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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by leo33 on January 12, 2007, at 20:06:57
I seem to have this question? Since with drug addiction they say its just masking the symptoms. Don't the psych drugs do the same? It seems like there is no cure just temporary relief until it poops out and then more drugs. Just wondering what people think?
Posted by SLS on January 12, 2007, at 21:02:08
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
> I seem to have this question? Since with drug addiction they say its just masking the symptoms. Don't the psych drugs do the same?
Drugs of abuse are not antidepressants and don't work the same. Drugs of abuse can sometimes mitigate symptoms of depression or "mask" them to some degree, but the underlying depressive illness persists.
> It seems like there is no cure just temporary relief until it poops out and then more drugs. Just wondering what people think?
For me, antidepressants do not mask symptoms. They make the the whole disorder disappear. What's the difference? I'm sure there will be people to challenge me on this, but it is more than just a question of semantics. Simply masking symptoms does not account for things like the reversal in the abnormal brain structure seen in depression when remission is achieved with antidepressant treatment.
When mood illness is stabilized with therapeutic medication, addicts find it much easier to abstain from substance abuse.
- Scott
Posted by Phillipa on January 12, 2007, at 21:45:38
In reply to Re: Do people feel medications help or mask sympto, posted by SLS on January 12, 2007, at 21:02:08
Nothing scientific here I just think that if something happens in a persons life that greatly shatters their world that for a short time they may need meds. Different from Scott's disorder. Love Phillipa ps not referring to me
Posted by laima on January 12, 2007, at 22:19:00
In reply to Re: Do people feel medications help or mask sympto, posted by Phillipa on January 12, 2007, at 21:45:38
I almost think that meds often cover up a disorder, but allow a person to make changes or just live with relief for awhile. Hopefully a long while. I still am waiting to hear of someone who goes through a trial of antidepressents and is actually "cured" for good. It almost seems as if the brain overcomes the medication's interference at some point; that the medication doesn't re-train the brain in any way. I actually hope to be wrong here-
Posted by Quintal on January 12, 2007, at 22:30:59
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
>I seem to have this question? Since with drug addiction they say its just masking the symptoms. Don't the psych drugs do the same?
I've come to the conclusion they do work largely by masking symptoms based everything I've read and experienced myself. An exception would be thyroid hormones being used to treat depression resulting from thyroid disease.
I felt wonderful when I was taking Klonopin and Parnate but it was an illusion as I found out after stopping them and reviewing my behaviour. They just seemed to blind me to the negative (and very real) side of life that I preferred not to see. SSRIs were like emotional anaesthetics to me, they certainly did simply mask my symptoms. My old psychiatric nurse would argue fervently that benzos only mask symptoms while antidepressants address the root cause of the problem (he was a disciple of Prof. Heather Ashton), but I found the opposite true. I had a full range of emotion on benzos but even then although I thought I was doing great, my life was really going down the pan but I couldn't see it until I had to quit them.
The main difference with drugs of abuse is that they produce rapid and powerful changes in consciousness that makes them attractive to casual users as well as depressives. I notice that some of the newer treatments are moving a step closer to the underlying mechanisms of some drugs of abuse, such as the triple reuptake inhibitors. I also suspect (and hope) they will be more effective antidepressants because of this. It is also likely that they will have a more severe withdrawal syndrome than many other currently available antidepressants.
It is suggested by Robert K. Siegel Ph.D. in his book "Intoxication: the universal drive for mind altering substances" that there will be a focus on producing safer, self-limiting versions of drugs of abuse in the future development of antidepressants and anxiolytics. I think it's an interesting idea and I hope he's right.
Q
Posted by laima on January 12, 2007, at 22:40:32
In reply to Re: Do people feel medications help or mask symptoms? » leo33, posted by Quintal on January 12, 2007, at 22:30:59
Quintal, you bring up an interesting thing about "drugs of abuse"- I never figured it out until just recently, but like you I think that they are the ones which can produce a rapid and dramatic effect. In my own experience, I saw there was a rapid "benefit" to taking extra benzo, I can easily see a "benefit" to taking an extra adderall or ritalin- no such rapid boost anticipated from an extra Emsam patch! No wonder stimulants are frowned upon as antidepressents- a depressed person would naturally be extra-tempted to take more, because if a little can cause a dramatic improvement, and a little more does a bit more, so even more must be better...but of course, not quite so simple or true in the big picture.
Posted by yxibow on January 13, 2007, at 2:37:23
In reply to Re: Do people feel medications help or mask sympto, posted by SLS on January 12, 2007, at 21:02:08
> > I seem to have this question? Since with drug addiction they say its just masking the symptoms. Don't the psych drugs do the same?
>
> Drugs of abuse are not antidepressants and don't work the same. Drugs of abuse can sometimes mitigate symptoms of depression or "mask" them to some degree, but the underlying depressive illness persists.
>
> > It seems like there is no cure just temporary relief until it poops out and then more drugs. Just wondering what people think?
>
> For me, antidepressants do not mask symptoms. They make the the whole disorder disappear. What's the difference? I'm sure there will be people to challenge me on this, but it is more than just a question of semantics. Simply masking symptoms does not account for things like the reversal in the abnormal brain structure seen in depression when remission is achieved with antidepressant treatment.
>
> When mood illness is stabilized with therapeutic medication, addicts find it much easier to abstain from substance abuse.
I would agree with the above. I think we've beaten a dead horse, donkey, elephant, and several endangered species on the discussion of the model of biochemical disorders and psychiatry and medication and come full circle again.So again we dig... Well, there will be people who will steadfastly have their own opinions and that's what free will is in countries that allow it. Numerous PET scan studies have shown changes in brain chemistry in depression, OCD, schizophrenia, etc.
It is my belief that in order to escape the stigma of "mental illness", the world at large, or at least the western world at this point in time, we have to recognize that mental disorders have biological origins. They may have environmental factors that trigger them but ultimately it all ends up in the neurotransmitters, and how they differ in some way in certain people, genetically, or otherwise. Do we really want paltry caps on mental health care insurance ?
It really doesn't matter actually if you believe it or not, because an environmental belief of depression can be shown to be biochemical also -- the outside world affects a person, which in turn, sets off a chain of reactions in the brain, etc. How do you type on the keyboard here? You have a thought, which triggers a neurotransmitter message to the part of the brain involved in processing movement and in turn you type something out.
Anyhow, that is just a long lead-in to helping and masking. I currently suffer from a fairly rare life-affecting but not life-shortening strong Somatiform disorder and have for the past five years, mostly involving an inability to filter out visuality as much as the rest of the world does in microseconds (i.e. traffic lights are brighter, etc.) For the first part of the treatment, it was to prevent suicide (which may still have breakthrough issues) and to see how far medications, and eventually psychotherapy as well, could help things. They have not been without side effects I've never seen in previous disorders or medications I've never dreamed of taking. But while they blunt things as much as the disorder itself blunts myself from the world, they have enabled me to get to a point where I am at a "guarded" or partially-treated point that I can function in the world. If I were asked about my treatment I would say, I wouldn't be talking to you today standing here without the countless medications and hours of therapy that I've had.Now comes the harder part. Reducing the medications to a minimum effective dose (MED), to see whether I can tolerate a lower dose and still not have symptoms from the past. We don't know what will happen. I do know that there have been stages of withdrawal and temporary odd symptoms that creep in and back out again.
To a degree, the medications may be masking things -- if that is all they are doing, I am saddened, I never signed up for this, it just struck suddenly sometime around November 17, 2001. But I still have my mind. I may have an equivalent to a physical handicap but my intelligence is still here, despite the lethargy of medicine and the pain of disorder.
From a psychodynamic point of view, the fewer the medications the greater the chance that inside therapy may get to the core of Somatiform disorders, which are anxiety expressed completely as a bodily manifestation -- and are not malingering as thought in the past -- in fact pseudoseizures are the most common (there are facticious disorders but those are only a subclass.)
So the object here is a model of greater functioning in the world, slowly, by occupying time with life-affirming activities, that may push some of the disorder out of my mind. Or so my multiple doctor(s) think. Hope does come from within and it takes a lot to believe in it when old symptoms come crashing back in and in the past , when things were moving rapidly "better", I could tolerate what now I am used to more "normal" existence and find old symptoms less tolerable.
So I can't say whether they have helped or masked. In this case only time may say.When I had my breakout of OCD at 17 (well I had it at 12, and variations up to 17, but the worst came then) and was hospitalized, it wasn't really until the end of treatment that I took an SSRI. And Prozac helped with things, and may have made it easier to continue behaviour therapy which was already well under way. I think that for OCD, except for pure obsessions which are hard to fight (I still have garbage nonsense that goes on a track in my brain at times), medications are a help, but they should be accompanied by behaviour therapy. In fact, behaviour therapy alone can be a treatment for less severe OCD if one follows a plan well.
But in the end, with serious biochemical disorders like schizophrenia (I take neuroleptics for dopamine blockade but I am not psychotic -- it is Somatiform NOS, not otherwise specified and falls sort of in the OC Spectrum range) and bipolar, and MDD (which I have, even if it is secondary to the disorder), one may have to take medications, whether they mask, or help the disorder for many years. My parents -- myself, I ask, well you can't take medication for life.. and I certainly don't wish to be on polypharmacy. But for some disorders, especially for those that cannot be managed by therapy alone, severe schizophrenia, etc., one may have to be on a variety of medication for many years because this is the best we have in 2007. We don't have brain surgery on the sub nanometer level and I don't think most all of us would sign up for psychosurgery.
This question often comes up with people who are being treated for anxiety, depression, OCD, or both, with SSRIs, and decide to discontinue their medication only to discover that they felt better on them. I know that I have had that experience with SSRIs for dysthymia and the like.
Now, Phillipa brought up a point which I think relates to the fact that during a person's lifetime, they are likely to face a traumatic event in the life cycle that we all live in. For them, maybe just an SSRI for a while will help them cope with a traumatic event, and then they can discontinue it and perhaps follow up with some therapy as well and move through another phase in their lives. For them, it isn't an endogenous disorder per se. It is for an instance, but it isn't genetic, and it doesn't mutate and change form over a lifetime. It just is a temporary fork in life.
For others, with clinical lifetime disorders, I believe that medications both can mask and help, purely mask, purely help, or any of a combination of the above.
That's my 2c anyhow- tidings
Jay
Posted by Klavot on January 13, 2007, at 3:31:27
In reply to Re: Do people feel medications help or mask sympto » SLS, posted by yxibow on January 13, 2007, at 2:37:23
Well said, Jay. I have begun taking Zoloft and Wellbutrin again, because after about a 3 month absence, I have concluded that I am simply a much better person using these medications. If I analyse the past 10 years of my life, I have definitely been a better person during the times that I have used psychotropic medication versus the times that I haven't. To me, it doesn't really matter whether medication treats or simply masks my depression; what matters is that I have *QUALITY OF LIFE* while on medication. Three doctors now have suggested to me that I stay on antidepressants long-term, possibly for the rest of my life. In the past I have rebelled at the idea, but I am starting to realise that I probably do have a pathologically based tendency towards depression.
Klavot
Posted by SLS on January 13, 2007, at 4:55:42
In reply to Re: Do people feel medications help or mask sympto » SLS, posted by yxibow on January 13, 2007, at 2:37:23
Real quick, Jay.
Did 9/11 affect you in any way?
Have you tried Paxil?
- Scott
Posted by Meri-Tuuli on January 13, 2007, at 10:44:04
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
Hey!
Well, for me, medications have been of no help whatsoever. In fact, they only make things worse for me. I'm doing far better off meds than I was on them. Okay, so things might be a little shaky at times, and sometimes its great and others not so great, but I'm far better off without them. I'm making alot more progress without drugs than I ever did on them. Now, I'm able to look at things and address problems I have etc. On celexa, for instance, I only cared about eating, sleeping and shopping. I wasted several years like that, not addressing any of my problems when I could have really been sorting myself out with therapy etc.
So for me, drugs really just mask symptoms and I don't make any progress. I'll come off them, crash and then try a different drug. Now I haven't crashed majorly in quite a while and I'm really working hard to address my 'issues' and low self esteem etc which are at the root of my problems.
For me, I think my mental problems are entirely psychological and have no biological basis whatsoever. I've given up completely with seeking a chemical solution to my problems - although I do try some herbs, although I never actually take any at any theraputic doses.
But this is just me, and my own experience. I don't say for others. But I will say that I know I went through a phase of denial, and thinking that I must have a biochemical imbalance or something. Its alot easier to cope with, and I think doctors and drug companies do tend to push the biological component of depression etc. I know that here in the UK, therapy is very very limited (on the state healthcare system at any rate) so GPs will dish out SSRIs like candy rather than getting to the roots of problems with therapy.
I mean, I distinctly remember telling a psychiatric nurse during my first ever depressive episode that prozac just felt like a pain killer - it didn't address the cause of the pain, just blunted it.
Kind regards
Meri
Posted by yxibow on January 13, 2007, at 12:18:03
In reply to Re: Do people feel medications help or mask sympto » yxibow, posted by SLS on January 13, 2007, at 4:55:42
> Real quick, Jay.
>
> Did 9/11 affect you in any way?
>
> Have you tried Paxil?
>
>
> - ScottYes, a good observation of a devastating trauma to myself and our country -- it is believed that my disorder may have been triggered by the extreme anxiety that happened just after 9/11. My reaction was disproportionate to those around me. I would be constantly checking my cellphone for news, be worried at night that nuclear war was going to break out, and a myriad of things that led to a total breakdown of my grip on life.
Of course, these threats to our way of life were always present, we just lived through the Reagan me generation, and the relative calm of the Clinton era (we can ignore the politics here, at any rate for the sake of this discussion, but anyhow...),
But somehow spontaneously, and I believe it was about Nov 17, because I was driving up the local mountains for my somewhat annual viewing of the Leonids (meteor showers, only visible in the southwest usually because of weather, anyway) and I was seriously almost blinded by the light of cars coming and going and I saw a few meteors and got off the mountain as safe as possible.
I thought this was some sort of fluke or illness that would pass and I went out to a more local dark sky area, and again I was hit by car lights and I remember passing a gas station and seeing purple blotches in my vision on the way home.
(Yes, I have had several opthamologist appointments, an MRI, every test imaginable including Lyme, etc.)
I haven't tried Paxil, but I did try and respond to Luvox, mostly for the hysteria that followed the hysteria -- 16 hour a day discussions and breakdowns with my parents about my disorder and what medications might be doing to me (it doesn't really help a disorder if you are acutely vigilant about every nuance of medication that is attempting to help you -- it is sort of counterproductive.)I was up to 450 when the electric shocks while excercising got a bit too much, and backed to 400. I was on it for a while before Cymbalta came out and I was switched, primarily because I believe my doctor felt it was better for what had become a secondary (or primary, who knows) MDD.
Indeed, there came an eventual epiphany for lack of words one day when we hit 80 on Cymbalta -- didnt have that lilt after it but I knew something was better -- Cymbalta is subtle and takes a while to take its final effect. I now take 120.
I have thought and we have occasionally discussed adding something like a small dose of Lexapro to the mixture but there are now several 5HT agents on board (Seroquel and Cymbalta) that a reduction of one or the other would have to occur because I am on polypharmacy and even the presence of Robaxin, which was made before standard P450 challenging, caused a minor Serotonin Syndrome.
But, at the moment with a slow reduction plan in Valium and Seroquel that may be something to try in the future. In the meanwhile, my treatment plan of expanding my life outside the house, volunteering places several days a week and taking several extension classes in certification for a video editing program (to add to my forte which is video editing, ironic with my visual problems), is occupying time at the moment so rocking the boat with a third variable wouldn't be good right now.
But at a later point, yes, I do wonder how much an anti-OCD (Cymbalta doesn't do much for secondary garbage thoughts in my mind which isnt my primary concern at the moment though it can be annoying) agent would add to the mixture.
Curiously, before I agreed to a neuroleptic fully on board (we did try Zyprexa but the pseudoparkinsonism was much greater than Seroquel and I was more than a bit concerned even though I swear it wiped out most things -- but then at each stage of "more wellness" its hard to judge what "wiped out" really meant today), Remeron sort of acted I think like one, at its highest dose, 45 (52.5 was a bit much), with its 5HT blockade. It was rather good for things except for adding massive pounds, so it was dropped.
At any rate, even before all of this I have had issues with getting jobs and the like, frustration and slowly giving up. I sometimes wonder if I didn't panic about possible loneliness causing suicide and have myself moved home from where I graduated from college, what fork my life might have taken. I still miss it back there and I want to return. I still go most years on a roadtrip (I still loath planes, have for a long time, but these days... ugh) back to visit though they say you can't go home and my friend circle there and everywhere I've been including home has dwindled.
And that's where getting out more and possibly pushing the darkness out of my mind might happen. But as I say, we -- or I really, don't know that this could occur.
As for ever trying Paxil, I think I was switched to it when I had my worst OCD, I don't know, I forget now -- I may have used it for dysthymia in college, or Zoloft -- my mind is fuzzy there.
But one thing in common with most all of the agents on board is -- sedation. And that alone may play a role in treatment itself though it can obviously be a detriment in managing daily affairs.
Thanks for your observation-- Jay
Posted by notfred on January 13, 2007, at 15:43:29
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
Whichever it is I could care less as I have been in remission for over 20 years with just a few breakthru depressive episodes. This statement would suggest they treat but I do not spend time wringing my hands over is issue. It works, move on.
Posted by laima on January 13, 2007, at 16:04:31
In reply to Re: Do people feel medications help or mask sympto, posted by notfred on January 13, 2007, at 15:43:29
I think the drawbacks of masking would be evident if and when the meds konk out. They do konk out for a lot of people, so real cures would be worth pursuing.> Whichever it is I could care less as I have been in remission for over 20 years with just a few breakthru depressive episodes. This statement would suggest they treat but I do not spend time wringing my hands over is issue. It works, move on.
Posted by SLS on January 14, 2007, at 7:05:23
In reply to Re: Do people feel medications help or mask sympto, posted by laima on January 13, 2007, at 16:04:31
> I think the drawbacks of masking would be evident if and when the meds konk out. They do konk out for a lot of people, so real cures would be worth pursuing.
But I don't think that the fact that meds konk out is de facto proof that they only mask symptoms. Such can also occur if symptom relief is the result of remission of the illness itself. Note that remission does not equate to cure. As with so many other illnesses, antidepressant treatment can produce a complete remission rather than a partial mitigation of selected symptoms. And as is also true with other illnesses, treatments sometimes fail to remain effective indefinitely, in which case there is a relapse into illness. This failure to produce an indefinite remission does not make the remission any less complete. It does not all of a sudden warrant us to redefine the remission as symptom-masking.
Yes, a cure is worth pursuing, but so is remission. Too many people experience incomplete responses to treatment with residual symptoms. This is not good enough. I encourage people to continue to explore treatment refinements until they find something that hits closer to the target and brings about remission. It is my impression from the results of the STAR*D study that at least 66% of people can attain remission after only 4 drug trials. Think of the possible combinations of drugs we have to work with and the number of trials that represents. I think the odds are in one's favor that they will eventually find something that works well if they are persevering.
- Scott
Posted by naughtypuppy on January 14, 2007, at 9:48:34
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
I call it the antidepressant vs anathesia effect. Tegrol made me so apathetic that I didn't know that I was depressed. I just couldn't get off the couch and attend to daily affairs.
Posted by Phillipa on January 14, 2007, at 18:22:02
In reply to Re: Do people feel medications help or mask sympto, posted by SLS on January 14, 2007, at 7:05:23
Scott and who better to say that than you. Love Jan
Posted by laima on January 15, 2007, at 17:43:19
In reply to Re: Do people feel medications help or mask sympto, posted by SLS on January 14, 2007, at 7:05:23
Yes, good point, a remission is nothing to turn one's nose up at.
The more I think about it, the more it seems to me that the answer to the remission/cover up symptoms question is probably varied and fuzzy. There's probably some of both, and of course, everyone's circumstances are a little different. After experiencing dramatic poop-outs for both prozac (extended to inefficacy of other SSRIs) and benzos, I'm not going to hold my breath- but will take what good opportunities I get. I have a doctor who won't make any promises about how long the therapeutic effects of drugs will last, and I'm finally heeding his urgings to work at therapy and making improvements in my lifestyle. Just no guarentees in life.
Posted by notfred on January 16, 2007, at 17:55:46
In reply to Re: Do people feel medications help or mask sympto » SLS, posted by laima on January 15, 2007, at 17:43:19
"The more I think about it, the more it seems to me that the answer to the remission/cover up symptoms question is probably varied and fuzzy."
Remission is a very specific word. Google it.
It is not related to "cover up".
Posted by laima on January 16, 2007, at 19:14:06
In reply to Re: Do people feel medications help or mask sympto, posted by notfred on January 16, 2007, at 17:55:46
Yes, I know very well it's a different word and don't need to google it. Perhaps it was my fuzzy punctuation that was confusing. We were debating whether medications covered up symptoms OR helped induce remission, and I concluded that they can do both, either, or neither. In other words, perhaps pointless to debate since there isn't an absolute answer that fits everyone. Well, I've got my copy of Eats, Shoots and Leaves sitting here next to me, maybe I'll look into it.
> "The more I think about it, the more it seems to me that the answer to the remission/cover up symptoms question is probably varied and fuzzy."
>
>
> Remission is a very specific word. Google it.
> It is not related to "cover up".
>
Posted by shadowplayers721 on January 16, 2007, at 19:54:10
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
IMO, people with drug addiction take a drug to the totally numb out and it's a cycle. It's complicated. It's a roller coaster controlled by the user. Drug addiction is not a form of functioning.
Antidepressants don't give a high to me. They try to level me to function. In other words, I am not bottoming out in depression. I don't feel it's masking my depression. I feel it's actually treating it. I don't know if I explained this well. better go back to the shadows>>>>>>
Posted by Quintal on January 16, 2007, at 20:01:20
In reply to Re: Do people feel medications help or mask sympto » notfred, posted by laima on January 16, 2007, at 19:14:06
"Eats, Shoots and Leaves" Great book.
Q
Posted by Quintal on January 16, 2007, at 20:04:41
In reply to Re: Do people feel medications help or mask sympto, posted by shadowplayers721 on January 16, 2007, at 19:54:10
>IMO, people with drug addiction take a drug to the totally numb out and it's a cycle.
I take codeine to help me function better. It generally takes my pain away and leaves me sanguine. Is codeine really treating my depression or simply masking it? What's the difference?
Q
Posted by SLS on January 16, 2007, at 20:22:07
In reply to Re: Do people feel medications help or mask sympto » shadowplayers721, posted by Quintal on January 16, 2007, at 20:04:41
> >IMO, people with drug addiction take a drug to the totally numb out and it's a cycle.
>
> I take codeine to help me function better. It generally takes my pain away and leaves me sanguine. Is codeine really treating my depression or simply masking it? What's the difference?What is the constellation of symptoms associated with your disorder?
- Scott
Posted by shadowplayers721 on January 17, 2007, at 0:27:28
In reply to Re: Do people feel medications help or mask sympto » shadowplayers721, posted by Quintal on January 16, 2007, at 20:04:41
Well, I feel you have much wisdom deep inside to give an answer to the proposed question. If I were your true inner self without any inner critic to comment at the side, what would be my answer to you from this question?
"Is codeine really treating my depression or simply masking it?"
Posted by laima on January 17, 2007, at 0:50:53
In reply to Re: Do people feel medications help or mask sympto » laima, posted by Quintal on January 16, 2007, at 20:01:20
It's nice, isn't it? :)How'd you get it to turn into a link like that?
I think I was supposed to do that, too. I forgot.> "Eats, Shoots and Leaves" Great book.
>
> Q
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