![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 33. Go back in thread:
Posted by Glydin on October 2, 2005, at 21:48:10
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
I urge you to bring out the nurse in you and think about yourself, others you’ve heard from struggling with mental illness and patients you may have cared for and use that litmus test. Can you find validity in what the doc said – even if he was a doc? I do not. That kind of thinking implies there’s a character flaw, weakness, lack of will and any other number of fallacies we have FOUGHT against.I’m sorry that happened to you and I hope you don’t believe it.
Posted by JenStar on October 2, 2005, at 22:07:56
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
hi Phillipa,
I both agree and disagree with him. I think SOME things are "mind over matter" -- things like sticking to a diet or exercise regimen, studying, beating a bad habit like thumb-sucking or hair-twisting, or cursing. Those things are fixable by oneself (usually). I even think that maybe some 'borderline' mental disorders can be cured by positive thinking/etc. alone -- maybe very mild depression, mild anxiety, mild social phobias.But I also think there are larger problems that are NOT fixable without some help. People who suffer from severe depression, anxiety or phobias need real help to improve. And so far it seems that the meds DO help...unless we're all struck with a collective case of "the emperor has no clothes" syndrome!
I believe that meds are overprescribed, and maybe people DO experience a placebo effect. But so far, the meds seem to help!
There are professionals (mostly those who have never suffered a severe or debilitating mental disorder, I presume) who think that people can/should cure themselves of all mental struggles. Maybe the med school wanted someone like him because they worry about meds being overprescribed, and wanted someone who could focus on a different, holistic, therapy-related approach to problem solving. It's hard to say!
If you trust this guy, and have a relationship with him, could you set up an informal appointment just to talk with him? Could you say, "You know, I was really upset the other day when you told me XYZ. The truth is I've been getting better on the meds, and I want to give them a chance. I really felt like I was headed for confusion or a setback when you said XYZ to me. Can we meet so I can learn more about your philosophy and why you said that to me? I think it's only fair that you owe me some time. It's difficult to hear such a quick, flip, 5-minute assessment of my condition and NOT be upset. I kind of feel that you "owe" me a bit more time to explain!"
If you don't feel like doing that, remember that he's only ONE person and one opinion. Even experts disagree. Although he's the director of that school, he doesn't know you or your situation intimately. It's possible he'd even change his mind if he knew it better!
I'd say keep doing what you're doing -- give it a fair try. If it doesn't work, then you can move on. But don't feel swayed by his "expertise" to drop a plan that you've committed to and has been suggested by someone you trust!
good luck! :)
JenStar
Posted by Emily Elizabeth on October 2, 2005, at 23:51:45
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
Grrr. That makes me angry. Also, remember he is a PhD in biochem, NOT an MD. He has no clinical experience. Perhaps he knows a little more abt meds and the human body, but I suspect he is talking way out of his area of expertise. He might as well been a history prof.
In the end, only you can decide what is best for you. Meds are not a perfect cure-all, but as long as you are making an informed decision and are using them responsibly, then they are worth a try. In fact, I think most babblers would be willing to shave a few yrs off the end of their lives if they could feel better for the years that they have. (not even saying that meds will cause that, just for the sake of argument).
His comment was flip and insensitive. Ignore it.
Best,
EE
Posted by SLS on October 3, 2005, at 9:12:33
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
> Okay it's me again. Today I was with my husband and ran into an aquaintance who is a Professor at a Medical School. He has a PHD in biochemistry. He asked how I was and I explained that I was still taking meds for anxiety/depression. He very nicely told me to wean off the meds as they were not good for me. He said it is mind over matter.
LOL
:-(
Let this person remain a student of biochemistry. I'm sure he is very good at what he does.
You need students of psychiatry to help make diagnostic and treatment decisions for you.
If you notice, I still consider a professor and a doctor to be students. The day they become satisfied that they know everything is the day they are no longer the best at what they do.
Even professors and physicians are humans. Sometimes, humans become very emotionally attached to a school of thought without fully considering the applicability or validity of others.
I find this professor's advice to you to be inadvisable to follow.
- Scott
Posted by rainbowbrite on October 3, 2005, at 9:57:06
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
PJ Ignore peole like that!
Thats so unfair to tell someone that. It seems to be something I come accross alot as well, and it has resulted in me being an in the closet med taker. But there is nothing wrong with taking meds! And that guy was out of line in telling you that IMO.
Try not to let it bug you, whatever makes you happy and helps you is the best thing to do.((PJ))
Posted by Bill LL on October 3, 2005, at 11:57:59
In reply to Re: Professor at Med School Says Wean off All Meds » Phillipa, posted by rainbowbrite on October 3, 2005, at 9:57:06
Thank God that this professor is not a physician!
Posted by CK1 on October 3, 2005, at 19:07:10
In reply to Re: Professor at Med School Says Wean off All Meds » Phillipa, posted by SLS on October 3, 2005, at 9:12:33
Phillipa,
I think that guy is an idiot. Phillippa, come on, you know you need meds or you wouldn't be trying them. Right? SSRI's, Benzos, MAOI's, etc. have all improved MILLIONS of lives. There are there over 20 million prescriptions written every year for SSRI's and, in a majority of cases, they make peoples lives better. Obviously, that guy doesn't understand depression/anxiety well enough to know that some people DO need these meds to function obtimally.
Phillipa, I realize you suffer from anxiety/depression. I'm just wondering why you're going to try Lexapro considering how many SSRI's you've been on before and none of them worked. After 2-3 don't work, you can bet that Lexapro isn't going to be much different, you know? After trying 4 SSRI's myself over the past few months and having them not work, I am getting ready to try Nardil. It's a much more effective AD and it has a 60-85% success rate for anxiety while SSRI's have a 15% success rate. And, I've heard from many people that the side effects are blown way out of proportion and are no worse than SSRI's. I would even try if if you're anxiety/depression is just mild. You might be amazed............but, I think you've tried enough ssri's (my humble opinion :).
On a different note, I have one major problem with this board! There seem to be very few success stories with meds leading many to become afraid of them. All I read about on this board is people having bad side effects, people not getting better, and frustration at everything that is going wrong in their lives. Come on, isn't there anything positive going on in anyone's lives?
Posted by linkadge on October 3, 2005, at 22:32:10
In reply to Re: Professor at Med School Says Wean off All Meds, posted by CK1 on October 3, 2005, at 19:07:10
I know this is a med board, but I think this guy is on the right track.
Linkadge
Posted by Ilene on October 4, 2005, at 0:11:09
In reply to Re: Professor at Med School Says Wean off All Meds, posted by CK1 on October 3, 2005, at 19:07:10
> On a different note, I have one major problem with this board! There seem to be very few success stories with meds leading many to become afraid of them. All I read about on this board is people having bad side effects, people not getting better, and frustration at everything that is going wrong in their lives. Come on, isn't there anything positive going on in anyone's lives?
The reason most of us are here is because of bad side effects, not getting better, and having a tough go of it. You might try the Social board for more upbeat postings.
I.
Posted by DanielJ on October 4, 2005, at 8:44:05
In reply to Re: Professor at Med School Says Wean off All Meds, posted by lynn970 on October 2, 2005, at 20:07:59
Mind over matter doesn't work when the mind isn't working correctly.
Mad dogs and college professors can also be classified as Quackpots
with little or no exposure to people with real mental illness issues.
There was one Professor who had a web site inviting all Schizophrenics
and Bipolar sufferer to give up their medications and go with his method.
Duh he described how after many years of therapy someone with
undifferentiated schizophrenia now was much better.
Well my son is one of those sufferers and after the correct anti psychotic
and AD combo was determined. Well he is back in High School with top
grades and few issues and has been that way for over 2 years. He "must"
take medications daily. Don't listen to this Guy, he is a theoritician with
no real world connections!
Posted by SLS on October 4, 2005, at 9:45:44
In reply to Re: Professor at Med School Says Wean off All Meds, posted by linkadge on October 3, 2005, at 22:32:10
> I know this is a med board, but I think this guy is on the right track.
>
> LinkadgeHmm.
If you don't need drugs, don't take them. That's a pretty simple principle to understand and follow.
Psychotherapy is sometimes all that is needed if the depression is not biologically driven. That's another pretty simple idea to work with.
How do you know when someone needs medication?
Never?
It is a tough decision to make. There are so many variables. That's why psychiatrists get paid the big bucks. That's why the competent ones are actually worth it.
The longer one goes without successfully treating major depressive disorder (MDD), the worse the depression gets and the more resistant to medical treatment it becomes. This is particularly true for people whom develop depression early in life.
Linkadge, it might be difficult to parse out exactly why your depression has become more severe and resistant to drug treatment. However, it does follow a pattern that has been observed and noted by psychiatry.
It does seem that people who have been exposed to a particular drug become more resistant to it over time if it is repeatedly stopped and restarted. If one is to discontinue medication, the more gradually the drugs are tapered, the lower the risk of relapse. Taper periods can be weeks to months long. During a slow taper, if a relapse occurs, you can quickly raise the dosage of the medication and recapture the antidepressant response. For those people who need long-term or indefinite treatment, the longer the time spent between an abrupt discontinuation and eventual relapse, the less likely they are to respond adequately to the same drug. This is probably less of a problem for people whose depressive episodes are separated by years than for someone who has demonstrated a higher rate of recurrence.
Linkadge, it is entirely possible that you suffer an Axis I and Axis II disorder comorbidly. The Axis II personality disorder might produce enough psychosocial stress to drive the Axis I mood disorder. The Axis I mood disorder might make it much harder to do the psychological work necessary to process psychotherapy. It might be an ideal multimodal treatment strategy to pursue both treatments concurrently.
- Scott
Posted by DanielJ on October 4, 2005, at 10:25:47
In reply to Re: Professor at Med School Says Wean off All Meds » linkadge, posted by SLS on October 4, 2005, at 9:45:44
If it already has been determined by the Pdoc that a serious mental illness exists then the correct medication can be precribed. This determination may take weeks or even months.
My son could not function as a normal human being and this happened virtually overnight. It took about 3 months to get him under control
and another 3 to get him stabilized. His psychotic episode was severe and he relapsed a month later. He had therapy sessions as well but in his case the real elixirs were Zyprexa and Zoloft. Three days off these meds and it would be a disaster in the making.
Those who can communicate rationally with a Pdoc are probably more apt to be helped by therapy. In truth my son occasionally speaks at length with his psychiatrist now. We got a highly recommended therapist for a few sessions. My son didn't like him and I believe the feeling was mutual. We dumped him before he could do any damage and my son feels his talks with his Pdoc are productive and helpful. He is satisfied with his life thus far and doesn't feel the need for additional therapy.
Posted by gardenergirl on October 4, 2005, at 12:32:33
In reply to Re: Professor at Med School Says Wean off All Meds » linkadge, posted by SLS on October 4, 2005, at 9:45:44
Posted by linkadge on October 4, 2005, at 14:10:47
In reply to Re: Professor at Med School Says Wean off All Meds » linkadge, posted by SLS on October 4, 2005, at 9:45:44
Its not that I don't think the idea of needing medication is wrong, I simply think that the current medications do more harm than good.
So I do agree with him when he says get off them, because well, I think they can to a lot of dammage to the brain.
Linkadge
Posted by Nickengland on October 4, 2005, at 15:24:18
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
I think there is truth in the fact that indeed whilst the argument put forward that medication is the answer to go forward to treat mental illness, there is also truth in the fact that medications are not *the* answer to make you well alone.
Some of what the professor said, was perhaps not worded as what you would expect from someone of his background, but at the same time I think there is some middle-ground within what he was saying.
>...to wean off the meds as they were not good for me.
Some medications can make people worse rather than better, although one would have to be in a position to know if this was the case.
>He said it is mind over matter.
When the causes of the disease(s) are unknown, but there are biological things going on and genetic's involved, then it would be easy to say that in some respects when the person does not have such an illness of unknown causes. Also the mind would have to functioning to a good standard in the first place for it to be able to fix itself and problems around it. In certain fears it can be like the chicken and the egg factor, in some ways to break the fears it can be mind over matter but its a very loose term and it doesnt correspond well to other areas of mental ilness at all.
>And if he put a scope in my mouth to my intestines it would look like a pharmacy.
I long for the day when they can put some kind of scope into my brain and say "hey...thats the problem" lets it fix and *cure* it with X. But then its mind over matter right? lol
>He basically said meds will not make you well.
But if only these people could then tell you what would...
Medication when treating any mental illness will only treat the symptoms...I do not believe they can cure anything but only help you live with the illness better than how you did without the medication before. If genetics play a part in certain peoples illness's then taking no amount of medication on todays market from what I understand, be it antidepressants, anticonvulsants, antipsychotics etc are going to cure the genetic defects which caused the illness. The drugs will however at best help you to have more symptom control over the symptoms which you were currently suffering from.
What if you've tried all the medications and now you're getting no where? Medication may not be the answer to the problems...Therapy could well be.. Like Scott said sometimes a combination of both can produce the best possible outcome..
I remember once being told by a psychiatrist I should take prozac, just like a diabetic has to take insulin. At the time I could understand what he was saying, but the diabetic has a problem with *insulin* whereas I do not have a problem with levels of prozac in my brain. Funnily enough the actual problem I had was that I shouldnt have being taking the stuff in the first place as it was making me worse - but there was the psychiatrist saying how badly I needed it compared to that of a diabetic with insulin.. I was 17 at the time.
I guess in the future, I hope that the ways in which we are told to take drugs will correspond exactly with how our illness presents itself. Just like that of the diabetic and insulin. No one says to the diabetic its mind of matter and hopefully in the future when advances are made and more is known about the causes which brings newer treatments specifically targeted at them, people will not be saying such things. Just like many years ago, people said mental patients were to be locked up and left to die. It doesn't happen anymore and oneday people won't say things like this professor guy did I hope.
Support I believe is one thing that can truely make people get better no matter what illness they have. Having proper support from friends and family and the community around you, just knowing that people care gives you *hope* ~ and with that *hope* comes peace of mind that you will get better...it gives you that little extra that things will work out.
Africa, has some of the poorest deprived countires of the world, but an example of how hope can make you better is this. When someone gets sick in the village, the leader of the tribe will gather the people of the community, all the people will then go and visit the sick person. Can you imagine living in a small town where you got mentally ill and everyone came to visit you to "gee you up" so to speak. The encouragement of everyone being together and helping in itself would be truely amazing. Its just unfortunate that in the western world, sometimes the very people we turn to treat our illness give us the exact oppsite of what we really need to make us feel better..
I even read recently that whilst schizophrenia was once thought to be a degenerative disease, it is now thought that the brain can actually repair itself. This offers hope.
Also with medications and mental illness (here it shows schizophrenia) could actually depend which country you live in. If the professor was speaking to you (and you had schizophrenia) in India Colombia or Nigeria then he might have something to go on by..
"The World Health Organization conducted two long-term follow-up studies involving more than 2,000 people suffering from schizophrenia in different countries, and discovered these patients have much better long-term outcomes in poor countries (India, Colombia and Nigeria) than in rich countries (USA, UK, Ireland, Denmark, Czechoslovakia, Japan, and Soviet Union)despite the fact antipsychotic medication is typically not widely available in poorer countries."
>Why does someone always make you doubt your decisions?
I wish I could answer that question, but let me just say that alot of people here have the greatest faith in your decisions Phillipa :-)
Kind regards
Nick
Posted by SLS on October 4, 2005, at 19:51:00
In reply to Re: Professor at Med School Says Wean off All Meds, posted by Nickengland on October 4, 2005, at 15:24:18
Hi Nick.
:-)
> I think there is truth in the fact that indeed whilst the argument put forward that medication is the answer to go forward to treat mental illness, there is also truth in the fact that medications are not *the* answer to make you well alone.
Tell that to a lithium responder.
> Medication when treating any mental illness will only treat the symptoms...
I disagree with this characterization. When one responds robustly to an antidepressant, there is a global improvement of all symptoms simultaneously. This indicates to me that some core process or processes have been modulated by the treatment such that the illness itself goes into remission. I don't think that the word "cure" serves well to describe treatment success with mood illness. "Remission" seems more appropriate.
> I do not believe they can cure anything but only help you live with the illness better than how you did without the medication before.
You should see the difference in brain function between depressive episode versus remission as imaged by a P.E.T. scan. In relapse, most of the brain appears blue and inactive. In remission, the whole brain lights up yellow, orange, and red. This is virtually identical to the portrayal of a healthy brain. Semantics aside, this person no longer has to contend with any aspect of depression other than maintaining the effective treatment.
I have experienced a full remission. Depression was completely absent. I functioned as if I had no mood illness. I was unbound to begin putting my life and my psyche in order. It is a recovery process. Additionally, being free of MDD does not mean being free of other psychiatric problems. A completely healthy person must work to build a psyche and life that brings them happiness. Problems encountered along the way must be dealt with to overcome. They usually do not disappear by themselves. Why would anyone think for one moment that a drug will make such problems disappear? At best, a drug will bring a depressed individual who has been made incapable of dealing with these problems into a state of remission that will then enable them to. From effective treatment comes health. From health comes problem-solving capacity.
Looking into the future, I believe that our ever-expanding ability to look at how the brain functions through imaging techniques like PET, SPECT, and fMRI will allow for a biological testing protocol that will be able to identify effective drugs for each individual using an array of compounds as biological probes. In addition, genetic microarrays might be able to screen for deficiencies and excesses of particular gene products. This would help identify which genes are turned on and which ones are turned off. A gene-activity profile can be constructed to produce a matrix from which abnormal function can be characterized and treated.
Many of us were born at least 20 years too early.
- Scott
Posted by SLS on October 4, 2005, at 19:55:12
In reply to A lot of wisdom in this post (nm) » SLS, posted by gardenergirl on October 4, 2005, at 12:32:33
With all the posting I've done over the years, I guess I was bound to hit once.
:-)
Thanks.
- Scott
Posted by Glydin on October 4, 2005, at 20:20:30
In reply to Re: A lot of wisdom in this post » gardenergirl, posted by SLS on October 4, 2005, at 19:55:12
I have enjoyed your posts for years. I appreciate your ability to articulate well and I appreicate your knowledge, insight, willingness to share your life experiences, and compassion.
Posted by DanielJ on October 4, 2005, at 21:22:27
In reply to Re: A lot of wisdom in this post » gardenergirl, posted by SLS on October 4, 2005, at 19:55:12
I almost hate to add this one but why not. A person can spout technical jargon for paragraph after paragraph.write books on the subject and even "Do" the lecture circuit, but in my book there is only one criteria that is important and stands alone in the eyes of all who may seek to evaluate performances. One question perhaps two questions/ of Professors,Pdocs,Counselors and therapists et al
1. How many people have you really helped?
2. Is it important to you that these people are better off than they were?
Posted by grammy on October 4, 2005, at 23:31:10
In reply to Re: A lot of wisdom in this post, posted by DanielJ on October 4, 2005, at 21:22:27
The comment the biochemist made about getting off of the meds is the exact reason I got off my meds 2-3 times. I felt like I should be able to pull myself up by my boot straps and get well on my own, but I couldn't. It made me feel even worse to have to rely on medication to function so-called "normally". Also, when I got on ADs, people didn't talk about it like they do now, so I was in the closet. You know that song, "Nineteenth Nervous Breakdown"? That was me.
Each time I got off my meds, I relapsed into deeper depressions and more intense anxiety, until I finally had to get back on the medications. Sometimes, even after 16 years on ADs, I think I can get off of them and try again to function normally. However, I think back at how sick I was and I know I can't.
I sometimes wonder what I would've done if I'd have been born in a different era, before medications - it's scary.
Philippa, please ignore him. Carole
Posted by ramsea on October 5, 2005, at 8:07:46
In reply to Re: A lot of wisdom in this post, posted by grammy on October 4, 2005, at 23:31:10
I've become used to the way that all of us, myself included, have a tendency to generalize too widely from our own experience. Because I was misdiagnosed and almost fatally overmedicated as a teenager some 30 years ago in a breakdown crisis, I refused medical help for years. I self-medicated. My bipolar ruined a lot of things for me and nearly killed me and through negligence possibly others.
I ended up in self-help groups and 12-step groups and found a deluge of people advocating all sorts of all-cures, from their brand of counseling, or religion, or diet, or ideas about all-sorts.
So much black and white thinking, and overgeneralizing and presumptuousness. I used to be very anti-psychiatric medication, and could only see "addicts" everywhere I looked.
That's until I ended up being a mental health worker and saw first hand how some chronic severely mentally ill people could live independent, rewarding lives but only with a lot of human encouragement, social support--and their meds.
Take away those meds, and the other aspects just didn't do enough, they lapsed into overexcitement and confusion--and got sectioned and even arrested.
There are many causes of mental distress, the trick is working out if one has got past needing a med or will need medical support for life--most likely. But even there, I've seen some chronic "schizophrenics" recover and not need meds.
Each person's experience is unique, and I try not to think too strongly and linearly from my own viewpoint. I despise what Prozac did to me, for example, but would never dream (anymore) of trashing it or other anti-deps out of hand. Or benzos, or anything. The sky's the limit and I might be wrong about what will/will not be "just the thing" for some one. And that includes out of hand advocating that people on psych meds stop taking them.
I'm not a doctor or a mindreader, and even if I were, I think it would be inappropriate and possibly very dangerous to tell people I am not treating as a patient that they're current doctor is hurting them.
A good friend of mine had a clinical psychologist tell him this (after over 30 years on his lithium and anti-psychotic) and he followed this advice. The result was quite catastrophic, and this psychologist (who had only seen him a few times and was not working in collaboration with the psychiatrist and medical team) lost their job.
One question to ask, perhaps, is--when someone gives us advice like this, are they legally responsible for our possible bad reaction to the withdrawl? Or any in-hospital treatment we may require if our symptoms bring us to crisis again? Will they be helping us to pay for and get other forms of therapy and support? Do they know our medical history in-depth? Could they be just platforming their own theories at the expense of our own stability? Yeah, I have asked questions like this and found most would-be advisors/ other people controllers don't qualify to interfere in my fragile health. sorry to write so much, ramsea
Posted by Glydin on October 5, 2005, at 9:15:29
In reply to Re: overgeneralizing, posted by ramsea on October 5, 2005, at 8:07:46
~~~ I commend your objectivity in the face of a situation that did not turn out well for you. I think that's a difficult thing for folks to have -it seems to turn some folks quite bitter and that does give way to overgeneralizing.
> One question to ask, perhaps, is--when someone gives us advice like this, are they legally responsible for our possible bad reaction to the withdrawl? Or any in-hospital treatment we may require if our symptoms bring us to crisis again? Will they be helping us to pay for and get other forms of therapy and support? Do they know our medical history in-depth? Could they be just platforming their own theories at the expense of our own stability? Yeah, I have asked questions like this and found most would-be advisors/ other people controllers don't qualify to interfere in my fragile health. sorry to write so much, ramsea~~~ Good points!
Posted by Nickengland on October 5, 2005, at 10:42:10
In reply to Re: Professor at Med School Says Wean off All Meds » Nickengland, posted by SLS on October 4, 2005, at 19:51:00
Hello Scott
Ahh my previous post did possibly come across slightly antipsychiatry/antimeds lol My apologies, that was not my intention, just trying to cover some middle-ground :-)
>Tell that to a lithium responder.
Yes!...My mother is one of nearly 20 years, same dosage, never been upped, never been lowered and keeps her well.
>I disagree with this characterization.
Lithium carbonate is an antimanic medicine. Priadel (The brand of Lithium my Mother takes) is used to
*control the symptoms* of 1. Mania (a state of high excitability and exaggerated emotions) and hypomania (a mild form of mania) 2. Bipolar depression. (where the mood changes between manaia and depression) when treatment with other antidepressant drugs has not been successful. 3. Aggressive behaviour or intentional self half. It is also used to prevent mood problems which occur frequently.It says in the drug information leaflet that the drug is used to control the symtoms?
>When one responds robustly to an antidepressant, there is a global improvement of all symptoms simultaneously.
:-) All symptoms. Which suggests the medication is treating the symtoms of the illness - which suggests it is keeping the illness under control.
>This indicates to me that some core process or processes have been modulated by the treatment such that the illness itself goes into remission.
"The definition "Remission" in bipolar means a return to the level of mood symptoms seen in the general population. A limitation to this definition is that it does not include functionality level.
In the majority of cases, symptoms will be brought under control. "For any given episode, the prognosis of that episode being over is extremely good...you can almost count on it." More challenging is decreasing the number of total episodes, and regaining previous function - that is, how long does it take before the person can do what they used to do before they got sick. According to Dr. Ketter (based on his clinical experience), It can take months or years after a remission of symptoms to build back previous function." (That was taken from another website http://www.schizophrenia.com/moodswing%20pages/bpQandA.htm#remission)
>I don't think that the word "cure" serves well to describe treatment success with mood illness. "Remission" seems more appropriate.
A Long-Term Illness That Can Be Effectively Treated
Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes."Yes I agree that remssion is appropriate to describe the treatment success in todays climate for mental illness. The word cure doesn't serve well, as of yet, because there isn't one, but that said I don't think we should be afraid to use the word in the hope that in the future this is something that will become a reality, or closer to.
>You should see the difference in brain function between depressive episode versus remission as imaged by a P.E.T. scan. In relapse, most of the brain appears blue and inactive. In remission, the whole brain lights up yellow, orange, and red. This is virtually identical to the portrayal of a healthy brain. Semantics aside, this person no longer has to contend with any aspect of depression other than maintaining the effective treatment.
:-)
>I have experienced a full remission. Depression was completely absent. I functioned as if I had no mood illness. I was unbound to begin putting my life and my psyche in order.
:-)
>Looking into the future, I believe that our ever-expanding ability to look at how the brain functions through imaging techniques like PET, SPECT, and fMRI will allow for a biological testing protocol that will be able to identify effective drugs for each individual using an array of compounds as biological probes. In addition, genetic microarrays might be able to screen for deficiencies and excesses of particular gene products. This would help identify which genes are turned on and which ones are turned off. A gene-activity profile can be constructed to produce a matrix from which abnormal function can be characterized and treated.
Yes!...This is what I hope the future will bring too :-)
I think my wording would have sounded better with regards to medications being answer if I would have said it like this. In the present, drugs are are the answer to go on by when dealing with the serious mental illness which requires such help. Using myself for an example, I have to have drugs everyday. When faced with Bipolar disorder, if I did not take medication I run the risk of literally destroying my life and the high chance of losing it. Not being a gambling man as such, i'm not willing to run that risk anymore because of the destruction the illness has already caused me in the past. Therefore, I am willing if need be to take the drugs i'm currently on now (if they still work and do not cause damage of course!) for the rest of my life indefintely. However the side effects, possible longterm damages of the drugs and realisation that the illness could be better controlled, are the things which make me personally think that although they are the answer for today so to speak, in tomorrows world I have the hope that there will be better furture treatments that will provide an even better answer to one I currently have to day. That said lol I am forever grateful for the answer in which I find in the drugs I take today..
Its like, my thinking is looking at past, present and furture treatments. In the past, for example a couple of hundred years ago people were locked up and left to die, that was the answer then. Today the answer is drug treatments, which is a great step forward! In a couple of hunded years time will lithium still be the gold standard for Bipolar disorder? I feel that as much as these treatments are excellent at bringing the illness into remission - I just have this feeling that there is still more in the way of working towards a cure, (although we're getting close possibly) firstly controling the illness and secondly minimising the side effects of the medications currently used, like the permanent changes in kidney structure and function lithium can cause for example.
Psychiatry in general is still in its infancy, and like that of an infant it cannot know all the answers just yet, especially when working with what could be considered the most complex organ known to mankind in the entire universe. I for one though am grateful for the answers that have been discovered so far.....the learning and future treamtments are quite literally mind boggling :-)
Kind regards
Nick
Posted by SLS on October 6, 2005, at 10:28:52
In reply to Re: Professor at Med School Says Wean off All Meds » SLS, posted by Nickengland on October 5, 2005, at 10:42:10
> Hello Scott
>
> Ahh my previous post did possibly come across slightly antipsychiatry/antimeds lol My apologies, that was not my intention, just trying to cover some middle-ground :-)No, it really didn't come off that way, but I can see how my response seemed curt or defensive.
Thanks for the link to the Terrence Ketter interview. He was one of the researchers working at the NIHH while I was a patient there. He is a smart guy and does good work with imaging and bipolar disorder. He was part of one hell of a team of clinical investigators that included Mark George, Robert Post, William Potter, Mark Schmidt, Lauren Marangell, and P. Pazzaglia, and Fred Goodwin, to name a few. Most of these people have since left, but they occasionally colaborate. They make for a nice think tank.
I guess I still have a problem with the use of the phrase "treats symptoms" when it comes to the robust antidepressant response and remission brought about by antidepressants. With bipolar disorder and depression, it seems to me that there is a core pathology that produces a multitude of symptoms. Each individual symptom could be treated one at a time as a palliative measure. For instance, one can treat the anxiety with a benzodiazepine, the loss of energy with a stimulant, the impairments in memory with a PDE (Alzheimers drug), constipation with a laxative, aches and pains with an analgesic, insomnia with a hypnotic, etc. These are the symptoms of the disorder. On the other hand, when a robust response is achieved, it seems that a single antidepressant drug can somehow rectify or compensate for the core pathology in such a way that all signs of the illness disappear. Unfortunately, too many people on PB demonstrate treatment resistence or incomplete response. In these cases, residual symptoms often remain despite treatment, leading one to believe that remission of the illness is impossible, but that variable degrees of "symptomatic relief" are the best that anyone can expect.
I have not had much luck in life. However, I did get to experience antidepressant-induced remissions on a few occasions - once for as long as 9 months. Dr. Ketter is right in portraying the recovery process as a slow one. I think it took me two full months for me to feel 100%. My generalization is this, if I could experience a 100% disappearance of 100% of depressive symptoms (remission), so can others. It just doesn't "feel" like my symptoms were treated. It felt like the disease state was abolished - it went into remission. The disorder is not cured, but remains inactive.
Do anticonvulsants merely treat the symptoms of epilepsy or do they treat the pathology itself? Do these drugs make the convulsions disappear even though the brain is experiencing ictal epileptic activity? No. They prevent the disease state and all of its symptoms from manifesting. The disorder is not cured, but it has been brought into remission.
I don't think I am expressing myself very well here.
- Scott
Posted by Sebastian on October 8, 2005, at 15:05:41
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
He is full of it. Thinks that meds are not good and that any one can stop. I think he is wrong, as I have tried many times.
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