![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Garnet71 on January 28, 2009, at 11:12:30
Being the hyper-contextual thinker that I am, I want to list several things going on here in the field of mental health, then elaborate on these points. This is sort of in response to the type of thinking (not to anyone in particular) "there are no studies that suggest a link or causation between permanent damage and long-term antidepressant use".
I strongly think that narrowing down variables to derive proposed solutions is one of the main reasons why problems are not solved - both within and outside the field of psychiatry or psychology or neuroscience or whatever. There are so many variables in life, I believe they should ALL be considered when solving problems, whenever possible anyway.
- groupthink
- the medical-industrial complex
- politics
- money
- science itself
- the training of psychiatrists and other experts
- lack of out-of-the-box type thinking
- lack of creative thinking
- lack of interdisciplinary methods
- above average attractiveness of pharmaceutical salespeople (haha-had to wake you up); as funny as it sounds, this is a variable, imoI don't think it's too idealistic to suggest throwing a bunch of different types of cognitive thinkers and professionals and people with life experience into a room on a regular basis to try to solve problems.
For example-combine left-brained and right-brained thinkers, the hard scientific thinkers, the intuitive thinkers (I am in this category), the anti-psychiatry people, psychiatrists, neurologists, and artists...for discussion. Look at Meyers-Briggs - include one person from each type.
Now to use the example I wrote above, "there are no studies that suggest a link or causation between permanent damage and long-term antidepressant use" - in context with this comment some of you are probably thinking is strange, consider the list of variables above:
1. The medical industrial complex - how many studies are actually funded that even look at long-term damage and psychiatric meds?
2. Groupthink - the experts are so 'experted' they ignore the obvious THIS IS VERY COMMON in all fields and aspects of life (if you are in doubt, just look at how all the Yale and Harvard grads cannot solve the problems in the US - in fact, many of them make the problems worse)
3. Money - the ultimate motivator to action
4. Science itself - if something is not proven by science, then it does not exist
5. Your psychiatrist - just because your psychiatrist never came across a study that SSRIs, etc, cause permanent damage - that does not mean he/she is correct
6. Your psychiatrist (again) - maybe your psychiatrist is a sociopath, doesn't care about you, has a miserable life, has many problems, is going through a divorce, etc. They are only human and subject to human errors.
7. Science (again) - I have problems with the model and concept of 'theory'; then again, I don't have a better alternative. There may be better alternatives that have not yet been invented. Maybe some genious will derive one, someday. Something like a diagnostic approach in lieu of theory.
8. Groupthink, groupthink, groupthink...Okay, so take the statement I originally pointed out about long-term psychiatric drug damage...and compare with the online groups of people popping up all over the net - groups of people who say their sexual ability has permanently ceased (suspected autonomic nervous system damage some say)..and that they had taken say, Prozac, long term..and the sexual symtpoms started shortly thereafter...now they lost the inability to have orgasms and have ED...now the reason for the disability could be factors totally outside the psychiatric field, but THINK of the other variables, such as those I listed above, in context with this situation. THINK
Okay, so the categories are interrelated and blurred, or I blurred them. I'm not trying to write an essay, this is just a comment on a message board, and I am just spitting out the words as they come to mind. I will write later; I don't have much time now but wanted to throw this thought out in the universe.
Disclaimer: These are my opinions; my conclusions are based upon personal experience, intuition, education (mostly unrelated to psychiatry), knowledge of others experiences and things I have read. Furthermore, I am not implying my opinions are correct are better than those of others.
Posted by Phillipa on January 28, 2009, at 12:09:24
In reply to Dedicated to those who cannot get better..., posted by Garnet71 on January 28, 2009, at 11:12:30
Before entering medicine as only an RN I used to go by my own exeriences as didn't know a thing about medicine only what I saw. When schooling in medicine occurred I believed then that medicine was the answer and kind of got away from the things I experienced like how I felt after doing something. I began to question the scientific facts for things. So I kind of changed the sides of my brain I thought with. No experiences at that time except panic attacks didn't question the med that made it go away it just did. Then with a bit of knowledge not much I admit I changed how I thought now it was show me so that's scientific I guess. I witnessed staff on brain meds and how they kept having to up doses or they didn't work anymore. I really don't know what I'm trying to say but I've lost a lot of faith in medicine and doctors I guess. And confidence to stick to my personal beliefs. That's it for now things to do also. Phillipa
Posted by Garnet71 on January 28, 2009, at 13:17:05
In reply to Dedicated to those who cannot get better..., posted by Garnet71 on January 28, 2009, at 11:12:30
If anyone cares (hi Phillipa!), I have an idea for Dr. Bob's students.
They should all go to different medical specialists with the exact same symptoms (similar to those of us with treatment resistant or just with untreatable symptoms). Go to endochronogistis, nerologists, psychiatrists, internal medicine, etc.; while they at it, hit the nutritionists and alternative practictioners.
Have a third of the students say they have a familiy history of bipolar, depression, schitzo; another third tell the doctor they have had depression and anxiety in their life but no family history; the other third say they have no personal or family history of mental illness whatsoever.
See what the results are. Better yet, set up a scientific study to see the flaws in our system of medical diagnosis and treatment.
What led me to think of this, among many other things, is a past experience I had. When I had a physical problem, I went to 4 different specialists, 2 of which diganosed me with an "illness" that falls into their speciality, one said it was an allergy; the other one admitted he did not know what the problem was (and he was by far, the best one of the four). I decided to let it go untreated as opposed to taking drugs from specialist who gave me a random diagnosis.
To this day, I don't know what the problem was/is.
BUT - imagine the implications of being treated - not according to your illness - but according to what specialty the doctor is. This is a scary concept.
And I am to trust that a doctor's diagnosis is correct? Even has a 50/50 chance of being correct?
Can anyone else see the implications of this? And so many wonder why people like me question that anyone really knows whats wrong with us/me. The implications are that one is prescribed drug after drug-some with serious side effects - without even knowing the cause of your illness. Scary! Meanwhile, your real illness is ignored and continues to grow!
The problem lies in the system itself.
Posted by Garnet71 on January 28, 2009, at 13:32:31
In reply to Dedicated to those who cannot get better..., posted by Garnet71 on January 28, 2009, at 11:12:30
This is philosphical. So if the DSM - the system -is flawed, would not the outcome of treatment be flawed as well?
If all the illnesses in the DSM are based on societal NORMS, then one's diagnosis is based on that person in contect with the norms of society -rather than being based upon the individual's health that is being treated.
Does anyone question the DSM or is it the Bible of psychiatry? After all, it used to include homesexuality as a mental illness, and who knows what other crazy designations of the so called mentally ill.
Why not design a new 'system' to treat people based on the individual, rather than societal norms?
I would love to do a project such as this! Would anyone want to be my partner?
Posted by Phillipa on January 28, 2009, at 13:34:08
In reply to To the sudents of Dr. Bob, posted by Garnet71 on January 28, 2009, at 13:17:05
How bout go to a few doctors and say how you feel with same symptoms and see if diagnosis and med treatment the same? Kind of the same as with your scenario. Wasn't there some students once that pretended to be mentally ill got locked up and then no one believed them staff and they remained locked up. I believe that was a study a long time ago. Anyone know what the results of that were. Wouldn't know how to search it???? Phillipa like in my 40's went to a back doctor said had the neck bones of a person in their 70's and must wear a neckbrace sip drinks from a straw and never bend my head down or back again and go on those pain meds that were recalled by FDA as not being safe. Can't remember the name there were two. I wore the neckbrace for a week took it off and said to heck with this. I went back at the time to running discs in neck fused on their own. Wasn't celebrex the other one. Phillipa
Posted by Sigismund on January 28, 2009, at 14:46:14
In reply to Maybe the DSM is flawed » Garnet71, posted by Garnet71 on January 28, 2009, at 13:32:31
I don't want to say anything to make supporters of the DSM feel put down.
I see no reason to take it seriously.
Posted by JadeKelly on January 28, 2009, at 15:28:49
In reply to Maybe the DSM is flawed » Garnet71, posted by Garnet71 on January 28, 2009, at 13:32:31
> This is philosphical. So if the DSM - the system -is flawed, would not the outcome of treatment be flawed as well?
>
> If all the illnesses in the DSM are based on societal NORMS, then one's diagnosis is based on that person in contect with the norms of society -rather than being based upon the individual's health that is being treated.
>
> Does anyone question the DSM or is it the Bible of psychiatry? After all, it used to include homesexuality as a mental illness, and who knows what other crazy designations of the so called mentally ill.
>
> Why not design a new 'system' to treat people based on the individual, rather than societal norms?
>
> I would love to do a project such as this! Would anyone want to be my partner?Partner? I want you to adopt me and choose my health care providers/plan for me. Oh, did I mention I have twin boys? And my nephew lives with us. We could really use you full time. Haha.
I'm only geussing but I think some of us know in the back of our stressed out brains, that you are right. I have never been so totally cognitively impaired as I became when deeply depressed (check my spelling). Our diagnosis, treatments, etc. all lay in the hands of rushed professionals that we really know very little about. I don't care how much hype he/she has gotten over the years.And we have to choose them at the worst possible of times.
There are some really smart people on this site that you could probabaly spend hours with, but most of us I think just want to get well,and not be alone in our conditions.
In addition, there is some very valuable information floating around if you know how to find it and use it for what it is.
Here's what I propose, when you are done with your research above, btw does the partner position come with salary and benefits?, I propose you hire yourself out as a private patient advocate. I would like to be first on your list for pro-bono work.
I hope that when I am 100% (getting there!), my mind is half as quick and as questioning as yours is.
Thank you for the interesting topic!
~Jade
Posted by SLS on January 28, 2009, at 15:44:50
In reply to Maybe the DSM is flawed » Garnet71, posted by Garnet71 on January 28, 2009, at 13:32:31
The descriptions of the Axis I disorders are very disappointing. Actually, it is grossly incompetent in my opinion. However, it is a remarkable piece of work when it comes to identifying Axis II disorders.
I should check to see if I qualify as a cynical, melancholic, misanthropic narcissist. Maybe I should look in the mirror?
- Scott
Posted by Sigismund on January 28, 2009, at 15:47:47
In reply to Re: Maybe the DSM is flawed, posted by SLS on January 28, 2009, at 15:44:50
>cynical, melancholic, misanthropic narcissist.
Hmmmm. Sounds very fetching.
Posted by SLS on January 28, 2009, at 15:51:54
In reply to Re: Maybe the DSM is flawed » SLS, posted by Sigismund on January 28, 2009, at 15:47:47
LOL.
You got me on that one!
- Scott
Posted by Phillipa on January 28, 2009, at 20:41:15
In reply to Re: Maybe the DSM is flawed, posted by SLS on January 28, 2009, at 15:44:50
Ha Ha Scott I think not. Thankfully I have no Axis 11. Got Axis 111 though. Phillipa
Posted by seldomseen on January 28, 2009, at 21:26:57
In reply to Dedicated to those who cannot get better..., posted by Garnet71 on January 28, 2009, at 11:12:30
"Every system is perfectly designed generate the results that it yields."
Sometimes I think if I hear that quote one more time I will simply croak, and yet here I am quoting it.
And yet, I wonder sometimes, where am I in this system?
Seldom.
Posted by SLS on January 29, 2009, at 7:44:23
In reply to Dedicated to those who cannot get better..., posted by Garnet71 on January 28, 2009, at 11:12:30
Hi Garnet.
You are a gifted thinker.
I just have a problem with your original subject line. I am not sure how you meant it.
I am not a big fan of the words "can't" or "cannot", especially when it comes to the treatment of mental illness. There is so little that can be proved at this point. How can one prove that someone will never respond to treatment unless they have tried all that is available and that will be available? For me, there are just too many variables extant for me to subscribe to what I see as an absolute statement. I guess I find the words to be a signal of defeat.
- Scott
Posted by yxibow on January 29, 2009, at 17:23:40
In reply to Re: Dedicated to those who cannot get better... » Garnet71, posted by SLS on January 29, 2009, at 7:44:23
> Hi Garnet.
>
> You are a gifted thinker.
>
> I just have a problem with your original subject line. I am not sure how you meant it.
>
> I am not a big fan of the words "can't" or "cannot", especially when it comes to the treatment of mental illness. There is so little that can be proved at this point. How can one prove that someone will never respond to treatment unless they have tried all that is available and that will be available? For me, there are just too many variables extant for me to subscribe to what I see as an absolute statement. I guess I find the words to be a signal of defeat.
I also have some trouble with this -- the statement makes every case with terrific problems sound like fatal tissue necropsy, or something else to be rather blunt.Why assume the worst as if everyone had to be on a morphine drip when there could be some equally good combination around the corner.
Also, waiting until you are better (and this I have a lot of problems getting myself to get to this point) to do things in life means you may miss out on however much you can take from life at a given point.
Should you go out the door and walk around the block or sit inside the house with deep depression and regret you didn't walk around the block? I know it sounds capricious or something, but there is a point here.
-- Jay
Posted by SLS on January 29, 2009, at 18:37:13
In reply to Re: Dedicated to those who.... may yet get better » SLS, posted by yxibow on January 29, 2009, at 17:23:40
Hi Jay.
> Also, waiting until you are better
I did this for so many years. As severely vegetatively depressed as I was, it doesn't seem as if I had too much choice, though. But here I am, waiting for my reluctant doctor to increase my dosage of desipramine. I am not doing that badly, but I know that I am just 100mg from remission. I now find that I am waiting again. Not smart.
Frustrated and angry.
- Scott
Posted by yxibow on January 29, 2009, at 19:19:58
In reply to Re: Dedicated to those who.... may yet get better » yxibow, posted by SLS on January 29, 2009, at 18:37:13
> Hi Jay.
>
> > Also, waiting until you are better
>
> I did this for so many years. As severely vegetatively depressed as I was, it doesn't seem as if I had too much choice, though. But here I am, waiting for my reluctant doctor to increase my dosage of desipramine. I am not doing that badly, but I know that I am just 100mg from remission. I now find that I am waiting again. Not smart.
>
> Frustrated and angry.
>
>
I can completely understand the anger -- no.. this is not like "I can feel your pain", because that would sound pithy -- I sympathize is a better way of putting it.And also, though I know you have been through a strong battle with things -- I have seen the list of agents and agents you have been on, it isn't necessarily the case that you're X milligrams away from a problem.
But I can respect that feeling because I know that unfortunately I am, or I think I am but it may not necessarily be true, X and Y milligrams away from functionality from 2 agents I'd just assume not be taking so long.
Psychoactive substances take their time, as of course you already know, plasma life, transmitter life, etc.
Have you ever tried psychodynamic approaches adjucnt to your medication lists?
-- best wishes
-- Jay
Posted by garnet71 on January 29, 2009, at 20:03:49
In reply to Re: Dedicated to those who cannot get better... » Garnet71, posted by SLS on January 29, 2009, at 7:44:23
> I just have a problem with your original subject line. I am not sure how you meant it.
>
> I am not a big fan of the words "can't" or "cannot", especially when it comes to the treatment of mental illness. There is so little that can be proved at this point. How can one prove that someone will never respond to treatment unless they have tried all that is available and that will be available? For me, there are just too many variables extant for me to subscribe to what I see as an absolute statement. I guess I find the words to be a signal of defeat.
>
>
> - Scott
------------------
Thanks Scott, but it was only a bad choice of words, not a concept behind the meaning of my message.Perhaps I should have said to those who 'feel' they cannot get better.
It's just so sad to see so much despair here; contrary to how you perceived my (poorly written) message, I think what I said could bring more hope to those who feel they cannot get better. If you consider other variables involved - rather than this med or that med - your are more inclined to find an answer, in my opinion.
I think being open minded, rather than reading things in black and white, has personaly helped me. Maybe it could help someone else. If not, at least I can say I tried.
In any case, I find myself valuing your opinions here, Scott.
ps - I never proofread, edit, check spelling or typos when I post comments on blogs/message boards. I have to conserve my mental energy for my graduate studies ;)
Posted by SLS on January 29, 2009, at 20:54:04
In reply to Re: Dedicated to those who.... may yet get better » SLS, posted by yxibow on January 29, 2009, at 19:19:58
> Have you ever tried psychodynamic approaches adjucnt to your medication lists?
I have psychotherapy once a week. Over a two-year period, it has helped me enormously. While it does not make much of a dent in the depression, it sure helps accelerate my rate of personal growth. I have been working on the "software" since age 20, even before understanding that I had a biological mood illness. Self-actualization was an early goal of mine. For starters, I wanted to clean-up as much of the damage childhood left me with. I have been as dedicated to improving my psychology as I have my biology. Why not? This is one thing I never was waiting to do, despite the difficulties that depression presents to the healthy processing of issues. I refuse to stand still.Thank God, I don't have a cynical, melancholic, misanthropic, or narcissistic cell in my body. I deem these things to be self-destructive. I know people with these traits are no more at fault for having them than I am for having bipolar disorder. Yet, I don't think I would have had the vigilance and hopeful outlook to continue living with such pain were I to be so negativistic. I would have offed myself long ago. I do not take for granted the gifts I have been given. Among them, the most important are those that have allowed me to live this long and contribute to my own successful treatment.
- Scott
Posted by SLS on January 29, 2009, at 21:00:09
In reply to Re: Dedicated to those who cannot get better..., posted by garnet71 on January 29, 2009, at 20:03:49
I value your opinions as well. I came to respect them very quickly. If I keep hanging around here, I look forward to watching you and your belief systems evolve. It is exciting to watch a young mind flower - even if it's been around for awhile.
With great respect,
- Scott
Posted by garnet71 on January 29, 2009, at 21:46:57
In reply to Re: Dedicated to those who cannot get better... » garnet71, posted by SLS on January 29, 2009, at 21:00:09
What a thoughtful thing to say, Scott. What I should be doing now, however, is studying...I can't get motivated to do it. I love my studies-love my school-love learning. Maybe it is a bit of OCD that I find myself here instead? Maybe a bit of bipolar? I've been SSRI free for about 10 days now. The brain/electrical shocks have gone away, but the anxiety came back. I want to wait it out and see if it is temporary - because I plan to go to endo and neur and get tests - and want to be SSRI free when I get them.
I feel so guilty posting here instead of doing my homework, and am afraid of failing graduate school. I wish I had someone here who knows how to do mathematical modeling to help me, because I sure don't. I think math is so interesting, but unfortunately, it is the most difficult thing for my brain to process - that abstract stuff - especially now with the cognitive difficulties I recently developed.
I'm a "healer", I mean my Meyers Briggs..but I don't like one-on-one stuff that much..I like to look at everything on the macro level; the big picture. When I was as young as 8, I used to tell my Grandmother I wanted to be a psychologist. Even read Freud when I was that little..don't remember much, but my childhood was miserable and I read my parents books to escape. Iwasn't allowed to do much else. Anyway, my Grandmother suffered from Schitzophrenia, and I look back and am so sad that my parents made fun of her, and that I didn't get to know her more before she passsed. She was such an intelligent, insightful person who thought way beyond her time. She was 'doing' alternative medicine before it was even invented..lol. Unfortunately, she lacked motivation. I wonder if she really had schitzophrenia or was bipolar? She had a nervous breakdown when her husband died at 35; went into a catatonic depression and got ECT. She did hallucinate..and did stuff like exorcise the house and stab devils on the windowsills with forks, only at times. One time it was when we were watching Amityville Horror, as kids, and she was babysitting us. I think that triggered her episode. I feel so much empathy for people with mental illness. And abused dogs..just seeing if you are awake..lol, no really.
So you had a bad childhood as well? I agree with you concerning psychotherapy--it always leads to growth somehow, some way. They always tried to push cognitive therapy on me, though, but it didn't seem to help as much. I can't afford therapy right now; when I could, the therapists I visited did always help in their own special way. But my very first therapist died of pancreatic cancer. It was so sad that I was telling him of my problems and didn't even know he was dying. he just sat there and listened; more quiet than usual; more reserved. My last visit I could see it in his eyes, but didn't put 2 and 2 togetehr until it was too late. I only had the privelege of seeing him less than a dozen times, and he diagnosed me with PTSD; I have found no therapist to match his insight since. When I graduate from school, I will resume therapy. Did you ever try EFT?
Sorry for the rambling. I guess I am in more of a mood to talk then listen right now. And you just happen to by the person to have to get bombarded with my thoughts tonight :)
Posted by garnet71 on January 29, 2009, at 21:57:50
In reply to Re: Dedicated to those who cannot get better... » garnet71, posted by SLS on January 29, 2009, at 21:00:09
Scott - one more thing before I hit the books (yeah right)...The world would be a very boring place without "bipolar" people like you (since you mentioned the word).
In fact, I wouldn't think of you as a 'bipolar' person. Instead, I would think of you as a 'remarkable' person :)
Posted by SLS on January 30, 2009, at 5:19:08
In reply to Re: Dedicated to those who.... may yet get better » SLS, posted by yxibow on January 29, 2009, at 19:19:58
Hi Jay.
I am almost certain that a dosage increase is the key to full remission for me. I have been on desipramine a numerous times, and careful titration has always landed me on 300mg as my minimum effective dosage. 350mg showed no further improvement. So, really, it is more of a recognition of the conclusions arrived at in the past that drives my current belief.
- Scott
Posted by yxibow on January 30, 2009, at 10:42:09
In reply to Re: Dedicated to those who.... may yet get better » yxibow, posted by SLS on January 30, 2009, at 5:19:08
> Hi Jay.
>
> I am almost certain that a dosage increase is the key to full remission for me. I have been on desipramine a numerous times, and careful titration has always landed me on 300mg as my minimum effective dosage. 350mg showed no further improvement. So, really, it is more of a recognition of the conclusions arrived at in the past that drives my current belief.
>
>
> - ScottOh I wasn't questioning what you had believed was a good dose in the past -- it was just sometimes our chemistry changes over time.. still if you're fairly familiar with that I can understand your concern.
E.g. I've been on clomipramine at 75mg and 100mg produced too much anxiety issues from NE. Same with Namenda as it approached 20mg, things got awfully strange so it was dropped.
On the other hand 400mg of Seroquel "worked" in the past but it doesnt quite do what it should do now. Still we don't really want to go past that MED level for other reasons.
-- Jay
Posted by SLS on January 30, 2009, at 13:12:55
In reply to Re: Dedicated to those who.... may yet get better » SLS, posted by yxibow on January 30, 2009, at 10:42:09
Oh. I see what you are saying. Good points.
When I first moved up from 150mg to 200mg, I felt it might have been the best decision because I entertained the possibility that things in the brain might have indeed changed. I was hoping, anyway. But as the days passed, I began to lose ground. I am functioning with the use of caffeine, which we know can be an effective stimulant. Of course, the effect is but transient over the course of a few hours (unlike an antidepressant). Actually, if I abstain for a few days to a week. I can get the stimulant effect to last for most of the day. Block those adenosine receptors!
Did you know that the main source of adenosine release in the brain is astrocyte glial cells and not neurons? The role of adenosine and its receptors are to produce sleep-pressure. Cool. Glial cells have been largely ignored. I think this has been a mistake. They act as their own signaling network.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.