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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 59. Go back in thread:
Posted by violette on September 15, 2010, at 18:42:44
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » violette, posted by SLS on September 15, 2010, at 10:15:52
Thanks for the info Scott..though I'm personally happy taking my doctor's word for it....
And to be frank, I'd rather see overdiagnosis of bipolar than people dx'd with personality disorders--dx that may not be covered by insurance or which can affect them for the rest of their life, ie employment, stigma..as long as they get the appropriate treatment.
If the overdiagnosis of bipolar is such a problem, doctors who revise the DSM could combine the axis i and ii if they wanted to. Any mental illness should be reimbursed-whether it's temporary traits or more permenant traits. I don't blame the doctors in the hospital for sometimes giving borderlines a bipolar dx and hope they continue to do so...to enable those who need intensive help to have access to treatments they may otherwise not have.
Posted by Phillipa on September 15, 2010, at 19:58:47
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 15, 2010, at 17:09:09
Very familiar with New Milford Ct being originally from CT any chance you know a pdoc from Wilton Dr Richard Hamilton as he was mine and wonderful. When I move to VA Beach area a psychiatrist I worked with labeled all his patients bipolar said they had been misdiagnosed if had another diagnosis. They were given lithium. He didn't go by lithium levels if they were low the patients response to them. Also quite a few Alchohoics received lithium and they looked relaxed in about two days. Now when I had pms and this was a very friendly and respected RN's greatly he would say dissolve small amount of lithium in a solution and drink and it would eliminate it. I'm really learning a lot from your posts and hope you stay awhile. Would love to here of Dr. Hamilton practiced in Norwalk Hospital. Phillipa a great doc in my opinion of course
Posted by emmanuel98 on September 15, 2010, at 20:10:25
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by violette on September 15, 2010, at 18:42:44
I have had very unstable moods. I get severely depressed, then snap out of it when I get busy. One psychiatrist I saw in a hospital suggested this was "hypomania" and I was bipolar 2. But there's a difference between hypomania (whatever the heck that is) and just feeling normal when busy. I think it's more likely that I have occasional bouts of atypical depression with mood reactivity and that I'm just moody. I don't get into hyper states, I just feel better sometimes.
To tell the truth, I don't even know what bipolar 2 is or how you would diagnose it. Hypomania is such a vague concept. Yet clinicians use it to justify mood stabilizers. My p-doc, who I also see for therapy refuses to diagnose me as having anything but recurrent depression.
Posted by Simon Sobo, M.D. on September 15, 2010, at 20:39:57
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by Phillipa on September 15, 2010, at 19:58:47
> Very familiar with New Milford Ct being originally from CT any chance you know a pdoc from Wilton Dr Richard Hamilton as he was mine and wonderful. When I move to VA Beach area a psychiatrist I worked with labeled all his patients bipolar said they had been misdiagnosed if had another diagnosis. They were given lithium. He didn't go by lithium levels if they were low the patients response to them. Also quite a few Alchohoics received lithium and they looked relaxed in about two days. Now when I had pms and this was a very friendly and respected RN's greatly he would say dissolve small amount of lithium in a solution and drink and it would eliminate it. I'm really learning a lot from your posts and hope you stay awhile. Would love to here of Dr. Hamilton practiced in Norwalk Hospital. Phillipa a great doc in my opinion of course>
Don't know the doctors you mentioned. I find the story about adding lithium for PMS fascinating. I don't have the balls to do something like that and I just can't bring myself to call it BP so it is "legitimate" to do it. I'm a real chicken. I criticize the mainstream for their obsession with diagnoses, and while I make a case for using meds for the particular psychological effect I think they have. and try to integrate that with what the patient seems to need regardless of diagnosi., It never occurred to me to use lithium that way. Perhaps that is because I don't really have a feel for what it does psychologically. I know it helps bipolar and sometimes unresponsive depressions but I just don't understand the psychological effects like I do SSRI and dopamine agonists
the real killer is that there is no journal where me and other clinicians of like mind could communicate their opinions and observations so that we might educate each other ( thereby helping patients with oriIginal sensible treatments.) The journals are all of the variety manifested by the other poster's point of view. It rules all of the journals. Like what numbers can you cite as "evidence." Otherwise there is nothing to talk about.
Frankly, I've given up. I tried to sell this point of view to the main journals, but they are locked tight in their paradigm. This is the first writing I've done in psychiatry in quite some time. I've turned to screenwriting. Now that is a very hard business to get a foot through the door. Anyone know someone?
As for posting here. It probably won't be long. My bluntness usually sets people off and pretty soon the squabbling begins. It's my fault as much as my critics. I could be nicer, but I am at an age where you start to get grumpy, or you don't have to make believe you are a goody goody person. I value frank talk more than nice nice talk. Like everyone else, however, I don't like where the frankness too easily leads. Useless "I am smarter than you" competitions. Later that night I can awake from a nightmare where I am a dummy. It really sucks
But thank you for appreciating my company. Believe it or not I like that as much as anyone else.
Posted by Simon Sobo, M.D. on September 15, 2010, at 20:49:36
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by emmanuel98 on September 15, 2010, at 20:10:25
Sounds right to me. The kind of quick change in mood you are talking about is exactly the nonsense an unpsychological psychiatrist would describe as a "mood swing" and be dead wrong. There are more and more psychiatrist thinking this way. It's pretty amazing watching my field be taken over by people with zero capacity for understanding human motivation.
If you are interested in what Bipolar 2 is and more relevantly, what it has mistakenly become, you might try some of my articles
Posted by Simon Sobo, M.D. on September 15, 2010, at 20:59:32
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by violette on September 15, 2010, at 18:42:44
Agree that making a diagnosis so insurance companies will reimburse is a legitimate strategy, but if so the patient should be told that is what is happening, so he doesn't believe he must take medication for his "chemical imbalance" that will be with him for life.
However you are wrong that bipolar is a good diagnosis from the point of view of getting insurance or employment opportunities
Posted by Phillipa on September 15, 2010, at 21:56:14
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 15, 2010, at 20:39:57
Oh I feel that there are quite a few people here that are interesting in your views. One thing I noticed and it stood out is when I reviewed all my floors patients labs for the day that a good majority had thyroid disorder. In what way do you see this or what do you feel it indicates. And if you like you can babblemail me . Which is private message. Simply click my posting name in blue and a screen for typing private mail appears. Your name is in black so yours is off. And when you get to the end of the message make sure you click at the bottom to send. I find your views fascinating. Thanks Phillipa
Posted by Simon Sobo, M.D. on September 16, 2010, at 5:34:09
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by Phillipa on September 15, 2010, at 21:56:14
If those lab results were from patients taking lithium it is not surprising at all. Hypothyroidism is a very common side effect of chronic lithium treatment. I check for it once a year. Thyroid abnormalities usually have major effects psychologically
> Oh I feel that there are quite a few people here that are interesting in your views. One thing I noticed and it stood out is when I reviewed all my floors patients labs for the day that a good majority had thyroid disorder. In what way do you see this or what do you feel it indicates. And if you like you can babblemail me . Which is private message. Simply click my posting name in blue and a screen for typing private mail appears. Your name is in black so yours is off. And when you get to the end of the message make sure you click at the bottom to send. I find your views fascinating. Thanks Phillipa
Posted by Simon Sobo, M.D. on September 16, 2010, at 5:58:44
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Conundrum, posted by SLS on September 14, 2010, at 8:15:16
Response to a medication is not, repeat is not, diagnostic, of anything. Much of the discussion here is based on that mistaken assumption. When I was beginning practice it was not unusual to treat panic and high anxiety patients with "major tranquilizers" The "minor tranquilizers" were the benzodiazipines. This stopped when it became clear that tardive dyskinesia was a real problem. Then suddenly drugs like Thorazine and Haldol were being called "anti-psychotics" as if that is all they did. Thorazine was originally a preanesthetic calming agent until some one thought of using it in psychiatry, The newer atypical neuroleptics didn't cause anywhere near as much tardive dyskinesia so they began to be used more and more in non psychotic conditions.
I disagree with your doc's assessment that if you use a "mood stabilizer" it will help with mood instability. I suggest you take a look at my discussion of this very point in my article "Mood Stabilizers and Mood Swings: In Search of a Definition" http://www.psychiatrictimes.com/mood-disorders/content/article/10168/54226
Mood stabilizer is a real sloppy term that seems to be applied whenever an anti manic drug is found. In my opinion SSRIs, when they work, are damn good mood stabilizers, in the sense that term has been commonly applied, when given to a non manic patient
> > My pdoc has recently suspected I have issues with mood stability. I'm not sure it fits. I haven't responded well to lamictal or abilify, except that abilify seems to work like a cup of coffee for a few days and then stops. I'm not sure the lamictal has done anything at all and I am on 400mgs now.
>
> I was on Lamictal 300mg for quite awhile. It produced unacceptable cognitive impairments. When I first reduced the dosage to 200mg, I experienced an increase in the severity of depression for two days, and then stabilized. Similarly, I have recently reduced to 100mg with the same outcome. I feel no better at 100mg than I did at 300mg. I think people are fooled into raising the dosage when they experience transient improvements upon each dosage increase.
>
> > I'm guessing my suspected diagnosis will change since those meds didn't work and higher doses of abilify made me feel worse.
>
> That's disheartening. In what ways did Abilify make you feel worse?
>
>
> - Scott
Posted by SLS on September 16, 2010, at 6:11:01
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by violette on September 15, 2010, at 18:42:44
> Thanks for the info Scott..though I'm personally happy taking my doctor's word for it....
I think the DSM is woefully inadequate and just short of comical when it comes to describing Axis I disorders. I am not very knowledgable about Axis II disorders.
- Scott
Posted by ed_uk2010 on September 16, 2010, at 13:40:54
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 15, 2010, at 17:09:09
>I don't have the slightest idea what the true rate is.
Neither do I. Although I don't have any evidence, I get the distinct impression from this website that Bipolar II has become a catch all diagnosis for a wide variety of mood disorders. It seems to include a lot of patients who would have (in years gone by) received diagnoses such as agitated depression, treatment-resistant depression, recurrent depression etc.
I've also noticed that there seems to be a tendency to diagnose antidepressant adverse reactions (or lack of response) as being due to bipolar disorder eg. if an SSRI causes agitation/anxiety, it must be bipolar.
Posted by Simon Sobo, M.D. on September 16, 2010, at 13:59:26
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by ed_uk2010 on September 16, 2010, at 13:40:54
At least in children DSM V is specifically designating an entity for grouchy, agitated kids, so they can no longer be thrown into the bipolar waste basket and given antipsychotics.
As for agitated depression, treatment-resistant depression and the like some of them may indeed become manic depression, but it is far too glib to automatically diagnose them bipolar rather than be alert to the possibility.
Posted by SLS on September 16, 2010, at 14:52:52
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by ed_uk2010 on September 16, 2010, at 13:40:54
> >I don't have the slightest idea what the true rate is.
>
> Neither do I.Not the slightest idea?
Most of the older literature suggests that the rate of incidence of bipolar disorder is between 1% and 1.5%. More recent quotes go as high as 3%.
- Scott
Posted by ed_uk2010 on September 16, 2010, at 15:20:20
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 15, 2010, at 20:39:57
>As for posting here. It probably won't be long.
That's a shame. It's always good to hear from new people who have something interesting to say.
Posted by Tomatheus on September 16, 2010, at 18:28:34
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 16, 2010, at 5:58:44
> In my opinion SSRIs, when they work, are damn good mood stabilizers, in the sense that term has been commonly applied, when given to a non manic patientMaybe for some patients. I actually experienced a destabilizing of mood on the SSRIs Paxil and Prozac even though I had never experienced any mania or hypomania up to that point. I've also never experienced any mania or hypomania on Wellbutrin or the MAOIs. So, for me, inhibiting the reuptake of serotonin seems to be the *only* thing that does bring on hypomania and rapid cycling, and I find it hard to believe that SSRIs could be considered to be effective "mood stabilizers" (since they do the opposite to me).
Tomatheus
Posted by Phillipa on September 16, 2010, at 20:16:43
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 16, 2010, at 5:34:09
No this was a different hospital and docs and we treated all diagnosis's from depression, schizophrenia, bipolar, even substance abuse. I also was in charge here. And from personal experience I know the thyroid effects mood as now mine is hasimotos not caused by a med autoimmune. Also we did not use TCA's nor MAOI's. Klonopin was the drug of choice at the time for anxiety. When I had my first panic attack and it was bad ended up on miltown 400mg and valium 5mg TID. Also three beers a night. Now this was before nursing and felt great after a while so just discontinued the miltown. Never had a withdrawal effect wonder why? Now I'm 64 still on low doses of benzos but don't take during day. And they really don't work anymore. Also lost sense of taste and smell 7 years ago MRI tomorrow got to find out one last ditch attempt if a physical reason. Thanks for answering. And don't leave. Phillipa
Posted by Lou Pilder on September 16, 2010, at 20:18:16
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by Tomatheus on September 16, 2010, at 18:28:34
Friends,
'' If anyone suggests to you to take Paxil, I am requesting that you view the folloing video.
Lou
To see this video,
A. pulll up google
B. Type in:
[youtube, Paxil deaths]
You wll see a frame with writing on it.It was posted by dixiefd64
Posted by Lou Pilder on September 16, 2010, at 20:51:44
In reply to Lou's request-psiehmhunpsez, posted by Lou Pilder on September 16, 2010, at 20:18:16
Friends,
If anyone suggests that you take an SSRI, I am requesting that you viewthe following video..
Lou
To view this video;
A. pull up google
B. Type in:
[youtube, Ex-Parmaceutical Rep]
you will see a picture of a lady and the time is 9 min and the date is April 25, 2007
Posted by Simon Sobo, M.D. on September 16, 2010, at 21:26:19
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by Tomatheus on September 16, 2010, at 18:28:34
Sorry, I guess my statement about SSRIs was confusing. I didn't mean it is a mood stabilizer for bipolar patients. I meant that for non-bipolar excitable patients they often calm down the intensity of emotions. I call them the well whatever drugs. Sorry for the confusion
Posted by Lou Pilder on September 16, 2010, at 21:27:10
In reply to Lou's request-psiehmhunpsezesesariez, posted by Lou Pilder on September 16, 2010, at 20:51:44
Friends,
If you have been told to taske an SSRI, I am requesting that you view the following video.
Lou
To see this video,
Pull up google
B: Type in;
[youtube, SSRIs-song from the "reason"
you will see a red picture and was posted on Jan 15, 2009 and is 4 min
Posted by Phillipa on September 16, 2010, at 21:44:04
In reply to Lou's request-psiehmhunpsezmewdpstahybulizr, posted by Lou Pilder on September 16, 2010, at 21:27:10
Lou have taken SSRI's for years and paxil at l0mg worked well. So I didn't die it worked quite well for me. Did you have a bad experience with SSRI's . If so sorry. Phillipa
Posted by Lou Pilder on September 16, 2010, at 22:30:11
In reply to Re: Lou's request-psiehmhunpsezmewdpstahybulizr » Lou Pilder, posted by Phillipa on September 16, 2010, at 21:44:04
Freiends,
If you are under the impression that a testamonial here is a valid reason to take psychotropic drugs, I am requesting that you watch the following video
Lou
To see this video,
A. pull up google
B. Type in:
[youtube,The About Antidepressants #1]
Look at around the 4th one down. It is posted on Aug 22, 2009 and says,{the Health Effects of long-term anti depressant use. when the video comes up, it will be by Dr Timothy Scott
Posted by Lou Pilder on September 17, 2010, at 10:36:18
In reply to Lou's request-datruz, posted by Lou Pilder on September 16, 2010, at 22:30:11
Friends,
If you are in he mind of (redacted by respondent) psychiatry or in the mind of taking psychotropic drugs, I am requesting that you view the following video.
Lou
You could view this video by;
A. Pull up google
B. Type in:
[youtube,Psychiatry Industry Part 3/10]
you will see a picture that was posted on Jan 24, 2009 and is 10 min long.
Posted by olivia12 on September 20, 2010, at 21:14:25
In reply to Lou's request-duyunho, posted by Lou Pilder on September 17, 2010, at 10:36:18
This was a hideous video--why did you wish us to view it? I barely was able to get through 1/2 of it and was left wondering why you would encourage one to view it. Perhaps I am missing your point? This is a site to encourage one to write on their experiences with mental illness and meds that have helped them to escape some of the dreary day-to-day "I feel badly". No disrespect to you, Leo, but what are you getting at? Yes, many mistakes have been made re: mental health, but we no longer drill into the heads of schitzophrenics. We are not perfect, but we have evolved. What was your intent?
Posted by olivia12 on September 20, 2010, at 21:18:59
In reply to Re: Lou's request-duyunho, posted by olivia12 on September 20, 2010, at 21:14:25
Lou--not Leo--sorry, I was kinda taken aback by that awful video.
This is the end of the thread.
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