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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 95. This is the beginning of the thread.
Posted by SLS on August 4, 2008, at 5:24:19
Some people here don't want to believe that medication can adequately treat mental illness and argue vehemently their position. Yet, professional neuroscientists state otherwise and produce conclusive results of investigations supporting the utility of psychotropics. Why is this?
Anger?
It seems to me that having such an attitude is counterproductive to successful treatment. It can cause people to fail to commit themselves to trials of different medications. One consequence might be that such an unbelieving person tends to abort drug trials prematurely, and never get the answer they are looking for - remission. Holding on to melancholic and negative thoughts can only work against treatment and prevent the changes in the brain from taking place to produce a therapeutic response. There is power in positive thinking.
- Scott
Posted by dcruik518 on August 4, 2008, at 8:48:12
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
It seems to me that most people here believe that meds can be helpful. That said, however, I think many people here have difficult or treatment resistant cases and they come here to seek advice above and beyond the easy first-year-resident kind of "ssri's work for everything" crap. If there's anger, it's anger at the large number of incompetent dopes who call themselves psychiatrists. We therefore have to educate ourselves and sometimes take matters into our own hands. More than any other of the medical specialities, psychiatry needs to be done democratically, not autocratically, and I think it's this need for dominance among the p-docs that leads to patient frustration as much as anything else. The top down model is bunk.
~DRC
Posted by johnj on August 4, 2008, at 9:27:25
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
Scott:
I tend to be in both camps. I don't believe all on meds probably need them but you can't discount people that have been helped by them. Some docs prescribe them like candy.
Take my ex-boss. He was paranoid and just always unreasonable for years. I could never figure him out and nobody could understand his methods. Well, he quits, he gets much worse and he cannot hinde the pyschosis anymore. typical schizo symptoms. Fast forward a year and a half later. I saw him last night and it was the first time he talked "normal" in years. Meds worked for him even though he will never work again. I am ok that he is on disability, he deserves it for the suffering he endured. I should also say he never treated me with any respect and I disliked him at the time. Now, I feel sorry for his suffering as he should have had help years earlier.
Another friend with a sick wife heading into surgery can't sleep well about a 8 weeks prior to surgery so the doc prescribes an ssri. It makes him worse, angry, jittery, and spaced out. We talk, heart to heart, I tell him my experiences. He quits the ssri and tells me he finally feels better and talked to a counseler. It is situational and he should never have been prescribed drugs. Life is not easy and you can't numb out everything unless you just can't cope anymore. He is sleeping better now after successful surgery. Note, I didn't tell or ask him to quit the ssri. We just had a very good talk and I was supportive.
Me, on meds for 15 years after panic attack living abroad. I was convinced I needed meds. I recover for 10 years. I get pneumonia and in an accident and my meds no longer work. I start the med merry go round. From antipsychotics, new ad's, mood stabilizers and THEY all make me worse. I suffered on remeron for 3 years because it at least allowed me to sleep. I almost lost everything, my job, wife, and house. Why? because I thougtht I needed something. Finally, I give up, go off meds and last 6 months. I started again, and feel worse. Go off, and over the last year, yes, it has been one year pretty much med free. I get better slowly, very slowly. Ups and downs, but isn't that life? Well, last night I slept 9 hours and Sunday nights are usually the worse for me thinking of work, etc. I have weaned off benzos a few years back. It was hell and yes I was addicted.
My point is one size doesn't fit all. Some need meds but I am not sure about me. I definately needed help when I had the panic attack but did I need to stay on for 10 years plus? I don't know. Things are never black and white. If I get bad again, I would try meds again but right now I probably don't need them. I can't believe I survived the last year and yes I had to recover from the meds. Yes, I had to recover as I feel my brain just was not right. I can't explain it but the brain is incredible. You can get better. For some it is meds, for some it is not.
Regards
johnj
Posted by Phillipa on August 4, 2008, at 10:51:41
In reply to Re: Some people don't want to believe. » SLS, posted by johnj on August 4, 2008, at 9:27:25
You said that so well. Yes for times in a person's life they need different things sometimes meds, sometimes treating the medical condition that is causing the mental anguish. I will always need something for my anxiety or quick trigger negative thoughts but also need to talk myself down. Even my pdoc says the thyroid loop is the basis of my problems and until it's straightened out which hopefully it will be I have to hang in there and try my best. I find learning about meds on this board is very educational. I'm thrilled that you were able after many trials to be med free . Congratulations on that. I hope one day minus the synthroid to join you. Hope you take this post in the positive way I mean to convey it to you. I also do a lot of talking with others and find so many on meds and then they get off and feel better. But then others will need something for life. As we're all different. And congrats again to you. Phillipa
Posted by linkadge on August 4, 2008, at 11:52:29
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
Well, I think its fairly obvious that SLS thinks he is referring to me.
Surely you know that my stance on the efficacy (or lack thereof) of modern antidepressant agents is a little more complex that what you have stated.
It is important to realize how the pharmacudical industry has traditionally adulterated the procedure of obtaining quality data reagarding the efficacy and safety of modern psychotropics. To argue that it has always historically been an exact, rigorous and honest science is not true IMHO.
It really comes down to what you want to believe fundamentally. After that, you can find the data to support any stance you may choose.
It doesn't bother me that people beleve what they want to believe. It bothers me when, for whatever reason, people don't get the results that www.paxil.com says they should and then they come to internalize that problem.
Linkadge
Posted by Bob on August 4, 2008, at 12:03:09
In reply to Re: Some people don't want to believe., posted by dcruik518 on August 4, 2008, at 8:48:12
> It seems to me that most people here believe that meds can be helpful. That said, however, I think many people here have difficult or treatment resistant cases and they come here to seek advice above and beyond the easy first-year-resident kind of "ssri's work for everything" crap. If there's anger, it's anger at the large number of incompetent dopes who call themselves psychiatrists. We therefore have to educate ourselves and sometimes take matters into our own hands. More than any other of the medical specialities, psychiatry needs to be done democratically, not autocratically, and I think it's this need for dominance among the p-docs that leads to patient frustration as much as anything else. The top down model is bunk.
>
> ~DRC
>
>Well put, I must say.
Posted by Chris O on August 4, 2008, at 14:07:46
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
I really think this is a great discussion. It's a debate I have in my head all the time. I believe that there is something dysfunctional about my brain or brain chemistry. And, I am open to any drug, method, treatment, belief, whatever, that helps it. However, even when psychiatrists do not use the "top down" approach, it's unnerving (for me, at least) putting all kinds of powerful chemicals in my body that are at best validated in one, two, or three month trials. At the same time, if they "work" and help me to live a more functional life, I am all for it. But in my two long-term trials with SSRIs, the results were...mixed. One time, they sort of worked; the next time they barely worked. Now, I am trying again, and open to "whatever works." But I hate the waiting, the not knowing if I should add or drop something, the feeling that the drugs "kind of work," but that the side effects are not worth it. We've all been down this road before, I think. And being the health conscious person I am, there's always the concern that the drawbacks of meds outweigh the gains (or that if I just exercise enough this horrible anxiety/depression I have will go away!) But at 41 years old and getting worse, I now realize that meds, for me, are probably the best viable option. I guess it's just a matter of getting the right one, or combo, or hoping for something better on the horizon.
Posted by Bob on August 4, 2008, at 14:24:33
In reply to Great discussion. Empathize w/all posters! » SLS, posted by Chris O on August 4, 2008, at 14:07:46
> I really think this is a great discussion. It's a debate I have in my head all the time. I believe that there is something dysfunctional about my brain or brain chemistry. And, I am open to any drug, method, treatment, belief, whatever, that helps it. However, even when psychiatrists do not use the "top down" approach, it's unnerving (for me, at least) putting all kinds of powerful chemicals in my body that are at best validated in one, two, or three month trials. At the same time, if they "work" and help me to live a more functional life, I am all for it. But in my two long-term trials with SSRIs, the results were...mixed. One time, they sort of worked; the next time they barely worked. Now, I am trying again, and open to "whatever works." But I hate the waiting, the not knowing if I should add or drop something, the feeling that the drugs "kind of work," but that the side effects are not worth it. We've all been down this road before, I think. And being the health conscious person I am, there's always the concern that the drawbacks of meds outweigh the gains (or that if I just exercise enough this horrible anxiety/depression I have will go away!) But at 41 years old and getting worse, I now realize that meds, for me, are probably the best viable option. I guess it's just a matter of getting the right one, or combo, or hoping for something better on the horizon.
In addition to feeling sorry for myself a lot, I feel bad for my family and loved ones who struggle to deal with my situation. It can be brutal.
Posted by Sigismund on August 4, 2008, at 14:56:35
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
Scott, my bias comes from the fact that the only medical intervention that helped me was nutritional medicine.
Professional neuroscientists?
Oh yes.
Posted by SLS on August 4, 2008, at 15:38:26
In reply to Re: You are refering to me?, posted by linkadge on August 4, 2008, at 11:52:29
> Well, I think its fairly obvious that SLS thinks he is referring to me.
I can't read your mind. You can't read mine. Let us not try to.
> It really comes down to what you want to believe fundamentally.
Yes. This is the problem. I think that what one *wants* to believe influences how they interpret the world. It is a question of attitude and perspective being imposed upon by emotional reasoning instead of deductive or inductive reasoning. *Wanting* to believe something does not make for objective and functional interpretation of evolving facts.
> After that, you can find the data to support any stance you may choose.
I don't think so. What is, is. Drugs work - human investigations verify this with objective observation and using statistics. I am, of course, biased because drugs do work for me and have made life wonderful and worth living. I can't be terribly unique in this regard. And this might be the crux of the matter. For those people whom drug therapy has been disappointing, there might be a bias towards disbelieving the utility of these treatments. However, given my personal success story, I would encourage those people whom prefer to believe that drugs are ineffective to pay more attention to cases like mine.
No guarantees.
- Scott
Posted by SLS on August 4, 2008, at 15:57:26
In reply to Re: Some people don't want to believe. » SLS, posted by Sigismund on August 4, 2008, at 14:56:35
> Scott, my bias
What exactly is your bias?
> comes from the fact that the only medical intervention that helped me was nutritional medicine.
I am not sure it follows from logic that because nutrition is effective, drugs are not. My position is not an either-or statement. It is simply that drugs work. What's the problem?
> Professional neuroscientists?
> Oh yes.I guess I have developed another bias towards the level of sophistication and intelligence at which these professionals function. I have had the privilege to be amongst them at the NIH, NYU, Harvard, and Columbia. I even got to see the rats of NIMH in action. Poor things.
- Scott
Posted by Sigismund on August 4, 2008, at 16:23:03
In reply to Re: Some people don't want to believe. » Sigismund, posted by SLS on August 4, 2008, at 15:57:26
>I am not sure it follows from logic that because nutrition is effective, drugs are not.
I didn't say that. They haven't helped me much though. Except for tianeptine.
Posted by Bob on August 4, 2008, at 16:27:52
In reply to Re: Some people don't want to believe. » Sigismund, posted by SLS on August 4, 2008, at 15:57:26
> > Professional neuroscientists?
> > Oh yes.
>
> I guess I have developed another bias towards the level of sophistication and intelligence at which these professionals function. I have had the privilege to be amongst them at the NIH, NYU, Harvard, and Columbia. I even got to see the rats of NIMH in action. Poor things.
>
>
> - Scott
>
>
>
>What do you mean by this? Are you biased for or against these scientists and the facilities?
Posted by Toph on August 4, 2008, at 17:02:22
In reply to Some people don't want to believe., posted by SLS on August 4, 2008, at 5:24:19
It seems that some of the disagreement comes from using generalities like "drugs work," Scott. Not all drugs work. Fortunately, like for you, mine do work for me. But I balance the side affects with the benefits to make the determination that Lithium works for me. I have to put up with diarrhea, dry mouth, and potential harm to my thyroid and kidneys in order to keep out of the psych ward. Since it has reliably done the latter for 25 years now I would say that it works.
Posted by linkadge on August 4, 2008, at 17:11:03
In reply to Re: You are refering to me? | No., posted by SLS on August 4, 2008, at 15:38:26
>I don't think so. What is, is. Drugs work -
So do placebos.
>human investigations verify this with objective >observation and using statistics. I am, of course, biased because drugs do work for me and have made life wonderful and worth living.
I see.
>I can't be terribly unique in this regard. And >this might be the crux of the matter. For those >people whom drug therapy has been disappointing, >there might be a bias towards disbelieving the >utility of these treatments.
>However, given my personal success story, I >would encourage those people whom prefer to >believe that drugs are ineffective to pay more >attention to cases like mine.
No offence, but your sucess story is full of strange twists and turns, at least thats how it comes across here.
Linkadge
Posted by Justherself54 on August 4, 2008, at 17:15:40
In reply to Re: You are refering to me? | No., posted by SLS on August 4, 2008, at 15:38:26
>For those people whom drug therapy has been disappointing, there might be a bias towards disbelieving the utility of these treatments.
After 25 years on and off meds and a diagnosis of bipolar, coupled with the fact that every AD in whatever class has pooped out on me between 6 months and a year, I think I have the right to a bit of bias...however I have to keep plugging along...'cause the alternative is...well...not good...
Do I think there is value in a nutritional approach? Of course I do. I'm just too fat, unmotivated and apathetic to get into that mode...
Jaded Justy
Posted by linkadge on August 4, 2008, at 17:20:50
In reply to Re: Some people don't want to believe. » SLS, posted by Bob on August 4, 2008, at 16:27:52
>I guess I have developed another bias towards >the level of sophistication and intelligence at >which these professionals function. I have had >the privilege to be amongst them at the NIH, >NYU, Harvard, and Columbia. I even got to see >the rats of NIMH in action. Poor things.
You keep quoting these institutions as if its supposed to mean something. Sure they're smart that doesn't mean that they're always right or that they're in hot presuit of anything that will amount to anything. If your claim to fame is coming into contact with a bunch of people that their entire day studying monoamine uptake mechanisms then its time to move on.
I got to meet David Healy, so whats your point?
Linkadge
Posted by Justherself54 on August 4, 2008, at 17:51:57
In reply to Re: Some people don't want to believe., posted by linkadge on August 4, 2008, at 17:20:50
I know you two like a good debate, that's obvious..however, whenever I have posted to a thread where you are debating I tend to feel ignored and hesitant to post. I feel hostility...could be just how I'm feeling today...had to voice it..
Posted by SLS on August 4, 2008, at 18:18:53
In reply to Re: Some people don't want to believe. » SLS, posted by Bob on August 4, 2008, at 16:27:52
>
> > > Professional neuroscientists?
> > > Oh yes.
> >
> > I guess I have developed another bias towards the level of sophistication and intelligence at which these professionals function. I have had the privilege to be amongst them at the NIH, NYU, Harvard, and Columbia. I even got to see the rats of NIMH in action. Poor things.> What do you mean by this? Are you biased for or against these scientists and the facilities?
I tend to like these people and what they do.
- Scott
Posted by SLS on August 4, 2008, at 18:34:44
In reply to Re: Some people don't want to believe., posted by Toph on August 4, 2008, at 17:02:22
Hi Toph.
> It seems that some of the disagreement comes from using generalities like "drugs work," Scott.
Well, they do.
Of course, some people are more treatable with these drugs than others.
> Not all drugs work.
Name one FDA approved antidepressant that doesn't work. Even trazodone works for some people.
How many people with depression must a drug not work for before we deem it ineffective?
I don't understand what the big deal is. Drugs work for at least 85% of people. Drugs work. This is not generalization. It is fact. That doesn't sound too complicated a statement to interpret. Besides, it was not the point of my thread to demonstrate that Scott is right about anything regarding the efficacy of current treatments. It was about outlook and expectations, and how these impact upon the compliance of people with treatment, and thus their chances for success.
- Scott
Posted by SLS on August 4, 2008, at 18:37:21
In reply to Re: Some people don't want to believe., posted by linkadge on August 4, 2008, at 17:20:50
> I got to meet David Healy, so whats your point?
Respect for exposure.
- Scott
Posted by SLS on August 4, 2008, at 18:43:47
In reply to Re: You are refering to me? | No. » SLS, posted by linkadge on August 4, 2008, at 17:11:03
> No offence, but your sucess story is full of strange twists and turns,
How so?
> at least thats how it comes across here.
To everyone, or just you?
- Scott
Posted by SLS on August 4, 2008, at 18:48:29
In reply to Re: Some people don't want to believe. Linkage/SLS, posted by Justherself54 on August 4, 2008, at 17:51:57
> I know you two like a good debate,
For me, this isn't an academic exercise. It really isn't a hell of a lot of fun either.
> whenever I have posted to a thread where you are debating I tend to feel ignored and hesitant to post.
At first, I was surprised that you should feel that way, but I guess I can understand. The hostility is unfortunate, and it is very uncomfortable to witness.
- Scott
Posted by SLS on August 4, 2008, at 18:56:13
In reply to Re: Bias and drug therapy, posted by Justherself54 on August 4, 2008, at 17:15:40
> After 25 years on and off meds and a diagnosis of bipolar, coupled with the fact that every AD in whatever class has pooped out on me between 6 months and a year, I think I have the right to a bit of bias...
I hope you didn't infer from my postings that you had no such right or even legitimate reasons to feel the way you do. I didn't think I came off that way. I apologize if I did.
> however I have to keep plugging along...'cause the alternative is...well...not good...
So, if a drug doesn't work for more than 6 months, it doesn't work? I think it demonstrates, minimally, that you are treatable, and have a good chance to remain well.
Which drugs have worked for you in the past? Which combinations?
- Scott
Posted by linkadge on August 4, 2008, at 19:16:52
In reply to Re: Some people don't want to believe. » linkadge, posted by SLS on August 4, 2008, at 18:37:21
>Respect for exposure.
Its not always a good idea to let idealization of an individual get in the way of an unbiased interpretation of what they are asserting, thats the first step to flawed science. "They are from such and such a university, well then, what they say must be correct".
Linkadge
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