![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by bulldog2 on April 18, 2008, at 15:50:00
After reading all the controvery over meds or no meds I realized how difficult it can be to determine the correct strategy to finding a cure for one's own depression.
In the age of the internet so much info is available on the internet. Some may be based in science and some mere conjecture.
There are so many avenues proposed as to the causes of depression. Some I've read are about are:
1.thyroid
2.adrenals
3.sex hormones
4.mercury
5.food
6.pollution
7.faulty thinking
8 genetics
9.etc.Now depression may be caused by one or any combination of the above. The problem is determining what is causing our depression and or anxiety with so much info available.
I've found that one can end up on an endless quest for a physical cause or a magic bullet to cure our depression. Once you have eliminated one cause you begin looking for another biological cause. The Problem is the quest becomes eternal as you keep looking for the magic bullet. The problem becomes greater if you begin bouncing around between looking for the magic bullet and trying medications and never really staying the course.
So how does one handle all this info now available without short circuiting our brains? Is there a reasonable strategy of eliminating physical issues before beginning a sometimes grueling routine of going the AD route?
If you follow every theory on the internet or in print you could end up on an eternal search for the magic bullet. So when do you stop and just say enough time looking for physical quick fixes and just give AD's a reasonable shot? In the past I've pestered my docs for every blood test in the world until they're ready to terminate you as a patient.
A patient needs some kind of methodical strategy to wade through all the possibilities..Anyone ever determine a good method of finding a solution in some kind of analytical methodolgy?
Posted by Phillipa on April 18, 2008, at 16:29:29
In reply to The Depression Delimna, posted by bulldog2 on April 18, 2008, at 15:50:00
Eliminate physical causes treat those you can and then take from there. Real live docs eliminate physical causes and treat first at least that is my experience. Never had to beg for a test they saw the results of there own bloodwork and took it from there. Phillipa
Posted by bleauberry on April 18, 2008, at 19:07:56
In reply to The Depression Delimna, posted by bulldog2 on April 18, 2008, at 15:50:00
You and I ask the same questions. It is a massive dilemma.
You can get any lab tests you want online. There are several places on the net where you can get just about any urine/blood/saliva lab test you want mailed to your home. Some are home tests, some you have to go to a nearby lab for blood draw, but you don't need a doctor. The labs that do the actual analysis are big name national labs such as Doctor's Data and Great Smokies. I have had several tests done this way and was highly impressed. Bottom line, we live in a new age where you do not need a doctor to get the tests you want. The only advantage of a doctor is that it insures coverage by health insurance. Insurance companies don't take kindly to tests not ordered by a doctor. Don't fall prey to a stubborn doctor. He is supposed to work with you and for you, not against you. Who pays who?
As you said, there could be multiple problems causing symptoms. There is probably one main problem causing all the others. For example, mercury will throw adrenals, thyroid, and intestines all out of whack. Another example, adrenal fatigue can turn heatlhy thyroid into sluggish thyroid, as it downregulates itself in a self survival mode. An unknown food intolerance can cause so much stress as to cause the adrenal fatigue. On and on.
My tests confirmed what I already suspected. But it was a rude awakening to actually see it on formal paper in charts and graphs and decimals and numbers and measurements and stuff.
I don't know of any magic bullet. Once the problems are identified, then it begins a journey of fixing the worst one first, while gently tweeking the others. Treating the main problem will often reduce or eliminate some of the others. In that regard, myself and many others are of the belief that nothing is more crucial for all healings than adrenal support.
I believe all psychiatric drugs affect adrenals and thyroids one way or the other. People stumble onto a cure with an ssri, or something, as an example, believing they had low serotonin, when all along the real thing going on was that the drug was reducing excess cortisol or stabilizing abnormal fluctuations or raising low cortisol. Go to pubmed sometime and type in a search the name of a drug and cortisol and see what you get. Do it with a bunch of drugs. You'll see what I mean. Try it with thyroid too.
However, even heavily suffering mercury toxic folks can improve dramatically when they find meds that counteract what mercury is doing, even without detoxing mercury. Might be a simple as an ssri to some complex cocktail of anti-glutamate pro-dopamine stuff, or anything inbetween. Without even treating the known problem itself, meds can help a lot. But as you and I know, finding the right meds is an educated guess...trial and error, 2 months at a time.
With or without lab tests to identify multiple depression causes, I do not know of a better methodology of treating depression than the current art of trial and error. What sets many of us back is when intolerable side effects or apparant lack of efficacy prevent us from going a full 8 to 12 weeks.
I wish I had the magic bullet you and I both want. I don't. But I can at least tell you, if you want some tests and your doctor is stubborn, get them yourself. You'll take more ownership of your destiny and cure in the process. The doctor is not the owner of your health. You are.
Tests I believe are most important, in order of importance:
24 hour 4 sample saliva cortisol...Doctors Data also includes DHEA and gluten intolerance in the same test from the same samples.
Thyroid freeT3, freeT4, TSH, total T4.
Hair sample from Doctors Data that includes all metals...including obscure things like Lithium. Other labs don't test enough metals and it makes diagnosis less reliable.
Though the results are theoretical in interpretation, sometimes helpful and sometimes not, I like a urine neurotransmitter metabolite analysis done. The other tests above are way more important. If the neuros are whacky, it's probably because of something else. Simply raising or lowering whacky neuros won't fix what's making them whacky, but should relieve symptoms to some degree.
With all of the tests above, interpretation is key. Seek help here, at Yahoo chelation forums, Yahoo adrenal/thyroid forums. Even when a doctor thinks the numbers are in the so-called "normal range" (subjective and proven faulty), you can read what the numbers are saying instead of just seeing if they lie within a normal band or not. There are quite obvious telltale patterns that most doctors are blind to, possibly from the beaurocratic FDA/pharmaceutical company mold. As my doc said, even though we can measure thyroid hormones in the blood, we cannot see how they are working or not working at the cellular receptor level. He says lab tests are responsible and usefull, but the bottom line is to treat the symptoms regardless of what the paper says and see how the patient responds.
One doc said that given any difficult patient, they all respond to 1 to 3 of 20 of the doc's favorite drugs, most of them off-label (weird things like Naltrexone, Memantine, Benadryl, Monicycline...). But trial and error was admitted as being the only way to identify which of those drugs would work for which person. And in the end when the patient was living a new life, neither the patient nor the doctor knew why the drug worked. It just did.
Posted by bulldog2 on April 18, 2008, at 19:29:04
In reply to Re: The Depression Delimna, posted by bleauberry on April 18, 2008, at 19:07:56
I think the whole process would take a dramatic step forward when p-docs can run the appropraiate blood tests and prescribe the proper drugs. Use diagnostics instead of trial and error and shorten the period to finding the right cocktail. But science will have to figure out how these drugs really work to do that. Right now we just have hypothesis such as low serotonin, or ne or da which may not be correct.
Posted by Phillipa on April 18, 2008, at 20:14:16
In reply to Re: The Depression Delimna, posted by bleauberry on April 18, 2008, at 19:07:56
Blueaberry do you know why T4 is a more important indicator that a TSH in Hashimotos as did search and could find no data. Love Phillipa ps endo says T4 high so lower synthroid but TSH is 2.5 so within a normal range.
Posted by bleauberry on April 18, 2008, at 21:59:30
In reply to Re: The Depression Delimna » bleauberry, posted by Phillipa on April 18, 2008, at 20:14:16
> Blueaberry do you know why T4 is a more important indicator that a TSH in Hashimotos as did search and could find no data. Love Phillipa ps endo says T4 high so lower synthroid but TSH is 2.5 so within a normal range.
My doctor says the numbers are helpful and a responsible thing to look at, but that the primary guide in prescriptions is the symptoms, not the numbers. My doc will prescribe various thyroid meds based on symptoms regardless of whether the numbers agree with it or not.
The "normal" range is just a guide, not a Bible. Sadly many docs see it as a Bible.
The most important indicator? Actually, none. They have to be looked at in unison, together, like a picture or a puzzle. freeT3, totalT4, freeT4, and TSH only tell the story when you look at them all at the same time.
We don't want "normal" numbers. We want "optimal" numbers. Tell your doc that at the next appointment. Tell him normal is not good enough. Tell him politely but firmly you want optimal numbers and zero symptoms.
To see if he is using his creative detective juices or not, ask him this "What is my reverse T3?" It is a simple mathematical substraction with the numbers you already have. Ask him what it means and how it plays into the whole thing.
Posted by Molybdenum on April 19, 2008, at 2:39:40
In reply to Re: The Depression Delimna, posted by bleauberry on April 18, 2008, at 21:59:30
My approach when I realised I was depressed was to follow what the doc recommended - what he saw working for more patients than not. He was an OK doc when it came to other medical matters, so I trusted him to be a good generalist. That got me onto citalopram.
When that pooped out I took more of an interest and read about receptors. My approach then was to attack the hell out of as many possible causes as I could at once in the hope that I'd feel "more better" and sooner! What's a good name for that? I know - I'll borrow it from Lt. Ripley in Aliens27 "Lets Nuke the site for morbid". So in that spirit I decided "California Rocket Fuel" (venlafaxine & mirtazapine) sounded exactly right for me. All I had to do then was manipulate the doc a bit until I was on high doses of both. If bupropion (Wellbutrin) was on the govt subsidised list here for depression, I would be on that too. That would cover ALL the big receptors according to Stephen M. Stahl's "Essential Psychopharmacology" (which incidentally is VERY available on torrent sites *ahem*) Unfortunately bupropion is only govt subsidised here for "short term use as an adjunct to quitting smoking" (!). Anyway, so that's where I am now on the Rocket Fuel & it really is working for the depression. I've always had trouble sleeping & the mirtazapine sure helps with that too.
Would I still be OK with 1/2 my current dose? Maybe I would - so I am self adjusting the mirtazapine down gradually until I feel bad & then up she'll go a bit until I am OK again.
Would I still be OK with a completely different set of meds? Maybe I would but it's an experiment that I'm not prepared to try. As you know, feeling really depressed is f*ck*ng awful. So I won't be willingly changing the mix any time soon for sure.
I don't believe for a minute that the docs really know how these drugs work. But I do believe that they have seen a lot of people "report feeling better" by taking them. In 2008 I think that's about as good as I can get, so I'll accept it until something better comes along.
All the theories about thyroid & metals, etc may be quite valid indeed. I just know I'll never personally produce enough blood to run every test there is. And until a new theory is commonly accepted "believed", there's no point in me getting tested for something that'll only end up as an interesting conversation piece at my doc's next dinner party.
At the moment this bunch of drugs is working for me & so I'll only rock the boat when I feel I'm in calmer waters. So that's my approach. ;)
Ooooohhhhh now I suppose after all that I better give it a name, hey?
OKOKOKOKokokokok...here it is :
"Shrugenism"
Take Care ;)
M.
Posted by bulldog2 on April 19, 2008, at 9:01:04
In reply to Re: The Depression Delimna » bleauberry, posted by Phillipa on April 18, 2008, at 20:14:16
> Blueaberry do you know why T4 is a more important indicator that a TSH in Hashimotos as did search and could find no data. Love Phillipa ps endo says T4 high so lower synthroid but TSH is 2.5 so within a normal range.
Could we please keep it to the topic..
Posted by Phillipa on April 19, 2008, at 18:03:54
In reply to Re: The Depression Delimna, posted by bleauberry on April 18, 2008, at 21:59:30
Thank-you Blueaberry it's written down for next appointment still not sure if should change dose as internist is associate professor at Chapel Hill and it thought it looked fine and I'd only been on l25 for two weeks when blood drawn from the old number of l5 TSH on the dose endo wants me on which is l00 six days and a half the other day. What would you do? Apologies to Bulldog for hyjacking his thread. Love Phillipa
Posted by bulldog2 on April 19, 2008, at 19:05:06
In reply to Re: The Depression Delimna » bleauberry, posted by Phillipa on April 19, 2008, at 18:03:54
> Thank-you Blueaberry it's written down for next appointment still not sure if should change dose as internist is associate professor at Chapel Hill and it thought it looked fine and I'd only been on l25 for two weeks when blood drawn from the old number of l5 TSH on the dose endo wants me on which is l00 six days and a half the other day. What would you do? Apologies to Bulldog for hyjacking his thread. Love Phillipa
As usual hacking into other people's threads and making it about you. You could start your own thread.
Posted by Phillipa on April 19, 2008, at 19:14:28
In reply to Re: The Depression Delimna, posted by bulldog2 on April 19, 2008, at 19:05:06
Bulldog I apologize. Sorry. Phillipa
Posted by bleauberry on April 19, 2008, at 20:40:40
In reply to The Depression Delimna, posted by bulldog2 on April 18, 2008, at 15:50:00
Sorry bulldog. I accidentally participated in hijacking your thread by responding to an off-topic question. I apologize for that.
Posted by bulldog2 on April 20, 2008, at 8:43:32
In reply to Re: The Depression Delimna » bulldog2, posted by Phillipa on April 19, 2008, at 19:14:28
> Bulldog I apologize. Sorry. Phillipa
That's okay..Just trying to keep it on topic.
Posted by 49er on April 21, 2008, at 17:48:22
In reply to The Depression Delimna, posted by bulldog2 on April 18, 2008, at 15:50:00
Bulldog,
You may or may now know but I am tapering off of my psych meds. As a result, I have been on an endless search to find the right combination of supplements that could help with withdrawal symptoms and allow me to work on my faulty thinking.
I didn't focus on the other things you mentioned because this seemed the most obvious to me.
I particularly zeroed on fish oil capsules as I had been frustrated they weren't helping me as much as I felt they should be. Because I also have ADHD, I started visiting ADHD boards to see what their recommendations were.
They were recommending fish oil capsules with a ratio of 7 EPA to 1 DHA. Let me digress by stating that EPA and DHA are the main elements of fish oil capsules.
Anyway, I had also seen studies that showed this high of a ratio being effective for depression.
Unfortunately, I would have needed to order these types of fish oil capsules through the Internet and I needed them tomorrow. So I bought ones at a local store with a 4 to 1 ratio that are working beautifully. They are the Nordic Naturals with high EPA.
Unfortunately, they are expensive and I might try to see if I can find cheaper effective alternatives. Stay tuned.
I don't have much faith in doctors but that is my own personal bias at work. That is why I don't think I pursued the other things that you mentioned.
Hope this helps.
49er
This is the end of the 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.