication is a daunting one, whether it's rheumatoid arthritis, diabetes, epilepsy, bipolar disorder, or others. Almost every young person diagnosed with such a condition has had to deal with resistance/denial. It will be difficult for you to move on with the rest of life until/unless you are as certain of your diagnoses as your pdoc is. To help accomplish this, you could seek other medical opinions and/or learn more about bipolar disorder yourself. One web site that includes a self-test is
http://depression.about.com/cs/bipolardiagnosis/
(There is an abundance of info and self-tests on ADD, as well.)
Severe or prolonged psychological trauma or stress are thought to cause neurochemical imbalances in the brain similar to those seen in "mental" illnesses, so it's not surprising that these effects can be difficult to distinguish from one another. Also, research has shown that both medication and psychotherapy can cause similar changes in brain functioning.
So...one alternative you might consider is leaving your current meds as they are while you utilize psychotherapy to develop healthier coping mechanisms for dealing with emotions. You may want to discuss Behavior Therapy with your pdoc. Then later, if you decide to change or discontinue meds, you will have some internal and external resources for support.
BTW, the upside of dealing with such problems at age 25 is that, at 50 (and later), you may have (and have had) a *life*, not just a lifetime of lost potential.
Well wishes---medlib
Posted by gilbert on November 29, 2001, at 18:53:23
In reply to Re: ex drug-addicts and psychopharmocology, posted by medlib on November 29, 2001, at 15:34:41
> Hi Peter--
>
I am an ex alcoholic and coke user. I have been on xanax for the last 3 years and it has saved my life. I would be drunk if it were not for these meds. I waited until I had 13 years sobriety and struggled with panic sober trying to CBT it away trying to pray it away trying to 12 step it a way trying to Lucinda Bassett it away and it only got worse. After my 10 year anniversary in AA I was suicidal. I could no longer live that way. I managed to survive another 3 years and finally gave in and saw my doc got meds and have a great life now. I have no more panics. I come and go as I please. I still am very active in AA and this has taken a while not to feel guilty about taking xanax and going to AA but I don't use xanax the way I used dope and alcohol. I just feel normal. I don't get in trouble and my personality does not change for the worse. My sponsor who has 25 years is on xanax also for the same condition. Remeber the the drinking and drugging were only symptoms of the illness, and sometimes that illness requires medication. I have said this over and over on this board, even the cofounder of AA Bill Wilson dropped LSD after many years of sobriety in hopes of alleviating his depressions. He was sober but still suffered greatly from depression. In 99.99% of all drug abuse and drinking is self medication for some underlying neurotic tendency or some pyschosis.....very few people set out to kill themselves on booze or drugs....they get comfort from them, why because they are in pain from some underlying illness.Good LUck,
Gil
Posted by Peter on November 29, 2001, at 21:30:47
In reply to Re: ex drug-addicts and psychopharmocology, posted by gilbert on November 29, 2001, at 18:53:23
Mitch, Medlib, and Gilbert:
I just want to thank you guys for sharing your experience and comforting/encouraging me.
Peter
Posted by Mitch on November 29, 2001, at 23:41:47
In reply to Re: ex drug-addicts and psychopharmocology, posted by Peter on November 29, 2001, at 11:52:43
> > You pretty much already answered your own question. When you stopped the Depakote you started to become unstable.
> Mitch:
> This was my doctor's explanation, but I just wonder if my heightened anxiety/instability at the time could have been due to sept.11 and other disturbing things that were happening in my life. I live in Manhattan so I was sort of in the thick of it all. Additionally, around the same time my dermatologist suddenly demanded that I needed a biopsy. These are events that would make anyone unstable (with or without a neurological disorder). Plus, I had been down to a very small dose of depakote during the months leading up to these events and I seemed fine. On the other hand, I'm aware that the events could have triggered or exacerbated a dysphoric manic cycle, requiring my need to restart the medication. But I wasn't out of control; I was just very uncomfortable and anxious. I find it very difficult to discern between psychological reactions and biological imbalances. Finally, there's the additional possibility that my discomfort at the time was a natural, temporary rebound effect of depakote withdrawel (since I'd been taking it continuously for 4 years), which would have dissipated had I 'toughed out' the tapering a bit longer. These are my concerns; I've shared them with my pdoc but he's pretty set in his opinions.
> PeterPeter,
I think maybe you ought to bug your pdoc about a different mood stabilizer than Depakote in this case (that would satisify his conviction that you need an MS and *you* might find something really helpful in a different one). I remember when I withdrew from Depakote for the first time I did experience a lot of agitation which felt like a mixed state. I was told by my pdoc at the time (a behavioural neurologist) that Depakote withdrawals/dose reductions can be a bit "buzzy" and unsettling.
A Depakote withdrawal combined with environmental stressors could be a good explanation for your state. I remember the Sept. 11th situation very well. I was *totally* unfocused at work-I felt this weird numbness that seemed to result from the over-adrenalization from the immediate event. It felt like I had been up for several days *moving* into a *new house* or something-the world around me had changed fundamentally and I had to adjust one way or another.
As far as dependencies go-a mood stabilizer (that works for you) makes a more reliable long-term *wet-suit* (with respect to the irrational world around us) over time than does heroin....
Posted by Peter on November 30, 2001, at 1:49:11
In reply to Re: ex drug-addicts and psychopharmocology » Peter, posted by Mitch on November 29, 2001, at 23:41:47
Thanks Mitch. I have tried different stabilizers in the past. I tried Neurontin, but it was before I started klonopin and I was on moclobemide and drinking alot. As a result, I experienced intense panic attacks, depersonalization, and wierd adverse reactions, like a burning sensation on the skin of my back. So, while I concentrated on cutting out the drinking, my pdoc decided to have me 'clean my medication slate' and begin again with depakote (since I had been familiar with it) and added klonopin. So I don't know how Neurontin would affect me along with my current combo of klonopin and adderall xr. I also started lamictal at one point, but my anxiety kicked in and I got so panicked about the possibility of getting that fatal rash that I stopped before it could be of any benefit. Depakote hasn't caused any problems. It has been my 'foundation medication' for 4 years. The only problems I experienced on depakote were episodes of depression, since I'm aware that depakote tends to target the manic side of bipolar more than the depressive side. So, that's one of the reasons why my pdoc decided to keep me on depakote and klonopin (SP/panic) and add adderall xr, the newest drug I'm on.
Moreover, regardless of all this info I've given you, the main thrust of my original post has more to do with my concerns about being on so many meds since I stopped illegal drugs; I don't even know for sure that I have an underlying neurological disorder since, as I stated before, I haven't spent any time as an adult without medication or illicit drugs.
>As far as dependencies go-a mood stabilizer (that works for you) makes a more reliable long-term *wet-suit* (with respect to the irrational world around us) over time than does heroin....
I certainly agree it's a better dependency, but for me it's not really a question of 'changing wet suits'; it's more a question of finding out if I need one and how to do that. Remember, the whole reason I attempted to taper the depakote was not to transfer to another drug, but to test and see how I would be without medication; isn't it possible that the agitation when I tapered the dep. was my body's natural reaction to coming off of the medication PLUS a psychological reaction to the terrible world events at the time? I don't see how my becoming agitated at the time is any proof that I am in fact bipolar. I realize that I could be in denial about my diagnosis; but the fact is, if I just had more evidence of BP in my history , even observations from friends and family, of which I have none, I'd feel more comfortable with taking alot of meds. My pdoc says my evidence of BP is apparent in the fact that I was a drug addict(impulsive, manic, etc.). But man, not all drug addicts are bipolar just as not all bipolars are drug addicts! I just desire more conclusive evidence of my diagnosis and, if I get it, I'd be able to be more comfortable and less doubtful taking whatever medications my doc sees fit.
Peter
Posted by Elizabeth on November 30, 2001, at 2:01:34
In reply to ex drug-addicts and psychopharmocology, posted by Peter on November 29, 2001, at 1:03:02
Hi. I don't think that ADD and bipolar d/o are generally considered "neurological" disorders (that is, a neurologist usually isn't the person to treat them, and neurological methods aren't the best way to diagnose them).
In regard to the Klonopin and Adderall: if you're not abusing your meds, I wouldn't worry about what other people think or get bogged down in whether you really have a "chemical imbalance" or whatever. You know if you're abusing the meds or not; if you're not, then what's the problem?
I'm skeptical of the value of functional brain imaging (e.g., SPECT and PET scans) for diagnostic purposes, for a few reasons; the simplest of these reasons is that any distinct state of mind you're in will produce a unique image. A SPECT scan may give you the *feeling* of "absolute certainty" that you want, but for me it's hard to get past the lack of evidence supporting the use of these tests for diagnosing these kinds of conditions. Some clinicians claim to have spectacular results using functional imaging to diagnose psychiatric disorders, but such claims can be very misleading (not necessarily intentionally, of course).
It seems to me that in the diagnosis of psychiatric conditions, what's important is what works: does a particular diagnostic technique help predict treatment response? If a simpler technique (such as a basic psychiatric interview) works, there's no reason to go get expensive tests done.
BTW, I know a few people who are addicts or former addicts who have a more general obsession with drugs (and even psychopharmacology). So you're not alone. Maybe you just have an obsessive personality in general? (I'm not saying that's necessarily a pathological thing so don't start thinking about how you can "treat" it!)
-elizabeth
p.s. I'm 25 too. I've been diagnosed with depression since I was 14, and recently there've been some indications that I might have epilepsy too. Shit happens to young people sometimes; it's not like you're not allowed to be sick just because of your age. A lot of people seem to first come down with chronic medical conditions when they're in their early 20s; when I was in college, I knew people who'd recently developed everything from drug addictions to chronic pain syndromes (especially RSI) to inflammatory bowel disease. It seems to be a common age of onset for a lot of things.
Posted by Peter on November 30, 2001, at 2:12:34
In reply to Re: ex drug-addicts and psychopharmocology, posted by gilbert on November 29, 2001, at 18:53:23
> Hi Gil:
I went to rehab and was in AA for about a year. I worked with a sponser, but continued to relapse. Finally, I left the program, rebelled in a big way, went on a speedball spree, and ended up being detoxed and monitered by a special doctor . That was the last of it; I went directly from detox to my first meeting with the pdoc. It was then that I was placed on depakote and a variety of different medications over the years since. I agree with you fully that one can still be sober and miserable because of an underlying mental disorder and that, in fact, in most cases addicts/alcoholics seek drugs and alcohol in the first place for relief of these underlying illnesses, even if they are unaware of it at the time. Taking xanax to help with severe panic is completely understandable and logical, even for a sober addict. Right after I detoxed that last time and went on depakote, I did not return to AA. For me, Church became the answer (though I had never had any experiences with religion in the past except negative ones). But I believe, in my particular case, that God began to reveal himself to me through AA, and that led me to seek Him in Church. That works for me. I have alot of spiritual support, new friends, positive role models, and I'm seeing a counseler who has experience with addictions. My quality of life is ok. The only thing that I can't seem to stop worrying about is that I might be on the wrong medications or that I might not need medication. I tried, with the advice of an AA friend/fellow jazz musician, to taper off everything to see how I'd be. But I ended up running back to the doc for relief, just like as an active addict I used to run for the drugs whenever I'd feel the slightest bit uncomfortable. So it's a catch 22! Oh well, just felt like venting. Thanks,
Peter
Posted by Peter on November 30, 2001, at 2:37:41
In reply to Re: ex drug-addicts and psychopharmocology » Peter, posted by Elizabeth on November 30, 2001, at 2:01:34
Elizabeth:
I think you hit the nail right on the head in your last paragraph - I'd be the first one to point out I have an obsessive personality. I think the addict in me just loves to obsess, overthink, and control everything. Thanks for your helpful advice. It really comes down to my trusting in my pdoc, that he knows what he's doing, and in my resting in the fact that things are a lot better than I make them out to be. It does suck to find out we have problems, but there's a plethora of solutions out there. Good luck with your possible epilepsy. If you do have it, I'm sure you know there are multiple efficacious treatments. Thanks again.
Peter
Posted by Mitch on November 30, 2001, at 9:08:23
In reply to Re: ex drug-addicts and psychopharmocology, posted by Peter on November 30, 2001, at 1:49:11
> Thanks Mitch. I have tried different stabilizers in the past. I tried Neurontin, but it was before I started klonopin and I was on moclobemide and drinking alot. As a result, I experienced intense panic attacks, depersonalization, and wierd adverse reactions, like a burning sensation on the skin of my back. So, while I concentrated on cutting out the drinking, my pdoc decided to have me 'clean my medication slate' and begin again with depakote (since I had been familiar with it) and added klonopin. So I don't know how Neurontin would affect me along with my current combo of klonopin and adderall xr. I also started lamictal at one point, but my anxiety kicked in and I got so panicked about the possibility of getting that fatal rash that I stopped before it could be of any benefit. Depakote hasn't caused any problems. It has been my 'foundation medication' for 4 years. The only problems I experienced on depakote were episodes of depression, since I'm aware that depakote tends to target the manic side of bipolar more than the depressive side. So, that's one of the reasons why my pdoc decided to keep me on depakote and klonopin (SP/panic) and add adderall xr, the newest drug I'm on.
> Moreover, regardless of all this info I've given you, the main thrust of my original post has more to do with my concerns about being on so many meds since I stopped illegal drugs; I don't even know for sure that I have an underlying neurological disorder since, as I stated before, I haven't spent any time as an adult without medication or illicit drugs.
> >As far as dependencies go-a mood stabilizer (that works for you) makes a more reliable long-term *wet-suit* (with respect to the irrational world around us) over time than does heroin....
> I certainly agree it's a better dependency, but for me it's not really a question of 'changing wet suits'; it's more a question of finding out if I need one and how to do that. Remember, the whole reason I attempted to taper the depakote was not to transfer to another drug, but to test and see how I would be without medication; isn't it possible that the agitation when I tapered the dep. was my body's natural reaction to coming off of the medication PLUS a psychological reaction to the terrible world events at the time? I don't see how my becoming agitated at the time is any proof that I am in fact bipolar. I realize that I could be in denial about my diagnosis; but the fact is, if I just had more evidence of BP in my history , even observations from friends and family, of which I have none, I'd feel more comfortable with taking alot of meds. My pdoc says my evidence of BP is apparent in the fact that I was a drug addict(impulsive, manic, etc.). But man, not all drug addicts are bipolar just as not all bipolars are drug addicts! I just desire more conclusive evidence of my diagnosis and, if I get it, I'd be able to be more comfortable and less doubtful taking whatever medications my doc sees fit.
> Peter
Thanks for the clarification. Now, you have got me wondering about my own situation! I am beginning to see how a lot of my BP symptoms could just as easily be explained by a combination of my adult ADHD and social phobia/panic probs just as easily. Those two conditions have had more adverse impact on my life than hypomanias-no doubt there. If the ADHD is treated effectively-I am not depressed either! I know there is a lot of overlap, though. I don't like taking more meds than I need to, either. I am convinced though that I need *some* med(s), but which ones.....Mitch
Posted by manowar on November 30, 2001, at 15:51:17
In reply to Re: ex drug-addicts and psychopharmocology » Peter, posted by Elizabeth on November 30, 2001, at 2:01:34
> Hi. I don't think that ADD and bipolar d/o are generally considered "neurological" disorders (that is, a neurologist usually isn't the person to treat them, and neurological methods aren't the best way to diagnose them).
>
> In regard to the Klonopin and Adderall: if you're not abusing your meds, I wouldn't worry about what other people think or get bogged down in whether you really have a "chemical imbalance" or whatever. You know if you're abusing the meds or not; if you're not, then what's the problem?
>
> I'm skeptical of the value of functional brain imaging (e.g., SPECT and PET scans) for diagnostic purposes, for a few reasons; the simplest of these reasons is that any distinct state of mind you're in will produce a unique image. A SPECT scan may give you the *feeling* of "absolute certainty" that you want, but for me it's hard to get past the lack of evidence supporting the use of these tests for diagnosing these kinds of conditions. Some clinicians claim to have spectacular results using functional imaging to diagnose psychiatric disorders, but such claims can be very misleading (not necessarily intentionally, of course).Hello again Elizabeth,
Unless Dr. Amen is lying about his work, which could very well be the case, but I doubt it-- SPECT imaging is a VERY useful tool in HELPING to diagnose a psychiatric or neurological problem. It is only a "tool" or another piece of information that can help a doctor better diagnose, therefore better treat a condition. What harm is that? I think information is power as long as we know what the limitations to the information may be, which in the case of SPECT I'm sure the doctors know. SPECT could play a very important role in Neurology and Psychiatry if more doctors and patients could set aside their skepticism and look at the facts.Dr. Amen has spotted problems using SPECT that have saved people's lives. In his book he cites at least a couple cases in which MRI didn't show a problem (like evidence of strokes) that SPECT did.
In my case, I was not diagnosed with ADD until I had the SPECTs done. Earlier I suspected that I had ADD, but the doctors disagreed. I would have never had a chance to try a psychostimulant (which in my case has been VERY beneficial) if I didn't have the SPECTs done. By the way, when I went to my local pdoc and gave him the 10 page report from the Amen Clinic, he completely and without question accepted the diagnosis and recommendations. Furthermore, I don’t think my insurance would have reimbursed me for the procedure if it were not helpful.
When finding out I had been to the Amen clinic, my new doc (he specializes in ADD) said to me “I see you’ve been to Mecca!” People come from all over the world to go to his clinics and get evaluations from him. I even saw a guarded prisoner in chains come to the clinic for an evaluation. I found out later that SPECT evaluations can be highly regarded evidence in insanity cases in the state of CA.
I don’t completely understand why more physicians are not doing it. I’m pretty sure that in CA, AZ, WA and other western states there are several clinics that specialize in SPECT besides Dr. Amen’s clinic. I know that in Dr. Amen’s case, he had to get extensive training to be certified in the technology before he could use it in his practice. Even though he has at least four of five pdocs that work for him he personally has to evaluate each and every scan. After a doctor goes into practice, I would assume that he would be very reluctant to go back to school, purchase a lot of very expensive equipment, hire a technician and plan to open a psychiatric clinic that specializes in an obscure imaging technology that is not widely accepted.
It seems to me that most doctors want to be 110% clear about a patient’s medical condition before he treats the patient. The more information he has the better. But it doesn’t seem to be that way in psychiatry. Now if the data is misleading then certainly the evaluation can be counterproductive. I don’t think it is. And just because a technology isn’t used often or it’s not widely accepted or it hasn’t been “proven” does not mean that the technology is not effective.
In Peter’s case, by having a multitude of problems (being diagnosed as bipolar, ADD, addiction and substance abuse issues and SP-- whatever that is), I think he would be a perfect candidate to have such an evaluation. What if his present doctor is wrong and he doesn’t have ADD? As you know, treating someone with pstims that doesn’t need them can make depression worse and I’m sure can make other problems worse too. Even if the scans do not change a doctor’s decision on a diagnosis and treatment plan, it could certainly help a patient accept his diagnosis and become more compliant with his doctor and his treatment.
Again, what harm is that other than a few days off, a little dose of radiation, and a lot of money. If a person is willing to do those things, I think the procedure can be VERY beneficial. A tiny ray of hope may give someone a reason to live that they didn’t have before. It did me.
Have a nice day:)
--Tim
Posted by Elizabeth on November 30, 2001, at 16:58:20
In reply to SPECT imaging has its place in psychiatry » Elizabeth, posted by manowar on November 30, 2001, at 15:51:17
> Unless Dr. Amen is lying about his work, which could very well be the case, but I doubt it-- SPECT imaging is a VERY useful tool in HELPING to diagnose a psychiatric or neurological problem.
Read what I said again. I am well aware that Dr. Amen and some other physicians have reported excellent results from using SPECT and PET scans in a clinical context to predict treatment response in psychiatric disorders. I certainly don't believe they are lying about their results; rather, I think that such "real world" results can be *misleading* because of the absense of clear scientific evidence supporting the use of these tests for the purpose of making such diagnoses. They functional brain scans are an experimental tool, not a proven one, so while I think they can be useful under certain circumstances (which is why I had one). They're not appropriate for general use. We don't all need to be rushing out to get a SPECT or PET scan!
In Peter's case in particular, I think the use of functional neuroimaging would be inappropriate because it sounds like simpler, inexpensive methods are working fine for him.
> I think information is power as long as we know what the limitations to the information may be, which in the case of SPECT I'm sure the doctors know.
Doctors are smart, of course, but they're human beings just like the rest of us. Doctors who are interested in experimental methods often get very excited when something seems promising. Sometimes
they can get overly excited and forget that their impressive results are only the beginning of the study of their new technique.> SPECT could play a very important role in Neurology and Psychiatry if more doctors and patients could set aside their skepticism and look at the facts.
IMO, the need is not for doctors and patients to "set aside their skepticism and look at the facts," but for researchers to do the necessary studies to determine what the facts *are* so the rest of us (i.e., doctors and patients) can benefit from them.
> In my case, I was not diagnosed with ADD until I had the SPECTs done. Earlier I suspected that I had ADD, but the doctors disagreed. I would have never had a chance to try a psychostimulant (which in my case has been VERY beneficial) if I didn't have the SPECTs done.
Our situations have a great deal of similarity, and indeed, many of my doctors have been very impressed by my SPECT results, which are apparently "abnormal." I also have a hunch that I might have ADD (or at least, that amphetamine might be helpful for some of my problems). I am fairly sure I could find a professional who would be able to make an argument that my SPECT result shows that I have ADD. I'm glad I don't have to go to all that effort, but also, I'd feel like I was being dishonest if I abused someone's excitement over a new diagnostic procedure to get someone to give me what I wanted.
> By the way, when I went to my local pdoc and gave him the 10 page report from the Amen Clinic, he completely and without question accepted the diagnosis and recommendations.
That doesn't mean much to me, sorry.
> Furthermore, I don’t think my insurance would have reimbursed me for the procedure if it were not helpful.
Again, I'm not willing to conclude anything from that. Insurance companies are strange beasties.
> I found out later that SPECT evaluations can be highly regarded evidence in insanity cases in the state of CA.
[Insert California joke here]
> I don’t completely understand why more physicians are not doing it.
I do -- the equipment is bloody expensive. Hospitals have it; doctors in private or group practices generally don't. What I don't understand is why more researchers aren't trying to pin down the psychiatric implications of SPECT and PET scans.
> I know that in Dr. Amen’s case, he had to get extensive training to be certified in the technology before he could use it in his practice.
Well, sure; this is heavy-duty equipment. That doesn't have anything to do with interpreting the results, though.
> After a doctor goes into practice, I would assume that he would be very reluctant to go back to school, purchase a lot of very expensive equipment, hire a technician and plan to open a psychiatric clinic that specializes in an obscure imaging technology that is not widely accepted.
But in fact, many people are flocking to these clinics. Why? Because the excitement about the technology is contagious. Like Peter, patients everywhere want to get "proof" that they have a "neurological disorder." It's not that puzzling.
> What if his present doctor is wrong and he doesn’t have ADD?
A SPECT scan is not going to show that he does or doesn't have ADD. It sounds to me like what Peter wants is to have his condition "validated," to feel like he's justified in taking drugs that have abuse potential after having been addicted to similar drugs. A SPECT scan may give him that sense of comfort, but it would be a false sense. I'd prefer to see him come to terms with his need for medication, to feel comfortable taking his meds without feeling like he doesn't deserve to feel well because of his addiction history. This isn't what a SPECT result would give him; rather, it would make him feel that what he really has should be considered a "neurological disorder" and that for *that* reason, he deserves to feel well (as though a mere drug addict would not deserve to feel well). No, I don't think that using the SPECT scan for the "ray of hope" reason is a good thing at all.
And there's something important to consider: what if the SPECT scan "showed" that Peter doesn't have ADD and thus made his doctor decide that he shouldn't be taking Adderall (even though it's working)? Would that be a good thing? You don't have to have ADD to have a positive response to stimulants. They help many people with depression and other conditions as well.
The functional brain scans may well become an important part of psychiatric diagnosis in the future. For now, let's not get carried away.
-elizabeth
Posted by Mitch on November 30, 2001, at 23:19:23
In reply to SPECT imaging has its place in psychiatry » Elizabeth, posted by manowar on November 30, 2001, at 15:51:17
Tim,
Could you explain a little about the science/technology involved with a SPECT scan? It seems that a controversy has been unearthed here that we don't have all of the facts displayed regarding..physics-chemistry-what is going on, i.e. I remember when I went for my cardiac stress test a few months ago. I saw something in the radiology department that seemed to related to what you are discussing. The stuff I saw (info-pamphlet-publication from GE) appeared to be about radiolabeling dextroamphetamine and injecting it. Then they do a "scan" showing where the brain is using the d-amphetmaine the least or most. Is this accurate?
Mitch
Posted by SLS on December 1, 2001, at 9:46:49
In reply to Re: SPECT imaging has its place in psychiatry » manowar, posted by Mitch on November 30, 2001, at 23:19:23
> Tim,
>
> Could you explain a little about the science/technology involved with a SPECT scan? It seems that a controversy has been unearthed here that we don't have all of the facts displayed regarding..physics-chemistry-what is going on, i.e. I remember when I went for my cardiac stress test a few months ago. I saw something in the radiology department that seemed to related to what you are discussing. The stuff I saw (info-pamphlet-publication from GE) appeared to be about radiolabeling dextroamphetamine and injecting it. Then they do a "scan" showing where the brain is using the d-amphetmaine the least or most. Is this accurate?
>
> Mitch
Matter + Antimatter = annihilation > positron
- Scott
Posted by manowar on December 3, 2001, at 21:11:56
In reply to place of functional neuroimagining in psychiatry » manowar, posted by Elizabeth on November 30, 2001, at 16:58:20
> > I found out later that SPECT evaluations can be highly regarded evidence in insanity cases in the state of CA.
>
> [Insert California joke here]That's good...
Thanks Elizabeth, you make some very interesting and valid points. It's healthy to be skeptical about what "seems" to be pretty revolutionary. I just wanted to share what my opinion was (for what it's worth) along with others, because it seems that SPECT has gotten a bad rap here.
You're right, there is not any good "hard" data out there that SPECT is helpful in diagnosing and treating mental illness. The evidence that SPECT is useful is very speculative. But for that matter most of psychiatry along with most of everything that we talk about here on this site is speculation. Many times good science, research and proof woefully lag behind experience, common sense, discovery, and invention. My contention is that psychiatry is 90% speculation anyway. Even the monoamine theory of depression is still a theory, not a fact.
I think that one of the reasons that SPECT is not more widely accepted is because many people still believe that a person's "mental health" depends on his/her character. It's hard for most of us including myself to think that we are as "hard wired" as we are. The idea that someone is mentally ill- not because of a "psychological problem", but because there could be a physiological or functional malfunction is sometimes still be hard for me to accept. But at the same time, the thought was very liberating for me...
I have always thought that if I tried harder, went to the right psychoanalyst, or if I prayed enough, or whatever --I would get better. Having the scans done let me know once and for all (along with my doctors) that I had serious functional problems that needed to addressed aggressively with medication.
You know, the pdoc had to take a few minutes to prep me before I viewed my scans to get me ready for what I was about to see. He basically let me know that the image was a functional image not an anatomical image (I had some big holes of functioning all around my cortex). Paradoxically, when I saw the scans, it scared the hell out of me- but at the same time it relieved me.
It clarified that I had some real problems, and that I needed some real solutions. Since then, I have been much more compliant with treatment, and I have found a much better doctor. I'm also less hesitant about calling the doctor's office if I need to- rather than waiting for two more weeks for my appointment. I also believe that my doctor is a lot more sympathetic with me and aggressive with drug therapy than he would have been if I hadn't had the testing done.
People with chronic heart problems have SPECT, MRIs and EEG testing done all the time. What is so bad about having a SPECT done if a person has a chronic "mental health" problem?
In all, by having the scans done, I think that I'm much farther along in getting better than if I hadn't had them done.
Anyway, I'm not trying to argue here, I just thought that sharing my experience might be helpful.
--Tim
Posted by manowar on December 3, 2001, at 22:57:55
In reply to Re: SPECT imaging has its place in psychiatry, posted by SLS on December 1, 2001, at 9:46:49
> > Tim,
> >
> > Could you explain a little about the science/technology involved with a SPECT scan? It seems that a controversy has been unearthed here that we don't have all of the facts displayed regarding..physics-chemistry-what is going on, i.e. I remember when I went for my cardiac stress test a few months ago. I saw something in the radiology department that seemed to related to what you are discussing. The stuff I saw (info-pamphlet-publication from GE) appeared to be about radiolabeling dextroamphetamine and injecting it. Then they do a "scan" showing where the brain is using the d-amphetmaine the least or most. Is this accurate?
> >
> > Mitch
>
>
> Matter + Antimatter = annihilation > positron
>
>
>
>
> - ScottHi Scott,
I'm glad you mentioned that procedure. I had forgotten about it. When I first met my new "ADD doctor", he was very excited about the scans that I had gotten at the Amen clinic. My scans though, were for testing overall brain function, which is different from the testing that you're talking about. He told me that a SPECT procedure was being developed that could help pdocs and neurologists clearly diagnose ADD in patients. (There is no clear scientific method that exists yet) He had done some research on that procedure and yes, it involves giving a patient a dose of some kind of dopamergic drug (I can't remember if it was dextroamphetamine), which was radiolabled. I can't remember for sure, but I think that doctors look at the scan to see how large the area is in the brain that takes up the drug. I think he told me that scientist hypothesized that people with ADD have too many dopamine receptors.Anyway, the next time I see him I'll ask him more about it and post it on this site. The research is supposed to be very promising.
All I can do is give you a layman answer to the way my procedure was done. It may not be very accurate, but here goes:
1) Injected with a radioisotope that binds with glucose in the blood. (Glucose is not injected; the radioisotope binds with the glucose that is naturally in the blood already.)
2) You're put on a table and you're pushed into a tube that surrounds you're head.
3) For about 15 minutes the tube rotates. There are cameras inside the tube taking x-ray pictures of the isotope (which is binded with the glucose). It-very effectively- in essence is measuring the uptake of glucose, which is necessary for all cells to function (hence- functional image)
4) A computer takes the data and creates different types of 3D images
5) The images give doctors an idea of how the different parts of the brain are functioning.The supposed advantages of a SPECT scan to psychiatry are that:
1) A doctor does not have to totally rely on symptomology (which is not always accurate or definitive) to diagnose a condition
2) Therefore, if there is a more accurate diagnosis, a more accurate treatment regimen can be prescribed to help a patient
3) When presented with more information, hopefully a patient is more likely to comply with the treatment regimen
Hope that was helpful,
Tim
Posted by MB on December 4, 2001, at 10:17:00
In reply to Re: SPECT imaging has its place in psychiatry » SLS, posted by manowar on December 3, 2001, at 22:57:55
I'm going in less than two weeks for one of these SPECT scans. I'm totally nervous. I've been off of medication for over a year (sometimes handling it well, other times not so well). I've just had bad luck with pharmaceuticals...they either don't work or make things worse. I'm hoping they will be able to see something -- some kind of clue -- that will help them figure out something that will work. If not, I think I'm going to give up on medication (maybe not forever, but at least until they come up with something *drastically* new). I'm hopeful that they might find an answer, and, at the same time, I'm scared that they won't. Maybe there's just not a medication out there that would help me. That's a freaky thought, I guess.
Posted by manowar on December 4, 2001, at 13:32:34
In reply to Re: SPECT imaging has its place in psychiatry » manowar, posted by MB on December 4, 2001, at 10:17:00
> I'm going in less than two weeks for one of these SPECT scans. I'm totally nervous. I've been off of medication for over a year (sometimes handling it well, other times not so well). I've just had bad luck with pharmaceuticals...they either don't work or make things worse. I'm hoping they will be able to see something -- some kind of clue -- that will help them figure out something that will work. If not, I think I'm going to give up on medication (maybe not forever, but at least until they come up with something *drastically* new). I'm hopeful that they might find an answer, and, at the same time, I'm scared that they won't. Maybe there's just not a medication out there that would help me. That's a freaky thought, I guess.
I know how you feel. I wanted to get a clean bill of health, but at the same time I wanted for them to find a problem. I was really scarred that my scans would be normal! But realistically, I knew there had to be an explanation to my problems. Again, going through the procedure has done more for me psychologically than I could have gotten from a lifetime of psychotherapy. There was so much guilt, denial, anger, and frustration that had built up in me over the last 15 years. I keep reminding myself that folks that take heart medication for a malfunctioning heart don't beat themselves up for having the condition. They just get the best medical treatment they can get. What's the difference with the brain? Of course, many people "think" themselves into a depression, but at the same time many people don't. I just wasted a lot of time and effort thinking I had "thought" myself into my depression.
Good luck with the scans. Please let us know how you did.
--Tim
Posted by MB on December 4, 2001, at 18:19:16
In reply to Re: SPECT imaging has its place in psychiatry » MB, posted by manowar on December 4, 2001, at 13:32:34
> Good luck with the scans. Please let us know how you did.
>
> --Tim
Thanks for the wishes of good luck. I don't know yet what I'm going to do about my caffeine intake. The lady with whom I made my appointment told me that caffeine can "really mess a scan up," and one of the leaflets in my intake packet told me not to drink caffeine on **the day of** the scan. But that left me wondering. I mean, when I go a day without caffeine, I'm literally bed-ridden. The headache, nausea and depression are so bad I can't really function. It seems to me that being in such a severe state of withdrawal could also mess a scan up. I wish I could get off of it for a few days before the scan, but my willpower is impotent against the cravings.Do you drink coffee? If so, how long were you off of it before you got your SPECT scan?
Posted by manowar on December 4, 2001, at 19:14:49
In reply to Re: SPECT imaging has its place in psychiatry » manowar, posted by MB on December 4, 2001, at 18:19:16
> > Good luck with the scans. Please let us know how you did.
> >
> > --Tim
>
>
> Thanks for the wishes of good luck. I don't know yet what I'm going to do about my caffeine intake. The lady with whom I made my appointment told me that caffeine can "really mess a scan up," and one of the leaflets in my intake packet told me not to drink caffeine on **the day of** the scan. But that left me wondering. I mean, when I go a day without caffeine, I'm literally bed-ridden. The headache, nausea and depression are so bad I can't really function. It seems to me that being in such a severe state of withdrawal could also mess a scan up. I wish I could get off of it for a few days before the scan, but my willpower is impotent against the cravings.
>
> Do you drink coffee? If so, how long were you off of it before you got your SPECT scan?That is fascinating about the coffee. It's remarkable how coffee affects people differently.
Coffee does absolutely nothing for me by itself. When I add it to Ritalin it seems to nicely compliment the CNS activating action of the drug. I told my SPECT doc that I could drink a gallon of coffee in the morning and it didn't seem to pick me up at all. He had looked at my scans and told me that I needed something a lot stronger than coffee to activate my cortex. From what I've read, for ADD it may stimulate the cortex in the short run, but its vasoconstriction effects can make ADD worse in the long run.
I drink maybe a cup or two of coffee or hot tea in the morning, but I could live without it--no problem.You may want to call the clinic and see if you can get the scan(s) first thing in the morning. But I would make sure that the pdoc doing the scan knew about you're condition. You're right, if you're that addicted to caffeine and suddenly stop it for a day I would think it could seriously alter brain function.
Tell the receptionist you are scheduled to have a scan done, but you have a very important medical concern that you need to discuss with the doctor or his nurse (if he has one).
Don't forget to let us know how it went.
God bless,
--Tim
Posted by MB on December 5, 2001, at 13:43:23
In reply to Re: SPECT imaging has its place in psychiatry » MB, posted by manowar on December 4, 2001, at 19:14:49
> Tell the receptionist you are scheduled to have a scan done, but you have a very important medical concern that you need to discuss with the doctor or his nurse (if he has one).
>
> Don't forget to let us know how it went.
> God bless,
> --TimThanks for all the warm wishes. I will definitely keep you posted on how it goes. I realize I need to talk to someone at the clinic and find out to what degree a severe withdrawal state will affect the scan. I'm just avoiding the call; I don't want to face the possibility that they will tell me to quit for a week or something like that!! OUCH! Well, I need to conquer my avoident personality traits and face the proverbial music. Can't get better without facing reality, I guess.
Peace
Posted by manowar on December 10, 2001, at 16:08:58
In reply to Re: SPECT imaging has its place in psychiatry » manowar, posted by MB on December 5, 2001, at 13:43:23
This is the end of the thread.
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