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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 rabble_rouser on July 6, 2005, at 16:00:27
More of my brain-dump for you. Scuse me if im waffling ....
Just a thought on worrying about being on the meds forever. If you like it, try it. If not ... no loss.
This might be a little too hippy-tastic for some, but listen to a guy called Wayne Dyer. He has an audio book called "How to get what you really really want". You can download it from P2P programs.
Listen to what he says about how you get what you place your mind on.
He says that people tend to get what they think about. What they spend most mental energy on.
"if you always think about what you DON'T want, thats what you're gonna get! ..... So, why not think about what you DO want?"
A depressed person will think:
"I dont wanna screw this up"
"I musn't get nervous"
"I musn't let people see how weak I am"And as we know, for some reason, it keeps on happening - that very thing we tried so hard not to have happen - happens right before our very eyes.
In your case, I hope you don't think me rude by suggesting that you might be thinking "I don't want to be on this med forever like my mum". Maybe lots of reasons why you dont want this come along too - and maybe they float around for a long time.
Maybe "I would like to be a healthier person, free from medication, and accepting of myself as I am" would be a better thought. You might like to think of all the ways in which you might make this happen, like taking other steps to overcome your difficulties, and learning skills that take you through life a happier person.
You might like to think of all the good things that you will feel and see and hear when your mind and body support themselves and keep you happy in a completely natural, healthy way.
Play with it in your mind - and enjoy the journey.
Rabble
Posted by rabble_rouser on July 6, 2005, at 16:02:33
In reply to Re: fear of staying on effexor forever., posted by rabble_rouser on July 6, 2005, at 16:00:27
nm
Posted by SLS on July 6, 2005, at 17:05:02
In reply to Re: fear of staying on effexor forever., posted by rabble_rouser on July 6, 2005, at 16:00:27
Hi RR.
> Just a thought on worrying about being on the meds forever. If you like it, try it. If not ... no loss.
I'm not sure what you mean here. Are you suggesting to discontinue worrying or to discontinue taking medication?
Where biological issues predominate, there can be an enormous loss when discontinuing a medication that is working well. It often occurs that one does not respond as well once the medication is restarted.
The decision as to whether or not to experiment and discontinue medication involves multiple factors, including frequency of recurrences, symptomology, and family history.
- Scott
Posted by Shortelise on July 6, 2005, at 22:35:19
In reply to Re: fear of staying on effexor forever., posted by rabble_rouser on July 6, 2005, at 16:00:27
RR, I do understand positive reinforcement, and the use of mantras, aka a word I can't think of at the moment.
Your point is well taken, though. Thanks. You can't be more of a hippie than I am, btw. But I'm a dogmatic hippie. :-)
ShortE
Posted by Shortelise on July 6, 2005, at 22:38:51
In reply to Re: fear of staying on effexor forever. » rabble_rouser, posted by SLS on July 6, 2005, at 17:05:02
Thanks Scott, that's something I need to know, that it's possible not to have the same good effect if I go off and go back on this med.
It's something I really need to re-discuss with my doc, and as I am having some struggles with him at the moment, I think I might be a little less than rational.
But I do want to try the supplements that RR has suggested. He is not alone in his ideas, my doc agrees with him on some of these, and will probably have lots to say about them next time I see him.
Thanks again. I need all of the info I can get, and RR does seem to draw people into responding where I fail.
ShortE
Posted by rabble_rouser on July 7, 2005, at 1:36:52
In reply to Re: fear of staying on effexor forever. » SLS, posted by Shortelise on July 6, 2005, at 22:38:51
hi all,
yes all valid arguments, I agree. I understand a lot of you are suffering out there and I dont mean to sound prescriptive. I read a lot of posts from people that are still very much depressed, and in the stages of withdrawing. I would prefer to think that I am in fact trying to offer people hope, and a little belief.
I suppose I should always add the caveat that this is what is working for ME. I'm 27 and have had this over me since i was 12, and all the ensuing destruction that has brought along with it. All the stuff im posting is what has set me free, finally.
In answer to questions - I guess Im saying that, from my experience, meds only mask problems (ive been on three different types so far), and if you don't address the psychological bits, then your chances of success are slim. Once the crutches are gone, the remaining bad mental habits just bring you back down. (My experience from 300mg to zero and the progression back down to clinical depression within 6 months is testament to this).
You know what? The other day, I suddenly thought "Christ, I havn't been depressed for a whole week". And ive been rapidly coming off effexor.
Suddenly I felt a bit disoriented. What do I do if Im NOT depressed anymore?
If I'm honest, it was quite scary.
Yes there is a possibility of being on effexor forever. I'm just asking you to think about the possibility that you might not be! :)
I agree with all the psychopharmalogical issues raised, and I have bought the t-shirt on side-effect, withdrawal, losing it etc etc.
It is only since I sat down and said "right, Im really going to beat this. Im not going to allow my own self-pity, or the pity of others, to convince me that its safer to remain a depressed person forever, and I am going to fight every day to overcome it."
The key word for me is "fight". All the techniaues I have posted are HARD WORK. But I expected that. Ive spent 15 years learning the skills of depression. Its taken the last 6 years of research, experimentation, CBT, drug therapy and most importantly education to get me to this point.
Things that are with us a long time become familiar. Accepted, almost. Are you ready to accept that there may be a day when you are no longer depressed?
The most important thing is this: Do what works for you.
Big hugs
Rabble
Posted by rabble_rouser on July 7, 2005, at 4:18:56
In reply to Re: fear of staying on effexor forever. » rabble_rouser, posted by SLS on July 6, 2005, at 17:05:02
Hi Scott,
Apologies if my post was unclear. "If you like it, try it ..." I meant to try the technique that I posted. I agree totally that people should do what works for them.
My suggestions were intended to be supportive and try to give hope to ShortE (sorry to refer to you in the third person if you are reading this ShortE!) and her unique situation, i.e. worries of being on the med forever. I realise it is impossible in the case of depression to make a blanket statement, depression being unique to each individual sufferer.
Like I said, its a bit hippie-ish, but I take great comfort in these paraphrased words of Henry Ford:
"There is no person living that can not do more than they think they can".
In other news, someone has just started planting bombs in london, and has so far blown up a bus and a train. I think I'm getting a taxi home :(
Blue skies
Ross
Posted by SLS on July 7, 2005, at 9:29:45
In reply to Re: fear of staying on effexor forever., posted by rabble_rouser on July 7, 2005, at 4:18:56
The difficult thing about suggesting to others that they use whatever works is that finding what works can sometimes be a lengthy process of trial and error for which only 20/20 hindsight brings wisdom. Some treatments have higher probabilities of working than others; discovered and based solely upon clinical investigation and experience. Only recently have designer drugs become possible; targeting specific receptors based upon the theories and hypotheses that our new found understandings of the physiology of the body now allows for. Also being studied by the NIH and other institutions are treatments that are considered "alternative". It is probably counterproductive to define medical treatment as a dichotomy in this way. Many "natural" treatments might have been overlooked. In any event, alternative or natural treatments should be no less scrutinized than those developed in test tubes. But like you said, whatever works. I just hope that alternative treatments offer paradigms that work with probablities of success that are better than placebo.
Personally, I tend to believe the accounts offered by the people on the PB Alternative board. They describe success. Perhaps I am too easily influenced by anecdotes. I am certainly influenced by repetition. Since I don't frequent the Alternative board, I really don't have much of a feel as to which treatments have repeatedly demonstrated effectiveness. There is nothing wrong with allowing the scientific method access to alternative ideas.
BIOLOGY OR PSYCHOLOGY?The best answer to this question may be "either and both".
Many of us here have been diagnosed as having a mental illness. Mental illnesses are NOT mental weaknesses. The diagnoses that we are most familiar with include:1. Major Depression (Unipolar Depression)
2. Bipolar Disorder (Manic Depression)
3. Dysthymia (Minor Depression)
4. Seasonal Affective Disorder (SAD)
5. Schizophrenia
6. Schizo-Affective Disorder
7. Obsessive-Compulsive Disorder (OCD)
8. Post-Traumatic Stress Disorder (PTSD)All of these disorders have one thing in common. They are not our fault. Each has both biological and psychological components. We all begin our lives with a brain that is built using the blueprints contained within the genes we inherit from our parents. Later, hormones change the brain to prepare it for adulthood. The brain can be changed in negative ways by things such as drugs, alcohol, and injury. The brain is also changed by the things we experience.
How we think and feel are influenced by our environment. Probably the most important environment during our development is that of the family, with the most important time being our childhood. We all have both positive and negative experiences as we travel through life. How we are as adults is in large part determined by these positive and negative experiences. They affect our psychology, our emotions, and our behaviors. All of us can be hurt by unhealthy negative experiences.
Some of us are also hurt by unhealthy brains. Medical science has long recognized that many mental illnesses are biological illnesses. Even Sigmund Freud, who we know for his development of psychoanalysis, proposed a role for biology in mental illness. The first solid evidence for this concept in modern times came with the discovery of lithium in 1947. Lithium was found to cause the symptoms of bipolar disorder (manic- depression) to disappear completely, allowing people to lead normal lives. Lithium helps to correct for the abnormal biology that is the cause of bipolar disorder. Later biological discoveries included the observations that the drug Thorazine (an antipsychotic) successfully treated schizophrenia, and that Tofranil (an antidepressant) successfully treated depression. Again, these drugs help to correct for the abnormal biology of the brain that accompanies these illnesses.
What about psychology? What role does it play in mental illness? This can be a two-way street. The abnormal biology that occurs with some mental illnesses affects our psychology – how we think, feel, and behave. On the other hand, our psychology can also affect our biology. As we now know, the emotional stresses and traumas we experience change the way our brains operate. This is especially true of things we experience during childhood. These stresses can trigger the induction of abnormal brain function that leads to major depression, bipolar disorder, schizophrenia, and other major mental illnesses. In order for this to happen, however, there must be a genetic or some other biological vulnerability to begin with.
Unfortunately, there are still too many people who cannot bring themselves to believe that the most common mental illnesses are actually brain disorders. However, the vast majority of our top researchers in psychiatry and neuroscience do.
The National Institutes of Health, the federal government’s official repository of medical research, has made available to the public free publications describing the current research into psychiatric disorders. They include descriptions of the biological and psychological aspects of major mental illness. Each of their press releases and research publications begin by stating emphatically that these are indeed brain disorders.
NIMH Public Inquiries
6001 Executive Boulevard, Rm. 8184, MSC 9663
Bethesda, MD 20892-9663 U.S.A.
Voice (301) 443-4513; Fax (301) 443-4279
TTY (301) 443-8431It is important to understand that not all psychological and emotional troubles are biological in origin. Again, we are all products of our environments – family, friends, enemies, school, work, culture, climate, war, etc. Environments that are unhealthy often produce unhealthy people. This, too, is not our fault.
In conclusion, regardless of the cause of our mental illnesses, it is important that we treat both the biological and the psychological. We will all benefit most if we do.
- SLS
Posted by SLS on July 7, 2005, at 10:06:51
In reply to Re: fear of staying on effexor forever. » SLS, posted by Shortelise on July 6, 2005, at 22:38:51
Hi.
I don't know whether or not you would need to stay on an antidepressant forever.
Can you describe your case history? I still would not presume to make a decision for you, but I might be able to give you an idea as to what the current medical opinion is.
- Scott
Posted by SLS on July 7, 2005, at 10:45:04
In reply to Re: fear of staying on effexor forever. » SLS, posted by Shortelise on July 6, 2005, at 22:38:51
The following is a nice review regarding long-term treatment with antidepressants. One thing that is not included is the importance of achieving full remission. People who do have a much lower risk of relapse than those who experience residual symptoms despite treatment.
- Scott
-----------------------------------------
CNS Drugs. 2003;17(15):1109-17. Related Articles, Links
Comment in:
CNS Drugs. 2003;17(15):1119-22.Treatment of recurrent depression: a sequential psychotherapeutic and psychopharmacological approach.
Fava GA, Ruini C, Sonino N.
Affective Disorders Program, Department of Psychology, University of Bologna, Viale Berti Pichate 5, 40130, Italy. fava@psibo.unibo.it
The chronic and recurrent nature of major depressive disorder is receiving increasing attention. Approximately eight of ten people experiencing a major depressive episode will have at least one more episode during their lifetime, i.e. recurrent major depressive disorder. In the 1990s, prolonged or lifelong pharmacotherapy emerged as the main therapeutic tool for preventing relapses of depression. This therapeutic approach is based on the effectiveness of antidepressant drugs compared with placebo in decreasing relapse risk and on the improved tolerability profile of the newer antidepressants compared with their older counterparts. However, outcome after discontinuation of antidepressant therapy does not seem to be affected by the duration of administration. Loss of clinical effects, despite adequate compliance, has also emerged as a vexing clinical problem. The use of intermittent pharmacotherapy with follow-up visits is an alternative therapeutic option. This leaves patients with periods free of drugs and adverse effects and takes into account that a high proportion of patients would discontinue the antidepressant anyway. However, the problems of resistance (that a drug treatment may be associated with a diminished chance of response in subsequent treatments in those patients whose symptoms successfully responded to it but who discontinued it) and of discontinuation syndromes are substantial disadvantages of this therapeutic approach. In recent years, several controlled trials have suggested that sequential use of pharmacotherapy in the treatment of the acute depressive episode and psychotherapy in its residual phase may improve long-term outcome. Patients, however, need to be motivated for psychotherapy, and skilled therapists have to be available. Despite an impressive amount of research into the treatment of depression, there is still a paucity of studies addressing the specific problems that prevention of recurrent depression entails. It is important to discuss with the patient the various therapeutic options and to adapt strategies to the specific needs of patients.
Posted by rabble_rouser on July 7, 2005, at 11:40:10
In reply to Re: fear of staying on effexor forever. » SLS, posted by Shortelise on July 6, 2005, at 22:38:51
Dear Elise,
Hope all goes well with trying to free yourself from Effexor. I hope that, in my perhaps misguided enthusiasm to help (inspired by my own recent recovery) I have not ridden over yours, or others, feelings in any way.
I have noticed that people have felt it necessary to post caveats to much of what I am saying, which I did not intend to be controversial. As my intention was to encourage faith and hope, then I find this a little sad.
I don't want to engage in a heated exchange of opinion, acknowledged as it is that depression remains an undefined animal.
If my posts have helped in any way then I am very happy.
Keep on fighting and good luck.
Ross
Posted by Shortelise on July 7, 2005, at 13:55:09
In reply to Re: fear of staying on effexor forever., posted by rabble_rouser on July 7, 2005, at 11:40:10
Thanks Ross.
SLS is giving additional information from a different perspective, and that's great.
I hope that no one here is foolish enough to take information or advice given here as some sort of gospel and follow it accordingly.
It may seem otherwise, and I say this without malice or offense, but I am interested in everything and able to make intelligent, informed decisions. The more information I get, including what you AND anyone else writes, the better.
I believ ethat supplements will make me feel better. I also know that I am Borderline and a generally f*cked up person and I need to do everything I can to keep my mood even.
If that means that I stay on Celexa forever, that's life. I am going to use these supplemtns along with 3/4 dose of Celexa until I seemy doc on the 18th. I'll talk with him, and as he's into alternatives and well-versed in them, I know we'll be on the same page to a certain extent.
But please don't take offense at SLS. His info is as valuable to me as yours. And I know you aren't trying to tell me what I should do. And I also understand that there is some fighting I need to do - it's partly biological but if I don't do the rest, I'm not sure it'll work.
((Ross)) thank you.
ShortE
Posted by Shortelise on July 7, 2005, at 13:56:03
In reply to Re: fear of staying on effexor forever. » Shortelise, posted by SLS on July 7, 2005, at 10:06:51
I will do this later in the day, as soon as I have a minute. Er, maybe about 1/2 hour!
Thanks Scott. Very much.
SHortE
Posted by SLS on July 7, 2005, at 20:44:24
In reply to Celexa!!!! » rabble_rouser, posted by Shortelise on July 7, 2005, at 13:55:09
If you really, really, really are borderline (its diagnosis is still the subject of debate), and wish to further explore medications, Trileptal + Zyprexa can work wonders. Zyprexa has its issues, however. Weight gain is perhaps the one most likely to dissuade many from using it. I don't know if other neuroleptics are as effective for BPD, but I like Abilify. I find that it offers an antidepressant effect along with an anti-anxiety effect. It is also used for mania in bipolar disorder as well as schizoid disorders. It does not produce weight gain. Having taken both drugs, I find that they have similar psychotropic effects. It is my hope that they will have similar anti-BPD effects as well, but I don't know of anyone taking Abilify for that. If I were BPD, I would probably want to try a combination of Trileptal, Abilify, and psychotherapy, perhaps in the form of DBT (dialectic behavior therapy).
There is about a 90% chance that I will need to be on medication indefinitely. It is a personal journey to travel from the point of denial to the point of acceptance. However, this does not mean that continued exploration of alternatives comes to a halt. You can only do the best you can with what information is available combined with a bit of experimentation.
- Scott
Posted by SLS on July 7, 2005, at 21:07:59
In reply to Re: fear of staying on effexor forever., posted by rabble_rouser on July 7, 2005, at 11:40:10
> enthusiasm to help (inspired by my own recent recovery)
It is difficult not to be enthusiastic when you feel you have uncovered an answer that works. It certainly demonstrates altruism. It is an attractive idea to think that this answer will work for everyone else as well. I often fall into that trap. I find that I must remind myself that there is a tendency toward overgeneralization, and that the first person I advise to exercise caveat when making suggestions to others is me.
IMO, the power of positive thinking and acquisition of positive energy will help just about anyone. However, each person has a unique upper limit as to how far such an approach will take them. As long as it is recognized that there are limits, as unexplored as they may be, sabotage can be avoided. It is sabotage to take personal responsibility for failure to accomplish what cannot be accomplished.
> acknowledged as it is that depression remains an undefined animal.
I do not acknowledge that depression is an undefined animal. I do, however, see that the English language uses a single word, "depression", to describe a multitude of phenomena. This is extremely counterproductive and only helps to misdiagnose, misprescribe, and misrepresent a true illness. If one uses the diagnostic criteria found in the DSM, one finds that depression is indeed a well-defined illness. For the most part, it works. People who need help will get help if it is used. People love to bash the DSM and the very idea that mental illness can be diagnosed at all. I find that this is underserved, and quite dangerous to the individual suffering from one.
- Scott
Posted by Shortelise on July 8, 2005, at 13:40:12
In reply to Re: Celexa!!!! » Shortelise, posted by SLS on July 7, 2005, at 20:44:24
I have been in psychotherapy for seven years with a good psychiatrist. We are in the "termination" phase of therapy, a slow tapering of session which will take a couple years more, I think.
I went into therapy because I was having a great deal of work related anxiety, which is pretty normal for the intense business I work in. I was unable to work for a couple of years.
I began taking Celexa after I had a reaction to Topomax which I was taking as a migraine preventative. It caused acute anxiety. After about a week of taking Celexa, I had a period of about a month where I felt wonderful. It was amazing.
That was three years ago. I have gained about 20 lbs. Not good. The last thing a menopausal 50 year old woman wants is to be fat. I am fat.
As for being borderline, this is self-diagnosis. I read about it a few years ago and my psychiatrist said that nowhere had he made such a diagnosis, but he did not say, no, you are not BPD. I am self-aware enough to recognize myself in any and all of the descriptions I have read of BPD.
I have found that the OCD stuff I do increases with a decrease of 1/4 of the Celexa. I have never discussed the OCD stuff with my doc as it's nothing severe.I have gone back to the full dose of Celexa.
Read in all of this that yes, I am peri-menopausal - so there's the hormone thing. I am now on HRT.
It would be very helpful to me if you'd keep your language within the understanding of the lay-person, Scott. I didn't understand what it means for meds to have a "similar psychotropic effect", for example, and had to look it up. It can get pretty frustrating when there are toomany of those in a post, in addition to a bunch of meds I look up.
I am not ungrateful, I just get frustrated.
Thanks Scott.
ShortE
Posted by SLS on July 8, 2005, at 20:25:13
In reply to Re: Celexa!!!! » SLS, posted by Shortelise on July 8, 2005, at 13:40:12
> It would be very helpful to me if you'd keep your language within the understanding of the lay-person, Scott. I didn't understand what it means for meds to have a "similar psychotropic effect", for example, and had to look it up.
Sorry about the foul language.
:-)
I'll try to be more mindful. Unfortunately, there are some fundamental terms to be learned that are part of the self-education process once one becomes involved with mental illness and its treatment. "Psychotropic" is definitely one of them. However, I probably could have left out this word this *one* time :-) and still retained the meaning of the sentence that I was trying to convey.
- Scott
Posted by Shortelise on July 10, 2005, at 13:10:05
In reply to Re: Celexa!!!! » Shortelise, posted by SLS on July 8, 2005, at 20:25:13
Scott, your response bothers me a lot.
It feels like you are offended that I asked you to keep your terms simple.
I work in a field that is rife with terms that no one understands but those of us who work in it, yet I can talk with anyone about it, and am often obliged to do so. There is not one single term without an alternative that anyone can understand.
I poured out my "history" as you suggested, and your only response was to my request that you use language that is easy to follow.
Let's drop it all now, ok? I've figured out what to do, and how to do it, and am following that path. I just wanted to let you know that I felt badly about your response.
So, it's back to the psychology board for me.
Thanks again for the info.
ShortE
Posted by SLS on July 10, 2005, at 22:14:15
In reply to Re: Celexa!!!! » SLS, posted by Shortelise on July 10, 2005, at 13:10:05
> Scott, your response bothers me a lot.
>
> It feels like you are offended that I asked you to keep your terms simple.I hope you don't mind if I not just drop things.
Although I did not feel offended by you, I can easily see how you could have been offended by my curt response to your request.
I apologize.
- Scott
This is the end of the thread.
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