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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 twinleaf on October 19, 2008, at 0:27:20
I can scarcely believe I'm writing this, but the major depression which I have had since my mother died ten years ago disappeared completely about a month ago! I began to notice that people seemed more relaxed and friendly around me and yesterday I was startled when three people told me I looked "pretty". (to appreciate how unusual this is, I have never been called pretty in my entire life until now, and I'm not young any longer!) For weeks I was sure that I would start to feel awful again at any moment, but it hasn't happened. Medication once played a big part in my treatment, although none of them worked very well. Now I take just 300 mg of Lithium and vitamins. TMS has been extremely helpful during the times when I felt the worst; now that it's going to be readily obtainable, I don't know whether I'll need it or not.
I was trying to understand what made this happen. Longtime posters might remember some of the posts about the psychoanalyst I went to from 2003 to 2007 when I used the name Pfinstegg- the one who seemed so warm and skillful, but who suddenly fell completely apart, told me he didn't feel safe in the office with me, was afraid I was going to attack him sexually, and ended by shouting at me to get out of his office. I had really trusted him and had certainly told him far more things than I have had time to tell my present analyst. It's hard to put my finger on what is better and different with this one. One of the things he has faithfully done is to always try to make up missed sessions. For example, he had jury duty several months ago. When it was cancelled at about 10 AM, he called my cell to see if I could come in sometime that day. Another time, I was prevented from driving there by a fire which closed the highway; when I called, he asked if I could come at 7 PM- late for him. When he goes away on a trip, we usually have extra sessions before and after. I think he is like this with all his patients, but I think he is especially aware of how painfuj the rejection by the other analyst was to me. Even though I know he actually had a breakdown, somehow it still hurt a lot. But I'm wondering...the new analyst-Dr. K. -doesn't let his mind stray from me. He doesn't put much emphasis on verbal interpretations, but I'd call him a world-class listener..Somehow, the things I have told him get silently metabolized by him, and then returned to me in forms that are less painful, less anxiety-producing, less shameful, less hopeless. He does want you to work hard; there is never a choice to not say something. He needs me to say everything I possibly can. Comparing the two analysts, I'd say that this one places a lot more emphasis on the relationship that we have- especially in tracking and expressing the slightest changes in feeling which occur in me while I am with him. Even though he's a psychoanalyst, we have yet to analyze a dream! When I think of him- that's every minute or two- I see this wonderful face with the thoughtful expression and the penetrating eyes. I'm the center of his world when I'm there, and he's the center of mine.
Daisy wrote recently about "moments of meeting". I read somewhere that a baby cuddling with its mother, smiling, meeting her eyes, looking away, grasping a toy, babbling- in 20 minutes of doing that will lay down many thousands of new connections between the 100 billion neurons it is born with. Since it has been discovered not too long ago that the brain can change and remodel its connections throughout life, and can even create new neurons in some places like the hippocampus, something like that must be happening when therapy really works. Maybe we can think of effective therapy as an extra-long, extra-good mother-baby experience. Before long, there will be much better MRIs; perhaps we'll be able to see it happening!
Posted by Phillipa on October 19, 2008, at 12:52:12
In reply to it crept up on me when I wasn't noticing..., posted by twinleaf on October 19, 2008, at 0:27:20
Twinleaf that is fantastic news. What meds were you on and the TMS is what cured you? I'm sure your very pretty if not beautiful. So relish in that. And bet you are young too. Live it up. Love Phillipa
Posted by lucie lu on October 19, 2008, at 13:23:59
In reply to Re: it crept up on me when I wasn't noticing... » twinleaf, posted by Phillipa on October 19, 2008, at 12:52:12
Twinleaf,What a wonderful story! I'm glad you decided to share it. I admire your resilience in not giving up on analysis after your first analyst had a (psychotic?) melt-down. You described those times rather matter-of-factly but they must have been devastating and frightening at the time. Your new analyst sounds wonderful (must Daisy's T move over in my crush list?), and I'm very glad that you are having the corrective experience you were denied before by your previous analyst's breakdown.
I am convinced that therapy potentially does remodel the brain. I believe that may be the major way in which LT therapy of any sort works. Thinking new ways or experiencing new ways to relate to others, or a new type of primary relationship is bound to rewire circuits. Maybe you also heard as I did that LT untreated depression also remodels the brain and, of course, not for the better, shrinking the hippocampus etc. And that early treatment for depression can prevent these structural effects on the brain, whereas the untreated depressed people have a much greater risk of having subsequent episodes. I found all this to be perfectly reasonable and understandable when put in the context of therapy, the therapeutic relationship, and corrective experiences. Good grief, how did I get started on this?? I guess I just want to see therapy validated in terms of its effectiveness and to justify the considerable investment many of us have put into it.
Anyway, thanks so much for sharing your story, which I found to be very moving. And most of all, I'm glad to know you are feeling so much better these days.
Best,
Lucie
Posted by twinleaf on October 19, 2008, at 13:51:41
In reply to Re: it crept up on me when I wasn't noticing... » twinleaf, posted by Phillipa on October 19, 2008, at 12:52:12
Thank you, Phillippa! That's very sweet of you to say. I'm not young (52) and not pretty or beautiful; I think everyone was accustomed to seeing me look kind of discouraged and sad, much as I tried to conceal it, and it was me looking happier and brighter which they probably noticed even before I did.
Over the past ten years, I've taken Prozac, Paxil, Lexapro, Zyprexa, Elavil, Wellbutrin and Lithium. I never really felt any of them had much antidepressant effect. They toned down the pain of the depression some but left me feeling very indifferent and flat- as many others have reported. Wellbutrin and Lithium were probably the best, but I began having elevated blood pressures on the Wellbutrin- that was the one I would have liked to keep on taking- wouldn't you know!.
As to the TMS, it has been shown in animals to have very good effects on brains whose physiology has been altered by depression. Some of the things it does include increasing the blood flow to the left frontal cortex (this is decreased in depression), damping down the HPA axis and thus lowering cortisol output, (it tends to be elevated sometimes, although not always, in depression), increasing BDNF (brain-derived neurotrophic factor) in the hippocampus, which in turn allows the CA3 cells there to start regaining normal architecture and the production of hew neurons (in health the hippocampus makes several thousand new neurons daily).. I haven't had any TMS for about a year and a half, but it really does work wonderfully for about half of the people who try it- and these are all people who have failed a number of drug trials. Since it seems to get at the heart of what goes wrong in the brain during depression, it might be very valuable in helping the brain get back to a physiologically more normal state. I'm considering continuing it on a maintenance basis it for that reason.
I don't think any of the medications I took were in any way useful in helping overcome the depression. I do think the TMS
may have played in important role by giving my brain periods of more normal functioning. But I think the most vital and important role was played by the wonderful therapy I have had for the last year and a half.
Posted by lucie lu on October 19, 2008, at 13:51:44
In reply to it crept up on me when I wasn't noticing..., posted by twinleaf on October 19, 2008, at 0:27:20
Posted by Kath on October 19, 2008, at 14:13:34
In reply to it crept up on me when I wasn't noticing..., posted by twinleaf on October 19, 2008, at 0:27:20
Also wonder what TMS is? And what vitamins & dosages?? B vitamins??
How lovely to be told you look pretty.
I've loved being told that I look younger than I am - 61 - (by all kinds of people, including my 24 yr old son's friends). Sorry comment on society I guess, that there's such emphasis on YOUTH & looking YOUNG etc etc. I hate it that I've 'bought into' that!
Anyway, sorry to get off topic.
I am very happy for you that you're feeling better What a wonderful miracle-gift!
hugs, Kath
Posted by twinleaf on October 19, 2008, at 14:29:34
In reply to Re: it crept up on me when I wasn't noticing... » Phillipa, posted by lucie lu on October 19, 2008, at 13:23:59
Thank you, Lucie. I couldn't agree more about the seriousness of depression and the need to treat it promptly- because of those changes which take place in the brain which you mentioned. But it does seem like almost all of us have to spend a lot of time floundering around trying different medications, and trying to find a helpful therapist.
Even though my previous analyst really did break down, I had a terrible time dealing with it, and for a long time thought it was my fault that it had happened.. Now, I feel more objective about what happened; at the time it caused me endless sleepless nights and long bouts of hopeless crying- actually, part of almost every day for a year. It was a tragedy for everybody. It happened during the spring of 2007, and is documented in painful detail in the archives under my then posting name, Pfinstegg- in case anyone wants to read the gory details!. But I don't think I communicated how long and painful the mourning period was for me. The Babblers were absolutely wonderful - tons of unconditional understanding and support.
TMS is Transcranial Magnetic Stimulation, which has just been approved by the FDA on October 9 of this year for TRD depression. It uses electromagnetic pulses, and unlike ECT does not require anesthesia and does not cause any memory loss or other mental changes. Even though the good effect was only a few weeks long for me, one or two treatments would reliably bring me back to a depression-free state. I think, because it is so safe, it is going to rapidly become important in the treatment of bipolar and unipolar depression. People who need more help than their medication and therapy are giving them can give TMS a try and have peace of mind while they are doing it. The worst thing it can do is not work; it won't damage you the way ECT might.
Posted by twinleaf on October 19, 2008, at 14:54:03
In reply to Re: it crept up on me when I wasn't noticing... » lucie lu, posted by twinleaf on October 19, 2008, at 14:29:34
I know it! There's just no escaping the pressure to stay as young-looking as possible. The vitamins are:
Solgar's V tablets, which has some of all the vitamins and minerals
Twinlab B-complex- for more of all the Bs (your body will just use what it needs, and you can't take too much, the way you can with the fat-soluble ones A,E,and D)
Vitamin D3- 800 iu-making a total of 1200 units when I include the Solgar tablet
Calcium citrate with magnesium= 1000 mg.
and a little thing I read in the National Enquirer, that fount of medical wisdom, 20 years ago, which said "take this every day, and your hair won't ever get gray"
PABA 500 mg
Pantothenic Acid 200 mg
Folic Acid 400 mcgI did, and it hasn't.
Posted by stellabystarlight on October 19, 2008, at 15:48:57
In reply to it crept up on me when I wasn't noticing..., posted by twinleaf on October 19, 2008, at 0:27:20
"In the midst of winter, I finally learned that there was in me an invincible summer." -Albert Camus
I'm so happy for you, Twinleaf! This must be such an amazing time of rediscovering your authentic self. Your successful therapy story gives me hope that my therapy will work out for me. I've read your old posts about your horrific abandonment experience, and I admire the way you handled such pain with so much dignity. I'm not surprised that you are winning your battle with depression...I always thought you could do it...your intelligence and dignity come through your posts. You're not just a "pretty" face! Lol!
I believe people are saying you look pretty because your inner beauty is radiating from your authentic self. The first time I had this experience was not through therapy but through a soul awakening trip through Asia. I came back to the US feeling at peace, forgiving and loving myself and others. I noticed after the trip, that people were warm and calm in my presence, and couldn't get enough of my new loving self. Unfortunately, this only lasted for 3 months as I slowly started to succumb to the painful darkness again. But I was grateful for this beautiful experience no matter how brief, and held on to it as one of the most remarkable time in my life where I connected to my true self...without pain and emptiness.
That was 15 years ago, but recently, I started experiencing brief moments of that same wholeness again with my therapist. It started happening when I finally realized that he truly does care about "me". Not as a woman or a patient that pays his bills, but as a human being that he can "see", fundamentally "feel", and connect to on a deep level. With this powerful realization, I found myself thinking if he can "love" me, then maybe I am lovable and worth loving. My T is not as "steady" as your Dr.K, and we have ruptures from time to time, but I'm learning and healing through the repairs with him.
Through your post, I now see my T and I together as loving parents, "laying down new connections" and re-wiring a neglected and traumatized adopted baby(myself) through love and understanding. Mirroring the baby's thoughts and feelings as you have said, in a way that's "less painful, less anxiety-producing, less shameful, less hopeless." Fifty minutes a week, he and I are parents nurturing and healing the baby...lovingly watching her "cuddling with its mother, smiling, meeting her eyes, looking away, grasping a toy..."
I wish we could throw you and Dr. K a "depression elimination" party! Your Dr. K is not only a world-class listener, but also a world-class "lover" for allowing himself and you to love you, together. Thanks for sharing the wonderful news!
Stellabystarlight
Posted by lucie lu on October 19, 2008, at 19:01:52
In reply to Re: it crept up on me when I wasn't noticing... » lucie lu, posted by twinleaf on October 19, 2008, at 14:29:34
> Thank you, Lucie. I couldn't agree more about the seriousness of depression and the need to treat it promptly- because of those changes which take place in the brain which you mentioned. But it does seem like almost all of us have to spend a lot of time floundering around trying different medications, and trying to find a helpful therapist.
So true. Actually I was thinking about my own experiences with depression and that of my 20-something daughter. I had my first significant episode of depression as a child; it lasted about two years. Then small ones followed and another major one in my teens that lasted about 3 years. In those days (60's) it was believed that children did not get depressed so there was no treatment available. I have battled recurrent depression for many years, hospitalized once. So... the point of this is that my daughter, when she was in her teens, became severely depressed and she too was hospitalized. But she got treatment pretty promptly - meds and therapy. The message I got from that study was that my years of untreated depression are likely to have affected my brain structure and chemistry, leaving me vulnerable to recurring depressive episodes (although I believe that therapy - and maybe meds as well - are reversing this trend). My daughter though is fortunate because she was not depressed long enough for significant brain changes, so she will not be likely to have future recurrences. I like this theory, it makes sense to me. Plus it's a comfort to me as a mother. Neuroscience is wonderful.
> Even though my previous analyst really did break down, I had a terrible time dealing with it, and for a long time thought it was my fault that it had happened.. Now, I feel more objective about what happened; at the time it caused me endless sleepless nights and long bouts of hopeless crying- actually, part of almost every day for a year. It was a tragedy for everybody. It happened during the spring of 2007, and is documented in painful detail in the archives under my then posting name, Pfinstegg- in case anyone wants to read the gory details!. But I don't think I communicated how long and painful the mourning period was for me. The Babblers were absolutely wonderful - tons of unconditional understanding and support.
I recognize your old posting name. What an awful, terrible, sad experience! I'm so sorry you had to go through that. But it seems remarkable that you still had the courage to risk yourself again after such an experience. And now you are rewarded with a wonderful relationship :)
> TMS is Transcranial Magnetic Stimulation, which has just been approved by the FDA on October 9 of this year for TRD depression. It uses electromagnetic pulses, and unlike ECT does not require anesthesia and does not cause any memory loss or other mental changes. Even though the good effect was only a few weeks long for me, one or two treatments would reliably bring me back to a depression-free state. I think, because it is so safe, it is going to rapidly become important in the treatment of bipolar and unipolar depression. People who need more help than their medication and therapy are giving them can give TMS a try and have peace of mind while they are doing it. The worst thing it can do is not work; it won't damage you the way ECT might.
I had heard of that but didn't realize it was so effective or so quickly becoming mainstream. I'll have to look into it. Thanks for the info.
Lucie
Posted by twinleaf on October 19, 2008, at 19:13:14
In reply to You do look pretty! » twinleaf, posted by stellabystarlight on October 19, 2008, at 15:48:57
Thank you so much, Stella, for your lovely post, which touched on so many things- all so important, moving and life-changing. It's so good to hear that your relationship with your therapist contains so many great things. It may have started with sexual attraction- probably mutual, but why not? That can be a really good place to begin, and it can give meaning to the relationship as you both add ever deeper layers of understanding and connection. And there's no need for it to ever go away- it's a definite plus, I think!.But I do think, also, that what we really want and need is that powerful feeling of respect, understanding and implicit love and connection. That's why we are there= to get what we didn't get earlier in life.
Your post was really beautiful- it brought tears to my eyes. I have printed it for my journal. Thank you again!!
Posted by stellabystarlight on October 20, 2008, at 18:16:19
In reply to what a wonderful post... » stellabystarlight, posted by twinleaf on October 19, 2008, at 19:13:14
> Thank you so much, Stella, for your lovely post, which touched on so many things- all so important, moving and life-changing. It's so good to hear that your relationship with your therapist contains so many great things. It may have started with sexual attraction- probably mutual, but why not? That can be a really good place to begin, and it can give meaning to the relationship as you both add ever deeper layers of understanding and connection. And there's no need for it to ever go away- it's a definite plus, I think!.But I do think, also, that what we really want and need is that powerful feeling of respect, understanding and implicit love and connection. That's why we are there= to get what we didn't get earlier in life.
>
> Your post was really beautiful- it brought tears to my eyes. I have printed it for my journal. Thank you again!!
>
>Thanks for saying such beautiful words to me. Means a lot...
Stay strong. Hugs to you.Stellabystarlight
Posted by antigua3 on October 24, 2008, at 12:07:49
In reply to Re: it crept up on me when I wasn't noticing... » Phillipa, posted by lucie lu on October 19, 2008, at 13:23:59
It has been proven that therapy can rewire the brain. That's why we have to go over the insights, changes, etc. again and again until this happens.
I don't have the studies handy, but I know I've read them and I discussed it with my pdoc, who confirmed it.
antigua
Posted by Phillipa on October 24, 2008, at 20:12:21
In reply to Re: it crept up on me when I wasn't noticing... » lucie lu, posted by antigua3 on October 24, 2008, at 12:07:49
Oh I do wish you did. Phillipa Also Twinleaf someone on meds is looking for TMS experiences and no answers. Phillipa
Posted by twinleaf on October 25, 2008, at 8:15:22
In reply to Re: it crept up on me when I wasn't noticing... » antigua3, posted by Phillipa on October 24, 2008, at 20:12:21
Philippa, if a person wants to find out who in their area is going to be giving TMS, they can look on the Neuronetics website. There is a phone number and an e-mail there so that you can find the name of a doctor.
Posted by lucie lu on October 25, 2008, at 11:04:10
In reply to Re: it crept up on me when I wasn't noticing... » lucie lu, posted by antigua3 on October 24, 2008, at 12:07:49
> It has been proven that therapy can rewire the brain. That's why we have to go over the insights, changes, etc. again and again until this happens.
>
> I don't have the studies handy, but I know I've read them and I discussed it with my pdoc, who confirmed it.Antigua, If you find the studies or articles at some point, I'd be really interested in reading them. They are hard to search for in the literature using subject terms.
Thanks, Lucie
Posted by seldomseen on October 25, 2008, at 12:57:00
In reply to studies about therapy remodeling the brain » antigua3, posted by lucie lu on October 25, 2008, at 11:04:10
This really is a brand new field of study in psychiatry and the results are just now beginning to filter past peer review and into the literature.
Here are a few studies that I found with just one search of pubmed (keywords psychotherapy fMRI)
Most likely I could have found more, but pubmed is soooo slow today.
Seldom
Posted by twinleaf on October 25, 2008, at 13:22:03
In reply to Re: it crept up on me when I wasn't noticing... » lucie lu, posted by antigua3 on October 24, 2008, at 12:07:49
Thanks so much for finding those articles, Seldom. It's fascinating that OCD can be treated by therapy with resultant favorable changes on fMRI. (I had always thought that it was one of the harder things to treat, but apparently not).
It will be exciting to keep our eyes on the literature, because I feel certain there will be many more articles like these.
Posted by lucie lu on October 25, 2008, at 21:00:14
In reply to Re: some studies., posted by seldomseen on October 25, 2008, at 12:57:00
Posted by antigua3 on October 26, 2008, at 15:21:18
In reply to Re: some studies., posted by seldomseen on October 25, 2008, at 12:57:00
This is the end of the thread.
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