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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by utopizen on July 21, 2003, at 18:34:52
My p-doc wants me to consider Xyrem for my fatigue and social anxiety. He said he's had remarkable results with depression patients of his who tried it. You take it at nighttime and wait 6 weeks to notice effects. Anyone try it before?
Posted by Jack Smith on July 21, 2003, at 19:11:15
In reply to P-doc wants me to try Xyrem for social phobia, posted by utopizen on July 21, 2003, at 18:34:52
> My p-doc wants me to consider Xyrem for my fatigue and social anxiety. He said he's had remarkable results with depression patients of his who tried it. You take it at nighttime and wait 6 weeks to notice effects. Anyone try it before?
That's rather surprising. Everything I have read, both clinically and on message boards, suggests that GHB is generally quite bad for treating depression. I would be interested to see how it helps you, particularly with the fatigue.
Posted by utopizen on July 22, 2003, at 9:26:48
In reply to Re: P-doc wants me to try Xyrem for social phobia, posted by Jack Smith on July 21, 2003, at 19:11:15
> That's rather surprising. Everything I have read, both clinically and on message boards, suggests that GHB is generally quite bad for treating depression. I would be interested to see how it helps you, particularly with the fatigue.
>I would point to questioning whether these trials are double-blind crossover placebo trials or simply anecdotal records of doctors relating their patient's subjective responses (which is often indexed in MEDLINE, so be warned if it's not explicitly stated that it was a "double-blind crossover placebo trial.")
Moreover, remember my doc is considering using it before bedtime. Some quacks and their patients have for whatever reason thought GHB should be taken continously through the day. If that occurs, of course you'll get depressed- it'll slow you down, it's a hypnotic for goodness sakes!
The idea is the GHB is helpful in making sleep more restorative. It's will known, and has been recently reported in Psychology Today (effects of insomnia on inducing insomnia) that poor sleep quality can cause depression. If you don't wake up feeling refreshed and have a brightened mood, you're probably not getting restorative sleep.
Posted by Jack Smith on July 22, 2003, at 12:18:02
In reply to Re: P-doc wants me to try Xyrem for social phobia, posted by utopizen on July 22, 2003, at 9:26:48
> The idea is the GHB is helpful in making sleep more restorative. It's will known, and has been recently reported in Psychology Today (effects of insomnia on inducing insomnia) that poor sleep quality can cause depression. If you don't wake up feeling refreshed and have a brightened mood, you're probably not getting restorative sleep.
>I guess it would make sense that it would be helpful in treating depression if your depression is caused by lack of sleep. I am still skeptical that if its the other way around, GHB is only going to make things worse in the depression department. As for social phobia, I would be rather surprised to learn that a good night's sleep could reduce social phobia symptoms, but I don't suffer from social phobia so my understanding of it is not very good.
I am very curious to see how it goes for you, please keep us informed.
JACK
Posted by utopizen on July 22, 2003, at 16:54:50
In reply to Xyrem » utopizen, posted by Jack Smith on July 22, 2003, at 12:18:02
> I guess it would make sense that it would be helpful in treating depression if your depression is caused by lack of sleep.
>Considering 51% of the population suffers from chronic insomnia at some point, and far fewer suffer from depression at some point, and very few doctors understand that current research proves insomnia often induces depression if it's left untreated for five weeks, I would just say you're placing a lot of faith on what doctors know of for the causes of depression as they relate to sleep quality.
If you asked a random psychiatrist if insomnia can lead to depression, he would probably mumble something about how depression causes insomnia. Which is sometimes true. But new research also points to insomnia unrelated to depression ("primary insomnia") inducing depression when it's left untreated for five weeks. Current issue of Psychology Today discusses this finding. The insomniac doesn't have depression, the patient is misdiagnosed as having depression by an overly simplistic evaluation, and put on something like Paxil which can worsen insomnia instead of getting a sedative which will prevent the patient from getting depression in the first place. That doesn't make sense, does it? It shouldn't, but it's what doctors do because all they hear in med school is about how depression causes insomnia. Which it does, but they're not told that insomnia itself can often cause depression.
So instead of preventing something from occuring in the first place, they basically induce depression as a result of not properly treating the insomnia. And five weeks later, they "prove" their diagnosis because the patient is now depressed, whether or not he or she still has insomnia.
Unless a psychiatrist also studies sleep medicine (99% don't), few understand the correlations between sleep and mood to begin with, much less the correlation with specific drugs used on insomnia and the effects it has on mood during the day! Most couldn't spell Xyrem, even if they've heard of it. About 600 doctors prescribe it right now, to about 1400 patients. But it should be used in psychiatry, especially in treatment-resistant cases. For one thing, it can't hurt that much, especially if sleep apnea has been ruled out. Another thing, it's safer than atypicals.
This is the end of the thread.
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