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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by spike4848 on December 20, 2001, at 18:42:46
So, does anyone have an opinion about Dr. Phelp and his web site www.psycheducation.org? Specifically, What do you people think about the idea that up to 40% of depressed people are bipolar and should not be on any antidepressants? Elizabeth? Cam?
Posted by spike4848 on December 20, 2001, at 21:07:38
In reply to What do you guys think about Dr. Phelp's Site?, posted by spike4848 on December 20, 2001, at 18:42:46
Posted by Cam W. on December 21, 2001, at 0:36:19
In reply to What do you guys think about Dr. Phelp's Site?, posted by spike4848 on December 20, 2001, at 18:42:46
Spike - I think Dr.Phelps has overblown the situation a bit. What he is saying about many depressions actually being bipolar II has been known for quite a while. I'm fairly sure that we have talked about it on this board.
I had supper with Dr.E.Roy Chengappa, from Case Western in Pittsburgh, one night a couple of years ago. He had given a group of pdocs (and me) a talk on Topamax's use as a mood stabilizer. He was saying that he thought that the increased incidence of bipolar disorder since World War II was due to the discovery of antidepressants, especially the MAOIs and TCAs. These two classes of antidepressants have a fairly significant "manic switch" rate.
Today's newer generation do not seem to cause manic switch as readily, although it happens in about 5% of the time. I Phelp's figure of 40% is correct, this means that SSRIs, SNRIs, bupropion, etc. will cause manic switch in bipolar patients only about half the time.
I really don't think that the figure is as high as 40%, but if it is, there are a lot of mild cases out there. I don't know if it would be worth the side effects and risk of hepatoxicity to put everyone who is depressed, on divalproex (Epival™ or Depakote™) or risk a life-threatening rash with lamotrigine (Lamictal™) before trying an antidepressant.
I have seen a lot of people treated with antidepressants (literally hundreds), but I have only 2 cases of manic switch. I know that there are more than I see, but you'd think I would at least here about during "shop-talk" with the pdocs.
Yes, doctors should diagnose more carefully, but diagnoses, especially subtle ones, are easily missed. - Cam
Posted by Karen Curtis on December 23, 2001, at 12:07:22
In reply to Re: What do you guys think about Dr. Phelp's Site? » spike4848, posted by Cam W. on December 21, 2001, at 0:36:19
> Spike - I think Dr.Phelps has overblown the situation a bit. What he is saying about many depressions actually being bipolar II has been known for quite a while. I'm fairly sure that we have talked about it on this board.
>
> I had supper with Dr.E.Roy Chengappa, from Case Western in Pittsburgh, one night a couple of years ago. He had given a group of pdocs (and me) a talk on Topamax's use as a mood stabilizer. He was saying that he thought that the increased incidence of bipolar disorder since World War II was due to the discovery of antidepressants, especially the MAOIs and TCAs. These two classes of antidepressants have a fairly significant "manic switch" rate.
>
> Today's newer generation do not seem to cause manic switch as readily, although it happens in about 5% of the time. I Phelp's figure of 40% is correct, this means that SSRIs, SNRIs, bupropion, etc. will cause manic switch in bipolar patients only about half the time.
>
> I really don't think that the figure is as high as 40%, but if it is, there are a lot of mild cases out there. I don't know if it would be worth the side effects and risk of hepatoxicity to put everyone who is depressed, on divalproex (Epival™ or Depakote™) or risk a life-threatening rash with lamotrigine (Lamictal™) before trying an antidepressant.
>
> I have seen a lot of people treated with antidepressants (literally hundreds), but I have only 2 cases of manic switch. I know that there are more than I see, but you'd think I would at least here about during "shop-talk" with the pdocs.
>
> Yes, doctors should diagnose more carefully, but diagnoses, especially subtle ones, are easily missed. - CamAt the same time I can understand how a pdoc would be very reluctant to try a bipolar patient on anti-depressants. My son was on one a year ago- disaster. The pdoc was very reluctant to put him on this, and my son cannot take them again. So we have been through many trials of mood stabalizers, including lamictal. Right now Evan is in the hospital, and will be on 3 mood stabalizers, including lithium. Lots of bipolar kids just cannot take antidepressants at all. It is very tricky when they get depressed!! The atypical antipsychotics help my sons depression also. Karen Curtis
Posted by IsoM on December 23, 2001, at 13:05:21
In reply to What do you guys think about Dr. Phelp's Site?, posted by spike4848 on December 20, 2001, at 18:42:46
Spike, I went to his site & took the test on ADHD/bipolar as I've been diagnosed with ADHD, & I have depression, but some people think I'm almost manic at times.
It was obvious in looking over the questions what my results would be. I'm simply hyper when I get going - I didn't score one trait that's bipolar. I think the differences are obvious to me but some of the tests may be uselful for those who aren't sure if their problems are bipolar or something else.
I can't speak on anything else much on his site. I don't know the what the actual statistics are.
> So, does anyone have an opinion about Dr. Phelp and his web site www.psycheducation.org? Specifically, What do you people think about the idea that up to 40% of depressed people are bipolar and should not be on any antidepressants? Elizabeth? Cam?
Posted by Elizabeth on December 28, 2001, at 14:03:58
In reply to What do you guys think about Dr. Phelp's Site?, posted by spike4848 on December 20, 2001, at 18:42:46
> So, does anyone have an opinion about Dr. Phelp and his web site www.psycheducation.org?
I think a lot of what he has to say is pretty reasonable. I just looked at a small part of his site, so I can't vouch for the whole thing, but what I read seemed to be generally accurate. I like that he has a lot of links to other sites. I also think his site is well-organized, a feature that is lacking in many web sites! Something that I really respect is his willingness to acknowledge that his opinions are just opinions and that others disagree. It's pretty rare to find an "expert" who thinks and talks this way. I like that he discusses both sides of the issues.
> Specifically, What do you people think about the idea that up to 40% of depressed people are bipolar and should not be on any antidepressants?
That's probably an overstatement, just in terms of the percentages, but I also think that a lot of bipolar patients need ADs as well as mood stabilizers (although ADs alone are probably a bad idea). In any case, I don't think that was what he was saying -- I think he said that the controversy is about using ADs *alone* in people with bipolar or "bipolar spectrum" disorders.
He seems pretty cool, overall. I don't think he's very in touch with some of the problems that patients experience, but pshrinks seldom are. (This is one of many reasons I admire Dr. Bob for setting up this board -- hopefully, he gets to see things from our perspective by reading some of the posts here.)
It's an interesting site, and unusual in many ways. Thank you for pointing me to it.
-elizabeth
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