![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 68. Go back in thread:
Posted by IsoM on January 7, 2002, at 0:18:15
In reply to Re: Previous Life Expectancies » bob, posted by Jane D on January 6, 2002, at 23:27:12
My 2¢ worth only, but in reading about history, other cultures, & the rise of depression...
We tend to think that that way we view life is the way other cultures throughout the world & throughout time have viewed life. The quality & pursuit of happiness are relatively modern concepts. Yes, happiness was always something nice to have but few except the wealthy or privileged classes had the chance to achieve it. The average person working & struggling to survive under some pretty adverse conditions, at most times, was too busy with the rigours of everyday life.
Even nowadays, in places where life is hard & difficult, little thought is given to whether they're happy. Life is filled with duties & work. Happiness is derived from being around family & community as one works through each day. Happy times were to be savoured during weddings, births, & holidays - it wasn't thought to be necessary in everyday life.
I believe that with the more leisure time we have available now, we also have the time to reflect on our lives & inner thoughts. Depression is fairly acceptable now - we don't lock up people in asylums anymore. How many of us would admit to depression if we thought our only choice was to be locked away in an asylum like they used to be?
Even in other parts of the world where there was never thought to be much depression, rates for people afflicted with depression are rapidly rising as they, too, develop more leisure time & desire this "happiness" in their lives too. I think it's always been with us but in past generations, we've never had the luxury of stating it & having others understand us as we do now.
As I said, my 2¢ only.
Posted by bob on January 7, 2002, at 0:22:33
In reply to Re: Previous Life Expectancies, posted by OldSchool on January 6, 2002, at 20:54:41
Unfortunately for me, I turned south at about 22 or 23. I think I either would have been dead long ago, or lived some seriously miserable years before I died. Of course, I'm miserable a lot anyway, even with meds.
Posted by BarbaraCat on January 7, 2002, at 0:38:33
In reply to Re: Previous Life Expectancies » OldSchool, posted by bob on January 7, 2002, at 0:22:33
There are alot of us out there (me too) with serious treatment resistant depression. An AD kicks in to offer hope, then fizzles out. Yes, some times are filled with simple contentment, pleasure even, but really, much of life just ain't worth it when it hurts all the damn time. What makes us continue with it? Is it hope that a new med will appear - the 'magic bullet'? Our spiritual beliefs (my personal hell is that I'll just have to come back and do the same thing over again, and again, and again. No escape. Pretty bleak, huh?) The grief of those left behind? Some secret gift in depression? I have read Noonday Demon, but I still ponder why nature has allowed this miswiring/firing to get so far along in the evolutionary scale. I too agree with another's post that it's primarily neurological. Why are there not more MRI's pet scans, imaging offered to us to pinpoint where our brain is malfunctioning? Expensive? Yes, but what is the cost of escalating depression?
Posted by manowar on January 9, 2002, at 19:18:44
In reply to So what makes us continue?, posted by BarbaraCat on January 7, 2002, at 0:38:33
Hi BarbaraCat, I've got one word for you and that's "faith"
Yes, I agree, it totally sucks having depression. I hope you have times like I do of remission, where you feel normal. That really helps me keep going.
I read Lance Armstrong's book- you know the bicyclist that has won the last 3 Tour De Frances. He said that the cancer that almost killed him was the best thing that ever happened to him--he really meant it. It made him a man. His life is 100X better than it was before the cancer. It made him face the facts of life, and what really mattered in his life.
I'm optimistic, even though it’s hard-- that I'll get better. And when I do, I'll be a stronger, more successful, more compassionate human being than I ever thought about being before. I certainly will appreciate life a lot more than most.
I've also have gotten quite a layman's education on Psychopharmacology:)
Posted by BarbaraCat on January 9, 2002, at 19:33:04
In reply to Re: So what makes us continue? » BarbaraCat, posted by manowar on January 9, 2002, at 19:18:44
Thanks, Manowar for your words of wisdom. Yes, when I'm having a good day I'm grateful for the experiences that have made me a very strong and compassionate person. And has gotten me in touch with a loving Presence and Grace... Keeping a journal during those good times helps (however I never seem to keep up writing during those good times as I do when I'm down - just having too much fun I guess.)
I agree on the education received - how fascinating! If I can ever maintain a consistent level of health and motivation I'd like to go back to school and aim for using this hard won knowledge in a health/psych field. And I'm 50 years old, so having faith is necessary even in the best of times. Good luck to you.
> Hi BarbaraCat, I've got one word for you and that's "faith"
>
> Yes, I agree, it totally sucks having depression. I hope you have times like I do of remission, where you feel normal. That really helps me keep going.
>
> I read Lance Armstrong's book- you know the bicyclist that has won the last 3 Tour De Frances. He said that the cancer that almost killed him was the best thing that ever happened to him--he really meant it. It made him a man. His life is 100X better than it was before the cancer. It made him face the facts of life, and what really mattered in his life.
>
> I'm optimistic, even though it’s hard-- that I'll get better. And when I do, I'll be a stronger, more successful, more compassionate human being than I ever thought about being before. I certainly will appreciate life a lot more than most.
>
> I've also have gotten quite a layman's education on Psychopharmacology:)
Posted by manowar on January 9, 2002, at 20:18:48
In reply to Re: WHY are we all so 'chemically challenged'?, posted by OldSchool on January 6, 2002, at 13:07:21
> The psychiatrists dont really know whats wrong with us. The whole problem here is we suffer from serious brain based illnesses, which are in fact neurological problems basically. But instead are oftentimes treated like mere "emotional" problems by the mental health field. Its BS.
>
> Until the mental health field is formally handed over the Neurology field lock, stock and barrel someday, we "mental patients" will continue to be treated like second class citizens.
>
> Old School
************************************************I agree with you. The problem is that too many politicians and citizens have an 'old school' view concerning mental health (sorry for the pun). Let's face it; I would venture to say that 75-90 percent of healthy Americans view most-if not all- mental health problems as 'psychological'. --Thanks Freud
The mental health parity measure in Congress failed--why? Ignorance! Until the American people are educated that mental health is not simply a 'psychological' problem or even a problem with 'a chemical imbalance in the brain', we'll continue to see millions and millions of people suffer and die because of this illness.
For the most part, I think depressions are neurologically based. I'll never understand why doctors continue to scan people's kidneys, livers, hearts, lungs, bones etc. and it practically takes an act of Congress to get a brain scan. Please tell me why this is? The human brain is the most complex organ in the known Universe, yet unless someone has a stroke, a Neurologist won't even consider a brain scan for someone with major depression.
Most Psychiatrists don't seem to give a damn, and seem to be more like drug doctors. "Uh-let's see-you tried this-this and this, well let's try you on this--yea, here's a free trial to last you for a week". THEY'VE GOTTEN LAZY! (and fat too, from all the free dinners they get from drug reps.) I think most of them have sold out to drug reps that have them convinced that people that have depression have 'chemical imbalances in the brain'. –Like our brain is just a big sack of chemicals. B-S! It's not that simple.
Psychiatry and Neurology (and Psychology for that matter) seem to overlap, yet the disciplines seem to have their own agendas and don't seem to work at all at joining forces.
Someday I think Psychiatry and Neurology will merge. But it won't be anytime soon, that's for sure.
Posted by OldSchool on January 9, 2002, at 21:20:41
In reply to Old School nailed it » OldSchool, posted by manowar on January 9, 2002, at 20:18:48
>
> I agree with you. The problem is that too many politicians and citizens have an 'old school' view concerning mental health (sorry for the pun). Let's face it; I would venture to say that 75-90 percent of healthy Americans view most-if not all- mental health problems as 'psychological'. --Thanks FreudI totally agree. I try to point this out to so many people and most dont have a clue what Im even talking about. Most people just do not think of mental illness in terms of its a brain/CNS disease. It severely screws up your sleep, your appetite, your sexual drive and function...it screws up your cognition and ability to think clearly. These are all CNS controlled physiological bodily functions which in a normal healthy person they dont even think about and take for granted. In severe mental illness, these bodily functions get screwed up.
To me thats hard evidence mental illness is neurological. Who studies sleep? Who runs the sleep labs? Neurologists. Good sleep is critical for good mental health. Sleep is a CNS controlled function and its PHYSICAL not "mental."
>
> The mental health parity measure in Congress failed--why? Ignorance! Until the American people are educated that mental health is not simply a 'psychological' problem or even a problem with 'a chemical imbalance in the brain', we'll continue to see millions and millions of people suffer and die because of this illness.Yep...lots of stupidity surrounding mental illness. More so than any other type of medical problem. Stupidity sums it up good.
>
> For the most part, I think depressions are neurologically based. I'll never understand why doctors continue to scan people's kidneys, livers, hearts, lungs, bones etc. and it practically takes an act of Congress to get a brain scan. Please tell me why this is? The human brain is the most complex organ in the known Universe, yet unless someone has a stroke, a Neurologist won't even consider a brain scan for someone with major depression.I totally agree. All severe forms of mental illness are basically neurological problems. There are no diagnostic tests in psychiatry, like brain scans. Well actually there is the functional neuroimaging thing but thats still experimental and hasnt filtered down to clinical psychiatry yet.
Why are Neurologists ALREADY using brain scans like SPECT/PET and MRI to help diagnose Parkinsons, Alzheimers, dementia and other "mainstream" neurological disorders, but not severe mental illness? Answer? Stupidity.
>
> Most Psychiatrists don't seem to give a damn, and seem to be more like drug doctors. "Uh-let's see-you tried this-this and this, well let's try you on this--yea, here's a free trial to last you for a week". THEY'VE GOTTEN LAZY! (and fat too, from all the free dinners they get from drug reps.) I think most of them have sold out to drug reps that have them convinced that people that have depression have 'chemical imbalances in the brain'. –Like our brain is just a big sack of chemicals. B-S! It's not that simple.
>
> Psychiatry and Neurology (and Psychology for that matter) seem to overlap, yet the disciplines seem to have their own agendas and don't seem to work at all at joining forces.As far as Im concerned, Neurologists should be treating all severe forms of mental illness TODAY.
>
> Someday I think Psychiatry and Neurology will merge. But it won't be anytime soon, that's for sure.Agree...in reality its gonna be a long time before this ever happens. Sad
Old School
Posted by manowar on January 9, 2002, at 21:49:00
In reply to WHY are we all so 'chemically challenged'?, posted by BarbaraCat on January 6, 2002, at 0:16:07
> I know we're an imperfect species, we've had miserable childhoods for the most part, our aymgdalas are bonked out and there are many reasons for not feeling great, but have you all noticed how many of us suffer from depression -- 'chemical imbalances'? Any ideas why this might be? I've been exploring and researching everything from micoplasma infection (who knows, those chemtrails we've been spotting overhead are spraying something!) to substance P overload in the CS fluid to every thing I can get my hands on. I also have fibromyalgia along with severe depression and when I get depressed it's a TOTAL body thing. I hurt all over, every cell aches, I'm tired and I'm in deep despair. Yes, I take meds and it helps sometimes and sometimes not. But it makes me wonder -- what's going on? Why are we so sick? Any takers on this question of the ages?
************************************************Good thread,
First of all, the 'chemical imbalance' theory of depression is nonsense in my opinion. A 'chemical imbalance' may happen when the brain is not functioning the way it should, so it may be the EFFECT of improper brain functioning. The improper brain functioning could be due to psychological and/or physiological reasons.
And yes--in most cases depression can be treated by using meds that alter the improper functioning (THE CAUSE), not the 'chemical imbalance’ (THE EFFECT).
But to answer you're question, I have a theory. Viruses may cause many depressions.
Whatever happened to the 'Borna Virus' theory of depression? It was a major news story a couple years ago- haven't heard it mentioned since. Why is that?
We're not the only species to suffer from depression. I think that when a virus causes Horses to commit suicide by jumping off cliffs, we may be on to something.
Here's a story from 1998 from CNN-
August 31, 1998
Web posted at: 8:29 p.m. EDT (0029 GMT)
(CNN) -- New research from Germany indicates some cases of serious depression may be caused by a virus."We think that there is ... a lot of evidence that Borna virus has clinical significance for this type of disease," said Dr. Liv Bode of the Robert Koch Institute in Berlin.
In the United States, at least 17 million people have some form of clinical depression -- not just a passing case of the blues, but a disabling and often long-term disease.
Scientists are still unraveling the causes of the disease: genetics, stress and possibly a virus.
The virus was first identified in the late 1800s among horses near the town of Borna, Germany. The horses stopped eating, walked in circles and got sick. Some even killed themselves.
Autopsies led scientists to the virus in the region of the horses' brains that controls emotions. Researchers in Berlin have found a similar strain in humans.
"I think it is supporting our hypothesis that this virus, this particular agent, has really something to do with this type of disorder," Bode said.
The anti-viral drug amantadine, used to treat Parkinson's disease, has been found to relieve some cases of depression. A trial is now under way.
"I think I'm one of the most skeptical people around ... but I have to face the fact that for about a year now, we've been treating patients and we've been seeing responses to amantadine," said Dr. Ron Ferszt of the Free University of Berlin.
German patient Rosemarie Wenzlaff, who suffered from depression for 10 years, says the medication changed her life.
"I didn't take care of myself when I was depressed; I couldn't eat," she said. "Now I'm thinking of cooking marmalade. I listen to music now. I watch TV. It's a totally different life."
Scientists in the United States say these early findings are interesting, but not conclusive. Results are expected later this year from clinical trials in Berlin that might demonstrate a link between the Borna virus and depression.
***********************************************Below is MAJOR speculation on my part. Either a brainstorm or a brain fart, but so what--I'm babbling-right?
I think a viral infection ATTACKING the brain, and DESTROYING cells and synapsis causing functional problems leading to ‘chemical imbalances’ is as just a viable theory as any.
-- Of course I could and probably am wrong:)
I had childhood encephalitis. I’m SURE that the virus did irreversible damage to my brain and how it functions, as I’m sure everyone reading my posts can attest to:)
Take care,
Tim
Posted by BarbaraCat on January 9, 2002, at 22:18:03
In reply to A bug?, posted by manowar on January 9, 2002, at 21:49:00
> > I know we're an imperfect species, we've had miserable childhoods for the most part, our aymgdalas are bonked out and there are many reasons for not feeling great, but have you all noticed how many of us suffer from depression -- 'chemical imbalances'? Any ideas why this might be? I've been exploring and researching everything from micoplasma infection (who knows, those chemtrails we've been spotting overhead are spraying something!) to substance P overload in the CS fluid to every thing I can get my hands on. I also have fibromyalgia along with severe depression and when I get depressed it's a TOTAL body thing. I hurt all over, every cell aches, I'm tired and I'm in deep despair. Yes, I take meds and it helps sometimes and sometimes not. But it makes me wonder -- what's going on? Why are we so sick? Any takers on this question of the ages?
> ************************************************
>
> Good thread,
>
> First of all, the 'chemical imbalance' theory of depression is nonsense in my opinion. A 'chemical imbalance' may happen when the brain is not functioning the way it should, so it may be the EFFECT of improper brain functioning. The improper brain functioning could be due to psychological and/or physiological reasons.
>
> And yes--in most cases depression can be treated by using meds that alter the improper functioning (THE CAUSE), not the 'chemical imbalance’ (THE EFFECT).
>
> But to answer you're question, I have a theory. Viruses may cause many depressions.
>
> Whatever happened to the 'Borna Virus' theory of depression? It was a major news story a couple years ago- haven't heard it mentioned since. Why is that?
>
> We're not the only species to suffer from depression. I think that when a virus causes Horses to commit suicide by jumping off cliffs, we may be on to something.
>
> Here's a story from 1998 from CNN-
>
> August 31, 1998
> Web posted at: 8:29 p.m. EDT (0029 GMT)
> (CNN) -- New research from Germany indicates some cases of serious depression may be caused by a virus.
>
> "We think that there is ... a lot of evidence that Borna virus has clinical significance for this type of disease," said Dr. Liv Bode of the Robert Koch Institute in Berlin.
>
> In the United States, at least 17 million people have some form of clinical depression -- not just a passing case of the blues, but a disabling and often long-term disease.
>
> Scientists are still unraveling the causes of the disease: genetics, stress and possibly a virus.
>
> The virus was first identified in the late 1800s among horses near the town of Borna, Germany. The horses stopped eating, walked in circles and got sick. Some even killed themselves.
>
> Autopsies led scientists to the virus in the region of the horses' brains that controls emotions. Researchers in Berlin have found a similar strain in humans.
>
> "I think it is supporting our hypothesis that this virus, this particular agent, has really something to do with this type of disorder," Bode said.
>
> The anti-viral drug amantadine, used to treat Parkinson's disease, has been found to relieve some cases of depression. A trial is now under way.
>
> "I think I'm one of the most skeptical people around ... but I have to face the fact that for about a year now, we've been treating patients and we've been seeing responses to amantadine," said Dr. Ron Ferszt of the Free University of Berlin.
>
> German patient Rosemarie Wenzlaff, who suffered from depression for 10 years, says the medication changed her life.
>
> "I didn't take care of myself when I was depressed; I couldn't eat," she said. "Now I'm thinking of cooking marmalade. I listen to music now. I watch TV. It's a totally different life."
>
> Scientists in the United States say these early findings are interesting, but not conclusive. Results are expected later this year from clinical trials in Berlin that might demonstrate a link between the Borna virus and depression.
> ***********************************************
>
> Below is MAJOR speculation on my part. Either a brainstorm or a brain fart, but so what--I'm babbling-right?
>
> I think a viral infection ATTACKING the brain, and DESTROYING cells and synapsis causing functional problems leading to ‘chemical imbalances’ is as just a viable theory as any.
>
> -- Of course I could and probably am wrong:)
>
> I had childhood encephalitis. I’m SURE that the virus did irreversible damage to my brain and how it functions, as I’m sure everyone reading my posts can attest to:)
>
> Take care,
>
> TimYes, I was hoping someone would mention the Borna virus because that is a tantalizing piece of the puzzle. I've had some interesting experiences while on the antiviral med acyclovir for periodic herpes outbreaks. I've found that a five day course can stop a depression cold if I'm in the midst of one, or just make me feel neurologically better in general. I always wondered if that was placebo talking, or if there was some neuro anti-viral activity. Another implicating culprit has been the mycoplasma bacteria. There's all kinds of info out on the internet ranging from serious research studies to scary conspiracy theories on how the different forms can seriously compromise physical and mental health. I've had the mycoplasma pneumonea strain three times - one case chronically lasting for 2 years before it was diagnosed and treated with antibiotics. And what about all the virus theories for chronic fatique (myalgic encelphalitis) where lesions do show up on brain imaging and 'malingering' is no longer the knee-jerk diagnosis.
It seems that how we deal with organic or metabolic dysfunctions in our current medical paradigm is to search out the down-current results and use band-aids after it's broken, rather than seek the source of the break (malfunctioning pituitary in the HPA axis? Excess cortisol effectively frying receptor sites? Secondary messenger systems gone awry? Poor gene transcription causing various hormonal receptor resistance?) Or maybe just a nasty bug?
Posted by manowar on January 10, 2002, at 20:47:45
In reply to Re: Old School nailed it, posted by OldSchool on January 9, 2002, at 21:20:41
>
> >
> > I agree with you. The problem is that too many politicians and citizens have an 'old school' view concerning mental health (sorry for the pun). Let's face it; I would venture to say that 75-90 percent of healthy Americans view most-if not all- mental health problems as 'psychological'. --Thanks Freud
>
> I totally agree. I try to point this out to so many people and most dont have a clue what Im even talking about. Most people just do not think of mental illness in terms of its a brain/CNS disease. It severely screws up your sleep, your appetite, your sexual drive and function...it screws up your cognition and ability to think clearly. These are all CNS controlled physiological bodily functions which in a normal healthy person they dont even think about and take for granted. In severe mental illness, these bodily functions get screwed up.
>
> To me thats hard evidence mental illness is neurological. Who studies sleep? Who runs the sleep labs? Neurologists. Good sleep is critical for good mental health. Sleep is a CNS controlled function and its PHYSICAL not "mental."
>
> >
> > The mental health parity measure in Congress failed--why? Ignorance! Until the American people are educated that mental health is not simply a 'psychological' problem or even a problem with 'a chemical imbalance in the brain', we'll continue to see millions and millions of people suffer and die because of this illness.
>
> Yep...lots of stupidity surrounding mental illness. More so than any other type of medical problem. Stupidity sums it up good.
>
> >
> > For the most part, I think depressions are neurologically based. I'll never understand why doctors continue to scan people's kidneys, livers, hearts, lungs, bones etc. and it practically takes an act of Congress to get a brain scan. Please tell me why this is? The human brain is the most complex organ in the known Universe, yet unless someone has a stroke, a Neurologist won't even consider a brain scan for someone with major depression.
>
> I totally agree. All severe forms of mental illness are basically neurological problems. There are no diagnostic tests in psychiatry, like brain scans. Well actually there is the functional neuroimaging thing but thats still experimental and hasnt filtered down to clinical psychiatry yet.
>
> Why are Neurologists ALREADY using brain scans like SPECT/PET and MRI to help diagnose Parkinsons, Alzheimers, dementia and other "mainstream" neurological disorders, but not severe mental illness? Answer? Stupidity.
>
> >
> > Most Psychiatrists don't seem to give a damn, and seem to be more like drug doctors. "Uh-let's see-you tried this-this and this, well let's try you on this--yea, here's a free trial to last you for a week". THEY'VE GOTTEN LAZY! (and fat too, from all the free dinners they get from drug reps.) I think most of them have sold out to drug reps that have them convinced that people that have depression have 'chemical imbalances in the brain'. –Like our brain is just a big sack of chemicals. B-S! It's not that simple.
> >
> > Psychiatry and Neurology (and Psychology for that matter) seem to overlap, yet the disciplines seem to have their own agendas and don't seem to work at all at joining forces.
>
> As far as Im concerned, Neurologists should be treating all severe forms of mental illness TODAY.
>
> >
> > Someday I think Psychiatry and Neurology will merge. But it won't be anytime soon, that's for sure.
>
> Agree...in reality its gonna be a long time before this ever happens. Sad
>
> Old School
************************************************
Old School,Don't be sad, be glad:)
Actually, there are some Psychiatrist that are beginning to 'see the light' and recommend scans for patients with 'treatment resistant' depressions. Luckily, I had a pdoc that referred me to the Amen Clinic in CA last summer. The scans were a wake up call for my physicians and me. I've already written about my experiences before, but Dr. Bob’s server is running very slowly, and I can’t find my posts (it could be a conspiracy:)
In brief:
I'm a firm believer in the viability in using modern SPECT equipment to HELP diagnose and treat depression and other psychiatric ailments. It's my humble opinion (I’ve had the scans done) that it really works in showing what areas of the brain are not functioning correctly. The fact is-- when certain parts of your brain are not functioning correctly it is FAIRLY predictable how a patient functions (i.e. Schizophrenia, Major Depression, Parkinson’s, Alzheimer’s)There are many on this board that disagree and think that its use is only for 'testing purposes'. --I dissent. Modern SPECT imaging is absolutely unreal. You really 'see' a three dimensional FUNCTIONAL image of your brain on a computer screen. And BTW: Changing your thought patterns during the tests have very little impact, if any, on the completed image- that’s baloney- Well maybe if you’re thinking of sex or of eating you’re favorite food. But who in the hell does that when he is in a tube that turns every 15 seconds and makes weird noises?
By using this type of technology, a pdoc can, in many cases, save a patient years of agony and frustration and actually 'target' treatment, instead of forcing a patient through endless trial and error with psychoactive drugs—which can in many cases makes problems worse, and can cause irreversible brain damage.
And yes, I do think that people with hard to treat psychiatric disorders should all have ‘their heads examined’. Why not? I think most people in America that have heart ailments get either an MRI, SPECT, or any number of imaging studies for it. Why should the brain be any different?
Again, I think most pdocs are fat and lazy. If they kept up with Neurology along with Psychiatry (which overlap-tremendously), we as patients would be much better off. I don’t think Psychiatrist and Neurologists mingle much at all. There are but a few exceptions. BTW: Dr. Amen is both a Psychiatrist and a Neurologist.
There is a growing number of pdocs that are beginning to use this technology in their practices. Most of them are on the West coast, though.
People, please don’t casually dismiss this argument, by saying, “Its just a scam”, or “Junk science” without putting effort into examining the information that’s out there! That’s just a cop out.
Take care,
--Tim
Posted by OldSchool on January 10, 2002, at 21:07:42
In reply to Re: Old School nailed it » OldSchool, posted by manowar on January 10, 2002, at 20:47:45
> ************************************************
> Old School,
>
> Don't be sad, be glad:)
>
> Actually, there are some Psychiatrist that are beginning to 'see the light' and recommend scans for patients with 'treatment resistant' depressions. Luckily, I had a pdoc that referred me to the Amen Clinic in CA last summer. The scans were a wake up call for my physicians and me. I've already written about my experiences before, but Dr. Bob’s server is running very slowly, and I can’t find my posts (it could be a conspiracy:)
>
> In brief:
> I'm a firm believer in the viability in using modern SPECT equipment to HELP diagnose and treat depression and other psychiatric ailments. It's my humble opinion (I’ve had the scans done) that it really works in showing what areas of the brain are not functioning correctly. The fact is-- when certain parts of your brain are not functioning correctly it is FAIRLY predictable how a patient functions (i.e. Schizophrenia, Major Depression, Parkinson’s, Alzheimer’s)
>
> There are many on this board that disagree and think that its use is only for 'testing purposes'. --I dissent. Modern SPECT imaging is absolutely unreal. You really 'see' a three dimensional FUNCTIONAL image of your brain on a computer screen. And BTW: Changing your thought patterns during the tests have very little impact, if any, on the completed image- that’s baloney- Well maybe if you’re thinking of sex or of eating you’re favorite food. But who in the hell does that when he is in a tube that turns every 15 seconds and makes weird noises?
>
> By using this type of technology, a pdoc can, in many cases, save a patient years of agony and frustration and actually 'target' treatment, instead of forcing a patient through endless trial and error with psychoactive drugs—which can in many cases makes problems worse, and can cause irreversible brain damage.
>
> And yes, I do think that people with hard to treat psychiatric disorders should all have ‘their heads examined’. Why not? I think most people in America that have heart ailments get either an MRI, SPECT, or any number of imaging studies for it. Why should the brain be any different?
>
> Again, I think most pdocs are fat and lazy. If they kept up with Neurology along with Psychiatry (which overlap-tremendously), we as patients would be much better off. I don’t think Psychiatrist and Neurologists mingle much at all. There are but a few exceptions. BTW: Dr. Amen is both a Psychiatrist and a Neurologist.
>
> There is a growing number of pdocs that are beginning to use this technology in their practices. Most of them are on the West coast, though.
>
> People, please don’t casually dismiss this argument, by saying, “Its just a scam”, or “Junk science” without putting effort into examining the information that’s out there! That’s just a cop out.
>
> Take care,
>
> --TimTim...I totally, absolutely 100% AGREE with everything you just said. I couldnt have put it better myself. You and I think exactly the same in regards to mental illness. Its your BRAIN, not your "mind" or some "psychological" problem.
I didnt realize Dr. Amen is dually trained in both Psychiatry and Neurology. Thats good. I was in the rTMS clinical trials back in 99 at the Medical University of South Carolina. That program with rTMS, VNS, DBS, etc. is run by another guy who is board certified in both Psychiatry and Neurology, Dr. Mark George. And Dr. George is very heavily involved in this functional neuroimaging stuff. He is doing things like taking treatment resistant folks, giving them an initial brain scan using functional MRI, SPECT or PET. Then doing VNS implant, rTMS, DBS or some other depression treatment on them. And then giving a POST TREATMENT brain scan afterwards. The results of before treatment and after treatment show up on these functional neuroimaging scans. Its real neuroscience for a change, rather than the usual psychology/psychiatry subjective psychobabble.
I think many are afraid or intimidated by these new ideas within Neuropsychiatry research. That is my personal opinion. Many people, including many with severe mental illness, just cannot get over the hump in regards to truly accepting that their problem is IN YOUR BRAIN!
You are 100% correct Tim and Ive thought about getting a SPECT scan myself.
Old School
Posted by BarbaraCat on January 10, 2002, at 23:11:16
In reply to Re: Old School nailed it, posted by OldSchool on January 10, 2002, at 21:07:42
Very fascinating. Correct me if I'm wrong, but I didn't think that Dr. Amen was doing SPECT scans any longer but treated based on symptomatology, or gut reaction he arrived at after seeing so many SPECTs? At any rate, given the fact that many of us have insurance with brain imaging facilities on-site (I belong to Kaiser - lotsa neuroimaging stuff at their disposal), how does one go about demanding to receive realistic and beneficial tests? I've had MRI's done at the drop of a hat for a neck injury. I've brought up the subject about getting my brain scanned for my depression and my pdoc says "oh, the science isn't in for sure yet". Horse pucky! It's a lack of education, or buckling under to Management's financial dictates, but WE are the ones paying their bills! What are your opinions on how we, as big-buck paying subscribers, can go about getting what we NEED. I think that many of us in this group are more informed than our pdocs regarding the myriad issues that hit-or-miss psychopharmacology specialization does not address. How do we educate/work with them and insist upon getting tests that are available, right now, that could alleviate or at least provide good info on why we're suffering? It's not even a cost issue since proper diagnosis and treatment would save insurers beaucoup bucks.
>
> > ************************************************
> > Old School,
> >
> > Don't be sad, be glad:)
> >
> > Actually, there are some Psychiatrist that are beginning to 'see the light' and recommend scans for patients with 'treatment resistant' depressions. Luckily, I had a pdoc that referred me to the Amen Clinic in CA last summer. The scans were a wake up call for my physicians and me. I've already written about my experiences before, but Dr. Bob’s server is running very slowly, and I can’t find my posts (it could be a conspiracy:)
> >
> > In brief:
> > I'm a firm believer in the viability in using modern SPECT equipment to HELP diagnose and treat depression and other psychiatric ailments. It's my humble opinion (I’ve had the scans done) that it really works in showing what areas of the brain are not functioning correctly. The fact is-- when certain parts of your brain are not functioning correctly it is FAIRLY predictable how a patient functions (i.e. Schizophrenia, Major Depression, Parkinson’s, Alzheimer’s)
> >
> > There are many on this board that disagree and think that its use is only for 'testing purposes'. --I dissent. Modern SPECT imaging is absolutely unreal. You really 'see' a three dimensional FUNCTIONAL image of your brain on a computer screen. And BTW: Changing your thought patterns during the tests have very little impact, if any, on the completed image- that’s baloney- Well maybe if you’re thinking of sex or of eating you’re favorite food. But who in the hell does that when he is in a tube that turns every 15 seconds and makes weird noises?
> >
> > By using this type of technology, a pdoc can, in many cases, save a patient years of agony and frustration and actually 'target' treatment, instead of forcing a patient through endless trial and error with psychoactive drugs—which can in many cases makes problems worse, and can cause irreversible brain damage.
> >
> > And yes, I do think that people with hard to treat psychiatric disorders should all have ‘their heads examined’. Why not? I think most people in America that have heart ailments get either an MRI, SPECT, or any number of imaging studies for it. Why should the brain be any different?
> >
> > Again, I think most pdocs are fat and lazy. If they kept up with Neurology along with Psychiatry (which overlap-tremendously), we as patients would be much better off. I don’t think Psychiatrist and Neurologists mingle much at all. There are but a few exceptions. BTW: Dr. Amen is both a Psychiatrist and a Neurologist.
> >
> > There is a growing number of pdocs that are beginning to use this technology in their practices. Most of them are on the West coast, though.
> >
> > People, please don’t casually dismiss this argument, by saying, “Its just a scam”, or “Junk science” without putting effort into examining the information that’s out there! That’s just a cop out.
> >
> > Take care,
> >
> > --Tim
>
> Tim...I totally, absolutely 100% AGREE with everything you just said. I couldnt have put it better myself. You and I think exactly the same in regards to mental illness. Its your BRAIN, not your "mind" or some "psychological" problem.
>
> I didnt realize Dr. Amen is dually trained in both Psychiatry and Neurology. Thats good. I was in the rTMS clinical trials back in 99 at the Medical University of South Carolina. That program with rTMS, VNS, DBS, etc. is run by another guy who is board certified in both Psychiatry and Neurology, Dr. Mark George. And Dr. George is very heavily involved in this functional neuroimaging stuff. He is doing things like taking treatment resistant folks, giving them an initial brain scan using functional MRI, SPECT or PET. Then doing VNS implant, rTMS, DBS or some other depression treatment on them. And then giving a POST TREATMENT brain scan afterwards. The results of before treatment and after treatment show up on these functional neuroimaging scans. Its real neuroscience for a change, rather than the usual psychology/psychiatry subjective psychobabble.
>
> I think many are afraid or intimidated by these new ideas within Neuropsychiatry research. That is my personal opinion. Many people, including many with severe mental illness, just cannot get over the hump in regards to truly accepting that their problem is IN YOUR BRAIN!
>
> You are 100% correct Tim and Ive thought about getting a SPECT scan myself.
>
> Old School
Posted by bob on January 10, 2002, at 23:14:22
In reply to Re: Old School nailed it » OldSchool, posted by manowar on January 10, 2002, at 20:47:45
I'm not so convinced about SPECT imaging, or any other imaging to help in out *treatment* of our diseases. For example, say a person consults a psychiatrist complaining of classic OCD behavior and depression. Then the patient is referred for a SPECT scan and it is confirmed that, indeed, the specific areas of the brain involved in those aberrations are indeed not functioning properly. How would that change the treatment? What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
Posted by BarbaraCat on January 10, 2002, at 23:56:00
In reply to Re: Old School nailed it » manowar, posted by bob on January 10, 2002, at 23:15:36
Yes, you bring up a good point in that potentially there is nothing more available than the current treatment. However, the possibility exists that something else would show up, more information gained, more fine-tuning accomplished. My issue is what can we, as responsible and proactive patients, do to accelerate this process if we feel that it's in our best interest? Like many of us, I've been on the meds merry go round for too many years to just sit back and be a nice little patient when there just might be better diagnostic methods. All of us on meds are research subjects. Well, then, let's start doing some serious research. The tools are out there, the science is waiting, so what are we waiting for?
> I'm not so convinced about SPECT imaging, or any other imaging to help in out *treatment* of our diseases. For example, say a person consults a psychiatrist complaining of classic OCD behavior and depression. Then the patient is referred for a SPECT scan and it is confirmed that, indeed, the specific areas of the brain involved in those aberrations are indeed not functioning properly. How would that change the treatment? What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
Posted by bob on January 11, 2002, at 0:00:30
In reply to I wanna see my brain!, posted by BarbaraCat on January 10, 2002, at 23:56:00
I fully agree with you. We are research subjects. I doubt that brain imaging will change what we can do about abnormalities now, but one day it may. It can certainly lead to better diagnoses than just listening to what someone has to say. The tools for fixing these problems, however, will require better insight into the actual brain functioning, not just what region is active.
Posted by sjb on January 11, 2002, at 9:22:54
In reply to Re: WHY are we all so 'chemically challenged'?, posted by OldSchool on January 6, 2002, at 16:36:29
Old School,
I always read your posts and would like your advice. I'm sick and tired of all the past 6 years of "conventional" mental treatment. All the drugs, the appts, let's try this, let's try that and just feeling like another upper-class, white female w/ "major depression" and "eating disorder NOS. Blah, blah, blah, blah. I need help and feel shortchanged, gosh dang it!!!
I prayed so hard not to wake up this morning after days of bingeing on crap food and wine. Alas, I did. Came to work looking a like a bum, in part, 'cause of weight gain and business clothes no longer fit. Tired of binge eating, crying, isolating, trying again and again to get into marathon shape. Used to be an athlete.
I do not know where to turn. I no longer have the patience to try yet another drug or a different dose, etc. My cravings for sweets overwhelm all my goals. I'm sick and tired of trying to will myself better. Don't want to go to eating disorder place. Been there, done that. Lots of teenage anorexics and I stick out like a sore thumb, like "Why are your here?" Have to go to bathroom in a "hat", have to let nurse flush when you do #2. Not allowed to go out and excercise. Given a bunch of Zanax if you get too upset about not being allowed outside and then scolded if you start falling asleep in group therapy which ends up in additional restrictions. . . .I digress.
My original question was just to ask where I could get a brain SPECT on the east coast. I read the Amen book and liked it very much. I seem to recall in the appendix that there was someone from the Wash DC area but I'd prefer Phila/NY area. Anyone have any ideas?
I'm taking the rest of my Adderall (not much - was only given 10mg per day), stopping the Celexa and stopping my PDoc appts. Have no idea where to turn and don't feel like I'm even worth it anyway.
Posted by OldSchool on January 11, 2002, at 10:09:52
In reply to Re: WHY are we all so 'chemically challenged'?, posted by sjb on January 11, 2002, at 9:22:54
> My original question was just to ask where I could get a brain SPECT on the east coast. I read the Amen book and liked it very much. I seem to recall in the appendix that there was someone from the Wash DC area but I'd prefer Phila/NY area. Anyone have any ideas?
>Functional neuroimaging for psych problems is not being done at very many places yet. Its still experimental as of right now. Unfortunately it has not filtered down to clinical psychiatry yet. The best place I personally know of to have functional neuroimaging done on the east coast is the Medical University of South Carolina. Which is in Charleston. Thats the program run by Dr. Mark George.
I also read something about Mclean hospital doing functional neuroimaging. And Im sure NIMH in Washington DC is doing it. However the place Im most familiar with is MUSC.
This link takes you directly to the MUSC functional neuroimaging lab:http://www.musc.edu/psychiatry/fnrd/function.htm
And here is a "primer" for psychiatrists who want to learn the super basics of functional neuroimaging.
http://www.musc.edu/psychiatry/fnrd/primer_index.htm
As for advice to you, I dont know what to tell you about treatment except if it gets bad enough to where you think you might honestly kill yourself there is always ECT.
Old School
Posted by bob on January 11, 2002, at 14:51:02
In reply to Re: WHY are we all so 'chemically challenged'?, posted by sjb on January 11, 2002, at 9:22:54
SJB:
You don't mention having had any intense psychotherapy, although that just may have been an omission on your part. If you indeed haven't been, or aren't participating in that, I strongly suggest that you do so in light of your impending decision to go off all meds. Psychotherapy may help you to see some things in a different way, and there will be a person who you see regularly about your problems.
Just a suggestion. When I read your message, it hit home. Especially the part about being so tired of all the meds, appts, and med changes. For me, the meds take away some of my mental torture, but they make my life unmanageable in other ways, such as not being able to get out of bed because I'm so tired. It's unbelievable sometimes.
Bob
Posted by manowar on January 11, 2002, at 17:33:50
In reply to Re: A bug?, posted by BarbaraCat on January 9, 2002, at 22:18:03
> > > I know we're an imperfect species, we've had miserable childhoods for the most part, our aymgdalas are bonked out and there are many reasons for not feeling great, but have you all noticed how many of us suffer from depression -- 'chemical imbalances'? Any ideas why this might be? I've been exploring and researching everything from micoplasma infection (who knows, those chemtrails we've been spotting overhead are spraying something!) to substance P overload in the CS fluid to every thing I can get my hands on. I also have fibromyalgia along with severe depression and when I get depressed it's a TOTAL body thing. I hurt all over, every cell aches, I'm tired and I'm in deep despair. Yes, I take meds and it helps sometimes and sometimes not. But it makes me wonder -- what's going on? Why are we so sick? Any takers on this question of the ages?
> > ************************************************
> >
> > Good thread,
> >
> > First of all, the 'chemical imbalance' theory of depression is nonsense in my opinion. A 'chemical imbalance' may happen when the brain is not functioning the way it should, so it may be the EFFECT of improper brain functioning. The improper brain functioning could be due to psychological and/or physiological reasons.
> >
> > And yes--in most cases depression can be treated by using meds that alter the improper functioning (THE CAUSE), not the 'chemical imbalance’ (THE EFFECT).
> >
> > But to answer you're question, I have a theory. Viruses may cause many depressions.
> >
> > Whatever happened to the 'Borna Virus' theory of depression? It was a major news story a couple years ago- haven't heard it mentioned since. Why is that?
> >
> > We're not the only species to suffer from depression. I think that when a virus causes Horses to commit suicide by jumping off cliffs, we may be on to something.
> >
> > Here's a story from 1998 from CNN-
> >
> > August 31, 1998
> > Web posted at: 8:29 p.m. EDT (0029 GMT)
> > (CNN) -- New research from Germany indicates some cases of serious depression may be caused by a virus.
> >
> > "We think that there is ... a lot of evidence that Borna virus has clinical significance for this type of disease," said Dr. Liv Bode of the Robert Koch Institute in Berlin.
> >
> > In the United States, at least 17 million people have some form of clinical depression -- not just a passing case of the blues, but a disabling and often long-term disease.
> >
> > Scientists are still unraveling the causes of the disease: genetics, stress and possibly a virus.
> >
> > The virus was first identified in the late 1800s among horses near the town of Borna, Germany. The horses stopped eating, walked in circles and got sick. Some even killed themselves.
> >
> > Autopsies led scientists to the virus in the region of the horses' brains that controls emotions. Researchers in Berlin have found a similar strain in humans.
> >
> > "I think it is supporting our hypothesis that this virus, this particular agent, has really something to do with this type of disorder," Bode said.
> >
> > The anti-viral drug amantadine, used to treat Parkinson's disease, has been found to relieve some cases of depression. A trial is now under way.
> >
> > "I think I'm one of the most skeptical people around ... but I have to face the fact that for about a year now, we've been treating patients and we've been seeing responses to amantadine," said Dr. Ron Ferszt of the Free University of Berlin.
> >
> > German patient Rosemarie Wenzlaff, who suffered from depression for 10 years, says the medication changed her life.
> >
> > "I didn't take care of myself when I was depressed; I couldn't eat," she said. "Now I'm thinking of cooking marmalade. I listen to music now. I watch TV. It's a totally different life."
> >
> > Scientists in the United States say these early findings are interesting, but not conclusive. Results are expected later this year from clinical trials in Berlin that might demonstrate a link between the Borna virus and depression.
> > ***********************************************
> >
> > Below is MAJOR speculation on my part. Either a brainstorm or a brain fart, but so what--I'm babbling-right?
> >
> > I think a viral infection ATTACKING the brain, and DESTROYING cells and synapsis causing functional problems leading to ‘chemical imbalances’ is as just a viable theory as any.
> >
> > -- Of course I could and probably am wrong:)
> >
> > I had childhood encephalitis. I’m SURE that the virus did irreversible damage to my brain and how it functions, as I’m sure everyone reading my posts can attest to:)
> >
> > Take care,
> >
> > Tim
>
> Yes, I was hoping someone would mention the Borna virus because that is a tantalizing piece of the puzzle. I've had some interesting experiences while on the antiviral med acyclovir for periodic herpes outbreaks. I've found that a five day course can stop a depression cold if I'm in the midst of one, or just make me feel neurologically better in general. I always wondered if that was placebo talking, or if there was some neuro anti-viral activity. Another implicating culprit has been the mycoplasma bacteria. There's all kinds of info out on the internet ranging from serious research studies to scary conspiracy theories on how the different forms can seriously compromise physical and mental health. I've had the mycoplasma pneumonea strain three times - one case chronically lasting for 2 years before it was diagnosed and treated with antibiotics. And what about all the virus theories for chronic fatique (myalgic encelphalitis) where lesions do show up on brain imaging and 'malingering' is no longer the knee-jerk diagnosis.
>
> It seems that how we deal with organic or metabolic dysfunctions in our current medical paradigm is to search out the down-current results and use band-aids after it's broken, rather than seek the source of the break (malfunctioning pituitary in the HPA axis? Excess cortisol effectively frying receptor sites? Secondary messenger systems gone awry? Poor gene transcription causing various hormonal receptor resistance?) Or maybe just a nasty bug?Amazing,
I open my email this morning, and guess what I see? An email from PsychiatryMatters.MD that lists feature psychiatry research briefs, and one of the stories happened to be about the Borna Virus. What a coincidence! Because I wrote about the Borna Virus just a day or so ago--and haven't read any lit concerning the Borna Virus in a long time.Anyway, here is the brief
from "PsychiatryMatters.MD":Animal virus linked to psychiatric disorders in humans
Borna disease virus (BDV) could be linked to psychiatric diseases, such as schizophrenia, depression and chronic fatigue in humans, suggests a team from the University of Veterinary Sciences, Vienna. Norbert Nowotny (University of Veterinary Science, Vienna) and colleagues suggest that the virus, which triggers severe meningoencephalitis in animals, may interfere with neurotransmitter activities leading to psychiatric disorders in humans. Compared with the reaction in animals, only subtle changes are suspected in humans. Evidence to support the theory comes from findings that patients with diseases such as panic disorder have higher frequencies of antibodies to the virus in their blood. In addition, Nowotny's team has isolated the virus' genetic material from a man with chronic fatigue syndrome. Nevertheless, the link between BDV and human psychiatric disorders still remains controversial, and has been questioned in recent studies. For example, it is still unclear whether the virus passes from animals to humans or if there is a specific human strain. Johan Fazakerley, a leading UK expert on Borna disease, from the Centre for Infectious Diseases at the University of Edinburgh, points out that if a link is confirmed, it is likely to be implicated in only a small proportion of psychiatric cases. The findings were presented at the meeting of the European Societies of Clinical and Veterinary Virology and the Society for General Microbiology at the Royal College of Physicians in London.
*************************************************Here's the brief from The society for general Microbiology:
A virus may contribute to certain psychiatric disorders
09 January 2002
A virus that causes a fatal brain disease in horses and sheep may be linked to certain mental disorders in man, medical experts heard today (Wednesday 09 January 2002) during a joint meeting of the European Societies of Clinical and Veterinary Virology and the Society for General Microbiology at the Royal College of Physicians, London.
"Recent investigations have again stimulated highly controversial discussions as to whether Borna disease virus can infect humans and lead to psychiatric disorders," says Professor Norbert Nowotny of the University of Veterinary Sciences, Vienna.
Borna disease virus (BDV) is endemic in animals in certain areas of central Europe, though epidemics are rare and usually only sporadic cases of Borna disease are recorded. Horses and sheep are the main host species for this virus, although natural cases of infection have also occurred in cattle, rabbits and dogs. A wide variety of other animals including chickens and certain apes can be infected experimentally.
Professor Nowotny reveals, "Whilst BDV infection in animals leads to a severe and often lethal meningoencephalitis, such inflammation has never been seen in man. In humans, only subtle changes are suspected, which may interfere with neurotransmitter activities leading to psychiatric disorders. For example, we have detected BDV in a patient suffering from chronic fatigue syndrome."
Professor Nowotny explains, "The link between BDV and psychiatric disorders such as some subgroups of schizophrenia and depression may be very difficult to prove for certain. However, by learning more about how the virus is transmitted we can take actions to prevent it from causing disease in humans and in animals."
Posted by manowar on January 12, 2002, at 1:40:35
In reply to Re: Old School nailed it » manowar, posted by bob on January 10, 2002, at 23:14:22
Hi Bob,
Thank you for your post and I'm glad you raised these concerns.
> I'm not so convinced about SPECT imaging, or any other imaging to help in out *treatment* of our diseases. For example, say a person consults a psychiatrist complaining of classic OCD behavior and depression. Then the patient is referred for a SPECT scan and it is confirmed that, indeed, the specific areas of the brain involved in those aberrations are indeed not functioning properly. How would that change the treatment?
First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
>What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
Examples of subtypes of depression:This is from Dr. Amen’s web page www.brainplace.com:
Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
· Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
· Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
· Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.God Bless
--Tim
Posted by BarbaraCat on January 12, 2002, at 2:10:52
In reply to Why I think we all need our heads examined » bob, posted by manowar on January 12, 2002, at 1:40:35
Tim,
Great post! This is the stuff that changes things. My question to you is, how did you go about getting these tests? Did you contact Dr. Amen's clinic on your own? Pay for it on your own? What sources would you suggest for getting the best info on this to present as evidence to my own pdoc? If I have to pay for it myself, so be it, but I won't go down without a fight. You think a Pit Bull's got tenacity? This is one brain-battered gal on a mission!BTW, the Borna virus re-vivification is uncanny. I was also talking about this a few weeks ago to my husband wondering what ever happened to the research. He says maybe it should now be called the 'Bornagain' Virus. . .
Barbara
> Hi Bob,
>
> Thank you for your post and I'm glad you raised these concerns.
>
> > I'm not so convinced about SPECT imaging, or any other imaging to help in out *treatment* of our diseases. For example, say a person consults a psychiatrist complaining of classic OCD behavior and depression. Then the patient is referred for a SPECT scan and it is confirmed that, indeed, the specific areas of the brain involved in those aberrations are indeed not functioning properly. How would that change the treatment?
>
> First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
>
> My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
>
> BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
>
>
> Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.
>
> In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
>
> For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
>
> My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
>
> My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
>
> The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
>
> And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
>
> I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
>
> >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
>
> Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
>
> Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
>
> Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
>
>
> Examples of subtypes of depression:
>
> This is from Dr. Amen’s web page www.brainplace.com:
>
> Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
>
> SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
> · Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
> · Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
> · Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.
>
> God Bless
>
> --Tim
Posted by bob on January 12, 2002, at 2:22:10
In reply to Why I think we all need our heads examined » bob, posted by manowar on January 12, 2002, at 1:40:35
Tim:
I don't disagree for one moment that brain imaging is a valuable tool that will one day may lead to accurate *diagnoses* of depressive subtypes. However, I'm still not convinced at this point that going to the AMEN clinic and having my brain scanned will matter a hill of beans in my *treatment*. I've tried many, many, many med combos, and there are many more that I could try. I don't see where there is a one to one correlation between an abnormal brain scan, and what medecine(s) to prescribe for a certain individual to make it normal. There would still be trial and error, because we don't understand the underlying mechanisms by which the meds work, and what they are actually doing to the brain. I don't see a very black and white relationship between brain scans, and what medecines to pick, except in certain cases. I still think, however, that brain scan research is heading in the right direction.
>
> First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.I realize that scans don't treat depression, and I don't believe I stated that. How does a brain scan tell you why a person is not responding to a treatment if they've tried, say, 20 different combos of meds and haven't achieved satisfaction. Many on this board have been through the pharmacological ringer.
>> BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
I agree, it's pathetic that mental disorders have no diagnostic tests. I don't think brain scans are there yet though. They can help, but what we would eventually need is a distinct scan pattern for every subtype, an **understanding** of the subtypes, and then we would have to know how to fix it. Our ability to treat mental illness in many individuals falls far short of satisfaction. The fact that we can diagnose things like MS, haven't really improved the treatments much, if at all.
>
>
> Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.I wholeheartedly agree.
>
> In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.If your case was treatment resistant, I don't know why that didn't lead your doctors to try different approaches before the scans. My doctors have tried many approaches, and the only limit to my treatment has been my increasing inablility to go on and off of these meds.
>
> For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
>
> My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.It sounds to me like your pdoc was somewhat timid with the treatments before the scans, and that the scans gave him the impetus to be more creative.
>
> >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
>
> Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.I said refractory to meds, not "all therapies". I realize there are things like ECT available also. "Refractory depression" does exist, and is characterized by a lack of response to available treatments. All you have to do is type the phrase in any internet search engine, and all kinds of info will come up. There are also many situations where people cannot physically tolerate the meds for one reason or another. Say, for example, you only got a temporary response from your pstims, and then it faded?
>
> Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)It sounds to me like the doctor had was very narrow minded in his treatments. I don't think my doctor would resist much of anything I suggested, as long as it was available here in the US. If I wanted to try Microcurrent Stimulation, I don't think he'd have any problem with it.
>
> Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.I'm definitely not among the popular believers then, because it has severely impaired my existence. I agree.
>
>
It seems that you've found a suitable solution to your problems with a med combo, and I'm glad to hear that.Again, brain scans are definitely useful, and I wouldn't mind having them done... I'm just not sure at this point for me that it would change my treatment. There would still be trial and error inherent in the med trials.
Bob
Posted by manowar on January 12, 2002, at 2:56:22
In reply to Re: Old School nailed it, posted by BarbaraCat on January 10, 2002, at 23:11:16
Horse pucky! -- Such foul language:):):)> Very fascinating. Correct me if I'm wrong, but I didn't think that Dr. Amen was doing SPECT scans any longer but treated based on symptomatology, or gut reaction he arrived at after seeing so many SPECTs? At any rate, given the fact that many of us have insurance with brain imaging facilities on-site (I belong to Kaiser - lotsa neuroimaging stuff at their disposal), how does one go about demanding to receive realistic and beneficial tests? I've had MRI's done at the drop of a hat for a neck injury. I've brought up the subject about getting my brain scanned for my depression and my pdoc says "oh, the science isn't in for sure yet". Horse pucky! It's a lack of education, or buckling under to Management's financial dictates, but WE are the ones paying their bills! What are your opinions on how we, as big-buck paying subscribers, can go about getting what we NEED. I think that many of us in this group are more informed than our pdocs regarding the myriad issues that hit-or-miss psychopharmacology specialization does not address. How do we educate/work with them and insist upon getting tests that are available, right now, that could alleviate or at least provide good info on why we're suffering? It's not even a cost issue since proper diagnosis and treatment would save insurers beaucoup bucks.
************************************************
Regarding your question, "Correct me if I'm wrong, but I didn't think that Dr. Amen was doing SPECT scans any longer but treated based on symptomatology, or gut reaction he arrived at after seeing so many SPECTs?"Uh, I don't understand what you're saying. If you mean that in the beginning when he first started using the technology he was a bit skeptical, and had the attitude that most pdocs have today--you're right. He wouldn't order a scan normally. Only after lots of frustration using typical psychiatry for refractory patients with little benefit, he began to use scans. He really didn't think it would be much of a benefit, but he started noticing abnormalities, which completely changed his psychiatric paradigm.
If you mean that since he has so much experience and that he can arrive at a diagnosis of a problem and prescribe treatment without the use of SPECT, you're right. Normally though, people want to spend the money and have the scans done. Why not? The more information, the better. Most people that go to the Amen clinic INSIST on having scans done.
>How do we educate/work with them and insist upon getting tests that are available, right now, that could alleviate or at least provide good info on why we're suffering?
Bring books, journals, abstracts, reports, anything you can get you're hands on. For me it was very difficult to find a progressive, foward thinking doctor. It's hard work. But don't settle for second best.
If they don't listen, walk.
Out of total frustration, I called the Amen Clinic on my own. I talked to a person that basically interviewed me over the phone and told me how the procedure works and what the charges are etc. I didn't need a referral, even though my pdoc was happy to give me one if I needed it. I made a phone appointment with a doctor at the Amen Clinic before I made the decision to go there. It really didn't matter to me if the clinic was 200 miles or 2000 miles away; luckily I have lots of sky-miles. I'm in Knoxville TN.-- I could have called Emory in Atlanta or have even called the University of TN, which has an excellent program. There are a million options. You've just got to research, and make phone calls, and be vigilant. I ultimately decided on the Amen Clinic because I believed the guy, and I was at the point where I decided not to waste another minute.
Of course, the clinic filed for my insurance, but I had to pay then and there. But I knew that going in. When I got a check for $2,300 in the mail from my insurance company a month later- it was one of the happiest days of my life. I honestly never counted on it!
Have a great weekend,
Tim
> >
> > > ************************************************
> > > Old School,
> > >
> > > Don't be sad, be glad:)
> > >
> > > Actually, there are some Psychiatrist that are beginning to 'see the light' and recommend scans for patients with 'treatment resistant' depressions. Luckily, I had a pdoc that referred me to the Amen Clinic in CA last summer. The scans were a wake up call for my physicians and me. I've already written about my experiences before, but Dr. Bob’s server is running very slowly, and I can’t find my posts (it could be a conspiracy:)
> > >
> > > In brief:
> > > I'm a firm believer in the viability in using modern SPECT equipment to HELP diagnose and treat depression and other psychiatric ailments. It's my humble opinion (I’ve had the scans done) that it really works in showing what areas of the brain are not functioning correctly. The fact is-- when certain parts of your brain are not functioning correctly it is FAIRLY predictable how a patient functions (i.e. Schizophrenia, Major Depression, Parkinson’s, Alzheimer’s)
> > >
> > > There are many on this board that disagree and think that its use is only for 'testing purposes'. --I dissent. Modern SPECT imaging is absolutely unreal. You really 'see' a three dimensional FUNCTIONAL image of your brain on a computer screen. And BTW: Changing your thought patterns during the tests have very little impact, if any, on the completed image- that’s baloney- Well maybe if you’re thinking of sex or of eating you’re favorite food. But who in the hell does that when he is in a tube that turns every 15 seconds and makes weird noises?
> > >
> > > By using this type of technology, a pdoc can, in many cases, save a patient years of agony and frustration and actually 'target' treatment, instead of forcing a patient through endless trial and error with psychoactive drugs—which can in many cases makes problems worse, and can cause irreversible brain damage.
> > >
> > > And yes, I do think that people with hard to treat psychiatric disorders should all have ‘their heads examined’. Why not? I think most people in America that have heart ailments get either an MRI, SPECT, or any number of imaging studies for it. Why should the brain be any different?
> > >
> > > Again, I think most pdocs are fat and lazy. If they kept up with Neurology along with Psychiatry (which overlap-tremendously), we as patients would be much better off. I don’t think Psychiatrist and Neurologists mingle much at all. There are but a few exceptions. BTW: Dr. Amen is both a Psychiatrist and a Neurologist.
> > >
> > > There is a growing number of pdocs that are beginning to use this technology in their practices. Most of them are on the West coast, though.
> > >
> > > People, please don’t casually dismiss this argument, by saying, “Its just a scam”, or “Junk science” without putting effort into examining the information that’s out there! That’s just a cop out.
> > >
> > > Take care,
> > >
> > > --Tim
> >
> > Tim...I totally, absolutely 100% AGREE with everything you just said. I couldnt have put it better myself. You and I think exactly the same in regards to mental illness. Its your BRAIN, not your "mind" or some "psychological" problem.
> >
> > I didnt realize Dr. Amen is dually trained in both Psychiatry and Neurology. Thats good. I was in the rTMS clinical trials back in 99 at the Medical University of South Carolina. That program with rTMS, VNS, DBS, etc. is run by another guy who is board certified in both Psychiatry and Neurology, Dr. Mark George. And Dr. George is very heavily involved in this functional neuroimaging stuff. He is doing things like taking treatment resistant folks, giving them an initial brain scan using functional MRI, SPECT or PET. Then doing VNS implant, rTMS, DBS or some other depression treatment on them. And then giving a POST TREATMENT brain scan afterwards. The results of before treatment and after treatment show up on these functional neuroimaging scans. Its real neuroscience for a change, rather than the usual psychology/psychiatry subjective psychobabble.
> >
> > I think many are afraid or intimidated by these new ideas within Neuropsychiatry research. That is my personal opinion. Many people, including many with severe mental illness, just cannot get over the hump in regards to truly accepting that their problem is IN YOUR BRAIN!
> >
> > You are 100% correct Tim and Ive thought about getting a SPECT scan myself.
> >
> > Old School
Posted by OldSchool on January 12, 2002, at 10:58:33
In reply to Why I think we all need our heads examined » bob, posted by manowar on January 12, 2002, at 1:40:35
>
> First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
>
> My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
>
> BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
>
>
> Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.
>
> In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
>
> For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
>
> My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
>
> My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
>
> The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
>
> And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
>
> I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
>
> >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
>
> Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
>
> Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
>
> Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
>
>
> Examples of subtypes of depression:
>
> This is from Dr. Amen’s web page www.brainplace.com:
>
> Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
>
> SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
> · Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
> · Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
> · Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.
>
> God Bless
>
> --Tim
Tim...I agree with EVERYTHING you post about this neuroimaging stuff! You are 100% right on. The psychiatrists DO NOT know whats going on with us, particularly the treatment resistant folks.Psychiatry should in my personal opinion, be outlawed and done away with and totally replaced with Neurology. Mental illness should be treated like the real disease it is...a brain based PHYSICAL illness. Tests need to be developed and implemented, like the SPECT scans. We NEED this sort of thing in the diagnosis of severe mental illness.
I agree with your statements that some people are put on psychiatry drugs which worsen one's condition, due to a vague or incorrect diagnosis in the beginning. SPECT scans could help prevent that sort of thing from occurring.
The psychology aspects of psychiatry need to be ditched. It doesnt work a large percentage of the time. The psychology/psychiatry approach should be replaced by a high tech, modernized, neurological approach to mental illness. Bring on the SPECT scans and everything like it I say.
Hell, hire NASA to figure out severe mental illness. I bet NASA could figure this stuff out given the budget and goal. Psychiatry wont ever figure it out.
Old School
Posted by manowar on January 13, 2002, at 1:18:27
In reply to Re: Why I think we all need our heads examined, posted by OldSchool on January 12, 2002, at 10:58:33
> >
> > First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
> >
> > My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
> >
> > BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
> >
> >
> > Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.
> >
> > In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
> >
> > For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
> >
> > My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
> >
> > My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
> >
> > The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
> >
> > And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
> >
> > I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
> >
> > >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
> >
> > Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
> >
> > Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
> >
> > Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
> >
> >
> > Examples of subtypes of depression:
> >
> > This is from Dr. Amen’s web page www.brainplace.com:
> >
> > Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
> >
> > SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
> > · Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
> > · Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
> > · Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.
> >
> > God Bless
> >
> > --Tim
>
>
> Tim...I agree with EVERYTHING you post about this neuroimaging stuff! You are 100% right on. The psychiatrists DO NOT know whats going on with us, particularly the treatment resistant folks.
>
> Psychiatry should in my personal opinion, be outlawed and done away with and totally replaced with Neurology. Mental illness should be treated like the real disease it is...a brain based PHYSICAL illness. Tests need to be developed and implemented, like the SPECT scans. We NEED this sort of thing in the diagnosis of severe mental illness.
>
> I agree with your statements that some people are put on psychiatry drugs which worsen one's condition, due to a vague or incorrect diagnosis in the beginning. SPECT scans could help prevent that sort of thing from occurring.
>
> The psychology aspects of psychiatry need to be ditched. It doesnt work a large percentage of the time. The psychology/psychiatry approach should be replaced by a high tech, modernized, neurological approach to mental illness. Bring on the SPECT scans and everything like it I say.
>
> Hell, hire NASA to figure out severe mental illness. I bet NASA could figure this stuff out given the budget and goal. Psychiatry wont ever figure it out.
>
> Old SchoolRight on brother, now you're talking! When I first read you're post this afternoon, I laughed my ass off (BTW: I still am, and will for weeks to come--thanks Old School and thanks Provigil!) It seems that you don't like to pussyfoot around an issue much! Hehehehe
I have to say that psychology is also an important component to mental health. What good is having a perfectly functioning brain, without knowing how to socially interact, or plan for the future, or have values, beliefs, and goals in life?
But first and foremost, the hardware (brain) must work right before the software (i.e. goals, social interaction, planning) can run well at all.
Talk about scamarama:
Until modern imaging techniques are accepted and appreciated by the public, we as patients will be forced to visit our pdoc once a month, and put up with the same drill, over and over and over again! You chat for 25 minutes, then they politely tell you to shut up, and they write the scripts, you pay the cashier and you're out the door. We're nothing but cattle! There is something wrong with this picture! They rely solely on just what a person tells him, to make a diagnosis and prescribe drugs. They are drug dealers, with a license! This paradigm has to change!The problem seems to be that Neurologist are too busy dealing with trauma patients to be able to adequately deal with psychiatric disorders.
Therefore, after laughing for five or ten minutes after reading you're mighty bold statement that psychiatry should be outlawed, I thought to myself, he's right! --In it's present form-- it should be.
This is what I think:
When you visit a clinic for the first time, they should be required to do blood work. Also, there should be a requirement that every pdoc have certified imaging technology at his disposal-- either at his clinic or at a hospital near by.
Old School is right, what is everyone waiting for? Doctors-get aggressive—scan us, do blood work, poke and prod us, ALONG with doing a psychological profile on us- so that the BEST and most economical treatment can be prescribed, so we can get well sooner.
--And if a person does not get better within a certain time period, psychosurgery should become a consideration. Why mess around with the Vagus Nerve, when a Neurologist can get right to the source (brain) and plug in a pacemaker, just like they do for heart patients?
Let’s move on, we have the technology, and we can make it happen!
--Tim
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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