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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Squiggles on November 28, 2005, at 13:15:06
I think that when a patient is
treatment-resistant after the doctor
has tried many drugs and adjuncts,
it may be worthwhile to look at the
patient's attitude. It's possible, for
example, that an adjunct tried with
a basic drug has not worked because of
the dose. But because the patient is
either tired or is actually holding a
grudge, or fearing more experimentation,
the opportunity to juggle the dosage
may be missed. So, a slight variation
is not tried, and the experiment fails
for reasons outside the treatment
strategy.Also, depression, in itself can make
a person lose the motivation or hope
for improvement.This is what I have noticed, and it's
a sad situation. I don't know how doctors
would handle something like that - I think
they are just too busy to cope with
subterfuge as well as depression.Squiggles
Posted by med_empowered on November 28, 2005, at 16:27:39
In reply to Hurdles in med treatment, posted by Squiggles on November 28, 2005, at 13:15:06
Med treatment is tricky. Doctors get so irritated, so quickly. I cant count the times Ive seen a shrinks face fall into an expression of irritation, or downright anger, as I explained that I'm having side effects or not experiencing results, etc. Then again...you're right. Patients who are tired and hopeless to begin with are probably the least able to go through trial after trial. I find that what helps some people is to break down psychiatric diagnoses/concepts--which tend to *big* and *vague*--into smaller, more concrete concepts, and then work on addressing these problems. So..instead of "treating depression," the goal could be: being able to get out of bed, not being suicidal, feeling less apathetic, not having slowed thoughts as often, etc. "Anxiety" would be fewer panic attacks, able to leave house, better ability to concentrate, etc. I think that's helpful.
Posted by Squiggles on November 28, 2005, at 16:39:58
In reply to Re: Hurdles in med treatment, posted by med_empowered on November 28, 2005, at 16:27:39
I thinks compartmentalization of symptoms
is a good idea, because as you say the
whole concept of "depression" is large
enough to contain too many aspects in
everyday life.But how to treat these details, in a
way that resembles a car mechanic, takes
a long time, with cooperation and understanding
on both parties.I don't know where you live, but where
I am from, we are having a crisis in
health care, not only in psychiatry (which
is very time-demanding) where specialists
are leaving for greener pastures, but in
just about all health care problems, except
perhaps breast cancer screening.I think it is a two-fold problem: the
patient gets cranky and the doctor gets
fed up. Personally, I have benefitted
from the net sites such as Dr. Bob's, but
here the personality comes into play as well.
Some people just give up :-(Squiggles
Posted by med_empowered on November 28, 2005, at 17:29:37
In reply to Re: Hurdles in med treatment, posted by Squiggles on November 28, 2005, at 16:39:58
yeah, i hear you. Here the problem is lack of access to treatment (a lot of people just cant afford it), a relative scarcity of providers (they're around, and alot of people can be served, but some people still fall through), and, as I see it, a lack of really good, creative psychiatric care. A lot of docs here seem to base their treatment either on the newest, most expensive approach (which I affectionately call the "pill-of-the-month" method), or they take the old-school, top-down, unimaginative approach. Either way, the patient tends to get screwed.
I also think shrinks have power issues and ego issues...which is weird, since the move since the 70s has basically been to take therapy out of psychiatry and replace it with medications, sometimes ECT. You'd think that such a move would reduce the amount of ego invested by the doc in a particular treatment, but it doesn't seem to. Docs seem to take the failure of a pill really personally...at the same time, they seem to feel uneasy about well-informed, assertive patients. Its really not a good situation.
Posted by Squiggles on November 28, 2005, at 17:46:39
In reply to Re: Hurdles in med treatment, posted by med_empowered on November 28, 2005, at 17:29:37
> yeah, i hear you. Here the problem is lack of access to treatment (a lot of people just cant afford it), a relative scarcity of providers (they're around, and alot of people can be served, but some people still fall through), and, as I see it, a lack of really good, creative psychiatric care.
That's worse. I think we should have
hospitals again; even poor countries could
manage better that way.A lot of docs here seem to base their treatment either on the newest, most expensive approach (which I affectionately call the "pill-of-the-month" method), or they take the old-school, top-down, unimaginative approach. Either way, the patient tends to get screwed.
I think I would trust the old-school method,
as the new drugs have to prove themselves
over many unhappy bodies in due time.>
> I also think shrinks have power issues and ego issues...which is weird, since the move since the 70s has basically been to take therapy out of psychiatry and replace it with medications, sometimes ECT.Hmm, I suppose we must consider the human
factor, but this is a generalization, right;You'd think that such a move would reduce the amount of ego invested by the doc in a particular treatment, but it doesn't seem to. Docs seem to take the failure of a pill really personally...at the same time, they seem to feel uneasy about well-informed, assertive patients. Its really not a good situation.
Really? If that is the case, I have been
lucky; my doctor will not push me to
take or have a treatment I disagree with.
But it must be awful to have a
doctor who is overly certain, in this
uncertain field. I'm still hoping that
the opiates will be good adjuncts for
some clinical depressives.I consider myself lucky, but I have
noticed that unless you are yourself
under the influence of this mysterious
illness, you do not *really* understand;
you may, at most imagine or sympathize.I rather trust the neurologists, but
they are busy doing research.Squiggles
Posted by med_empowered on November 28, 2005, at 18:45:40
In reply to Re: Hurdles in med treatment, posted by Squiggles on November 28, 2005, at 17:46:39
yeah...I have bad experiences with docs pushing meds on me (lithium...try it. GOOD STUFF!) from the first visit. For some reason, its also been my experience that docs give me numerous different meds, and the dosages tend to be on the higher-end of things (I'm really not that treatment resistant...I've noticed that even my *starting* doses tend to be higher than my friends, even when we visit the same shrink. Weird)
Anyway, there are lots of good, collaborative docs out there, which is nice...there just don't seem to be any around *here*, which I think may have to do with social factors (its the south and a lot of the docs aren't from the south; they seem to have this weird, condescending approach towards southern culture...even though they live here.) Plus, alot of my docs have been younger--it seems like the younger docs tend to have more ego "issues" and what not. Oh well.Good luck with opiates! I hear they work really well on a lot of people...apparently, there's even some evidence they can help with hardcore mental health problems like treatment-resistant schizophrenia.
Posted by Phillipa on November 28, 2005, at 22:29:24
In reply to Re: Hurdles in med treatment, posted by med_empowered on November 28, 2005, at 18:45:40
The very best pdoc I ever had was the one I had in Connecticut. I was actually able to be med free and alchohol free. Felt great and ran l3 miles in the snow and ice one New Year's Day. The second best was in VA Beach but he was a schoolchum of the pdoc in Connecticut. Fondly, Phillipa
Posted by xbunny on November 29, 2005, at 6:52:07
In reply to Re: Hurdles in med treatment, posted by med_empowered on November 28, 2005, at 16:27:39
>I find that what helps some people is to break down psychiatric diagnoses/concepts--which tend to *big* and *vague*--into smaller, more concrete concepts, and then work on addressing these problems. So..instead of "treating depression," the goal could be: being able to get out of bed, not being suicidal, feeling less apathetic, not having slowed thoughts as often, etc. "Anxiety" would be fewer panic attacks, able to leave house, better ability to concentrate, etc. I think that's helpful.
I couldnt agree more, it was a turning point for me when my doctors decided to stop treating me for 'schizophrenia' and instead decided to help me leave the house, be calmer at home, able to face the world, that kind of thing. It was my therapist who bought about the change, throughout the sessions we were always setting an acheivable goal and assessing how well we were doing to reach it. The notion of psychosis and paranoia went out the window we were interested in whether I got to the shop or walked past the passerby without freaking out. When I mentioned this approach to my psychiatrist he immediately latched onto it and went with it (surprisingly), instead of drugging me to the eyeballs to eradicate a poorly defined psychosis instead we were working on something solid like operating the cooker or watching TV. Sorry Im rambling just what you said really struck a chord I reckon a lot of people could be helped more if this approach was taken.
Buns
Posted by Squiggles on November 29, 2005, at 8:20:41
In reply to Re: Hurdles in med treatment » med_empowered, posted by xbunny on November 29, 2005, at 6:52:07
The method sounds innovative and
emphasizes the experiential aspects
of the illness; but treating an
illness like schizophrenia without drugs,
would not be my cup of tea. It is
after all a chronic illness and not
curable. Perhaps some people never did
have "schizophrenia" and therefore *can*
be cured.Squiggles
This is the end of the thread.
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