![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Else on July 14, 2001, at 14:41:38
I am beginning to think that no drug in the world is as effective as what I seem to be looking for. My pdoc has finally agreed to prescribe Klonopin (he even asked me how much I thought was O.K. which left me speechless). Now I'm taking 2mg daily and I guess I am doing better because I have the nerve to actually post something here which was not the case last week. But I'm just wondering. How do I know this is as good as it is going to get? I can't help but think I am so neurotic nothing will ever be good enough. But how good is good enough? How do normal people feel? I don't think I'll ever be completely satisfied no matter what and maybe this is nothing a pill can fix. I have had superb but short lived responses to a variety of drugs in the past so I can't help but believe in pills. But I just don't know how much of it is up to me. Anyway, I don't know if what I am saying makes any sense.
Posted by Zo on July 14, 2001, at 16:47:16
In reply to How good is good enough?, posted by Else on July 14, 2001, at 14:41:38
It makes perfect sense. . and there's no reason to stop at "good enough". . . as long as you've got the courage and your pdoc has the guts to keep striving for excellent results.
Have been fortunate to have been at this for 10 yrs. with same pdoc. . .seeing it all evolve, seeing the meds themselves change. Having found excellence in some areas of functioning, losing it, regaining it. . .Just keep trying!
Best,
Zo
Posted by Else on July 14, 2001, at 21:16:38
In reply to Re: How good is good enough? » Else, posted by Zo on July 14, 2001, at 16:47:16
I guess you're right. And if it was entirely up to me to decide what I should try, or what sounds effective at this point, this would not even be an issue. But somehow, I'm always worried my doctor will think I'm a pain in the ass for complaining all the time about little things when the bulk of his patients (presumably) have more serious problems than mine. Of course it's silly. He's very nice and has been quite open-minded recently. I guess it's just my own insecurity talking.
Anyway thanks for the encouragment. When I get a bit depressed,I start thinking I don't deserve "excellent" treatment because so many people are worse off. But then it's like when your parents used to tell you to finish your plate because children are dying in Africa. As though that had any bearing on the famine over there.
> It makes perfect sense. . and there's no reason to stop at "good enough". . . as long as you've got the courage and your pdoc has the guts to keep striving for excellent results.
>
> Have been fortunate to have been at this for 10 yrs. with same pdoc. . .seeing it all evolve, seeing the meds themselves change. Having found excellence in some areas of functioning, losing it, regaining it. . .Just keep trying!
>
> Best,
> Zo
Posted by Racer on July 15, 2001, at 13:46:06
In reply to Re: How good is good enough? » Zo, posted by Else on July 14, 2001, at 21:16:38
You know, I always told my mother that she should pack up my leftovers and mail them to China if there were so many kids over there who would be grateful for them! Needless to say, Mother didn't keep mentioning it.
How good is good enough? My answer to that one is that if I am asking that question, it's not good enough. Then again, my problems were obviously much worse than yours, since I do think I deserve decent care. {{snicker, snork}}
(That was my warped sense of humor, by the way. I'm trying to get a silly grin from you.)
The fact that your doctor is willing to work with you says volumes for both of you. Don't mess it up by second guessing it! Just accept both the good care you're getting, and your doctor's obvious respect for your involvement in this process! Else, Else, rah rah rah! It's a compliment that you have that sort of rapport. Accept that compliment graciously.
As for the 'what now?' part, talk to your doctor about your worry. I know that I worry about how the doctor is likely to perceive my input. As a woman, I know that many doctors will class my attempt to involve myself in my own treatment as a sign of the neurotic behavior all women in every universe exhibit. That's because nothing is ever wrong with women, it's only neurotic behavior. Freud told us that, remember? There are still doctors out there who really did learn something very much like that, and haven't yet learned any differently. It doesn't sound as though you have one of those. Celebrate your good fortune!
The other thing that helped me a lot was to write down a nice, clear, concise list of what I wanted, what I needed, what I'd tried, etc. I made a spreadsheet with all the drugs I'd been on, what the effects had been, side effects, etc. I made a list of all the side effects I could tolerate and what side effects were not tolerable for me. I also had a list of what my rights and responsibilities and demands were! For example: It is my right to be listened to by my doctor. It is my responsibility to be POSITIVELY involved in my treatment. It is my DEMAND that my doctor respect my perceptions of intolerable side effects. Since I tend to stammer and stutter and cry when I feel challenged by authority, having the written word to fall back on certainly helped me. And because stuttering, stammering, and crying don't exactly display one's brilliant grasp of logic, well, having it in writing did help prove my point that I'm not a total turnip.
Also, maybe best, having a list of all the meds that I'd tried and what the results had been certainly made a difference in finding out what drugs might make a difference. First thing we tried helped a lot.
This isn't necessarily the thing you really want to hear right now, but here goes anyway: The only thing that really helped me in the last few steps off the penultimate plateau, it took having something else to concentrate on. Something positive, obviously. While it's not a perfect position, I now have a part time job with no benefits which is challenging me, interesting me, using my imagination, and doing all those other good things. Mind you, it's not a 'real' job, and I have a lot of issues about it, but at least it's something I feel competant doing, something that feels good to me, something I enjoy. As if that were easy to find, huh? Hell, if we could all have jobs like this, paying living wages and offering medical benefits, who would take the trouble to be depressed, right?? When I'm Empress of the Universe, I promise I'll give you one of those jobs. In the meantime, can you find something good to do for yourself that might help you express an interest outside yourself? Maybe teaching a class or volunteering at a preschool or becoming a docent at a local museum? Something positive, since sometimes working with the truly downtrodden can be more disheartening than we can handle. Just some way of getting outside yourself and feeling good for an hour or so a week?
Good luck. For what it's worth, what you're expressing sounds very real and very frustrating. I won't say 'I know how you feel', because we both know I don't and can't, but I do empathise with you. Rah rah sis boom bah, you can do it! Here's a good thought for you, from me.
Posted by Neal on July 15, 2001, at 23:56:00
In reply to How good is good enough?, posted by Else on July 14, 2001, at 14:41:38
If you've just started the Klonopin, give it a week or two before you seriously evaluate it. (unlike some AD's) you most probably will get a response from it.
Posted by sweetmarie on July 16, 2001, at 7:54:19
In reply to How good is good enough?, posted by Else on July 14, 2001, at 14:41:38
> I am beginning to think that no drug in the world is as effective as what I seem to be looking for. My pdoc has finally agreed to prescribe Klonopin (he even asked me how much I thought was O.K. which left me speechless). Now I'm taking 2mg daily and I guess I am doing better because I have the nerve to actually post something here which was not the case last week. But I'm just wondering. How do I know this is as good as it is going to get? I can't help but think I am so neurotic nothing will ever be good enough. But how good is good enough? How do normal people feel? I don't think I'll ever be completely satisfied no matter what and maybe this is nothing a pill can fix. I have had superb but short lived responses to a variety of drugs in the past so I can't help but believe in pills. But I just don't know how much of it is up to me. Anyway, I don't know if what I am saying makes any sense.
Else
It sounds like you`ve got a good doctor, who is willing to listen to you and work with you on your treatment.
In practical terms, `good enough` would be `well` enough to function and start getting your life towards somewhere nearing a `normal` life. By this I mean making moves towards doing the things that you need to do to get through, e.g. going to the shop once a day, taking a short walk, contacting friends - say one a week. Just small things like that. Even if you can`t do these things, just having them in mind as a goal is O.K.
For me, `well enough` to do these things would be 4 - 5 out of 10 moodwise. I`m still at 2 - 3 out of 10, and can only really do rudimentary things (getting up, going for a walk - a short one - and maybe sending an email).
Finding a level where you can function, and get SOME enjoyment is a good start. This doesn`t mean to say that you should settle for this - it isn`t really a decent quality of life. But, a foundation will be set so that further improvement can be worked on.
Basically what I`m saying is that if you can get as many things underway whilst you are able to (even if it means pushing yourself to a certain extent), and I don`t mean big `life issues`, these routines will be in place to a certain extent, and you won`t have to start from square 1 when your mood is at an acceptable level. For me, 6 out of 10 is my goal. I can operate on 4 out of 10, but I struggle and get very little enjoyment.
I`m actually telling myself as much as I`m telling you. In my case, as in yours, I have a doctor (a professor actually) who is working with me towards an acceptable level of mood. He specialises in treatment resistant depression, which is what mine is. It doesn`t sound like your doctor will give up on you just because you`ve reached a level where you can function.
Another thing to remember is that it`s probably not realistic to expect a long-term illness (I don`t know how long you`ve been ill) to `go away` quickly. These things take time. By my calculations, if I continue to improve at the rate I`m going at the moment, I`ll reach my goal sometime around Dec/Jan. This seems like a nightmarish time, but I think that I`d trust a slow improvement more than I would if I suddenly got better overnight (as it were).
It`s still hideous, and I completely don`t deny that. I don`t relish the thought of being in a state of severe depression for any longer than I have to - it`s been this way for 3 and a 1/2 years now and frankly I`m totally sick and tired of it. I still spend time wishing I were dead. But ...
... it will get better. Hopefully sooner rather than later.
As for medications, I think they are vital. I too have had responses in the past - once I was well for a year, and another time I was well for about 8/9 months. On both occasions I discontinued the med because I was so much better and consequently fell flat on my face. Neither worked 2nd time around. However, the fact that you HAVE responded in the past gives you a better prognosis than if you had never responded. The hospital doctor told me this (I`m in hospital at the minute), and I`ve got no reason to doubt him. Logically it makes sense.
I hope that this is helpful.
Good luck,
Anna.
Posted by Lorraine on July 16, 2001, at 10:32:03
In reply to Re: How good is good enough? » Else, posted by sweetmarie on July 16, 2001, at 7:54:19
Anna: Your message was really inspirational to me. Thanx.
Lorraine
Posted by Else on July 17, 2001, at 7:21:42
In reply to Re: How good is good enough? » Else, posted by Racer on July 15, 2001, at 13:46:06
Your experience parallels mine so precisely, it's uncanny. I do think I have a great doctor, a real scientist, not a disciple of Freud. The main problem for me has been actually expressing myself clearly while I was at his office ( which only happens once a month). I have made countless charts and graphs and I have known for a long time which drugs were most effective for me. Of course, when push came to shove, I would show up there and babble incoherently and because I was so nervous, I would blank out. Even the cards I brought along with me were useless because the words I had written on them had become undecipherable.
So anyway, recently, after leaving his office very frustrated and angry at myself (after all, he can't read my mind), I wrote him a letter. Anger does give you this little extra strenght you need to get things done. I wrote down everything I thought about the drugs I had been taking and what I thought would be best for me based on my experience. I brought to letter to his office before I could change my mind. Of course, I was extremely embarassed when I went back to see him but to my surprise, he was very pleased and said : "Finally, this is *clear*". (We do have a good rapport and joke around so this was not insulting in any way). But I don't think I would have been able to do any of this had I not asked my brother for some of his tranquilizers. I would have stayed stuck. Social Anxiety causes these vicious circle type of situations.
Right now I am in this government program to re-enter the work force. I was really depressed last year and was in the hospital for a while. I feel I've come a long way but there's still a long way to go. I always used to screw up my interviews and now I think I can handle them without having a nervous breakdown. I'm more optimistic now than I've been in years (decades).I absolutely agree with you that focusing on work (whether a "real 9 to 5 job", occupationnal therapy, art work, etc...) is crucial to recovery. It's hard to tell you've gotten better unless you challenge yourself. Anyway, thank you for your encouragements. I hope things are going O.K. for you as well.
> You know, I always told my mother that she should pack up my leftovers and mail them to China if there were so many kids over there who would be grateful for them! Needless to say, Mother didn't keep mentioning it.
>
> How good is good enough? My answer to that one is that if I am asking that question, it's not good enough. Then again, my problems were obviously much worse than yours, since I do think I deserve decent care. {{snicker, snork}}
>
> (That was my warped sense of humor, by the way. I'm trying to get a silly grin from you.)
>
> The fact that your doctor is willing to work with you says volumes for both of you. Don't mess it up by second guessing it! Just accept both the good care you're getting, and your doctor's obvious respect for your involvement in this process! Else, Else, rah rah rah! It's a compliment that you have that sort of rapport. Accept that compliment graciously.
>
> As for the 'what now?' part, talk to your doctor about your worry. I know that I worry about how the doctor is likely to perceive my input. As a woman, I know that many doctors will class my attempt to involve myself in my own treatment as a sign of the neurotic behavior all women in every universe exhibit. That's because nothing is ever wrong with women, it's only neurotic behavior. Freud told us that, remember? There are still doctors out there who really did learn something very much like that, and haven't yet learned any differently. It doesn't sound as though you have one of those. Celebrate your good fortune!
>
> The other thing that helped me a lot was to write down a nice, clear, concise list of what I wanted, what I needed, what I'd tried, etc. I made a spreadsheet with all the drugs I'd been on, what the effects had been, side effects, etc. I made a list of all the side effects I could tolerate and what side effects were not tolerable for me. I also had a list of what my rights and responsibilities and demands were! For example: It is my right to be listened to by my doctor. It is my responsibility to be POSITIVELY involved in my treatment. It is my DEMAND that my doctor respect my perceptions of intolerable side effects. Since I tend to stammer and stutter and cry when I feel challenged by authority, having the written word to fall back on certainly helped me. And because stuttering, stammering, and crying don't exactly display one's brilliant grasp of logic, well, having it in writing did help prove my point that I'm not a total turnip.
>
> Also, maybe best, having a list of all the meds that I'd tried and what the results had been certainly made a difference in finding out what drugs might make a difference. First thing we tried helped a lot.
>
> This isn't necessarily the thing you really want to hear right now, but here goes anyway: The only thing that really helped me in the last few steps off the penultimate plateau, it took having something else to concentrate on. Something positive, obviously. While it's not a perfect position, I now have a part time job with no benefits which is challenging me, interesting me, using my imagination, and doing all those other good things. Mind you, it's not a 'real' job, and I have a lot of issues about it, but at least it's something I feel competant doing, something that feels good to me, something I enjoy. As if that were easy to find, huh? Hell, if we could all have jobs like this, paying living wages and offering medical benefits, who would take the trouble to be depressed, right?? When I'm Empress of the Universe, I promise I'll give you one of those jobs. In the meantime, can you find something good to do for yourself that might help you express an interest outside yourself? Maybe teaching a class or volunteering at a preschool or becoming a docent at a local museum? Something positive, since sometimes working with the truly downtrodden can be more disheartening than we can handle. Just some way of getting outside yourself and feeling good for an hour or so a week?
>
> Good luck. For what it's worth, what you're expressing sounds very real and very frustrating. I won't say 'I know how you feel', because we both know I don't and can't, but I do empathise with you. Rah rah sis boom bah, you can do it! Here's a good thought for you, from me.
Posted by Else on July 17, 2001, at 7:26:39
In reply to Re: How good is good enough? » Else, posted by Neal on July 15, 2001, at 23:56:00
I've been on it for 4 days now and it's great. This isn't the first time I take it but it's never been prescribed to me at more then 0.5mg bid or for more than ten days before. Since I'm already doing great, I can't wait to see what happens in the long run. And I am finally off anti-depressants.
> If you've just started the Klonopin, give it a week or two before you seriously evaluate it. (unlike some AD's) you most probably will get a response from it.
Posted by Else on July 17, 2001, at 7:58:49
In reply to Re: How good is good enough? » Else, posted by sweetmarie on July 16, 2001, at 7:54:19
Thanks Anna,
My main problem has never been depression, thankfully. I have my moments. Last year I was even hospitalized after a suicide attempt. Today, this whole episode baffles me. I can't remember much of it but it's hard to believe I could have felt that bad. Anyway, after this happenned I decided to take it easy and stop worrying about my success (or lack thereof). I gave myself a vacation and did whatever I felt like for about 6 months. I think an important part of recovery is accepting that it's no big deal if you screw up. Now I've started working again and I do things I like and take it easy. I don't think I've ever been as depressed as you though, and I think it's very brave of you to post this reply. My own goal right now is at least an 8 or a 9. I want to do CBT (for social phobia). My mood is great, I don't think anything could stop me from improving as much as I want to. I am quite certain you will get better. Your post shows that you are strong and willful.One thing about meds. I agree with you but it's often difficult to get the drugs you do need. I have spent years (15) struggling with social phobia, had very few friends or boyfriends (good ones, thankfully), stayed in miserable jobs because they were the ones that allowed me to avoid social contact, and I feel all of this might have been avoided had I received adequate treatment right from the start. But since my condition was considered "minor" (even though it completely ruined my teens and early twenties), I got stuck with non-MD Freudian psychologists every time I went for help. Yes, dissing my mother was fun, but it did not do anything for my extreme shyness. I had to see 7 psychologists and psychiatrists until I found the right one, and even then, it took a year before the right medication was prescribed. In addition to this, I had to do my own research and ask my doctor for a specific drug or I would have remained neuro-vegetative on Zoloft for years (doctors don't like prescribing benzos in Canada).
Anyway, thank you for your reply and I wish you well. I am sure you will get out of this, you sound very courageous.
Thank you.
>
> Else
>
> It sounds like you`ve got a good doctor, who is willing to listen to you and work with you on your treatment.
>
> In practical terms, `good enough` would be `well` enough to function and start getting your life towards somewhere nearing a `normal` life. By this I mean making moves towards doing the things that you need to do to get through, e.g. going to the shop once a day, taking a short walk, contacting friends - say one a week. Just small things like that. Even if you can`t do these things, just having them in mind as a goal is O.K.
>
> For me, `well enough` to do these things would be 4 - 5 out of 10 moodwise. I`m still at 2 - 3 out of 10, and can only really do rudimentary things (getting up, going for a walk - a short one - and maybe sending an email).
>
> Finding a level where you can function, and get SOME enjoyment is a good start. This doesn`t mean to say that you should settle for this - it isn`t really a decent quality of life. But, a foundation will be set so that further improvement can be worked on.
>
> Basically what I`m saying is that if you can get as many things underway whilst you are able to (even if it means pushing yourself to a certain extent), and I don`t mean big `life issues`, these routines will be in place to a certain extent, and you won`t have to start from square 1 when your mood is at an acceptable level. For me, 6 out of 10 is my goal. I can operate on 4 out of 10, but I struggle and get very little enjoyment.
>
> I`m actually telling myself as much as I`m telling you. In my case, as in yours, I have a doctor (a professor actually) who is working with me towards an acceptable level of mood. He specialises in treatment resistant depression, which is what mine is. It doesn`t sound like your doctor will give up on you just because you`ve reached a level where you can function.
>
> Another thing to remember is that it`s probably not realistic to expect a long-term illness (I don`t know how long you`ve been ill) to `go away` quickly. These things take time. By my calculations, if I continue to improve at the rate I`m going at the moment, I`ll reach my goal sometime around Dec/Jan. This seems like a nightmarish time, but I think that I`d trust a slow improvement more than I would if I suddenly got better overnight (as it were).
>
> It`s still hideous, and I completely don`t deny that. I don`t relish the thought of being in a state of severe depression for any longer than I have to - it`s been this way for 3 and a 1/2 years now and frankly I`m totally sick and tired of it. I still spend time wishing I were dead. But ...
>
> ... it will get better. Hopefully sooner rather than later.
>
> As for medications, I think they are vital. I too have had responses in the past - once I was well for a year, and another time I was well for about 8/9 months. On both occasions I discontinued the med because I was so much better and consequently fell flat on my face. Neither worked 2nd time around. However, the fact that you HAVE responded in the past gives you a better prognosis than if you had never responded. The hospital doctor told me this (I`m in hospital at the minute), and I`ve got no reason to doubt him. Logically it makes sense.
>
> I hope that this is helpful.
>
> Good luck,
>
> Anna.
Posted by jojo on July 17, 2001, at 11:35:05
In reply to How good is good enough?, posted by Else on July 14, 2001, at 14:41:38
> I am beginning to think that no drug in the world is as effective as what I seem to be looking for. My pdoc has finally agreed to prescribe Klonopin (he even asked me how much I thought was O.K. which left me speechless). Now I'm taking 2mg daily and I guess I am doing better because I have the nerve to actually post something here which was not the case last week. But I'm just wondering. How do I know this is as good as it is going to get? I can't help but think I am so neurotic nothing will ever be good enough. But how good is good enough? How do normal people feel? I don't think I'll ever be completely satisfied no matter what and maybe this is nothing a pill can fix. I have had superb but short lived responses to a variety of drugs in the past so I can't help but believe in pills. But I just don't know how much of it is up to me. Anyway, I don't know if what I am saying makes any sense.
Below is the beginning of some thoughts that occurred to me after reading Elizabeth's message that the
AD effects of buprenorphine stop within hours of stopping taking it (failing to take the next dose, {or would the psychodynamiclly oriented say that making the decision to stop taking it is relevant?}). These ideas need a lot of expansion, but I thought I'd toss the first part in here because Else has brought up such
a "pregnant" question.
This raises some interesting philosophical questions. For instance, I always considered an "Antidepressant" to be a drug whose activity occurred in two separate stages. The first, or acute stage,
was generally apparent after the first dose, about the same time as most "side effects", and, although these effects might be therapeutic, they generally appear to be of little interest to the Psychiatrist. The second, or "True Antidepressant" effect, if it does occur, begins after some delay, formerly the standard 3-6 weeks, although a big goal of research has been to shorten this period. With buprenorphine, the rapidity of onset, the "True Antidepressant " effect, appears to have merged with the acute effect of the more usual antidepressants, and appears to act more like the classical "euphoriants", e.g. heroin, except that it doesn't cause "euphoria" as the word has become commonly used, as an abnormal, "heightened" state of mood,
but rather the "euphoria" that follows its etymological roots, i.e. "eu", meaning normal, and "phoria", referring to mood. BTW, my Psychologist friend tells me that "mood" has no scientific definition. How then can one be said to have a "mood disorder"? I guess it's like pornography, 'I can't define it, but I know it when I see it'. I don't know, but would be interested in learning how this word was appropriated by physicians or attorneys or Drug Warriors, to have a "negative" meaning. i.e., PDR, Adderall: Adverse Reactions:…,…, euphoria …One of the questions that this raises is that of Else, "How good is good enough?"
Buprenorphine is not considered a euphoriant. Does it than raise ones "mood" to THE 'Normal'
level and then stop? How does it know when to stop? Is there a "mood thermostat", and the drug brings the "mood" up to that level? If you plot "mood" on the horizontal axis, and amount of drug, or time, on the vertical axis, is the curve smooth, or does it flatten out as one passes through the "Normal" zone?
Morphine, methadone and heroin are said to be "antidepressants". Using the graph suggested above, does one get something approximately like a straight line, slanting upward to the right, mostly at the same angle, or does it flatten out at the "NORMAL PLATEAU", giving us a clue as to "how good is good enough?"
Because of the behavior of Bipolars in the Manic phase, we seem to accept that too much of a good thing (too much "mood"???) is a bad thing, but it's difficult to discuss without a definition of "mood".
With the more "classical" antidepressants, one stopped increasing the dose when the "side effects" became greater that the "therapeutic effects", or the higher doses presented some physical threat."How Good is Good Enough raise many questions which beg for answers.
Posted by Else on July 17, 2001, at 22:22:18
In reply to Re: How good is good enough?, posted by jojo on July 17, 2001, at 11:35:05
I don't have much time to write but this is basically what I think: If it wasn't for purely man-made moral codes telling us ecstasy (a strong word, I know), is wrong (morally) or an adverse effect (medically) which amounts to the same, we wouldn't be asking these questions. It's absurd to settle for pathetic "euthymia" when you can feel euphoric. I don't mean psychotic mania. I mean just feeling really good. Like yesterday, for instance, was a beautiful day. I went to the park and spent about thirty minutes on the swings (I don't think I'll ever outgrow these, I'm 26). Anyway, it was what is sometimes called a "glorious day". I felt genuinely ecstatic.
But the goal of psychiatry is not to make people happy but to make them productive. Now in order to be productive (for instance, show up at the office on a rainy monday morning) you sometimes have to renounce some hapiness. The political and medical establishments are so afraid of joy because it has the potential to disrupt social order, albeit in a potentially delightful way. What are we so afraid of? Are we afraid that hapiness will stop us from spending 40 hours a week watching mind-numbing crap on TV, another forty hours at a dreadful job and the rest sleeping. Is the social order so great that we are willing to sacrifice our well-being to maintain it. Just think of what SSRIs do. I know they can help a lot of people in severe pain and I think they are certainly useful in some cases but my experience with them has taught me that in the long run they promote acceptance of the status quo, they make you comfortable with it because they numb you. Well here I go again! Anyway, I don,t believe in some big conspiracy theory. But we are stuck in this puritannical moral paradigm and there will always be powerful people who think pain is necessary. I happen to disagree (unless your hand is on the stove or something). In concrete terms, it's not complicated at all: good enough is GREAT. In judeo-christian moral terms, good enough is able to function as a productive member of society, even if it means having a miserable time till the day you die.P.S. I am quite hysterical and use strong words. This is how I am and I can't help it. You can tell me I'm exagerating, I often do. But my thinking fundamentally remains the same even though I may lack nuance. Well that's enough for now. Must have forgotten the Haldol or something.
> > I am beginning to think that no drug in the world is as effective as what I seem to be looking for. My pdoc has finally agreed to prescribe Klonopin (he even asked me how much I thought was O.K. which left me speechless). Now I'm taking 2mg daily and I guess I am doing better because I have the nerve to actually post something here which was not the case last week. But I'm just wondering. How do I know this is as good as it is going to get? I can't help but think I am so neurotic nothing will ever be good enough. But how good is good enough? How do normal people feel? I don't think I'll ever be completely satisfied no matter what and maybe this is nothing a pill can fix. I have had superb but short lived responses to a variety of drugs in the past so I can't help but believe in pills. But I just don't know how much of it is up to me. Anyway, I don't know if what I am saying makes any sense.
>
>
> Below is the beginning of some thoughts that occurred to me after reading Elizabeth's message that the
> AD effects of buprenorphine stop within hours of stopping taking it (failing to take the next dose, {or would the psychodynamiclly oriented say that making the decision to stop taking it is relevant?}). These ideas need a lot of expansion, but I thought I'd toss the first part in here because Else has brought up such
> a "pregnant" question.
>
>
>
> This raises some interesting philosophical questions. For instance, I always considered an "Antidepressant" to be a drug whose activity occurred in two separate stages. The first, or acute stage,
> was generally apparent after the first dose, about the same time as most "side effects", and, although these effects might be therapeutic, they generally appear to be of little interest to the Psychiatrist. The second, or "True Antidepressant" effect, if it does occur, begins after some delay, formerly the standard 3-6 weeks, although a big goal of research has been to shorten this period. With buprenorphine, the rapidity of onset, the "True Antidepressant " effect, appears to have merged with the acute effect of the more usual antidepressants, and appears to act more like the classical "euphoriants", e.g. heroin, except that it doesn't cause "euphoria" as the word has become commonly used, as an abnormal, "heightened" state of mood,
> but rather the "euphoria" that follows its etymological roots, i.e. "eu", meaning normal, and "phoria", referring to mood. BTW, my Psychologist friend tells me that "mood" has no scientific definition. How then can one be said to have a "mood disorder"? I guess it's like pornography, 'I can't define it, but I know it when I see it'. I don't know, but would be interested in learning how this word was appropriated by physicians or attorneys or Drug Warriors, to have a "negative" meaning. i.e., PDR, Adderall: Adverse Reactions:…,…, euphoria …
>
> One of the questions that this raises is that of Else, "How good is good enough?"
> Buprenorphine is not considered a euphoriant. Does it than raise ones "mood" to THE 'Normal'
> level and then stop? How does it know when to stop? Is there a "mood thermostat", and the drug brings the "mood" up to that level? If you plot "mood" on the horizontal axis, and amount of drug, or time, on the vertical axis, is the curve smooth, or does it flatten out as one passes through the "Normal" zone?
> Morphine, methadone and heroin are said to be "antidepressants". Using the graph suggested above, does one get something approximately like a straight line, slanting upward to the right, mostly at the same angle, or does it flatten out at the "NORMAL PLATEAU", giving us a clue as to "how good is good enough?"
> Because of the behavior of Bipolars in the Manic phase, we seem to accept that too much of a good thing (too much "mood"???) is a bad thing, but it's difficult to discuss without a definition of "mood".
> With the more "classical" antidepressants, one stopped increasing the dose when the "side effects" became greater that the "therapeutic effects", or the higher doses presented some physical threat.
>
> "How Good is Good Enough raise many questions which beg for answers.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
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