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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 52 to 76 of 95. Go back in thread:
Posted by Deputy Dinah on August 5, 2008, at 10:04:28
In reply to Re: You are refering to me? | No. » SLS, posted by linkadge on August 5, 2008, at 6:50:38
> Cute. Although, I am not fascinated.
Please don't be sarcastic, or post anything that could lead others to feel accused or put down.
You've been warned before, both individually and as part of a general warning by Deputy 10derheart in this thread, to follow the civility guidelines of this site. Here is the link to the guidelines.
http://www.dr-bob.org/babble/faq.html#civil
I'm going to have to block you from posting from one week.
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
Dinah, acting as deputy to Dr. Bob
Posted by Deputy Dinah on August 5, 2008, at 10:09:35
In reply to Re: You are refering to me? | No. » linkadge, posted by SLS on August 4, 2008, at 20:42:50
> I am fascinated that you are so focused on my condition. I would have preferred that you get the story right, though.
Please don't post anything that could lead others to feel accused or put down.
Because of the timing of this post, it is possible that you did not see Deputy 10derheart's warning before this was posted. I'm going to give you the benefit of the doubt and not block you from posting. Please follow the guidelines in the future.
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
Dinah, acting as deputy to Dr. Bob
Posted by Toph on August 5, 2008, at 10:34:36
In reply to Re: Some people don't want to believe. » Toph, posted by SLS on August 4, 2008, at 18:34:44
> Name one FDA approved antidepressant that doesn't work.
While this whole thread may just boil down to semantics Scott there are some people, especially those with treatment-resistive depression, for whom none of the FDA antidepressants work, if by working you mean that the drugs relieve them of their depressive symptoms. And for some patients with Lewy Body dementia and other dementias many psychotropic medications have a paradoxical effect whereby these meds make symptoms worse. They certainly do not work for these patients. But as you have implied the exceptions should not make the rule.
Posted by SLS on August 5, 2008, at 13:24:21
In reply to Re: Some people don't want to believe. » SLS, posted by Toph on August 5, 2008, at 10:34:36
> > Name one FDA approved antidepressant that doesn't work.
> While this whole thread may just boil down to semantics Scott there are some people, especially those with treatment-resistive depression, for whom none of the FDA antidepressants work,
It is more than just semantics. That no one drug helps everyone is manifestly true. However, it is just as true that every drug helps some percentage of people get well. In my saying that drugs work, it was the point of my posting that drugs are effective and can help a much larger percentage of people than is often suggested. I never indicated that drug monotherapy works for everyone.
I am smitten with optimism for others, to be sure. I am not completely objective because I am projecting my own treatment history. It took decades and 73 different drugs to get to where I am today. (I need help with the math here) If we then take combinations of only two drugs from my list of 73, I think that would yield over 1000 permutations. Combinations of 3 drugs equals at least 10,000 permutations - perhaps more. Of course, no one wants to perform 1000 different 6 week drug trials. That would take 100 years. So, how then do you begin choosing drugs?
When do you stop trying?
I think it should infuse hope into some people that even a brief improvement in depression is an indicator that they are treatable. Often, it is the doctor that gets in the way. If no doctor were willing to combine Nardil with nortriptyline, I wouldn't be in this improved condition. The tools are there. Unfortunately, they are too often not used optimally.
Speaking of anger, I get angry when I see people stop pursuing drug treatment. The number of available combinations of drugs that can be used is staggering.
Currently:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.5mg
N-acetylcysteine 1800mg
Omega-3 from fish oil
So, how did I come to find this treatment? Educated guesses and algorithms for combining drugs.I would be curious to know how many of us would find their treatment to achieve remission contained within a single, published, algorithm - STAR*D. The STAR*D investigation is incredibly limited in the number of treatment permutations offered. However, even with so small a number of treatments included, 75%-85% of participants were robustly improved.
In light of these findings and my own experience, it is hard for me to want to qualify my statement that "drugs work". They do.
- Scott
Posted by Toph on August 5, 2008, at 14:09:27
In reply to Re: Some people don't want to believe. » Toph, posted by SLS on August 5, 2008, at 13:24:21
Optimism is a goog thing Scott. And I'm glad that you found drugs that work for you. You should be applauded for perservering. I've always felt fortunate that a simple salt keeps me out of the cycle of psychosis I once suffered. I only wish others were so fortunate as you and I.
Posted by SLS on August 5, 2008, at 16:37:06
In reply to Re: Some people » SLS, posted by Toph on August 5, 2008, at 14:09:27
> Optimism is a goog thing Scott. And I'm glad that you found drugs that work for you. You should be applauded for perservering. I've always felt fortunate that a simple salt keeps me out of the cycle of psychosis I once suffered. I only wish others were so fortunate as you and I.
Me too.
- Scott
Posted by bleauberry on August 5, 2008, at 18:14:43
In reply to Re: Some people don't want to believe. » Toph, posted by SLS on August 5, 2008, at 13:24:21
As a mild departure from the topic of the thread, though still related, I think it deserves mention of how people don't recognize no one approach is perfect, but that a balanced approach yeilds best odds. By that I mean continue with drug trials, especially trying to follow the STARD plan (switch rather than pile tons of meds of top of each other); but also healthy living...reduce or eliminate caffeine, reduce or eliminate sugars, focus on frequent meals of proteins, raw veggies and raw fruits, drink lots of water that has been purified, through diet or supplements get a good balance of the good fats (omega3 and 6), remove any amalgam fillings in the teeth, stick to a regular sleep plan, force oneself to be involved in any capacity with a church or volunteer organization, force oneself to be employed in at least a minimum capacity, walk, exercise in strong sshort bursts 3 times a week if able. If someone really really really wants to get well, they would do well to nurture what is good for the human body as all of the above are. Isolation, amalgam fillings, poor diet, sugar and caffeine...these do not spell healing.
And of course followup doctor testing. For example, it is going to be real hard to get a psych drug to work if there is longterm hidden Lyme disease, just one example. Thyroid needs to be optimal...normal isn't good enough. Body temperature and symptoms tell that story better than lab tests. Nothing will work right if the average body temp is 97.8 instead of 98.6.
Ya know? Drugs, yes. But don't forget the other half. Drugs can't do it all. The mind and body are intricately intertwined in the whole thing.
As to a previous post by Linkadge about meds not much better than placebo, political involvement, and everything else...well, yeah, good points were made. However, it is hard to discount when we see people right here, real people, get amazingly better on their prozac, zoloft, trivastel, milnacipran, zyprexa, depakote, klonopin, nardil, or whatever. It happens. Can't say it doesn't. Those were not placebo.
Posted by dbc on August 5, 2008, at 18:20:30
In reply to Re: Some people » Toph, posted by SLS on August 5, 2008, at 16:37:06
Im disillusioned about big pharm, the rigged studies, the doctors that belive these studies, supporting other people with mental issues, wanting to help.
I generally do not care. Not everything in the world is a disorder. If all abnormal behaviours are a disorder than what is this person were all shooting to become.
There was a thread about internet addiction that really made me ask "are they really this stupid" and sadly the answer was yes. There was all sorts of self diagnostics going on about this being a disorders and what can be done to fight it. This sounds like material for Oprah not a serious psychiatric medicine medical board.
It did make me realize that the reason i read these boards isnt because im not at all interested in any person that ever posts but what they have to say about medicine. "is this a complaint about a side effect" Skip it.
My positive message is total and utter apathy, its therapeutic for me anyway.
Posted by Phillipa on August 5, 2008, at 19:38:46
In reply to Re: Some people don't want to believe., posted by bleauberry on August 5, 2008, at 18:14:43
Well I guess that leaves me out of meds working as do have chronic lymes disease and test as positive each time tested. And hasimotos thyroiditis is not controlled to an optimal number. Just because the endo says 1-2 is what I should be at feel better when it's higher. Had a pdoc that thought I should be a little above the normal somwehere around 6. Does the endo listen to how I feel no and no way do I know how to adjust synthroid. Phillipa
Posted by Deputy 10derHeart on August 6, 2008, at 0:23:57
In reply to Re: Some people, posted by dbc on August 5, 2008, at 18:20:30
>a thread about internet addiction that really made me ask "are they really this stupid" and sadly the answer was yes.
Please don't post anything that could lead others to feel accused or put down, and please respect the feelings and opinions of others even if you don't agree with them.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Psycho-Babble Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
-- 10derHeart, acting as deputy for Dr. Bob
Posted by annabamma on August 6, 2008, at 2:02:56
In reply to Re: Some people don't want to believe. » johnj, posted by Phillipa on August 4, 2008, at 10:51:41
> 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
UH oh-Minus the thyroid? Most hypothyroids have to stay on some form of thyroid-you can't just take it and then be 'all-better'-did you mean you're switching-maybe to Armour?
Posted by annabamma on August 6, 2008, at 2:28:43
In reply to Re: Some people don't want to believe., posted by annabamma on August 6, 2008, at 2:02:56
> > 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
>
> UH oh-Minus the thyroid? Most hypothyroids have to stay on some form of thyroid-you can't just take it and then be 'all-better'-did you mean you're switching-maybe to Armour?P.S.- Docs that WONT listen gotta go!
Posted by Jamal Spelling on August 6, 2008, at 6:56:22
In reply to Re: Some people don't want to believe., posted by bleauberry on August 5, 2008, at 18:14:43
I agree that a multi-disciplinary approach is best.
Don't forget THERAPY. I personally have benefited hugely from therapy, probably more so than from drugs.
By this I am not trying to discount the benefit that many people get from drugs.
The way I see it, drugs address the hardware issues and therapy the software issues.
In my case, I have both hardware and software issues, although I think my software issues are bigger.
There are also studies which show that the combination of drugs with therapy yields better results than either modality used alone.
> As a mild departure from the topic of the thread, though still related, I think it deserves mention of how people don't recognize no one approach is perfect, but that a balanced approach yeilds best odds. By that I mean continue with drug trials, especially trying to follow the STARD plan (switch rather than pile tons of meds of top of each other); but also healthy living...reduce or eliminate caffeine, reduce or eliminate sugars, focus on frequent meals of proteins, raw veggies and raw fruits, drink lots of water that has been purified, through diet or supplements get a good balance of the good fats (omega3 and 6), remove any amalgam fillings in the teeth, stick to a regular sleep plan, force oneself to be involved in any capacity with a church or volunteer organization, force oneself to be employed in at least a minimum capacity, walk, exercise in strong sshort bursts 3 times a week if able. If someone really really really wants to get well, they would do well to nurture what is good for the human body as all of the above are. Isolation, amalgam fillings, poor diet, sugar and caffeine...these do not spell healing.
>
> And of course followup doctor testing. For example, it is going to be real hard to get a psych drug to work if there is longterm hidden Lyme disease, just one example. Thyroid needs to be optimal...normal isn't good enough. Body temperature and symptoms tell that story better than lab tests. Nothing will work right if the average body temp is 97.8 instead of 98.6.
>
> Ya know? Drugs, yes. But don't forget the other half. Drugs can't do it all. The mind and body are intricately intertwined in the whole thing.
>
> As to a previous post by Linkadge about meds not much better than placebo, political involvement, and everything else...well, yeah, good points were made. However, it is hard to discount when we see people right here, real people, get amazingly better on their prozac, zoloft, trivastel, milnacipran, zyprexa, depakote, klonopin, nardil, or whatever. It happens. Can't say it doesn't. Those were not placebo.
Posted by UGottaHaveHope on August 6, 2008, at 15:25:36
In reply to Please be civil » SLS, posted by Deputy Dinah on August 5, 2008, at 10:09:35
You all do a wonderful job of monitoring this board, along with taking all sides into consideration, which is commendable.
However, as a longtime member of this board, I must point out that SLS is one of the most helpful people ever on this board. Now there are a lot of other helpful people too, so many, but SLS is definitely one of them.
Posted by Dinah on August 6, 2008, at 17:50:38
In reply to SLS one of most helpful ppl ever/Please be civil » Deputy Dinah, posted by UGottaHaveHope on August 6, 2008, at 15:25:36
I'm certainly not going to disagree. I hope that Scott is well aware of the high esteem I hold for him and his contributions to Babble.
Posted by Dinah on August 6, 2008, at 17:51:46
In reply to Re: SLS one of most helpful ppl ever » UGottaHaveHope, posted by Dinah on August 6, 2008, at 17:50:38
I don't think I worded that strongly enough. I agree wholeheartedly.
Posted by yxibow on August 6, 2008, at 19:43:08
In reply to Re: You are refering to me? | No. » yxibow, posted by linkadge on August 5, 2008, at 7:12:52
> >Second of all, would you rather have someone >commit suicide, or possibly have a nth degree >risk of cancer later in life?
>
> There is no proof that antidepressants reduce the risk of suicide. On the contrary there is evidence that antidepressants may increase the risk of suicide in certain patient populations.
>
> Linkadge
Oh good lord -- the *ss protection that the FDA slapped on all anti-depressants; I personally believe that was a terrible mistake because it discourages the people that need them the most from taking it.
It vilifies all anti-depressants, furthering the agenda of the anti-psychiatry camp, which, does include Scientology, religious groups --- its true, so I'm not going to say that it doesn't exist in reality as my opinion to satisfy board guidelines because that doesn't make sense.
Certain "religions", valid ones or potentially cults, which I have to say because Scientology unfortunately received 501 (c) protection in the US, do have strong stances against psychiatry.Brand name Luvox was withdrawn partly because of Columbinism and partly because of low sales, only recently returned as Luvox CR.
Yes, there are people susceptible to unexplained reasons of anti-depressant suicide -- but a majority of that population would have jumped out of a window anyhow, if I must be crass, because they were suicidal in the first place. Of course you can't interview them afterward, sadly.
My point was that it was, purely in my opinion, such a blurry shade of worry about possible cancer in 30 years when the benefits clearly outweigh those risks and other risks in patients with risk of high suicide.
Lithium is also one of the fastest ways of reducing suicide for some people. Antipsychotics are others.
But if a theoretical patient is stabilized on a tricyclic because it works and other things don't, and they're not feeling like killing themselves, I consider that a triumph, and the worry about future risk of cancer way below what has happened.
There's no guarantee of anything in life. You or any of us could be struck with cancer in life, just from exposure to the air or living long enough. If you don't die of some horrible gardening accident, you'll likely die of a heart attack or cancer. We all hope we will just pass in our sleep, I think, anyhow. But this is getting morbid.
-- tidingsJay
Posted by Phillipa on August 6, 2008, at 19:52:10
In reply to Re: Some people don't want to believe., posted by annabamma on August 6, 2008, at 2:02:56
Oh I see how you misunderstood my apologies as I meant no meds but yes to synthroid. Oops sometimes don't word things correctly. Yes it's for life the synthroid and probably reality wise something else as well. Phillipa
Posted by coral on August 6, 2008, at 21:11:32
In reply to Re: You are refering to me? | No. » linkadge, posted by yxibow on August 6, 2008, at 19:43:08
In full agreement. Speaking only for myself, I flat-out know that Zoloft saved my life.
Posted by linkadge on August 12, 2008, at 16:13:45
In reply to Re: You are refering to me? | No. » linkadge, posted by yxibow on August 6, 2008, at 19:43:08
>Oh good lord -- the *ss protection that the FDA >slapped on all anti-depressants; I personally >believe that was a terrible mistake because it >discourages the people that need them the most >from taking it.
What it does is give people a more detailed profile of possible side effects. Some people would rather patients not hear about potential side effects, but when you're dealing with medications that are on average statistically no better than placebo, it becomes very important that people know about potential risks.
>It vilifies all anti-depressants, furthering the >agenda of the anti-psychiatry camp, which, does >include Scientology, religious groupsIt gives a warning. How the information is used is a separate issue.
>Yes, there are people susceptible to unexplained >reasons of anti-depressant suicide -- but a >majority of that population would have jumped >out of a window anyhow, if I must be crass, >because they were suicidal in the first place. >Of course you can't interview them afterward, >sadly.
The FDA panel that voted for this decsion are intellegent people taking a relatively unbiased decision. People have the right to know about what clinical trial data suggests.
>My point was that it was, purely in my opinion, >such a blurry shade of worry about possible >cancer in 30 years when the benefits clearly >outweigh those risks and other risks in patients >with risk of high suicide.
Theres no proof that antidepressants reduce the risk of suicide.
>Lithium is also one of the fastest ways of >reducing suicide for some people. Antipsychotics >are others.
Antipsychotics as a class do not have demonstrated antisuicide effect. Clozapine does, but this effect has not been demonstrated with other AP agents. Based on the data, those at high risk of suicide should be put on lithium or clozapine (for which there are no black box warnings of increased risk of suicide).
>But if a theoretical patient is stabilized on a >tricyclic because it works and other things >don't, and they're not feeling like killing >themselves, I consider that a triumph, and the >worry about future risk of cancer way below what >has happened.
Research suggests that depression and suicide are two separate things. Self reports of suicidal ideation do not readily correlate with actual risk of suicide. So, just because a patient reports that "drug x saved their life" does not necessarily make it so.
Linkadge
Posted by linkadge on August 12, 2008, at 16:29:27
In reply to Re: You are refering to me? | No., posted by coral on August 6, 2008, at 21:11:32
>In full agreement. Speaking only for myself, I >flat-out know that Zoloft saved my life.
The only way you would know for 100% sure that zoloft save your life is if we had a time machine and we went back and took the drug away from you and you did end up killing yourself.
Of course its not really possible for me to say, "I am skeptical" without insulting you, but that is indeed my intention.
People become very attached to, and convinced about the efficacy of the agents that they believe help them. Whether it be rabbits feet, religion or the Q-Ray bracelet.
People who respond to placebos in general, show no smaller degree of conviction about their beliefs regarding the efficacy of the drug they have been ingesting than those who have recieve an active drug.
People take the notion that they may have repsonded to placebo as a personal insult. Its just like everbody believes they have higher than average IQ. Nobody wants to believe they have lower than average I.Q.
Obviously something changes when people recieve the placebo. Perhaps it is hope placed in the medication, improved recognigition of their problems or a feeling of hope that is associated with medical care. All of these things can lead to real biochemical changes in the brain and body.
I am not saying that your responce is necessarily a placebo responce, all I am saying is that I remain skeptical and from a scientific standpoint I am not persuaded by you personal convicion.
Linkadge
Posted by Bob on August 12, 2008, at 16:37:11
In reply to Re: You are refering to me? | No. » coral, posted by linkadge on August 12, 2008, at 16:29:27
> >In full agreement. Speaking only for myself, I >flat-out know that Zoloft saved my life.
>
> The only way you would know for 100% sure that zoloft save your life is if we had a time machine and we went back and took the drug away from you and you did end up killing yourself.
>
> Of course its not really possible for me to say, "I am skeptical" without insulting you, but that is indeed my intention.
>
> People become very attached to, and convinced about the efficacy of the agents that they believe help them. Whether it be rabbits feet, religion or the Q-Ray bracelet.
>
> People who respond to placebos in general, show no smaller degree of conviction about their beliefs regarding the efficacy of the drug they have been ingesting than those who have recieve an active drug.
>
> People take the notion that they may have repsonded to placebo as a personal insult. Its just like everbody believes they have higher than average IQ. Nobody wants to believe they have lower than average I.Q.
>
> Obviously something changes when people recieve the placebo. Perhaps it is hope placed in the medication, improved recognigition of their problems or a feeling of hope that is associated with medical care. All of these things can lead to real biochemical changes in the brain and body.
>
> I am not saying that your responce is necessarily a placebo responce, all I am saying is that I remain skeptical and from a scientific standpoint I am not persuaded by you personal convicion.
>
>
>
>
> Linkadge
>
>
>Linkage,
Do you believe there is anything that can help people with mental illness, or do you feel that we are meddling with something that will forever be beyond our grasp?
Bob
Posted by SLS on August 12, 2008, at 17:36:17
In reply to Re: You are refering to me? | No., posted by coral on August 6, 2008, at 21:11:32
> In full agreement. Speaking only for myself, I flat-out know that Zoloft saved my life.
Your experience with Zoloft is a reflection of how the majority of other people diagnosed with major depressive disorder respond to antidepressant treatment. This has been demonstrated by the STAR*D study.
- Scott
Posted by linkadge on August 12, 2008, at 19:02:53
In reply to Re: You are refering to me? | No. » linkadge, posted by Bob on August 12, 2008, at 16:37:11
I am not saying the medications cannot or do not help some people to some degree.
It just seems strange to me when people turn what is still a psudoscience into some sort of rigorously established airtight doctrine of medical fact (and then appear to bask in it).
Linkadge
Posted by linkadge on August 12, 2008, at 19:03:44
In reply to Re: You are refering to me? | No. » coral, posted by SLS on August 12, 2008, at 17:36:17
>Your experience with Zoloft is a reflection of >how the majority of other people diagnosed with >major depressive disorder respond to >antidepressant treatment. This has been >demonstrated by the STAR*D study.
Ok, thats not even worth my time responding to.
Linkadge
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