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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by WeeWilly on August 18, 2006, at 14:33:09
Since the modes of actions of all pycho-active medications are unknown, treatment is literally a shot in the dark. I have felt for many many years that it was very unfortunate that the initial developments in depressive disorder research focused on monoamines. It has not only given us to many me too medications but also me too research fixated on monoaminergic theories.
I will be 48 yrs old in another month and have been battalling depressive like symptoms my whole life. From changes in my symptoms begining back when I was about 13 or so, made me suspect a problem in my endocrine system was at the core of my disorder. As time has gone on I have tried so many treatments. Most have been various AD's and combinations. Tried some steroids and endocrine treatments. Like probably most of you, I have followed developments in research. Slowly I have seen a turn away from the fixation on monoaminergic theories as the be all and end all of mood disorders.
Getting back to modes of action and their help in developing a plan of treatment. If they were known it would help in treatment planning and development of better treatments etc. .
Currently I am trying Rozerem. Their seems to be evidence that it can advance circadian rythyms and also lower testosterone, who knows what else?
Do you think I am off base in my ideas? Best wishes.
Posted by Estella on August 18, 2006, at 14:58:04
In reply to Mode of action could be quite helpfull, posted by WeeWilly on August 18, 2006, at 14:33:09
there is evidence that medication helps...
there is comperable evidence to show that therapy helps...
there is even evidence to show that a combination of both therapy and medication together are most effective.have you tried out therapy?
Posted by WeeWilly on August 18, 2006, at 15:09:57
In reply to Re: Mode of action could be quite helpfull, posted by Estella on August 18, 2006, at 14:58:04
> there is evidence that medication helps...
> there is comperable evidence to show that therapy helps...
> there is even evidence to show that a combination of both therapy and medication together are most effective.
>
> have you tried out therapy?Thanks for your reply. I have tried some therapies and found them not to be usefull for my disorder. I do think there are some disorders in which therapy could be helpfull. Unfortunatly mine is'nt one of those. Best wishes.
Posted by Phillipa on August 18, 2006, at 15:13:42
In reply to Re: Mode of action could be quite helpfull, posted by WeeWilly on August 18, 2006, at 15:09:57
Tom your're in the Uk aren't you? Don't you have meds there we don't have here? I want to try EMSAM . If it were available there do you think you'd try it? Love Phillipa
Posted by Phillipa on August 18, 2006, at 15:15:10
In reply to Re: Mode of action could be quite helpfull, posted by Estella on August 18, 2006, at 14:58:04
Sorry wrong name are you in the USA? Have you considered EMSAM if you are? Love Phillipa
Posted by WeeWilly on August 18, 2006, at 15:25:50
In reply to Re: Mode of action could be quite helpfull, posted by Phillipa on August 18, 2006, at 15:15:10
> Sorry wrong name are you in the USA? Have you considered EMSAM if you are? Love Phillipa
aHi, Phillipa
I live in the US and have Emsam towards the top of my list of possible future trials. I get quite good response for three months with Parnate. For three months less of a positive response to Nardil. I repeat what I expressed in my initial post, if the modes of action of these meds were known it sure would help. Best wishes
Posted by linkadge on August 18, 2006, at 16:29:27
In reply to Re: Mode of action could be quite helpfull, posted by WeeWilly on August 18, 2006, at 15:25:50
I agree with you. The long term benifit of the drugs probably lies in their ability to regulate the HPA axis.
Sometimes the drugs don't do this however. I was reading a study that said SSRI's actually increased cortisol in one patient group.
So finding a drug that direclty targets cortisol rythems would likely be benificial for certain patients.
Linkadge
Posted by notfred on August 18, 2006, at 18:52:06
In reply to Re: Mode of action could be quite helpfull, posted by WeeWilly on August 18, 2006, at 15:25:50
I repeat what I expressed in my initial post, if the modes of action of these meds were known it sure would help. Best wishes
Knowing modes of action but not having a biological
model for MI that works does not really help, does it ?
Posted by Phillipa on August 18, 2006, at 19:39:14
In reply to Re: Mode of action could be quite helpfull, posted by linkadge on August 18, 2006, at 16:29:27
Link if you had to go on an antidressant for yourself now what would you chose if you were hightly anxious and had trouble in social situations, and going to the store etc. Just curious. Love phillipa ps I respect you knowledge
Posted by Estella on August 18, 2006, at 20:16:55
In reply to Re: Mode of action could be quite helpfull, posted by WeeWilly on August 18, 2006, at 15:09:57
>I have tried some therapies and found them not to be usefull for my disorder.
Okay. Therapies can be a bit like meds in the sense that it can take a bit of time and experimentation to find what works best for you. How many meds did you try before finding something that helped?
> I do think there are some disorders in which therapy could be helpfull. Unfortunatly mine is'nt one of those.
Depression / dysthymia?
Posted by WeeWilly on August 18, 2006, at 23:09:56
In reply to Re: Mode of action could be quite helpfull » WeeWilly, posted by Estella on August 18, 2006, at 20:16:55
> >I have tried some therapies and found them not to be usefull for my disorder.
>
> Okay. Therapies can be a bit like meds in the sense that it can take a bit of time and experimentation to find what works best for you. How many meds did you try before finding something that helped?
>
> > I do think there are some disorders in which therapy could be helpfull. Unfortunatly mine is'nt one of those.
>
> Depression / dysthymia?
>
>
I have'nt found a medication yet that has been effective more than 3 months. Parnate worked the best but for only three months. I have lost count of how many medications I have tried.
About talk therapy and my disorder (depression/dysthymis/Social Phobia/Delayed sleep phase syndrome/HPGA disfunction/SAD/48 years of jet lag/etc., etc.) . It just is not appropriate. I wish it was. I am certain that myself and suspect many others have an endocrine disorder masquerading as a mental disorder. Do you think people talk their way out of a hypothyroid condition? In coming years we will see new endocrine conditions elucidated that cause mental imparement.
Best wishes
Posted by Estella on August 18, 2006, at 23:32:08
In reply to Re: Mode of action could be quite helpfull, posted by WeeWilly on August 18, 2006, at 23:09:56
> I have'nt found a medication yet that has been effective more than 3 months. Parnate worked the best but for only three months. I have lost count of how many medications I have tried.
Yeah, I hear you on that one. I had trouble trying to find a med that I benefited from too.
> I am certain that myself and suspect many others have an endocrine disorder masquerading as a mental disorder. Do you think people talk their way out of a hypothyroid condition? In coming years we will see new endocrine conditions elucidated that cause mental imparement.
Yeah, on with the march of science :-)
I think that therapy can help medical conditions. I mean... Psych conditions ARE medical conditions and therapy is supposed to be precisely for dealing with psych conditions. And not just psych conditions either. People with medical conditions like chronic pain, cancer, HIV and so forth often benefit from suitable therapy too. It might not cure their symptoms but it can help them manage their symptoms and cope better with them so they aren't so distressed by them any more.
I think that part of the trouble with the mental / physical divide is that... There isn't a mental / physical divide. Talking can change your neurology just like medication can change your neurology. Start thinking about something like a person insulting you and you can feel your heart race and your facial expression and the like change. Thinking causes changes to your body and changes to your brain as well. Talk therapy can alter neurology just like meds can.
That being said it can be as hard to find a good therapist as it can be to find a good medication. Some people don't seem to have much trouble getting one or the other or (probably ideally) both. Other people have to search for a while.
Anyway... I'm just putting some thoughts out there.
I have an interest in the notion that mental illnesses are (all?) caused by an underlying neurological malfunction in some mechanism or other. That is controversial... Hard to say whether thinking about things being hopeless etc is a cause of depression or a result of being depressed. Probably... Round and round things go. Medication is one intervention, yup. But therapy is another.
I don't mean to suggest that you should stop looking for a good med. Just meant to suggest that you might benefit from a good therapist if you could find one. I guess it might be about... How desperate you feel or something.
Anyway, good luck with your search.
Posted by WeeWilly on August 19, 2006, at 12:20:15
In reply to Re: Mode of action could be quite helpfull, posted by Estella on August 18, 2006, at 23:32:08
> > I have'nt found a medication yet that has been effective more than 3 months. Parnate worked the best but for only three months. I have lost count of how many medications I have tried.
>
> Yeah, I hear you on that one. I had trouble trying to find a med that I benefited from too.
>
> > I am certain that myself and suspect many others have an endocrine disorder masquerading as a mental disorder. Do you think people talk their way out of a hypothyroid condition? In coming years we will see new endocrine conditions elucidated that cause mental imparement.
>
> Yeah, on with the march of science :-)
>
> I think that therapy can help medical conditions. I mean... Psych conditions ARE medical conditions and therapy is supposed to be precisely for dealing with psych conditions. And not just psych conditions either. People with medical conditions like chronic pain, cancer, HIV and so forth often benefit from suitable therapy too. It might not cure their symptoms but it can help them manage their symptoms and cope better with them so they aren't so distressed by them any more.
>
> I think that part of the trouble with the mental / physical divide is that... There isn't a mental / physical divide. Talking can change your neurology just like medication can change your neurology. Start thinking about something like a person insulting you and you can feel your heart race and your facial expression and the like change. Thinking causes changes to your body and changes to your brain as well. Talk therapy can alter neurology just like meds can.
>
> That being said it can be as hard to find a good therapist as it can be to find a good medication. Some people don't seem to have much trouble getting one or the other or (probably ideally) both. Other people have to search for a while.
>
> Anyway... I'm just putting some thoughts out there.
>
> I have an interest in the notion that mental illnesses are (all?) caused by an underlying neurological malfunction in some mechanism or other. That is controversial... Hard to say whether thinking about things being hopeless etc is a cause of depression or a result of being depressed. Probably... Round and round things go. Medication is one intervention, yup. But therapy is another.
>
> I don't mean to suggest that you should stop looking for a good med. Just meant to suggest that you might benefit from a good therapist if you could find one. I guess it might be about... How desperate you feel or something.
>
> Anyway, good luck with your search.
>Estella,
I have enjoyed your posts. It's apparent you and I have developed quite different view points on mental illness. Which is fine. I'm not sure how long or if you have struggled with a mental health disorder. I probably followed the typical stages that sufferers go through. First realizing there is a problem, then looking for simple non invasive solutions that can be applied on ones own(self help books, religion,etc.). Seeing a doctor of some kind is a big difficult step, if I remember right in my case( damn it's been a long time ago). Many of us, don't respond to the medications available in the country we are in or from what the doctors we are seeing will prescribe. For me talk therapy, I would'nt say is absolutely worthless, I would say its value is below things like good dental hygiene, sleep, diet, etc..
I wish alot of things were different with my conditions, for example I wish I could think my way into good mental health. It is not gonna happen. Bummer. Oh well, we have to play the cards we are dealt. Best wishes
Posted by linkadge on August 19, 2006, at 16:18:20
In reply to Re: Mode of action could be quite helpfull » linkadge, posted by Phillipa on August 18, 2006, at 19:39:14
Well, I'd like to give tianeptine a trail, but I'm not so sure it would hit the nail.
Linkadge
Posted by Estella on August 19, 2006, at 19:22:38
In reply to Re: Mode of action could be quite helpfull » Estella, posted by WeeWilly on August 19, 2006, at 12:20:15
> I have enjoyed your posts.
Thanks. I've enjoyed yours too.
> It's apparent you and I have developed quite different view points on mental illness.
I'm not particularly sure that I have a view. It is something I'm interested in is all. So... Which of the following would you think are caused by neurological dysfunction:
- gambling
- masterbation (that used to be in DSM remember)
- homosexuality (that used to be there too)
- substance use (tolerance / withdrawal)
- dysthymia
- dissociative identity disorder
- schizophrenia
- depressionand what do you mean by an inner neurological malfunction? do you mean that an inner neurological malfunction is the CAUSE of the behaviour (where the behaviour is what leads the person to be classified as having a mental disorder)? Is the inner malfunction the same within each individual? Does that mean that DSM categories are natural kinds? Or maybe you think there is a gene?
Hard to say but... Things aren't looking so promicing.
> Seeing a doctor of some kind is a big difficult step, if I remember right in my case( damn it's been a long time ago).
Sure, I understand that one.
> Many of us, don't respond to the medications available in the country we are in or from what the doctors we are seeing will prescribe.
So if meds don't work you conclude you haven't had the right meds. But if therapy doesn't work you conclude therapy is worthless for you. Why don't you go the same way regarding the utility of meds? Because of your views on neurological disturbance? Do you think it is a structural disturbance or a problem with neurotransmission? If it is structural then wouldn't brain surgery be more likely to assist than medications?
I'm sceptical that there is a marker within every individual. Not because of limitations on the state of our knowledge but because things just aren't that simple. There has been some stuff written on Anorexia. About whether the disorder is caused by neurological deficit or social factors. Seems to be fairly unanamous (though there are of course dissentors) that the neurological alterations (found within SOME individuals) are the result of starvation rather than the cause.
But perhaps medication is the cure for anorexia too?
(I'm not denying medication can help I'm just sceptical on it being the only or best way to go)
> I would'nt say is absolutely worthless, I would say its value is below things like good dental hygiene, sleep, diet, etc..Well call me holistic, but I tihnk they are probably all fairly important.
Do you find benefit to talking to people here? Is its value below things like good dental hygene and the like?
> I wish alot of things were different with my conditions, for example I wish I could think my way into good mental health. It is not gonna happen. Bummer.
Do you think that is what I'm saying? That you can simply think your way into good health? That would be oversimplifying as much as my asking whether you mean to say that you can simply take a pill and be cured.
Both of those are too simple.
The med that worked out for three months then stopped...
What was happening in your life during the time it was working and... What changed just before / as it started to not work again?
Were there external stressors or something like that?
Posted by jealibeanz on August 20, 2006, at 11:30:48
In reply to Mode of action could be quite helpfull, posted by WeeWilly on August 18, 2006, at 14:33:09
I was thinking about Rozerem too. I'm wondering why it's not used much. It's actually been available for over a year, but the drug company wanted to hold off on advertising in the media and allow practitioners to become familiar with it's use and performance.
What an idea... letting the doctors prescibe the medications, NOT the patients! Haha, I've always haaaated prescriptions ads. They're getting out of hand and the result of this probably just is clogging up GP's offices, leaving them with less time to spend with us, the people who need attention! :)
With people suffering from chronic insomnia, it seems like a good choice. I know my circadian rhythm is not right, especially since the onset of my sleeping problems began when I returned from a summer abroad.
I bet you could use Rozerem along with another sleep med too. Rozerem works by stimulating the pineal gland in the epithalamus (a tiny little thing under the hypothalamus, which is responsible for endocrine function) to secrete melatonin, and in turn induces sleep by a very natural mechanism. Since you think your problems are rooted in hormonal inbalances, this could very well be beneficial to you.
It's not a general sedative like Lunesta or Ambien. But since they're so different, it would probably be very effective to use them concurrently. Don't you think?
Posted by WeeWilly on August 20, 2006, at 12:11:53
In reply to Re: Mode of action could be quite helpfull, posted by Estella on August 19, 2006, at 19:22:38
> > I have enjoyed your posts.
>
> Thanks. I've enjoyed yours too.
>
> > It's apparent you and I have developed quite different view points on mental illness.
>
> I'm not particularly sure that I have a view. It is something I'm interested in is all. So... Which of the following would you think are caused by neurological dysfunction:
>
> - gambling
> - masterbation (that used to be in DSM remember)
> - homosexuality (that used to be there too)
> - substance use (tolerance / withdrawal)
> - dysthymia
> - dissociative identity disorder
> - schizophrenia
> - depression
>
> and what do you mean by an inner neurological malfunction? do you mean that an inner neurological malfunction is the CAUSE of the behaviour (where the behaviour is what leads the person to be classified as having a mental disorder)? Is the inner malfunction the same within each individual? Does that mean that DSM categories are natural kinds? Or maybe you think there is a gene?
>
> Hard to say but... Things aren't looking so promicing.
>
> > Seeing a doctor of some kind is a big difficult step, if I remember right in my case( damn it's been a long time ago).
>
> Sure, I understand that one.
>
> > Many of us, don't respond to the medications available in the country we are in or from what the doctors we are seeing will prescribe.
>
> So if meds don't work you conclude you haven't had the right meds. But if therapy doesn't work you conclude therapy is worthless for you. Why don't you go the same way regarding the utility of meds? Because of your views on neurological disturbance? Do you think it is a structural disturbance or a problem with neurotransmission? If it is structural then wouldn't brain surgery be more likely to assist than medications?
>
> I'm sceptical that there is a marker within every individual. Not because of limitations on the state of our knowledge but because things just aren't that simple. There has been some stuff written on Anorexia. About whether the disorder is caused by neurological deficit or social factors. Seems to be fairly unanamous (though there are of course dissentors) that the neurological alterations (found within SOME individuals) are the result of starvation rather than the cause.
>
> But perhaps medication is the cure for anorexia too?
>
> (I'm not denying medication can help I'm just sceptical on it being the only or best way to go)
>
>
> > I would'nt say is absolutely worthless, I would say its value is below things like good dental hygiene, sleep, diet, etc..
>
> Well call me holistic, but I tihnk they are probably all fairly important.
>
> Do you find benefit to talking to people here? Is its value below things like good dental hygene and the like?
>
> > I wish alot of things were different with my conditions, for example I wish I could think my way into good mental health. It is not gonna happen. Bummer.
>
> Do you think that is what I'm saying? That you can simply think your way into good health? That would be oversimplifying as much as my asking whether you mean to say that you can simply take a pill and be cured.
>
> Both of those are too simple.
>
> The med that worked out for three months then stopped...
>
> What was happening in your life during the time it was working and... What changed just before / as it started to not work again?
>
> Were there external stressors or something like that?
>
>
>
>I don't have much use for the DSM. In an nutshell it's just goofy. For me, discourse on this site is not of help, its the information that people often convey about how medications effect them that has value.
I have used Parnate 3 months every year for about 20 years. It is very effective for this short time and allows me to keep my business afloat during our most hectic season.
We should be able to take a pill( appropriate medication) and be cured(have remission of problem causing symptoms). The mental health industry turns their failings around and blames the patient, claiming the patient is not trying to get well and other such nonsense. It appears that so many patients buy into that hogwash.
You asked what I meant by an inner neurological malfunction. Do not no! I never mentioned that term. Is there an outer neurological malfunction?
Individuals with quite similar symptoms can have very different causes for these symptoms. Cutting to the quick about my own disorder, I am quite certain the a key factor is a lack of sufficient production of Inhibin B in an enormous symphony of hormonal proteins that we all produce in a rythmic fashion throughout the day. It does'nt look like treatment to address this directly with be available to me for many years. I just have to keep tying things that make my existance bearable untill proper treatment is here.
Extrapolating from my own condition to other mental disorders, leads me to surmise that parts of endocrine systems, circadian rythyms, HPG axis, and hormonal proteins are probably overlooked(ignored) as keys to understanding the biochemistry of various disfunctions.
This is not my field and I do not want it to be. I just yearn for the day when many more in this field pull their heads out. Best wishes.
Posted by Estella on August 20, 2006, at 20:57:11
In reply to Re: Mode of action could be quite helpfull » Estella, posted by WeeWilly on August 20, 2006, at 12:11:53
>For me, discourse on this site is not of help, its the information that people often convey about how medications effect them that has value.
I see.
I hope you find what you are looking for.
Posted by linkadge on August 22, 2006, at 15:46:42
In reply to Re: Mode of action could be quite helpfull, posted by jealibeanz on August 20, 2006, at 11:30:48
rozerm is a melatonin receptor agonist. But why not just use OTC melatonin, it is a melatonin receptor agonist too!
Linkadge
Posted by WeeWilly on August 22, 2006, at 18:56:11
In reply to Re: Mode of action could be quite helpfull, posted by linkadge on August 22, 2006, at 15:46:42
Rozerem can have some effects on the hpg axis among other areas. It seems to have some unique properties. Best wishes
This is the end of the thread.
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