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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by MB on June 1, 2003, at 18:57:07
OK, it's obvious that the people on this board are very educated about psych med pharmocodynamics; putative disease etiologies; side effect profiles of various treatments; etc.
In fact, most of the language people use on this board sounds like it's been directly lifted from some scientific journal, which leads me to believe that the posters here are doing *a lot* of in-depth research.Also, it's obvious that most of the peole that have been here for a while are treatment resistent (or treatment intolerant); if they weren't, they probably wouldn't need to stick around very long.
So, I'm wondering if there is a correlation between education about psychopharmacology and treatment resistence. And if there is a correlation, is it causative? And if the correlation is causative, which comes first, the treatment resistence or the education.
I can understand that the person with treatment resistant psychiatric illness would definitely start doing all kinds of research trying to find what options are out there, and how those options might apply to that person's specific illness.
But what if there's a causative relationship, also, in the other direction. For example, after I bought my first PDR, I became much more treatment intolerant. I don't know if this was because I began *looking* for the side effects listed in the book each time I tried a new med, or if it was because, at that time, I was becoming a vetran of the med-go-round.
When I first took Prozac, I couldn't tell that I was taking it, other than the fact that my depression was better. However, I did end up in physical therapy with a stiff neck and headaches. Also, I lost the ability to orgasm. These effects turned out to be due to the Prozac, but for years I lived with these symptoms thinking the Prozac was wonderful, not knowing that the Prozac caused them. Once I started educating myself about SSRIs and their ability to cause headache and dystonia, I decided to get off the Prozac to see if the symptoms got better. They did get better. The last time I took Prozac, and I developed dystonia and headaches, I was unwilling to comply with the treatment, knowing that they were caused by the Prozac. Years ago, "ignorance was bliss": I took the Prozac, learned to live with the dystonia and headaches, and things were relatively O.K.
Sometimes I think that treatment resistance is related to treatment intolerance. When I take a new SSRI and the "same old side effects" appear, I think to myself, "geez, this again? I don't want to live like this! Isn't there something better??" There's an added hopelessness when I *know* that my treatment for depression is the cause of some newly aquired psysical complaint. I think knowing that I'm going to have to live with weight gain, anorgasmia, headaches, fatigue, akathisia, etc. hampers the efficacy of the AD I'm on.
I wish I could go back to the old days when I never made a correlation with the medication and its side effects. I just let the medication work. And as far as the side effects, I simply thought, "I must just be going through a phase or a growth spurt."
Anyway, I'm very pro education. I read articles and the PDR and pharmacology texts and physiology texts. I think It's great to be educated about these drugs and these diseases. But sometimes I wonder if I'd be easier to treat if I was ignorant about the whole ball of wax.
Any thoughts?
MB
Posted by Cruz on June 1, 2003, at 19:47:19
In reply to Does Med Education Correlate With tx Resistence?, posted by MB on June 1, 2003, at 18:57:07
99.9% of us have a biochemical problem. Unfortunatly our biochemistry is poorly understood.
Posted by stjames on June 1, 2003, at 20:13:46
In reply to Does Med Education Correlate With tx Resistence?, posted by MB on June 1, 2003, at 18:57:07
> So, I'm wondering if there is a correlation between education about psychopharmacology and treatment resistence. And if there is a correlation, is it causative? And if the correlation is causative, which comes first, the treatment resistence or the education.
Yes and no. If you make choices about meds
based on a flawed understanding then you have made poor choices. I see people here saying
"I did not take X becuase a poster here
had <whatever> side effect". This totally misses
the point that SE's are person specific. There is no way to know till you try. I also find people
fix on whatever SE, read the PDR and get freaked out. A poster was very conserned, having read the PDR, about a minor SE of an AP. Minor in that it was reversable, if they stopped the med. Seems they just glossed over the more significant SE's
that are not reversable.I do feel that many come here a decide not to take X meds because of what might happen.
Given that X SE might happen or not, and also
this med could be very sucessful or not, I will go with a possible positive outcome. Take the med and see.Also there is the issue of this web page representing a good cross section of folks with
mental illness. It does not, not by a long shot.
Most here don't do well on meds & have lots of problems with them. So, basing a final desision
on a med based on others sucess or failure (from
this list) is flawed.
Posted by MB on June 1, 2003, at 21:16:24
In reply to NO!!!!!, posted by Cruz on June 1, 2003, at 19:47:19
> 99.9% of us have a biochemical problem. Unfortunatly our biochemistry is poorly understood.
I would even hazard to guess that if a person ends up on this board there's probably 100% chance that they have a chemical imbalance. I wasn't trying to suggest that we're not physically sick...I *definitely* believe that we are. However, sometimes I wonder if I'm sabotaging my treatment by spending so much time focusing on the etiology of my disease, and the pharmacology of the meds I'm on. I hope I didn't offend you.
MB
Posted by bookgurl99 on June 1, 2003, at 21:30:30
In reply to Does Med Education Correlate With tx Resistence?, posted by MB on June 1, 2003, at 18:57:07
Maybe we can become resistant, but only to certain meds. For example, I have a family history of diabetes and several other risk factors to develop diabetes. Hence, when my GP suggested I take Zyprexa, I refused because I already knew -- both due to PBabble and other sources -- that Zyprexa has been associated with weight gain and onset of diabetes.
I view this as an intelligent informed choice. With the market having created so many medications, we may as well choose the ones that are the best for us individually. This could take trial and error, but sometimes extra information is useful.
If you feel that focusing on the side effects of your meds will keep you from sticking to treatment, then you have choices:
1. Choose no treatment.
2. Choose the old treatment (Prozac), while also consciously choosing to live with the side effects.
or
3. Keep searching until you find a med that does not have discomfort-causing side effects for you.
It sometimes can be useful to pay attention to the experience of someone who has experiences that are similar to yours, because what works for them _might_ work for you. However, I've seen people make blanket statements, like X drug gives _everyone_ mania, that I know not to be true. Obviously, you have to consider the quality of the info.
Posted by Larry Hoover on June 1, 2003, at 22:27:38
In reply to Does Med Education Correlate With tx Resistence?, posted by MB on June 1, 2003, at 18:57:07
> So, I'm wondering if there is a correlation between education about psychopharmacology and treatment resistence. And if there is a correlation, is it causative? And if the correlation is causative, which comes first, the treatment resistence or the education.I snipped to this paragraph, as I think all else flows from the answers to these questions.
You're quite correct to wonder at the significance of correlations based on your own experience, and the observations of others. However, any leap to causation is probably without foundation.
There is a possibility the reading the extensive listings of possible side effects in the drug monograph or PDR might induce some level of suggestibility. But the incidence rates of most side effects are small, and even among the more common ones, you're not going to get them all. Side effects, as a generality, are more the rule than the exception.
Moreover, I think it unlikely that an attitude of doubt about the true efficacy of meds could do much to block their physiological effects, if there are to be any. It could, however, reduce the likelihood of placebo-type responsiveness. Perhaps that sense of doubt increases with each treatment failure. But that's the human element, something I wouldn't necessarily associate with familiarity with the PDR or measures of intelligence.
I wonder if you've considered the logical fallacy "post hoc, ergo propter hoc", i.e. after this, therefore because of this. I think this form of (il)logic may well be hard-wired into our brains. We see one significant or salient thing happen, and then following that, another significant or salient event. We know they are linked by the flow of time, a temporal sequence. It seems to be inferred that the earlier event may be causative of the latter one, even without a logical or rational link between them.
Your refer to trying SSRI meds on different occasions, but noticing similar effects. Could that be because they are similar meds, rather than because you read up on their psychopharmacology?
Methinks you may thinks too much about this.
Respectfully,
Lar
Posted by stjames on June 1, 2003, at 23:34:08
In reply to Re: NO!!!!! » Cruz, posted by MB on June 1, 2003, at 21:16:24
However, sometimes I wonder if I'm sabotaging my treatment by spending so much time focusing on the etiology of my disease, and the pharmacology of the meds I'm on. I hope I didn't offend you.
One thing I try to remember when reading on
the science of mental illness is that even the experts still can't pick a med for me that will
work and I can tolerate, without doing a lot of trial and error. We have not model for mental illness that works correctly.If you are excluding other treatments and approaches, such as social and psychological
issues and support, & seeking total understanding
and treatment from the standard medical approach then yes you are "sabotaging" your treatment.
Posted by BekkaH on June 2, 2003, at 1:00:04
In reply to Does Med Education Correlate With tx Resistence?, posted by MB on June 1, 2003, at 18:57:07
MB,
Your post seems to be a rather circuitous way of blaming yourself for your illness. Blaming yourself is punishing yourself. Punishing yourself is a symptom of depression, and it certainly won't make you feel any better.
I think the term "treatment resistant" is another way of blaming the patient for psychiatry's and psychiatrists' failures. I've come across a number of psychiatrists who have very little insight into themselves, and rather than acknowledge their inability to help the patient, rather than admit how little they know and how primitive psychopharmacology is compared with pharmacology in other specialties, they take out their frustrations and feelings of inadequacy on the patient. They blame the patient, and come up with all kinds of useless diagnostic labels and terms that serve only to further distance themselves from the patient and from their own painful truths. Collaborating with them in the blame game will not help you.
Psychopharmacology is way behind pharmacology in other fields. Although there are a few promising medicines currently being researched, most of the money is going into those good-for-nothing Prozac wannabee's -- more ssri's and ssri/snri combos that are, at best, band-aid jobs. The approval of truly novel antidepressants is still a long way off. In addition, I believe that nearly all psychotropic drugs, if taken long enough, will eventually "poop-out" or create "tolerance." Perhaps there is some homeostatic basis for this.
The FDA, the greedy pharmaceutical companies, and the psychiatrists who are in bed with those companies are at fault; not you. I have seen first-hand and read about numerous instances of drug companies handsomely remunerating psychiatrists to manipulate statistics and massage the data from clinical studies, to make the results of the studies appear better than they really are. So, you see, you can't possibly compare yourself with those patients who responded so well in the clinical studies because the data are seriously flawed. The first and most important thing to do when reading a clinical study of a drug is to look at who paid for the research. If it was paid for and sponsored by the pharmaceutical company that makes the drug, you can take most of the information with a grain of salt. I see I'm going off on a tangent here, but the point I'm trying to make is that the patient should not be blamed for the sorry state of psychiatry.
Posted by Ritch on June 2, 2003, at 10:41:47
In reply to Does Med Education Correlate With tx Resistence?, posted by MB on June 1, 2003, at 18:57:07
> Also, it's obvious that most of the peole that have been here for a while are treatment resistent (or treatment intolerant); if they weren't, they probably wouldn't need to stick around very long.
...I disagree to some extent about the med ed. == Treatment resistance/intolerance correlation-that it is causative, but you have brought up some interesting and important ideas. I think that the blizzard of new psych. medications showing up very suddenly in the last decade coupled with high-tech pharmaceuticals with multiple meds for everything in the pipelines (and news about them), may be keeping people in a constant state of *expectation* about the newest magic bullet around the corner. That heightened level of expectation and vigilance coupled with the large possiblity of combinations/dosages of existing meds may likely be creating a phenomenon of hyperfocus on the meds. However, I think this is a broad sociological thing that is going on that involves some kind of "information impatience" about many aspects of daily living.
Posted by MB on June 2, 2003, at 17:17:45
In reply to Re: Does Med Education Correlate With tx Resistence?, posted by bookgurl99 on June 1, 2003, at 21:30:30
<cut>
> Hence, when my GP suggested I take Zyprexa, I refused because I already knew -- both due to PBabble and other sources -- that Zyprexa has been associated with weight gain and onset of diabetes.
See, this is kind of what I do, except to a greater degree...like I don't want to take a tricyclic or remeron because I know that I can't tolerate antihisamines. I feel hopeless about SSRIs because none have worked so far. I'm afraid of lithium because I've already got hypothyroidism and I'm still recovering from the shock of 40 lbs of fat put on from Paxil. Depakote scares me because a friend's son suffered irreversable liver damage from it, and the two people I know who've gone on it have gained MAJOR weight. I'm a psychiatrist's nightmare. I look at all of the psychotropic medications available and have already tried the ones I'm willing to try. Either I have to become more open-minded, or they have to invent a new drug (one that works and is tolorable). I'm losing my open-mindedness (or what little I had).
I know that there are infinite combos to be tried, but I've been on so many that haven't worked...and after each failed trial, I feel like I'm even more sensitive to the drugs, more depressed, and more brain-fried. I'm not anti-med...maybe just jaded from my experience with psych meds. Uggg...I'm just exasperated. I wish I had just stayed on the Prozac years ago, that I never associated the dystonia and headaches with the drug, and that I stayed on my little uninformed, ignorant, but semi-decent path. Or I wish they'd give me unlimited morphine and money and let me sit and test lollipops all day. Why can't they at least do that?
MB
Posted by bookgurl99 on June 2, 2003, at 17:39:48
In reply to Re: Does Med Education Correlate With tx Resistence? » bookgurl99, posted by MB on June 2, 2003, at 17:17:45
> Or I wish they'd give me unlimited morphine and money and let me sit and test lollipops all day. Why can't they at least do that?
>
Whoa, I know this is a joke, but you sound really depressed. Did you realize that? Morphine? Basically you're saying you don't want to feel anything?What's going on? What kind of symptoms are you having? It almost sounds to me like more is going on than the depression. Maybe your hypo-self needs to be retreated.
Posted by MB on June 2, 2003, at 17:44:00
In reply to Re: Does Med Education Correlate With tx Resistence? » MB, posted by Larry Hoover on June 1, 2003, at 22:27:38
> Moreover, I think it unlikely that an attitude of doubt about the true efficacy of meds could do much to block their physiological effects, if there are to be any. It could, however, reduce the likelihood of placebo-type responsiveness. Perhaps that sense of doubt increases with each treatment failure. But that's the human element, something I wouldn't necessarily associate with familiarity with the PDR or measures of intelligence.
See, I agree that doubt about the drug shouldn't hamper its efficacy, yet my doctor tells me that if I *believe* that nothing will work, then nothing will work. This sounds preposterous. The belief that nothing will ever work--that kind of hopelessness--seems like just another symptom of depression; a symptom that any *real* antidepressant should correct...i.e., my cynicism about medication shouldn't hamper its efficacy. I agree. Ok, so I think I answered my own question from the previous post...in a way. Learning about these things shouldn't make them less effective. But, I can see that I might "be on the lookout for side effects" and feel them when I might not have otherwise. Or I might be afraid to try a medication because its mechanism of action is similar to something I've tried in the past that didn't agree with me...hence my rapidly closing mind regarding psychopharmacology (and my rapidly opening mind regarding drugging myself into oblivion with things that, in the past, may not have improved my functionality, but improved the way I felt)> I wonder if you've considered the logical fallacy "post hoc, ergo propter hoc", i.e. after this, therefore because of this.
Yeah, I was thinking of that. I noticed that education and treatment resistance coincided, and I was just wondering if anyone *thought* there might be a causative relationship in either direction. I know what you mean about the mind assuming causal relationships just because there is a temporal correlation between two events. That is probably going on to a certain degree in my mind (well, I *know* it is, or I wouldn't have asked the question in the first place).
> Your refer to trying SSRI meds on different occasions, but noticing similar effects. Could that be because they are similar meds, rather than because you read up on their psychopharmacology?Actually what was happening was that the side effects of each subsequent trial were getting worse, and the drugs seemed progressively less effective in the order in which I tried them. Simultaneously, I was reading up on pharmacology, trying to figure out what was going on. There may have been a few times that I was oversensitive to side effects because I was on the lookout for them...or a couple of times when I said, "heck, this Zoloft works just like the Prozac I recently discontinued...the Prozac didn't work, so why stay on the Zoloft?" I know I've been guilty of those lines of thinking in the past.
> Methinks you may thinks too much about this.
Hahaha...that's an understatement! I think if I could think less, the whole world could benifit! lol
MB
Thanks for the imput, Lar
Posted by MB on June 2, 2003, at 17:52:58
In reply to Re: maybe, posted by stjames on June 1, 2003, at 23:34:08
> If you are excluding other treatments and approaches, such as social and psychological
> issues and support, & seeking total understanding
> and treatment from the standard medical approach then yes you are "sabotaging" your treatment.Yeah, I have sort of flaked on my therapy, and have been relying simply on a doc who is "managing" my meds. Very little discourse. Maybe I want something for nothing. It's probably time to be more proactive (e.g., get more exercise, get back in therapy, eat better, try supplements, etc). It's just that exercise seems impossible (both when I'm depressed and when I'm medicated) and all I want to eat is carbs and sweets. It's very difficult. I've been irresponsible about flaking on therapy. My sick mind is saying, "why can't there just be a pill that makes it all better?" and then I look at what's available and stick my nose in the air at the options. I'm becoming somewhat of a baby about this after so many years.
MB
Posted by MB on June 2, 2003, at 18:02:22
In reply to MB - Stop blaming yourself, posted by BekkaH on June 2, 2003, at 1:00:04
Wow. You can be my therapist from now on (no, I wouldn't wish that on anyone, lol). There was truth in what you said--truth that I once knew, but suppressed in my state of depressive self-loathing. I don't know why, but reading your post made me feel a lot better. Thanks. It's not my fault that their drugs only work halfway and that they make me feel icky. I could read books until the cows come home, and it's stillnot my fault if something makes me sick or if something only brings me part way out of the pit. The only reason I did the research in the first place was because their methods were unsatisfactory...I felt like I had to take things into my own hands.
MB
Posted by MB on June 2, 2003, at 18:10:06
In reply to Re: Does Med Education Correlate With tx Resistence? » MB, posted by Ritch on June 2, 2003, at 10:41:47
<cut>> That heightened level of expectation and vigilance coupled with the large possiblity of combinations/dosages of existing meds may likely be creating a phenomenon of hyperfocus on the meds.
<cut>
But do you think that an individual's hyperfocus on the meds might be a problem? I can see myself some days sitting in the house waiting for the meds to "kick in," when maybe they've already kicked in and all I have to do is go out and join life.
However, on second thought, it seems like if they were really working, I'd *want* to go out and join life. Maybe I've just built up so much inertia sitting around, that getting up and out will require some kinda crucial impetus that the meds can't give. Here I go over-thinking.
MB
Posted by stjames on June 2, 2003, at 18:33:41
In reply to Re: maybe » stjames, posted by MB on June 2, 2003, at 17:52:58
I'm becoming somewhat of a baby about this after so many years.
>
> MBWell, you have a choice. Do nothing and suffer.
Everyone can come up with good reasons to not do
whatever, but I have yet to hear a good reason to suffer. As mental illness is progerssive, it will get worse.Now, you don't have to do everything. Pick one thing and work on it, be it thearpy, nutrution, or (ick!) exercise.
Posted by Ritch on June 2, 2003, at 22:28:15
In reply to Re: Does Med Education Correlate With tx Resistence? » Ritch, posted by MB on June 2, 2003, at 18:10:06
>
> <cut>
>
> > That heightened level of expectation and vigilance coupled with the large possiblity of combinations/dosages of existing meds may likely be creating a phenomenon of hyperfocus on the meds.
>
> <cut>
>
> But do you think that an individual's hyperfocus on the meds might be a problem? I can see myself some days sitting in the house waiting for the meds to "kick in," when maybe they've already kicked in and all I have to do is go out and join life.
>
> However, on second thought, it seems like if they were really working, I'd *want* to go out and join life. Maybe I've just built up so much inertia sitting around, that getting up and out will require some kinda crucial impetus that the meds can't give. Here I go over-thinking.
>
> MBI remember a post of yours from quite some time ago where we were talking about OCD. I mentioned something about "rehearsing" what has been said and continually re-examining all of the angles and alternate possibilities, and you replied back mentioning that this was "EXACTLY" what your thoughts were doing. Well....I've noticed a big increase in this sort of thing in the last few weeks....and it seems to be associated with this bipolar transition state I get into every so often. I don't know how it actually relates to OCD for sure (if it does), but it is after I "crash" from a "bubbly" manic phase, but .. not into a depressive phase, but a mixed state thing where I feel temporarily wired at odd times during the day... upbeat when environmental things go well... then very existentially funked-out the minute the good things go away. The thing I've noticed for sure is this major sleep disruption-like sleep earthquakes of some kind. My sense of humor wanes, but I don't feel sad-it's really weird. Anyhow... I notice that when I am waking in the middle of the night that my mind is working on these type of issues/problems, like I have been employed to solve them somehow and must continue to compute all the possibilities. Is it OCD? I'm not sure-it is kind of like being an unenthusiastic draftee-I'm going along for something I'm not into. When I'm in a "pure" high I feel in control of the ideas-like a designer of a well-head to control the oil flow or something. This mixed stuff is different-it is like you are being *presented* with everybody *else's* ideas and you have to deal with too much on the input side-instead of the output side.
Posted by McPac on June 2, 2003, at 22:45:26
In reply to MB - Stop blaming yourself, posted by BekkaH on June 2, 2003, at 1:00:04
What an AWESOME post!
Posted by linkadge on June 3, 2003, at 20:49:39
In reply to Bekka, Re: MB - Stop blaming yourself, posted by McPac on June 2, 2003, at 22:45:26
I'd say there is possibly some correlation. But thats a natural human instinct isn't it. Your car was once the best in town and you felt proud of it. When somebody gets a better car, all of a sudden yours isn't so good. Has the car changed ? No.
We all must remember here, that the brain can only accept so much pleasure. In the future, antidepressants will not get much better, but they will be more reliable, work faster, and with better effects.Last year, after I recovered from Depression, I started to get really hedonistic about it all. Spending my entire day finding ways to improve my mood just a little bit more. To make a long story short, I ended up feeling better and better untill I went fully fledged manic and psychotic.
Is it in my genes ? Perhaps.A mind that is constantly and persistantly aroused cannot last. Glutimate will eventually start acting as a toxin and cause brain dammage.
Most people here, were so frightened by their initial episode of illness, that all the research they do, is a desparate attmempt to prevent it from happening again. That is natural for a human.
So the idea of our society looking for a constantly better mood is just not realistic.
Besides, recovery from depression is very similar in the brain, regardless of the treatment method.
This is why taking more antidepressant than you need really doesn't do much long term. Once I tested to see if 40 mg of Celexa was better than 20mg. At first it was, then it just made me very lethargic and unmotivated.
The point I am trying to make is that the
term "chemically imblanced" really does apply.SSRIs can cause a little bit of an ititial euphoria, but this quickly tapers off as the brain begins to fix itself.
We have to remember that mania, (the state that some people think that us drug users are seeking)
is just as destructive depression.
Linkadge
This is the end of the thread.
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