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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by jay on March 10, 2003, at 9:22:15
I know, sounds like an 'outlandish' question. Also, please, I am not speaking from some Breggin kind-of (what I consider) "radical, irrational" viewpoint. But taking into account a few things:
a) 'First..do no harm' as our pal Hippocrates (sorta) said. The massive "popularity" of antidepressants, and both the massive amount of 'adverse effects' and seemingly lack of overall efficacy in their use in monotherapy. (I know..this is controversial, but even some of the most stringent pharmacologists admit that the singular use of antidepressants has brought on many complications along with their anywhere from '40 to 80' percent 'cure' rate...take your pick on the figures to believe.) There is even some numbers to indicate that some (quite a few, actually) who are treated with just an a.d. may get some harm in future responses. (This being those prone to 'rapid cycling', and who fall into any place on the bipolar spectrum.) I will admit some of my thinking on this is influenced by some of the research brought up by Jim Phelps. (Controversial, again, as always.)
b) The lack of overall effect of a major component of depression by monotherapy of antidepressants on suicide and suicidal ideation. The mood stabilizers, and lithium in particular, as well as the antipsychotics, still hold more efficacy towards suicidal ideation than antidepressants. Suicidal ideation is often a common link shared with depression (not always of course...and again I know...this is controversial...etc. etc.), and it seems that even if a person has had suicidal thoughts, many pdocs and docs will still prescribe an antidepressant without (or rather than) the more proven treatment of lithium, et al. I know this is deeply complicated, and it's a question of "treat the depression...it will (should) treat the suicidal ideation." But, again, the numbers show that mood stabilizers are more effective for suicidal ideation than antidepressants. That leaves wide open some very, VERY important questions of using antidepressants first-line for depression.
I know this all makes things so much more confusing and such, but I think we should be deeply concerned because millions are treated quite simply for depression with a singular antidepressant, a treatment that still seems to be rather 'scattered'. (In addressing a few but leaving so many symptoms/questions wide open.)
Please take into account the whole YMMV, controversial, etc. aspect of this. It's great to see these questions being asked in the halls of research clinicians, psychopharmacologists, etc, but even amongst the large population of psychiatrists and doctors, these questions seem to go passively by. Remember when you first went for treatment for your depression? How much of the spectrum of questions above did your pdoc or doc address, and how long did it take for you to ask some of these deeper questions? Even for those who have found some contented relief, there often was a *LOT* of suffering in between. What do you folks think?
Jay
Posted by Jack Smith on March 10, 2003, at 12:11:51
In reply to Do we *all* need mood stabilizers w/ a..d.'s? , posted by jay on March 10, 2003, at 9:22:15
Jay,
I think you are making the mistake of taking people's reactions on this board as the "typical" reactions to AD's. Most people on this board react to AD's in an atypical manner. It is sometimes hard to remember that most who come to this board and post for long terms have failed many different types of treatments. If you look through the archives, you will read from many people who no longer post here, I think it is safe to assume that most of those people have found an effective long-term treatment, many without mood stabilizers.
I know there are impressive studies saying that Lithium is statistically superior for suppressing actual suicides BUT we all know that there are so many things that go into this that it is hard to conclude that Lithium in general is better than any other agent at suppressing suicide.
To answer your question: do we "all" need mood stabilizers? The answer to this question is obvious: NO. Everyone has a unique reaction to these agents and making blanket statements/predictions about what we "all" need is worthless. I am not bipolar. Yet, my pdoc tried Lithium augmentation for a pooping out AD (this is a conventional way to deal with AD poop out). After just a few days of Lithium, I felt more depressed than ever and within a day of removing it I felt noticably better. If anything, Lithium for me pushed me more towards suicidal thinking. I also know of someone who was mistakenly dx'd as "Bipolar II" (which I personally believe is not a real diagnosis) and went through a year of different mood stabilizers. That year was the most hellish year of his life. After he returned to SSRI monotherapy, he experienced a robust remission. What may work for you probably won't work for many others.
JACK
Posted by JackD on March 10, 2003, at 13:49:17
In reply to Re: Do we *all* need mood stabilizers w/ a..d.'s? » jay, posted by Jack Smith on March 10, 2003, at 12:11:51
Posted by Ron Hill on March 10, 2003, at 14:29:02
In reply to Re: Do we *all* need mood stabilizers w/ a..d.'s? » jay, posted by Jack Smith on March 10, 2003, at 12:11:51
>I also know of someone who was mistakenly dx'd as "Bipolar II" (which I personally believe is not a real diagnosis) and went through a year of different mood stabilizers.
I'm curious. If BP II is not a real diagnosis, what dx would you give a person like me who cycles between hypomanic, normal, and depressive mood states without medication, is pushed into full-blown mania when treated with AD mono-therapy, but who responds favorably to a mood stabilizer? I (and others) call it BP II.
-- Ron
Posted by colin wallace on March 10, 2003, at 14:45:53
In reply to Re: Bipolar II is not a real diagnosis? » Jack Smith, posted by Ron Hill on March 10, 2003, at 14:29:02
Hmmmmmm....I have friends-even relatives- who (tacitly)refuse to accept even plain old, bog-standard clinical depression as anything other than a character flaw, or a diagnosis invented to make us mental weaklings feel better about ourselves.They don't have it, ergo it don't exist....
Just an observation mind.
Posted by cybercafe on March 10, 2003, at 15:37:50
In reply to Re: Bipolar II is not a real diagnosis? » Jack Smith, posted by Ron Hill on March 10, 2003, at 14:29:02
> >I also know of someone who was mistakenly dx'd as "Bipolar II" (which I personally believe is not a real diagnosis) and went through a year of different mood stabilizers.
>
> I'm curious. If BP II is not a real diagnosis, what dx would you give a person like me who cycles between hypomanic, normal, and depressive mood states without medication, is pushed into full-blown mania when treated with AD mono-therapy, but who responds favorably to a mood stabilizer? I (and others) call it BP II.
>
> -- Ron
>i think the problem with mistaken diagnoses is that doctors simply do not spend enough time with patients
when i'm feeling euphoric (hypomanic) it's always been pretty obvious to me that i am experiencing things people around me don't even come close to
Posted by Maximus on March 10, 2003, at 16:31:18
In reply to Re: Do we *all* need mood stabilizers w/ a..d.'s? » jay, posted by Jack Smith on March 10, 2003, at 12:11:51
Posted by Jack Smith on March 10, 2003, at 16:32:03
In reply to Re: Bipolar II is not a real diagnosis? » Jack Smith, posted by Ron Hill on March 10, 2003, at 14:29:02
> I'm curious. If BP II is not a real diagnosis, what dx would you give a person like me who cycles between hypomanic, normal, and depressive mood states without medication, is pushed into full-blown mania when treated with AD mono-therapy, but who responds favorably to a mood stabilizer? I (and others) call it BP II.
>
> -- RonI am not a doctor but this is what I would say--you have a mild form of Bipolar disorder and maybe BP II is a good way of expressing this. But, I tend to think that BP II has become a sort of over-diagnosed thing for people who have not fully responded to AD's. A Pdoc dx'd me with it because I felt better some days and worse others but when I felt better, I was nowhere close to hypomanic or manic. I told him this and he said that you don't need either to be BP II. Now, I am sure there are better pdocs but this seems to be a common thing with people I have talked to--If you feel good some days on AD's and then depression still breaks through once in a while, you are BP II and let's break out the mood stabilizers.
In fairness, I should have said that I think BP II is real but perhaps over-diagnosed. I guess I am guilty of overgeneralizing based on my own personal experiences.
JACK
Posted by Jack Smith on March 10, 2003, at 16:34:06
In reply to Re: IMHO Symptoms are more important than DX! (nm), posted by Maximus on March 10, 2003, at 16:31:18
I agree. I think that doctors are too quick to bunch people up into a certain category and proceed with treatment based on that rather than taking a more individualized approach. But, in fairness, it takes more resources to take an individualized approach and our health care system is overburdened.
JACK
Posted by KrissyP on March 10, 2003, at 18:23:28
In reply to Do we *all* need mood stabilizers w/ a..d.'s? , posted by jay on March 10, 2003, at 9:22:15
Hi jay,
I hear you YMMV and all the rest that goes with this issue. This is solely my experience and I really hope it helps.
I remember well when I first went for treatment for my depression. I had a great pdoc and my OCD was in full force. I had more ruminating thoughts/worrying.etc. but I also was majorly depressed. She started me on Anafranil and Prozac. I was new to it all and it took me a while to ask those "deeper" questions. I was in need of some serious help. *Come to find out later by a pdoc at UCI-California, I was diagnosed with rapid cycling*, which relates to your statement>>>"There is even some numbers to indicate that some (quite a few, actually) who are treated with just an a.d. may get some harm in future responses. (This being those prone to 'rapid cycling', and who fall into any place on the bipolar spectrum.)" Then I was eventually (after I think was a late diagnosis) Diagnosed with Bipolar II in Nov 1999-by another extremely great psychiatrist. I had done a *LOT* of suffering in between my journey that started back in 1995. You also point out>>"The mood stabilizers, and lithium in particular, as well as the antipsychotics, still hold more efficacy towards suicidal ideation than antidepressants"Seroquel helped me, in adjunction to my AD for my suicidal thoughts/ideations-A LOT. I was always on "just" an AD and later in Nov 1999 was given a MS for the bipolar, etc. I hear you here.
Did this make sense, I would love to her further from you about this and anyone else.
Great post!
Thanks, Kristen:-)
==================================================================================================
Remember when you first went for treatment for your depression? How much of the spectrum of questions above did your pdoc or doc address, and how long did it take for you to ask some of these deeper questions? Even for those who have found some contented relief, there often was a *LOT* of suffering in between. What do you folks think?
Jay
Posted by Ron Hill on March 10, 2003, at 22:21:43
In reply to I'm Guilty of OverGeneralizing » Ron Hill, posted by Jack Smith on March 10, 2003, at 16:32:03
Hi Jack,
> In fairness, I should have said that I think BP II is real but perhaps over-diagnosed. I guess I am guilty of overgeneralizing based on my own personal experiences.
Thank you for your pleasant response. Best wishes.
-- Ron
Posted by Rainee on March 10, 2003, at 23:15:16
In reply to Re: Bipolar II is not a real diagnosis?, posted by cybercafe on March 10, 2003, at 15:37:50
The way I see it with me is I have a mood disorder. I have severe alcholism on both sides of the family I come by it honestly if not genetically than enviromentally. It's an on going process. I've been dx'd anxiety disorder,panic disorder,agoraphobic,borderline,major depression,bi-polar II, major depression with psyhcotic features (what ever that is), personality disorder..lol
My family has self medicated for ever why?
I have no clue.
Posted by judy1 on March 10, 2003, at 23:31:22
In reply to Re: Bipolar II is not a real diagnosis? » cybercafe, posted by Rainee on March 10, 2003, at 23:15:16
"My family has self medicated for ever why?"
Because, quite honestly it works- and very well for the anxiety spectrum of disorders. Unfortunately there are a lot of negative effects. take care, judy
Posted by KrissyP on March 10, 2003, at 23:46:12
In reply to Re: Bipolar II is not a real diagnosis? » Rainee, posted by judy1 on March 10, 2003, at 23:31:22
I used to self-medicate with food-and I gained 60 Lbs. Why? Because I didn't want to feel.-I am guilty of self-medicating BIG TIME-now with my cigarettes-only been smoking for 3 years, but I get a somewhat "high" feeling when I smoke but then there's the addiction for me- I have an addictive personality. There can be negative effects yes, but I am trying to self-medicate more by, EXERCISE That is healthy and no negative effects-all positive, and I am also eating more fish-ya know the omega 3 fatty acids kind? :-)
I had salmon for lunch-cheap little can-and swordfish for dinner-because I went out with a friend.
Hope this helped, Kristen
Posted by cybercafe on March 11, 2003, at 0:06:11
In reply to Re: Bipolar II is not a real diagnosis? » cybercafe, posted by Rainee on March 10, 2003, at 23:15:16
> The way I see it with me is I have a mood disorder. I have severe alcholism on both sides of the family I come by it honestly if not genetically than enviromentally. It's an on going process. I've been dx'd anxiety disorder,panic disorder,agoraphobic,borderline,major depression,bi-polar II, major depression with psyhcotic features (what ever that is), personality disorder..lol
> My family has self medicated for ever why?
> I have no clue.wow that's a lot...
how are things going for you? are you able to hold down a job?
Posted by judy1 on March 11, 2003, at 10:33:47
In reply to Re: Bipolar II is not a real diagnosis? » judy1, posted by KrissyP on March 10, 2003, at 23:46:12
Exercise and diet are great and despite not making a dent in my symptoms (bipolar 1 and PTSD, DD-NOS, etc.), I try to incorporate exercise daily just because it makes me feel good. When I was on zyprexa full-time I gained a great deal of weight, but because of my regime now- medicating episodes (which I don't recommend for anyone else:-), weight really hasn't been a problem. I hope you continue to do good things for your body. take care, judy
Posted by Krissy P on March 11, 2003, at 14:46:32
In reply to Good for you! » KrissyP, posted by judy1 on March 11, 2003, at 10:33:47
Posted by Rainee on March 11, 2003, at 22:14:29
In reply to Re: Bipolar II is not a real diagnosis?, posted by cybercafe on March 11, 2003, at 0:06:11
Hi there,
No actually all my jobs have been short lived. I had been on SSI but just stopped recieving it.
I have alot of developmental issues that I'm working on with a good therapist. I'll tell ya alot of this stuff can get all mixed up and a doc might want to medicate when it's really a therapy issue. All this has taken a long time...UGGG
But I'm hopeful.Rainee :)
Posted by Krissy P on March 11, 2003, at 22:43:28
In reply to Re: Bipolar II is not a real diagnosis? » cybercafe, posted by Rainee on March 11, 2003, at 22:14:29
Hi, remain hopeful-good for you! :-)
Over my long, tough, frustrating "hunt" for the "right" med(s)-I also have found that a lot can be helped by the use of some good, intense therapy (not that it was easy). I did EMDR with a great MFCC for a molestation at 7 and it worked. Yes, doesn't it take a long time?
UGGGGGGG Keep stayin hopeful:-)
All the best, Kristen
==================================================================================================
Hi there,
No actually all my jobs have been short lived. I had been on SSI but just stopped recieving it.
I have alot of developmental issues that I'm working on with a good therapist. I'll tell ya alot of this stuff can get all mixed up and a doc might want to medicate when it's really a therapy issue. All this has taken a long time...UGGG
But I'm hopeful.
Rainee :)
Posted by ayuda on March 11, 2003, at 23:32:10
In reply to Do we *all* need mood stabilizers w/ a..d.'s? , posted by jay on March 10, 2003, at 9:22:15
Sometimes I think that everyone on the earth needs mood stabilizers, especially those people who aren't taking anything because they think they are sane.
Seriously, though, I took Neurontin with Celexa a few years ago, and I loved the combination. I was only on the Neurontin for a few months (it was during a difficult work situation that required my being in control even when someone in a position above me was completely pushing my buttons). I am only on Lexapro now, and while I am doing just fine, some days I wish I was on a mood stabilizer just so that I can stop reacting to issues that upset me. But I guess that a part of the treatment process is that I have to learn how to deal with daily issues such as anger and hurt feelings without slipping back into anxiety and depression.
Posted by David Smith on March 11, 2003, at 23:49:33
In reply to Do we *all* need mood stabilizers w/ a..d.'s? , posted by jay on March 10, 2003, at 9:22:15
This is a great thread.
I think I will donate $$$ to the board.
Thanks.
dave
Posted by Jack Smith on March 12, 2003, at 12:16:23
In reply to Re: Do we *all* need mood stabilizers w/ a..d.'s? , posted by David Smith on March 11, 2003, at 23:49:33
Posted by wendy b. on March 12, 2003, at 22:13:18
In reply to Re: Do we *all* need mood stabilizers w/ a..d.'s? » jay, posted by ayuda on March 11, 2003, at 23:32:10
> Sometimes I think that everyone on the earth needs mood stabilizers, especially those people who aren't taking anything because they think they are sane.
Now you're talkin'! (How about slipping some to Geo Bush?)
> Seriously, though, I took Neurontin with Celexa a few years ago, and I loved the combination. I was only on the Neurontin for a few months (it was during a difficult work situation that required my being in control even when someone in a position above me was completely pushing my buttons).I took Xanax and an AD for the same problem; work was insane, my boss was insane, she drove me insane-er...
>I am only on Lexapro now, and while I am doing just fine, some days I wish I was on a mood stabilizer just so that I can stop reacting to issues that upset me. But I guess that a part of the treatment process is that I have to learn how to deal with daily issues such as anger and hurt feelings without slipping back into anxiety and depression.
Why should you just have to "deal with" it? If the Neurontin was helping you, why not go back on it? Just a need to go it alone? Pish tosh! A low-level, once-a-day hit of Neurontin might be all you need. Anyway, it's a very safe med. Why are you reluctant to go back on it? Just curious, you don't have to answer if you don't want to...
best,
Wendy
Posted by David Smith on March 12, 2003, at 23:51:22
In reply to Have we again taken to speaking in code?? (nm) » David Smith, posted by Jack Smith on March 12, 2003, at 12:16:23
Re: Have we again taken to speaking in code??
Dear Jack,
Thanks for the perspective.
I was referring to Dr. Bob's request for donations. I imagine this board is expensive and time consuming. Here is the link which I should have posted with the above message.http://www.dr-bob.org/support.html
Have a good day.
dave
Posted by jumpy on March 20, 2003, at 17:31:46
In reply to Do we *all* need mood stabilizers w/ a..d.'s? , posted by jay on March 10, 2003, at 9:22:15
> I know, sounds like an 'outlandish' question. Also, please, I am not speaking from some Breggin kind-of (what I consider) "radical, irrational" viewpoint. But taking into account a few things:
>
> a) 'First..do no harm' as our pal Hippocrates (sorta) said. The massive "popularity" of antidepressants, and both the massive amount of 'adverse effects' and seemingly lack of overall efficacy in their use in monotherapy. (I know..this is controversial, but even some of the most stringent pharmacologists admit that the singular use of antidepressants has brought on many complications along with their anywhere from '40 to 80' percent 'cure' rate...take your pick on the figures to believe.) There is even some numbers to indicate that some (quite a few, actually) who are treated with just an a.d. may get some harm in future responses. (This being those prone to 'rapid cycling', and who fall into any place on the bipolar spectrum.) I will admit some of my thinking on this is influenced by some of the research brought up by Jim Phelps. (Controversial, again, as always.)
>
> b) The lack of overall effect of a major component of depression by monotherapy of antidepressants on suicide and suicidal ideation. The mood stabilizers, and lithium in particular, as well as the antipsychotics, still hold more efficacy towards suicidal ideation than antidepressants. Suicidal ideation is often a common link shared with depression (not always of course...and again I know...this is controversial...etc. etc.), and it seems that even if a person has had suicidal thoughts, many pdocs and docs will still prescribe an antidepressant without (or rather than) the more proven treatment of lithium, et al. I know this is deeply complicated, and it's a question of "treat the depression...it will (should) treat the suicidal ideation." But, again, the numbers show that mood stabilizers are more effective for suicidal ideation than antidepressants. That leaves wide open some very, VERY important questions of using antidepressants first-line for depression.
>
> I know this all makes things so much more confusing and such, but I think we should be deeply concerned because millions are treated quite simply for depression with a singular antidepressant, a treatment that still seems to be rather 'scattered'. (In addressing a few but leaving so many symptoms/questions wide open.)
>
> Please take into account the whole YMMV, controversial, etc. aspect of this. It's great to see these questions being asked in the halls of research clinicians, psychopharmacologists, etc, but even amongst the large population of psychiatrists and doctors, these questions seem to go passively by. Remember when you first went for treatment for your depression? How much of the spectrum of questions above did your pdoc or doc address, and how long did it take for you to ask some of these deeper questions? Even for those who have found some contented relief, there often was a *LOT* of suffering in between. What do you folks think?
>
> JayGreat question Jay ... I just watched Dr. Post's Lecture on the Neurobiology of Bipolar disorder. He was talking about depression and the tremendous amount of brain cell death that occurs with each episode. He goes on to talk about lithium and how it increase all the growth factors in the brain. Maybe low dose lithium would help all of us ... prevent loss of millions of brain cells even in unipolar depression.
I am going to speak to my pdoc about going on low dose lithium ... would it be rational. (I have several family members with bipolar disorder). One ... to protect me against going into a manic cycle, two ... to encourage cell growth, three ... see if it help my chronic recurrent depression (some say all chronic, relapsing depressions are variants of bipolar illness ... cycling illnesses).
Great observations.
Jumpy
This is the end of the thread.
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