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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 36 to 60 of 74. Go back in thread:
Posted by SLS on March 25, 2012, at 19:09:09
In reply to Re: Most psychiatrists, posted by emmanuel98 on March 25, 2012, at 18:24:55
> believing that if meds don't work or work well enough, it helps to learn to control your reaction to your mood swings.
Yes. I found that to be very important in my fight to stay alive. CBT was very helpful in this regard.
- Scott
Posted by zazenducke on March 25, 2012, at 19:31:39
In reply to Re: new pdoc says there 'are no answers' » zazenducke, posted by SLS on March 25, 2012, at 19:00:46
> > Scott how can you prove
>
> I didn't know I was supposed to prove anything.
>I certainly wasn't suggesting you were "supposed" to prove anything.
> > that the good feelings you are having now
>
> How kind of you to notice.I was very happy to see you reporting that you felt well. I've always tried to treat you kindly. I'm glad I succeeded.
>
> > are NOT a placebo effect?
>
> What's your opinion?I don't know. I don't think anyone really does. Because how can you really prove it with something like depression for which nobody even knows the cause? I know I feel way better not using aspartame and I have no way of knowing if that's a placebo effect but if it is I welcome it. I also know that every time I start it again I feel the same kind of better when I quit. Would I have the same reaction in a blind test? I don't know. Can I prove it helps the depressed feelings? No not anymore than I can prove the depressed feelings exist.
>
> > What would change for you if that could be proven?
>
> Nothing.Sometimes I get the idea that some people believe it somehow lessens the reality of their pain if it is relieved by a placebo. I think if I believed I was cured by a placebo I'd be fascinated and also hope that the placebo effect could be evoked with something that would cause the least harm to myself and to others who might be inclined to try it themselves because of my experience. I also think it would fascinate me on a psychological level-probably because I have had way too much therapy;)
Posted by linkadge on March 25, 2012, at 19:46:52
In reply to Re: new pdoc says there 'are no answers' » linkadge, posted by SLS on March 25, 2012, at 7:29:53
>How often has the placebo effect worked for you?
>If never, then why not?
>If so, then why did you not remain well?Back in the late 90's I think celexa may have worked. Then I learned that they don't work, and they just stopped working.
Linkadge
Posted by SLS on March 26, 2012, at 6:11:11
In reply to Re: new pdoc says there 'are no answers', posted by linkadge on March 25, 2012, at 19:46:52
> >How often has the placebo effect worked for you?
> >If never, then why not?
> >If so, then why did you not remain well?
>
> Back in the late 90's I think celexa may have worked. Then I learned that they don't work, and they just stopped working.
>
> Linkadge
How do you account for amitriptyline?Listen, I don't mean to attack you so much as challenge your statement. I believe that the current backlash against antidepressants using the placebo argument is, for the most part, spurious.
- Scott
Posted by zazenducke on March 26, 2012, at 6:56:27
In reply to Re: new pdoc says there 'are no answers' » linkadge, posted by SLS on March 26, 2012, at 6:11:11
>
>
>
> Listen, I don't mean to attack you so much as challenge your statement. I believe that the current backlash against antidepressants using the placebo argument is, for the most part, spurious.
>
>
Believing the placebo argument is spurious of course would enhance the chances that one would obtain a robust placebo response. Which would be helpful if the placebo was harmless. But the chemicals marketed by the pharmaceutical companies cause a great deal of harm to a great many people as well as a great deal of profit for the companies.
Posted by SLS on March 26, 2012, at 7:19:16
In reply to Re: new pdoc says there 'are no answers' » SLS, posted by zazenducke on March 25, 2012, at 19:31:39
> > What's your opinion?
> I don't know. I don't think anyone really does.Well, the placebo effect has not remained unexplored in science. Dr. Frederick Quitkin performed some formal investigations of the placebo effect. He addressed its phenomenology and quantizisation. If you are interested, you can find his writings on the Web. Also, I have written quite a bit regarding the placebo phenomenon and what I believe to be its unintended inflation statistically resulting from poor screening for Major Depressive Disorder (MDD). The issue of placebo effect is complex and deserves more consideration than what I am disposed to give it here.
> Because how can you really prove it with something like depression for which nobody even knows the cause?
If you mean that the precise cascade of biological events involved in the evolution of MDD have not yet been elucidated, I would agree. If you mean that there is no evidence of any sort indicating that MDD does indeed represent a biologically driven pathology, I would disagree.
> Sometimes I get the idea that some people believe it somehow lessens the reality of their pain if it is relieved by a placebo.
Treatment with placebo is not necessarily "no treatment". With depression investigations, there is often quite a bit of emotional support present in the environment of the study. Sometimes, interacting with the personel administering the study is the first true positive human connection made by the patient since the onset of their illness. This is indeed therapeutic psychologically. Does this inflate the statistics for placebo response? You bet.
* "Depression" is not synonymous with "Major Depressive Disorder".
- Scott
Posted by SLS on March 26, 2012, at 7:23:07
In reply to Re: new pdoc says there 'are no answers', posted by zazenducke on March 26, 2012, at 6:56:27
> > Listen, I don't mean to attack you so much as challenge your statement. I believe that the current backlash against antidepressants using the placebo argument is, for the most part, spurious.
> Believing the placebo argument is spurious of course would enhance the chances that one would obtain a robust placebo response.How so?
The placebo "response" rate decreases as the degree of severity of depression increases. What are your thoughts on this observation?
- Scott
Posted by zazenducke on March 26, 2012, at 8:46:28
In reply to Re: new pdoc says there 'are no answers' » zazenducke, posted by SLS on March 26, 2012, at 7:23:07
>
> > Believing the placebo argument is spurious of course would enhance the chances that one would obtain a robust placebo response.
>
> How so?The placebo effect depends on the person who receives the placebo not realizing it is a placebo. If you take a pill and believe the studies which show the relief afforded by this pill are caused by the placebo effect it cannot act as a placebo. If you believe there is no placebo effect and the studies show it to be effective, it is a perfect candidate for placebo effect.
>
> The placebo "response" rate decreases as the degree of severity of depression increases. What are your thoughts on this observation?
>
>
> - Scott
That people don't have the energy to be active participants in the placebo effect and are isolated from a culture which would support it? The first ingredient is believing and that can be enhanced by research and interactions with people who believe in it, interactions with docs, watching commercials on tv, being part of a popular culture which believes that depression is a chemical imbalance and can be cured by pills, interacting with people who would encourage any signs of positive response. People who have severe depression are more likely to have lost more because of it-jobs friends opportunities etc so any return to normal is still a confrontation with grief and loss.What do you think?
Posted by SLS on March 26, 2012, at 9:44:45
In reply to Re: new pdoc says there 'are no answers' » SLS, posted by zazenducke on March 26, 2012, at 8:46:28
> > > Believing the placebo argument is spurious of course would enhance the chances that one would obtain a robust placebo response.
What I meant to say is that the the high rate of placebo response evident in more recent investigations of major depressive disorder is used by some people to promulgate a thesis that antidepressants are ineffective. I believe this is a spurious argument.
> The placebo effect depends on the person who receives the placebo not realizing it is a placebo.I think the placebo effect depends upon the understanding that the assignment of placebo versus active treatment is randomized. Sometimes, an active placebo is used to fool people that they are being given the active treatment.
> If you take a pill and believe the studies which show the relief afforded by this pill are caused by the placebo effect it cannot act as a placebo.
Sorry. I don't understand what you are saying here.
> > The placebo "response" rate decreases as the degree of severity of depression increases. What are your thoughts on this observation?
Quite simply, I believe this means that the likelihood of selecting people who truly have the disease being investigated is greater. People who are eligible for the study will exhibit severe psychomotor retardation, cognitive impairments, slow thinking and speech, profound anergia, etc. These people are likely to have the MDD illness. People with less severe depressions will more often be representitive of conditions other than MDD and that are more responsive to psychosocial influences.
Frederick Quitkin noted in his studies that placebo responders will report feeling improved earlier, often in week 1, compared to active treatment. In addition placebo responders more often relapse early, often by week 4.
You synthesize very logical and insightful propositions. It might be instructive for you to have more facts to work with to refine those propositions. I think you will find that the issue is rather complex. It is somewhat difficult to find relevant investigations and articles that are objective in approach.
- Scott
Posted by ron1953 on March 26, 2012, at 12:43:28
In reply to new pdoc says there 'are no answers', posted by raisinb on March 24, 2012, at 9:01:20
This "pdoc" obviously doesn't understand that mental-health professionals are paid to tell people what they want to hear, as opposed to what they need to hear.
Posted by SLS on March 26, 2012, at 12:46:46
In reply to Re: new pdoc says there 'are no answers', posted by ron1953 on March 26, 2012, at 12:43:28
> This "pdoc" obviously doesn't understand that mental-health professionals are paid to tell people what they want to hear, as opposed to what they need to hear.
What would be an example of this?
- Scott
Posted by ron1953 on March 26, 2012, at 12:56:04
In reply to Re: new pdoc says there 'are no answers' » ron1953, posted by SLS on March 26, 2012, at 12:46:46
> > This "pdoc" obviously doesn't understand that mental-health professionals are paid to tell people what they want to hear, as opposed to what they need to hear.
>
> What would be an example of this?
>
>
> - ScottLMAO
Posted by SLS on March 26, 2012, at 14:28:34
In reply to Re: new pdoc says there 'are no answers', posted by ron1953 on March 26, 2012, at 12:56:04
> > > This "pdoc" obviously doesn't understand that mental-health professionals are paid to tell people what they want to hear, as opposed to what they need to hear.
> >
> > What would be an example of this?
> >
> >
> > - Scott
>
> LMAO
Couldn't come up with one, eh?
- Scott
Posted by TiredofChemicals on March 26, 2012, at 14:41:52
In reply to Re: new pdoc says there 'are no answers' » zazenducke, posted by SLS on March 26, 2012, at 9:44:45
> > > > Believing the placebo argument is spurious of course would enhance the chances that one would obtain a robust placebo response.
>
> What I meant to say is that the the high rate of placebo response evident in more recent investigations of major depressive disorder is used by some people to promulgate a thesis that antidepressants are ineffective. I believe this is a spurious argument.
>
> > The placebo effect depends on the person who receives the placebo not realizing it is a placebo.
>
> I think the placebo effect depends upon the understanding that the assignment of placebo versus active treatment is randomized. Sometimes, an active placebo is used to fool people that they are being given the active treatment.
>
> > If you take a pill and believe the studies which show the relief afforded by this pill are caused by the placebo effect it cannot act as a placebo.
>
> Sorry. I don't understand what you are saying here.
>
> > > The placebo "response" rate decreases as the degree of severity of depression increases. What are your thoughts on this observation?
>
> Quite simply, I believe this means that the likelihood of selecting people who truly have the disease being investigated is greater. People who are eligible for the study will exhibit severe psychomotor retardation, cognitive impairments, slow thinking and speech, profound anergia, etc. These people are likely to have the MDD illness. People with less severe depressions will more often be representitive of conditions other than MDD and that are more responsive to psychosocial influences.
>
> Frederick Quitkin noted in his studies that placebo responders will report feeling improved earlier, often in week 1, compared to active treatment. In addition placebo responders more often relapse early, often by week 4.
>
> You synthesize very logical and insightful propositions. It might be instructive for you to have more facts to work with to refine those propositions. I think you will find that the issue is rather complex. It is somewhat difficult to find relevant investigations and articles that are objective in approach.
>
>
> - Scottlol, wut
kidding, I really have to study all that is written to begin to understand what is being said. I admit too that, I have to blow the dust off the ol' Websters as there are words being used here that I am unfamiliar with.
I'm being educated. I appreciate it.
Regards
Posted by SLS on March 26, 2012, at 15:19:21
In reply to Re: new pdoc says there 'are no answers', posted by TiredofChemicals on March 26, 2012, at 14:41:52
> kidding, I really have to study all that is written to begin to understand what is being said. I admit too that, I have to blow the dust off the ol' Websters as there are words being used here that I am unfamiliar with.
>
> I'm being educated. I appreciate it.
>
> Regards
I am genuinely happy that you feel that way.I don't intend to "dumb-down" everything I have to say. How pretentious that would be. The people here deserve better than that. Besides, I genuinely believe that everyone here is capable of learning things. I am always delighted when I see one of us "laymen" (including me) digest facts and become capable of synthesizing their own ideas using them. Knowing facts is valuable, but not nearly as valuable as applying oneself to gain true understanding using them.
I know that a dictionary comes in handy. It is a bit of a balancing act. When I address individual posters, I try to take into consideration where I think they are along their journey to self-education and understanding. I would rather be understood than to seem pedantic and have nothing I write be understood. There is no lack of intelligence here - only a disease that convinces us otherwise about ourselves.
I use a dictionary, too. Some very impressive words are being thrown about at Psycho-Babble.
- Scott
Posted by SLS on March 26, 2012, at 19:50:25
In reply to Re: new pdoc says there 'are no answers' » SLS, posted by zazenducke on March 26, 2012, at 8:46:28
> Frederick Quitkin noted in his studies that placebo responders will report feeling improved earlier, often in week 1, compared to active treatment. In addition placebo responders more often relapse early, often by week 4.
Andrew A Nierenberg, Frederic M Quitkin, Charlotte Kremer, Martin B Keller, and Michael E Thase
http://www.nature.com/npp/journal/v29/n5/full/1300405a.html
I think this is a very well done article.
Check out the bibliography.
- Scott
Posted by zazenducke on March 26, 2012, at 20:00:01
In reply to Re: new pdoc says there 'are no answers' » zazenducke, posted by SLS on March 26, 2012, at 9:44:45
> > > > Believing the placebo argument is spurious of course would enhance the chances that one would obtain a robust placebo response.
>
> What I meant to say is that the the high rate of placebo response evident in more recent investigations of major depressive disorder is used by some people to promulgate a thesis that antidepressants are ineffective. I believe this is a spurious argument.
>Now I understand what you are saying but I don't agree.
> > The placebo effect depends on the person who receives the placebo not realizing it is a placebo.
>
> I think the placebo effect depends upon the understanding that the assignment of placebo versus active treatment is randomized. Sometimes, an active placebo is used to fool people that they are being given the active treatment.DEFINITION The placebo effect is a positive therapeutic effect claimed by a patient after receiving a placebo believed by him to be an active drug. I was talking about individuals not studies.
>
> > If you take a pill and believe the studies which show the relief afforded by this pill are caused by the placebo effect it cannot act as a placebo.
>
> Sorry. I don't understand what you are saying here.
>Again I am talking about individuals. If an individual takes a pill which he believes produces relief by placebo effect then he does not believe the pill is an active agent which is required by the definition.
> > > The placebo "response" rate decreases as the degree of severity of depression increases. What are your thoughts on this observation?
>
> Quite simply, I believe this means that the likelihood of selecting people who truly have the disease being investigated is greater. People who are eligible for the study will exhibit severe psychomotor retardation, cognitive impairments, slow thinking and speech, profound anergia, etc. These people are likely to have the MDD illness. People with less severe depressions will more often be representitive of conditions other than MDD and that are more responsive to psychosocial influences.
>
> Frederick Quitkin noted in his studies that placebo responders will report feeling improved earlier, often in week 1, compared to active treatment. In addition placebo responders more often relapse early, often by week 4.
>
> You synthesize very logical and insightful propositions. It might be instructive for you to have more facts to work with to refine those propositions. I think you will find that the issue is rather complex. It is somewhat difficult to find relevant investigations and articles that are objective in approach.
>
>
> - ScottScott if you change the definition of MDD then the studies don't prove anything either way. They're irrelevant. The whole definition is so subjective. And then evaluating results with self reporting and checklists by clinicians based on their judgement with no objective tests or lab results etc etc
You may be right though.
Sorry I was unclear.
Posted by SLS on March 26, 2012, at 21:04:54
In reply to Re: new pdoc says there 'are no answers', posted by zazenducke on March 26, 2012, at 20:00:01
> Scott if you change the definition of MDD then the studies don't prove anything either way.
Are you saying that *I* have changed the definition of MDD?
- Scott
Posted by TiredofChemicals on March 26, 2012, at 21:09:36
In reply to Re: new pdoc says there 'are no answers', posted by zazenducke on March 26, 2012, at 20:00:01
I had the placebo effect for ten years just having a caring and nice psychiatrist. The meds didn't do sh*t but I, at least, felt "cared for."
I would probably still be under his care if life events hadn't changed.
My decision to stop taking psychiatric drugs was not entirely my own decision. I was forced to move away from where he practiced.
I also could not afford to see a psychiatrist on a regular basis which, really did not impact me negatively.Different family dynamics, for me, has been one of the biggest positive impacts as to a better overall state of well being.
Posted by SLS on March 26, 2012, at 21:14:17
In reply to Re: new pdoc says there 'are no answers', posted by TiredofChemicals on March 26, 2012, at 21:09:36
> I had the placebo effect for ten years just having a caring and nice psychiatrist. The meds didn't do sh*t but I, at least, felt "cared for."
>
> I would probably still be under his care if life events hadn't changed.
>
> My decision to stop taking psychiatric drugs was not entirely my own decision. I was forced to move away from where he practiced.
> I also could not afford to see a psychiatrist on a regular basis which, really did not impact me negatively.
>
> Different family dynamics, for me, has been one of the biggest positive impacts as to a better overall state of well being.
This is all good stuff. I hope your life heads in the direction you want it to while remaining drug-free. If I could, I would do the same.
- Scott.
Posted by TiredofChemicals on March 26, 2012, at 21:40:44
In reply to Re: new pdoc says there 'are no answers' » TiredofChemicals, posted by SLS on March 26, 2012, at 21:14:17
Scott, I have posted it before but I will post it again so that I can remain on a (hopefully) trustworthy basis here, I thought I did anyways.
I recently had a traumatic injury so I am prescribed pain medications. The pain medications impact my mood significantly. So, as it is now, I am posting "under the influence."
My doctor has also prescribed Lyrica to treat neuropathic pain. As it turns out, the Lyrica is helping to manage nerve spasms that have been affecting my life since around 2006 or so.
I have been exhaustively searching for something to help me to manage these spasms for the last couple of years. It is a godsend that has also affected my mood greatly.
My state of well being has been greatly impacted for the better for only the last month or so.
I am still experiencing and relishing the great relief that the Lyrica has provided for the nerve spasms that have plagued me since 2006! It has changed my life!
So, wait until I am off the pain medications and we will see where I am at. I am a pretty miserable person when not under the influence and totally drug free.
Posted by TiredofChemicals on March 26, 2012, at 21:54:17
In reply to Re: new pdoc says there 'are no answers' » TiredofChemicals, posted by SLS on March 26, 2012, at 21:14:17
> > I had the placebo effect for ten years just having a caring and nice psychiatrist. The meds didn't do sh*t but I, at least, felt "cared for."
> >
> > I would probably still be under his care if life events hadn't changed.
> >
> > My decision to stop taking psychiatric drugs was not entirely my own decision. I was forced to move away from where he practiced.
> > I also could not afford to see a psychiatrist on a regular basis which, really did not impact me negatively.
> >
> > Different family dynamics, for me, has been one of the biggest positive impacts as to a better overall state of well being.
>
>
> This is all good stuff. I hope your life heads in the direction you want it to while remaining drug-free. If I could, I would do the same.
>
>
> - Scott.
Maybe I should stop posting altogether or start an opiate responder thread of my own. I am sorry if I have mislead people.All that I have posted has been truthful up to this point however.
Posted by SLS on March 26, 2012, at 22:04:20
In reply to Re: new pdoc says there 'are no answers', posted by TiredofChemicals on March 26, 2012, at 21:54:17
> Maybe I should stop posting altogether
Now, that's silly.
> or start an opiate responder thread of my own. I am sorry if I have mislead people.
You have not misled anyone. You are simply reporting your experiences. If you felt the need to amend your descriptions, you are demonstrating a great deal of fidelity - something that I hold in high esteem and hope that I can duplicate for myself. You are not untrustworthy. The worst thing you can be accused of is an unintentional incompleteness in presenting your entire life story in a single post. :-)
> All that I have posted has been truthful up to this point however.
And by amending your descriptions, you remain truthful. Right?
- Scott
Posted by TiredofChemicals on March 26, 2012, at 22:12:44
In reply to Re: new pdoc says there 'are no answers' » TiredofChemicals, posted by SLS on March 26, 2012, at 22:04:20
And by amending your descriptions, you remain truthful. Right?
What I have said has been true.
That's my story and I'm sticking to it lol.;-)
Posted by zazenducke on March 27, 2012, at 6:45:50
In reply to Re: new pdoc says there 'are no answers' » zazenducke, posted by SLS on March 26, 2012, at 21:04:54
> > Scott if you change the definition of MDD then the studies don't prove anything either way.
>
> Are you saying that *I* have changed the definition of MDD?
>
>
> - ScottAre you saying that?
Or are you saying participants in study were misdiagnosed?
Then the researchers were incompetent who cares about the results?Or are you saying the study was not done on people who were diagnosed with MDD? Then why are we trying to make it relevant?
Or would you like to talk about the weather? I would ! Nice seeing you again!
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Dr. Bob is Robert Hsiung, MD,
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