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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 scatterbrained on March 8, 2006, at 0:39:59
The following is an article I found that might give explaination as to why some of us are treatment resistent
"Brain white-matter hyperintensities linked to antidepressant outcome
Subcortical white-matter hyperintensities in the left hemisphere, but not in other brain areas, may be associated with poor response to antidepressant medication in people with major depression, investigators have found.
Moreover, the findings suggest that a large proportion of brain hyperintensities might be vascular in origin.
"The association between major depressive disorder and increased prevalence of brain white-matter hyperintensities has been reported in elderly people, but studies in younger patients have been inconclusive," Dan Iosifescu (Massachusetts General Hospital, Boston, USA) and colleagues observe.
To address this, the team assessed brain white-matter hyperintensities and cardiovascular risk factors in 84 people, aged an average of 39.6 years, with major depressive disorder prior to initiating antidepressant treatment.
For comparison, hyperintensities in 35 mentally healthy individuals were also assessed.
Although the researchers were unable to find any correlation between global white-matter hyperintensity measures and clinical outcome, subcortical hyperintensities were evident in the left hemispheres of depressed patients who had a poor response to antidepressant treatment.
After adjusting for age, subcortical white-matter hyperintensities in the left hemisphere correlated with lower rates of response, with an odds ratio of 10.1. In contrast, the correlation between hyperintensities in this part of the brain and remission did not reach statistical significance.
White-matter hyperintensities were also correlated with hypertension and total scores for six cardiovascular risk factors - increasing age, hypertension, family history of cardiovascular disease, smoking, diabetes, and hypercholesterolemia.
"One personal interpretation of our results is that cardiovascular risk factors correlate with a higher severity of subcortical white-matter lesions, which in turn correlates with poor treatment outcome in depression," write Iosifescu et al in the British Journal of Psychiatry.
This interpretation is consistent with the "vascular depression" model, they note, although global measures of white-matter hyperintensities would have been expected.
The researchers therefore suggest that specific white-matter tracts may be involved in mood regulation, potentially explaining a selective impact of left-hemisphere subcortical hyperintensities on treatment outcome"
Maybe it's time for some of us to look into WHY we are treatment resistent.
Posted by Squiggles on March 8, 2006, at 14:06:59
In reply to Reason for treatment resistance, posted by scatterbrained on March 8, 2006, at 0:39:59
I've come across the vascular theory
of depression in guess where? Kraeplin
and Alzheimer -- yup - irregular, or
hemispheric, or artherosclerosis were
speculative theories, back then.Problem is -- even if this were the
case, how could psychopharmacology
deal with problem? It looks like the
kind of disorder requiring brain
surgery.Squiggles
Posted by bipolarspectrum on March 8, 2006, at 14:12:23
In reply to sub-therapeutic doses » scatterbrained, posted by Squiggles on March 8, 2006, at 14:06:59
Hi,
I think the reason for treatment-resistance among our little community here is that many of us have bipolar spectrum disorders... and i recently read in a reputable journal that more than 50% of bipolar patients need a minimum of 3 drugs... it takes such a long time to get to that level...
bps
Posted by Squiggles on March 8, 2006, at 14:31:06
In reply to BIpolarity, which often requires at least 3 drugs, posted by bipolarspectrum on March 8, 2006, at 14:12:23
> Hi,
> I think the reason for treatment-resistance among our little community here is that many of us have bipolar spectrum disorders... and i recently read in a reputable journal that more than 50% of bipolar patients need a minimum of 3 drugs... it takes such a long time to get to that level...
> bpsInteresting. Is there a distinguishing
method/tool for diagnosing bp from up --
other than cycling behaviour -- which
i recently read in an article to be
the hallmark of bp.Squiggles
Posted by scatterbrained on March 8, 2006, at 14:31:50
In reply to sub-therapeutic doses » scatterbrained, posted by Squiggles on March 8, 2006, at 14:06:59
Maybe psychopharmachology alone CAN'T deal with certain treatment resistent cases that have left white matter problems due to vascular problems or whatever. Maybe these people need help from various medical professionals, not just solely from some psychiatrist. I believe that treatment resistent depression should be taken very seriously in the medical community because it's a sign of possible other conditions, and this study proves it.
Posted by Squiggles on March 8, 2006, at 14:36:47
In reply to Re: sub-therapeutic doses » Squiggles, posted by scatterbrained on March 8, 2006, at 14:31:50
Breath of fresh air- hope you have the
ear of Dr. Torrey or others of that ilk :-)Squiggles
Posted by bipolarspectrum on March 8, 2006, at 14:42:01
In reply to sub-therapeutic doses » bipolarspectrum, posted by Squiggles on March 8, 2006, at 14:31:06
Hi Squiggles,
I understood that any type of cycling is reason for placing the patient on the bipolar spectrum.. its a spectrum so one can be very far to the unipolar side yet still suffer from bipolar symptoms.... I dont believe theres a definate method of diagnosing, however, i do know there seems to be two type of pdocs developing... one is the oldfashion kind who follows the dsm-iv... ie. if u dont have symptoms like the bipolars in the book, ur not bipolar... these pdocs tend to clash with the more progressive types, who view any cycling as a sign of bipolarity... these types also hope that the new dsm-v will be more liberal in its classification... an example of the new liberal thinking is that, theres no real science behind this point however a sign of bipolarity is an allergy to antibiotics and exsperiencing migranes at some point in life... anywayz, just some food for thought, but my pdoc and i dont really care for classfication because there doesnt seem to be much of a correlation between accurate classification and effective treatment..
bps> > Hi,
> > I think the reason for treatment-resistance among our little community here is that many of us have bipolar spectrum disorders... and i recently read in a reputable journal that more than 50% of bipolar patients need a minimum of 3 drugs... it takes such a long time to get to that level...
> > bps
>
> Interesting. Is there a distinguishing
> method/tool for diagnosing bp from up --
> other than cycling behaviour -- which
> i recently read in an article to be
> the hallmark of bp.
>
> Squiggles
Posted by linkadge on March 8, 2006, at 14:57:18
In reply to BIpolarity, which often requires at least 3 drugs, posted by bipolarspectrum on March 8, 2006, at 14:12:23
I'm not so sure that I'd agree with the standpoint of the bipolar theory of treatment resistance.
Bipolar meds did something, but never helped with certain clusters of symptoms like anhedonia, apathy etc.
I think the assertion that we are all bipolar is an attempt to turn the train on some of the high occurances of AD poop-out etc.
But mood stablalizers can poop out. I had a strong AD effect from lithium, but it never lasted longer than 1 month.
Linkadge
Posted by scatterbrained on March 8, 2006, at 15:09:36
In reply to sub-therapeutic doses » scatterbrained, posted by Squiggles on March 8, 2006, at 14:36:47
Yeah, I hope somebody listens. It doesn't make any sense why this disorder is not taken seriously. If I were a researcher, I'd do a study taking a group of treatment resistent patients with depression and a group of patients who are experiencing a remission from their depression and I'd give both groups a very thorough medical evaluations(mayo clinic style). I'd be willing to bet that a much larger portion of the treatment resistent group would have medical disorders, and the responders not so much.
Please some researcher steal this idea from me!
Posted by Squiggles on March 8, 2006, at 15:52:42
In reply to Re: sub-therapeutic doses, posted by bipolarspectrum on March 8, 2006, at 14:42:01
I think the liberal approach is
more reasonable as diagnosis in
psychiatry is still an incomplete
science. My dr. shares this attitude
to mental illness as well, i think.
Hunches and practical trial and
error is the best we have now, i think.
Psychiatry may change in the future
with the aid of neurology or other
discoveries. Psychiatry is less
than 100 yrs old as a medical practice.Squiggles
Posted by Phillipa on March 8, 2006, at 18:13:35
In reply to sub-therapeutic doses » bipolarspectrum, posted by Squiggles on March 8, 2006, at 15:52:42
Believe it or not there was a show on Dr. Phil on bipolar disease. They called the up and down cycling bipolar ll. And they said it takes at least l0yrs to receive a proper dx of bipolar disorder. Fondly, Phillipa
Posted by linkadge on March 8, 2006, at 18:44:49
In reply to Re: sub-therapeutic doses, posted by Phillipa on March 8, 2006, at 18:13:35
I personally think that bipolar is overblown. Some doctors are lumping all of the symtpoms that were once classified as depression into that of bipolar.
Anxiety -> Bipolar
Agitation -> Bipolar
Anger -> BipolarSo I don't really know what depression is classified as anymore.
I think it boils down to this. It seems that everybody reacts to antidepressants differently, but putting somebody on a mood stabalizer produces a more predictable outcome. I think that bipolar is a "safer" diagnosis for the doctor to make, albeit much more burdonsome for the patient.
Linkadge
Posted by Squiggles on March 8, 2006, at 18:49:39
In reply to Re: sub-therapeutic doses, posted by linkadge on March 8, 2006, at 18:44:49
That may be underestimating the
years of sweat and toil in medical
school; maybe disuss that idea with
your dr.?Squiggles
Posted by Squiggles on March 8, 2006, at 19:26:32
In reply to Re: sub-therapeutic doses, posted by Phillipa on March 8, 2006, at 18:13:35
> Believe it or not there was a show on Dr. Phil on bipolar disease. They called the up and down cycling bipolar ll. And they said it takes at least l0yrs to receive a proper dx of bipolar disorder. Fondly, Phillipa
I saw the show. It was pretty accurate, though
short and sweet. It was very gracious of Dr. Phil
to bring in neurologists and to interview a
bipolar. A popular show for the masses - but
it's a good way to educate.Squiggles
Posted by ed_uk on March 9, 2006, at 13:26:42
In reply to Re: sub-therapeutic doses, posted by linkadge on March 8, 2006, at 18:44:49
The concept of a sub-therapeutic dose is interesting. It's important to rememeber that different people benefit from different doses. What is sub-therapeutic for one person may be ideal for another.
Ed
Posted by cecilia on March 9, 2006, at 18:08:31
In reply to sub-therapeutic doses » bipolarspectrum, posted by Squiggles on March 8, 2006, at 15:52:42
I can't help but be a little suspicious that the new emphasis on treatment resistant depression really being bipolar may have a lot to do with the fact that traditional antidepressants are going off patent and drug companies are pushing expensive AP's instead. Every magazine I read has a big advertisement for Abilify, with suggestions for patients about how their depression is really bipolar and Abilify is the magic cure. Cecilia
Posted by bipolarspectrum on March 9, 2006, at 18:22:19
In reply to Bipolar spectrum, posted by cecilia on March 9, 2006, at 18:08:31
Hello,
I think great points have been made in regards to the excessive movement towards bipolar diagnoses... i think ive been manipulated by the stats ive read... for example, bipolars have a much higher level of comorbidity... hence, the people with multifaceted mental problems that often join one another on these types of sites are suffering from a bipolar spectrum illness... ive experienced great irony in my mental illness, as i was once the patient of a highly wellknown psychopharmacologist in canada who specialized in bipolar disorder and he didnt diagnose me as such! then i saw a pdoc with much clinical experience who instantly diagnosed me as bipolar! it just seemed so ironic to me.. but anywayz, in the end, i dont think diagnosing really offers that many benefits in terms of treatment.. and, really in the end, effective treatment is all that really matters... in my mind at least..
bps
Posted by cecilia on March 10, 2006, at 2:36:00
In reply to Re: Bipolar spectrum, posted by bipolarspectrum on March 9, 2006, at 18:22:19
I'd like to see a study where a good actor goes to a bunch of different doctors with the same symptoms each time and see how many different diagnoses the doctors come up with. Cecilia
Posted by naughtypuppy on March 10, 2006, at 9:43:08
In reply to Bipolar spectrum, posted by cecilia on March 9, 2006, at 18:08:31
That's exactly what my pdoc told me when I inquered about what he thought of the new "trendy" diagnosis of bipolar II. Since Prozac went generic, they have really been pushing the even more expensive Zyprexa. Notice Lilly is now marketing a combination of Prozac and Zyprexa. Makes you go "hmmm".
Posted by Squiggles on March 10, 2006, at 10:48:18
In reply to Re: Bipolar spectrum, posted by cecilia on March 10, 2006, at 2:36:00
> I'd like to see a study where a good actor goes to a bunch of different doctors with the same symptoms each time and see how many different diagnoses the doctors come up with.
Cecilia
If the actor were Sir Nigel Hawthorne, i
would bet they would all hit the same
diagnosis.http://users.skynet.be/fa419863/madness.html
Squiggles
Posted by Caedmon on March 12, 2006, at 23:49:25
In reply to Re: sub-therapeutic doses, posted by linkadge on March 8, 2006, at 18:44:49
> I personally think that bipolar is overblown. Some doctors are lumping all of the symtpoms that were once classified as depression into that of bipolar.
>
> Anxiety -> Bipolar
> Agitation -> Bipolar
> Anger -> Bipolar
>I don't know, this might be a simplistic representation of the concept. It would be AS simplistic as saying that every presentation of anxiety, agitation, or anger were a symptom of DEPRESSION (which of course they are not - mood states shouldn't be immediately classed as pathological in the first place).
http://www.psycheducation.org/depression/02_diagnosis.html
Interesting thread though.
I was Dx'ed bipolar spectrum, by a very enlightened pdoc, and am much better for it because the Tx is winding up more effective.
Posted by Caedmon on March 13, 2006, at 0:01:03
In reply to Reason for treatment resistance, posted by scatterbrained on March 8, 2006, at 0:39:59
Some guesses as to why Tx resistance occurs:
1) The meds pretty much suck anyway
2) Major depressive disorder, at least, would seem to be overemphasized as a biological condition. My guess is that most cases are not; rather are circumstantial or learned helplessness.
3) Overreliance on meds reinforces learned helplessness.
4) SSRIs being firstline for... everything these days, it can decrease DA and therefore cause a sort of apathy/poop-out phenomenon. This probably happens an awful lot.
5) Inappropriate medicating for comorbid Sx; e.g. insisting on citalopram for social phobia when a lorazepam might do better, with fewer side effects.
6) Life is just cruel that way.
Posted by scatterbrained on March 17, 2006, at 0:06:53
In reply to Re: Reason for treatment resistance, posted by Caedmon on March 13, 2006, at 0:01:03
I think that it should be a part of treatment to find out WHY one is treatment resistent. A doctor should systematically go through and look into each possible reason(which means refering patients to various specialists). To just call somebody treatment resistent, liberally prescribe polypharmacy or some experimental treatment, or ect without looking into everything first is one of the low points of the psychiatric profession.
Posted by jerrympls on March 21, 2006, at 23:18:57
In reply to Bipolar spectrum, posted by cecilia on March 9, 2006, at 18:08:31
> I can't help but be a little suspicious that the new emphasis on treatment resistant depression really being bipolar may have a lot to do with the fact that traditional antidepressants are going off patent and drug companies are pushing expensive AP's instead. Every magazine I read has a big advertisement for Abilify, with suggestions for patients about how their depression is really bipolar and Abilify is the magic cure. Cecilia
I completely agree with you Cecilia!!-Jerry
Posted by jerrympls on March 21, 2006, at 23:22:31
In reply to Re: Reason for treatment resistance, posted by Caedmon on March 13, 2006, at 0:01:03
> Some guesses as to why Tx resistance occurs:
>
> 1) The meds pretty much suck anyway
> 2) Major depressive disorder, at least, would seem to be overemphasized as a biological condition. My guess is that most cases are not; rather are circumstantial or learned helplessness.
> 3) Overreliance on meds reinforces learned helplessness.
> 4) SSRIs being firstline for... everything these days, it can decrease DA and therefore cause a sort of apathy/poop-out phenomenon. This probably happens an awful lot.
> 5) Inappropriate medicating for comorbid Sx; e.g. insisting on citalopram for social phobia when a lorazepam might do better, with fewer side effects.
> 6) Life is just cruel that way.LOL--I agree with you too!
Jerry
This is the end of the thread.
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