![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 38 to 62 of 80. Go back in thread:
Posted by Ritch on March 20, 2005, at 16:42:48
In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 19, 2005, at 17:12:20
> I ran across this thread and thought I'd shed some light on this confusion. A QEEG is a digital EEG (previous EEG's cannot be used to extract the data you want). What you DO with the data is the important issue. Everything in this thread has been talking about different uses than the article or the medication effects you're searching for. An rEEG is a "referenced" EEG originally done by years of research from 2 very bright and ethical scientist. The digital EEG is sent through a database that correlates the brain's electrical activity with the drug's known effects on the brainwaves. Therefore a more precise statistical analysis can, in essence, produce a report whereby people with your brainwaves have "X" probability of a positive response with the medication or combination of medications suggested. For those of us who've used this, our independant analysis seems to range from 72-95% success (being defined as "was the database either essential or very important" in getting the patient to our final regieme. I can no longer see practicing psychiatry without something like this. We are beyond the point of "throwing it against the wall to see what sticks" and this is the beginning of a new horizon, I believe. The website for the company is www.cnsresponse.com
> Daniel Hoffman, M.D. - NeuropsychiatristSo, a QEEG is an *individual* digital EEG that is done on an individual specific patient? I think I've gotten that one. However, the understanding of the composition of the rEEG database is still a little muddy to me. Also, do all psychiatric medications alter brainwave activity? How well do brainwaves mirror or reflect psychopathology? Can someone be indisputably schizophrenic (i.e.) and have a statistically normal QEEG? How would that square with this concept? Just curious...
Posted by Daniel Hoffman, M.D. on March 20, 2005, at 19:15:21
In reply to Re: rEEG System Helps Guide Prescribing » Daniel Hoffman, M.D., posted by Jakeman on March 20, 2005, at 13:14:11
Jake-
The rEEG makes no assumptions about diagnosis and can't predict side effects. With Poop-Out, I would predict that the rEEG would choose different medications than you had, or perhaps a combination such that the receptor would hold and not change it's regulation, thus keeping the effects. For example, mood stabilizers often will keep a receptor from re-regulating and thus Poop-out may not occur. Anecdotal stories of adding modafinal (Provigil) seemed to help prevent poop-out in some cases.The rEEG can't tell you about hormones, etc other than the net effect of such things on brainwaves. They do have, however, in their database, some of the natural products and sometimes can substitute a natural product for a pharmeceutical product.
Regarding where to get an rEEG... The company is small with little capacity and there aren't enough of people like me who know electrophysiology to make this common place. However, there is a large Neurofeedback community and most of them have the ability to collect the data in such a way that it can be processed by CNS. Then, you'd need a doctor that would be willing to consult with them or me or some medical director to help interpret and implement the results. You might want to write CNS and tell them where you're located as well as post it here. We might know someone in your area. Hope this is helpful.
Posted by Daniel Hoffman, M.D. on March 20, 2005, at 19:23:33
In reply to Re: rEEG System Helps Guide Prescribing » Daniel Hoffman, M.D., posted by Ritch on March 20, 2005, at 16:42:48
> > I ran across this thread and thought I'd shed some light on this confusion. A QEEG is a digital EEG (previous EEG's cannot be used to extract the data you want). What you DO with the data is the important issue. Everything in this thread has been talking about different uses than the article or the medication effects you're searching for. An rEEG is a "referenced" EEG originally done by years of research from 2 very bright and ethical scientist. The digital EEG is sent through a database that correlates the brain's electrical activity with the drug's known effects on the brainwaves. Therefore a more precise statistical analysis can, in essence, produce a report whereby people with your brainwaves have "X" probability of a positive response with the medication or combination of medications suggested. For those of us who've used this, our independant analysis seems to range from 72-95% success (being defined as "was the database either essential or very important" in getting the patient to our final regieme. I can no longer see practicing psychiatry without something like this. We are beyond the point of "throwing it against the wall to see what sticks" and this is the beginning of a new horizon, I believe. The website for the company is www.cnsresponse.com
> > Daniel Hoffman, M.D. - Neuropsychiatrist
>
> So, a QEEG is an *individual* digital EEG that is done on an individual specific patient? I think I've gotten that one. However, the understanding of the composition of the rEEG database is still a little muddy to me. Also, do all psychiatric medications alter brainwave activity? How well do brainwaves mirror or reflect psychopathology? Can someone be indisputably schizophrenic (i.e.) and have a statistically normal QEEG? How would that square with this concept? Just curious...The rEEG database takes the digital (QEEG) and first compares the patient's brain to a normative database. Then it takes these "abnormalities" and by using formulas etc (knowing the drug signature of each medication) it matches the patients brain to which medications will balance it. It does not contain the atypical antipsychotic medication at this time. It does not always match with our current nomenclature. For example, many patients who look depressed don't even show an antidepressant on the radar screen. Is that depression? a subtype? A study of 39 patients who were given 17 different diagnoses all turned out to have the same brain and respond to the same drug. I've never seen a patient with significant clinical symptoms have a normal rEEG, but I have seen patients who come back saying that having gotten off the medicine for the test in the first time in 10 years they feel better, and the rEEG results suggest that not very much is wrong with them. The schizophrenia example is not the best, since again, those meds aren't in the database - yet.
Posted by Jakeman on March 21, 2005, at 22:54:19
In reply to Re: rEEG System Helps Guide Prescribing » Jakeman, posted by Daniel Hoffman, M.D. on March 20, 2005, at 19:15:21
> Jake-
> The rEEG makes no assumptions about diagnosis and can't predict side effects. With Poop-Out, I would predict that the rEEG would choose different medications than you had, or perhaps a combination such that the receptor would hold and not change it's regulation, thus keeping the effects. For example, mood stabilizers often will keep a receptor from re-regulating and thus Poop-out may not occur. Anecdotal stories of adding modafinal (Provigil) seemed to help prevent poop-out in some cases.
>
> The rEEG can't tell you about hormones, etc other than the net effect of such things on brainwaves. They do have, however, in their database, some of the natural products and sometimes can substitute a natural product for a pharmeceutical product.
>
> Regarding where to get an rEEG... The company is small with little capacity and there aren't enough of people like me who know electrophysiology to make this common place. However, there is a large Neurofeedback community and most of them have the ability to collect the data in such a way that it can be processed by CNS. Then, you'd need a doctor that would be willing to consult with them or me or some medical director to help interpret and implement the results. You might want to write CNS and tell them where you're located as well as post it here. We might know someone in your area. Hope this is helpful.
---------------------Thanks for your feedback. I once suggested augmenting Celexa with a mood stabilizer to my doctor, he didn't agree with it for some reason. That's a good ideal about writing CNS, I'll follow up on that. I live in the Austin area. The Clinical Psychiatry News article at the beginning of this thread mentioned research being conducted at the University of Texas. So I might be able to find a contact there (or maybe be a participant in the clinical trial...)
-Jake
Posted by Daniel Hoffman, M.D. on March 21, 2005, at 23:07:30
In reply to Re: rEEG System Helps Guide Prescribing » Daniel Hoffman, M.D., posted by Jakeman on March 21, 2005, at 22:54:19
Jake,
If you can't hook up with anyone, I know of someone who could collect the data in Austin - but you'd still need an MD to prescribe based on the results.
Posted by Iansf on March 22, 2005, at 2:00:11
In reply to Re: rEEG System Helps Guide Prescribing » Jakeman, posted by Daniel Hoffman, M.D. on March 21, 2005, at 23:07:30
Dr. Hoffman, you mention that rEEG cannot predict side effects. So it seems the methodology would be useful primarily to people who have not tried many meds or who have not got relief from the meds they did try
It seems to me that those who have tried a variety of meds, which applies to many people on this board, could end up spending a lot of money only to be recommended drugs they previously discontinued because of intolerable, or at least unacceptable, side effects.
Certainly for me, side effects, not effectiveness, have been the real issue. Several SSRIs helped me a lot with both depression and social phobia, but all had what I considered unacceptable side effects, and efforts to counteract the side effects proved futile. On the other hand, Wellbutrin has no side effects but unfortunately only helps a little with depression and not at all with social phobia.
In case,s like mine, I can't see that rEEG would be of much benefit. Is this correct, or is there something I'm not seeing? Thank you.
Posted by Daniel Hoffman, M.D. on March 22, 2005, at 8:51:16
In reply to Re: rEEG System Helps Guide Prescribing » Daniel Hoffman, M.D., posted by Iansf on March 22, 2005, at 2:00:11
Your comments about side effects are "sort of" correct. Most of the people I've seen have been on many meds - upto 30 trials. So the person who has tried several medications is actually the primary target for this test. Often the person was on the right meds, but not the right combination to balance the brain and thus attain symptom relief. Sometimes, we can do a second rEEG with the meds on board and see if a remaining problem is due to some other finding popping up or perhaps dosing didn't move the EEG towards normal. However if the only problem is side effects not effectiveness of medications, than I would tend to agree that unless the rEEG offers a different class of drugs that one could in fact tolerate, it may not be as worthwhile. The problem is you don't know. There could be a few ways to treat a problem. E.G., if you can't tolerate SSRI's for example, maybe the same could be accomplished with a beta blocker and a stimulant (just as a hypothetical), in which case tolerability is resolved.
Posted by WeeWilly on March 22, 2005, at 14:43:16
In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 8:51:16
This smells like snake oil. Where are the studies to back up these claims. The main problem with the treatment of mood disorders is we do not know what are the causes of mood disorders. In my case I am certain it is an endocrine problem and not a serotonin,ne or dopamine imbalance. I suspect that many others have a endocrine problem that is the root of their mood disorder. Maybe I am wrong but something about this rEEG system sounds phony.
Posted by franco neuro on March 22, 2005, at 15:38:57
In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 8:51:16
Please allow me to throw my two cents into this discussion. Generally when I see a doctor post a message on psycho-babble I figure they're here trying to drum up business. Forgive my cynicism, but it's born of the experiences I've had in dealing with the medical community over the past few years. Having said that, I found the following sentence from your previous post very intriguing.
> There could be a few ways to treat a problem. E.G., if you can't tolerate SSRI's for example, maybe the same could be accomplished with a beta blocker and a stimulant (just as a hypothetical), in which case tolerability is resolved.
This tells me that you are someone who thinks outside of the box. A quality I've yet to come across in any of the doctors I've seen. And believe me I've seen dozens of doctors over the past few years. Maybe I'm just a hard case. Five or six years ago I went through a particularly stressful period. The dysthymia and GAD that I had chosen to ignore for the previous decade suddenly turned into a full blown neurosomatic disorder. I now have chronic pain, chronic fatigue, IBS, anhedonia and depression. (I ask you how could one not be depressed with the aforementioned problems?) In a headlong rush to find relief I bounced from doctor to doctor. And like many (if not most) of the people on this website, I began bouncing haphazardly from one medication to another while learning nothing in the process.
About two years ago I decided to become my own "medical detective." One of the books I read was "The Edge Effect" by Dr. Eric Braverman. It's an interesting, although somewhat simplistic book. In fairness, any book dealing with brain function that is aimed at the general public has to be "simplified" or no one would understand it. In the book he talks about how QEEG "Brain Mapping" is a large part of his diagnostic process. I was looking for a doctor who used this so I went to see him and had it done. (Ridiculously overpriced of course.) According to him the test showed that I have very low dopamine. Now I don't know if he used a comparative database or his own experience in using this device but it was the result I had come to expect. Here's why:
1. I'd been experimenting with amino acids during the past year and found that tyrosine helped me. Tyrosine, of course, is the precursor to dopamine and norepinephrine.
2. My father and uncle both take medications for parkinsonism. A condition of low dopamine. Perhaps indicating a genetic predisposition toward dopamine burnout.
3. SSRI's have not helped me. While slightly elevating mood they have tended to increase apathy and make my physical symptoms worse. Not only that. When I recently stopped taking Zoloft I had the best 2 or 3 days physically and mentally that I've had in a few years. Perhaps this is due to my serotonin level dropping below the pre-medication baseline for a couple of days until my brain was able to compensate for the cessation of the medication by increasing endogenous levels/transmission. I'm not a scientist so I may be totally wrong about this. However, if this is the case than maybe I'd benefit form a serotonin antagonist along with a dopaminergic med. Unfortunately when it comes to raising dopamine levels, our choices are few.
It would be nice to talk to Dr. Braverman about this but he isn't around much. He's been on Larry King and Neil Cavuto so I'm starting to worry that he aspires to be a celebrity. Even when he happens to be in the office it's virtually impossible to see him for more than a minute. So the frustration continues. If it gets bad enough maybe I'll hop in the car and drive to Colorado. Not likely though. I'm too darned tired. For now I think I'll just try picking a psychopharmacologist out of the phone book. It shouldn't be hard considering there are only 3 listed.
So the point of this rather long winded post is that I believe that the evidence taken in it's entirety may finally be pointing me in the right direction. In my case at least, the QEEG may have proven itself to be of use. Of course had my QEEG come up with a result other than the one I expected, I would be even more confused than ever. But until I get on the right medication and correct (as much as is possible) the suspected imbalance and start to feel better (God willing) I won't be able to say for sure how much it has helped me.
By the way, are you familiar with the work of Dr. Jay A. Goldstein? I was considering going out to California to see him but he retired last year. I just read his book "Tuning the Brain". Awesome book. It's a must read. Particularly if some of your patients with psychological problems have concomitant neurosomatic disorders. He's got me thinking that an NMDA antagonist might also help me. Although dopamine itself antagonizes NMDA. He's twenty years ahead of the rest of the medical community. No offense intended. :-)
Posted by Phillipa on March 22, 2005, at 16:02:46
In reply to Re: rEEG System Helps Guide Prescribing » Daniel Hoffman, M.D., posted by franco neuro on March 22, 2005, at 15:38:57
I would like to know how a person like me could feel the effects of meds so intensely, that I couldn't take any AD's. I did tolerate Luvox and actually got up to 250mg at which point the pdoc I was seeing[has since been in newspapers locally for medical fraud and illegal distribution of controlled substances], discontinued it. He said he needed l0 people for a Celexa trial when the med first came out. I refused, so when I came in for my appointment he said "you're catatonic", and I'm taking you off the med and putting you on Celexa. I wasn't catatonic, I had been attending A Group that stressed only doing one task a day and training your body to relax. Anyway I felt like death on the Celexa. I also was on xanax. He finally took me off after a month of misery. I also found out I had chronic active Lymes Disease at this time. Anyway since then I've never been able to tolerate even the luvox at doses over l2.5mg. Now it seems as if my body doesn't even respond to Ad's. I've been put on cymbalta, zoloft, remeron, and don't feel a thing. The only med that still seems to have an effect on me is valium. So what is my problem? Oh I've finished menopause. Fondly, Phillipa
Posted by Iansf on March 22, 2005, at 18:48:45
In reply to Extremely skeptical, posted by WeeWilly on March 22, 2005, at 14:43:16
> This smells like snake oil. Where are the studies to back up these claims. The main problem with the treatment of mood disorders is we do not know what are the causes of mood disorders. In my case I am certain it is an endocrine problem and not a serotonin,ne or dopamine imbalance. I suspect that many others have a endocrine problem that is the root of their mood disorder. Maybe I am wrong but something about this rEEG system sounds phony.
>
Calling rEEG snake oil seems rather harsh. In my opinion, it's always wise to be somewhat skeptical of new approaches, but as described by Dr. Hoffman it certainly sounds like rEEG has reasonable scientific grounding. It may not be THE answer, but generally it looks to be heading in the right direction.
And the fact that problems show up in brain wave patterns doesn't necessarily rule out an endocrine imbalance as a cause of mental imbalances. After all, everything going on in your body is ultimately tied to the brain.
It's conceivable that in some - perhaps all - cases, using meds that re-regulate the brain is treating a symptom, not a source. But surely tracking down a source outside the brain would be helped by looking at brainwave patterns, then tracing them back to the body systems most likely to affect the brain in that way.
All innovative therapies need polishing to achieve their full potential. Dr. Hoffman's approach holds promise. Be skeptical, but don't dismiss it out of hand.
Posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34
In reply to Re: rEEG System Helps Guide Prescribing, posted by Phillipa on March 22, 2005, at 16:02:46
It was with great reluctance that I entered into this thread. Nothing tics me off more than people questioning my integrity. I still see medicine as a very noble profession, so when someone is cynical or skeptical of my life's passions and volunteer commitments to help others with my EXTREMELY busy schedule, I don't take kindly to it. Now I know no one knows me and there is plenty of reason to be skeptical, but suffice it to say that I have been trying very hard to correct erroneous impressions of rEEG that were posted on this thread that were brought to my attention inadvertently. I have no desire nor need to drum up any business from anyone. I've devoted much of my neuropsychiatric career to helping bring my profession out of the dark ages. I've published, am a consulting editor of 3 national peer reviewed journals, etc and my goal was to offer some education on this topic. To summarize the original points I was trying to make initially:
Brain-mapping or any other QEEG analysis differs from rEEG in one extremely key easy to understand way. ONLY rEEG uses an outcome database – patients who were treated successfully and unsuccessfully. That is why it is more directly relevant to medication selection. Other approaches only had a comparison to a normative database – that is people without symptoms These identify differences from the norm but then had to make suppositions about what might correct the norms or perhaps what diagnosis was appropriate. Because of the patient database, rEEG goes the next step and asks, in fact what medications work most of the time for people having those aberrations. Without this data everything is necessarily a guess. So the lesson here is you can learn more from patients who have been treated than you can from untreated and asymptomatic individuals.
The scientists who spent 18 years developing this database on their own time are some of the top people I've ever met, and stand up well to scutiny with professors and chairmans at Stanford, Harvard, etc - where in fact research pilots are starting. There are some publications on this and some submitted. A field has to start somewhere. This is not a panacea, but offers some people an evidence based approach to their neurophysiology with possible alternatives and objectivity beyond nomenclature.
Eric Braverman uses QEEG, but not rEEG - yet. He has been exposed to it and is impressed with it (as far as I can tell).
I hope my input has clarified some things. I will now bow out to the sidelines, least I be further accused of trying to drum up business. While it is hard for me to say no to someone asking, I will make it a rule not to accept any inquiries from anyone on this site to support my independent objective uncomprimising position.
Posted by Phillipa on March 22, 2005, at 19:56:14
In reply to Re: Extremely skeptical » WeeWilly, posted by Iansf on March 22, 2005, at 18:48:45
I personally, am very honored that Dr. Hoffman took time away from his certainly very busy schedule, and attempts at leisure life. I have already forwarded his responses to quite a few people that I knew would benefit from his insight and knowledge. I appreciate your contrabution to the PsychBabble Board. I know this has given me and a lot of others faith that all pdocs are not "owned" by the drug companies, and truly have the best interests of their patients at heart. Congratulations, Dr. Hoffman, for not being afraid to stand up and be heard. To step forward and educate us to the promise of better treatment in the future. I graciously thank you. Fondly, Phillipa
Posted by Jakeman on March 22, 2005, at 22:44:45
In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34
I appreciate your contribution to this discussion and regret you took offense to some of the responses. I have to admit that I am a little taken aback by the stridency of your last post and your "rule" to not respond to any inquiries. Unfortunately there IS a lot of cynicism overall toward the psychiatric profession, but I agree with the poster who said you appear to be someone who is trying to improve the situation. I find rEEG and similar methods to be a fascinating subject and I will continue to read all I can about it (hopefully your papers as well). BTW, many of us are ALSO professionals with very busy schedules.
-Jake> It was with great reluctance that I entered into this thread. Nothing tics me off more than people questioning my integrity. I still see medicine as a very noble profession, so when someone is cynical or skeptical of my life's passions and volunteer commitments to help others with my EXTREMELY busy schedule, I don't take kindly to it. Now I know no one knows me and there is plenty of reason to be skeptical, but suffice it to say that I have been trying very hard to correct erroneous impressions of rEEG that were posted on this thread that were brought to my attention inadvertently. I have no desire nor need to drum up any business from anyone. I've devoted much of my neuropsychiatric career to helping bring my profession out of the dark ages. I've published, am a consulting editor of 3 national peer reviewed journals, etc and my goal was to offer some education on this topic. To summarize the original points I was trying to make initially:
>
> Brain-mapping or any other QEEG analysis differs from rEEG in one extremely key easy to understand way. ONLY rEEG uses an outcome database – patients who were treated successfully and unsuccessfully. That is why it is more directly relevant to medication selection. Other approaches only had a comparison to a normative database – that is people without symptoms These identify differences from the norm but then had to make suppositions about what might correct the norms or perhaps what diagnosis was appropriate. Because of the patient database, rEEG goes the next step and asks, in fact what medications work most of the time for people having those aberrations. Without this data everything is necessarily a guess. So the lesson here is you can learn more from patients who have been treated than you can from untreated and asymptomatic individuals.
>
> The scientists who spent 18 years developing this database on their own time are some of the top people I've ever met, and stand up well to scutiny with professors and chairmans at Stanford, Harvard, etc - where in fact research pilots are starting. There are some publications on this and some submitted. A field has to start somewhere. This is not a panacea, but offers some people an evidence based approach to their neurophysiology with possible alternatives and objectivity beyond nomenclature.
>
> Eric Braverman uses QEEG, but not rEEG - yet. He has been exposed to it and is impressed with it (as far as I can tell).
>
> I hope my input has clarified some things. I will now bow out to the sidelines, least I be further accused of trying to drum up business. While it is hard for me to say no to someone asking, I will make it a rule not to accept any inquiries from anyone on this site to support my independent objective uncomprimising position.
Posted by Phillipa on March 22, 2005, at 22:51:38
In reply to Re: Extremely skeptical, posted by Phillipa on March 22, 2005, at 19:56:14
Sorry Jake, I agree Dr. Hoffman is not the only one with a busy schedule. Where do the hours go? Fondly Phillipa
Posted by franco neuro on March 23, 2005, at 0:09:24
In reply to Re: rEEG System Helps Guide Prescribing » Daniel Hoffman, M.D., posted by franco neuro on March 22, 2005, at 15:38:57
Where in the following passage from my previous post do you see me questioning your integrity? If you read it closely you would have seen that I was actually paying you a compliment!
> Please allow me to throw my two cents into this discussion. Generally when I see a doctor post a message on psycho-babble I figure they're here trying to drum up business. Forgive my cynicism, but it's born of the experiences I've had in dealing with the medical community over the past few years. Having said that, I found the following sentence from your previous post very intriguing.
> There could be a few ways to treat a problem. E.G., if you can't tolerate SSRI's for example, maybe the same could be accomplished with a beta blocker and a stimulant (just as a hypothetical), in which case tolerability is resolved.
> This tells me that you are someone who thinks outside of the box. A quality I've yet to come across in any of the doctors I've seen.
I hardly think anything about the aforementioned passage warranted your rather hysterical response. I don't know you. You may be a wonderful person and a wonderful doctor. The scientists and colleagues that you work with may be wonderful altruistic people also. Unfortunately, this has not been the case with many of the doctors I have seen. The fact that you may or may not find this offensive is beyond my control. I've often refrained from asking questions when meeting with a doctor for fear that they would overreact and take offense as you just did to my rather benign post.Good God what is going on in the medical schools of this country. Is the word empathy ever spoken? I'm a good person. I'm a college graduate and a military veteran. I have a 141 IQ. I'm loyal, kind, and compassionate. And I always pay my rent and taxes on time. I'm no saint, but all in all I'm a pretty decent person. Who, along with most of the other people on this site, is suffering. Is it too much to ask to walk into a doctors office and expect to be treated with a little respect?
I have been to doctors who are good people and good doctors. But, who were unfortunately not able to help me. I'm fine with that. I've also walked out of many a doctor's office with a pain in my stomach feeling as if I had just been raped. I don't need to be smirked at, or scoffed at, or belittled and made to feel like garbage; simply because I had the gall to ask a question or show a little interest in matters concerning my own health. Especially when I'm paying my hard earned money for the privilege.
Once again. I meant you no offense. If some was taken I apologize and assure you it was unintended. I'm sure that there are other people on this site who have questions they would like to ask you. If you truly are someone who seeks to help those who are in desperate need of help, than you will continue to answer their questions and allow me to be the one who takes leave of this thread.
Posted by franco neuro on March 23, 2005, at 0:25:26
In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34
Where in the following passage from my previous post do you see me questioning your integrity? If you read it closely you would have seen that I was actually paying you a compliment!
> Please allow me to throw my two cents into this discussion. Generally when I see a doctor post a message on psycho-babble I figure they're here trying to drum up business. Forgive my cynicism, but it's born of the experiences I've had in dealing with the medical community over the past few years. Having said that, I found the following sentence from your previous post very intriguing.
> There could be a few ways to treat a problem. E.G., if you can't tolerate SSRI's for example, maybe the same could be accomplished with a beta blocker and a stimulant (just as a hypothetical), in which case tolerability is resolved.
> This tells me that you are someone who thinks outside of the box. A quality I've yet to come across in any of the doctors I've seen.
I hardly think anything about the aforementioned passage warranted your rather hysterical response. I don't know you. You may be a wonderful person and a wonderful doctor. The scientists and colleagues that you work with may be wonderful altruistic people also. Unfortunately, this has not been the case with many of the doctors I have seen. The fact that you may or may not find this offensive is beyond my control. I've often refrained from asking questions when meeting with a doctor for fear that they would overreact and take offense as you just did to my rather benign post.Good God what is going on in the medical schools of this country. Is the word empathy ever spoken? I'm a good person. I'm a college graduate and a military veteran. I have a 141 IQ. I'm loyal, kind, and compassionate. And I always pay my rent and taxes on time. I'm no saint, but all in all I'm a pretty decent person. Who, along with most of the other people on this site, is suffering. Is it too much to ask to walk into a doctors office and expect to be treated with a little respect?
I have been to doctors who are good people and good doctors. But, who were unfortunately not able to help me. I'm fine with that. I've also walked out of many a doctor's office with a pain in my stomach feeling as if I had just been raped. I don't need to be smirked at, or scoffed at, or belittled and made to feel like garbage; simply because I had the gall to ask a question or show a little interest in matters concerning my own health. Especially when I'm paying my hard earned money for the privilege.
Once again. I meant you no offense. If some was taken I apologize and assure you it was unintended. I'm sure that there are other people on this site who have questions they would like to ask you. If you truly are someone who seeks to help those who are in desperate need of help, than you will continue to answer their questions and allow me to be the one who takes leave of this thread.
Posted by KaraS on March 23, 2005, at 3:27:58
In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34
I also wanted to thank you for all of your information and advice here. I think it's awesome that you took the time to clarify things for us and answer our questions. You even took great pains to try to lead posters to where they might find doctors who use or are knowledgable about rEEG. Yes, many of us posters also have busy schedules but we come here looking for answers and support. You came here just to help us.
Unfortunately I think a misunderstanding has the taken this thread into a different direction and cast a dark cloud on the great discussion that occurred previously. (Nonetheless, all of your good information will stay with us.) It would be a big loss to many of us here if you stopped posting. Either way, many of us appreciate what you tried to do here.
Kara
Posted by Daniel Hoffman, M.D. on March 23, 2005, at 9:04:58
In reply to Re: THANK YOU!!! » Daniel Hoffman, M.D., posted by KaraS on March 23, 2005, at 3:27:58
The part about technology that I find sociologically difficult is written communication vs. being in the room with a person (it is why I don't do phone psychiatry). I come off the sideline bench to clarify.
First, I hope no one thought I was implying I was the only busy person. What I was trying to say was that for those in the thread, there is a vested interest in taking their time to find help for themselves - which is both admirable as well as necessary because of some of the problems with medicine that many of you mention or allude to. I was doing it only to help and clarify misinformation - which is why I can't turn down projects and am so busy.
I meant no attack on any one email response, but was seeing a trend develop that I wanted no part of (snake oil, trying to drum up business, etc). I devote my life, literally, to this field for no compensation from the dedicated people at the "company" who have formed a volunteer army to advance psychiatry and while I understand frustration with medicine and physicians, I refuse to be lumped into that category.
I think it would be of benefit to get back on track of the real purpose of this topic. Being on the side lines, to me, meant not being as active nor discussing other failures in medicine. My role was to be factual only - not to ever comment again in these posts.
Trusting that we're on the same page, and since I'm not sure how one answeres a specific question in a forum (this is new to me) I've just been responding to the last one, hoping it encompasses everything above it. This is perhaps wrong.
The person in So. Calif who I feel is the most gifted in this area, is one of the two scientists who developed rEEG, Hamlin Emory,M.D. I suppose you could reach him through the website (www.cnsresponse.com).
Posted by Ritch on March 23, 2005, at 10:09:23
In reply to Re: THANK YOU!!!, posted by Daniel Hoffman, M.D. on March 23, 2005, at 9:04:58
Hi, I've got a specific question. The answer might be way over my head.. but can you clarify or discuss in greater detail how medications affect or "signature" QEEG results? .. perhaps with a specific common medication? Maybe some facts about EEG generally, might help us some. Thanks for any input.
Posted by ravenstorm on March 23, 2005, at 10:27:06
In reply to Re: Medication signature question, posted by Ritch on March 23, 2005, at 10:09:23
I much appreciate your input. I am two years out of severe paxil withdrawal and still trying to find a medication. My main problem, however, is finding something that my stomach can handle.
My husband and I have decided this will be worth the money to pursue. It will be just devastating, however, if the results come back with a medication that I can not take due to disabling stomach problems.
Do you know of anyone in the midwest who does this or would be open to it?
Also, why aren't the atypicals in the data base yet? I was really disappointed to hear that as I really don't have a lot of antidepressants left to try and was thinking a low dose AP might be the next step.
The thing that really appeals to me about this process, is that, as someone who suffers withdrawal symptoms from nearly everything (prozac and wellbutrin being the only exceptions so far), it could save me months of withdrawal from another drug trial. Currently I am on mirtazapine, which, while not having enough efficacy for me, has also now started causing such severe heartburn that I am sick much of the time, can not eat normally, and the acid is starting to affect my vocal cords (even on prilosec). Unfortunately, when I tried halving the med I went into withdrawal, which for me doesn't seem to be self limiting. So, I will have to do a slow taper and hope my esophagus doesn't get erroded in the mean time. It is amazing to me that if you are mentally ill and have severe stomach problems you are pretty much out of luck.
Any input you could give about doctors in the midwest would be so much appreciated.
Thanks for braving the waters and jumping into psychobabble. I really believe this will be the future of psychiatry. It just seems so much more humane. I know it may not help me because of my stomach issues, but think of all the other people that you may have reached on this board who will be helped by your input. Thanks again.
Posted by Daniel Hoffman, M.D. on March 23, 2005, at 11:23:33
In reply to Re: Daniel Hoffman M.D.--anyone in the Madison, WI, posted by ravenstorm on March 23, 2005, at 10:27:06
The question about "signature" is not easily answered. Suffice it to say that by knowing what a drug does to brainwaves, which is pretty consistent, it can match it's effect to the problem presented to the database. So if stimulants raise "relative power" in certain parts of the brain, and the patient needs this, the database would suggest this as a possability based on their statistics of 10-20,000 medication trials and the fact that patients responded positively to that intervention. Atypicals haven't been entered due to when they started developing the database, the population they had access to and financial backing. They hope to include them when they can.
Regarding referrals, I can only suggest that you contact the company to see if they know of anyone in a particular area that is capable of providing the data to them.
While for obvious reasons I won't comment on particular cases nor practice medicine via a forum, stomach problems can be difficult but usually manageable with the H2 blockers or other GI meds. Of course some people are more sensitive than others.
Posted by ravenstorm on March 23, 2005, at 11:49:18
In reply to Re: Daniel Hoffman M.D.--anyone in the Madison, WI, posted by Daniel Hoffman, M.D. on March 23, 2005, at 11:23:33
Ok, I will contact them. I am on H2 blockers currently to no avail. If I can't tolerate a med, stomach wise, the only thing that helps is not taking the med anymore. Thanks for the speedy reply
Posted by Iansf on March 23, 2005, at 17:32:40
In reply to Re: THANK YOU!!!, posted by Daniel Hoffman, M.D. on March 23, 2005, at 9:04:58
Dr. Hoffman,
How would you compare your approach to alternative approaches that also use brain data, such as the BrainSpect system of the Amen Clinic? There's a clinic in Walnut Creek, Calif. - whose name I can't recall - that uses some other system based on MRIs or some such. I imagine there's even more that I don't know of. All seem to focus on measures of actual brain function for either diagnosis or prescription, yet all take different approaches.
Posted by Daniel Hoffman, M.D. on March 23, 2005, at 18:59:12
In reply to Dr. Hoffman - alternative approaches, posted by Iansf on March 23, 2005, at 17:32:40
> Dr. Hoffman,
> How would you compare your approach to alternative approaches that also use brain data, such as the BrainSpect system of the Amen Clinic? There's a clinic in Walnut Creek, Calif. - whose name I can't recall - that uses some other system based on MRIs or some such. I imagine there's even more that I don't know of. All seem to focus on measures of actual brain function for either diagnosis or prescription, yet all take different approaches.
SPECT imaging is cerebral blood flow. Daniel Amen has pioneered some great work in looking as sub-typing of disorders. From a clinical perspective, I find I need to know HOW to treat a brain more so than what's wrong with it. Once SPECT scans identify the areas of abnormality, it is a clinical decision knowing what medicines effect that part of the brain - and if you don't know what's off, that can be helpful. But the problems I see more is a treatment resistant patient who's been on many medications, but still has significant symptoms. I want to know which medicines, or combination of medicines, and sometimes in WHAT ORDER of use will help the person.As far a I'm concerned, you can't give me enough information to help figure out my patients. This is the neonatal development of neuro-imaging and it won't be long before some form of scan that matches a treatment with a patient will be performed routinely before you ever even see the doctor. We're the only field of medicine that has no test for a diagnosis and this is the beginning. We still have a long way to go.
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