Psycho-Babble Medication Thread 11227

Shown: posts 1 to 12 of 12. This is the beginning of the thread.

 

Anti-Placebo Effect

Posted by Kathy on September 8, 1999, at 5:49:56

Does anyone have any thoughts on whether your mind can make an antidepressant drug NOT work? I have failed to respond to a multitude of drugs and my ex-therapist more or less implied that this was because of my belief that I don`t deserve to improve and fears about how my life would change if I did. On the one hand it makes sense that if there can be a placebo effect there can also be an anti-placebo effect--on the other hand surely negative thoughts and beliefs are an inherent part of depression so in a way it`s blaming the victim.

 

Re: Anti-Placebo Effect

Posted by Bob on September 8, 1999, at 9:26:44

In reply to Anti-Placebo Effect, posted by Kathy on September 8, 1999, at 5:49:56

> Does anyone have any thoughts on whether your mind can make an antidepressant drug NOT work? I have failed to respond to a multitude of drugs and my ex-therapist more or less implied that this was because of my belief that I don`t deserve to improve and fears about how my life would change if I did. On the one hand it makes sense that if there can be a placebo effect there can also be an anti-placebo effect--on the other hand surely negative thoughts and beliefs are an inherent part of depression so in a way it`s blaming the victim.

Well, that could explain a lot for me (and the rest of us non-responders!). I doubt it, tho. What meds did your doc have you on? For how long? Did he give them an adequate trial? There are just so many issues in taking antidepressants -- it goes back to a comment on another thread: did you see a GP or a psychiatrist/psychopharmacologist? That comment to me sounds like a GP who hasn't done his homework. I, personally, **hated** the idea of going on meds. The notion of surrendering "control" to a chemical, by my upbringing, was the most "unmanly" thing I could do. I had a really strong desire to prove that the meds wouldn't help. I was wrong. I responded immediately. Not stabily, not for a 1.5 months or so, but I did respond.

(Given my drug response history, tho, I've always wondered about getting a placebo if I was in some study ... I'm sure that I'd show placebo side effects.)

Get a second opinion on that, from someone who knows psychopharms well.

Cheers,
Bob

 

Re: Anti-Placebo Effect

Posted by Kathy on September 9, 1999, at 4:50:24

In reply to Anti-Placebo Effect, posted by Kathy on September 8, 1999, at 5:49:56

> Does anyone have any thoughts on whether your mind can make an antidepressant drug NOT work? I have failed to respond to a multitude of drugs and my ex-therapist more or less implied that this was because of my belief that I don`t deserve to improve and fears about how my life would change if I did. On the one hand it makes sense that if there can be a placebo effect there can also be an anti-placebo effect--on the other hand surely negative thoughts and beliefs are an inherent part of depression so in a way it`s blaming the victim.

Actually it was my "talk" therapist (a clinical social worker in private practice) who said this.I don`t know whether the doctorwho prescribes my meds thinks anything will help or not--he~s the head pychiatrist of my HMO and so far he`s been willing to prescribe whatever I want to try next, even if he has to getspecial permission from the HMO to cover it--but I don`t know what he thinks--a doctor can hardly say to a patient-"Nothing`s going to help you-you might as well go home and kill yourself." (Though what my "talk' therapist said came close-after 632 sessions over 7 years she told me "I can`t help you-you obviously need to be depressed."

 

Re: Anti-Placebo Effect

Posted by Noa on September 9, 1999, at 6:48:59

In reply to Re: Anti-Placebo Effect, posted by Kathy on September 9, 1999, at 4:50:24

(Though what my "talk' therapist said came close-after 632 sessions over 7 years she told me "I can`t help you-you obviously need to be depressed." Are you still seeing this therapist? Did you discuss with her how it felt when she said this to you? My understanding is that when a therapist and patient reach an "impasse" it is good practice to get an outside consult to see what can help them get through the impasse.

 

Re: Anti-Placebo Effect

Posted by Bob on September 9, 1999, at 8:48:11

In reply to Re: Anti-Placebo Effect, posted by Noa on September 9, 1999, at 6:48:59

Outside consult? I think Kathy's therapist needs
to see her own ... she obviously has feelings of
inadequacy and failure in not being able to help
Kathy progress, and so she is projecting this
failure on Kathy to protect her own ego.

... and I'm only half joking when I say that.

I do think Noa's advice is a good move. How can
she continue to help you if she's got an attitude
like that -- but is it enough to give up the
relationship you have developed with her? I think
you might want to consider the same for your pdoc,
if he really is so laid-back. Or, at least, try
to draw out some guidance from him, get him to
discuss what course of medication he thinks you
should follow over the next six months or something
like that.

Cheers,
Bob

 

Re: Anti-Placebo Effect

Posted by Kathy on October 31, 1999, at 4:00:53

In reply to Re: Anti-Placebo Effect, posted by Bob on September 9, 1999, at 8:48:11

> Outside consult? I think Kathy's therapist needs
> to see her own ... she obviously has feelings of
> inadequacy and failure in not being able to help
> Kathy progress, and so she is projecting this
> failure on Kathy to protect her own ego.
>
> ... and I'm only half joking when I say that.
>
> I do think Noa's advice is a good move. How can
> she continue to help you if she's got an attitude
> like that -- but is it enough to give up the
> relationship you have developed with her? I
think
> you might want to consider the same for your pdoc,
> if he really is so laid-back. Or, at least, try
> to draw out some guidance from him, get him to
> discuss what course of medication he thinks you
> should follow over the next six months or something
> like that.
>
> Cheers,
> Bob


My talk therapist and I parted company soon after this impasse. I know she was angry and frustrated because she couldn`t help me, but losing her hurt more than anything else in my whole life. As for my P-doc, I can`t imagine ever being brave enough to ask him this--as it is I don`t sleep at all the nights before my appointments. I`m always in so much terror that he`s going to imply that I`m a fool to keep trying meds, that it`s my own fault I`m depressed. I realize I`m projecting (I paid $40,000 for therapy that didn`t work,but I did get that much out of it). But I don`t know how to stop.I really admire all the people on this board who truly believe that depression is just a biochemical thing. I have so much shame about my depression. Deep down I believe I`m depressed because I`m bad and I`m bad because I`m depressed, that I deserve to be depressed because I`m shy and fat. Seven yers of therapy didn`t touch this belief, even though I know intellectually there are plenty of people who are shy and fat but not depressed. For the people who`ve been lucky enough to find meds that work-do they really change your deep down beliefs about yourself? That seems so impossible-as science fictionish as being able to pop a pill on a flight to Paris and suddenly being able to speak French.

 

Re: Anti-Placebo Effect

Posted by saint james on October 31, 1999, at 6:19:27

In reply to Re: Anti-Placebo Effect, posted by Kathy on October 31, 1999, at 4:00:53

For the people who`ve been lucky enough to find meds that work-do they really change your deep down beliefs about yourself? That seems so impossible-as science fictionish as being able to pop a pill on a flight to Paris and suddenly being able to speak French.

James here....

The meds level the playing field so I can be rational about my beliefs. I did thearpy first
then got on meds. The thearpy was great, to a point, but it was not till I got on meds that I could really put to use what I learned in thearpy. I understood and agreed with everything on an interectual level but not till the meds did I believe things with thw whole of my being.

Pills can't do it all, I don't think anyone is saying that, but if someone is chemical

 

Re: Anti-Placebo Effect: Lengthy Lecture.

Posted by JohnL on October 31, 1999, at 7:38:04

In reply to Re: Anti-Placebo Effect, posted by Kathy on October 31, 1999, at 4:00:53


>> My talk therapist and I parted company soon after this impasse. I know she was angry and frustrated because she couldn`t help me, but losing her hurt more than anything else in my whole life.

I know that feeling of comfort and reassurace a therapist can give. Kind of like a cocoon. Sometimes we get drawn into that and continue paying for service that in fact isn't really helping much. But face it, all that time and money and you're still in trouble? I respect my therapist so much because after 6 weekly visits of frustrating progress, he was honest in suggesting we might not make further progress in a meaningful way without medication first. He strongly insisted on medication first. Then therapy continuation later. Obviously honest and compassionate, because he lost money while I was out getting attention with medicine instead. I think your therapist has milked you dry and I cannot for the life of me understand feeling any loss in bringing that unsuccessful relationship to an end.

>>As for my P-doc, I can`t imagine ever being brave enough to ask him this--as it is I don`t sleep at all the nights before my appointments. I`m always in so much terror that he`s going to imply that I`m a fool to keep trying meds, that it`s my own fault I`m depressed.

If that's the case, you definitely have the wrong pdoc. There are others ya know. Who pays who anyway? And it's YOUR fault? Ha. That pdoc should go back to school and start over.

>> I realize I`m projecting (I paid $40,000 for therapy that didn`t work,but I did get that much out of it). But I don`t know how to stop.

Not so hard. Just say stop. Enough already. Wipe the board clean. Get a new pdoc. Ditch the therapy for a while. You've got the rest of your life to go back to it if you want. Your previous approaches and your current medical support is lacking. Make some calls. Ask around. Plenty of choices. Never too late to start fresh. Sometimes it's best just to throw out the old and start with something new. Like instead of pouring tons of money into an old car, sooner or later it's best just to drive it to the junkyard and go buy a new one.

>> I really admire all the people on this board who truly believe that depression is just a biochemical thing.

It's a clinically proven fact, not a belief. Thousands of scientific studies prove it. It is a biochemical thing, intertwined with the psychological. Who's been feeding you such nonsense? Is diabetes a biochemical thing? How about a skin disorder? Bone marrow depression? Mental retardation? What makes one believe the brain is somehow off limits and immune to having a biological problem?

>> I have so much shame about my depression.

That's a classic symptom of depression. Depression 101.

>> Deep down I believe I`m depressed because I`m bad and I`m bad because I`m depressed, that I deserve to be depressed because I`m shy and fat.

More classic textbooks symptoms. A therapist would want you to believe there are deepseeded problems to solve by talk. That's so they can keep making money. But you describe classic textbook symptoms of depression that are indeed relieved with medication alone.

>> Seven yers of therapy didn`t touch this belief, even though I know intellectually there are plenty of people who are shy and fat but not depressed.

I'm skinny shy and tall. Body size doesn't have that much to do with anything. A lot of people are overweight because they are depressed, not vica versa. Overeating is yet another classic textbook symptom that represents a form of self-medication. Depression causes the overeating. Then the shame of fatness worsens the depression. What a vicious circle. Antidepressants can and do break that vicious cycle. Even if one remains fat, the shame can be tamed. And then one can actually get out of the dark hole and do something about it.

>> For the people who`ve been lucky enough to find meds that work-do they really change your deep down beliefs about yourself?

Actually yes. A shy person can become comfortable in a crowd. Confident speaking with a boss. Proud of oneself. In control. Content instead of worried. Huge issues become small and easily manageable. Negative thought patterns take a back seat. Without even trying. The burdens that weigh you down suddenly become lightweight.

>> That seems so impossible-as science fictionish as being able to pop a pill on a flight to Paris and suddenly being able to speak French.

Try popping a pill of heroin or LSD. That's an extreme example, but imagine what that would do to you. You might indeed speak French! :) (joking) Is that science fiction? How about a sleeping pill. Science fiction? How about insulin for a diabetic. Science fiction? On and on and on. You know, antidepressants can and do actually reverse all the feelings you describe. All by themselves. Then, once you're brain is on an even keel, all the talk therapy begins to have a real impact. You can accomplish in one session what used to take 20 sessions. Take leaps forward instead of tiny steps.

Sorry, don't mean to be so straight forward here. I just get so irked when therapists and doctors inadvertently lead patients astray. I've been in your shoes and it still angers me how much time was wasted in futile efforts. A good therapist and a good doctor would have had your life back in order many years ago. Maybe not cured, but at least 90% better than you are now. Maybe indeed totally cured. It's not too late. Forget them all. Go out and get a new team. You've tried the other approach already. So try this one instead...get stabilized on a good medicine first with a new doc. Then go back to the talk therapy. Drugs first, talk second. Then come tell us how wonderful you feel and how you wish someone would have guided you that way in the first place. Like my therapist told me, focus on finding a med that I can tolerate at therapeutic doses and that works. If that isn't accomplished FIRST, nothing else will work. That's my experience anyway.

 

Re: Anti-Placebo Effect.

Posted by Bob on October 31, 1999, at 14:58:23

In reply to Re: Anti-Placebo Effect: Lengthy Lecture., posted by JohnL on October 31, 1999, at 7:38:04

Hi Kathy, I'm glad you're back to fill us in.

St. james and johnl have made some very good points, so I'll just try to be succinct to add what I can without repeating too much.

It's your life. You need to take control of making the decisions. If your pdoc has you that anxious, he's doing you more harm than good.

What you describe sounds like you're caught in a circle of the "vicious" type, but those circles can also be, well, "effervescent". They can buoy you up. *You* make a descision, *you* be decisive, and you'll know that the decision is best and you're doing yourself some good. That gives you the hope and the energy to try something else. Focus on what you can do for yourself, and keep the steps small for now. Don't try for a miracle overnight, just slow steady progress. Nothing succeeds like success.

For me, coming to accept that a good portion of my disorder was biologically based was very difficult. When I felt bad, I wanted to blame myself for it. When I felt good, I wanted to accept all the responsibility for it. I wanted to do it all alone. Accepting that my mind alone could not change the way my brain dealt out and used neurotransmitters was a big defeat at first -- I couldn't have that ultimate responsibility I thought I should have. Then, it finally sank home ... I no longer had the burden of that responsibility, either. I knew that medication couldn't "fix" me 100%, but as my therapist told me, meds give you a window on feeling different. Little did I know that I'd have about 8 different perspectives on myself in 2.5 years, but it has all pointed out for me that the right combination, when I find it, will put me at the *optimal* place to attack those psychological issues. Like JohnL said, meds can change the way you interact with the outside world dramatically. And thank God for it -- without my current cocktail, I would never have been able to challenge the BS my employer is dumping on me. As it is, not only do I have the law on my side, I've got myself on my side, and I'm just about ready to kick some tail about it. So yes, the right meds can change how you feel, and the right talk therapy can help you change the way you behave and respond.

So much for being succinct.

Time for you to take that second step, Kathy (parting with your therapist was the first) ... don't stop now, the journey's just beginning.

Bob

 

Re: Anti-Placebo Effect.

Posted by Noa on October 31, 1999, at 16:44:19

In reply to Re: Anti-Placebo Effect., posted by Bob on October 31, 1999, at 14:58:23

> Hi Kathy, I'm glad you're back to fill us in.
Ditto.

Depression, like many conditions is both biological and psychological, both mutually interactive. Don't torture yourself by trying to tease apart the cause. It seems to be adding to your shame.

I agree that you are taking steps to take control of your treatment. That is good. Get a good psychopharmocologist, one who will listen to you, who will share his or her thought process with you, who will cooperate with your talk therapist, and who will, of course not shame you. And find a good therapist, one who knows that depression usually needs a multimodal treatment approach, who will cooperate with the psychopharmocologist, and who, of course, will not shame you.
I, too, have the down-in-the-gut feeling of badness. It is part of my depression, but because it has been with me so long, and has been the thing I have tried to avoid thinking about (using less than healthy avoidance mechanisms), starting to look at and understand these feelings is part of my therapy. But when I am really depressed, getting too close to those feelings is risky. I advise you to not delve into the anxiety stimulating material in therapy until your depression lifts a bit with proper medication. You need to reach a safer more stable place. As someone on this thread mentioned, you need to be able to access some rational skills when looking at these very irrational feelings. When in the throes of depression, I know that my thinking is too much in line with the irrational negative beliefs I have deep down inside.
So, don't give up on therapy. You are right that a pill will not enable you to be fluent in French. What I think it does is heighten the language learning abilities, the ability to attune your ear and hear things in a new way, which would allow you to pick up the language more effectively.
Keep us posted. Glad you are back.

 

Re: Anti-Placebo Effect.

Posted by Kathy on October 31, 1999, at 19:42:17

In reply to Re: Anti-Placebo Effect., posted by Noa on October 31, 1999, at 16:44:19

> > Hi Kathy, I'm glad you're back to fill us in.
> Ditto.
>
> Depression, like many conditions is both biological and psychological, both mutually interactive. Don't torture yourself by trying to tease apart the cause. It seems to be adding to your shame.
>
> I agree that you are taking steps to take control of your treatment. That is good. Get a good psychopharmocologist, one who will listen to you, who will share his or her thought process with you, who will cooperate with your talk therapist, and who will, of course not shame you. And find a good therapist, one who knows that depression usually needs a multimodal treatment approach, who will cooperate with the psychopharmocologist, and who, of course, will not shame you.
> I, too, have the down-in-the-gut feeling of badness. It is part of my depression, but because it has been with me so long, and has been the thing I have tried to avoid thinking about (using less than healthy avoidance mechanisms), starting to look at and understand these feelings is part of my therapy. But when I am really depressed, getting too close to those feelings is risky. I advise you to not delve into the anxiety stimulating material in therapy until your depression lifts a bit with proper medication. You need to reach a safer more stable place. As someone on this thread mentioned, you need to be able to access some rational skills when looking at these very irrational feelings. When in the throes of depression, I know that my thinking is too much in line with the irrational negative beliefs I have deep down inside.
> So, don't give up on therapy. You are right that a pill will not enable you to be fluent in French. What I think it does is heighten the language learning abilities, the ability to attune your ear and hear things in a new way, which would allow you to pick up the language more effectively.
> Keep us posted. Glad you are back.

Thank you everyone. My current p-doc hasn`t ever shamed me (though another I saw when he was on sabbatical did, or at least I interpeted it that way). It`s just me. All that shame and mistrust is the main reason I failed therapy-standard self fulfilling prophecy-I believed that anyone who got to know the real me would eventually abandon me, and acted in ways to cause this to happen. I don`t blame my therapist for getting fed up, but even though it`s been over two years since I saw her, the pain of this loss is with me day and night. Well, ok, I do blame her, but I blame myself even more. (Yes, I know, like the abused child who still clings to his parent and blames himself forthe abuse. Anyway I`ve given up on therapy, I still keep trying meds, though sometimes I wonder if I keep trying just to punish myself with the side effects, since none has ever had any beneficial effects. So far, over the past 12 years, I`ve tried adequate tharapeutic trials of Zoloft. Paxil, Nardil, Serzone, Remeron, St; John`s Wort, Nortriptyline, Nortriptyline plus Zoloft, Serzone plus Buspar, Celexa, and Celexa plus Buspar. I`ve also tried, but been unable to tolerate the side effects of Desipramine, Imipramine, Prozac, Wellbutrin, Effexor, Anafranil, Paxil plus thyroid, and Zoloft plus lithium. Currently I`m trying Celexa plus Wellbutrin-I couldn`t tolerate the Wellbutrin when I tried it before, but decided to try again starting at a tiny dose and building up very slowly-so far I`ve made it up to 150 mg aday, which I know is still only half the therapeutic dose. Hopefully by the time I get up to a therapeutic dose and have an adequate trial, Reboxetine will be on the market, after that who knows. When I talk about tolerating side effects my only criteria is, can I go to work and function with this drug. I know that just because I don`t respond to drugs doesn`t mean it`s not biochemical. any more than a cancer patientnot responding to chemotherapy means the cancer`s all in their head. But it is very discouraging.

 

Re: Anti-Placebo Effect.

Posted by Kathy on November 1, 1999, at 2:22:53

In reply to Re: Anti-Placebo Effect., posted by Kathy on October 31, 1999, at 19:42:17

> > > Hi Kathy, I'm glad you're back to fill us in.
> > Ditto.
> >
> > Depression, like many conditions is both biological and psychological, both mutually interactive. Don't torture yourself by trying to tease apart the cause. It seems to be adding to your shame.
> >
> > I agree that you are taking steps to take control of your treatment. That is good. Get a good psychopharmocologist, one who will listen to you, who will share his or her thought process with you, who will cooperate with your talk therapist, and who will, of course not shame you. And find a good therapist, one who knows that depression usually needs a multimodal treatment approach, who will cooperate with the psychopharmocologist, and who, of course, will not shame you.
> > I, too, have the down-in-the-gut feeling of badness. It is part of my depression, but because it has been with me so long, and has been the thing I have tried to avoid thinking about (using less than healthy avoidance mechanisms), starting to look at and understand these feelings is part of my therapy. But when I am really depressed, getting too close to those feelings is risky. I advise you to not delve into the anxiety stimulating material in therapy until your depression lifts a bit with proper medication. You need to reach a safer more stable place. As someone on this thread mentioned, you need to be able to access some rational skills when looking at these very irrational feelings. When in the throes of depression, I know that my thinking is too much in line with the irrational negative beliefs I have deep down inside.
> > So, don't give up on therapy. You are right that a pill will not enable you to be fluent in French. What I think it does is heighten the language learning abilities, the ability to attune your ear and hear things in a new way, which would allow you to pick up the language more effectively.
> > Keep us posted. Glad you are back.
>
> Thank you everyone. My current p-doc hasn`t ever shamed me (though another I saw when he was on sabbatical did, or at least I interpeted it that way). It`s just me. All that shame and mistrust is the main reason I failed therapy-standard self fulfilling prophecy-I believed that anyone who got to know the real me would eventually abandon me, and acted in ways to cause this to happen. I don`t blame my therapist for getting fed up, but even though it`s been over two years since I saw her, the pain of this loss is with me day and night. Well, ok, I do blame her, but I blame myself even more. (Yes, I know, like the abused child who still clings to his parent and blames himself forthe abuse. Anyway I`ve given up on therapy, I still keep trying meds, though sometimes I wonder if I keep trying just to punish myself with the side effects, since none has ever had any beneficial effects. So far, over the past 12 years, I`ve tried adequate tharapeutic trials of Zoloft. Paxil, Nardil, Serzone, Remeron, St; John`s Wort, Nortriptyline, Nortriptyline plus Zoloft, Serzone plus Buspar, Celexa, and Celexa plus Buspar. I`ve also tried, but been unable to tolerate the side effects of Desipramine, Imipramine, Prozac, Wellbutrin, Effexor, Anafranil, Paxil plus thyroid, and Zoloft plus lithium. Currently I`m trying Celexa plus Wellbutrin-I couldn`t tolerate the Wellbutrin when I tried it before, but decided to try again starting at a tiny dose and building up very slowly-so far I`ve made it up to 150 mg aday, which I know is still only half the therapeutic dose. Hopefully by the time I get up to a therapeutic dose and have an adequate trial, Reboxetine will be on the market, after that who knows. When I talk about tolerating side effects my only criteria is, can I go to work and function with this drug. I know that just because I don`t respond to drugs doesn`t mean it`s not biochemical. any more than a cancer patientnot responding to chemotherapy means the cancer`s all in their head. But it is very discouraging.
>

Plus in addition to therapy and all those meds, I`ve tried homeopathy, various bodywork type therapies, a SAD light box, EMDR, hypnosis, and cognitive therapy classes. Oh, and I tried to get into a transcranial magnetic stimulation study, but they wouldn`t take me bcause I`m on blood pressure medication. Nothing has made any difference that I can see. And I`m still terrified and humiliated by talking to doctors and mental health professionals. They say that what doesn`t kill you makes you stronger, but it feels like I`ve gone through all that humiliation for nothing.


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