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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 rickjen on September 10, 2009, at 3:21:30
What does this mean? I never thought antidepressants were supposed to take away ALL of your depression symptoms. OR ARE THEY???? Any input would be appreciated. Thank you.
Posted by emme on September 10, 2009, at 4:40:02
In reply to 'treatment resistant depression', posted by rickjen on September 10, 2009, at 3:21:30
> What does this mean? I never thought antidepressants were supposed to take away ALL of your depression symptoms. OR ARE THEY???? Any input would be appreciated. Thank you.
For me, treatment resistant means repeated poop-outs on drugs and a great deal of difficulty finding medications that work. My depression is recurrent and treatment resistant. That said, I have experienced periods where medication has brought me into remission.
As in depression gone.
All symptoms.
Gone.
It is possible.My current meds have kept me in partial remission for a couple of years, but when I say partial, it's a pretty big percentage of symptoms that are resolved. I have recently relapsed, but it's looking like an increase in one of my medications is starting to take effect. Several months ago I had pared down to a very low dose, so I've got lots of room to increase again.
Good luck,
emme
Posted by SLS on September 10, 2009, at 5:47:12
In reply to Re: 'treatment resistant depression' » rickjen, posted by emme on September 10, 2009, at 4:40:02
Hi Emme.
> I have recently relapsed, but it's looking like an increase in one of my medications is starting to take effect.
That is wonderful news.
- Scott
Posted by SLS on September 10, 2009, at 6:19:22
In reply to 'treatment resistant depression', posted by rickjen on September 10, 2009, at 3:21:30
> What does this mean? I never thought antidepressants were supposed to take away ALL of your depression symptoms. OR ARE THEY???? Any input would be appreciated. Thank you.
"Depression" is one word that, unfortunately, has many meanings. Depression can be the result of internal psychological conflicts that result from a lack of nurturing early in life or from trauma. It can be the result of bereavement and grief. It can be a reaction to many different kinds of loss. However. depression can also have biological underpinnings, even if the original psychosocial stress was external or internal.
Called "major depressive disorder" (MDD), it represents a specific clinical diagnosis that is made according to a medical guideline. When the diagnosis is made accurately, which is difficult because doctors are evaluating a subjective experience, it seems that there are strong biological components. PET and MRI scans have detected differences in the shape and function of the brains of people with MDD. Genes have been identified that are associated with MDD, although there are more than just one. In short, MDD is very often a biological condition triggered by psychosocial stresses. However, once triggered, biological therapies might be necessary to treat it. There is also a depressive counterpart to bipolar disorder. This usually needs a biological therapy to treat, and is often resistant to treatment.
In addition to drug therapy, psychotherapy is often recommended to deal with the origninal triggering issues, or those that have developed as a direct result the biological depression.
Just as there are microbial infections that are resistant to treatment with antibiotics, there are MDD depressions that are resistant to the first series of antidepressants tried. There are several different definitions of how many failed drug trials qualify someone as being treatment resistant. For the most part, it is an arbitrary number. I think that it is unusual to find people who are completely refractory to all available treatments. Often combinations of drugs from different classes are necessary to bring about an improvement.
Psycho-Babble is a community that seems to be comprised of a high percentage of treatment-resistant people or people with troubling side effects. It is important to take this into consideration if one is attempting to formulate an idea of how the average person with MDD responds to treatment.
- Scott
Posted by Phillipa on September 10, 2009, at 12:13:18
In reply to Re: 'treatment resistant depression' » rickjen, posted by SLS on September 10, 2009, at 6:19:22
Scott that's the best post I've read in a long time. Thanks for that inclusive post. There's been quite a bit of overlapping topics lately this clears things up for me at least. Hope that lithium is still working well. Love Phillipa
Posted by rjlockhart04-08 on September 10, 2009, at 13:11:07
In reply to Re: 'treatment resistant depression' » rickjen, posted by SLS on September 10, 2009, at 6:19:22
____________________________________
Treatment resistant, I try to give the best insight that i can give but I don't know if it's accurate. Say Paxil, or Prozac, doesnt work [in someone who is seriouly inflicted with depression]. Usally there is second line, antidepressants, such as Parnate, Nardil, Marplan, yet you have to moniter what you eat, cheeze, red wine, avacado's.
Yet, been through day's I wished i would, just not "expereince" bad feelings, sometimes they get intense, and I think it's related to fear, and the knowing of failure, I do routines to change it. Because this "stall" i've been in, it's all belief systems in the mind, other's where just bad choices. Prozac has taken care of some part's of it, not all. Session's I can talk it out, but i write so much better than I talk.
Really, the main treatment resistant medication would be Parnate, yet it has side effect's.
That's all.
Have a good day.
Posted by bleauberry on September 10, 2009, at 18:53:23
In reply to 'treatment resistant depression', posted by rickjen on September 10, 2009, at 3:21:30
I totally agree with SLS's take. Awesome explanation.
I would like to add to that another angle. It is intended to be added to what SLS. Another piece of the pie, the same pie.
Depression can result from biological causes outside the brain that have nothing at all to do with the brain, nothing to do with a psychosocial issues, and nothing to do with any kind of life trauma.
The brain is the final target that receives the insult, but the fault may not actually be there. It could be somewhere else. Inflammation of the brain. What in the body is causing it? Drugs that manipulate neurotransmitters are not likely to have much impact on that kind of depression, unless the particular AD has demonstrated anti-inflammatory mechanisms. And thus it will appear to be treatment resistant depression, except it really isn't, it just isn't getting the correct class of medications or herbs. Infectious diseases. Same thing. Even things that appear as silly as food intolerances can make someone feel like crap and depressed as heck and they have no idea that favorite food of theirs is doing it.
These are difficult issues to deal with because they are impossible to pinpoint with routine testing. They can only be identified through trial and error and provocative testing or challenge testing. It is so much easier to follow the crowd and assume the theory of an imbalanced neurotransmitter is the only possible culprit. Much easier. Can't test for that either. It also is a trial and error challenge test. But for some reason, many are lulled into thinking the psychiatric challenge test is the only one under the sun.
So what I am saying is, some cases of treatment resistant depression are not in fact treatment resistant at all. They accidentally resulted in being perceived as treatment resistant because, of all the known biological causes of depression, and with a variety of toolboxes to choose meds from, the only toolbox considered was the psychiatric one.
Posted by emme on September 11, 2009, at 6:07:52
In reply to Re: 'treatment resistant depression' » rickjen, posted by SLS on September 10, 2009, at 6:19:22
Posted by fattoush on September 13, 2009, at 17:59:37
In reply to Re: 'treatment resistant depression' » rickjen, posted by SLS on September 10, 2009, at 6:19:22
Thank you SLS for saying it with dignity to all of us suffering. Articulating this scary condition out clearly somehow gives some relief from helplessness.
I was myself for the longest time treatment-resistant. I might go there again. I sure hope not. Lithium has been working but so has changing a lot of environmental factors. I guess that would fall under the therapy umbrella.
Posted by desolationrower on September 15, 2009, at 0:20:28
In reply to Re: 'treatment resistant depression', posted by bleauberry on September 10, 2009, at 18:53:23
its when you don't responde to placebo of a drug
-d/r
Posted by psych chat on September 15, 2009, at 12:55:34
In reply to Re: 'treatment resistant depression', posted by desolationrower on September 15, 2009, at 0:20:28
My two cents are that some people need to work on the psychological issues behind the symptoms. It's easier said than done. Also, being a patient in therapy does not necessarily mean the problems are being addressed appropriately.
This article delineates the psychological and biochemical sources of pathologies but also articulates the interdependency of the two:
http://www.wholeminds.com/web/index.php?module=article&view=9&lay_quiet=1
From these descriptions of attachments combined with traumatic events, I hope one can see how excruciating life experiences foster psychopathology and somatic ailments. When talking about pathology in these terms, we are not using medical or psychological diagnoses to describe behavior or health conditions. We are focusing on coping patterns and environmental factors as the key proponents in causing symptoms, abnormal behavior, and how a person sees himself and the world around him. If he is geared up to take on the world as an adult with the residue of anger, sadness, or abandonment issues, then the world will be construed as his enemy. It is important to point out malfunctions of normal brain processing and how it is evident in behavior. Deprivation in nurturing and attunement seemingly has a role in disabling the normal tasks in self-regulation and conscious awareness. I am not admonishing genetic factors for psychological problems; however, there is a consistency with the types of attachments that show a predisposition to future psychological impairment and genetic formation. It has been proven that insecure attachments will exacerbate mental instability, whether a person is genetically misfortunate or develops psychopathology later in life.
The brain fires neurons by observing how one perceives an experience. Neurons will link together to form a neural net to match the perceived experience by associating it with old patterns and experiences. For example, if a girl had experienced physical abuse from her parents, along with being told that she is loved; even though a new experience of love from her boyfriend doesnt involve physical abuse, she has a negative reaction when her boyfriend tells her that he loves her and associates love with the feeling of being abandoned. We construct our models in our brains by the way we perceive our environment. Its like we tell ourselves a story about the outside world, whether its true or false. Any new information we take in from our environment is always colored with an association and experience we had in the past.
In short, most of us are never really experiencing the here-and-now. Physiologically nerve cells that fire together are wired together; and if you practice something over and over again, those nerve cells build a long-term relationship. If a person becomes angry on a daily basis or gives reasons for his victimization in his life, he is hardwiring and reintegrating those beliefs in his neural net, hence, creating a long-term relationship with the feeling of being angry. Because those biochemical changes are created within him, he is literally self-deprecating and sabotaging himself. This could link to the loss of volume of the hippocampus in people who have suffered from clinical depression.
Posted by SLS on September 15, 2009, at 13:17:40
In reply to Re: 'treatment resistant depression', posted by psych chat on September 15, 2009, at 12:55:34
For some people, the rectification of brain dysfunction brings remission from psychopathology without the need for psychotherapy. I think people occupy different points along a spectrum of relative contributions of the biological and the psychological.
- Scott
Posted by psych chat on September 15, 2009, at 13:42:37
In reply to Re: 'treatment resistant depression', posted by SLS on September 15, 2009, at 13:17:40
When you say 'remission" - do you mean symptom relief or cure?
It's not clear to me whether or not you read the article I posted, but it does explain how psychological factors change or influence or interact with our brain's neurochemistry. I'm not saying this article is the sole source or explanation for the cause of mental health problems, but I found it to be very informative.
It just seems like if a person gets relief from meds, they are not cured, but putting a band aid on the problem. And there's nothing wrong with relying on meds, that's anyone's choice, but it becomes an issue when the meds no longer work, side effects, costs, access to health care, etc. It seems to make sense to address the psychological aspects that influence affective states rather than rely on meds alone. Aim for a permanent solution-a cure.
Just sharing information here, not saying this applies to everyone. But at the same time, how would a person know for sure if they are treatment resistant if they've never tried anything but medications?
Posted by SLS on September 15, 2009, at 14:24:02
In reply to Re: 'treatment resistant depression' » SLS, posted by psych chat on September 15, 2009, at 13:42:37
> When you say 'remission" - do you mean symptom relief or cure?
I used the word "remission" as it is used in the field of medicine. It does not mean "cure".
Was there anything in what I wrote that you found contradictory to your own belief system?
So that it be clear to you, I did read the article. However, I don't know why you would have placed such expectations upon me. I really don't feel qualified to critique it, if that's what you were looking for me to do.
I do not subscribe to the characterization of psychotropic drugs as being merely bandaids. Perhaps you can describe to me exactly what you feel they are bandaids for?
- Scott
Posted by sowhysosad on September 15, 2009, at 14:55:29
In reply to Re: 'treatment resistant depression' » psych chat, posted by SLS on September 15, 2009, at 14:24:02
> I do not subscribe to the characterization of psychotropic drugs as being merely bandaids. Perhaps you can describe to me exactly what you feel they are bandaids for?
Here in the UK there seem to be a lot of people who are sceptical about the benefits of psych meds. "Stiff upper lip", "pull yourself together" and all that.
Many people in this country who feel they have the right to lecture others about their med usage use some variation of the "bandaid" argument.
If anything it shows they refuse to believe depression has a physiological basis.
Posted by psych chat on September 15, 2009, at 15:20:25
In reply to Re: 'treatment resistant depression' » psych chat, posted by SLS on September 15, 2009, at 14:24:02
Hi,
"Perhaps you can describe to me exactly what you feel they are bandaids for?"
To answer your question, in terms of band aids, meds may eliminate symptoms in the short-run, but might not cure. This is not to say they do not cure in all situations.
To clarify my post, I've read a lot of material that shows therapy can lessen or even alleviate symptoms too, and the improvement lasts after the treatment discontinues. So in some situations, therapeutic solutions may be more curative in nature-more permanent vs. temporary relief. It seems that when some people quit meds, their symptoms reappear. When people who improved from therapy quit treatment, their symptoms may not reappear, or reappear in a crisis situation.
I'm not saying this applies to your situation or anyone else's in particular, but I'm saying it could be a possibility for treatment resistant cases. I was able to identify my situation with the article, and maybe someone else here will find it applies to their situation as well.
Posted by psych chat on September 15, 2009, at 15:27:10
In reply to Re: 'treatment resistant depression' » psych chat, posted by SLS on September 15, 2009, at 14:24:02
Sorry, forgot to answer your other question:
"Was there anything in what I wrote that you found contradictory to your own belief system?"
No-you offered your opinion on the subject.
"However, I don't know why you would have placed such expectations upon me. I really don't feel qualified to critique it, if that's what you were looking for me to do."
No, I wasn't asking for a critique. I was just wondering if you had read it, because your response below didn't mention anything specific in the article.
"For some people, the rectification of brain dysfunction brings remission from psychopathology without the need for psychotherapy. I think people occupy different points along a spectrum of relative contributions of the biological and the psychological."
Posted by SLS on September 15, 2009, at 15:57:34
In reply to Re: 'treatment resistant depression' » SLS, posted by psych chat on September 15, 2009, at 15:27:10
> To answer your question, in terms of band aids, meds may eliminate symptoms in the short-run,
Short-run only? Antidepressants can also eliminate symptoms in the long-run. There are people who have been maintained on tricyclics for decades. Many of these people have tried to discontinue their treatment every now and then, only to relapse.
> I'm not saying this applies to your situation or anyone else's in particular, but I'm saying it could be a possibility for treatment resistant cases. I was able to identify my situation with the article, and maybe someone else here will find it applies to their situation as well.
I liked the article. I did not find too many things written in it that I would take exception with.
Just so that there not be too much misunderstanding, I will reference my previous post and say that I think each person with depression occupies a point along a spectrum of relative contributions of the biological and the psychological to the etiology of their individual depression. I do not see how this challenges the article you suggested we read. I do have a problem when people treat all "depression" as if it were a single psychologically-driven state of mind that remits once psychological issues are addressed. I do not see that you have done this, though.
"In short, most of us are never really experiencing the here-and-now."
Do you have any data to confirm that it is indeed a majority of people who never really experience the here-and-now? Speaking for myself only, I think I do a pretty good job of it. However, it becomes immensely easier for me when my depressive state is not there to get in the way. Severe MDD or BD are obstacles to self-actualization.
- Scott
Posted by Sigismund on September 15, 2009, at 17:59:33
In reply to Re: 'treatment resistant depression' » psych chat, posted by SLS on September 15, 2009, at 15:57:34
>In short, most of us are never really experiencing the here-and-now."
If I was to put all the times together when I have been in the here and now, maybe I'd make half an hour out of 50 years?
I'm undecided as to whether this is some kind of achievement.
Posted by psych chat on September 15, 2009, at 18:46:40
In reply to Re: 'treatment resistant depression' » psych chat, posted by SLS on September 15, 2009, at 15:57:34
"Do you have any data to confirm that it is indeed a majority of people who never really experience the here-and-now?"
That's a good question, but probably one I can't answer. I thought the author did an excellent job at articulating 'why' we don't ever exclusively experience the here-and-now, but as far as providing specific data....I don't know if that's even possible.
Maybe it's like this: We could say most of us recognize when we experience pleasure, and can identify with experiencing that feeling, regardless of how it is defined. Yet, is there any data that confirms the majority of people know they can identify with the experience of pleasure? But ask anyone you know if they recognize they are feeling pleasure when, for example, they are getting a body massage? Not that body massages are pleasurable to everyone, but just an example.
Sigismund's post triggered a thought; maybe it's more like this: If we have an urge to pee, most of us go to the toilet without thinking about it. This is because someone long ago taught us this behavior. Of course, when we have those urges, we don't remember or identify with being taught that we are supposed to use a toilet. It doesn't cross our mind, but it's automatic. This behavior is ingrained in our unconsciousness.
I tend to agree with the author that most of our behaviors and relationship dynamics are influenced by our past. Past emotions, experiences, accrued knowledge, etc., influence most of what we do, but we are not always aware of the link. Psychoanalysis helped me identify how unconscious motives and influences affect my here-and-now.
For me, unconscious memories and emotions entering my consciousness 'proves' that much of my behavior/thoughts/emotion is based upon or are influenced by the past rather than merely reacting to the here-and-now. I just can't see how it can be avoided unless I had the ability to erase memories from my past.
Maybe there is no 'data' because we can't really measure the link between the here-and-now and past or quantify the unconsciousness because it's intangible and is unique to every individual.
Posted by SLS on September 15, 2009, at 19:40:39
In reply to Re: 'treatment resistant depression', posted by psych chat on September 15, 2009, at 18:46:40
> > > In short, most of us are never really experiencing the here-and-now.
> > "Do you have any data to confirm that it is indeed a majority of people who never really experience the here-and-now?"
> That's a good question, but probably one I can't answer. I thought the author did an excellent job at articulating 'why' we don't ever exclusively experience the here-and-now, but as far as providing specific data....I don't know if that's even possible.This is one reason why I did not care for the phrase "most of us". I felt as though I was to be included in a pitiable majority of people who live there lives without a clue.
> I tend to agree with the author that most of our behaviors and relationship dynamics are influenced by our past.
Of course.> Past emotions, experiences, accrued knowledge, etc., influence most of what we do, but we are not always aware of the link.
At this point in my history, it is a biological brain disorder that influences most of what I think, feel, and do.
Do you agree that, for some people, somatic therapies are the best treatments for their mental illness?
> Psychoanalysis helped me identify how unconscious motives and influences affect my here-and-now.It is wonderful that you have found a path that works for you.
> For me, unconscious memories and emotions entering my consciousness 'proves' that much of my behavior/thoughts/emotion is based upon or are influenced by the past rather than merely reacting to the here-and-now. I just can't see how it can be avoided unless I had the ability to erase memories from my past.
I very much respect your self-descriptions here.
> Maybe there is no 'data' because we can't really measure the link between the here-and-now and past or quantify the unconsciousness because it's intangible and is unique to every individual.
Why make sweeping generalizations, then?
- Scott
Posted by sowhysosad on September 15, 2009, at 19:55:23
In reply to Re: 'treatment resistant depression' » SLS, posted by psych chat on September 15, 2009, at 15:20:25
> To clarify my post, I've read a lot of material that shows therapy can lessen or even alleviate symptoms too, and the improvement lasts after the treatment discontinues.
>
> I'm not saying this applies to your situation or anyone else's in particular, but I'm saying it could be a possibility for treatment resistant cases.Yeah, a lot of research shows the double-pronged approach is more effective.
However, I've read elsewhere that stubborn depressions are likely to be more "biological" in nature.
By contrast, "non-melancholic", largely psychological depressions often respond to placebo effect or go into spontaneous remission in a few months.
Posted by SLS on September 15, 2009, at 19:55:39
In reply to Re: 'treatment resistant depression', posted by psych chat on September 15, 2009, at 18:46:40
> > > In short, most of us are never really experiencing the here-and-now.
> > "Do you have any data to confirm that it is indeed a majority of people who never really experience the here-and-now?"
> That's a good question, but probably one I can't answer. I thought the author did an excellent job at articulating 'why' we don't ever exclusively experience the here-and-now, but as far as providing specific data....I don't know if that's even possible.This is one reason why I did not care for the phrase "most of us". I felt as though I was to be included in a pitiable majority of people who live there lives without a clue.
> I tend to agree with the author that most of our behaviors and relationship dynamics are influenced by our past.
Of course.> Past emotions, experiences, accrued knowledge, etc., influence most of what we do, but we are not always aware of the link.
At this point in my history, it is a biological brain disorder that influences what I think, feel, and do. I am still a product of my past, but my here-and-now is severely affected by bipolar depression.
Do you agree that, for some people, somatic therapies are the best treatments for their mental illness?
> Psychoanalysis helped me identify how unconscious motives and influences affect my here-and-now.It is wonderful that you have found a path that works for you. There are others.
> For me, unconscious memories and emotions entering my consciousness 'proves' that much of my behavior/thoughts/emotion is based upon or are influenced by the past rather than merely reacting to the here-and-now. I just can't see how it can be avoided unless I had the ability to erase memories from my past.
I very much respect your self-descriptions here.
> Maybe there is no 'data' because we can't really measure the link between the here-and-now and past or quantify the unconsciousness because it's intangible and is unique to every individual.
Why make sweeping generalizations, then?
- Scott
Posted by Sigismund on September 16, 2009, at 0:16:44
In reply to Re: 'treatment resistant depression' » psych chat, posted by SLS on September 15, 2009, at 19:55:39
Yet the enchainment of past and future
Woven in the weakness of the changing body
Protects mankind from heaven and damnation
Which flesh cannot endure.TS Eliot, Burnt Norton
This is the end of the thread.
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