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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by jay on October 29, 2002, at 10:56:01
There is a great website with some good scientific research in plain terms and info we can all use. Much of it may explain why we have such a tough time with just antidepressants..or even just mood stabalizers. Dr. Phelps at www.psycheducation.org gives a strong case for things such a being 'soft bipolar', and that we may all actually sit on a spectrum between unipolar and bipolar, not stuck exactly at either end. Here is a bit from his website:
"Prevalence of bipolar variants in primary care depression has been reported as high as 30%Manning. Obviously this means that of all your patients with depression, as many as one in three might have a bipolar variation. You will learn here that antidepressants may even worsen bipolar disorder, and that mood stabilizers you can learn to use are the treatment of choice. At minimum, for your patients who have not improved on antidepressants and psychotherapy, consider Bipolar II. Read on to learn more about this diagnosis."
Then, see this page for his views on specific treatment: http://www.psycheducation.org/bipolar/03_treatment_app.html#Anchor-Troubleshooting-3086
He states that antidepressants *shouldn't* be used...but this is highly debated, and it is clear many benefit from combination therapy. Here is a good explanation of that:
http://link.springer.de/link/service/journals/00406/bibs/0250002/02500057.htm
European Archives of Psychiatry and Clinical Neurosciences
ISSN: 0940-1334 (printed version)
ISSN: 1433-8491 (electronic version)Table of Contents
Abstract Volume 250 Issue 2 (2000) pp 57-68
Have some guidelines for the treatment of acute bipolar depression gone too far in the restriction of antidepressants?
H.-J. Möller, H. Grunze
Psychiatrische Klinik der Ludwig-Maximilian-Universität, Nussbaumstr. 7, D-80336 Munich, Germany
Received: 3 January 2000 / Accepted: 2 February 2000Abstract This paper gives a critical review of recommendations concerning the drug treatment of acute bipolar depression. The suggestions of different guidelines and consensus papers, especially in US-American and Canadian psychiatry, have a strong tendency against antidepressants in bipolar depression; they prefer mono-therapy with mood stabilizers and, in the case of co-medication with mood stabilizers and antidepressants in severe depression, to withdraw the antidepressant as early as possible. The intention of this restrictive use is to avoid the risk of mania and the risk of rapid cycling induced by antidepressants. However, apparently the risk of suicidal acts, which is as prominent in bipolar depression as in unipolar depression, has been totally neglected. Furthermore, the fact that none of the mood stabilizers have proven their antidepressive efficacy leads not only to the risk of depression-related suicidal behavior but also to the risk of chronicity of depressive symptoms due to undertreatment. Altogether the view expressed in some guidelines and consensus papers appears not well balanced. Furthermore, the fact that apparently the selective serotonin re-uptake inhibitors and possibly some other modern antidepressants have only a low risk of inducing a switch to mania should stimulate a rewriting of the guidelines on drug treatment in acute bipolar depression in a less restrictive way concerning the use of antidepressants.
So..basically..do your research...and challenge, challenge, challenge!!! IF you are not getting better. I hope this can be of help.Jay
Posted by Shawn. T. on October 29, 2002, at 16:52:50
In reply to For ALL with problems with antidepressants alone.., posted by jay on October 29, 2002, at 10:56:01
Dr. Phelps's information is right on the money. I've created a page about the dangers of reckless antidepressant use in psychiatry:
http://www.neurotransmitter.net/admania.htmlShawn
Posted by Tabßitha on October 30, 2002, at 10:03:18
In reply to For ALL with problems with antidepressants alone.., posted by jay on October 29, 2002, at 10:56:01
I saw that guy's page, and it was so seductive. He seemed so sure of himself. Finally... the answer! Unfortunately in practice mood stabilizers alone don't work for me and I still need the ADs. Maybe it's just I get such awful side effects from the mood stabilisers (nausea and dizziness to the point where I don't feel safe driving) that I can't tolerate a high enough dose to do much good.
This is the end of the thread.
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