![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 37 to 61 of 61. Go back in thread:
Posted by mattdds on May 29, 2003, at 20:10:49
In reply to Re: Is their a solution to this? Larry H ?? » johnj, posted by Larry Hoover on May 29, 2003, at 12:00:04
Larry,
All this (your post) sounds very CBT'ish. I am curious as to your take on CBT. Do you have any formal CBT-type therapy under your belt? Or do you use CBT self help techniques? Or not a "believer"? It often seems your posts have embedded CBT suggestions in them, haha. I enjoy reading them.
I myself am a big enthusiast of CBT, and think it is the most underutilized tool in psychiatry. It relieved about 80% of my generalized anxiety, 100% of my depression and 100% of anticipatory anxiety secondary to panic attack symptoms.
Klonopin helps with residual derealization that I can't seem to shake, and I am currently experiencing what I feel is a good response to Mg supplementation (seems to help with MVP-like symptoms that overlap a lot with panic, e.g. palpitations, random sympathetic discharge, insomnia. It also seems to "smooth" out my moods, like a mild mood stabilizer. I'm also pretty sure it augments my Klonopin. Recently, I've reduced my dose a bit, as my old dose is making me sedated! Time will tell. As for now, I'm getting more and more convinced.)
But I digress, my question was about CBT. What's your take?
Thanks,
Matt
"Yesterday is history. Tomorrow's a mystery. Today is a gift. That's why they call it the present."
"You can't think your way into a new way of acting, but you can act your way into a new way of thinking."
....which has a corrollary in, "If you keep on doing what you always did, you'll keep on getting what you always got."
....and another one in, "Doing the same thing over and over again, and expecting different results, is a true measure of insanity."
....which underlie my belief that you have to "do the experiment".
Posted by colin wallace on May 30, 2003, at 3:56:13
In reply to john/Larry, Re: Is their a solution to this? , posted by McPac on May 29, 2003, at 18:33:18
> " I don't take an ssri, but remeron does have a sexual side effect for me."
>
> >>>>>>> Remeron doesn't cause sexual side efects for most people, correct? I've read that sometimes it is actually prescribed to help improve SSRI-induced "floppiness", lol,......I'm taking it and so far it seems to help.....does that mean it has 'anti-droop' characteristics for me, lol.When I was taking Remeron, my gut grew so fat I couldn't even reach my pecker if I wanted to...
Posted by Ron Hill on May 30, 2003, at 10:55:09
In reply to Re: john/Larry, Re: Is their a solution to this? » McPac, posted by colin wallace on May 30, 2003, at 3:56:13
> When I was taking Remeron, my gut grew so fat I couldn't even reach my pecker if I wanted to...
Or did you just sit to pee when you were on Remeron? :-)
-- Ron
Posted by JackT on May 30, 2003, at 11:25:15
In reply to Re: Mg? How you making out finding it? » JackT, posted by Larry Hoover on May 28, 2003, at 15:04:24
Lar,
I haven't had a chance to go to Wal-Mart yet. I'll try there first this week-end and then the on-line store you recommended.
I've got another question for you. What is your take on d-phenylalanine as a precursor to phenylethylamine? Do you suspect it would work as a mild anti-depressant?
I have been looking for something that would make me feel good again. Between the GAD, social phobia, and the benzos, I just don't enjoy life. I go through the motions everyday but I'm always mildly depressed (nothing clinical). I've been considering Nardil, mainly because of Ace, selegiline (although my current pdoc won't prescribe it) and mirapax (sp?). Do you have any guidance of drugs or supplements with a lasting dopamine boost or other mood-lifting mechanisms? I'm willing to try almost anything if it looks promising. Maybe this is an impossible question to answer and I probably have asked it before. Anyway, it doesn't hurt to keep probing.
Jack T.
Posted by colin wallace on May 30, 2003, at 11:52:25
In reply to Re: It must have been hard to use the urinal, huh? » colin wallace, posted by Ron Hill on May 30, 2003, at 10:55:09
Posted by Squiggles on May 30, 2003, at 11:56:30
In reply to I used incontinence pants (?!!!) (nm) » Ron Hill, posted by colin wallace on May 30, 2003, at 11:52:25
I wonder if this is considered uncivil?
Hmmm.
Squiggles
Posted by colin wallace on May 30, 2003, at 12:13:55
In reply to Re: I used incontinence pants (?!!!) » colin wallace, posted by Squiggles on May 30, 2003, at 11:56:30
> I wonder if this is considered uncivil?
>
> Hmmm.
>
> SquigglesSorry,
Maybe not uncivil, but granted, a little tasteless.Apologies, kisses, hugs and much grovelling..
Col*****
Posted by Ron Hill on May 30, 2003, at 14:03:53
In reply to Re: Mg? How you making out finding it? » Larry Hoover, posted by JackT on May 30, 2003, at 11:25:15
Hi Jack,
> Do you have any guidance of drugs or supplements with a lasting dopamine boost or other mood-lifting mechanisms?
May I jump in? Larry can tell you better than I, but have you looked into Enada NADH? It works well for me except it can cause irritability. I was able to solve the irritability problem by adding 250 mg/day of TMG and 250 mg/day of niacin.
When I first started taking Enada NADH 18 weeks ago, I took 10 mg/day of the sublingual product ENADAlert NADH during the acute treatment phase for my atypical bipolar depression. The results were immediately remarkable. However, within a week or so the 10 mg/day dose was too much and, therefore, I began titrating the dose in the downward direction. I currently take 2.5 mg twice a week of the enteric coated "down-the-hatch" Enada NADH tablets as a maintenance dose. If you want more detail, just ask.
Here are some of the links discussing Enada NADH:
http://www.healthwell.com/hnbreakthroughs/mar98/nadh.cfm?path=hw
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8101444&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9247090&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9013405&form=6&db=m&Dopt=b
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10047,00.html#Cautions
http://www.nadh.com/site7/SYSact20.htm#Top
http://www.nadh.com/site7/RSdprs05.htm#Top
http://www.smart-drugs.com/article-JamesSouth-NADH.htm
http://www.nadh-priceinfo.org/
http://qualitycounts.com/fpnadh.html
http://www.immunesupport.com/library/showarticle.cfm/id/3118/T/Both/
http://www.immunesupport.com/library/powersearch2.cfm (Note: enter “NADH” as keyword)
Posted by Larry Hoover on May 30, 2003, at 16:51:04
In reply to Re: Mg? How you making out finding it? » Larry Hoover, posted by JackT on May 30, 2003, at 11:25:15
> Lar,
>
> I haven't had a chance to go to Wal-Mart yet. I'll try there first this week-end and then the on-line store you recommended.
>
> I've got another question for you. What is your take on d-phenylalanine as a precursor to phenylethylamine? Do you suspect it would work as a mild anti-depressant?What I like about it is it's something in your control. It's effect may be subtle, perhaps more noticeable. But you're using your body's machinery the way it was intended to be used, ya know?
L-phenylalanine can get streamed two way....towards PEA, or towards dopamine. D-phenylalanine can only go to PEA. Moreover, it suppresses diversion of L-PA from going towards PEA. So, I generally recommend DLPA, the racemic mixture of d-,l-phenylalanine. Can't hurt. Might help. Take on an empty stomach. Some time that day, make sure you get some B-complex, to make sure the old enzymes are all fired up.
> I have been looking for something that would make me feel good again. Between the GAD, social phobia, and the benzos, I just don't enjoy life. I go through the motions everyday but I'm always mildly depressed (nothing clinical). I've been considering Nardil, mainly because of Ace, selegiline (although my current pdoc won't prescribe it) and mirapax (sp?). Do you have any guidance of drugs or supplements with a lasting dopamine boost or other mood-lifting mechanisms? I'm willing to try almost anything if it looks promising. Maybe this is an impossible question to answer and I probably have asked it before. Anyway, it doesn't hurt to keep probing.
>
> Jack T.There are lots of ideas. Ron mentioned NADH. It directly contributes to dopamine activity. Niacinamide can be soothing (anxiolytic), and also contributes to NADH downstream. Magnesium should have a calming effect, but as many people have noted, there are substantial differences in dose-response. Moreover, magnesium can potentiate (make it seem like you took a higher dose of) your benzos. Be a little cautious. Selenium has been shown to increase measures of well-being even in "normal" people, but also in depressed ones. Fish oil has a general mellowing/resiliency effect for a lot of people. Vitamin C gives some people mental clarity, and we're just getting reports of the same thing from vitamin E. Alphalipoic acid is another antioxidant with psychotropic activity.
There are many things you can try, but just take it slow. You didn't get sick in one day, so it's best to patiently try things, see how they fit in (or not). Go off something, try it again later, to see if the effect is the same. We're talking lifestyle changes here.
Lar
Posted by Larry Hoover on May 30, 2003, at 17:22:42
In reply to Larry, your take on CBT? » Larry Hoover, posted by mattdds on May 29, 2003, at 20:10:49
> Larry,
>
> All this (your post) sounds very CBT'ish. I am curious as to your take on CBT. Do you have any formal CBT-type therapy under your belt? Or do you use CBT self help techniques? Or not a "believer"? It often seems your posts have embedded CBT suggestions in them, haha. I enjoy reading them.I'm glad somebody does. I hate to sound like I'm preaching. Without any feedback, it's awfully hard to "read the audience".
Yes, my posts often contain CBT-based ideas. I can't believe that HMOs, for example, will pay for drug after drug, but not cover CBT to any great extent (if at all). I think attitude problems underly a large number of medication failures. A pill can't fix stinkin' thinkin'.
I am a true believer in CBT. I have a degree in psych, I take part in CBT therapy (as a patient), and I employ self-taught/borrowed "self-help" CBT almost every thought I have. Seriously.
> I myself am a big enthusiast of CBT, and think it is the most underutilized tool in psychiatry. It relieved about 80% of my generalized anxiety, 100% of my depression and 100% of anticipatory anxiety secondary to panic attack symptoms.
OK, I won't preach to you. This is for the rest of the audience. <wink>
What convinced me that cognition has a powerful effect on therapeutic response flows from my own experience. Some years ago now, although I had been released from hospital, I was still very very depressed. My days, my endless stream of days, went something like this. Sleep for 10-12 hours. Get up, walk down the hall, and lie on the couch all day. Maybe open a can and eat straight from the can. Maybe not. Maybe bathe. Maybe not. Go back to bed.
I called this period my "couch days". I spent so much time on the couch (really a futon on a frame), that I had actually created a "Larry-shaped dent" in the damn thing. There it was, that dent, tangible evidence of my inability to function. All I could think about was all the things that needed doing, that weren't getting done. I just couldn't manage to do anything.
Then one day, I had an epiphany. I have no idea where it came from, but it felt heaven-sent. I saw that I had been consuming myself with guilt and self-reproach. I went to the couch for rest, I had assumed, but I got no rest there. I tortured myself, instead.
The day of the epiphany, I saw that Larry-shaped dent in a new way. It was the couch preparing to cradle me. And as I let myself down into that space, I let it hold me. And I emptied my mind of my worries, and let myself rest. And again, the same thing, the next day. I never had another couch day again.
I draw on all kinds of sources. Buddhism has been really helpful. I had a hard time grasping the idea that spiritual growth required adversity, at first. But then I began to see why. If life isn't a struggle, you have no reason to change, to grow.
Here's a contrast of the Buddhist/Western perception. Your house catches fire, and before the firetrucks can arrive at the scene, it burns to the ground. Everybody is safe, but you've lost everything.
Western response? Probably something like: devastated.
Buddhist response: absolute joy.Now, how can the same event inspire such different responses? Cognition.
Here's a symbolic representation. Most people believe that an event triggers an emotional response, a feeling.... i.e. E --> F
But that's not the way it works at all. You interpret the event before you feel.
E + I --> F
Your cognition, which can respond instantaneously when needed, will interpret events, and then trigger emotions consistent with the interpretation. You can't do anything about E. That's reality. You've no control over reality. And feelings arise from cognitive "templates", beliefs, attitudes, assumptions, memories, social norms, all that stuff, so you really can't do much to change them *directly*. The only way at the feelings is through deciding on using new interpretations. The only thing I can change is "I".
It takes effort to become aware of cognition, but once that skill is learned, it's with you forever. I feel very empowered whenever I consciously choose a new cognitive schema.
> Klonopin helps with residual derealization that I can't seem to shake, and I am currently experiencing what I feel is a good response to Mg supplementation (seems to help with MVP-like symptoms that overlap a lot with panic, e.g. palpitations, random sympathetic discharge, insomnia. It also seems to "smooth" out my moods, like a mild mood stabilizer. I'm also pretty sure it augments my Klonopin. Recently, I've reduced my dose a bit, as my old dose is making me sedated! Time will tell. As for now, I'm getting more and more convinced.)
Experiments will do that, whereas reading leaves a tad more doubt.
That's where "You can't think your way into a new way of acting, but you can act your way into a new way of thinking." fist in.
> But I digress, my question was about CBT. What's your take?
>
> Thanks,
>
> Matt
>
> "Yesterday is history. Tomorrow's a mystery. Today is a gift. That's why they call it the present."
>
> "You can't think your way into a new way of acting, but you can act your way into a new way of thinking."
>
> ....which has a corrollary in, "If you keep on doing what you always did, you'll keep on getting what you always got."
>
> ....and another one in, "Doing the same thing over and over again, and expecting different results, is a true measure of insanity."
>
> ....which underlie my belief that you have to "do the experiment".CBT is a wonderful tool.
Lar
Posted by Squiggles on May 30, 2003, at 19:07:59
In reply to Re: Larry, your take on CBT?, posted by Larry Hoover on May 30, 2003, at 17:22:42
You're beginning to frighten me.
How come Dr. Bob is so silent?Squiggles
Posted by Squiggles on May 30, 2003, at 19:30:40
In reply to squiggles » Squiggles, posted by colin wallace on May 30, 2003, at 12:13:55
It don't make no never mind to me;
i've done time at usenet - what i find
peculiar is that Dr. Bob is not offended
at this but was offended and reprimanded
me for my complaint against someone calling
doctors pushers.Of course it's his perogative to call
the shots - but what about the rules.Squiggles
Posted by Larry Hoover on May 30, 2003, at 19:51:01
In reply to Re: Larry, your take on CBT? » Larry Hoover, posted by Squiggles on May 30, 2003, at 19:07:59
> You're beginning to frighten me.
> How come Dr. Bob is so silent?
>
> SquigglesHow am I frightening?
Posted by Squiggles on May 30, 2003, at 19:53:21
In reply to Re: Larry, your take on CBT?, posted by Larry Hoover on May 30, 2003, at 19:51:01
Well, what with the emphasis on nutrition,
magnesium, and Cognitive Behaviour Therapy,
i wonder if you are not infact anti-psychiatric
drug treatment.Squiggles
Posted by mattdds on May 30, 2003, at 21:39:02
In reply to Re: Larry, your take on CBT? » Larry Hoover, posted by Squiggles on May 30, 2003, at 19:53:21
>>Well, what with the emphasis on nutrition,
magnesium, and Cognitive Behaviour Therapy,
i wonder if you are not infact anti-psychiatric
drug treatmentWhoa! What on earth are you talking about?
I will let Larry speak for himself, but since when does recognizing that there are other things that work for mental illness besides drugs mean you are "anti-psychiatry"?
Even the most hardcore pharmacologically oriented pdocs will admit that CBT, sound nutrition and a sound philosophical outlook on life will contribute to wellness. Even the American Psychiatric Association has published studies showing that CBT is equally effective as drugs in many disorders such as panic, anxiety and depression. I am not just making this stuff up, it is quickly becoming the standard of care!
I do CBT, *and* take Klonopin, for example. The two approaches (meds and therapy) are not at all mutually exclusive, but are rather extremely synergistic. You see, CBT, meds, and likely supplements are all just different avenues to change the way you feel.
I too feel that the current mental health system has some serious flaws. HMO's would never pay for terrific, evidence-based treatments like CBT because it would simply cost too much, so it's the assembly line approach. Also I believe that the pharmaceutical companies, with their strongly vested financial interests are exerting way too much influence on how psychiatrists are trained. So we are stuck with getting an extremely impersonal "what are your symptoms" ----> "here take this drug" ---->" now get the hell out so I can pay my overhead" approach.
Does this mean I'm "anti-med"? I guess I am anti-**only med**. But meds have saved my rear in more than one situation. They are one extremely important component of my recovery. But I feel without CBT, my response to the meds would not be anywhere near as robust. For example I tried benzos before CBT for panic disorder, and they did not do much. After CBT, I feel close to 100% better most of the time. For me, they very much had a synergistic effect.
It is not good to hold on to ideas or beliefs too tightly. I am as guilty of this as anyone, but I'm learning. But it seems that some people have an almost religious belief in psychopharmacology as the only method that works. We've really bought into the monoamine hypothesis to the point that we don't consider anything else! I'm all for *anything* reasonably safe that will work. I am not Peter Breggin. I just think that the only meds approach in psychiatry is akin to treating hypertension with only drugs, and ignoring the fact that you are prescribing them to an overtly obese chain-smoking couch potato. This approach does not fly for most good internists, so why do psychiatrists do it? To ignore all these other factors, in my mind is nothing short of negligence.
Best,
Matt
Posted by johnj on May 30, 2003, at 22:21:00
In reply to Re: Larry, your take on CBT?, posted by Larry Hoover on May 30, 2003, at 17:22:42
Larry,
Thank you. I will be drawing on your thoughts this weekend. I set up to visit the local university anxiety/depression clinic to get a good DX and where to go "grow" from there. I am sounding like a broken record, but you have answered things like you were my "couch", no weirdness intended there :)
johnj
Posted by johnj on May 30, 2003, at 22:27:36
In reply to Re: Larry, your take on CBT? » Larry Hoover, posted by Squiggles on May 30, 2003, at 19:53:21
Hey Squiggs,
I think Larry just believes they have there place in helping us with the illness but empowerment is also just as important. I for one and not just going to nod and take whatever my doc throws at me. I want to WHY he is prescribing what he is. BTW Larry stated meds saved his life at one time, as they have mine. Don't be so quick to judge, just read prior posts and you will see. Actually, Larry doesn't just spout off, he is ASKED his opinion and I find him and jrbecker to be great attributes to the board. Much better than myself. I hope I can contribute or help someone just 1/10th as much as I take from this board.
johnj :) :) :)
Posted by Squiggles on May 30, 2003, at 22:29:05
In reply to Re: Larry, your take on CBT? » Squiggles, posted by mattdds on May 30, 2003, at 21:39:02
I am in partial agreement with you.
Having just been reading Charles Medawar's
"Power and Dependence", you can understand
that i am in sympathy with the view that
the pharmaceutical cartel (just like all
big corporations) have an imbalance of power.
In matters of health, this is very serious
indeed, and the benefits of their product
may not be equivalent to the detriments such
as unreported, secretive, and unverifiable
ADRs.As for CBT, my view on that is that a person
must first be in a mental and emotional condition
where that kind of therapy is possible. After
all to be cognitively capable means to be
unperturbed psychologically - making this
a bit of a paradox.And nutrition and life-style -- well they may
be the road to a successful life - the kind i
envy in some people - but that is a matter
of fate and circumstances in a person's life.
There is not much we can do about grief, terror,
rape, war, etc. which leave victims in a
a bad condition. Nor, is there much we can
we do with people who inherit mental illness.So, it's complex.
I am sorry i immediately placed you in the
anti-med camp; perhaps i should explain that
though i am very critical myself of the bigpharms,
and have benefitted from withdrawing from
Xanax greatly, i am constantly worried of the
other extreme, which can be just as harmful.Hope that explains my position.
:-)
Squiggles
Posted by Squiggles on May 30, 2003, at 22:39:17
In reply to Re: Larry, your take on CBT? » Squiggles, posted by johnj on May 30, 2003, at 22:27:36
Oh, sorry i missed the trail of
posts putting this in clearer
perspective. I just sent a post
explaining my position vis a vis
nutrition, CBT, etc.Squiggles
Posted by Dr. Bob on May 31, 2003, at 0:18:38
In reply to Re: Larry, your take on CBT? » mattdds, posted by Squiggles on May 30, 2003, at 22:29:05
> Having just been reading Charles Medawar's
> "Power and Dependence", you can understand
> that i am in sympathy with the view that
> the pharmaceutical cartel (just like all
> big corporations) have an imbalance of power.I'd like follow-ups regarding the pharmaceutical cartel to be redirected to Psycho-Social-Babble.
> As for CBT, my view on that is that a person
> must first be in a mental and emotional condition
> where that kind of therapy is possible.And follow-ups regarding CBT to be redirected to Psychological Babble.
> I am sorry i immediately placed you in the
> anti-med campAnd follow-ups about posting policies to be redirected to Psycho-Babble Administration. Thanks,
Bob
Posted by Larry Hoover on May 31, 2003, at 11:58:13
In reply to Re: Larry, your take on CBT? » Squiggles, posted by mattdds on May 30, 2003, at 21:39:02
> >>Well, what with the emphasis on nutrition,
> magnesium, and Cognitive Behaviour Therapy,
> i wonder if you are not infact anti-psychiatric
> drug treatment
>
> Whoa! What on earth are you talking about?
>
> I will let Larry speak for himself, but since when does recognizing that there are other things that work for mental illness besides drugs mean you are "anti-psychiatry"?Well, you did such a good job presenting your arguments that I have little to add.
Nutrition, CBT, exercise, meditation, etc. are augmentative strategies, things that can be added to any treatment regime.
Lar
Posted by Dr. Bob on May 31, 2003, at 14:26:11
In reply to Redirect: Larry, your take on CBT?, posted by Dr. Bob on May 31, 2003, at 0:18:38
> And follow-ups about posting policies to be redirected to Psycho-Babble Administration.
Here's a link:
http://www.dr-bob.org/babble/admin/20030508/msgs/230441.html
Bob
Posted by Dr. Bob on May 31, 2003, at 14:30:32
In reply to Redirect: Larry, your take on CBT?, posted by Dr. Bob on May 31, 2003, at 0:18:38
> And follow-ups regarding CBT to be redirected to Psychological Babble.
Here's another link:
http://www.dr-bob.org/babble/psycho/20030529/msgs/230443.html
Bob
Posted by mattdds on May 31, 2003, at 16:32:22
In reply to Re: Larry, your take on CBT? » mattdds, posted by Larry Hoover on May 31, 2003, at 11:58:13
I'd actually love to go discuss CBT stuff at psycho psycho. I just always wind up talking to myself there, because nobody seems to post much on that board, and often I like to talk about CBT *and* meds in the same post.
Does this mean that if my post even mentions CBT, or does not exclusively discuss drugs, that I must go to another board?
That's what's hard - that my approach to my illness is integrative (combining meds, CBT, and supplements) and so I don't really know where to post.
Best,
Matt
Posted by Dr. Bob on June 1, 2003, at 14:22:02
In reply to Re: Larry, your take on CBT? » Larry Hoover, posted by mattdds on May 31, 2003, at 16:32:22
> Does this mean that if my post even mentions CBT, or does not exclusively discuss drugs, that I must go to another board?
No, but it definitely should go to Psychological Babble if it doesn't discuss drugs at all.
> That's what's hard - that my approach to my illness is integrative (combining meds, CBT, and supplements) and so I don't really know where to post.
Post on both boards, and integrate the information? :-)
Bob
This is the end of the thread.
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