![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 42 to 66 of 83. Go back in thread:
Posted by JahL on May 13, 2001, at 15:52:35
In reply to Re: Elizabeth..................... Me too., posted by gen on May 13, 2001, at 15:34:58
If it works, it works.
@ this point I wld like to refer to my 1st post on this thread...
j
Posted by Michele on May 13, 2001, at 16:23:54
In reply to and me..., posted by JahL on May 13, 2001, at 15:52:35
Shelli,
Are you referring to me as one of the two who is attacking Elizabeth?????? I never once wrote anything directed at her... or anything of that manner. In fact.... I have had at least 2 posts.... that quotes where included... that I was basically being yelled at for writing...WHEN I DIDN'T EVEN WRITE THEM. If you look closer... me and another person are getting confused. I think I'm getting attacked here.... and by things I didn't even say. I even wrote a post to "elizabeth needs to be shocked" saying that was harsh.... and should rerain from it. I may not agree with her.but I don't think I have to.Because I don't agree... does not mean that I'm attacking her.... by any means..... and when it comes to saying stuff like that.... refer to my post at the bottom..... where you are angry at me!! And for what?
Posted by gen on May 13, 2001, at 16:52:04
In reply to Re: and me.Shelli, posted by Michele on May 13, 2001, at 16:23:54
> Shelli, thought I should give you your own admiring post, not just tack yours onto Elizabeth's, so here it is. Your restraint has been truly remarkable, and I'm glad to have your example before me! (I've admired many of your posts in the past, as well.)
Gen
Posted by shelliR on May 13, 2001, at 18:19:20
In reply to Shelli, posted by gen on May 13, 2001, at 16:52:04
> > Shelli, thought I should give you your own admiring post, not just tack yours onto Elizabeth's, so here it is. Your restraint has been truly remarkable, and I'm glad to have your example before me! (I've admired many of your posts in the past, as well.)
> GenI think the more angry people get about something that doesn't involve them, and the more redundant they begin to sound, the easier it is for me to show restraint. Anyway, that's how I felt this weekend. It's sort of like being aware of trying to remain as clean as possible in a highly polluted environment. Just because it feels so much better not to be covered with soot.
Thanks for the compliment and the support.
Shelli
Posted by gen on May 13, 2001, at 21:01:27
In reply to Re: Shelli » gen, posted by shelliR on May 13, 2001, at 18:19:20
Yes, yes! That's what I admire, and what I need to hold before me as an example. To not get covered in the soot, mired in the hysteria. You've got so much going for you: you are brave and true (gee, I sound like a medieval romance poem), articulate, informed, reasoned, and yet passionate. Without even knowing it, you've given me support and encouragement over the months (I know you're not "new"), and I want to
thank you for that.
Gen
Posted by shelliR on May 13, 2001, at 22:29:32
In reply to Re: Shelli, posted by gen on May 13, 2001, at 21:01:27
> Yes, yes! That's what I admire, and what I need to hold before me as an example. To not get covered in the soot, mired in the hysteria. You've got so much going for you: you are brave and true (gee, I sound like a medieval romance poem), articulate, informed, reasoned, and yet passionate. Without even knowing it, you've given me support and encouragement over the months (I know you're not "new"), and I want to
> thank you for that.
> GenThanks. and I wish I could just be gracious and just accept your kind words. But I have to say, I have spent my share of time in soot, and wouldn't be surprised if I slip at times and end up there again (hopefully temporarily). So you may well be disappointed that I do not always live up to my own standards (or yours).
But thanks so much for telling me that my posts have had an influence on you. And I don't recall you posting under "gen" (sorry if I've just missed them), but I'm sure if you decided to join in the posting, I'd have a lot to learn from you also.
Now, no more compliments, please! shelli
Posted by Dr. Bob on May 13, 2001, at 22:34:47
In reply to Re: Whats... and Drug Seeking Behavior, posted by kazoo on May 12, 2001, at 0:13:38
> I will tell you one other thing: if you do get optiates to treat your so-called depression, and then you're shut off, you will experience the REAL depression you faked to begin with to get them.
Please don't accuse others of faking anything (unless you can substantiate that claim). Thanks,
Bob
PS: Any follow-ups regarding civility, if not redirected to Psycho-Babble Administration, may be deleted.
Posted by mikes on May 13, 2001, at 23:24:18
In reply to and me..., posted by JahL on May 13, 2001, at 15:52:35
"Hopefully this thread won't get hijacked by the anti-opiate brigade..."
You really called this one JahL, I didn't think it was going to get this bad.
> If it works, it works.
>
> @ this point I wld like to refer to my 1st post on this thread...
>
> j
Posted by MorganW on May 14, 2001, at 1:16:19
In reply to Re: and me.Shelli, posted by Michele on May 13, 2001, at 16:23:54
I have read all these threads from beginning to end and I don't see that you have done anything wrong. Don't get angry tho... I have read a lot of your posts form the archives and what not and you seem like such a caring person, I feel bad that these people seem to be after you. Just like people are sticking up for other individuals, I want to go on record as sticking up for you. Good luck, and hang in there.
Posted by Michele on May 14, 2001, at 2:15:15
In reply to Re: and me.Shelli--Michele, posted by MorganW on May 14, 2001, at 1:16:19
Thanks morgan. Much appreciated... I'm really feeling beaten up over this whole thing.
Posted by JahL on May 14, 2001, at 13:38:22
In reply to Re: please be civil » Nichole, posted by SLS on May 14, 2001, at 7:33:30
>Personally, I would consider drinking horse piss if I thought it would relieve me of the illness that I find so oppressive, and that is responsible for the catastrophic dissolution of my life.
I would *inject* the stuff.
Nice post (I 'lurked' 4 6mths b4 posting & am glad I did).
j
Posted by Nichole on May 14, 2001, at 13:54:12
In reply to Re: Shelli, posted by gen on May 13, 2001, at 21:01:27
Gen
Are you sucking up or what? I at least respect Shelli for asking you not to compliment her.
Give me a break. You hold an opiate pusher as your idol?
Posted by shelliR on May 14, 2001, at 17:23:37
In reply to Shelli, posted by gen on May 13, 2001, at 16:52:04
:-)
shelli
Posted by Dr. Bob on May 14, 2001, at 17:52:26
In reply to Re: Shelli, posted by Nichole on May 14, 2001, at 13:54:12
> Are you sucking up or what?
Please be civil, or I'll need to try to block you from posting. Thanks,
Bob
Posted by SLS on May 14, 2001, at 18:07:55
In reply to Re: please be civil » Nichole, posted by Dr. Bob on May 14, 2001, at 17:52:26
Hi All.
I don't know why my post sort of disappeared along this thread. Anyway, I hope this one stays put for a while. I won't address it to any one person. At this point, I would rather address it to the issue. I posted this in another thread, so I apologize for redundancy.
"
...skepticism is healthy. As I suggested in my other post, it is sometimes difficult to keep an open mind, especially when a contention deviates so much from the currently accepted or traditional treatment modalities. Much can come from the type of dialogue we have here. For instance, I took your opinion seriously and decided to investigate the matter further. In doing so, I found something that I believe will be informative for both you and I, and hopefully for anyone else following this thread. It is not a short piece, and at times does not make for easy reading, but the introduction and discussion at the end are worth a reading. The article appeared in one of the most respected medical journals, the Journal of Clinical Psychopharmacology. At the end of the article is the bibliography that contains a wealth of equally respected and well-known authors. This is truly a serious investigation into the utility of opiates, particularly buprenorphine, in the treatment of treatment-resistant depression. It is worth noting that this article was published in 1995, so we are not talking about a novel or radical idea.It is worth keeping an open mind.
Article: Buprenorphine Treatment of Refractory Depression
http://balder.prohosting.com/~adhpage/bupe.html
Sincerely,
Scott"
- Scott
Posted by Dr. Bob on May 14, 2001, at 18:37:24
In reply to Re: please be civil - O.K., if I must. :-), posted by SLS on May 14, 2001, at 18:07:55
> I don't know why my post sort of disappeared along this thread.
I'm deleting posts that should have been redirected to Psycho-Babble Administration, like I said I might.
Bob
Posted by gen on May 14, 2001, at 19:56:44
In reply to Re: Shelli » gen, posted by shelliR on May 14, 2001, at 17:23:37
> :-)
>
> gen
Posted by kazoo on May 15, 2001, at 2:25:40
In reply to Drug Seeking Behavior » kazoo, posted by Elizabeth on May 12, 2001, at 20:36:43
Transferred to "Psycho-Social-Babble."
Posted by Elizabeth on May 16, 2001, at 12:59:48
In reply to Re: Elizabeth..................... Me too., posted by SLS on May 13, 2001, at 15:13:55
> Actually, Elizabeth, I find your behavior in the midst of this nuisance enviable. When I grow up, I want to be just like you.
*blush* Compliment accepted gladly.
My dad likes to say he won't consider himself grown up until he's...uhh, I think it's somewhere in the late 200's. < g >
I think Shelli is right, we should ignore the trolls and other extremists. It's hard to watch this board become a place for people to unleash their hatred and prejudice, though. I'm sure you know what I mean.
-elizabeth
Posted by Elizabeth on May 16, 2001, at 13:05:00
In reply to Re: Whats the best opiate for depression ?, posted by jimmygold70 on May 7, 2001, at 15:48:13
> Pacha,
>
> Did you try ECT ? (Electroconvulsive Therapy). That's more effective than most drugs.This is a common belief. It was viewed as more effective when "depression" was defined more narrowly to include only very extreme, classic presentations (they used to call this "endogenous" as opposed to "neurotic" depression).
ECT works extremely well in severe melancholic, psychotic, and catatonic depressions (as well as certain forms of mania and schizophrenia). For more atypical or ambiguous presentations, it's less clear whether ECT works very well at all. Also, IMO, the risks are too great. I consider ECT to be the ace up my sleeve, something I would do only out of true desperation.
-elizabeth
Posted by Elizabeth on May 16, 2001, at 13:29:28
In reply to Re: Drug Seeking Behavior » Elizabeth, posted by judy1 on May 12, 2001, at 21:08:52
> Just read your well written response, I'm glad you have had access to such knowledgeable pdocs. Another effective use for opiates is for treatment resistant panic disorder; my pdoc has also prescribed them for depression. And he also is part of a well-respected reasearch program. Take care, judy
I'm happy for anyone who has access to good psychiatric care. It's disgracefully rare.
An interesting note about opioids for PD: they do seem to block panic attacks, but the effects of buprenorphine on respiration seemed to be a *contributing* factor in a PA I had. (This was when I had just started taking it after a long hiatus and wasn't used to the side effects.) This might be something that is specific to buprenorphine, though.
I use Xanax for breakthrough PAs because buprenorphine doesn't work fast enough (through the route I use) that a booster dose would work in that event.
best,
-elizabeth
Posted by Elizabeth on May 16, 2001, at 14:01:54
In reply to Re: Whats the best opiate for depression ? » Elizabeth, posted by shelliR on May 12, 2001, at 21:27:54
> > Codeine isn't the best choice for an AD anyway, IMO -- if you need a full agonist, a longer-acting one with fewer adverse effects relative to desired effects would be preferable.
>
> Like Ultram?That wasn't what I was thinking (the fentanyl patch (Duragesic) would best meet the specifications I listed), but Ultram does seem like a good choice in some ways. It has a (*very* mild) monoamine reuptake action in addition to being an opioid agonist. I believe that it is relatively lacking in potential for abuse or physiological dependence compared with morphine, etc., and it has milder side effects. It is not a controlled substance and so it is easier to get a prescription for Ultram than typical opioids (I'd guess it would be even easier to get than, say, Tylenol #3).
The down sides of Ultram include its short duration of action, lowering of the seizure threshold (which limits the safe dose range), and potential for icky interactions with monoamine reuptake and metabolism inhibitors (in particular, SSRIs, MAOIs, and mixed reuptake inhibitors like Effexor and Meridia). It's probably not as big a risk for interactions as, say, Demerol, but there have been enough reports to warrant serious caution (an appropriate Medline search should elicit a number of published reports).
Apparently a slow-release preparation of tramadol is in the works, which is excellent news. Also, I'm not sure how long it's been around, but it might be going generic soon.
> > I've heard many stories of people suing their doctors over some pretty absurd things. Dr. Bodkin takes particular risks in that he is willing to work with patients who may be personality-disordered (which often is associated with a tendency to blame other people for one's problems -- e.g., a patient misuses or overdoses on medication, then blames the doctor). I take Dr. B's willingness to work with these "difficult" patients as a sign of exceptional compassion.
>
> Elizabeth, yes, I believe the scenario with the law suit is very close to what you described above, and I didn't take it that Dr. Bodkin had done anything wrong. If I don't find someone around here that I highly respect to consult with, I may fly up to Boston.I think that Dr. Bodkin has been willing to consult with psychiatrists in other parts of the country on this subject. (Considering how busy he always is, this is really sweet of him if it's correct.) Your best chance is to find a pdoc in your area who has ties to McLean (e.g., who worked there or did a residency there). Those guys all seem to know each other, and someone who knows Bodkin personally would be more receptive to his research, I think. Failing that, the next best option is to find someone in your area who has a research background or orientation, or who is interested specifically in creative approaches to TRD.
> I also have an old friend living in Somerset.
Somerset...? (Where's that?)
> Still, in the long run it would be best to find someone in my immediate area. He did make the suggestion of going up very high on selegiline, but I'm not really anxious to go off the nardil and start again with a new MAOI, unless perhaps it was the patch.
Going off MAOIs is hard, yup -- on top of the worst withdrawal syndrome of all the classic ADs, there's that damned "washout period." Although I generally prefer to follow the middle path (an expression I picked up from Buddhism to describe a belief system that I've carried all my life), my experience suggests that the extreme approaches may be the best way to deal with MAOI-nonMAOI switches. One way is to taper off the phenelzine extremely slowly, especially once you're down to 15mg/day (like, go to 15mg every other day and stay at that dose for a week or more). The alternative is to drop the dose very rapidly, use a lot of benzos to get yourself through the withdrawal, and go with a minimal washout period rather than the more conservative ones suggested in the PDR. It kind of depends how badly off you'll be without the MAOI. I once switched between a nonhydrazine MAOI (Parnate) and a hydrazine (Marplan) with only **3 days** between them. (Kids, don't try this at home. The risk is probably less than, say, switching between MAOI and SSRI, but there still can be problems, and MAOIs shouldn't be combined with other MAOIs.)
I think the idea of selegiline in very high doses is an excellent one, and I often wonder if it wouldn't be worth it for me to give it another shot. (I didn't use benzos or anything to deal with the panic symptoms that I got when I was on it, so I never got past 40mg.) Selegiline seems to cause very little orthostatic hypotension and does not cause weight gain.
Good luck, whatever you end up deciding to do.
-elizabeth
Posted by Elizabeth on May 16, 2001, at 16:54:46
In reply to For Elizabeth » Elizabeth, posted by SalArmy4me on May 12, 2001, at 21:53:43
> I am hopeful that you will still be able to find an effective pharmacological treatment, despite having tried so many of them. I got some nice ideas for you:
>
> 1) Mirapex - proven as effective as imipramine in depression:
>
> Corrigan MH, Denahan AQ, Wright CE, Ragual RJ, Evans DL. Comparison of pramipexole, fluoxetine, and placebo in patients with major depression. Depress Anxiety. 2000;11(2):58-65.
>
> DeBattista C, Solvason HB, Breen JA, Schatzberg AF. Pramipexole augmentation of a selective serotonin reuptake inhibitor in the treatment of depression. J Clin Psychopharmacol. 2000 Apr;20(2):274-5.That's an interesting idea (although I don't see anything about imipramine in either of your citations, and Medline seems to be down so I can't check right now). I'd forgotten about that one. I'll look into it and mention it to my pdoc. It sounds like there is very little research, but what there is has been consistently positive.
> 2) Pindolol - it once was a wonder drug for me that I took without an antidepressant, (but most people will need one).
Tried that one, at a variety of doses, and with a couple different serotonergic ADs. (Wrote a paper on it while I was using it myself. That was fun. Unfortunately my instructor -- a PhD behavioural pharmacologist who was, at the time, a post-doc at the primate lab doing animal experiments -- didn't share my orientation toward molecular pharmacology, so, while I got a decent grade, I don't think he appreciated my excitement about the subject.)
BTW, the evidence is stronger for pindolol as an AD accelerator than as an augmentor. (Well, it was when I was immersed in the topic, anyhow.) I actually ended up being more impressed with buspirone by the time I finished that paper, believe it or not! I believe the apparent failure of BuSpar as an antidepressant-anxiolytic is due to the use of inadequate doses.)
> 3) Definitely try Tegretol XR if you get a chance.
> Its very tolerable.I know a young woman who takes it for temporal lobe epilepsy and (probably secondary) rapid-cycling/dysphoric bipolar II disorder. It has a very minor place in the treatment of TRD. If I were to try another anticonvulsant, I'd prefer carbamazepine's analog oxcarbazepine, which is safer, more tolerable, and less likely to interact with other drugs.
Incidentally, my neuro consult confirmed what I already expected: that there's no evidence that what I experienced was the result of any type of seizure. (I *still* haven't gotten the report on the SPECT scan, though!)
> 4) Ludiomil (MAPROTILINE) - that's a good one that few have heard about since it came out around the time Prozac came out and was overshadowed by Prozac.
Maprotiline, despite a novel variation in the middle ring, turned out to be basically just another tricyclic -- it has similar biochemical properties and works for roughly the same patient population as the rest of the TCAs. Its side chain -- the part of TCAs that is most associated with structure-activity relationships -- has a secondary amine structure which results in NE-selectivity comparable to protriptyline's (but not increased potency). The term "tetracyclic" is really kind of misleading, IMO; it's basically a tricyclic with a novel center ring (this is also what distinguishes imipramine, amitriptyline, and doxepin (and the secondary amine forms of IMI and AMI -- DMI and NOR). The middle ring has an ethylene-type bridge connecting opposite carbons. Such a bridge increases the rigidity of a molecule's structure and may contribute to maprotiline's relatively long elimination half-life (which is not even close to protriptyline's but is on the high end for TCAs).
My pdoc actually considers it *less* effective than his preferred TCAs (nortriptyline, clomipramine, desipramine, imipramine, amoxapine) in TCA-responsive patients. It has the same type of side effects that I find so hard to tolerate in TCAs, as well as a greater propensity than other TCAs for lowering the seizure threshold.
If I want to give another shot at that class of drugs, it would be desipramine, Like maprotiline, DMI is extremely NE-selective and lacks those pesky sexual side effects. Unlike maprotiline, DMI has little affinity for muscarinic or H1 receptors, and was considered one of the preferred TCAs for epileptics before the much safer SSRIs showed up on the scene.
My family history of "V-type" atypical depression (as described in the Columbia Atypical Depression Study) makes tricyclics a dubious choice for me, anyway, despite my dx of melancholia. (I'm sure you know how tricky such diagnostic subtleties can be!)
> 5) Geodon (ziprasidone) - works on serotonin and norepinephrine with little weight gain or sedation.
Side effects weren't the main issue for me with the atypical antipsychotics. It was lack of efficacy. I'm aware of some of the novel effects of ziprasidone at 5-HT and NE transporters, but I'd prefer something that isn't a dopamine antagonist (*clearly* not an appropriate choice for me) if I want to go that route again!
> 6) BuSpar - only effective in depression at higher doses according to the last study done on it and depression.
Yes, I mentioned this one. I found it innocuous when I took it (up to I think 45mg, with several different ADs), although it had no beneficial effects. (My above-mentioned paper focused on buspirone and pindolol as prototypes of antidepressants acting specifically at the 5-HT1a receptor, so I'm reasonably well-versed.)
> 7) Serzone - I was on it for a month with no side-effects.
Tried it. Twice, in fact (both were adequate trials).
> Thyroid Hormones T3 + T4 - pioneered by Dr. Whybrow at UCLA.
I've considered this. I'm not sure that they are such a great choice for someone with panic disorder, though.
> Foreign drugs:
Before going any further, I'd like to point out that I already said I'm not willing to do this. Doing it the legit way takes too much red tape and time, and I'm not going to go shopping on internet "pharmacies" (i.e., drug dealers!). Among other things, I can't afford these (mostly quite expensive) drugs, which would not be covered by my insurance because they are not FDA-approved.
> *Reboxetine,
Not worth the hassle. I'm not concerned about SSRI/SNRI sexual side effects. I'd just as soon try Meridia, which I can get here and which my prescription plan will cover. (Effexor is something I need to avoid due to a very bad toxic reaction I had in 1998. I think that there were probably other, unknowable contributing factors, but all the doctors I've consulted with consider it too risky to repeat the experiment, particularly since I had milder toxic syndromes the two times I tried immediate-release Effexor.)
> *Moclobemide (I can prove that it is effective, albeit not more than irreversible MAOI's)
I think I've mentioned why I don't consider this a worthwhile pursuit. In countries where it is marketed, moclobemide is a good first-line drug (rather than a drug for people who've already tried everything else) due to its safety profile. It's not a good choice when irreversible MAOIs are tolerated but are not sufficient to do away with the depression.
> *Mianserin,
I believe its metabolite, mirtazapine (you know -- Remeron???) is responsible for most of its antidepressant activity. Thus, I don't consider it worthwhile trying the very similar (and less safe, and more expensive) mianserin after having tried Remeron.
Something that does interest me is a combination approach utilising Meridia and Remeron (with the option of adding Buspar, Provigil, high-dose alprazolam, and others).
> *Tianeptine,
This one does interest me, one of the few foreign drugs that do.
> *Modafanil,
That's Provigil -- not a foreign drug.
> Brofaromine,
More promising than moclobemide, probably due to a dual RIMA/reuptake inhibitor action. But still not worth the hassle.
> *Amisulpride,
Again, of interest.
> *Adrafanil.
Might be worthwhile for augmentation, but I'm not clear that it's better than Provigil.
> Others: Bromocriptine, Ropinirole (another dopamine agonist),Direct dopamine agonists are overrated, I think. Anyone want to weigh in (who's gotten this far < g >)?
> Norvasc(?),
Ca++ blocker. Good for refractory bipolar disorder but might actually exacerbate depression.
> Pemoline(?) (a stimulant),
Cylert. I used it for a few months in college. It helped somewhat.
> *Seroquel,
Tried it. (I mentioned low-dose atypical neuroleptics (and moderate-dose Zyprexa), didn't I? The only exception is Clozaril (too risky).
> Tamoxifen(?),
Cancer drugs? Jeez. You know that depression is a known side effect of this drug, right???
(Don't suggest estrogens either...I have a history of depressive relapse and exacerbation on hormonal contraceptives. This is why I now use only "natural birth control" -- condoms, that is. < g >)
> Doxepin,
Just Another Tricyclic, with a side effect profile comparable to imipramine or amitriptyline. (In particular, doxepin is *very* sedating, probably because it's such a strong antihistamine -- there's even a topical version marketed for pruritis.)
> Yohimbine,
Anxiogenic.
> the new Depakote _ER_,
Depakote had no beneficial effect for me. I'm not interested in other preparations of valproate.
> Nomifensine.
Now that's an interesting one. But I thought it had been removed from the market worldwide. Do you happen to know where it might be available?
Thanks for your ideas. Always interested in new thoughts.
-elizabeth
Posted by Elizabeth on May 16, 2001, at 17:00:37
In reply to Re: To Eric » Cecilia, posted by Michele on May 13, 2001, at 0:19:20
> There is pysical pain, and there is mental pain. They are different. I believe that's why they probably make different drugs for each. :-)
Do you think that the mind is not the result of activity originating in the body? Or that the body above the neck is fundamentally different than that below? Or that there isn't any overlap between centrally and peripherally acting drugs?
The type of pain you're referring to as "physical pain" is more properly called "nocioceptive pain" to distinguish it from the pain of, say, depression. And there are many possible causes of nocioceptive pain, some of which originate centrally, not peripherally. Conversely, the peripheral actions of such "mental" drugs as Tegretol have resulted in their widespread use for "physical pain" that is of neuropathic origin.
-elizabeth
Posted by Elizabeth on May 16, 2001, at 17:14:09
In reply to Re: To Eric-Michele » Cecilia, posted by Michele on May 13, 2001, at 1:01:12
> So if your reading this elizabeth..... he'll be gone soon. Take it with a grain of salt.
Believe me, I take *everything* that Eric says with a huge barrel of salt. :-) He's been well known for similar behaviour on unmoderated Usenet groups for several years. He is an intensely emotionally reactive person, and these emotional reactions often manifest as rage or hostility. Based on my observations of him over the years, the intensity of Eric's visceral reactivity makes it impossible to engage him in a rational debate.
What underlies his hostility -- who knows? Perhaps it is partially temperamental. He has consistently professed a disdain for insight-oriented therapies, so it's unlikely that anyone ever will know (unless perhaps he does know, at some level). I personally don't believe that insight-oriented therapies are cures for any type of illness, but I do believe that they can improve one's understanding of oneself, which sometimes can change the direction of one's search for a cure.
-elizabeth
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