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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Deidre on March 21, 2001, at 8:51:09
In response to everyone's questions and comments on Celexa: I would like to say that as an RN and as a normal human being who has been down the road of difficulties in life that discussing your questions and comments with other people is the best thing everyone is doing!
I've heard good and bad comments on Celexa and my opinion is that it may help BUT in realistically it is only masking the underlying problems. Sure, you feel great and aren't depressed BUT have you dealt with the reason(s) you were feeling that way? Celexa, like any anti-depressant can in my opinion, be more damaging to your personal life and well being than a short period of time powering through the problems you feel are weighing down upon you.
In the cases that I've seen, many people feel better with Celexa but when discontinuing the medication, realize that they didn't face the real problem and in doing so, have hurt themselves and the people they love and now face a bigger problem than they began with.
I commend all of you for discussing your thoughts and feelings about Celexa and other medications you may have or may still be taking. BUT I strongly believe that facing the issues head on with the support of your friends and family is the best thing you can do. You will be miserable for a little while but WILL feel better with NO SIDE EFFECTS in the long run. If you can't discuss things with your family or friends, seek a free counseling service or a pastor, rabbi or priest. These people are here to listen and offer advice for FREE without medication. The short term wil be difficult but the longterm successful!
Posted by allisonm on March 21, 2001, at 19:52:42
In reply to Celexa, posted by Deidre on March 21, 2001, at 8:51:09
Deidre,
Thanks for writing. I have a few questions for you. Have you ever been diagnosed with depression? Have you ever taken antidepressants? Being an RN have you ever worked professionally with a psychiatrist and/or a psychotherapist?
While I agree that it is important to do talk therapy to try to improve one's life and mood, surely you do not think that this alone will always fix things. Have you read about the studies that advocate the use of antidepressants AND talk therapy as being more effective than one or the other alone? Have you read about the studies on the recurrence of depression, or the 'kindling effect' as described in Kramer's book? Have you ever heard of the theory/opinion that taking antidepressants can lift one up to a level (or put a floor under one's feet) so that one CAN discuss life's problems in therapy?
I myself have found this last theory to be true. I would be very happy not to take eight pills -- two antidepressants and a mood stabilizer -- a day in three doses while I do my weekly psychotherapy, but like it or not they keep me from feeling like killing myself. I heartily disagree with your assertion that ADs "mask" underlying problems. Further, a short amount of time "powering through problems" is not necessarily a short term source of discomfort, nor is it necessarily an effective remedy. It can take years of talk therapy to find resolution, which is why insurance companies today would much rather have doctors prescribe drugs because drugs are much less expensive in comparison. And you are mistaken if you think that psychotherapy does not have any side effects.
Perhaps you see patients who go to their GPs for ADs who probably aren't depressed and don't need ADs but who want some pill to fix everything. Perhaps you see people who go through simple bouts of depression that would go away in a few weeks or months whether or not they took ADs or went through psychotherapy.
Have you had any professional experience with people who have been suicidal, who have been depressed for many years, or who are incapacitated by depression or anxiety to the point where they cannot hold down jobs? Do you honestly think that a family member or clergyman is prepared to help them "power through" the problems "they feel" are weighing them down?
I don't mean to offend, but I find your opinion very naive.
Allison
Posted by Bill L on March 22, 2001, at 7:28:34
In reply to Re: Celexa, posted by allisonm on March 21, 2001, at 19:52:42
Allison has echoed my feelings exactly. I have in fact tried talking through my feelings of anxiety and depression with 100% candor. I was completely open and tried with a few people. If anything, I felt worse in the long run (I did feel better right after talking).
Chemical imbalances need to be treated with drugs in my opinion. The other option is to tough it out but that can be a rough way to go through life. So it's not a one size fits all situation. If someone was not depressed, then had a traumatic event which sent them into a depression, then talk therapy should work. But many people such as me have been depressed forever and drugs are the only thing that works.
> Deidre,
>
> Thanks for writing. I have a few questions for you. Have you ever been diagnosed with depression? Have you ever taken antidepressants? Being an RN have you ever worked professionally with a psychiatrist and/or a psychotherapist?
>
> While I agree that it is important to do talk therapy to try to improve one's life and mood, surely you do not think that this alone will always fix things. Have you read about the studies that advocate the use of antidepressants AND talk therapy as being more effective than one or the other alone? Have you read about the studies on the recurrence of depression, or the 'kindling effect' as described in Kramer's book? Have you ever heard of the theory/opinion that taking antidepressants can lift one up to a level (or put a floor under one's feet) so that one CAN discuss life's problems in therapy?
>
> I myself have found this last theory to be true. I would be very happy not to take eight pills -- two antidepressants and a mood stabilizer -- a day in three doses while I do my weekly psychotherapy, but like it or not they keep me from feeling like killing myself. I heartily disagree with your assertion that ADs "mask" underlying problems. Further, a short amount of time "powering through problems" is not necessarily a short term source of discomfort, nor is it necessarily an effective remedy. It can take years of talk therapy to find resolution, which is why insurance companies today would much rather have doctors prescribe drugs because drugs are much less expensive in comparison. And you are mistaken if you think that psychotherapy does not have any side effects.
>
> Perhaps you see patients who go to their GPs for ADs who probably aren't depressed and don't need ADs but who want some pill to fix everything. Perhaps you see people who go through simple bouts of depression that would go away in a few weeks or months whether or not they took ADs or went through psychotherapy.
>
> Have you had any professional experience with people who have been suicidal, who have been depressed for many years, or who are incapacitated by depression or anxiety to the point where they cannot hold down jobs? Do you honestly think that a family member or clergyman is prepared to help them "power through" the problems "they feel" are weighing them down?
>
> I don't mean to offend, but I find your opinion very naive.
>
> Allison
Posted by Chaston on March 22, 2001, at 8:02:27
In reply to Re: Celexa, posted by allisonm on March 21, 2001, at 19:52:42
Allison,
Thank you for taking the time to address this issue so cogently. Deidre's "power through" advice is probably appropriate for some people--for example,someone facing a situational challenge who could grow by dealing with it, but would (& could) avoid dealing with it if he/she had mood improvement from meds. Although I am sure Deidre meant no harm, applying this approach to everyone with long-term depression and mood disorders would prove to be extremely harmful. There is a long historical record of this before effective meds were developed: suicides, shattered lives, institutionalization. In contrast, with all due respect to the benefits of counselors and clergy, not a lot has changed in that approach in a comparable period. So while it can still help, and in some mild cases even suffice, it is indeed naive to state that everyone could rely on counseling alone to improve the quality of their mental health.
--Chaston
Posted by Kingfish on March 22, 2001, at 8:58:54
In reply to Re: Celexa Allison, posted by Chaston on March 22, 2001, at 8:02:27
Deidre:
This board is for people who have decided that medication is the answer for them. That decision is not made lightly. It often comes after years of struggling with depression and sometimes mania, losing friends and sometimes jobs, contemplating and sometimes trying suicide, living in fear and pain. And when the time comes that the decision is made to seek profession help and take medications, there's often guilt and feelings of worthlessness because you can't "make it on your own".
I really wish that people would not post here who are not supportive of the decision to use medications to help correct the chemical imbalances we have. You are not helping us - you are just opening up old wounds.
Posted by Chaston on March 22, 2001, at 19:04:09
In reply to Re: Celexa Deidre, posted by Kingfish on March 22, 2001, at 8:58:54
Kingfish,
You make a very good point. Although I hate to discourage anyone from sharing their (reasoned) opinions, words can be harmful, too. In looking back over 38 years of struggling with a mood disorder, I only wish that I had been able to accept it as a medical problem and get better medical treatment for it sooner. My life might have been much more productive, as well as happier. Now that so many more medications have become available, I would hate to think that shame or guilt might still prevent anyone form benefiting from them (or might contribute to their misery). That would be like denying vision correction to those with "weak" eyes, or insulin to diabetics.
> Deidre:
>
> This board is for people who have decided that medication is the answer for them. That decision is not made lightly. It often comes after years of struggling with depression and sometimes mania, losing friends and sometimes jobs, contemplating and sometimes trying suicide, living in fear and pain. And when the time comes that the decision is made to seek profession help and take medications, there's often guilt and feelings of worthlessness because you can't "make it on your own".
>
> I really wish that people would not post here who are not supportive of the decision to use medications to help correct the chemical imbalances we have. You are not helping us - you are just opening up old wounds.
Posted by Kingfish on March 23, 2001, at 7:08:51
In reply to Re: Celexa --Kingfish, posted by Chaston on March 22, 2001, at 19:04:09
> Chaston,
> I think I get a little worked up when I see "alter-opinions" on this board, but, as you say, it can be discouraging.Thanks for the support! :)
- K.
Posted by Snuffy on March 23, 2001, at 10:26:51
In reply to Re: Celexa --Chaston, posted by Kingfish on March 23, 2001, at 7:08:51
I agree with all of these responses and I really can't add much more then what has already been said. However, I have a difficult time dealing with people that think my problems are simple and can be resolved with facing my "issues". My "issues" are that I can't deal with my negitive, hateful, paranoia, anxiety, etc. I look forward to completing my day and going home to withdraw into some mind numbing activity (tv, sleep, ...etc). Before I started meds I thought that this is how everyone felt because when I tried to talk about my issues I would run into someone like you that think if I would just buck up and get off of the couch and stop being lazy my life would be wonderful. I can recognize my symptoms better now that I'm on meds and have a better understanding of how I can deal with them. Someone has turned on a light and I can see through my darkness better.
Posted by Cam W. on March 23, 2001, at 15:01:32
In reply to Re: Celexa, posted by allisonm on March 21, 2001, at 19:52:42
I agree that meds are needed in serious cases of depression. They readjust the neurochemical mix, thus alleviating some of the depressive symptoms, and, as Allison says, "puts the floor under one's feet". But I would also like to stress that, like insulin or antihypertensives, antidepressants are only a bandage. Psychotherapy, be it taking to a psychologist, clergy, or a good friend, helps to change the mindset and "fix the sh**" that caused the depression in the first place.
We are all born with a level of stress tolerance and life experiences (environment) raise or lower this level. Too much stress uncouples our body's stress response mechanism (HPA axis) resulting in the phenomenon we call depression. Sometimes this uncoupling is permanent and we may need to keep taking medications for life. Sometimes the uncoupling is repairable, as one comes to terms with the cause.
In mild cases of depression, sometimes talk therapy is enough, but one has to be able to understand and deal with the causes of the depression. Antidepressants can help bring about the ability to understand and I believe this to be the "floor" from which the doc or therapist can begin to work.
Just my opinion - Cam
Posted by Kingfish on March 23, 2001, at 15:25:39
In reply to Re: Celexa, posted by Cam W. on March 23, 2001, at 15:01:32
>But, Cam, how do you explain mental illnesses such as Schizophrenia? Surely this is not caused by "too much stress"? I certainly hesitate to debate this at all with you knowing your level of knowledge of the subject, :), but I can't come to terms with things such as manic episodes as being caused by stress, especially when others have much more stress in their lives and they do not have such a reaction.
I am reading a book called "Mood Genes" right now which is supportive of the concept that major mood disorders and schizophrenia are biological/genetic. Do you think there's anything to that at all?
Posted by Cam W. on March 23, 2001, at 16:49:04
In reply to Re: Celexa--Cam, posted by Kingfish on March 23, 2001, at 15:25:39
Kingfish - Schizophrenia can be thought of as a problem with nerve connections resulting in, in part, an excess of dopamine in certain parts of the brain. The indirect connection of the thalamus and prefrontal cortex are disturbed, perhaps by an excess of the number of connections that a dopamine neuron makes (perhaps because of a lack of the normal synaptic pruning of dendrites that normally occurs as we age).
Aldous Huxley in "The Doors of Perception" talks about a "reducing" valve in the brain that limits the amount of sensory stimulus that brain allows to be processed. This reducing value, in part, may be the thalamus. In schizophrenia, that reducing valve is more open than it should be; thus a person with schizophrenia receives too much stimulus and their brain has a hard time interpreting the inputted sensory stimulus. This may result in the positive symptoms (hallucinations and psychoses) we see in schizophrenia. When sensory overload occurs, some brain functions may shut down resulting in the negative symptoms (poverty of speech, withdrawl).
Therefore, schizophrenia can be seen as an organic disorder. Too much stress can be seen as a trigger to set off schizophrenia or bipolar disorder. The difference in stress levels is why identical twins do not always both get schizophrenia. Environmental stressors, combined with a genetic predisposition, set the "level of the bar" for the amount of stress that can be handled before one manifests the disorder.
I hope that this makes some sense. - Cam
Posted by JahL on March 23, 2001, at 17:09:15
In reply to Re: Celexa, posted by Cam W. on March 23, 2001, at 15:01:32
> > We are all born with a level of stress tolerance and life experiences (environment) raise or lower this level. Too much stress uncouples our body's stress response mechanism (HPA axis) resulting in the phenomenon we call depression.
Mmm...I had absolutely no stress leading up to my depression, nor have I had any since (other than dealing with the symptoms of the depression itself).
I am of the opinion that *some* depressions are *purely* organic in nature, & present myself as evidence. There is no mindset to 'fix' in my case.
J.
Posted by Cam W. on March 23, 2001, at 17:56:53
In reply to Re: Celexa » Cam W., posted by JahL on March 23, 2001, at 17:09:15
Jah - Stress is not defined as just psychological stress. Depression (or bipolar disorder or schizophrenia, etc) is set off by a stressor. This can be seen in the example of a herpes outbreak. Too much sun places a stress on the body (the skin, in the example of herpes) causing an outbreak out the latent virus. Thus, stress can be physiologic in nature.
OTOH depression can be purely endogenous in nature, as you say. Mindset may not have anything to do with some depressions, but in a majority of cases depression is triggered by a major psychological stressor. In cases of chronic depression medication for life may be essential for normal functioning. Behavioral psychotherapy can help in these instances. These treatments can help teach people to live within the boundaries of their illness, thus improving the quality of life.
The level or "bar" can be set ultralow and depression may be triggered by a seemingly inocuous event. Depression is not a single disorder, but has many causes (or system breakdowns). The body's HPA axis is integrally linked with many or most other bodily systems, both autonomic and sympathomimetic. The end result of varied disturbances manifest as depressive symptoms. This is why different treatments work (or don't work) for different people. A treatment will only work if it addresses the system that has broken down causing the depressive symptomatology. Present medical knowledge is unable to tell (in most cases) what has physiologically "caused" the depressive symptoms. Therefore doctors must try different antidepressants chosen on the basis of what specific symptoms are being presented. ECT is a shotgun approach that kinda jumpstarts multiple systems and this is probably why it is so effective in a majority of depressions.
I think that the above says that I agree with you - Cam
Posted by JahL on March 23, 2001, at 19:26:11
In reply to Re: Celexa » JahL, posted by Cam W. on March 23, 2001, at 17:56:53
> > Jah - Stress is not defined as just psychological stress. Depression (or bipolar disorder or schizophrenia, etc) is set off by a stressor. This can be seen in the example of a herpes outbreak. Too much sun places a stress on the body (the skin, in the example of herpes) causing an outbreak out the latent virus. Thus, stress can be physiologic in nature.
Thanks Cam, this hadn't occurred to me. Psychotherapists don't seem to convey this physiological side to stress(I wonder why?).
Strangely enough I had a mystery illness when a kid & developed an eating disorder immediately afterwards. The depression was not far behind...maybe this + a high disposition (or low bar) 4 depression was enough...?
J.
Posted by allisonm on March 23, 2001, at 19:47:05
In reply to Celexa, posted by Deidre on March 21, 2001, at 8:51:09
Cam,
Thanks so much for the explanations. They're great!
possum
Posted by Cam W. on March 23, 2001, at 20:01:40
In reply to Re: Celexa » Cam W., posted by JahL on March 23, 2001, at 19:26:11
Jah - Both the mystery illness and the eating disorder could each be considered stress (or stressors) to the body. - Cam
> > > Jah - Stress is not defined as just psychological stress. Depression (or bipolar disorder or schizophrenia, etc) is set off by a stressor. This can be seen in the example of a herpes outbreak. Too much sun places a stress on the body (the skin, in the example of herpes) causing an outbreak out the latent virus. Thus, stress can be physiologic in nature.
>
> Thanks Cam, this hadn't occurred to me. Psychotherapists don't seem to convey this physiological side to stress(I wonder why?).
>
> Strangely enough I had a mystery illness when a kid & developed an eating disorder immediately afterwards. The depression was not far behind...maybe this + a high disposition (or low bar) 4 depression was enough...?
>
> J.
Posted by Daveman on March 23, 2001, at 23:56:55
In reply to Re: Celexa, posted by Cam W. on March 23, 2001, at 15:01:32
Cam:
I agree with your analysis and it definitely applies in my case. I was "blindsided" (I thought) with a deep depression that started with total insomnia that lasted for 9 days, then turned into panic attacks and serious anxiety, which when controlled by Xanax revealed a depression so debilitating that I was forced to take a six week leave from my job. Celexa has now effectively controlled most of my symptoms, and through twice a week, continuing therapy I'm beginning to see that I was not really blindsided at all, but simply reached a breaking point in my life and career (I'm an attorney in a very high-stress job and simply did not catch the warning signs that my system was sending me).
So here we have a situation where medication was crucial to my becoming functional and is allowing me to face and understand what and why I encountered these problems. Medication and therapy, IMO, work hand in hand in cases like mine, and ultimately I hope the meds will no longer be needed. But for now I thank God that they exist and that I didn't have this depression 40 years ago, when I would probably have ended up in a mental institution undergoing shock therapy or some similar horror.
Oh and BTW the poster who started this thread shows an amazing ignorance of medical knowledge for someone who claims to be an RN!
Dave
> I agree that meds are needed in serious cases of depression. They readjust the neurochemical mix, thus alleviating some of the depressive symptoms, and, as Allison says, "puts the floor under one's feet". But I would also like to stress that, like insulin or antihypertensives, antidepressants are only a bandage. Psychotherapy, be it taking to a psychologist, clergy, or a good friend, helps to change the mindset and "fix the sh**" that caused the depression in the first place.
>
> We are all born with a level of stress tolerance and life experiences (environment) raise or lower this level. Too much stress uncouples our body's stress response mechanism (HPA axis) resulting in the phenomenon we call depression. Sometimes this uncoupling is permanent and we may need to keep taking medications for life. Sometimes the uncoupling is repairable, as one comes to terms with the cause.
>
> In mild cases of depression, sometimes talk therapy is enough, but one has to be able to understand and deal with the causes of the depression. Antidepressants can help bring about the ability to understand and I believe this to be the "floor" from which the doc or therapist can begin to work.
>
> Just my opinion - Cam
Posted by Daveman on March 24, 2001, at 0:05:29
In reply to Re: Celexa, posted by Cam W. on March 23, 2001, at 15:01:32
Oh and one more thing- I want to say how grateful I am to have found this Board. I am grateful to have found a place where people can exchange ideas and experiences concerning psychotropic medications without anti-med hysteria coloring the discussion. I've found the comments I've read here to be mostly informative, useful and, yes, sane. The responses to questions I've posted have definitely helped me understand my own course of therapy. Thanks to Dr. Bob and all of you!
Dave
> I agree that meds are needed in serious cases of depression. They readjust the neurochemical mix, thus alleviating some of the depressive symptoms, and, as Allison says, "puts the floor under one's feet". But I would also like to stress that, like insulin or antihypertensives, antidepressants are only a bandage. Psychotherapy, be it taking to a psychologist, clergy, or a good friend, helps to change the mindset and "fix the sh**" that caused the depression in the first place.
>
> We are all born with a level of stress tolerance and life experiences (environment) raise or lower this level. Too much stress uncouples our body's stress response mechanism (HPA axis) resulting in the phenomenon we call depression. Sometimes this uncoupling is permanent and we may need to keep taking medications for life. Sometimes the uncoupling is repairable, as one comes to terms with the cause.
>
> In mild cases of depression, sometimes talk therapy is enough, but one has to be able to understand and deal with the causes of the depression. Antidepressants can help bring about the ability to understand and I believe this to be the "floor" from which the doc or therapist can begin to work.
>
> Just my opinion - Cam
Posted by Dr. Bob on March 24, 2001, at 15:59:21
In reply to Re: Celexa » Cam W., posted by Daveman on March 23, 2001, at 23:56:55
> Oh and BTW the poster who started this thread shows an amazing ignorance of medical knowledge for someone who claims to be an RN!
I appreciate your other post, but this comment wasn't very supportive...
Bob
Posted by Daveman on March 24, 2001, at 20:29:00
In reply to Re: please be civil » Daveman, posted by Dr. Bob on March 24, 2001, at 15:59:21
Dr. Bob:
I was responding to the poster who took all of us to task for taking medications at all rather than simply seeking out talk therapy. Perhaps I should not have responded in kind, and if that was outside of the spirit of this Board, I do apologize. Perhaps it would have been better to simply seek clarification: Does this poster believe that medication has no relevance to psychiatric problems? Would she contend that people suffering from such things as schizophrenia, manic depression, and bipolar disorders should simply suffer rather than taking medications which can help them live a decent life?
Again, I did not mean to cause offense.
Dave
> > Oh and BTW the poster who started this thread shows an amazing ignorance of medical knowledge for someone who claims to be an RN!
>
> I appreciate your other post, but this comment wasn't very supportive...
>
> Bob
Posted by Rosa on September 1, 2001, at 4:46:07
In reply to Re: Schizophrenia » Kingfish, posted by Cam W. on March 23, 2001, at 16:49:04
My counselor explained that Schizophrenia is a "thought" disorder and different from mental illness.
Dr. Bob could you clarify this?
Dorland's Pocket Medical Dictionary describes Schizophrenia as any of a group of severe emotional disorders, usually of psychotic proportions, characterized by withdrawl from reality, delusions, hallucinations, ambivalence, inappropriate affect, and withdrawn, bizarre, or regressive behavior.
Rosa
Kingfish - Schizophrenia can be thought of as a problem with nerve connections resulting in, in part, an excess of dopamine in certain parts of the brain. The indirect connection of the thalamus and prefrontal cortex are disturbed, perhaps by an excess of the number of connections that a dopamine neuron makes (perhaps because of a lack of the normal synaptic pruning of dendrites that normally occurs as we age).
>
> Aldous Huxley in "The Doors of Perception" talks about a "reducing" valve in the brain that limits the amount of sensory stimulus that brain allows to be processed. This reducing value, in part, may be the thalamus. In schizophrenia, that reducing valve is more open than it should be; thus a person with schizophrenia receives too much stimulus and their brain has a hard time interpreting the inputted sensory stimulus. This may result in the positive symptoms (hallucinations and psychoses) we see in schizophrenia. When sensory overload occurs, some brain functions may shut down resulting in the negative symptoms (poverty of speech, withdrawl).
>
> Therefore, schizophrenia can be seen as an organic disorder. Too much stress can be seen as a trigger to set off schizophrenia or bipolar disorder. The difference in stress levels is why identical twins do not always both get schizophrenia. Environmental stressors, combined with a genetic predisposition, set the "level of the bar" for the amount of stress that can be handled before one manifests the disorder.
>
> I hope that this makes some sense. - Cam
This is the end of the thread.
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