![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 39. Go back in thread:
Posted by linkadge on December 4, 2006, at 17:59:53
In reply to Re: Why your medicine may not help » linkadge, posted by zmg on December 4, 2006, at 16:53:49
Interesting comments. Thank you.
Back in my great grandparent's day, depression wasn't an option.
Now, we've sort of adopted this..."its my right to be non depressed". Says who? Was that the 11th commandment from God to Moses. "I shall provideth an effective antidepressant at all times"
I don't understand when people come here just bewildered at why antidepressants aren't working.
"I pay for my SUV, and therefore it should work". "I pay for my prozac, and therefore I should be happy." "Its my right as an antidperessant consumer to get an effective antidepressant"
But, there are no guarentees in this buisness.
Linkadge
Posted by SLS on December 4, 2006, at 18:11:24
In reply to Why your medicine may not help, posted by Vale on December 4, 2006, at 15:54:34
Major Depressive Disorder (MDD) and Bipolar Disorder (BD) are not normal mood states. They are the result of abnormal brain function. There is much biological evidence to support this conclusion. These are pathological states for which the sufferer deserves remedial treatment. Fortunately, treatments have been discovered that are genuinely effective for the majority of properly diagnosed cases.
Psycho-Babble attracts people who have questions. People who are treated effectively don't have any that need to be answered.
Negativity is easy to entertain where failure is such a common occurrence. It can be infectious. It is easy to feed into. It is counterproductive. It can only reduce success rates. Unfortunately, it seems to be growing.
- Scott
Posted by linkadge on December 4, 2006, at 18:13:00
In reply to Re: Why your medicine may not help » Vale, posted by tensor on December 4, 2006, at 17:19:52
>There is a certain percentage that will have one >depression once for, say, three months and never >again. I'm not one of them. I believe mine is >genetically determined, my brain is hard-wired >to have certain levels of substances abundant in >the synaptic cleft etc.
But thats the thing. There is no basis for definicany of neurotransmitters in depression.
The fact is that depression almost always gets better on its own. The majority of depression lasts less than a year. Very rarely over a year.
It could very well be a life cycle. After all, the life is a very long and important event.
Its just like how everybody picks at a scab. They think, "yeah yeah, I know how my body works, and I don't like this scab here". So they pick off the scab and it leaves a scar.
If they had just left well enough alone, and let the wound to heal on its own, there would be no scar.
The problem is that depression is a message. It is a message to stop everything you're doing an
give yourself time to heal.But, antidepressants are all about keeping people productive. We want to speed heal the process, as quickly as possable.
But maybe the process of "speed healing" depression will leave a scar. Its all about this fast paced society. We want everything now. We don't want to wait for anything.My grandfather had 4 major depressive episodes, each lasting about 8 months. But, when he was well, he was 100% better. None of this hooked on antidepressants, bla bla, I need some augmentation, bla bla, my drug is pooping out, bla bla, I need more norepinephrine, bla bla, I'm impotent, bla bla, polypharamchology, bla bla.
I digress,Linkadge
Posted by linkadge on December 4, 2006, at 18:22:51
In reply to Re: Why your medicine may not help, posted by Edwin Ransom on December 4, 2006, at 17:29:38
>I could make the same kind of overgeneralized >analogy in favor of the pharmacological approach >and say “depression is like a situation where >your hand feels like its burning when its not.’ >There’s just nothing to learn, all you can do is >try to find a way to stop feeling the burning >sensation.”
But how is depression diagnosed this days?
"Sadness or unhapiness lasting 2 weeks or more."
WTF?
If people don't think about their problems for longer than 2 weeks, there is something wrong.
In addition, I'm not saying you need to have a reason to be depressed. Life and stress are reasons enough.
Stress is likely the number 1 cause of depression.
Linkadge
Posted by linkadge on December 4, 2006, at 18:27:28
In reply to Re: Why your medicine may not help, posted by SLS on December 4, 2006, at 18:11:24
>They are the result of abnormal brain function.
How can you say they are the result of abnormal brain function if no brain abnormality has been conclusively uncovered?
>There is much biological evidence to support >this conclusion.
The sum total of the biological evidence is zero. Give me any study that attempts to identifty a particular abnormality, and I will find an equally proportoned study that absolves that particular abnormality.
>Fortunately, treatments have been discovered >that are genuinely effective for the majority of >properly diagnosed cases.Oh I see, good use of the discalimer "properly diagnosed cases".
Linkadge
Posted by madeline on December 4, 2006, at 18:29:26
In reply to Re: Why your medicine may not help, posted by linkadge on December 4, 2006, at 18:13:00
To some extent, I agree with you. It is shocking to see the number of prescriptions for AD's that come out of general practioner's offices.
I think that is malpractice.
Good old fashioned psychotherapy, learning new life coping skills, developing social support systems, making life (career) changes, eating well, avoiding alcohol, exercising, simply finding something that makes you happy and DOING it, becoming confident enough to take control of your life - these are all things that are essential for battling long term depression.
I do think the AD's can be a powerful adjunct to the above by potentially offering enough relief to begin the changes above.
But overcoming major depression, like any other chronic major illness, requires lifestyle changes as well.
Doctors should tell us this, good psychiatrists will open the door for us and help us to walk through to it.
Posted by tensor on December 4, 2006, at 18:32:42
In reply to Re: Why your medicine may not help, posted by linkadge on December 4, 2006, at 18:13:00
>The fact is that depression almost always gets better on its own..
almost always. almost.
>The problem is that depression is a message. It is a message to stop everything you're doing an
give yourself time to heal.Then why is it a problem?
I have been tired all my life, lack of energy and motivation, as long as I can remember. I remember my first panic attack at an age of about 7. I started medicate at the age of 19 and got relief. My brain didn't heal over a period of 12 years, that's the longest I'm going to wait.
/Mattias
Posted by linkadge on December 4, 2006, at 19:05:39
In reply to Re: Why your medicine may not help » linkadge, posted by tensor on December 4, 2006, at 18:32:42
>I have been tired all my life, lack of energy >and motivation, as long as I can remember. I >remember my first panic attack at an age of >about 7. I started medicate at the age of 19 and >got relief. My brain didn't heal over a period >of 12 years, that's the longest I'm going to >wait.
It is impossable for me to say as I do not have access to the data regarding all past, and present stressors.
I'm not saying that some sort of biochemical abnormality might not exist in some depression, I am just saying that there is *no way* that the number of people taking antidepressants today all have so called "geniune non-stress induced biochemical abnormalities".
Everbody I know who has taken antidepressants usually started during a period of significant life/psychosocial stress.Wheather that be starting out at a new collage/university, loss of a job, loss of a loved one, school related psychosocial stress, family related stress, health issues, you name it.
Linkadge
Posted by blueberry on December 4, 2006, at 19:08:43
In reply to Why your medicine may not help, posted by Vale on December 4, 2006, at 15:54:34
The strange thing though is that many people are helped a lot by their medicine. It's just that they are doing so well that they don't hang out at psychobabble. We get a slanted view of how the real world is. We think everyone is having troubles with their meds just because we are. About 10% of the workforce at my job are on meds and you would never know it. They are happy productive people.
I've experienced true deep dense depression caused by a devastating life circumstance. Therapy and time was good for ending that. I have also experienced true deep dense depression that just strikes like the flu. That kind of depression was not helped by therapy or time. Medications have sometimes been perfect, sometimes been fair, and sometimes been a disaster.
The human brain and genetics are way too complicated. There will never be a perfect cure for biologically caused depression. But in a majority of people medications make it possible for them to live nearly symptom free.
Just an opinion.
Posted by Phillipa on December 4, 2006, at 19:43:34
In reply to Re: Why your medicine may not help, posted by blueberry on December 4, 2006, at 19:08:43
When I only had anxiety it would overwhelm me. An example was when I was in RN school I knew I couldn't raise my three kids, do an Aerobic Dance Businee, choreograph, train teachers, and put up with what was going on in the Associated Degree program. If your child was ill and you stayed home they booted you out no matter your grades and they let l00 into the program knowing they were allowed to only graduate 40. So the last day of school for first semester all finals taken and graded. We sat on the floor while the highter powers decided who would be booted who would stay based on a term paper. Well I was allowed to stay but knew it wouldn't be healthy. So lay on the couch for two weeks. Didn't attend parties and didn't care what my cheating husband was doing and had to decide whether to continut or drop out and I was on the Dean's list. I finally decided after the two weeks of nothing to drop out go the hospital route of degree and first take the Associates courses I needed. Two a semester. Then I entered the degree program nothing but nursing and it was perfect. I could have gone back to the Associates and was accepted into the Bachelors. But I knew my limits my love and it wasn't paperwork it was being with the patients. So that's what I did with absolutely no regrets. So doing nothing does work. And the slowing down. Now if I could do it again. Unfortunately this stupid thyroid and older age is messing it up. Love Phillipa my rant for the night
Posted by laima on December 4, 2006, at 20:21:34
In reply to Re: Why your medicine may not help » Vale, posted by tensor on December 4, 2006, at 17:19:52
My doctor told me that even if medication konks out, it can provide a window of opportunity for making changes and improving one's condition- by feeling better for awhile, getting some momentum, shifting one's frame of mind and experiences. If depression or anxiety was useful for any of my ancestors' survival- great. It's not useful for me--and those ancestors wouldn't want me depressed either!I'd also like to point out that poor and destitute people have high rates of depression- depression is not a rich person's indulgence.
Posted by laima on December 4, 2006, at 20:38:30
In reply to Re: Why your medicine may not help » zmg, posted by linkadge on December 4, 2006, at 17:59:53
My parents, grandparents, and many other mid-century refugees packaged it up differently than we do today- bluntly, they probably never heard of depression, but they drank very heavily, and they looked forward to going to heaven- which they earned after enduring earth. They were VERY religious and EXCRUCIATINGLY patriotic (for both their nation of origin, and to the one that gave them shelter). Heaven was one of the rewards to live for- the other was so future generations (ie me) could hopefully have a better life. That didn't mean that their profound stresses of living through wars and famine, then later poverty, very hard work, and xenophobia didn't leave them utterly drained and depressed at times. They always warned, "Life isn't meant to be fun". That's been going on for generations in my family genes, actually. It's also a cultural "teaching" that got passed down. The suspicious ones survived, the happy-go-lucky ones perished at the hands of who ever was invading that century. I think I deserve to break that cycle if I can. No longer useful. I think I do deserve a decent life on earth, as does everyone else.
> Interesting comments. Thank you.
>
> Back in my great grandparent's day, depression wasn't an option.
>
> Now, we've sort of adopted this..."its my right to be non depressed". Says who? Was that the 11th commandment from God to Moses. "I shall provideth an effective antidepressant at all times"
>
> I don't understand when people come here just bewildered at why antidepressants aren't working.
>
> "I pay for my SUV, and therefore it should work". "I pay for my prozac, and therefore I should be happy." "Its my right as an antidperessant consumer to get an effective antidepressant"
>
> But, there are no guarentees in this buisness.
>
>
>
>
>
>
> Linkadge
Posted by SLS on December 4, 2006, at 21:29:34
In reply to Re: Why your medicine may not help, posted by linkadge on December 4, 2006, at 18:27:28
> > They are the result of abnormal brain function.
> How can you say they are the result of abnormal brain function if no brain abnormality has been conclusively uncovered?
So, when does something become conclusive for Linkadge? I guess facts are really nothing more than opinions, afterall.
> >There is much biological evidence to support >this conclusion.
> The sum total of the biological evidence is zero.Oh, absolutely.
> Give me any study that attempts to identifty a particular abnormality, and I will find an equally proportoned study that absolves that particular abnormality.
I'm sure you will.
> > Fortunately, treatments have been discovered that are genuinely effective for the majority of properly diagnosed cases.
> Oh I see, good use of the discalimer "properly diagnosed cases".As opposed to treating an improperly diagnosed case? It's called a qualifier.
Linkadge, you make me feel so lucky sometimes.
- Scott
Posted by linkadge on December 4, 2006, at 22:15:10
In reply to Re: Why your medicine may not help » linkadge, posted by SLS on December 4, 2006, at 21:29:34
Whatever helps you sleep at night.
Linkadge
Posted by fires on December 4, 2006, at 23:10:55
In reply to Re: Why your medicine may not help, posted by Phillipa on December 4, 2006, at 17:35:58
> Well meds don't help me. Love Phillipa ps maybe my hypothoroidism that is now hyper?
As anyone suggested Hashimoto's Thyroiditis? It can cause swings from hypo to hyper.
Posted by SLS on December 5, 2006, at 6:17:10
In reply to Re: Why your medicine may not help » SLS, posted by linkadge on December 4, 2006, at 22:15:10
> Whatever helps you sleep at night.
It helps me live during the day, too.
I believe that, to the extent that it is possible, one should pursue happiness rather than amplify unhappiness. This is the job of cognition, not affect. It is a matter of perspective and attitude. It is a matter of choice. I am not saying that it is possible in all cases of depression to attain happiness, but it is always better to try to enhance one's cognitive processes through positive thinking than to languish in negative thinking. To actually choose to think negative when one is capable of thinking positive is self-destructive. It is precisely this depressive pressure (psychosocial stress) that can trigger and perpetuate and make treatment-resistant a depression.
- Scott
Posted by linkadge on December 5, 2006, at 9:43:01
In reply to Re: Why your medicine may not help, posted by SLS on December 5, 2006, at 6:17:10
Well, I'm not happy unless I'm miserable.
Linkadge
Posted by laima on December 5, 2006, at 10:28:52
In reply to Re: Why your medicine may not help, posted by linkadge on December 5, 2006, at 9:43:01
I wonder if you know this can actually be true for some people- "being right" more important, easy, and satisfying than illogically entertaining hope.
Well, I'm not happy unless I'm miserable.
>
> Linkadge
Posted by SLS on December 5, 2006, at 10:49:28
In reply to Re: Why your medicine may not help » linkadge, posted by laima on December 5, 2006, at 10:28:52
> I wonder if you know this can actually be true for some people- "being right" more important, easy, and satisfying than illogically entertaining hope.
What hope is it that you feel you must illogically entertain?
- Scott
Posted by laima on December 5, 2006, at 11:27:40
In reply to Re: Why your medicine may not help » laima, posted by SLS on December 5, 2006, at 10:49:28
I don't think hope need be illogical, but sometimes it can seem that way if medications poop out or things aren't going well. When that happens, at least for me, the struggle to maintain hope does take a lot more energy than sinking into "I knew it wouldn't work out-as usual. I've tried all this before, why should I waste my time, statistics show it won't work," etc. Of course, that's tricky turf- because that's also a mood disorder clouding cognition.Has anyone seen those reports that depressed people often are "more realistic" than non-depressed people? If so, I'd rather be less realistic, and am trying to do so :)
> > I wonder if you know this can actually be true for some people- "being right" more important, easy, and satisfying than illogically entertaining hope.
>
> What hope is it that you feel you must illogically entertain?
>
>
> - Scott
Posted by SLS on December 5, 2006, at 12:08:47
In reply to Re: Why your medicine may not help » SLS, posted by laima on December 5, 2006, at 11:27:40
> I don't think hope need be illogical, but sometimes it can seem that way if medications poop out or things aren't going well. When that happens, at least for me, the struggle to maintain hope does take a lot more energy than sinking into "I knew it wouldn't work out-as usual. I've tried all this before, why should I waste my time, statistics show it won't work," etc. Of course, that's tricky turf- because that's also a mood disorder clouding cognition.
Yes.
There are real things to be depressed about. Just living with the handicap of depression is reason enough. However, the depression produces cognitive distortions that can amplify negative thoughts and make things seem bleak and overwhelming.
Because I haven't tried every conceivable treatment yet, and that there are more treatments on the way, gives me logical hope for the future. At least, this is how I see things a great percentage of the time. However, there are times when a part of me comes to the seemingly logical conclusion that I will never get well. When this occurs, that's when I must make some choices. Do I continue to live, or do I choose death. So, for reasons that I won't get into here, I choose life. Then, I must decide whether to live with or without hope. I choose to acknowledge the uncertainties that life permits, and develop blind hope. It is not necessary illogical, but it relies on the unknown. Then, I must choose whether or not to strive for cognitive positivity and pursue happiness or allow passively the depression to ruin the quality of my life. That's a no-brainer after you make the other choices. However, it requires committment and work. It isn't easy, but it does become a habit after awhile. To develop a habit of looking for positive and constructive ways to approach life can only enhance one's experience in life, even if it doesn't correct the biology of a depressive disorder.
Have you ever tried:Effexor + Remeron?
Effexor + Wellbutrin + Lamictal?
Parnate + desipramine?
- Scott
Posted by laima on December 5, 2006, at 13:39:42
In reply to Re: Why your medicine may not help » laima, posted by SLS on December 5, 2006, at 12:08:47
Oh definately- yes, depression or other mood disorder can cloud clear thinking and perception, just as much as a pollyannaish view can. But I'm still sure there is a middle ground which preserves both good judgement and healthy mood. How to get there...
Efforts x and y didn't work out, therefore I logically deduce that statistically speaking, z likely won't either. Besides, my biological setpoint is low, and medications are not better than placebos. Studies show z doesn't work any better, and probably causes irreversable brain damage. And everyone knows placebos are a trick anyway-I'm too sophisticated and knowlegeable to fall for the simple tricks of megadrugcorporations or anyone else.
(Here my guess is I stay miserable, become increasingly ironic and jaded.)Efforts x and y didn't work out, yet I deduce z may be quite different because of abc. It's worth a good try- it could work-it might not- but there are good reasons to believe it'll work. It's not easy, but keep trying. We're narrowing down the best therapy for me to be z, which has worked for a lot of other people who got no relief from x and y. Megadrugcorporation? Can be shady, but there are all kinds of people working there, and some of them really do care that their product is genuinely helpful to someone- like me.
(Here my guess is I have a good likelihood to sprout hopes, feel better.)Or, efforts x and y didn't work out, yet I deduce z is just different, it's THE answer!!! Finally!!!
(Here my guess is I might be right- or I might set myself up for a major disillusionment.)Can I just feel optimistic about z and have it work out?
Effexor I couldn't tolerate, wellbutrin konked out. I think I was cognitively fuzzy and "slow" when I used lamictal, and it didn't help my mood, either. Emsam helps, modestly, but ok in conjunction with other efforts, which I haven't really gone through yet. I've never tried parnate- I do actually think it sounds quite different from what I've already tried- I'm sort of ready to just decide something works.
I sort of remember my doctor describing medications as "tools" which can provide a "valuable window of opportunity". I can't remember the exact quote, but when I think about it, the idea is interesting. I think it's a hopeful and useful middle-of-the-road sort of position, even if the medications don't ultimately work out in and of themselves, by themselves.
In a way, I think part of what this thread digs up is the 'ole nature/nurture debate. I think a lot- if not most- scholars are taking a more open and blended, blurry position of it these days than they used to. Ie, genes count a lot; they are not the whole story. Conditioning counts a lot; it is not the whole story. Conditioning may end up reflected in the gene pool, etc. We're stuck with our genes, but the conditioning, (which counts a lot), can be manipulated. And medication, I presume, can help manipulate- on an individual basis- what the genetic lottery dealt.
Posted by SLS on December 5, 2006, at 16:32:59
In reply to Re: Why your medicine may not help » SLS, posted by laima on December 5, 2006, at 13:39:42
I appreciate your endeavor to seek balance. It sounds very much like my own.
What exactly happened with Wellbutrin?
- Scott
Posted by Phillipa on December 5, 2006, at 17:34:52
In reply to Re: Why your medicine may not help » Phillipa, posted by fires on December 4, 2006, at 23:10:55
Fires it is hasimotos the autoimmune one. So besides to regulating of synthroid how long to feel better any idea? Love Phillipa
Posted by laima on December 5, 2006, at 22:53:59
In reply to Re: Why your medicine may not help » laima, posted by SLS on December 5, 2006, at 16:32:59
Wellbutrin worked out well for awhile, but it was a very stressful time in my life, and I was really, really anxious. The doctor thought that since wellbutrin is so "activating" it could be contributing to an anxious state. The thought was, remove stimulants rather than pile on more benzodiazapines. After that, I used selegeline tablets, and then the Emsam version. It's worked out ok-not perfect, but ok.> I appreciate your endeavor to seek balance. It sounds very much like my own.
>
> What exactly happened with Wellbutrin?
>
>
> - Scott
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.