Psycho-Babble Medication Thread 455823

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Re: rEEG System Helps Guide Prescribing Daniel Hoffman, M.D.

Posted by franco neuro on March 22, 2005, at 15:38:57

In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 8:51:16

Please allow me to throw my two cents into this discussion. Generally when I see a doctor post a message on psycho-babble I figure they're here trying to drum up business. Forgive my cynicism, but it's born of the experiences I've had in dealing with the medical community over the past few years. Having said that, I found the following sentence from your previous post very intriguing.

> There could be a few ways to treat a problem. E.G., if you can't tolerate SSRI's for example, maybe the same could be accomplished with a beta blocker and a stimulant (just as a hypothetical), in which case tolerability is resolved.

This tells me that you are someone who thinks outside of the box. A quality I've yet to come across in any of the doctors I've seen. And believe me I've seen dozens of doctors over the past few years. Maybe I'm just a hard case. Five or six years ago I went through a particularly stressful period. The dysthymia and GAD that I had chosen to ignore for the previous decade suddenly turned into a full blown neurosomatic disorder. I now have chronic pain, chronic fatigue, IBS, anhedonia and depression. (I ask you how could one not be depressed with the aforementioned problems?) In a headlong rush to find relief I bounced from doctor to doctor. And like many (if not most) of the people on this website, I began bouncing haphazardly from one medication to another while learning nothing in the process.

About two years ago I decided to become my own "medical detective." One of the books I read was "The Edge Effect" by Dr. Eric Braverman. It's an interesting, although somewhat simplistic book. In fairness, any book dealing with brain function that is aimed at the general public has to be "simplified" or no one would understand it. In the book he talks about how QEEG "Brain Mapping" is a large part of his diagnostic process. I was looking for a doctor who used this so I went to see him and had it done. (Ridiculously overpriced of course.) According to him the test showed that I have very low dopamine. Now I don't know if he used a comparative database or his own experience in using this device but it was the result I had come to expect. Here's why:

1. I'd been experimenting with amino acids during the past year and found that tyrosine helped me. Tyrosine, of course, is the precursor to dopamine and norepinephrine.

2. My father and uncle both take medications for parkinsonism. A condition of low dopamine. Perhaps indicating a genetic predisposition toward dopamine burnout.

3. SSRI's have not helped me. While slightly elevating mood they have tended to increase apathy and make my physical symptoms worse. Not only that. When I recently stopped taking Zoloft I had the best 2 or 3 days physically and mentally that I've had in a few years. Perhaps this is due to my serotonin level dropping below the pre-medication baseline for a couple of days until my brain was able to compensate for the cessation of the medication by increasing endogenous levels/transmission. I'm not a scientist so I may be totally wrong about this. However, if this is the case than maybe I'd benefit form a serotonin antagonist along with a dopaminergic med. Unfortunately when it comes to raising dopamine levels, our choices are few.

It would be nice to talk to Dr. Braverman about this but he isn't around much. He's been on Larry King and Neil Cavuto so I'm starting to worry that he aspires to be a celebrity. Even when he happens to be in the office it's virtually impossible to see him for more than a minute. So the frustration continues. If it gets bad enough maybe I'll hop in the car and drive to Colorado. Not likely though. I'm too darned tired. For now I think I'll just try picking a psychopharmacologist out of the phone book. It shouldn't be hard considering there are only 3 listed.

So the point of this rather long winded post is that I believe that the evidence taken in it's entirety may finally be pointing me in the right direction. In my case at least, the QEEG may have proven itself to be of use. Of course had my QEEG come up with a result other than the one I expected, I would be even more confused than ever. But until I get on the right medication and correct (as much as is possible) the suspected imbalance and start to feel better (God willing) I won't be able to say for sure how much it has helped me.

By the way, are you familiar with the work of Dr. Jay A. Goldstein? I was considering going out to California to see him but he retired last year. I just read his book "Tuning the Brain". Awesome book. It's a must read. Particularly if some of your patients with psychological problems have concomitant neurosomatic disorders. He's got me thinking that an NMDA antagonist might also help me. Although dopamine itself antagonizes NMDA. He's twenty years ahead of the rest of the medical community. No offense intended. :-)

 

Re: rEEG System Helps Guide Prescribing

Posted by Phillipa on March 22, 2005, at 16:02:46

In reply to Re: rEEG System Helps Guide Prescribing Daniel Hoffman, M.D., posted by franco neuro on March 22, 2005, at 15:38:57

I would like to know how a person like me could feel the effects of meds so intensely, that I couldn't take any AD's. I did tolerate Luvox and actually got up to 250mg at which point the pdoc I was seeing[has since been in newspapers locally for medical fraud and illegal distribution of controlled substances], discontinued it. He said he needed l0 people for a Celexa trial when the med first came out. I refused, so when I came in for my appointment he said "you're catatonic", and I'm taking you off the med and putting you on Celexa. I wasn't catatonic, I had been attending A Group that stressed only doing one task a day and training your body to relax. Anyway I felt like death on the Celexa. I also was on xanax. He finally took me off after a month of misery. I also found out I had chronic active Lymes Disease at this time. Anyway since then I've never been able to tolerate even the luvox at doses over l2.5mg. Now it seems as if my body doesn't even respond to Ad's. I've been put on cymbalta, zoloft, remeron, and don't feel a thing. The only med that still seems to have an effect on me is valium. So what is my problem? Oh I've finished menopause. Fondly, Phillipa

 

Re: Extremely skeptical WeeWilly

Posted by Iansf on March 22, 2005, at 18:48:45

In reply to Extremely skeptical, posted by WeeWilly on March 22, 2005, at 14:43:16

> This smells like snake oil. Where are the studies to back up these claims. The main problem with the treatment of mood disorders is we do not know what are the causes of mood disorders. In my case I am certain it is an endocrine problem and not a serotonin,ne or dopamine imbalance. I suspect that many others have a endocrine problem that is the root of their mood disorder. Maybe I am wrong but something about this rEEG system sounds phony.
>
Calling rEEG snake oil seems rather harsh. In my opinion, it's always wise to be somewhat skeptical of new approaches, but as described by Dr. Hoffman it certainly sounds like rEEG has reasonable scientific grounding. It may not be THE answer, but generally it looks to be heading in the right direction.
And the fact that problems show up in brain wave patterns doesn't necessarily rule out an endocrine imbalance as a cause of mental imbalances. After all, everything going on in your body is ultimately tied to the brain.
It's conceivable that in some - perhaps all - cases, using meds that re-regulate the brain is treating a symptom, not a source. But surely tracking down a source outside the brain would be helped by looking at brainwave patterns, then tracing them back to the body systems most likely to affect the brain in that way.
All innovative therapies need polishing to achieve their full potential. Dr. Hoffman's approach holds promise. Be skeptical, but don't dismiss it out of hand.

 

Re: rEEG System Helps Guide Prescribing

Posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34

In reply to Re: rEEG System Helps Guide Prescribing, posted by Phillipa on March 22, 2005, at 16:02:46

It was with great reluctance that I entered into this thread. Nothing tics me off more than people questioning my integrity. I still see medicine as a very noble profession, so when someone is cynical or skeptical of my life's passions and volunteer commitments to help others with my EXTREMELY busy schedule, I don't take kindly to it. Now I know no one knows me and there is plenty of reason to be skeptical, but suffice it to say that I have been trying very hard to correct erroneous impressions of rEEG that were posted on this thread that were brought to my attention inadvertently. I have no desire nor need to drum up any business from anyone. I've devoted much of my neuropsychiatric career to helping bring my profession out of the dark ages. I've published, am a consulting editor of 3 national peer reviewed journals, etc and my goal was to offer some education on this topic. To summarize the original points I was trying to make initially:

Brain-mapping or any other QEEG analysis differs from rEEG in one extremely key easy to understand way. ONLY rEEG uses an outcome database patients who were treated successfully and unsuccessfully. That is why it is more directly relevant to medication selection. Other approaches only had a comparison to a normative database that is people without symptoms These identify differences from the norm but then had to make suppositions about what might correct the norms or perhaps what diagnosis was appropriate. Because of the patient database, rEEG goes the next step and asks, in fact what medications work most of the time for people having those aberrations. Without this data everything is necessarily a guess. So the lesson here is you can learn more from patients who have been treated than you can from untreated and asymptomatic individuals.

The scientists who spent 18 years developing this database on their own time are some of the top people I've ever met, and stand up well to scutiny with professors and chairmans at Stanford, Harvard, etc - where in fact research pilots are starting. There are some publications on this and some submitted. A field has to start somewhere. This is not a panacea, but offers some people an evidence based approach to their neurophysiology with possible alternatives and objectivity beyond nomenclature.

Eric Braverman uses QEEG, but not rEEG - yet. He has been exposed to it and is impressed with it (as far as I can tell).

I hope my input has clarified some things. I will now bow out to the sidelines, least I be further accused of trying to drum up business. While it is hard for me to say no to someone asking, I will make it a rule not to accept any inquiries from anyone on this site to support my independent objective uncomprimising position.

 

Re: Extremely skeptical

Posted by Phillipa on March 22, 2005, at 19:56:14

In reply to Re: Extremely skeptical WeeWilly, posted by Iansf on March 22, 2005, at 18:48:45

I personally, am very honored that Dr. Hoffman took time away from his certainly very busy schedule, and attempts at leisure life. I have already forwarded his responses to quite a few people that I knew would benefit from his insight and knowledge. I appreciate your contrabution to the PsychBabble Board. I know this has given me and a lot of others faith that all pdocs are not "owned" by the drug companies, and truly have the best interests of their patients at heart. Congratulations, Dr. Hoffman, for not being afraid to stand up and be heard. To step forward and educate us to the promise of better treatment in the future. I graciously thank you. Fondly, Phillipa

 

Re: rEEG System Helps Guide Prescribing Daniel Hoffman, M.D.

Posted by Jakeman on March 22, 2005, at 22:44:45

In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34

I appreciate your contribution to this discussion and regret you took offense to some of the responses. I have to admit that I am a little taken aback by the stridency of your last post and your "rule" to not respond to any inquiries. Unfortunately there IS a lot of cynicism overall toward the psychiatric profession, but I agree with the poster who said you appear to be someone who is trying to improve the situation. I find rEEG and similar methods to be a fascinating subject and I will continue to read all I can about it (hopefully your papers as well). BTW, many of us are ALSO professionals with very busy schedules.
-Jake

> It was with great reluctance that I entered into this thread. Nothing tics me off more than people questioning my integrity. I still see medicine as a very noble profession, so when someone is cynical or skeptical of my life's passions and volunteer commitments to help others with my EXTREMELY busy schedule, I don't take kindly to it. Now I know no one knows me and there is plenty of reason to be skeptical, but suffice it to say that I have been trying very hard to correct erroneous impressions of rEEG that were posted on this thread that were brought to my attention inadvertently. I have no desire nor need to drum up any business from anyone. I've devoted much of my neuropsychiatric career to helping bring my profession out of the dark ages. I've published, am a consulting editor of 3 national peer reviewed journals, etc and my goal was to offer some education on this topic. To summarize the original points I was trying to make initially:
>
> Brain-mapping or any other QEEG analysis differs from rEEG in one extremely key easy to understand way. ONLY rEEG uses an outcome database patients who were treated successfully and unsuccessfully. That is why it is more directly relevant to medication selection. Other approaches only had a comparison to a normative database that is people without symptoms These identify differences from the norm but then had to make suppositions about what might correct the norms or perhaps what diagnosis was appropriate. Because of the patient database, rEEG goes the next step and asks, in fact what medications work most of the time for people having those aberrations. Without this data everything is necessarily a guess. So the lesson here is you can learn more from patients who have been treated than you can from untreated and asymptomatic individuals.
>
> The scientists who spent 18 years developing this database on their own time are some of the top people I've ever met, and stand up well to scutiny with professors and chairmans at Stanford, Harvard, etc - where in fact research pilots are starting. There are some publications on this and some submitted. A field has to start somewhere. This is not a panacea, but offers some people an evidence based approach to their neurophysiology with possible alternatives and objectivity beyond nomenclature.
>
> Eric Braverman uses QEEG, but not rEEG - yet. He has been exposed to it and is impressed with it (as far as I can tell).
>
> I hope my input has clarified some things. I will now bow out to the sidelines, least I be further accused of trying to drum up business. While it is hard for me to say no to someone asking, I will make it a rule not to accept any inquiries from anyone on this site to support my independent objective uncomprimising position.

 

Re: Extremely skeptical Phillipa

Posted by Phillipa on March 22, 2005, at 22:51:38

In reply to Re: Extremely skeptical, posted by Phillipa on March 22, 2005, at 19:56:14

Sorry Jake, I agree Dr. Hoffman is not the only one with a busy schedule. Where do the hours go? Fondly Phillipa

 

Re: rEEG System Helps Guide Prescribing

Posted by franco neuro on March 23, 2005, at 0:09:24

In reply to Re: rEEG System Helps Guide Prescribing Daniel Hoffman, M.D., posted by franco neuro on March 22, 2005, at 15:38:57

Where in the following passage from my previous post do you see me questioning your integrity? If you read it closely you would have seen that I was actually paying you a compliment!

> Please allow me to throw my two cents into this discussion. Generally when I see a doctor post a message on psycho-babble I figure they're here trying to drum up business. Forgive my cynicism, but it's born of the experiences I've had in dealing with the medical community over the past few years. Having said that, I found the following sentence from your previous post very intriguing.

> There could be a few ways to treat a problem. E.G., if you can't tolerate SSRI's for example, maybe the same could be accomplished with a beta blocker and a stimulant (just as a hypothetical), in which case tolerability is resolved.

> This tells me that you are someone who thinks outside of the box. A quality I've yet to come across in any of the doctors I've seen.


I hardly think anything about the aforementioned passage warranted your rather hysterical response. I don't know you. You may be a wonderful person and a wonderful doctor. The scientists and colleagues that you work with may be wonderful altruistic people also. Unfortunately, this has not been the case with many of the doctors I have seen. The fact that you may or may not find this offensive is beyond my control. I've often refrained from asking questions when meeting with a doctor for fear that they would overreact and take offense as you just did to my rather benign post.

Good God what is going on in the medical schools of this country. Is the word empathy ever spoken? I'm a good person. I'm a college graduate and a military veteran. I have a 141 IQ. I'm loyal, kind, and compassionate. And I always pay my rent and taxes on time. I'm no saint, but all in all I'm a pretty decent person. Who, along with most of the other people on this site, is suffering. Is it too much to ask to walk into a doctors office and expect to be treated with a little respect?

I have been to doctors who are good people and good doctors. But, who were unfortunately not able to help me. I'm fine with that. I've also walked out of many a doctor's office with a pain in my stomach feeling as if I had just been raped. I don't need to be smirked at, or scoffed at, or belittled and made to feel like garbage; simply because I had the gall to ask a question or show a little interest in matters concerning my own health. Especially when I'm paying my hard earned money for the privilege.

Once again. I meant you no offense. If some was taken I apologize and assure you it was unintended. I'm sure that there are other people on this site who have questions they would like to ask you. If you truly are someone who seeks to help those who are in desperate need of help, than you will continue to answer their questions and allow me to be the one who takes leave of this thread.

 

Re: rEEG System Helps Guide Prescribing Daniel Hoffman, M.D.

Posted by franco neuro on March 23, 2005, at 0:25:26

In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34

Where in the following passage from my previous post do you see me questioning your integrity? If you read it closely you would have seen that I was actually paying you a compliment!

> Please allow me to throw my two cents into this discussion. Generally when I see a doctor post a message on psycho-babble I figure they're here trying to drum up business. Forgive my cynicism, but it's born of the experiences I've had in dealing with the medical community over the past few years. Having said that, I found the following sentence from your previous post very intriguing.

> There could be a few ways to treat a problem. E.G., if you can't tolerate SSRI's for example, maybe the same could be accomplished with a beta blocker and a stimulant (just as a hypothetical), in which case tolerability is resolved.

> This tells me that you are someone who thinks outside of the box. A quality I've yet to come across in any of the doctors I've seen.


I hardly think anything about the aforementioned passage warranted your rather hysterical response. I don't know you. You may be a wonderful person and a wonderful doctor. The scientists and colleagues that you work with may be wonderful altruistic people also. Unfortunately, this has not been the case with many of the doctors I have seen. The fact that you may or may not find this offensive is beyond my control. I've often refrained from asking questions when meeting with a doctor for fear that they would overreact and take offense as you just did to my rather benign post.

Good God what is going on in the medical schools of this country. Is the word empathy ever spoken? I'm a good person. I'm a college graduate and a military veteran. I have a 141 IQ. I'm loyal, kind, and compassionate. And I always pay my rent and taxes on time. I'm no saint, but all in all I'm a pretty decent person. Who, along with most of the other people on this site, is suffering. Is it too much to ask to walk into a doctors office and expect to be treated with a little respect?

I have been to doctors who are good people and good doctors. But, who were unfortunately not able to help me. I'm fine with that. I've also walked out of many a doctor's office with a pain in my stomach feeling as if I had just been raped. I don't need to be smirked at, or scoffed at, or belittled and made to feel like garbage; simply because I had the gall to ask a question or show a little interest in matters concerning my own health. Especially when I'm paying my hard earned money for the privilege.

Once again. I meant you no offense. If some was taken I apologize and assure you it was unintended. I'm sure that there are other people on this site who have questions they would like to ask you. If you truly are someone who seeks to help those who are in desperate need of help, than you will continue to answer their questions and allow me to be the one who takes leave of this thread.

 

Re: THANK YOU!!! Daniel Hoffman, M.D.

Posted by KaraS on March 23, 2005, at 3:27:58

In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 19:03:34

I also wanted to thank you for all of your information and advice here. I think it's awesome that you took the time to clarify things for us and answer our questions. You even took great pains to try to lead posters to where they might find doctors who use or are knowledgable about rEEG. Yes, many of us posters also have busy schedules but we come here looking for answers and support. You came here just to help us.

Unfortunately I think a misunderstanding has the taken this thread into a different direction and cast a dark cloud on the great discussion that occurred previously. (Nonetheless, all of your good information will stay with us.) It would be a big loss to many of us here if you stopped posting. Either way, many of us appreciate what you tried to do here.

Kara

 

Re: THANK YOU!!!

Posted by Daniel Hoffman, M.D. on March 23, 2005, at 9:04:58

In reply to Re: THANK YOU!!! Daniel Hoffman, M.D., posted by KaraS on March 23, 2005, at 3:27:58

The part about technology that I find sociologically difficult is written communication vs. being in the room with a person (it is why I don't do phone psychiatry). I come off the sideline bench to clarify.

First, I hope no one thought I was implying I was the only busy person. What I was trying to say was that for those in the thread, there is a vested interest in taking their time to find help for themselves - which is both admirable as well as necessary because of some of the problems with medicine that many of you mention or allude to. I was doing it only to help and clarify misinformation - which is why I can't turn down projects and am so busy.

I meant no attack on any one email response, but was seeing a trend develop that I wanted no part of (snake oil, trying to drum up business, etc). I devote my life, literally, to this field for no compensation from the dedicated people at the "company" who have formed a volunteer army to advance psychiatry and while I understand frustration with medicine and physicians, I refuse to be lumped into that category.

I think it would be of benefit to get back on track of the real purpose of this topic. Being on the side lines, to me, meant not being as active nor discussing other failures in medicine. My role was to be factual only - not to ever comment again in these posts.

Trusting that we're on the same page, and since I'm not sure how one answeres a specific question in a forum (this is new to me) I've just been responding to the last one, hoping it encompasses everything above it. This is perhaps wrong.

The person in So. Calif who I feel is the most gifted in this area, is one of the two scientists who developed rEEG, Hamlin Emory,M.D. I suppose you could reach him through the website (www.cnsresponse.com).

 

Re: Medication signature question

Posted by Ritch on March 23, 2005, at 10:09:23

In reply to Re: THANK YOU!!!, posted by Daniel Hoffman, M.D. on March 23, 2005, at 9:04:58

Hi, I've got a specific question. The answer might be way over my head.. but can you clarify or discuss in greater detail how medications affect or "signature" QEEG results? .. perhaps with a specific common medication? Maybe some facts about EEG generally, might help us some. Thanks for any input.

 

Re: Daniel Hoffman M.D.--anyone in the Madison, WI

Posted by ravenstorm on March 23, 2005, at 10:27:06

In reply to Re: Medication signature question, posted by Ritch on March 23, 2005, at 10:09:23

I much appreciate your input. I am two years out of severe paxil withdrawal and still trying to find a medication. My main problem, however, is finding something that my stomach can handle.

My husband and I have decided this will be worth the money to pursue. It will be just devastating, however, if the results come back with a medication that I can not take due to disabling stomach problems.

Do you know of anyone in the midwest who does this or would be open to it?

Also, why aren't the atypicals in the data base yet? I was really disappointed to hear that as I really don't have a lot of antidepressants left to try and was thinking a low dose AP might be the next step.

The thing that really appeals to me about this process, is that, as someone who suffers withdrawal symptoms from nearly everything (prozac and wellbutrin being the only exceptions so far), it could save me months of withdrawal from another drug trial. Currently I am on mirtazapine, which, while not having enough efficacy for me, has also now started causing such severe heartburn that I am sick much of the time, can not eat normally, and the acid is starting to affect my vocal cords (even on prilosec). Unfortunately, when I tried halving the med I went into withdrawal, which for me doesn't seem to be self limiting. So, I will have to do a slow taper and hope my esophagus doesn't get erroded in the mean time. It is amazing to me that if you are mentally ill and have severe stomach problems you are pretty much out of luck.

Any input you could give about doctors in the midwest would be so much appreciated.

Thanks for braving the waters and jumping into psychobabble. I really believe this will be the future of psychiatry. It just seems so much more humane. I know it may not help me because of my stomach issues, but think of all the other people that you may have reached on this board who will be helped by your input. Thanks again.

 

Re: Daniel Hoffman M.D.--anyone in the Madison, WI

Posted by Daniel Hoffman, M.D. on March 23, 2005, at 11:23:33

In reply to Re: Daniel Hoffman M.D.--anyone in the Madison, WI, posted by ravenstorm on March 23, 2005, at 10:27:06

The question about "signature" is not easily answered. Suffice it to say that by knowing what a drug does to brainwaves, which is pretty consistent, it can match it's effect to the problem presented to the database. So if stimulants raise "relative power" in certain parts of the brain, and the patient needs this, the database would suggest this as a possability based on their statistics of 10-20,000 medication trials and the fact that patients responded positively to that intervention. Atypicals haven't been entered due to when they started developing the database, the population they had access to and financial backing. They hope to include them when they can.

Regarding referrals, I can only suggest that you contact the company to see if they know of anyone in a particular area that is capable of providing the data to them.

While for obvious reasons I won't comment on particular cases nor practice medicine via a forum, stomach problems can be difficult but usually manageable with the H2 blockers or other GI meds. Of course some people are more sensitive than others.

 

Re: Daniel Hoffman M.D.--anyone in the Madison, WI

Posted by ravenstorm on March 23, 2005, at 11:49:18

In reply to Re: Daniel Hoffman M.D.--anyone in the Madison, WI, posted by Daniel Hoffman, M.D. on March 23, 2005, at 11:23:33

Ok, I will contact them. I am on H2 blockers currently to no avail. If I can't tolerate a med, stomach wise, the only thing that helps is not taking the med anymore. Thanks for the speedy reply

 

Dr. Hoffman - alternative approaches

Posted by Iansf on March 23, 2005, at 17:32:40

In reply to Re: THANK YOU!!!, posted by Daniel Hoffman, M.D. on March 23, 2005, at 9:04:58

Dr. Hoffman,
How would you compare your approach to alternative approaches that also use brain data, such as the BrainSpect system of the Amen Clinic? There's a clinic in Walnut Creek, Calif. - whose name I can't recall - that uses some other system based on MRIs or some such. I imagine there's even more that I don't know of. All seem to focus on measures of actual brain function for either diagnosis or prescription, yet all take different approaches.

 

Re: Dr. Hoffman - alternative approaches

Posted by Daniel Hoffman, M.D. on March 23, 2005, at 18:59:12

In reply to Dr. Hoffman - alternative approaches, posted by Iansf on March 23, 2005, at 17:32:40

> Dr. Hoffman,
> How would you compare your approach to alternative approaches that also use brain data, such as the BrainSpect system of the Amen Clinic? There's a clinic in Walnut Creek, Calif. - whose name I can't recall - that uses some other system based on MRIs or some such. I imagine there's even more that I don't know of. All seem to focus on measures of actual brain function for either diagnosis or prescription, yet all take different approaches.


SPECT imaging is cerebral blood flow. Daniel Amen has pioneered some great work in looking as sub-typing of disorders. From a clinical perspective, I find I need to know HOW to treat a brain more so than what's wrong with it. Once SPECT scans identify the areas of abnormality, it is a clinical decision knowing what medicines effect that part of the brain - and if you don't know what's off, that can be helpful. But the problems I see more is a treatment resistant patient who's been on many medications, but still has significant symptoms. I want to know which medicines, or combination of medicines, and sometimes in WHAT ORDER of use will help the person.

As far a I'm concerned, you can't give me enough information to help figure out my patients. This is the neonatal development of neuro-imaging and it won't be long before some form of scan that matches a treatment with a patient will be performed routinely before you ever even see the doctor. We're the only field of medicine that has no test for a diagnosis and this is the beginning. We still have a long way to go.

 

Re: Dr. Hoffman - alternative approaches

Posted by ravenstorm on March 23, 2005, at 20:09:19

In reply to Re: Dr. Hoffman - alternative approaches, posted by Daniel Hoffman, M.D. on March 23, 2005, at 18:59:12

Exactly!!! No one would set a broken leg without an x-ray first! The developement of this technology/field is way over due in my opinion. Its too bad some of the money spent by the drug companies couldn't be used to fund this. Hopefully, the major universities now studying this will get the funding they need.

 

Re: Dr. Hoffman - alternative approaches Daniel Hoffman, M.D.

Posted by KaraS on March 23, 2005, at 22:11:22

In reply to Re: Dr. Hoffman - alternative approaches, posted by Daniel Hoffman, M.D. on March 23, 2005, at 18:59:12

Dr. Hoffman,
Does the database include MAOI medications? So many physicians are reticent to prescribe them. Also, I have been afraid to try them but would be more inclined if a test showed that one of them would be a good match for me. Perhaps once this kind of testing becomes more mainstream, this would also encourage more physicians to prescribe MAOIs rather than just routinely handing out the latest SSRI.

Thanks,
Kara

 

Re: Dr. Hoffman - alternative approaches

Posted by Daniel Hoffman, M.D. on March 23, 2005, at 22:22:37

In reply to Re: Dr. Hoffman - alternative approaches Daniel Hoffman, M.D., posted by KaraS on March 23, 2005, at 22:11:22

> Dr. Hoffman,
> Does the database include MAOI medications? So many physicians are reticent to prescribe them. Also, I have been afraid to try them but would be more inclined if a test showed that one of them would be a good match for me. Perhaps once this kind of testing becomes more mainstream, this would also encourage more physicians to prescribe MAOIs rather than just routinely handing out the latest SSRI.
>
> Thanks,
> Kara

Yes, the database includes MAOI's, but they don't fall under the "antidepressant" category. To the brain, they act similar to the "stimulants", which is often why only certain patients respond to them. rEEG had dramatically increased my use of MAOI's. American psychiatrists way under utilize these medications. Even a website by Harvard has chastised us for not using them the way European psychiatrists do. We're so afraid of litigation that we've scared ourselves and the public from considering these meds. None of my patients have had a problem with them, but it is initially scary to think about taking them. They are afraid of all the diet and medication restrictions. Several websites have reworked the foods you can eat categorizing them into high. medium and low risk. Newer MAOI's, which are reversible (but not available in the US) will not have the interactions that we see now. I think they are a definite viable option - but until rEEG I'd never used one. Shame on me!

 

Re: Dr. Hoffman - alternative approaches Daniel Hoffman, M.D.

Posted by KaraS on March 24, 2005, at 1:16:32

In reply to Re: Dr. Hoffman - alternative approaches, posted by Daniel Hoffman, M.D. on March 23, 2005, at 22:22:37

> > Dr. Hoffman,
> > Does the database include MAOI medications? So many physicians are reticent to prescribe them. Also, I have been afraid to try them but would be more inclined if a test showed that one of them would be a good match for me. Perhaps once this kind of testing becomes more mainstream, this would also encourage more physicians to prescribe MAOIs rather than just routinely handing out the latest SSRI.
> >
> > Thanks,
> > Kara
>
> Yes, the database includes MAOI's, but they don't fall under the "antidepressant" category. To the brain, they act similar to the "stimulants", which is often why only certain patients respond to them. rEEG had dramatically increased my use of MAOI's. American psychiatrists way under utilize these medications. Even a website by Harvard has chastised us for not using them the way European psychiatrists do. We're so afraid of litigation that we've scared ourselves and the public from considering these meds. None of my patients have had a problem with them, but it is initially scary to think about taking them. They are afraid of all the diet and medication restrictions. Several websites have reworked the foods you can eat categorizing them into high. medium and low risk. Newer MAOI's, which are reversible (but not available in the US) will not have the interactions that we see now. I think they are a definite viable option - but until rEEG I'd never used one. Shame on me!


Thanks again. That's surprising to me that the MAOIs are in the stimulant category, not so much for Parnate but for Nardil and Marplan. I had a feeling that rEEG would (and will) lead to more use of MAOIs. rEEG sounds like such a great improvement on the way things are currently done. I'm very encouraged by it. I wonder if I might ask you one more question about how success is measured here. An SSRI/SNRI might lift mood a lot and control anxiety but leave the patient feeling apathetic and without motivation. Would this be considered success according to this diagnostic system?

K

 

Question for Dr. Hoffman M.D Daniel Hoffman, M.D.

Posted by scatterbrained on March 24, 2005, at 2:39:36

In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 8:51:16

This all sounds really great and really promising and I commend you for not only using and helping develop this method but TELLING us about it. My question is as follows. After your post I read up a bit about this method and i would like to know how long you have to be off medication prior to taking the test? What if the drugs you are on are working partly but not in a lasting of complete way, it seems that going off at that moment would be sort of a gamble? Also I found that interesting what you said about maoi doing something similar to what a stimulant does considering that i take a stimulant Adderall, which has been the most helpful drug, along with zyprexa, for my depression. Perhaps an maoi would help my very extreme cognitive symptoms and anhedonia? Are there any other drugs that are not maoi that seem to do something similar in the brain as stimulants? If I could get away with not having to take an maoi, that would be ideal. Anyway, thanks again

 

To:Daniel Hoffman MD-multiple diagnoses and rEEG

Posted by Cairo on March 24, 2005, at 7:58:54

In reply to Re: rEEG System Helps Guide Prescribing, posted by Daniel Hoffman, M.D. on March 22, 2005, at 8:51:16

Do multiple diagnoses muddy the water with rEEGs in terms of prescribing? Or not? In my teen daughter's case, we have ADHD, dysthymia, social anxiety, Fibromyalgia/Chronic Fatigue features, learning disabilities, dyslexia, and language disorder. How effective would an rEEG be in sorting out all these issues as symptoms overlap so much? Medication side effects are a big problem, thus limiting dosing.

Thank you for any GENERAL insight you could give regarding managing multiple diagnoses.

Cairo

 

Re: Dr. Hoffman - alternative approaches

Posted by Daniel Hoffman, M.D. on March 24, 2005, at 8:27:33

In reply to Re: Dr. Hoffman - alternative approaches Daniel Hoffman, M.D., posted by KaraS on March 24, 2005, at 1:16:32

> > > Dr. Hoffman,
> > > Does the database include MAOI medications? So many physicians are reticent to prescribe them. Also, I have been afraid to try them but would be more inclined if a test showed that one of them would be a good match for me. Perhaps once this kind of testing becomes more mainstream, this would also encourage more physicians to prescribe MAOIs rather than just routinely handing out the latest SSRI.
> > >
> > > Thanks,
> > > Kara
> >
> > Yes, the database includes MAOI's, but they don't fall under the "antidepressant" category. To the brain, they act similar to the "stimulants", which is often why only certain patients respond to them. rEEG had dramatically increased my use of MAOI's. American psychiatrists way under utilize these medications. Even a website by Harvard has chastised us for not using them the way European psychiatrists do. We're so afraid of litigation that we've scared ourselves and the public from considering these meds. None of my patients have had a problem with them, but it is initially scary to think about taking them. They are afraid of all the diet and medication restrictions. Several websites have reworked the foods you can eat categorizing them into high. medium and low risk. Newer MAOI's, which are reversible (but not available in the US) will not have the interactions that we see now. I think they are a definite viable option - but until rEEG I'd never used one. Shame on me!
>
>
> Thanks again. That's surprising to me that the MAOIs are in the stimulant category, not so much for Parnate but for Nardil and Marplan. I had a feeling that rEEG would (and will) lead to more use of MAOIs. rEEG sounds like such a great improvement on the way things are currently done. I'm very encouraged by it. I wonder if I might ask you one more question about how success is measured here. An SSRI/SNRI might lift mood a lot and control anxiety but leave the patient feeling apathetic and without motivation. Would this be considered success according to this diagnostic system?
>
> K
>
>

Success was orinignally determined by significant changes in CGI scores that lasted over time. Now we determine success by using a "helpfulness index" to rate the value of this tool in where the patient ended up.

 

Re: Question for Dr. Hoffman M.D

Posted by Daniel Hoffman, M.D. on March 24, 2005, at 8:30:33

In reply to Question for Dr. Hoffman M.D Daniel Hoffman, M.D., posted by scatterbrained on March 24, 2005, at 2:39:36

> This all sounds really great and really promising and I commend you for not only using and helping develop this method but TELLING us about it. My question is as follows. After your post I read up a bit about this method and i would like to know how long you have to be off medication prior to taking the test? What if the drugs you are on are working partly but not in a lasting of complete way, it seems that going off at that moment would be sort of a gamble? Also I found that interesting what you said about maoi doing something similar to what a stimulant does considering that i take a stimulant Adderall, which has been the most helpful drug, along with zyprexa, for my depression. Perhaps an maoi would help my very extreme cognitive symptoms and anhedonia? Are there any other drugs that are not maoi that seem to do something similar in the brain as stimulants? If I could get away with not having to take an maoi, that would be ideal. Anyway, thanks again


A type I test must be done with a clean or naive brain. The person must be off their meds for 5 half lifes. If after using the suggestions the person isn't where they need to be, a type II can be done on the medications for comparison purposes to see if dosing is right or if this regieme is not moving the EEG, so alternatives are recommended. This means some people who can't go off meds would be precluded from using the rEEG.


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