![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by AndrewB on April 29, 2000, at 10:48:46
In reply to WWIII Averted - Just Beware of Pokemon, posted by Cam W. on April 29, 2000, at 10:26:15
Cam,
Thank you again for taking the time to respond with so many informative posts. I know I'm putting you on the spot a little, but is there any way Dr. Jensen's approach using short term trials of ADs has a usefulness?
Posted by Cam W. on April 29, 2000, at 11:18:07
In reply to Re: Cam, posted by AndrewB on April 29, 2000, at 10:48:46
Andrew - I haven't seen anything on Jensen's work (except what you and others have written). As you notice, I have been conspicuously absent from these discussions. Everything I know about the biochemical and pharmacological workings of meds says no to his theories (from what I have gleaned from the posts). Some aspects may have merit, but I would have to read the book and study his theories. Right now I do not have the time or energy for such a project (maybe later this summer).If his theories were so good and his methods so vital to medicine, why is profiting from them. I know many people profit from their medical discoveries, but I think that it is wrong. Scientific discovery and innovation should be freely held up to scientific scrutiny (randomized double blind placebo controlled clinical trials) before some writes a book an makes extraordinary claims (we need to extraordinary proof).
My unsubstantiated opinion - Cam W.
Posted by saint james on April 29, 2000, at 12:29:43
In reply to Not Trying To Start World War III, posted by anonymous on April 29, 2000, at 9:36:56
>
> As I go thru the searches I notice that some of the older posters seem to be changing meds from week to week (well maybe not week to week) but I know that it is not the 6 to 8 week period that all of you seem to recommend for us newbies.James here...
Having been on AD's since 1985 I can attest to the 6-8 weeks rule. You don't get the true AD effect till this time though sedating AD's do start to work on anxeity in the first few weeks.
james
Posted by Noa on April 29, 2000, at 13:16:23
In reply to Re: Not Trying To Start World War III, posted by saint james on April 29, 2000, at 12:29:43
I have given my meds a fair chance to work, too, except when they caused bad headaches, tinnitus or diarrhea. I don't know for sure that it is the only way to go, and I know there are others here who like the quick turnover methods, but the 6-8 week standard seems right for me.
Posted by KarenB on April 29, 2000, at 13:18:03
In reply to Re: Not Trying To Start World War III, posted by saint james on April 29, 2000, at 12:29:43
6-8 weeks is an eternity when I am depressed. In fact, five minutes is too long as far as I am concerned. I know that's how long it is supposed to take BUT I have had the advantage (or disadvantage) of having meds work very quickly and have come to expect a response in a substantially shorter time. If it's the wrong med, I think I know it right away and if it's right, at least within the first week. When I have been told to "hang in there" (with white knuckles, BTW), it has just NEVER gotten any better for me. Never.
So, there's my reason for breakin' the rules. I'm not recommending it to anyone else - it's just my personal experience. And, I know several individuals who have known "from the very first dose" that a med was right. My mother in law said "the lights came on" with her first dose of Prozac and has successfully been on it six years now, with no "poop out." With me, the lights went off. I have never experienced such dark feelings in my life and would not try that one again under any circumstances. 6-8 weeks and I'd have been committed for sure - if I survived.
Dr. Jensen's theory makes a whole lotta sense to me. Just wish I had the $300 right now...;^(
Just my $.02
Karen
Posted by allisonm on April 29, 2000, at 23:06:32
In reply to WWIII Averted - Just Beware of Pokemon, posted by Cam W. on April 29, 2000, at 10:26:15
Cam,
When you use the example of someone trying 3 SSRIs and finally the third works, probably because the person had been on SSRIs for 6-8 weeks. Would this happen across drug categories?
For example, I tried Zoloft and couldn't tolerate it. Then tried Effexor XR which was worse. Finally was able to tolerate Remeron and have kept with it for more than 2 years. But now my doctor and I are at a point where we're both wondering whether it's really working. And I am beginning to wonder whether it worked all that well in the first place (granted, I was under extraordinary stress at the time).
Any thoughts would be appreciated.
>
Posted by Cam W. on April 29, 2000, at 23:34:11
In reply to Re: WWIII Averted Q for Cam, posted by allisonm on April 29, 2000, at 23:06:32
Allison - I haven't any real life experience with Remeron (mirtazapine), but I have read a bit about it (not in Canada, yet). If you went from Zoloft to Effexor to, say, a TCA, I would say that the antidepressant effect might have travelled across drug classes (unless the TCA was like desipramine, with little SRI activity). All of these drugs have serotonin reuptake inhibition (SRI) activity.With the trial of Remeron after Zoloft and Effexor, I would have to say - maybe. Remeron (I think), in a round-about way, increases levels of both serotonin and norepinephrine in the synaptic gap. So, there is a possibility that the serotonin function kicked in with the third drug.
Another possibility is that your type of depression needed some norepinephrine increases to treat it. Then it would not be a cumulative effect of serotonergic drugs, but the different drug effect of Remeron.
As for if the drug had worked over the last few years; if your depression was lowered, it possibly was working. You would not expect placebo effect to last that long. You could as your doctor to try the SSRIs again or maybe even switch to reboxetine (if it is available where you are). Trials of each of these would determine if you depression was serotonin or norepinephrine based.
Wishy-washy answer, huh. - Cam W.
Posted by bob on April 30, 2000, at 0:59:26
In reply to Re: WWIII Averted Q for Cam, posted by Cam W. on April 29, 2000, at 23:34:11
I think that it may appear as if some of us old timers "switch" more frequently simply because we've been around long enough to hear about all different sorts of meds and what neurotransmitters they work on and such, and we just start bouncing ideas off one another in the cases where we think we need a change. I know that for the two or three serious, major changes I've made in my meds, I've been on here bouncing ideas around and looking for advice for several weeks prior to actually seeing my pdoc about it.
Then again, a lot of us have been on a lot of different meds ... perhaps just the fact that I can talk about being on 12 different medications makes it sound like I switch early, switch often -- but that's been over a better than three year period now.
Finally, quite a few of us are long past trying monotherapies and are taking cocktails of different meds. I think that 6-8 week rule is particularly important in monotherapy or with respect to what is to be your primary AD or other major med. But say you've been stable tho not quite all that great and you add in an augmentor. If you give it two weeks and you have been heading downhill all that time, I think we're more likely to give it up and head back for that stability we had before the trial.
cheers,
bob
Posted by Mark H. on April 30, 2000, at 1:36:16
In reply to Re: Not Trying To Start World War III, posted by KarenB on April 29, 2000, at 13:18:03
I'm fascinated that a few of the posters I most respect, and who have some of the greatest knowledge of biochemistry, support the 6-8 week AD trial theory, which has always seemed to me absurdly dangerous and ineffective.
I've said it before, but in my experience anything that makes a depressive worse should be stopped immediately, as the clinician is risking that person's life during the two-month "wait and see" period. To me, it is callous and cavalier and swerves perilously close to malpractice.
Anything that doesn't produce immediate improvement and has troubling or distorting side effects (vision abnormalities, reduced driving or work performance, increased sleep disturbances, etc.) should probably be replaced immediately as well, in as little as a week or two, based on my personal experience.
I'm with Karen B on this -- when my depression has been lifted by medication, the effect is not subtle, questionable, gradual or attributable to something else.
At point "x" I added "this" to the mix, and less than 48 hours later the heavy dark curtain of depression had lifted and I could begin my healing.The effect is so dramatic and sudden that I want to think I have simply and naturally gone into some sort of miraculous remission, but stopping my AD for EVEN ONE OR TWO DAYS a year or two later causes the curtain to fall -- and believe me, I know the difference between depression and withdrawal or rebound symptoms. (And nevermind that the "stabilization" theory would predict I could not possibly begin to crash that fast.)
The quantity of adjunctive meds I need to take fluctuates with my cycle. I'm usually most well in late Nov and all of December, and again in late May and most of June. I'm at my worst usu in late Aug and Sept and again in Feb and March. The other months are transitions up or down and are fairly predictable as well.
I still wonder if the 6-8 week trial period appears to work for some (or even a majority of?) people NOT because SSRIs have stabilized the neurotransmitters, but because the brain itself has found a new equilibium in that time, whether somewhat assisted by the AD or not.
Cam and others, whom I greatly respect, may in fact be right. But if they are, then I suspect some other factor is at work for me and others like me. My depression is refractive and cyclic and long-term. Trials of Prozac, Zoloft, Paxil, Serzone and others were NOT cumulative or helpful for me in any way, regardless of the length -- I remained severely depressed for months and months and months on SSRIs.
I'm classed as Bipolar II, but it would be counter-productive to clip my minor "highs," which is when I do my best work and feel most normal, and I have never responded (except negatively) to any of the so-called mood stabilizers. So much for the idea that being given an AD without a mood stabilizer will supposedly flip us bipolar folk over into mania -- either my diagnosis is incorrect or incomplete, or the "expert guidelines 2000" have made far too broad a generalization in this regard.
So if the 6-8 week theory isn't just an extended "active placebo effect," then I wonder what is going on for those of us who really can tell quickly whether something is going to work or not? Any ideas?
Thank you for your consideration and ideas.
By the way, do two "troughs" and two mild "highs" a year make me a "rapid cycler?"
Is there even such a thing for Bipolar II? I assumed a rapid cycler was someone who either experienced mixed states or vacillated within a few hours or days between states -- but some of what I've read on this site brings this into question. Any clarification will be appreciated.Many thanks,
Mark H.
Posted by JohnL on April 30, 2000, at 3:32:44
In reply to Re: AndrewB, posted by Cam W. on April 29, 2000, at 11:18:07
*****Cam, your posts are wonderful. I enjoy every one of them. I hope it's OK if I jump in and comment on a couple things?
> Andrew - I haven't seen anything on Jensen's work (except what you and others have written). As you notice, I have been conspicuously absent from these discussions. Everything I know about the biochemical and pharmacological workings of meds says no to his theories (from what I have gleaned from the posts).
*****Understandable. This variation of traditional psychiatry is just now finding its way into a few medical schools. At this time it is confined to a handful of private physicians, of which Jensen seems to be the pioneer.Some aspects may have merit, but I would have to read the book and study his theories.
*****You should. It will not replace what you already know, but add to it. Enhancement. More ammunition for the battle against the beast. It's easy reading and will take a few hours. Half of it is geared for the physician, chock full of technical stuff. But again, it isn't meant to replace conventional psychiatry. It is meant to enhance, and is specially geared for the difficult patients who have already had multiple 6 week failures.
>
> If his theories were so good and his methods so vital to medicine, why is profiting from them.
*****If my local GP has a good method, then why should he or she not profit from it? Should it be for free? Do we pay a psychiatrist for treatment that isn't getting us better, but not expect to pay for one who does? In reality, his fees are exactly the same as everyone else's. He isn't scalping or taking advantage. His fees are right in line with every other pdoc in the phone directory. As for the book, it's about $30. I think he could easily scalp people by charging $95 instead. I don't suspect he's getting rich off this modest book (workbook more accurately). It is not a requirement to pay for his service or his book, but rather a free choice. He can only profit from those who freely choose at their own discretion to enlist his service. Or they can pay someone else instead. Somebody's going to get paid, whoever provides the service.*****I think he's making an attempt to get his ideas into the psychiatry mainstream, including medical schools as we speak. I don't think it's for self glory either. I think he really does have an unusually prominent passion for psychiatry, above and beyond what we normally see. But his main goal is getting his patients well, which doesn't leave a whole lot of time to spread the word on what's working in his practice.
>I know many people profit from their medical discoveries, but I think that it is wrong.
*****That's the way of the world, isn't it? Every single person on this earth receives compensation for their contribution to society, whether it be a product, a service, an idea, or whatever.>Scientific discovery and innovation should be freely held up to scientific scrutiny (randomized double blind placebo controlled clinical trials) before some writes a book an makes extraordinary claims (we need to extraordinary proof).
*****I agree. Hopefully in the next five or ten years some energetic medical schoolers will put some new complimentary theories, like Jensen's for example, and perhaps others in the works, to the test. Until that time, I'm sure he will continue helping patients get well that have been failed by straight forward approaches. And until that time, I'm pretty sure hundreds upon thousands of other authors will come and go scalping people for the most ridiculous unproven books on every topic imaginable from A to Z.
>
> My unsubstantiated opinion - Cam W.
*****Mine too. :-) I thoroughly enjoy every one of your posts. Thank you very much for the time and energy you devote to sharing your knowledge with us all. I remember the first day you showed up. I wondered, who is this Cam W? I don't know where you came from or how you found this board, but I'm glad you're here! :) JohnL
Posted by dove on April 30, 2000, at 10:57:48
In reply to Re: Short Trial Success/Bipolar II Qx, posted by Mark H. on April 30, 2000, at 1:36:16
> I'm with Karen B on this -- when my depression has been lifted by medication, the effect is not subtle, questionable, gradual or attributable to something else.
>I have just a few comments to add.
First, I have also experienced a complete worsening of symptoms after the first pill was swallowed, the guilty agent being Prozac no less. It never got better from that point and I did stay on it for the full trial and at full recommended dosages. When I decided to stop taking it, I could feel a night-and-day difference after the first missed pill. And this is Prozac, super-long half-life and all!
Secondly, when we initiated Serzone (Nefazodone) I was hit pretty hard with lethargy, sleepiness, stupidity and the rest. I did not like the way I was feeling, and was pretty sure it was not going to get any better. Amazingly, after I adjusted to the sleepiness and more dry mouth (as I also take Amitriptyline) I actually began to feel better. I've left the house, went to an art viewing, which are few and far between in this little Minnesota town of ten thousand people, I saw a little ballerina pirouetting to Tchaikovsky's Sleeping Beauty and remembered that there are so many things I love and I had forgotten all about them.
Thirdly, combining different meds, as in cocktails and augmentors, doesn't always work the way we think it should. If someone is feeling scatterbrained, lethargic, their doc may recommend a stimulating AD (Prozac, Wellbutrin), or even a CNS Stimulant (Ritalin, Adderall) and find the augmentor's performance at odds with their circumscribed (hypothesized) effects.
Why can't we grapple with these agents in the light, why is it always in dark alleys and shadowed corners. Why are they so mysterious, when will we see their true bodies exposed? I want, really want to understand these psychotropic medications. Why do they all work so differently in every individual.
I am extremely interested in Dr. Jensen's initiation dosages, more so than anything else he is actively practicing. How high are these one week trial dosages? I know what it feels like to start a new med at full dosage, and to say it didn't feel good is not expressing the anguish strongly enough. Lowering the strength of the same med can unearth a good thing, a substance that really works with good effort. Meds like Buspar seem to work slowly and subtly, but work none the less. If you based the decision on whether to remain with Buspar versus one of the Benzo's by the time it took to feel any improvement, no one would be taking Buspar.
Just a little ramble of thoughts. Though, I really desire to comprehend these technical and biological feats of psychotropic meds, but the whole or complete knowledge of their workings doesn't seem to exist quite yet.
dove
Posted by Cam W. on April 30, 2000, at 11:05:43
In reply to Re: Short Trial Success/Bipolar II Qx, posted by Mark H. on April 30, 2000, at 1:36:16
> I'm fascinated that a few of the posters I most respect, and who have some of the greatest knowledge of biochemistry, support the 6-8 week AD trial theory, which has always seemed to me absurdly dangerous and ineffective.
• Old habits are hard to break (shrug), and I still work in generalities
> I've said it before, but in my experience anything that makes a depressive worse should be stopped immediately, as the clinician is risking that person's life during the two-month "wait and see" period. To me, it is callous and cavalier and swerves perilously close to malpractice.• I fully agree that if "depression" seems to be getting worse within the first week, another "cause" of the depression should be looked for. In these cases, the depression cause be a "somatic effect" of the underlying disease state. Many medical conditions can mimic depression (eg electrolyte imbalances, encephalitis, insulinoma, cancers, uremia, etc., etc.) as can many medications or other chemicals (eg some gram-positive antibiotics, propranolol, cycloserine, pentazocine, indomethacin, organic pesticides etc., etc.). These people are usually only a minority of the depressions that I work with. Problems are ususally caught long before they reach me.
> Anything that doesn't produce immediate improvement and has troubling or distorting side effects (vision abnormalities, reduced driving or work performance, increased sleep disturbances, etc.) should probably be replaced immediately as well, in as little as a week or two, based on my personal experience.• Agreed, but many people do not give the ADs that one or two weeks. In my experience people are ready to given up after a couple of days. As the pharmacist, I have to convince (coerce?) some people into taking the meds for a longer trial period.
• If an SSRI is being used for panic disorder, the symptoms of this disorder will definitely worsen in the first few weeks as the body readjusts its receptor/neurotransmitter balance.
> I'm with Karen B on this -- when my depression has been lifted by medication, the effect is not subtle, questionable, gradual or attributable to something else.> At point "x" I added "this" to the mix, and less than 48 hours later the heavy dark curtain of depression had lifted and I could begin my healing.The effect is so dramatic and sudden that I want to think I have simply and naturally gone into some sort of miraculous remission, but stopping my AD for EVEN ONE OR TWO DAYS a year or two later causes the curtain to fall -- and believe me, I know the difference between depression and withdrawal or rebound symptoms. (And nevermind that the "stabilization" theory would predict I could not possibly begin to crash that fast.)
• At one or two days into a therapy, you are still depressed. It is hard to be objective at times like this, especially when the disorder is affecting you or someone close to you. Placebo effect is still healing; it is a psychological, rather than biochemical healing.
> The quantity of adjunctive meds I need to take fluctuates with my cycle. I'm usually most well in late Nov and all of December, and again in late May and most of June. I'm at my worst usu in late Aug and Sept and again in Feb and March. The other months are transitions up or down and are fairly predictable as well.• I know you probably have, but there must be some "trigger" setting off your episodes at these predictable times (eg pre & post-Xmas blues, SAD, beginning & end of summer) I realize that these explanations are too simple, but are just meant for illustrative purposes. You may have to journal your moods and experiences around them to pinpoint what is going on.
> I still wonder if the 6-8 week trial period appears to work for some (or even a majority of?) people NOT because SSRIs have stabilized the neurotransmitters, but because the brain itself has found a new equilibium in that time, whether somewhat assisted by the AD or not.• I absolutely agree with you. Monoamine theories of antidepressant efficacy are garbage. There is something else going on (at a genetic or even sub-genetic level?).
> Cam and others, whom I greatly respect, may in fact be right. But if they are, then I suspect some other factor is at work for me and others like me. My depression is refractive and cyclic and long-term. Trials of Prozac, Zoloft, Paxil, Serzone and others were NOT cumulative or helpful for me in any way, regardless of the length -- I remained severely depressed for months and months and months on SSRIs.• Again, I was generalizing. Many other factors lead to depression, not just stress and low mood.
> I'm classed as Bipolar II, but it would be counter-productive to clip my minor "highs," which is when I do my best work and feel most normal, and I have never responded (except negatively) to any of the so-called mood stabilizers. So much for the idea that being given an AD without a mood stabilizer will supposedly flip us bipolar folk over into mania -- either my diagnosis is incorrect or incomplete, or the "expert guidelines 2000" have made far too broad a generalization in this regard.• In some people with bipolar disorder, I belive that the antidepressant just "unmasks" the mania and this could be the reason for manic switch. The depression, in these people is just an adaptation by the body to control the mania (maybe?). I made the mistake once of saying to a group with bipolar disorder that I'd like to be manic for a week (wrong thing to say).
> So if the 6-8 week theory isn't just an extended "active placebo effect," then I wonder what is going on for those of us who really can tell quickly whether something is going to work or not? Any ideas?• Hopefully, I tried to to give some theories on these questions above. Glucorticoid receptor upregulation (binding excess cortisol) takes 4 to 8 weeks to occur, as does ß-adrenoceptor downregulation (decreasing CRH/CRF production). There are probably many more examples of this, most unreseached as of yet. Low serotonin is definitely not the reason we get depressed.
> Thank you for your consideration and ideas.
> By the way, do two "troughs" and two mild "highs" a year make me a "rapid cycler?"
> Is there even such a thing for Bipolar II? I assumed a rapid cycler was someone who either experienced mixed states or vacillated within a few hours or days between states -- but some of what I've read on this site brings this into question. Any clarification will be appreciated.• Sorry, I am the "drug guy". I leave these questions up to the clinicians (diagnosers). Tell me what you got and I'll try to come up with a treatment plan, but give me a sick person and say "fix him". That I can't do. Bipolar disorders are on a continuum and I really don't know how clinicians decide where to break BPII from BPIII, etc.
>
> Many thanks,
>
> Mark H.• Thanks for the thoughful reply, you guys are making me a better pharmacist everyday (and for free). This is great. Keep questioning me, I still make plenty of mistakes. - Having fun - Cam W.
Posted by Cam W. on April 30, 2000, at 11:27:18
In reply to Re: Cam W., posted by JohnL on April 30, 2000, at 3:32:44
John - I definitely will buy and read Jensen's book later this summer. The psychiatrists in town have found me and I being pulled in many different directions right now. (thanks docs, but I really don't want the noteriety, I just want to play my own game) Any Alexander the Greats out there need an Aristotle? ;^) (oh yeah, I have a big ego as well)I still would have liked Jensen to have held his theories up to the scrutiny of fair people like Nancy Andreasen and Stephen Stahl and their people. I would like to hear their imput before recommending "scientifically" unproven theories. Especially when he is profitting off of it.
The "money for science" thing came as a personal jab at my boss. I found out what he gets paid for me and what I am getting paid. Yesterday I had to negotiate a subscription to J Clin Psychiatry by substracting it from my yearly bonus (2 CDs a month from Grateful Dead Merchandizing + a GD calendar + one tie-dye t-shirt - tax free - cool, huh). The journal cost me 6 CDs (sigh). Also, my fence fell down this winter ($1100), my 18yr. daughter burnt the engine out of my old clunker ($5200 to replace) and we had already shelled out mucho dinero to go to Disney World in June ($~1800 CDN, with discount card, just to get in the gate for 3 adults and 1 child for 7 days). Let's just say that for profit health care is pissing me off right about now.
Enough ranting. Thanks John for the wealth of information you have supplied. If it weren't for people like you, us extreme skeptics would still be walking a heliocentric, flat world.
Sincerely, your pal in medical advance - Cam W.
Posted by Janice on April 30, 2000, at 11:30:53
In reply to Re: Short Trial Success/Bipolar II Qx - To Mark, posted by Cam W. on April 30, 2000, at 11:05:43
Hi Mark,
I had a couple of ideas for you while I was reading your post.
I have Bipolar disorder also and I am extremely sensitive to light. I noticed your depression was worst at the time of year where the greatest fluctuation in light occurs, Feb/Mar and August/September. I am assuming you live in the Northern hemisphere Mark.
As far as I know, rapid cycling bipolar have at least four cycles a year. I have 96 cycles, and they are all like clockwork.
Hope I've helped, Janice
Posted by Scott L. Schofield on April 30, 2000, at 12:54:13
In reply to Re: Short Trial Success/Bipolar II Qx, posted by Mark H. on April 30, 2000, at 1:36:16
> I'm fascinated that a few of the posters I most respect, and who have some of the greatest knowledge of biochemistry, support the 6-8 week AD trial theory, which has always seemed to me absurdly dangerous and ineffective.
I share your frustrations with this approach.
If nothing else, it may take several dosage increases to reach the minimum level at which an antidepressant response will occur. I guess titration can be performed more rapidly than has been practiced traditionally.
I would not consider the necessity of 2-4-6 week trials to be so much a theory as an observation. I can't see stopping certain recognized antidepressants prior to the end of the third week. In my mind, these would include tricyclics, MAO-inhibitors, SSRIs, reboxetine, Serzone, Remeron, Wellbutrin, and Effexor. Effexor can elicit an early transient improvement in mood or energy, but it may still take 2-3 weeks to effect a sustained response. When these drugs are added to an ongoing treatment, they may sometimes produce results more quickly. I believe that other drugs show their potential effectiveness for depression (not bipolar) within three to ten days. This usually occurs when they are employed in the role of augmenting agents, either in combination with the traditional antidepressants, or with eachother. These drugs would include amphetamines, psychostimulants, antiobesity drugs, antinarcoleptics, anticonvulsants, neuroleptics, and lithium. Neuroleptics such as Zyprexa, Seroquel, and Solian (amisulpride) also demonstrate effectiveness as monotherapy in some cases.
I have read stories on this board describing almost instantaneous improvements with all of the traditional antidepressants. I believe them. I have not followed-up to see how long these improvements have lasted. I recall that some of them seemed to stick.
I think taking a survey on this board to find out the percentage of immediate vs. latent responses to specific drug treatments and how long these responses have been maintained would provide some incredibly valuable information. Developing a standard brief questionnaire to retrieve this information would make the process more efficient and produce more easily interpretable results.
The first and only time a drug regimen has produced a robust and long-lasting improvement (nine months) for me, I did not begin to feel anything until I was into the third week of treatment. It was a noticeable improvement, but VERY small. My condition improved VERY gradually over the course of three months until I reached the point of maximum benefit. Perhaps this is unusual, and associated with the refractoriness of my case.
To me, something rings true about the idea that those drugs that will be robustly effective will show some early positive results. I don't know. However, there is no doubt in my mind that there are many for whom none of the available drugs will produce this early improvement, and yet ultimately respond well to them.
I guess one could begin a screening process for potentially effective medications using a series of one to two week trials. If nothing comes of them, though, then it might be necessary to initiate longer trials with the understanding that one must return to all of the drugs tried previously. Drugs that had worsened their condition would be excepted.
> I've said it before, but in my experience anything that makes a depressive worse should be stopped immediately, as the clinician is risking that person's life during the two-month "wait and see" period.
I tend to agree with this. No drug that has initially made me feel worse has gone on to produce an improvement.
> I'm with Karen B on this -- when my depression has been lifted by medication, the effect is not subtle, questionable, gradual or attributable to something else.
Why did you not continue with any of these medications?
> At point "x" I added "this" to the mix, and less than 48 hours later the heavy dark curtain of depression had lifted and I could begin my healing. The effect is so dramatic and sudden that I want to think I have simply and naturally gone into some sort of miraculous remission,
It was those medications that you used as adjuncts that demonstrated these rapid improvements? What else were you taking at the time?
> but stopping my AD for EVEN ONE OR TWO DAYS a year or two later causes the curtain to fall
I know. It is scary and demoralizing to realize how totally and perpetually dependant one's brain functon can be on medication.
What drug(s) specifically do you label as being "ADs". Which are "augmenters".
> The quantity of adjunctive meds I need to take fluctuates with my cycle. I'm usually most well in late Nov and all of December, and again in late May and most of June. I'm at my worst usu in late Aug and Sept and again in Feb and March.
A girlfriend of mine who has been diagnosed as bipolar II demonstrates exactly the same cycle. She has just emerged from her March funk.
> I still wonder if the 6-8 week trial period appears to work for some (or even a majority of?) people NOT because SSRIs have stabilized the neurotransmitters, but because the brain itself has found a new equilibium in that time, whether somewhat assisted by the AD or not.
I think there are many who tend to think this way, myself included. Sometimes, I think that it doesn't really matter in which direction you push the system, as long as you force it to reset itself by establishing a new equilibrium. That the French drug tianeptine, a serotonin reuptake accelerator (as opposed to a reuptake inhibitor), works as an antidepressant seems to provide a rationale for this concept.
> Cam and others, whom I greatly respect, may in fact be right.
I don't think that if one is right, that the other needs to be wrong.
> But if they are, then I suspect some other factor is at work for me and others like me.
Exactamundo.
I've seen some researchers go so far as to conceptualize depression as being comprised of many different disorders.
> My depression is refractive and cyclic and long-term. Trials of Prozac, Zoloft, Paxil, Serzone and others were NOT cumulative or helpful for me in any way, regardless of the length -- I remained severely depressed for months and months and months on SSRIs.
Are you O.K. now? What does work and how well? What drugs are you currently taking?
> I'm classed as Bipolar II, but it would be counter-productive to clip my minor "highs," which is when I do my best work and feel most normal, and I have never responded (except negatively) to any of the so-called mood stabilizers. So much for the idea that being given an AD without a mood stabilizer will supposedly flip us bipolar folk over into mania -- either my diagnosis is incorrect or incomplete, or the "expert guidelines 2000" have made far too broad a generalization in this regard.
You may have a bunch of different stuff going on here. Perhaps you are bipolar II with a soft-SAD thing happening, or possibly a double-depression situation.
If you still need help, perhaps it is time to consider an MAO-inhibitor. What a surprise coming from me, right? :-)
I bet Depakote made you feel worse.
Parnate, Lamictal, along with a stimulant or Provigil in combination may be worth a look at.
> By the way, do two "troughs" and two mild "highs" a year make me a "rapid cycler?"
It probably indicates a SAD component.
> Is there even such a thing for Bipolar II?
> I assumed a rapid cycler was someone who either experienced> mixed states
No.
> or vacillated within a few hours or days between states
This is ultra-dian rapid-cyclicity and ultra rapid-cyclicity respectively.
> -- but some of what I've read on this site brings this into question.
How so?
> Any clarification will be appreciated.
>
> Many thanks,
>
> Mark H.Too many words. I hope I haven't muddied things up too much. I'm still pondering all of this stuff. It is extremely relevant, and your thoughts have helped me ponder further.
Thanks.
Sincerely,
Scott
Posted by allisonm on April 30, 2000, at 13:24:25
In reply to Re: WWIII Averted Q for Cam, posted by Cam W. on April 29, 2000, at 23:34:11
>
> Wishy-washy answer, huh. - Cam W.No, not at all. That helps me a lot. When I first started on these drugs, I was looking them up trying to understand which did what. Some info in the descriptions are over my head, as are some of the posts here. I was never very clear on what Remeron did. Good point on length of time vs. placebo effect. I hadn't thought of that. So I guess the Remeron was (is) working.
I have to say that since my Wellbutrin SR dose was upped almost 2 weeks ago from 200mg to 300, then upped again last week to 350-400 I have been feeling better. This weekend has been the first in more than a month where I actually went out and did a few things and felt pretty good. I used to hate weekends, then in the last 6-8 months I started looking forward to them (I'm trying to figure if that's coinciding with the time Wellbutrin was added to augment the Remeron). It's just been in the last month or so I've been hating the thought of weekends again, choosing to stay in bed or getting up but not doing anything. (Meanwhile the dustbunnies waged a clever coup attempt, but they haven't claimed victory yet. However, if I don't get better soon the grass in my flowerbeds soon will declare nation status.)
Maybe it is just placebo effect in this short period of time. Or maybe it is the dopamine (Wellbutrin works more on dopamine, right?) You've been taking Wellbutrin, too, haven't you? Could this be mostly dopamine-based? Remeron doesn't do so much with dopamine, does it?
I looked up reboxetine after reading your post. I'd like to try it if the Wellbutrin doesn't fix me. I see it's not available in the U.S. yet, and I couldn't find any information on when it might be approved. What I especially found interesting was its positive effect on self-perception and social behavior -- two areas in which I am grossly lacking.
Thanks again, Cam. I read almost all of your posts and appreciate very much your contributions to this board.
Allison
Posted by Mark H. on April 30, 2000, at 15:26:41
In reply to Re: Short Trial Success/Bipolar II Qx - To Mark, posted by Cam W. on April 30, 2000, at 11:05:43
Cam and all,
I'm posting from home at the moment, and my "antique" Pentium 133 and related software frustratingly cannot open everyone's messages in this thread. I'll catch up later this afternoon when I get into the office, but I apologize in advance if there are holes already answered in this follow-up.
First, Cam, THANK YOU for your detailed responses. I really appreciate your depth of understanding and willingness to share your knowledge. I hope you can help further.
I don't think my questions/statements were clear enough in a couple of cases, so I hope you don't mind my asking for clarification on these.
You wrote: > • I fully agree that if "depression" seems to be getting worse within the first week, another "cause" of the depression should be looked for.
Mark here: In my case (and others with whom I've corresponded), I had classic, moderate depression that rapidly deteriorated to severe on a TCA. Why would that be? Switching to Prozac after a few horrible weeks (stopping the TCA more likely) seemed to bring me back to the level of depression for which I sought help originally. However, it too did not improve the depression. Prozac followed by Zoloft followed by Paxil did not help, and there seemed to be no cumulative benefit. Eventually, I just cycled into my OK phase on my own, and stopped taking meds until the next phase started.
You wrote: > • ... many people do not give the ADs that one or two weeks. In my experience people are ready to give up after a couple of days.Mark here: Right. Since I'm conscientiously compliant, I forget that others sometimes blow off their doctor's instructions. When sulfa for an infection years ago made me so sick I was sweating, shaking, vomiting and literally fell down in the bathroom at one point, I still called my doctor before stopping treatment. Unrelated but interestingly, two local pharmacies have sent me home with other people's prescriptions, so it also pays to read labels carefully and not just start popping pills because your doctor said to take three of each a day. (These were clerk errors, not pharmacist errors, but I'm sure such things still keep you awake at night.)
I wrote: ... stopping my AD for EVEN ONE OR TWO DAYS a year or two later causes the curtain to fall..
>
You wrote: > • At one or two days into a therapy, you are still depressed.Mark here: What I meant to say was, after taking my drugs religiously every day for now almost three years, I still become very depressed for a couple of days if through a scheduling error or other mistake I don't take my primary AD for even one or two days. I rebound on the days I accidentally missed -- it's similar to hypomania, but a trough follows a day or two later as my system waits to regain the right med level. Does that make sense??
You wrote: > • I know you probably have, but there must be some "trigger" setting off your episodes at these predictable times (eg pre & post-Xmas blues, SAD, beginning & end of summer) I realize that these explanations are too simple, but are just meant for illustrative purposes. You may have to journal your moods and experiences around them to pinpoint what is going on.
Mark here: The journal is an excellent idea. There doesn't seem to be a trigger per se (but I'll still look deeper). The transition isn't sudden; it's like a slow slide up and down -- it's continuous, cyclic. Not related to light or holidays as far as I can tell, and not the times that other allergic people normally are affected by pollens and spores.
>
You wrote: > • In some people with bipolar disorder, I belive that the antidepressant just "unmasks" the mania and this could be the reason for manic switch. The depression, in these people is just an adaptation by the body to control the mania (maybe?).Mark here: That's an extremely interesting idea, Cam, even though I am not BP one. The reason is, in junior high when I was very hyper, the only way I learned to control myself at all was through intense self-hatred. At 50, I still forget occasionally that I have other skills with which to control inappropriate impulses, and that I don't have to kill my spirit (figuratively) to keep myself in line. Hmmm. I wonder if I'm creating depression out of unconscious guilt about my impulses when I feel OK? More work needed.
Thank you, Cam. If you have any insight on any of the above, I'd love to hear from you.
Very best wishes,
Mark H.
Posted by Cam W. on April 30, 2000, at 21:54:19
In reply to Thanks, Cam, posted by allisonm on April 30, 2000, at 13:24:25
Allison - I too experienced the initial boost of energy from Wellbutrin, but after a couple of months I went back to normal energy (eg drag my butt outta be to go to work in the morning).As for the norepinephrine/dopamine mechanism of action (MOA) of Wellbutrin, don't totally believe it. The reuptake block of these neurotransmitters does not occur until very high doses (>600mg/day), so even the company does not believe this is the MOA. Wellbutrin also modulates (or smooths out the flow) of norepinephrine in the locus cereuleus, giving that initial energy. I believe that it also has some dopamine modulating activity in the nucleus accumbens, but, again, only at higher doses. If the dopamine increases in the nucleus accumbens (one of the brain's pleasure centers) Wellbutrin would be great for addiction treatment (which it really isn't).
I believe that you may have just adjust to the energizing effect of Wellbutrin. This does not mean that it is not working, it just means that you do not have that energizing side effect anymore.
Reboxetine is being used in clinical trials and is being touted as a great antidepressant by one of our former "Doogie's" (former psych resident, now psychiatrist). I too, would like to see it available on the North American market.
Good luck - Cam W.
Posted by Cam W. on April 30, 2000, at 22:11:42
In reply to Re: Short Trial Success / Back to Cam, posted by Mark H. on April 30, 2000, at 15:26:41
Mark - I don't know why certain people decompensate quickly on TCAs. Could it be that the panic that gets worse for the first couple of weeks is kicking in hard? Perhaps another breakdown or anomoly of the HPA axis (or interrelated system) is at work.As for breakthrough depression following an initial hypomania when missing doses, this could mean that the blood level of your AD has dipped below the minimum effective concentration needed to adquately boost the biochemical entity (be it neurotransmitter or some undiscovered enzyme/protein) that is quelling the symptoms of your depression. This isn't usually seen unless the AD you are taking has a relatively short half-life (usually 24h or less).
Also, pharmacists, even me, do make mistakes. If a pharmacist says that they have never made a mistake, it is either their first day or they are lying. When in doubt, always ask!
As for the trigger for your hypomanic episodes, it can be something innocuous that you do at those times of year. Something even an simple as the excitement of cutting the grass for the first time that year (yea,right - sarcasm).
I hope you stay well and look forward to your insights on our conditions. Thanks for helping me on my quest for the Holy Grail (..er, knowledge). - Cam W.
Posted by JohnB on May 1, 2000, at 0:01:24
In reply to Re: Short Trial Success/Bipolar II Qx - Too long., posted by Scott L. Schofield on April 30, 2000, at 12:54:13
>I think taking a survey on this board to find out the percentage of immediate vs. latent responses to specific drug treatments and how long these responses have been maintained would provide some incredibly valuable information. Developing a standard brief questionnaire to retrieve this information would make the process more efficient and produce more easily interpretable results.
Scott- Good idea. That would take it beyond anecdotal evidence. I wonder if, on something as basic as that, there might already be some studies out there?
Another interesting database to collect here might be "What Worked - What Didn't". That is, everybody who wants to, give info on what meds worked, what had no change, what didn't, what pooped out, on a scale of "- - - - " to "+ + + +" The theory behind this is that while we are all different biochemistries, perhaps there is not an infinite difference, ie perhaps everyone is not a totally unique biochemistry.
Example; If meds A,B, and C, that I tried gave me scores of --, -, ++, and +, respectively. Then if there was an info database which showed that someone (or better, several people) who had the same illness as me, tried the same or nearly the same meds as me, got similar scores, and then went on to try med "D", which got a score of +++. Then that might give me some clue as to what might be the next med to mention to pdoc to try. Isn't this how pdocs work in their own practices anyway?
Of course, the common practice of "cocktails" would tend to muddy the waters, but I think there might still be some usefulness, not only us, but for research, and for practicing pdocs. --JohnB
Posted by Mark H. on May 1, 2000, at 1:13:29
In reply to Re: Short Trial Success/Bipolar II Qx - Too long., posted by Scott L. Schofield on April 30, 2000, at 12:54:13
Scott L.,
Many, many thanks for your fine response -- I was finally able to open your posting this evening; I couldn't access it earlier. Since I've posted my particulars before, I tend to forget our minions here are so vast that many of us have not read one another's previous personal posts. Also, if I see that you or Cam or John or Noa or several others have already worked on a thread, I tend not to participate unless I have specific questions or advice to offer, since I know the original poster has already received outstanding and helpful advice.
That said, here are my particulars: 50, white male, happily married, no kids, grants administrator for intl non-profit media org, way too much adrenalin (known since teens), dysthymic to bipolar II, borderline hyperactive age 8-9, first depression prob age 10, first hypomania prob age 12, major depression (all this undiagnosed, of course) age 13-14, hypomanic 15, suicidal 16, fluctuations 17-18, hypo 19-20, fairly stable (first marriage) 21-26, moderate to severe depression 26-27, up 28, down 29, up 30-31 followed by big crash 31-32, relatively stable 33-43 (third marriage, continues happily), 43 first diagnosis of major depression, onset at a time when I could not have been happier or less stressed -- great marriage, nice home, happily self-employed, newish cars paid for, no debts, spiritually centered, no exogeneous conflicts, parents alive and healthy, good health, plenty of free time, relaxed lifestyle. What a time to be hit with depression!
Under those circumstances, I didn't even think I was depressed when it hit like a freight train at 43 -- I thought I was getting Alzheimer's disease. I didn't have any sad affect for the first 3 or 4 years of this depression, nor was I suicidal during that time, not until it had completely worn me down after several years. I had all the other classic symptoms, including constipation, inappropriate guilt, early waking, increasing social phobias (unable to return phone calls, procrastination, avoiding friends, etc. -- I assume that's what's meant by social phobias?), greatly slowed mental and verbal abilities, memory loss of recent events with heightened memory of long-forgotten earlier-life events, confusion, lethargy, anhedonism, loss of sexual interest, bizarre uninvited homicidal and suicidal imagery and fantasies that were like bad movies rather than my own ideas.
Anecdotally, here are two examples: waking up at 3:30 a.m. racked with guilt that I hadn't been able to prevent the Polly Klaas kidnapping, even though I knew the thought/feeling was delusional and grandiose. The other, being in Monterey a year later (during a TCA trial) while my wife attended a tax conference, and recalling that on March 17, 1968, I had had a glass of Krug Gamay in a crystal goblet I had purchased at the May Company, but being unable to remember or tell my wife how I had spent that morning or early afternoon (in 1994).
Effexor was the first drug to work, and it worked fairly well for one year, but I had to take ever-increasing dosages to maintain the AD effect, and it had the annoying side effect of causing me to repeat everything I said as though I thought no one would believe me until I had made my point at least three times. By the time I quit taking it, in October 95 on an up-swing, it took me 6 weeks before the severe flu-like symptoms finally ceased. My doc and I thought we'd try other things instead in subsequent cycles.
Over four years, we tried 26 or 28 different ADs and adjunctives and over-the-counter-type remedies based on his experience and my research, including at least 20 different prescription drugs. I am my psychiatrist's poster-middle-age-guy for "don't give up."
Three years ago, I was so near death (during a bout of flu in March 97 I got down to 135 pounds at 6 foot 3), so despondent, so worn down by depression and multiple drug failures, having near-psychotic depressive episodes on stuff like Remeron and Wellbutrin and Buspar and Lithionate and others I don't even remember, that as a last resort we decided to put me back on Effexor, side effects and withdrawal symptoms notwithstanding.
I had been taking Cytomel (thyroid suppl) for 3 years, the only thing that consistently helped with my energy and focus. Because adrenalin overproduction seemed to be one piece of the puzzle in my case, we finally added a beta blocker (Pindolol), which cuts my wind horribly but does blunt the effects of adrenalin successfully and keeps me from long-range exhaustion. We took me off whatever the latest AD was, which was giving me nausea and sweats and necessitating lying on the floor at work with a bottle of Pepto for at least an hour every day, and started me back on Effexor.
My wife and I spent our Sierra vacation discussing the details of my suicide and her future; I was only willing to give this condition one more year if it didn't improve, and I wasn't willing to stick around and destroy her quality of life. An odd side note: when sick, I'm obsessed with cutting off my own head, but I get bogged down in the details of turning off the saw, not disturbing the neighbors, having the blood not make a mess, etc. etc. etc. It's all just too much bother!
A few years before, methylphenidate had helped some in the summer. So on June 20, 1997, my doctor added some Ritalin to the mix and suggested I try a night of sleep deprivation. On June 21, 1997, with the combination of Cytomel (25mcg morning), Pindolol (2.5mg morn/eve), Effexor (150mg morning after breakfast), and methylphenidate (10-20 mg day), my severe depression lifted suddenly and I began putting my life back together with lots of therapy (which had been a waste of time while I was so sick).
This mix has worked effectively for the last 2 years and 10 months, without needing to increase the Effexor. I have had to increase the Ritalin, especially in the last six months of extreme hypersomnia. I would not be able to work or drive without methylphenidate. The most Ritalin I've taken in a day has been 80mg, and that in hot weather while travelling (for reasons unknown, I become overwhelming sleepy in temperatures above about 75 degrees). Happily for us, we live in one of the most moderate climates in the US, where summer temps rarely top 70 degrees and winter temps rarely reach freezing. I currently take 30 to 60 mg of methylphenidate a day, which is more than I would like (but as my doc says, less than many 12 years olds take who have ADD).
About being bipolar: KarenB's referral today to the ADD site was helpful, especially the article about "296 vs. 314," which addresses how to tell the difference between bipolar and ADD. Although I might be 5 percent ADD, I fit 95% of their bipolar descriptions. It's the best fit I've ever read. I'm dxed Bipolar II, although Cam mentioned III, and I don't know what that is.
Another anecdote: My fourth day on Prozac, I did feel like jumping out of bed and dancing in the streets, but I controlled it and it went away and I was able to sleep. It changed my perception of color for the first two days, and otherwise I spent a month or so chasing side effects around my body, while my depression did not improve. Other drugs have caused "zooming," which is where, when driving, other cars seem to come faster or slower than they really are. Not pleasant.
Depakote was no good, as you predicted. Wellbutrin caused alarming memory problems -- scared the hell out of everybody. Lots of things caused "change" that could be interepreted as mild improvement for up to two weeks but then sent me into a tailspin. Remeron was a killer.
Benzodiazepines work differently at different times in my cycle -- Xanax good sometimes, very depressing other times; rarely use it. Clonazepam, which I take for PLMS and a REM disorder, is great: easy to get off of, no side effects or hangover, etc. I take 0.25 mg a night -- taking it or not taking it doesn't affect my depression or hypersomnia one way or the other. Ativan is too good -- I save it for days when I really need it, maybe once a month. Diazepam still the best for muscle spasms. Again, less than once a month. My doc knows I won't abuse these meds, so he lets me keep them on hand and gives me the discretion to use them when I just need to "get through the day," which fortunately isn't too often.
You asked me a surprisingly important question: how am I doing? I don't know -- I think I'm in a mixed state or a controlled hypomanic state. Reading the 296 v 314 article today was helpful, because I realized how little work I'm getting done is probably due to being more sick right now than I realize. At the same time, I've never written more about myself or my illness. It's as though I'm paralyzed with regard to work, and energized with regard to mental health inquiry. I have lots of energy for participating in Psycho-Babble discussions, but no energy or focus for even the most straightforward tasks pressing me at my job. I'm actually quite fearful that they're going to fire me -- I'm just not performing to minimum specs by any standard -- and at the same time, I know it's my illness. I'm scared and "I don't give a f***" at the same time. I should be at work now, since I have a cabinet meeting in the morning with our pres. My wife recently asked, "Are you trying to lose your job?"
It would be nice if I could choose to focus on work. Any suggestions? Sue's gone this weekend, and without her steadiness, I'm sleeping all day and up half the night and all I want to do is have intimate and passionate conversations about mental health with my friends on Psycho-Babble. How AM I doing?
Scott, thank you so much for your help and insight. I'm heartened that you have a friend on the same cycle -- what's going on with us? Sue and I attended a drubchen last October -- a powerful 8-day Buddhist intensive practice -- and since then I've been sleeping 12 hours a day and 14 hours or more a day on weekends. I've just been coming out of that within the last couple of weeks.
Thank you so much for all your help. Any insight or comments are greatly welcome. I expect to be on this drug regimen for the rest of my life (or as long as it works reasonably well). I've given up the idea that I'll just stop taking all this stuff when I feel better some day. Still, although my lama has never said anything other than "keep taking your meds," there's something in his eyes that says, "maybe someday."
I need to sleep some more. Thank you. Thank you.
Mark H.
Posted by Mark H. on May 1, 2000, at 1:21:53
In reply to Bipolar II -- to Mark H, posted by Janice on April 30, 2000, at 11:30:53
Thanks Janice for your information. I've had a big light box for several years, but I don't seem to be SAD in the traditional sense. However, as much as I hate the heat (I become overwhelmingly sleepy), up until a couple of years ago, if I could stand it for a few days, all the extra sun sometimes had an anti-depressant effect. It doesn't seem to work any more, however, and increasingly I get sick in the sun -- nauseated, confused, dizzy, ready to pass out. Of course, living on the coast I'm just not used to the heat, and when I go inland and the temp is well over 100, my body just isn't used to it at all.
96 cycles a year! Good god, girl! And I thought I was on a roller coaster.
Love you,
Mark
Posted by Mark H. on May 1, 2000, at 1:31:34
In reply to Re: Short Trial vs Long Waits, posted by dove on April 30, 2000, at 10:57:48
Dove,
I could finally open your post tonight -- thank you so much for the validation and for sharing your similar experiences. I've learned to start EVERY new drug at 1/4 whatever the doctor says the first dose should be. 20mg of Prozac was completely insane as an opening dosage for me. My doctor thought I should start Ritalin at 40mg a day. For the first half- year, 2.5 mg a day was PLENTY.
The most joyous thing I've learned through experimentation -- forgive me if you've seen me write this half-a-dozen times before -- is that Ritalin and Pindolol both seem to potentiate Effexor, so that I can hold my dosage steady at 150mg once a day and actually get a BETTER AD effect than when I had to take 600 or more mg a day without adjunctives. At 600mg a day plus, I would start having withdrawal symptoms six hours after taking my last dose. It was like being on a street drug or something. And the side effects increased with the dosage.
Your writing is beautiful. Thank you so much for putting me in your sights today.
Mark H.
Posted by Mark H. on May 1, 2000, at 1:44:00
In reply to Re: Info Survey idea - Scott, posted by JohnB on May 1, 2000, at 0:01:24
John B wrote: t someone (or better, several people) who had the same illness as me, tried the same or nearly the same meds as me, got similar scores, and then went on to try med "D", which got a score of +++. Then that might give me some clue as to what might be the next med to mention to pdoc to try.
Mark here: That's sure why I keep posting -- both in case someone's case is close enough to mine that I could cut almost 4 years off of their agony -- and also in case someone else already knows where I'm headed and can help me and my doc.
We were pulling in every resource we knew right up until we found that mix that worked for me -- I was preparing for a rational, calm, long-planned death a year in advance, based on simply not being willing to live in that state forever. Our motto: "Don't give up." The right mix for someone might be one Psycho-Babble message away.
By the way, isn't there an AI group already experimenting with commercial applications to predict sales-suggestions based on large preference databases? Did you see that on TV awhile back? A huge mail-order house in England hired this American company to do the crunching, with results that people who order a toaster could predictably be interested in buying a lawnmower, despite no logical connection, just huge records of correlation. What a wonderful use that might be put to in psychiatric medicine!
Mark H.
Posted by Rebecca on May 1, 2000, at 20:19:14
In reply to Re: ScottL/My Story /Very Long, posted by Mark H. on May 1, 2000, at 1:13:29
Mark--
What's your employer's take on your illness? Just curious. I haven't told anyone at work about me. My work was definitely suffering last fall, but the nature of what I do (and the fact that I was performing above expectations to begin with) made it easy to cover up reduced productivity.
Rebecca
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