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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by maxime on October 23, 2010, at 19:41:36
If you wish to be a discussant of this thread please go to YouTube and view the following video
Posted by maxime on October 23, 2010, at 19:44:55
In reply to various bipolar meds, posted by maxime on October 23, 2010, at 19:41:36
She is taking a lot of meds, but they work for her. I really like the way she uses the metaphor of an ice sculpture.
I wonder if she could get by taking less meds? She is on 3 antipsychotics - abilify, seroquel and Geodon. That seems like a lot, but it seems to work for her.
I wonder how her and her doctor came up with her cocktail?
Posted by violette on October 23, 2010, at 20:03:13
In reply to various bipolar meds, posted by maxime on October 23, 2010, at 19:41:36
enough already...please
Posted by maxime on October 23, 2010, at 22:39:19
In reply to Re: various bipolar meds » maxime, posted by violette on October 23, 2010, at 20:03:13
> enough already...please
I am very serious. I wanted to talk about her metaphor of the ice sculpture and the number of meds she is taking.
Posted by 49er on October 27, 2010, at 8:02:18
In reply to Re: various bipolar meds, posted by maxime on October 23, 2010, at 19:44:55
> She is taking a lot of meds, but they work for her. I really like the way she uses the metaphor of an ice sculpture.
>
> I wonder if she could get by taking less meds? She is on 3 antipsychotics - abilify, seroquel and Geodon. That seems like a lot, but it seems to work for her.
>
> I wonder how her and her doctor came up with her cocktail?Maxime,
As an FYI, I didn't listen to the video because I don't want to wake up my neighbor. But I will do it later today.
Anyway, the meds may work for her now but I have a hard time believing that she isn't going to pay big time with side effects over time.
Just so people know this isn't anti drug rant, I have seen mainstream psychiatrists come up with studies that show that poly pharmacy is not more effective than being on as few drugs as possible.
The other concern I have is when she starts developing side effects, that that will be medicated with other meds. Before you know it, she will be on something like 8 meds.
Those are my thoughts.
49er
Posted by SLS on October 27, 2010, at 12:51:52
In reply to Re: various bipolar meds » maxime, posted by 49er on October 27, 2010, at 8:02:18
> Just so people know this isn't anti drug rant, I have seen mainstream psychiatrists come up with studies that show that poly pharmacy is not more effective than being on as few drugs as possible.
You read the wrong stuff!
I've seen such literature. I don't know what the logic is behind rejecting rational polypharmacy in psychiatry. In cardiology, it is the rule rather than the exception to treat congestive heart failure with multiple drugs. Where is the scientific evidence that one antidepressant is better than two?
I read a recent study that concluded that it can make sense to start a patient on two antidrepressants simultaneously; the thought being that the two drugs have demonstrated a synergism that perhaps is the result of complementary mechanisms of action. The only time I responded robustly and persistently to antidepresseant treatment was when two drugs were combined and started simultaneously. Interestingly, I had already failed to respond to each of these two drugs monotherapeutically
I am trying to find the article so that we can critique its results and conclusions. No luck so far.
- Scott
Posted by SLS on October 27, 2010, at 13:12:11
In reply to Re: various bipolar meds, posted by SLS on October 27, 2010, at 12:51:52
I found the study protocol, but I can't find the results.
"Are Two Antidepressants a Good Initial Treatment for Depression?"
http://clinicaltrials.gov/ct2/show/study/NCT00296712
- Scott
Posted by morgan miller on October 27, 2010, at 13:43:24
In reply to Re: various bipolar meds » violette, posted by maxime on October 23, 2010, at 22:39:19
> > enough already...please
>
> I am very serious. I wanted to talk about her metaphor of the ice sculpture and the number of meds she is taking.Violette's talking about your first post being a mockery of Lou. I understand your frustration with Lou and I don't quite have the same reaction to mocking him that Violette does, but maybe we should just let it rest. It does not appear that Lou is responding to anyone's request anyway. And, if Lou is dealing with his own struggles, it's only fair for us to cut him some slack as he may not be well enough to give us what we want. Or, maybe he is and he does not care. We don't really know, so the only thing to do is to try to understand that we all struggle in our own way and we all need some forgiveness, understanding, and patience. While I think it is perfectly fine to get frustrated with Lou and express our frustration properly, we probably should not be stretching the issue out with mockery.
Please don't take this the wrong way Maxime. I also have been guilty of not dealing with my frustration with Lou as well as I should have. And I understand, I am not a moderator here, I'm just offering my thoughts, for whatever they are worth.
Morgan
Posted by 49er on October 27, 2010, at 15:31:24
In reply to Re: various bipolar meds, posted by SLS on October 27, 2010, at 12:51:52
> > Just so people know this isn't anti drug rant, I have seen mainstream psychiatrists come up with studies that show that poly pharmacy is not more effective than being on as few drugs as possible.
>
> You read the wrong stuff!
>
> I've seen such literature. I don't know what the logic is behind rejecting rational polypharmacy in psychiatry. In cardiology, it is the rule rather than the exception to treat congestive heart failure with multiple drugs. Where is the scientific evidence that one antidepressant is better than two?
>
> I read a recent study that concluded that it can make sense to start a patient on two antidrepressants simultaneously; the thought being that the two drugs have demonstrated a synergism that perhaps is the result of complementary mechanisms of action. The only time I responded robustly and persistently to antidepresseant treatment was when two drugs were combined and started simultaneously. Interestingly, I had already failed to respond to each of these two drugs monotherapeutically
>
> I am trying to find the article so that we can critique its results and conclusions. No luck so far.
>
>
> - ScottScott,
I don't mean to sound like a smart alleck but if polypharmacy is as wonderful as you say it is, why haven't you found the right combination?
Anyway, you might want to read this article on antipsychotic polypharmacy.
I am inferring that the studies have been limited but based on what exists, antispsychotic polypharmacy is not effective and greatly increases the side effects.
You also might want to read this blog entry:
http://davidmallenmd.blogspot.com/search/label/polypharmacy
A study of antidepressant and antipsychotic treatment effects showed there is an emphasis on "polypharmacy" in clinical practice, without much evidence of benefit and an increase in adverse effects. Swiss investigators reported these findings at the 23rd European College of Neuropsychopharmacology Congress (23rd European College of Neuropsychopharmacology (ECNP) Congress: Abstract P.2.c.019. Presented August 31, 2010).
"In our study, we found no advantages for 'complex' treatment approaches over conventional monotherapeutic approaches," said senior investigator Hans H. Stassen, PhD, of University Hospital of Psychiatry in Zurich, Switzerland. "There appear to be no controlled studies showing the superiority of combinations of drugs over [a single drug (monotherapy)]. We looked at this because we have observed in clinical practice that response rates are less and side effects are greater." (reported by Medscape).
49er
PS - By the way, the woman said her drug combination falls apart whenever she encounters a stressful situation. Doesn't sound like polypharmacy is working as life is not stress free,
I don't mean to sound flippant by the way but unfortunately, that is the way it is.
Posted by SLS on October 27, 2010, at 17:42:32
In reply to Re: various bipolar meds » SLS, posted by 49er on October 27, 2010, at 15:31:24
> I don't mean to sound like a smart alleck but if polypharmacy is as wonderful as you say it is, why haven't you found the right combination?
That is a horrendous question to ask me.
It is a cheap shot against me, the doctors whom have treated me, and the efforts of medical science to cure me. I don't understand your need to invalidate psychiatry as it is currently practiced, despite the limitations imposed upon it by a fundamental lack of understanding in a field that is still in its infancy. Neuroscience is working feverishly to gain knowledge and understanding so as to cure mental illness.
What does the validation of the rest of psychiatry have to do with me or the difficulties medical science has had in treating me? Do you think that all of the cases of cancer are responsive to the polypharmacy administered? Does one failed attempt to treat in this manner indicate a condemnation of the use polypharmacy in oncology? Of course not.
I don't think it serves well that you should use your own experience with psychiatry as a standard by which all other cases are to be compared. Mental illnesses are extremely variable in their presentations and treatment responses. What are the odds that all cases of mental illness should mirror your own? You didn't relapse when you discontinued antidepressant treatment? You are fortunate, but not unique. It happens. I think it depends upon the individual's endophenotype. It happens quite often that the discontinuation of psychiatric drugs allows for relapse. Greater chronicity and recurrency in the presentation of an affective disorder seems to indicate long-term treatment.
How is it that I never responded to monotherapy, yet reached remission with polypharmacy? The doctor discontinued my medication after only 9 months. I relapsed within 2 months. To treat this relapse, the doctor elected to use only one of the two drugs that got me well previously. By the time I had tried and failed to respond to a bunch of other drugs as monotherapy, I was no longer responsive to the previously successful combination treatment when it was reintroduced. There is more to my case history that leads me to believe that my chances of remitting spontaneously are nil. After 33 years of unrelenting chronic depression without spontaneous remissions, I think it would be irresponsible of me to neglect polypharmacy as an alterative treatment just because the idea is unpallatable to some authors who fail to demonstrate any science behind their conclusions.
- Scott
Posted by 49er on October 27, 2010, at 18:24:07
In reply to Re: various bipolar meds » 49er, posted by SLS on October 27, 2010, at 17:42:32
> > I don't mean to sound like a smart alleck but if polypharmacy is as wonderful as you say it is, why haven't you found the right combination?
>
> That is a horrendous question to ask me.
>
> It is a cheap shot against me, the doctors whom have treated me, and the efforts of medical science to cure me. I don't understand your need to invalidate psychiatry as it is currently practiced, despite the limitations imposed upon it by a fundamental lack of understanding in a field that is still in its infancy. Neuroscience is working feverishly to gain knowledge and understanding so as to cure mental illness.
>
> What does the validation of the rest of psychiatry have to do with me or the difficulties medical science has had in treating me? Do you think that all of the cases of cancer are responsive to the polypharmacy administered? Does one failed attempt to treat in this manner indicate a condemnation of the use polypharmacy in oncology? Of course not.
>
> I don't think it serves well that you should use your own experience with psychiatry as a standard by which all other cases are to be compared. Mental illnesses are extremely variable in their presentations and treatment responses. What are the odds that all cases of mental illness should mirror your own? You didn't relapse when you discontinued antidepressant treatment? You are fortunate, but not unique. It happens. I think it depends upon the individual's endophenotype. It happens quite often that the discontinuation of psychiatric drugs allows for relapse. Greater chronicity and recurrency in the presentation of an affective disorder seems to indicate long-term treatment.
>
> How is it that I never responded to monotherapy, yet reached remission with polypharmacy? The doctor discontinued my medication after only 9 months. I relapsed within 2 months. To treat this relapse, the doctor elected to use only one of the two drugs that got me well previously. By the time I had tried and failed to respond to a bunch of other drugs as monotherapy, I was no longer responsive to the previously successful combination treatment when it was reintroduced. There is more to my case history that leads me to believe that my chances of remitting spontaneously are nil. After 33 years of unrelenting chronic depression without spontaneous remissions, I think it would be irresponsible of me to neglect polypharmacy as an alterative treatment just because the idea is unpallatable to some authors who fail to demonstrate any science behind their conclusions.
>
>
> - ScottScott,
To be honest, I find your assumptions about me just as offensive.
I have worked darned hard at my recovery which has happened in spite of a parent's death and dealing with job instability, and severe insomnia. It wasn't just good fortune.
And just so everyone is clear on this board, I am not saying that if you relapse, you're not working hard.
Speaking of oncology, I think chemotherapy has a very low success rate if we're really honest about it. I still can't honestly say I would refuse it if god forbid, I was struck with cancer. But I did want to mention that.
We have already discussed relapse vs, withdrawal issues so I won't rehash that.
Everyone uses their experience when offering opinions including you. That is human nature.
By the way, please explain how the links I offered are unscientific. One of them was provided by a psychiatrist who is definitely not anti meds.
I am sorry if I offended you. My reasoning for asking the question was if I was on a remedy that wasn't working for many years be it drugs or natural remedies, I would be trying something else.
I found your reaction interesting because I reacted the same way when that parent who died asked if I needed to be on psych meds. I thought the question was absurd.
I cringe when I think of that.
I hope you find what you're looking for.
49er
Posted by SLS on October 27, 2010, at 21:46:05
In reply to Re: various bipolar meds » SLS, posted by 49er on October 27, 2010, at 18:24:07
> > > I don't mean to sound like a smart alleck but if polypharmacy is as wonderful as you say it is, why haven't you found the right combination?
> >
> > That is a horrendous question to ask me.
> >
> > It is a cheap shot against me, the doctors whom have treated me, and the efforts of medical science to cure me. I don't understand your need to invalidate psychiatry as it is currently practiced, despite the limitations imposed upon it by a fundamental lack of understanding in a field that is still in its infancy. Neuroscience is working feverishly to gain knowledge and understanding so as to cure mental illness.
> >
> > What does the validation of the rest of psychiatry have to do with me or the difficulties medical science has had in treating me? Do you think that all of the cases of cancer are responsive to the polypharmacy administered? Does one failed attempt to treat in this manner indicate a condemnation of the use polypharmacy in oncology? Of course not.
> >
> > I don't think it serves well that you should use your own experience with psychiatry as a standard by which all other cases are to be compared. Mental illnesses are extremely variable in their presentations and treatment responses. What are the odds that all cases of mental illness should mirror your own? You didn't relapse when you discontinued antidepressant treatment? You are fortunate, but not unique. It happens. I think it depends upon the individual's endophenotype. It happens quite often that the discontinuation of psychiatric drugs allows for relapse. Greater chronicity and recurrency in the presentation of an affective disorder seems to indicate long-term treatment.
> >
> > How is it that I never responded to monotherapy, yet reached remission with polypharmacy? The doctor discontinued my medication after only 9 months. I relapsed within 2 months. To treat this relapse, the doctor elected to use only one of the two drugs that got me well previously. By the time I had tried and failed to respond to a bunch of other drugs as monotherapy, I was no longer responsive to the previously successful combination treatment when it was reintroduced. There is more to my case history that leads me to believe that my chances of remitting spontaneously are nil. After 33 years of unrelenting chronic depression without spontaneous remissions, I think it would be irresponsible of me to neglect polypharmacy as an alterative treatment just because the idea is unpallatable to some authors who fail to demonstrate any science behind their conclusions.
> >
> >
> > - Scott
>
> Scott,
>
> To be honest, I find your assumptions about me just as offensive.I doubt it, but I would be curious to know just what you think my assumptions are about you.
> I have worked darned hard at my recovery
Recovery from what?
> which has happened in spite of a parent's death and dealing with job instability, and severe insomnia. It wasn't just good fortune.
Yes it was. It was your good fortune not to have the type of depression that never goes away, regardless of how much "work" one does. You are fortunate that you do not yet have terminal cancer. I guess fortune is a matter of perspective.
> And just so everyone is clear on this board, I am not saying that if you relapse, you're not working hard.
Thanks for clearing that up. How about if I do work hard, yet remain ill? I hope you are not intimating that I don't work hard.
> Speaking of oncology, I think chemotherapy has a very low success rate if we're really honest about it.
What are the alternatives you would prefer oncology to adopt during the time between now and when cures are developed? Would you elect to reject chemotherapy now because it is not a panacea?
> I still can't honestly say I would refuse it if god forbid, I was struck with cancer. But I did want to mention that.
Here, your mentioning it really serves to support the use of treatments that have a "very low success rate". How do you justify not treating mental illness with the same desperation? Perhaps your personal experience with depression wasn't desperate enough.
> We have already discussed relapse vs, withdrawal issues so I won't rehash that.You confuse my often stated belief in the existence of withdrawal rebound depression with your resistance to believe in the existence of post-discontinuation relapse. Hey, if you believe in both, then how would you tell the difference between one and the other? This is a critical question that you have never answered, despite my asking it of you several times. So, how would you?
> > Everyone uses their experience when offering opinions including you.
Not everyone.
> That is human nature.
Is it inhuman to follow the scientific method? Scientists are often perpetual students of objectivity. It must be practiced, but not before it is first internalized.
> By the way, please explain how the links I offered are unscientific. One of them was provided by a psychiatrist who is definitely not anti meds.
Link 1: Here is the conclusion of all of the authors' work:"12. Conclusion
We are not advancing that antipsychotic combination therapy should be banished from clinical practice. Indeed, a good clinical practice implies taking into account multiple complex variables while determining the best clinical algorithm that should be followed for a given patient. However, it could be argued that, in light of a relative lack of research-supported proof of efficacy, a treatment using the combination of antipsychotics represents polypharmacy, i.e. the prescription of toomany medicines from an EBM perspective."
Link 2: It's a blog of unsubstantiated opinions. A blog.> I am sorry if I offended you.
>
> My reasoning for asking the question was if I was on a remedy that wasn't working for many years be it drugs or natural remedies, I would be trying something else.You are clueless as to what I have exposed and subjected myself to in an effort to pursue sufficient improvement to feel alive and rejoin human society.
Clueless.
- Scott
Posted by 49er on October 28, 2010, at 6:21:55
In reply to Re: various bipolar meds » 49er, posted by SLS on October 27, 2010, at 21:46:05
Scott,
I do agree that I am fortunate in not having terminal cancer. Thanks for that reminder as it is an important perspective to have whether you're for psych meds or you are against them.
I am not sure why you think I am so fortunate regarding depression. A perfect example is an upsetting situation I am dealing with right now in which I am feeling stupid. Most people would not feel that way.
So I have to work like heck to remind myself that this is a learning experience and if the same situation occurs again, I will know how to better deal with it. In the past, this along with similar type episodes was a recipe for relapse.
But if you're not able to do this, it doesn't mean you're not working hard. I certainly wasn't able to it in the past so I would be the last person to condemn anyone who couldn't.
Look, we're both doing the best we can with different viewpoints.
49er
Posted by maxime on October 29, 2010, at 16:40:22
In reply to Re: various bipolar meds, posted by morgan miller on October 27, 2010, at 13:43:24
Thanks Morgan. but I really wasn't mocking Lou. I had come across the video while looking for stuff on bipolar meds and I really like the video because of her description of what it is like to have bipolar and her (and her pdocs) approach to poly pharmacy. I wanted a discussion on the merits of poly pharmacy.
Posted by maxime on October 29, 2010, at 16:54:10
In reply to Re: various bipolar meds » 49er, posted by SLS on October 27, 2010, at 17:42:32
Hi Scott, just out of curiosity have you been treated by the same pdoc for a long time? I am glad he/she is open to poly pharmacy for you. Do you research the meds and then suggest them? Or does your pdoc come up with them? Did it take you a long time to find a pdoc who was willing to work with someone who is so med resistant? I consider myself lucky that I have a pdoc who is willing to try unconvential med combos.
Also, how did you gain your vast knowledge of meds?
If someone told me that I had the choice between losing a leg and being permanently cured from depression I would choose an amputation.
Don't give up Scott!
Maxime
Posted by maxime on October 29, 2010, at 16:55:26
In reply to Re: various bipolar meds » SLS, posted by 49er on October 27, 2010, at 15:31:24
It's good to hear that someone is winning the fight again depression. You give me hope. Thank you.
Posted by SLS on October 29, 2010, at 16:59:09
In reply to Re: various bipolar meds » morgan miller, posted by maxime on October 29, 2010, at 16:40:22
> Thanks Morgan. but I really wasn't mocking Lou. I had come across the video while looking for stuff on bipolar meds and I really like the video because of her description of what it is like to have bipolar and her (and her pdocs) approach to poly pharmacy. I wanted a discussion on the merits of poly pharmacy.
My perspective on "polypharmacy" is that you do what it takes. What's the difference if the necessary therapeutic mechanisms are contained in two different drugs or in the same drug? I am very cautious whenever a "school of thought" (avoidance of polypharmacy) takes precedence over the scientific investigation to substantiate it.
- Scott
Posted by morgan miller on October 29, 2010, at 17:03:29
In reply to Re: various bipolar meds » morgan miller, posted by maxime on October 29, 2010, at 16:40:22
I believe you. Sorry if I sounded like I was lecturing. I do think Violette took it that way though. Hope your doing o.k.
Morgan
Posted by maxime on October 29, 2010, at 21:46:40
In reply to Re: various bipolar meds » maxime, posted by morgan miller on October 29, 2010, at 17:03:29
> I believe you. Sorry if I sounded like I was lecturing. I do think Violette took it that way though. Hope your doing o.k.
>
> MorganNo problem. I am doing as well as I can be. :)
Posted by 49er on October 30, 2010, at 5:39:59
In reply to Re: various bipolar meds » 49er, posted by maxime on October 29, 2010, at 16:55:26
> It's good to hear that someone is winning the fight again depression. You give me hope. Thank you.
Hi Maxime,
I am so glad to hear that, especially coming from someone like you who has bravely fought through some fierce struggles.
49er
This is the end of the thread.
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