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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Anna Laura on February 4, 2002, at 22:56:40
Hi all,
I've had a bout of severe depression years ago and i have been suffering from residual symptoms ever since.
My main symptoms are lack of motivation and anhedonia.
I've been doing a lot of research on the subject during this last year : i've grown rather confident i was going to find a remedy for my anhedonia, the main obstacle being just a matter of time and patience.
I've tried Imipramine (which had been effective when i relapsed last year, but made more apathetic in the long run), Prozac, Amytriptyline, Levosulpiride (similar to Amisulpride) Venlafaxine and Reboxetine together.
Prozac and Amytryptiline didn't improve anhedonia at all, Effexor and Reboxetine improved motivation and negative thinking in the long run.
I'm back on Effexor now but i'm afraid it's not kicking in like it did last summer. (still not sure, i'm going to give it a couple of more weeks trial, noticing no increase in motivation so far).
My negative thinking got really worse during the last month and i hit the rock bottom yeasterday as i bumped in to this article while surfing on the net:http://www.psychminded.co.uk/old%20news/Newsl10.htm
In a few words, it says you'd better stay off from drugs since they make your depression worse in the long run (sensitisation) and that switching it's not good for the same reason.
The article advocates Cognitive Behavioural Therapy for residual symptoms as the only way out.
I did CBT therapy for two years and didn't help much. What really helped me was Imipramine and a compassionate, supportive and empathetic pdoc.
He didn't believe in drugs though, so he made me drop imipramine after a year and a half.
My anhedonia grew worse in a couple of years.
As far as my personal experience is concerned, i shouldn't believe in what i read, but made me real upset no matter what.
I'm loosing faith about finding the right drug for me and i'm back in the pitch black tunnel, hopeless and desperate.
Don't know where to turn.
Hope that you guys are going to bring a couple of positive experience contradicting what the above article is reporting...Thanks for listening
Posted by Mr. Scott on February 5, 2002, at 0:28:16
In reply to Read an article: getting really pessimistic...., posted by Anna Laura on February 4, 2002, at 22:56:40
> Hi all,
>
>
> I've had a bout of severe depression years ago and i have been suffering from residual symptoms ever since.
> My main symptoms are lack of motivation and anhedonia.
> I've been doing a lot of research on the subject during this last year : i've grown rather confident i was going to find a remedy for my anhedonia, the main obstacle being just a matter of time and patience.
> I've tried Imipramine (which had been effective when i relapsed last year, but made more apathetic in the long run), Prozac, Amytriptyline, Levosulpiride (similar to Amisulpride) Venlafaxine and Reboxetine together.
> Prozac and Amytryptiline didn't improve anhedonia at all, Effexor and Reboxetine improved motivation and negative thinking in the long run.
> I'm back on Effexor now but i'm afraid it's not kicking in like it did last summer. (still not sure, i'm going to give it a couple of more weeks trial, noticing no increase in motivation so far).
> My negative thinking got really worse during the last month and i hit the rock bottom yeasterday as i bumped in to this article while surfing on the net:
>
> http://www.psychminded.co.uk/old%20news/Newsl10.htm
>
> In a few words, it says you'd better stay off from drugs since they make your depression worse in the long run (sensitisation) and that switching it's not good for the same reason.
> The article advocates Cognitive Behavioural Therapy for residual symptoms as the only way out.
> I did CBT therapy for two years and didn't help much. What really helped me was Imipramine and a compassionate, supportive and empathetic pdoc.
> He didn't believe in drugs though, so he made me drop imipramine after a year and a half.
> My anhedonia grew worse in a couple of years.
> As far as my personal experience is concerned, i shouldn't believe in what i read, but made me real upset no matter what.
> I'm loosing faith about finding the right drug for me and i'm back in the pitch black tunnel, hopeless and desperate.
> Don't know where to turn.
> Hope that you guys are going to bring a couple of positive experience contradicting what the above article is reporting...
>
> Thanks for listeningHello Anna Laura,
I read your anxiety producing article, and indeed it is an interesting theory. I would keep in mind that it is only a theory however. Also, that it is written by a psychologist and not a psychiatrist. So motivation to encourage CBT over meds must be considered. Even so the author raises some good points and BMJ is a respectable journal.
I cant put your mind at ease the way I'd like to (yours & mine that is), but I will say that we are all in this together. We are the first generation to really be so extensively medicated with these chemicals. One giant experiment is all psychiatry is right now. It's a terrible illness to have ours is, and without enough certainty. But don't give up hope that one day the truth and the answers will be found that will help us. And until then I think we need to take care of ourselves and eachother the best we can. I wish I could find the words I'm looking for instead of just delivering something cliche, but try to hang in there and keep your head above the water. If an answer is to be found, you'll have to keep looking until it is.
Finally I might add that the theory in the article is not tested, and that Hundreds of millions of people have taken antidepressants and that the vast majority of unipolars who do take them do improve with drugs. That has been tested!
I do hope things get better for you soon.
Scott
ps. Have your played with the dopamine/norepinephrine drugs like wellbutrin, reboxetine or desipramine. Based on your symptoms and earlier response to Imipramine I have a hunch you might do better there than with the highly serotonergic meds which often cause a decrease in motivation and or anhedonia.
Also...The Selegeline patch will be out soon which is highly dopamine and norepinephrine oriented.
Posted by IsoM on February 5, 2002, at 1:16:40
In reply to Read an article: getting really pessimistic...., posted by Anna Laura on February 4, 2002, at 22:56:40
Anna Laura, I was wondering how you've been doing & was going to send you an e-mail checking.
Doesn't seem to matter how I try to connect to the page with the article you give but it won't open for me. I'll try later but will answer some anyway.
I do beleive that meds & therapy work together most times. Many can improve just on meds alone, a few on talk therapy alone, but still many need to combine both. I don't think therapy works without fixing the chemistry first. When a person feels better, then they're ready to take steps to correct their thinking.
Probably a lousy illustration, but no one would expect someone to exercise & strengthen a broken leg till it was set & mended. Then strengthening exercises would work to get the weak, unused muscles working again.
I know I refuse now to stop all meds. I gave it three honest tries & I slip back into depression. While it never seemed like full blown depression when I was younger, I've always had some symptoms as long as I remember, even as a child. No talk therapy would ever have helped there. I don't feel bad about myself even when I am depressed. I don't feel guilty or have low self-esteem, just extreme bleakness.
Did you ever get to France to pick up the adrafinil? I'm so glad I've got my supply again & it's started working nicely again (day 17). I expect to feel more as the next few weeks go by. Let me know how things are, if you wish to e-mail me. I do care.
Posted by sid on February 5, 2002, at 9:02:53
In reply to Read an article: getting really pessimistic...., posted by Anna Laura on February 4, 2002, at 22:56:40
Anna Laura,
I think that once you find something that works well, you need to stay on it for a long time before stopping (given your history, probably 1 year+ at the dose where your symptoms have subsided). That's how you can prevent relapses. Indeed, switching drugs and stopping treatments too early can cause problems in the long run.I'm confident you'll find something that works for you again. This time, stick to it for a long time however. Find a doc that's aware of the long run negative impacts of drug switching (there should be a good reason for doing that) and stopping treatment too early. Together you can have a good plan and stick to it.
There's no point in losing hope, you need to think of better things than that. By the way, CBT worked for me for major depression, but not for residual symptoms. Now I have dysthymia left(have had it for 21 years), and I am treating it with Effexor XR, which seems to be working for now. I read a post by Elizabeth recently where she mentioned that CBT does not work for residual symptoms usually. Given her assessment and my experience, I think the article you mentioned may be right for some people (we all respond differently to different treatments), but certainly NOT for everybody!
Don't lose hope. Don't believe in statistics, keep trying instead and believing that something will work out for you.
- sid
Posted by Dinah on February 5, 2002, at 10:08:30
In reply to Read an article: getting really pessimistic...., posted by Anna Laura on February 4, 2002, at 22:56:40
How on earth do you do a study about the length of time on an antidepressant and the likelihood of relapse when it's discontinued? People who are on antidepressants for years are probably more likely to have severe and recurring (or chronic) problems with depression and are thus far more likely to relapse. How do you separate all the factors?
I guess you could put non-depressed people on antidepressants for differing lenghths of time and then study the results after discontinuance. But that would introduce different variables.
Or you could assess the severity and chronic-ness of depression in a group of people, find a group of patients with a similar profile, and randomly assign them antidepressants for varying lengths of time, and then assess the results. Is that what was done?
I'd really need to know the conditions the tests were conducted under before I believed any conclusions that were drawn from them.
Posted by jane d on February 5, 2002, at 11:09:17
In reply to Re: Read an article: getting really pessimistic.... » Anna Laura, posted by IsoM on February 5, 2002, at 1:16:40
> Doesn't seem to matter how I try to connect to the page with the article you give but it won't open for me. I'll try later but will answer some anyway.
IsoM,
It's a copy of this: http://bmj.com/cgi/content/full/322/7299/1428/a
Maybe this link will work better for you.
Jane
Posted by IsoM on February 5, 2002, at 11:47:37
In reply to another link to letter » IsoM, posted by jane d on February 5, 2002, at 11:09:17
Posted by Anyuser on February 5, 2002, at 12:06:43
In reply to Read an article: getting really pessimistic...., posted by Anna Laura on February 4, 2002, at 22:56:40
The article you cite is a letter from Giovanni Fava criticizing a more substantive article written by Gavin Andrews. I suggest you read the Andrews article, which is much more encouraging. Gava's first footnote is linked to it, and here's the url: http://bmj.com/cgi/content/full/322/7283/419. Andrews's article encourages the medical community to manage depression as a chronic disease. Here are Andrews's summary points:
1. The burden of depression is not being reduced.
2. The episodic nature of depression and the acute response to treatment means that episodes seem easy to treat.
3. They can be if patients comply with drug and cognitive therapy regimens.
4. The main problem is the next recurrence, if patients do not to come for treatment at all.
5. To reduce the burden of depression, we argue for a chronic disease management model.
6. We should manage depression proactively to ensure long term compliance with treatment.
That's not so scary. We already know all that: depression is recurrent and chronic. I would add a point that Andrews doesn't make: we all know vulnerability to depression increases with age.
Fava's point is an attention-getter: he says antidepressants make depression worse. I worry about that, but for now I don't think there's much science to back up Fava. Note the only person he cites to back up the two scariest sentences in his letter is: himself! Incidentally, I cannot find Fava's articles (the ones he cites in his letter) anywhere on the internet.
You say your doctor "didn't believe in drugs." If I were you, I'd get a new doc.
Posted by Anyuser on February 5, 2002, at 12:09:06
In reply to Re: Read an article: getting really pessimistic...., posted by Dinah on February 5, 2002, at 10:08:30
I agree with you. I also think your logic pertains to the "kindling" theory of depression.
Posted by spike4848 on February 5, 2002, at 17:59:36
In reply to Read an article: getting really pessimistic...., posted by Anna Laura on February 4, 2002, at 22:56:40
Hey There,
What a load of crap .... more propaganda produced by the psychologists pushing "talk therapy" and "drugs are bad". With a myriad of effective medications now, the field of psychology is shrinking .... freud is out the window. So you will come across these types of articles from time to time to try a scare patients away from medications.
Studies show that CBT has effect on mild depression, but *NO EFFECT* on severe depression. Meds and ECT are only effective in severe depression.
Please don't let this article discourage you ..... a relative of mine has been on imipramine for 25 years .... and she seems to be doing better every year.
Spike
Posted by Anna Laura on February 5, 2002, at 20:20:40
In reply to What a load of garbage? » Anna Laura, posted by spike4848 on February 5, 2002, at 17:59:36
I agree, with your theory, it's probably all propaganda...
Posted by Anna Laura on February 5, 2002, at 20:38:30
In reply to Re: Read an article: getting really pessimistic.... » Anna Laura, posted by sid on February 5, 2002, at 9:02:53
> Anna Laura,
> I think that once you find something that works well, you need to stay on it for a long time before stopping (given your history, probably 1 year+ at the dose where your symptoms have subsided). That's how you can prevent relapses. Indeed, switching drugs and stopping treatments too early can cause problems in the long run.
>
> I'm confident you'll find something that works for you again. This time, stick to it for a long time however. Find a doc that's aware of the long run negative impacts of drug switching (there should be a good reason for doing that) and stopping treatment too early. Together you can have a good plan and stick to it.
>
> There's no point in losing hope, you need to think of better things than that. By the way, CBT worked for me for major depression, but not for residual symptoms. Now I have dysthymia left(have had it for 21 years), and I am treating it with Effexor XR, which seems to be working for now. I read a post by Elizabeth recently where she mentioned that CBT does not work for residual symptoms usually. Given her assessment and my experience, I think the article you mentioned may be right for some people (we all respond differently to different treatments), but certainly NOT for everybody!
>
> Don't lose hope. Don't believe in statistics, keep trying instead and believing that something will work out for you.
>
> - sidSid
I shouldn't believe in statistics, you're right. Everybody's different. CBT wasn't that great for me. That's all.
So i shouldn't care about what the article is saying.
A question about drug switching: if i am supposed to stay on the same drug let's say, for about a year, how long am i going to take to find the right combo then?
The matter about drug switching it's pretty controversial: some say it's not harmful, others state the opposite. I don't know whose statement i should trust.
Posted by bob on February 5, 2002, at 21:38:24
In reply to What a load of garbage? » Anna Laura, posted by spike4848 on February 5, 2002, at 17:59:36
> Hey There,
>
> What a load of crap .... more propaganda produced by the psychologists pushing "talk therapy" and "drugs are bad". With a myriad of effective medications now, the field of psychology is shrinking .... freud is out the window. So you will come across these types of articles from time to time to try a scare patients away from medications.
>
> Studies show that CBT has effect on mild depression, but *NO EFFECT* on severe depression. Meds and ECT are only effective in severe depression.
>
> Please don't let this article discourage you ..... a relative of mine has been on imipramine for 25 years .... and she seems to be doing better every year.
>
> Spike
That imipramine story is very encouraging!
Posted by Bill L on February 6, 2002, at 11:15:29
In reply to Re: Sid: about drug switching....., posted by Anna Laura on February 5, 2002, at 20:38:30
Anna Laura - Right now you need to feel better. CBT is not the answer right now. It might help later after you are feeling better. I have done a lot of reading posts and research and have never heard anything that switching drugs is bad for anyone. Doctors do a lot of drug switching on patients if the drugs are not working well enough. If a drug does not work in a month or two, you should make a change either in the dosage or to a different drug or an additional drug. Also there is no evidence at all, at least that I am aware of, that long term usage of antidepressants is harmful. You have to keep in mind that there will always be articles written by people who are against drugs for some reason.
Your first step must be to find a different doctor who is knowledgable about antidepressants. This could either be a general practitioner or a psychiatrist.
> Sid
>
> I shouldn't believe in statistics, you're right. Everybody's different. CBT wasn't that great for me. That's all.
> So i shouldn't care about what the article is saying.
> A question about drug switching: if i am supposed to stay on the same drug let's say, for about a year, how long am i going to take to find the right combo then?
> The matter about drug switching it's pretty controversial: some say it's not harmful, others state the opposite. I don't know whose statement i should trust.
>
Posted by Noa on February 6, 2002, at 17:16:17
In reply to Re: Read an article: getting really pessimistic.... » Anna Laura, posted by Mr. Scott on February 5, 2002, at 0:28:16
Without having read the article, I can't comment on whether I think it has merit or not. But I can say this: Even if it is true, without medication, I would have been DEAD a long time ago, so it wouldn't matter if the theory has merit!
Posted by sid on February 6, 2002, at 19:38:34
In reply to Re: Sid: about drug switching....., posted by Anna Laura on February 5, 2002, at 20:38:30
Anna Laura,
first let me say that I'm no expert on this at all. But I've read many posts on this borad about people who have switched a lot and are finding it hard to find something that works the second or third time around. Also, my doctor recommends not to switch med unless there is a good reason. I read some recommendations about not switching ADs unless there's agood reason (poop out or serious side effects).You talk about combos... I'm still on one med only, which we'll augment later with "another molecule". I am not sure what it'll be yet. I never took ADs before (no other meds except antibiotics and aspirin), and the first one my doc prescribed seems to be working so far (Effexor XR for the past 2.5 months). We have increased the dosage to 75mg and I am not sure how high we'll go. I am trying to heal dysthymia and anxiety, and so far, I'm doing well. I am not even sure if we'll increase the dosage - right now I don't see it as necessary. I'm seeing my doc tomorrow, we'll see what she says. Anyhow, I figure that if I stay on Effexor XR, it should take about 6 months to get to the right dosage (if it changes again), 1 year maintenance, then tapering. Plus more time perhaps at some point for another molecule (not sure of the timing of that). Overall, I expect this adventure to be a 2-year thing for me. Then it'll be time for me to have babies before it's too late! I'm on a schedule. :-)
So I don't have a clear answer about how long it might take to find the right combo for you. I have expectations for myself, conditional on the fact that Effexor XR does not poop out. Things may not happen that way for me.
I think that first you need to be in sync with your doc about what needs to be accomplished, and how you can try to do so. From your previous message, that does not seem to be happening with you doc yet. So perhaps you should change doc, and ask your new doc or her that question. I don't know your entire story, and again, I'm not an expert at all.
- sid
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