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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by rjlockhart04-08 on July 3, 2010, at 12:34:32
Well, I have say that she is strict in a good way because she's licensed to addiction and has many guidelines against addictive medications.
How: this is the thing, i've been depressed and I don't know how to say to her i've been depressed. Because everytime I say it she questions it, or says you don't look depressed, you look happy. I was on 80mg of Prozac and she wanted to decrease it to 60mg. And ugh, that made things go bad. I can't get her to increase it, what am i suppost to say because I asked her about Parnate and she said its a 60's medication that has many side effects than Prozac, usally its the last resort medication. But there's people here that take it, but I don' know about the history of how many medications had to be tried before it. There is one mediaction that's a TCA and it has wakefulness improving properites.But my new doctor, she knows all medications and which ones are addictive, cut me off ambien she woulnt let me even take Provigel which she says can be abused, really it can't because abusing provigel is like abusing coffee, there's irrtiblity if you take too much. With amphetamine drugs, you can get higher the more you take, that's pretty much wellknown.
Just suggestions how should I talk to her? about depression?
Matt
Posted by Christ_empowered on July 3, 2010, at 12:44:42
In reply to My new doctor, posted by rjlockhart04-08 on July 3, 2010, at 12:34:32
Here's the thing: its good if your doctor is looking out for your well-being. If, for instance, they veto a medication because it has way too many side-effects and they think they can get comparable results with fewer side-effects, then...awesome.
But if they're so anti-"addictive" drugs that they're putting limits on what they're going to treat you with--basically saying that avoiding addiction is more important than your quality of life--then I think you have a problem, possibly a really big problem.
So, I don't know what to talk to her about. She may think you need to work on your unhappiness without drugs, or with fewer drugs. There's something to be said for that; medication can only do so much (and for a lot of people, meds don't do much at all, and cost $$$ and prodcue side effects).
I'd be concerned if my doc was dogmatic and dead set against proven therapies that might be ocnsidered "addictive." My thinking, of course, is that its my time and $$$ and health on the line here--treat my problems aggressively and with an open mind, while keeping me, the patient, informed about all potential problems, including "addiction".
As for the MAOI thing..she has a point. You could get comparable results (I would think) with a stimulant, but that doesn't look like its going to happen with her.
Why does she want to cut the Prozac? Are you stuck with her?
Posted by Phillipa on July 3, 2010, at 13:08:17
In reply to I dunno man..., posted by Christ_empowered on July 3, 2010, at 12:44:42
Matt aren't you supposed to use less meds now? Phillipa
Posted by rjlockhart04-08 on July 3, 2010, at 13:17:38
In reply to I dunno man..., posted by Christ_empowered on July 3, 2010, at 12:44:42
yes, until I get a job and can pay for my own doctor yes im stuck with her. I might as well just go off prozac and go on st. johns wort because the view this doctor has is least or no medications at all.
She's strict and will not go anywhere unless there is urgent mode to pressure her on it, like me telling her how bad the depression is. She told me, if you still depressed then ill move it up next time you see me. We'll i saw her next time, and she said well, you don't look depressed and the staff at the rehab thinks your doing great, so where staying where we are. You see, its hard to argue, and my mom thinks she the wonder doctor that got sent by God, so she's not going to get another doctor. Im basically screwed until I can move out. No ambien, no nothing, I mean maybe she'll recommend some vitamens? lol
I don't want to talk about something that I don't think is going to work out. She is a good doctor, she knows all medications but has her guidelines on them which I will give respect for.
I'll see in month, but really if there is any thing that you can .... what do I say to her? I'm so depressed I cant get out of bed?
ill ask her about the shock treatment if things don't get better. Cheers
rj
Posted by Christ_empowered on July 3, 2010, at 15:32:41
In reply to Re: I dunno man..., posted by rjlockhart04-08 on July 3, 2010, at 13:17:38
ummm...that's extreme. And expensive. And it damages your brain. And the relapse rate is really high...people usually need to mediated before, during, and after the process.
Vitamins aren't a bad idea. I'm taking 3-4 grams of niacinamide along with an equal amount of vitamin c, spread out over 3 daily doses and it really, really helps. I also take a b-100 capsule and vitamin e+selenium combo capsules. And a multi-vitamin. Sounds like a lot, but it really helps with absolutely 0 side effects.
Good luck.
Posted by rjlockhart04-08 on July 3, 2010, at 19:22:42
In reply to shock treatment?!?!, posted by Christ_empowered on July 3, 2010, at 15:32:41
thanks...
Posted by RocketMan on July 3, 2010, at 23:08:05
In reply to shock treatment?!?!, posted by Christ_empowered on July 3, 2010, at 15:32:41
> ummm...that's extreme. And expensive. And it damages your brain. And the relapse rate is really high...people usually need to mediated before, during, and after the process.
>Ummm, I have to disagree. ECT helped me tremendously in 1988. It lifted me out of severe depression which no med seemed capable of doing. And here's the kicker.... I was back to work 4 wks later, remarried, 2 wonderful daughters and a son, excellent performance evaluations for the next 20 years in a skilled labour position. No, I'm not the exception to the rule. The internet is a great way to research, lots of valuable information. Unfortunately, many people stumble across information as quoted above and end up with some preconceived notion that it must be the gospel.
Posted by Christ_empowered on July 4, 2010, at 4:46:16
In reply to Re: shock treatment?!?! » Christ_empowered, posted by RocketMan on July 3, 2010, at 23:08:05
I'm sure ECT helps many people. I know it helped a family member of mine back in the day, but those benefits came at a cost for her (this was back in the day, yes, but they were still using modern techniques). On the group level, the relapse rate following ECT is pretty high, hence the need for most people to take meds (http://jama.ama-assn.org/cgi/content/abstract/285/10/1299) .
I'm really glad ECT helped you; however, it does have a high relapse rate, and there are numerous former patients out there claiming ECT-induced brain damage has harmed them. There has even been a successful ECT lawsuit (http://www.ect.org/south-carolina-woman-wins-shock-suit/) in SC.
Again: I'm really glad ECT helped you and that you've had a stable, successful life since then. However, not everyone benefits, and for a lot of people any benefits they do get are relatively short lived and come at a great cost.
Posted by SLS on July 4, 2010, at 6:37:38
In reply to that's great..., posted by Christ_empowered on July 4, 2010, at 4:46:16
The use of medications has a high relapse rate if you discontinue them as soon as a clinical improvement is noticed. In other words, both medication and ECT require maintenance treatment. I am not necessarily a proponent of ECT. However, that one needs maintenance treatment for ECT is not a reflection of a lack of efficacy when compared to medications, which also require maintenance treatment.
- Scott
Posted by linkadge on July 4, 2010, at 17:21:00
In reply to Re: shock treatment?!?! » Christ_empowered, posted by RocketMan on July 3, 2010, at 23:08:05
I have to disagree with your disagreement. ECT is like playing Russian roulette. There is really no way to "control" a seizure. Its really a crap shoot as to which brain circuits will be affected the most. Also, results probably depend on individual brain organization, and release of neuroprotective mechanisms.
ECT increases BDNF. But, BDNF increases after many types of neuronal injury as a protective mechanism. There is individual variation in the release of BDNF in response to such an event.
In mouse studies, a high release of BDNF (or injection of BDNF) in response to hypoxia corresponds to a greatly improved neurological outcome. The mice that don't release the BDNF and other neuroprotective factors (GDNF, BCL-2, preseizure glutamate levels, antioxidative status etc), aren't so lucky.
The same goes with epilepsy. It is well known that epileptic seizures can damage neural tissue. This is why neurologists go to such degrees to prevent lifetime seizure incidence. Some patients with epilepsy show significant neurological impairment after just one seizure, for others, it takes many seizures to see any impact. Some have repeated seizures without apparent consequence. Why does this happen? We don't know.
Sure, there are sucess stories with ECT, but there are also many many horror stories. The procedure is way too unpredictable to recomend. Just because one person breezed through unscathed, doesn't mean others will too.
Statistically, the relaspe for ECT is very high.
Even Sakiem (who has stock in ECT machiene companies) admits a 70+% relapse rate within a year of treatment.
Posted by linkadge on July 4, 2010, at 17:35:29
In reply to Re: that's great..., posted by SLS on July 4, 2010, at 6:37:38
Maintainance ECT is even more risky.
>However, that one needs maintenance treatment >for ECT is not a reflection of a lack of >efficacy when compared to medications, which >also require maintenance treatment.
Some people don't require maintainance medications or ECT to recover. I think in this day in age there is a tendancy to believe that the brain will never be able to heal itself. At least, Pfizer and Lilly would like the millions taking SSRI's to believe that maintance treatment is crucial for wellness.
Its just like I believe that a good proportion of those with type II diabetes or high cholesterol necessary need medication for this. My mother was told she would need metformin for the rest of her life. She is managing her blood glucose quite well through diet and exercise.
Don't get me wrong. I believe depression is a real illness, just like high cholesterol or diabets. But, I do believe that medications are not necssary (or even effective) for a good proportion of depressed patients.
Type 2 diabetes has skyrocketed in the past 40 years, as has obesity and depression. Many people don't want to listen to the theories which suggest that their lifestyle is at least part to blame.
I just don't believe that 20 percent of the population has a depression gene.
Linkadge
Posted by RocketMan on July 4, 2010, at 18:23:25
In reply to Re: shock treatment?!?! » RocketMan, posted by linkadge on July 4, 2010, at 17:21:00
> I have to disagree with your disagreement. ECT is like playing Russian roulette. There is really no way to "control" a seizure. Its really a crap shoot as to which brain circuits will be affected the most. Also, results probably depend on individual brain organization, and release of neuroprotective mechanisms.
>A crap shoot, ya, okay, that explains it. The part about brain organization and neuroprotective mechanisms sound official as well. But you say results "probably".... I would expect a more definite reasoning from someone with absolute psychiatric knowledge?????
> ECT increases BDNF. But, BDNF increases after many types of neuronal injury as a protective mechanism. There is individual variation in the release of BDNF in response to such an event.
>
Again, BDNF, another impressive clinical term. Link, I bet you're a real doctor? Such a waste, you living your life at this site when you could be out in the real world, helping millions! Well, okay, you could at least be out there advocating for the removal of ECT from clinical practice. After all, it is a new millennium, mankind should know better.
> In mouse studies, a high release of BDNF (or injection of BDNF) in response to hypoxia corresponds to a greatly improved neurological outcome. The mice that don't release the BDNF and other neuroprotective factors (GDNF, BCL-2, preseizure glutamate levels, antioxidative status etc), aren't so lucky.
>I love cheese, so I guess I really was playing Russian roulette!!!! Then again, I once witnessed a mouse escape from a trap, it wasn't pretty, but the last I heard, he went on to live a normal life, go figure, Micky should have died!
> The same goes with epilepsy. It is well known that epileptic seizures can damage neural tissue. This is why neurologists go to such degrees to prevent lifetime seizure incidence. Some patients with epilepsy show significant neurological impairment after just one seizure, for others, it takes many seizures to see any impact. Some have repeated seizures without apparent consequence. Why does this happen? We don't know.
>Do you suffer with chronic epileptic fits? If yes, I'm sorry to hear that. If you don't, why the hell are you wasting your life away, researching a bunch of garbage that is meaningless. Again, it does sound quite impressive, and I bet many here are quite impressed with your wealth of knowledge. See, you are a real doctor!
> Sure, there are sucess stories with ECT, but there are also many many horror stories. The procedure is way too unpredictable to recomend. Just because one person breezed through unscathed, doesn't mean others will too.
>100% correct again. Damn, those crazy pdocs should have their butts sued for malpractice. Openly frying peoples brains while all the time having knowledge of such atrocities.... shame on them all!
>
> Statistically, the relaspe for ECT is very high.
>Hmm, I feel very lucky surviving such a barbaric torture treatment. I now understand how Micky felt when he escaped death in that horrific trap!
> Even Sakiem (who has stock in ECT machiene companies) admits a 70+% relapse rate within a year of treatment.
>Well then, Mr. Sakiiem should have a recheck on his scruples. Next time you're talking to him, you can tell him I lost a boat-load in the "Magic Bean for Depression" stock. There was so much convincing evidence that the medication was a clear winner. Studies indicated thousands upon thousands of happy mice???
I'll be back in September to see how you're doing. I have lots going on this summer so let me know if I miss anything over the next couple of months.
Keep smiling....or say cheese.
Posted by linkadge on July 4, 2010, at 20:48:49
In reply to Re: shock treatment?!?! » linkadge, posted by RocketMan on July 4, 2010, at 18:23:25
>A crap shoot, ya, okay, that explains it. The >part about brain organization and >neuroprotective mechanisms sound official as >well. But you say results "probably".... I would >expect a more definite reasoning from someone >with absolute psychiatric knowledge?????
Nothings official. Thats the point.
>Again, BDNF, another impressive clinical term. >Link, I bet you're a real doctor? Such a waste, >you living your life at this site when you could >be out in the real world, helping millions!
I'm not a real doctor. I am a real science teacher. This is just a hobby. Unless you've got something logical to refute my assertion, why make fun of it??
>I love cheese, so I guess I really was playing >Russian roulette!!!! Then again, I once >witnessed a mouse escape from a trap, it wasn't >pretty, but the last I heard, he went on to live >a normal life, go figure, Micky should have died!
Its one thing to not really care, or understand what I am trying to say, its another thing to just waste your own time. Its a fact that there is high variability of seizure threshold and duration among patients who undergo ECT. Are you suggesting that this has zero impact on the clinical outcome?
>Do you suffer with chronic epileptic fits? If >yes, I'm sorry to hear that. If you don't, why >the hell are you wasting your life away, >researching a bunch of garbage that is >meaningless. Again, it does sound quite >impressive, and I bet many here are quite >impressed with your wealth of knowledge. See, >you are a real doctor!
Its not really meaningless. Knowledge is power. There is a reason why researchers are spending time reseaching the utility of drugs, supplements, antioxidants etc. in the prevention of ECT induced neurotoxcity. Better take some extra vitamin E before the ECT sessions See:
"We have been shown an increase of lipid peroxidation in almost all structures of the rat brain, particularly in cortex, hippocampus and cerebellum, after electroshock-induced seizures and beneficial effects of antioxidant vitamin E on these processes"
http://www.advms.pl/roczniki_2005_supl_1/volumes/21_Artemowicz_B_Sobaniec_W.pdf
Here is a study of the use of the antinflamatory celecoxib for the prevention of ECT induced neurotoxicity:
"Electroconvulsive therapy (ECT)-induced amnesia may arise from glutamatergic excitotoxicity; if so, COX-2 inhibition may attenuate retrograde amnesia with ECT"
http://www.ncbi.nlm.nih.gov/pubmed/18523723
Here is another pubmed article suggesting that the sharp increase in cortisol seen after ECT may lead to hippocampal atrophy:
http://www.ncbi.nlm.nih.gov/pubmed/17072590
"Cortisol levels rise sharply immediately after electroconvulsive therapy (ECT); the resultant stimulation of steroid receptors in the hippocampus may be beneficial or harmful to cognition, depending on the magnitude of the stimulation. Steroid mechanisms may therefore modulate ECT-induced amnesia."
Notice how they suggest that the clinical actions of ECT may be either beneficial or detrimental depending on the magnitude of stimulation (among other factors).
Heres a study linking both the AD and cognitive effects to the stimulus intensity:
http://www.ncbi.nlm.nih.gov/pubmed/10807483
"Furthermore, the likelihood of both antidepressant response and cognitive deficits increased as stimulus dose increased relative to initial seizure threshold, up through 8 to 12 times the threshold."
Here is some data on the "debate" regarding electrode placement, clinical efficacy and memory impairment.
http://www.ncbi.nlm.nih.gov/pubmed/14636387
>100% correct again. Damn, those crazy pdocs >should have their butts sued for malpractice. >Openly frying peoples brains while all the time >having knowledge of such atrocities.... shame on >them all!
Thats why they make you sign a wiaver.
>Hmm, I feel very lucky surviving such a barbaric >torture treatment. I now understand how Micky >felt when he escaped death in that horrific >trap!
Now you're just being extreme. If everything I was saying was so "obviously" false, there would be no need for the over the top sarcastic tone.
>Well then, Mr. Sakiiem should have a recheck on >his scruples. Next time you're talking to him, >you can tell him I lost a boat-load in >the "Magic Bean for Depression" stock. There was >so much convincing evidence that the medication >was a clear winner. Studies indicated thousands >upon thousands of happy mice???
Whatever dude. You've just got your eyes closed now. Why would people be studying drugs with potential to protect the brain from the harmful effects of ECT, if there were no harmful effects? These are real studies by real scientists published in real medical journals. If there were no medical basis for the side effects, there would be no study.
Linkadge
Posted by europerep on July 5, 2010, at 9:19:42
In reply to Re: shock treatment?!?! » linkadge, posted by RocketMan on July 4, 2010, at 18:23:25
I do not quite know what to say, but I won't leave this post uncommented, and in my eyes it sure merits more than a PBC reminder..
everyone here is happy your treatment went so well, whereas you are not only showing no empathy whatsoever, but you're pouring salt into other people's wounds! I personally believe noone here needs that kind of statements.. it's great you share your success with ECT, to give the other side of the picture, but frankly, I do not even understand what's making you so mad about someone disagreeing with you while providing reasonable arguments for his position..
and, for example, here it does not matter what BDNF is, it would actually even obscure the actual point.. whether BDNF or anything else, the point is that ECT may cause neuronal injury..
Posted by rjlockhart04-08 on July 5, 2010, at 16:11:32
In reply to Re: shock treatment?!?! » RocketMan, posted by europerep on July 5, 2010, at 9:19:42
Posted by Dr. Bob on July 6, 2010, at 2:30:57
In reply to Re: shock treatment?!?! » linkadge, posted by RocketMan on July 4, 2010, at 18:23:25
> Such a waste, you living your life at this site
Please don't post anything that could lead others to feel put down.
But please don't take this personally, either, this doesn't mean I don't like you or think you're a bad person, and I'm sorry if this hurts you.
Link, I'm also sorry if you felt hurt.
More information about posting policies and tips on alternative ways to express yourself, including a link to a nice post by Dinah on I-statements, are in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by RocketMan on July 8, 2010, at 14:55:05
In reply to Re: please be civil » RocketMan, posted by Dr. Bob on July 6, 2010, at 2:30:57
I apologise Link for the earlier posts I made. I guess sometimes my heart takes over my brain. I should have taken time before posting. I hope you did not feel offended, I was not meaning it to be a personal attack. Sometimes I do think how my life would have turned out if I did not have the ECT. Maybe I would not have the present day struggles but that's something I'll never know. Again, sorry for the previous comment, please accept my apology.
Regards,
Rick
Posted by Dr. Bob on July 8, 2010, at 23:33:32
In reply to Sorry Link, posted by RocketMan on July 8, 2010, at 14:55:05
Posted by linkadge on July 9, 2010, at 18:02:44
In reply to Sorry Link, posted by RocketMan on July 8, 2010, at 14:55:05
No worries. Don't get me wrong, I am not totally anti-ECT. I just think that the benefits and risks must be carefully weighted, and of course reconsidered if / when new information comes to light.
Linkadge
This is the end of the thread.
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