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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by linkadge on January 18, 2007, at 16:24:04
I keep hearing that bipolar depresson is very hard to treat.
This is especially true when you decide to classify depression that doesn't respond to treatment as bipolar.
Linkadge
Posted by Phillipa on January 18, 2007, at 16:56:26
In reply to Bipolar depression, posted by linkadge on January 18, 2007, at 16:24:04
That's what the pdoc around here are doing saying tx resistant depression is a new form of bipolar. so add a mood stabalizer. Two have done this with me. and no it doesn't work. Love Phillipa
Posted by Meri-Tuuli on January 18, 2007, at 17:29:21
In reply to Re: Bipolar depression » linkadge, posted by Phillipa on January 18, 2007, at 16:56:26
I think perhaps that treatment resistant depression is a disorder of the mind, rather than the brain.
Posted by SLS on January 18, 2007, at 17:56:42
In reply to Re: Bipolar depression, posted by Meri-Tuuli on January 18, 2007, at 17:29:21
> I think perhaps that treatment resistant depression is a disorder of the mind, rather than the brain.
I think that all depressions are disorders of the universe.
- Scott
Posted by chiron on January 18, 2007, at 22:53:24
In reply to Re: Bipolar depression » linkadge, posted by Phillipa on January 18, 2007, at 16:56:26
My opinion is that the current catagories of depression need to be expanded or revamped. There is a spectrum of disorders that don't always fit into neat simple boxes. My pdoc sometimes thinks I have some bipolar symptoms, but he's not sure where I fit. We are just beginning to understand how the mind/brain works, and we have a long way to go.
-and just because something is "treatment-resistant" doesn't mean there isn't a biological cause. There are depressions that were "treatment-resistant" ten years ago that today can be eradicated with a pill.
Posted by Jimmyboy on January 18, 2007, at 23:30:00
In reply to Re: Bipolar depression, posted by Meri-Tuuli on January 18, 2007, at 17:29:21
Negative thoughts and pessimism don;t help, but its certainly not "just in your mind" , b/c the few times I have had remission because of medications, not just positive circumstances, my thinking changed also, for the better.. so I think you have to fix the "hardware" before you can truly completely fix the "software".
my opinion.
JB
Posted by Reggie BoStar on January 19, 2007, at 2:11:44
In reply to Bipolar depression, posted by linkadge on January 18, 2007, at 16:24:04
I was diagnosed as treatment-resistant years ago. By the time they changed that to bipolar II, I really was experiencing manic cycles that never happened before.
So in my case, at least, the bipolar diagnosis was not automatically applied when I was diagnosed as treatment-resistant; it was applied when I actually had become bipolar.
I'm not saying a bipolar diagnosis isn't made by many pdocs for someone who is treatment-resistant. I'm only saying that it didn't happen that way with me.
As far as depression being a disease of the "mind" and not the "brain": this can be a conclusion reached only by a "dualist", that is a person who believes that the mind and brain are two separate entities.
For a "materialist", who believes the brain and mind are one and the same, the conclusion that something can affect one and not the other has no meaning.
As someone else in this thread has said, chemical changes induced in the brain by medications can indeed change the way someone thinks. This would suggest one of two possibilities:
1. The mind and the brain are in fact one and the same, as a materialist believes.
2. Even if the mind and brain are separate entities, as a dualist believes, then there must be some degree of dependence between the two. Otherwise, chemical changes induced in the brain would not affect thinking.
Obviously this is open to debate, as it has been since Descartes started making waves with his dualist philosophy. Also, I've only scratched the surface when it comes to pro and con arguments for either philosophy. That's because I only know those two!
Take care,
Reggie BoStar
Posted by Meri-Tuuli on January 19, 2007, at 2:40:28
In reply to Re: Bipolar depression, posted by Jimmyboy on January 18, 2007, at 23:30:00
Obviously, things are very complicated and everyone is unique. Everyone's mental illness is unique. Obviously, you can't say all treatment resistant depression is due to X, Y or Z; generalizations are dangerous. I just wanted to provoke thinking about it. If you've tried lots of drugs, combinations, etc doesn't there come a time when you question this tactic and think that that something totally different is needed? I mean, isn't that the next logical step?
I really think that in psychiatry in general the biochemical imbalance/disorder card is played way too often. I really do think that, and actually my pdoc agrees with me. For me anyway (I'm not talking about others) psych drugs have been a complete and utter waste of time - I really wish I'd never have touched them. I'm doing much better now that I ever had on them and I'm addressing my issues and I'm in graduate school. And if you would have seen me a couple of years ago, you would have seen me posting here about my latest drug trial, and so on and so forth. I was desperate to find a chemical solution to my problems.
It had never occurred to me that the drugs don't work because my problems are entirely in my mind. And when you realise that, its very powerful.
Plus I do tend to think that its very convenient to ignore the psychological aspects of mental illness. Its convenient for the time hassled pdocs and GPs - they simply hand out medication in a 10min slot, rather than have hourly therapy sessions - they can get more money this way. Its very convenient for the drug companies making billions from us. Its very convenient for the patient who can blame his/her problems on biochemical inequalities, and not have to address their low self esteem etc, and thus not realizing that its their own doing. It can be a very hard pill to swallow (excuse the pun!) to realize that your illnesses are entirely constructed by your mind.
Anyway, I don't want to start one of 'those' threads - I'm not saying don't take drugs or anything like that, but I just wanted to say my points. I just think that the power of the mind (as opposed to the brain) is often under-represented. I'm not saying that therapy is the answer either or that their aren't physical manifestations of these disorders. I just wanted to get people thinking about their illness and wondering if they are like me. I doubt I can be the only one out there.
Posted by ronaldo on January 19, 2007, at 2:50:44
In reply to Re: Bipolar depression, posted by Meri-Tuuli on January 19, 2007, at 2:40:28
Posted by SLS on January 19, 2007, at 6:30:44
In reply to Re: Bipolar depression, posted by Meri-Tuuli on January 19, 2007, at 2:40:28
> generalizations are dangerous
Thank you.
- Scott
Posted by linkadge on January 19, 2007, at 8:18:33
In reply to Re: Bipolar depression, posted by Meri-Tuuli on January 19, 2007, at 2:40:28
It was just interesting that on the online conferences on treatement of depression in the 21st century, they list failure to respond to antidepressants as indicitave of bipolar disorder.
I can see that bipolar depression may not respond well to antidepressants, but think it is wrong to assume that those who fail to respond to antidepressants are bipolar.
Linkadge
Posted by Quintal on January 19, 2007, at 16:08:11
In reply to Re: Bipolar depression, posted by linkadge on January 19, 2007, at 8:18:33
My last pdoc told me I don't have bipolar disorder because I haven't responded to antidepressants. He thinks someone with bipolar would have had a manic episode after taking so many antidepressants without a mood stabilizer.
Q
Posted by linkadge on January 19, 2007, at 16:27:03
In reply to Re: Bipolar depression » linkadge, posted by Quintal on January 19, 2007, at 16:08:11
That makes more sense to me.
Linkadge
Posted by chiron on January 19, 2007, at 20:21:22
In reply to Re: Bipolar depression, posted by Jimmyboy on January 18, 2007, at 23:30:00
> Negative thoughts and pessimism don;t help, but its certainly not "just in your mind" , b/c the few times I have had remission because of medications, not just positive circumstances, my thinking changed also, for the better.. so I think you have to fix the "hardware" before you can truly completely fix the "software".
>
> my opinion.
>
> JB
Definitely. Good analogy.
It must be difficult to understand if you don't have hardware problems.
Posted by Meri-Tuuli on January 20, 2007, at 13:00:50
In reply to Re: Bipolar depression, posted by chiron on January 19, 2007, at 20:21:22
> > Negative thoughts and pessimism don;t help, but its certainly not "just in your mind" , b/c the few times I have had remission because of medications, not just positive circumstances, my thinking changed also, for the better.. so I think you have to fix the "hardware" before you can truly completely fix the "software".
> Definitely. Good analogy.
> It must be difficult to understand if you don't have hardware problems.Yes I agree with this also. Of course, I think that there is an infinite variety of depressions etc. I said that I believe all depression and mental illness are completely unique. So I agree with what you're saying too. I think some depressions are biological and I think some depressions are entirely psychological and there is alot of overlap between. But my point was that, for me, I believe my mental problems to be entirely psychological, and I was just trying to get people to question themselves. (My pdoc agrees with me, BTW, on this so its not just some anti-med sentiment I dreamed up). And I wanted to make the point that I think the psychological aspect of mental illness if often down played and not treated enough, well in my opinion.
And I think that there are different types of remission. I wouldn't call an absence of negative symptoms true remission either.
And yes, of course your thinking is going to change if you're experiencing a chemically induced flood of pleasure or a discontinuation of symptoms. But I think thats just trying to mask the underlying root cause of things. Like taking a paracetamol for a hangover headache - you still have a hangover headache, but the paracetamol just masks the pain. And obviously there's something to be said for just masking things until you're at a place when you can work on your problems. Sigh. I'm obviously a very small minority in my thinking here....and no shrink I might add!
Essentially, I wanted the people who are striving for a chemical solution to their problems to sit up and think and see if they think they could be helped by a more psychologically oriented approach, or if they really feel that the solutions to their problems lie in a drug. Because I was one of those medication people a couple of years ago, and really, it was a waste of time.
Oh well.
Meri
Posted by linkadge on January 20, 2007, at 21:41:45
In reply to My thoughts.... » chiron, posted by Meri-Tuuli on January 20, 2007, at 13:00:50
I think it is very difficult to say when a depression is biochemical or when it is environmental.
As tempting as it is to conclude, a response to an antidepressant unfortunately does not mean that a persons problems were entirely biochemical.
Many of these drugs were discovered, for instance, for their abilities to reverse experiementally induced depression in animals. Ie, depression induced by chronic mild stressors.
These mice had no known genetic susceptability to depression, they just react the same way that all other mice do to unavoible stress, with depression.
I agree it all seems like a nice closed case, untill the drugs poop out.
It also gives a person a better sense of control over their life if they conclude that their depression was biochemical, and not environmental. That way the solution is tangable, managable, and within one's control. That is less than can be said about the chronic mild stressor that is life.
Linkadge
Posted by polarbear206 on January 22, 2007, at 11:30:21
In reply to Re: Bipolar depression, posted by linkadge on January 19, 2007, at 8:18:33
> It was just interesting that on the online conferences on treatement of depression in the 21st century, they list failure to respond to antidepressants as indicitave of bipolar disorder.
>
> I can see that bipolar depression may not respond well to antidepressants, but think it is wrong to assume that those who fail to respond to antidepressants are bipolar.
>
>
> LinkadgeI find in the research I have done over the years that there is a very high prevalence to underlying undiagnosed bipolar disorders. However, this is my opinion and what I have experienced working in the psychiatric field.
polarbear
Posted by Phillipa on January 22, 2007, at 19:27:25
In reply to Re: Bipolar depression, posted by polarbear206 on January 22, 2007, at 11:30:21
And if they just never work and the side effects are so horrible you can't tolerate them. Do you feel the same? As I too worked in psych but you're more recently involved. I am truly interested. Thanks Phillipa
Posted by polarbear206 on January 23, 2007, at 11:32:23
In reply to Re: Bipolar depression » polarbear206, posted by Phillipa on January 22, 2007, at 19:27:25
> And if they just never work and the side effects are so horrible you can't tolerate them. Do you feel the same? As I too worked in psych but you're more recently involved. I am truly interested. Thanks Phillipa
Has your thyroid been unstable in your plight for medication relief?? That can really compound the problem. Dueling diagnoses create a challenge as well as those who are sensitive to medication and side effects. Have you seen anyone who specializes in treatment resistant depressions or a psycho-pharmacologist?
Posted by Phillipa on January 23, 2007, at 21:47:33
In reply to Re: Bipolar depression))Phillipa, posted by polarbear206 on January 23, 2007, at 11:32:23
No I keep trying to find someone in the Charlotte North Carolina area. Would you know how to help me. I'm not afraid to ask for help. So far my attempts have failed in doctors and therapists. There must be a way. I've googled and even in person seen three therapists two new docs and suggestions? I will give you my e-mail via babblemail. Love Phillipa
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