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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 63 to 87 of 102. Go back in thread:
Posted by violette on July 25, 2010, at 12:26:02
In reply to Re: toxic crap, posted by violette on July 25, 2010, at 11:51:59
Anyway, this article considers some things I'm trying to say here...I think the exclusion of psychology by psychiatrists is detrimental to medication outcomes for many people, and that psychodynamic formulations that include looking at the psychological side as opposed to only biological means, can improve treatment outcomes.
http://jppr.psychiatryonline.org/cgi/content/full/7/1/35
For my situation, I was able to repress and adapt to my childhood trauma for a considerable portion of my adult years. When my ego could no longer contain the emotional trauma-I got depression and anxiety symptomology, which basically matched the description of PTSD with a delayed onset, which was triggered by events-one of which I never would have connected to my illness if I had continued meds instead of reading about psychology. This was because, in part, psychiatrists only prescribed me medications, which delayed my recovery.
And this leaves me wondering how traumatic events during childhood or teen years, even seemingly non-traumatic events such as the intrusive parent, effect others here whose treatment plans only include medications?
Even though this article is geared towards PTSD, PTSD from childhood issues was not defined until after the Vietnam War--when it was recognized that from orphanages had higher rates PTSD than vets, with the same symptomology as those Vietnam Vets, while having lower recovery rates (see Wiki on that one). And 'PTSD' can manifest as a continum...like any symptomology.
=================================
"Currently, the symptom-oriented organization of the Diagnostic and Statistical Manual13 and the increasing availability of medications and behavioral approaches to treat symptoms directly may deflect clinicians from exploring the meaning of recent precipitating events and the complex relationship of such events to their patients' symptoms. Pharmacologic treatments, while often very helpful, are limited by side effects, incomplete results, and lack of acceptance by those patients who prefer to solve problems more definitively in psychotherapy.14 Cognitive-behavioral therapies, although reported to be efficacious in Vietnam veterans and rape victims,15 consist of discrete treatments for specific symptoms and do not easily lend themselves to application in more complex clinical situations. In addition, there has been little systematic investigation of what works best in whom.16 As with pharmacotherapy,some patients refuse to participate, and others may find such treatments ineffective or insufficient. At the other end of the spectrum, inexperienced clinicians armed with the PTSD diagnosis may overzealously explore traumas psychodynamically without adequate attention to the vulnerable state of the patient's ego functioning,17 thus overwhelming the patient's capacity to cope."
"Initial psychodynamic assessment usually takes place during approximately three 1-hour sessions. While exploring the patient's current problems, past treatment, early development, and social relationships, the interviewer also assesses mental status both indirectly and, when necessary, by asking direct questions. Although keeping in mind areas to cover, the interviewer is not limited in advance to prestructured questions and leaves time for problems and reactions to emerge spontaneously. In addition to focusing on specific symptoms or behaviors such as those listed in DSM-IV, the interviewer attends to patterns of symptom occurrence and recurrence. Using this information, as well as concurrent observations of the patient's behavior and affects, the interviewer evaluates the patient's past and current ego functioning. When the symptom picture suggests acute regression from a relatively high level of functioning but the relationship of symptoms to recent events remains obscure, an extended evaluation, combined with a trial of psychodynamic therapy, may be necessary for more definitive diagnosis and treatment."
"Despite difficulties studying psychodynamic treatments, a controlled study demonstrated that psychodynamic psychotherapy was as effective as hypnotherapy and trauma desensitization for PTSD when treated patients were compared with wait-listed control subjects.18 Patients treated with psychodynamic psychotherapy showed symptomatic improvement somewhat later than other treated patients, but they showed unexpected, and comparably greater, beneficial changes in personality traits."
"Recent reports document that posttraumatic reactions may be long lasting if not treated effectively. Rose,19 surveying the literature, found that brief supportive psychotherapy for adult survivors of sexual assault had frequently been inadequate to deal with persistent symptoms, even in patients with no preexisting psychopathology. Nader et al.20 described the considerable degree to which children remained symptomatic 14 months following an acute disaster. Terr21 prospectively studied children exposed to a day-long schoolbus kidnapping that involved no physical harm. The children showed symptoms of posttraumatic stress 4 years later, despite brief psychotherapy. Kessler et al.22 found that although treated patients fared better than others initially, one-third of all people with an index episode of PTSD failed to recover even after many years. These data suggest a pressing need for further research into the efficacy and methodology of psychodynamic psychotherapy with traumatized patients.
In this article I will focus on patients who come to treatment with acute symptoms following specific recent experiences and who have functioned at a relatively high level prior to the onset of these symptoms. Although the ego psychological approach to treating patients who complain of severe, chronic symptoms is beyond the scope of this article, the same approach can be clinically useful in understanding such patients.
Posted by morgan miller on July 25, 2010, at 12:44:16
In reply to Re: toxic crap » SLS, posted by 49er on July 25, 2010, at 11:43:22
49er, what other alternative treatments do you have in mind? There are sooooo many.
I don't think there is an alternative to medication for many people unfortunately, at least at this point. I do think many alternative treatments like fish oil should be considered as an adjunct by everyone with mental illness. Some do have negative reactions to fish oil unfortunately for some odd reason. I personally think everyone, mentally ill or physically ill should be taking fish oil if they don't react negatively to it.
I know Linkage mentioned thinking that fish oil was helping him. At least something that is healthy and non-toxic is helping.
Posted by linkadge on July 25, 2010, at 15:42:39
In reply to Re: toxic crap » 49er, posted by morgan miller on July 25, 2010, at 12:44:16
Do I feel better on meds???...define better?
Better in that I can't feel pain; in that emotions and drives are blunted; in that I am filled with a extremely shallow unidimentional sense of 'well being';..yes. But I feel worse too, in that I feel detached from myself - like my mind is being controlled and that everything I experience is a watered down version of its former self.
Off meds, sure I feel low, pessimistic and anxious but there is still (somehow) more richness to life. Somehow, I feel more in control.
Sure SSRI's worked in my adolecence, but as I grow older I have started to have more complex thought patterns. There are parts of me, I just don't want the drugs to shut off any longer. Thats why most AD's make me feel worse. Its not the akathesia, its the fact that they cheapen the quality of life for me. They take a way too much. Perhaps, I like feeling pain.
I keep thinking of the movie, Ordinary People. Like when the psychiatrist says to Conrad, "if you can feel pain, you can't expect to feel anything else". Nowdays the whole family would be on SSRI's. But that woundn't make make for a good plot, now would it? Thats the way I am on drugs, a life with no plot.
I really don't give a crap what people on this board think. You should all know that by now. If the drugs are a good tradeoff for you, then by all means keep taking them.
Maybe I'll feel better tomorrow, maybe I'll feel worse. Thats about the only thing that makes life worth living, the *capacity for change*. On meds there is no change. Its the same damn shallow flaky mood day in day out.
Thats why most of us are on this board. We are just looking for ways that things might change.
I care for my brain too much to perminantly screw it up now. Better meds will come out. Ones that don't demand so high stakes; and when they do, I want to be fully there to experience it.
Messing around with this garbage for too much longer is just going to make me more resistant (yeah, a bold an ultimately unsubstantiated opinion I realize, but one I believe). My neural pathways for rich human experience will have become so atrophied by the continual bombardment from the daily exposure to ultraphysiological levels of the neurotransmitter du jour.
Linkadge
Posted by ed_uk2010 on July 25, 2010, at 16:05:08
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 15:42:39
Hi Link,
>Better in that I can't feel pain; in that emotions and drives are blunted; in that I am filled with a extremely shallow unidimentional sense of 'well being'
I understand what you're saying, but does that apply to all current meds? For example, does it apply to the methylphenidate that you've taken lately?
>the neurotransmitter du jour
Haha, I like that one :) It's foolish to reduce human emotions and behavior down to a few neurotransmitters when there are actually many more transmitters, modulators, enzymes and receptors that we don't even consider.
Posted by morgan miller on July 25, 2010, at 18:49:24
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 15:42:39
>If the drugs are a good tradeoff for you, then by all means keep taking them.
Many people simply feel normal on their medication, full of emotion and lust for life. I experienced that on Zoloft for many years. Was it perfect? No. But then again life is not perfect.
>I really don't give a crap what people on this board think.
Then maybe you should not come on hear anymore. Do you care about what you friends and family think or how they feel? Probably not. Sad. You're just an angry bitter dude that will never be happy. I think you like the sadness and low self esteem and anxiety. You don't know how to live without it.
Posted by morgan miller on July 25, 2010, at 18:50:29
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 15:42:39
>I care for my brain too much to perminantly screw it up now.
Too late, already is.
Posted by morgan miller on July 25, 2010, at 19:18:37
In reply to Re: toxic crap, posted by morgan miller on July 25, 2010, at 18:50:29
BTW, not everyone experiences an impairment in the ability to think in certain ways. I experienced just as much an ability or more to think deeply, critically, abstractly, and analytically while medicated on both Prozac and Zoloft in the past. I simply felt "normal", whatever that means. And I functioned at a very high level. Believe it or not, and you will NOT be able to see this or come to this conclusion on Psycho-Babble, there are many many people functioning at a very high level and thinking very clearly on antidepressant medications.
For me, the chronic depression and anxiety and horrific mixed episodes(which have all occurred while not taking medications) have done the real damage. Though I will admit, with this past 2 years of medication trials, I do feel somewhat compromised. Like Scott said, medication trials, especially when the wrong medications are prescribed, can do some damage and change the way you respond to future treatments. All of this could have been avoided by me if I had just accepted that I was probably better off on Zoloft and continuing to do things the way I was doing them, instead of feeling like something was wrong with taking a foreign substance that may be toxic to my body which was not made to be exposed to it. That was part of my reasoning for getting off Zoloft. Bad bad reasoning. I didn't realize how well I was doing and that I really did not experience any negative side effects. I took a few months of giving Zoloft a shot at the right dose but I eventually was side effect free and stayed that way for years.
Posted by linkadge on July 25, 2010, at 20:21:32
In reply to Re: toxic crap, posted by morgan miller on July 25, 2010, at 18:49:24
>Then maybe you should not come on hear anymore.
Executive decision?
>You're just an angry bitter dude that will never >be happy.
How incredably supportive.
>I think you like the sadness and low self esteem >and anxiety. You don't know how to live without >it.
You're right about not knowing how to live without it.
Linkadge
Posted by linkadge on July 25, 2010, at 20:22:30
In reply to Re: toxic crap, posted by morgan miller on July 25, 2010, at 18:50:29
>I care for my brain too much to perminantly screw it up now.
Too late, already is.
Thanks bro.Linkadge
Posted by bleauberry on July 25, 2010, at 20:25:37
In reply to Re: toxic crap » linkadge, posted by SLS on July 25, 2010, at 4:49:19
I feel strongly in my bones, my soul, and my spirit, that what you say here is wrong. You are not treatment resistant. Drugs almost for sure didn't do you any favors, but they didn't make you treatment resistant.
The problem is, the right stuff hasn't been tried. The only things tried fill up the very limited briefcase of psychiatric meds. That, to me, is a good start, but only a start. The time spent at the starting line has been exaggerated long past its time. Time to look beyond the psych toolbox. What else causes depression besides serotonin, norepinephrine, dopamine, glutamate, issues? Forget those neurotransmitters. Forget about manipulating them. If that was going to work, it would have already. The writing is on the wall plain to see. Instead focus on what is getting in their way, what is screwing with their function. clogging them, corrupting them. It's something else.
All I know for sure is that when you try the right supplement, plant, or medicine that targets the real problem, you will quickly be saying you can't remember how long it's been since you felt this good. It is not likely, in my opinion, to come from the psychiatric toolbox. Something in there might be helpful, but that's about it.
What about ssri+ritalin? ssri+ritalin+tca?
I don't think lamictal is doing you any favors. It did not prevent return of depression longer than 9 months in clinical trials. Mood stabilizers by definition are going to blunt emotions.
I only say these things because of my own experiences. Like you and everyone else here, I had been fighting depression for 15 years on all kinds of meds and combos. Still ended up in the hospital and ECT. Still depressed, very treatment resistant. So imagine my total surprise when I felt alive and 30 years younger, like before depression ever hit, while on doxycycline. I didn't even know why at the time. Same thing on DMSA. I knew about the metals, but I had not a clue how cleaning some of them out would just open up a lot of clogged receptors and you could practically feel it happening.
It aint just me. There are a whole bunch out there just like me. They just don't know it. Or they don't believe it. Or they want proof before doing anything. As if they had any proof of anything else they've done thus far. Or instead of picking some starting point they say forget it. Or they got tested 10 years ago and nothing was found, as if tests are somehow gods that never miss a thing. And so they stay sick and wonder why.
> > The medical community? Are you certain that what they've done to you is Kosher?
>
> What they have done to me through the well-intentioned misapplication of drugs is to very likely produce permanent treatment resistance. This is a reality that I must deal with every day. Somehow, I do. It may not be logical, but it seems to be rather human.
>
>
> - Scott
Posted by linkadge on July 25, 2010, at 20:36:40
In reply to Re: toxic crap, posted by morgan miller on July 25, 2010, at 19:18:37
Ok so what? You once responded to zoloft, and you felt "normal". Once upon a time I responded to citalopram. I felt "normal". Now I no longer get the effect. Is this proof that the drugs are so wonderful - that they once worked? Don't you get it? Thats what I am talking about. The drugs don't work anymore. You know prozac poopout is really not that uncommon.
Who cares if a drug *once* had a good effect. I'm sure cocaine *once* had a good effect on every addict - its the memory of the "good effect" that keeps the addict coming back for more.
You know there is some preliminary research to suggest that continued pharmacological treatment of depression tends to make the disease more chronic.
Posted by Phillipa on July 25, 2010, at 21:08:09
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 20:36:40
And guess what I believe it and also six more weeks on doxycycline didn't make me feel a bit better. So what now? Phillipa
Posted by morgan miller on July 25, 2010, at 21:14:31
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 20:36:40
>You know there is some preliminary research to suggest that continued pharmacological treatment of depression tends to make the disease more chronic.
There's also a lot of evidence that suggests untreated depression(and this may be an absence of therapy as well as medication) will result in the worsening and progression of the illness.
Look, I think we both agree that medication is far from perfect.
Did you catch the part where I said that the main reason why Zoloft doesn't work the same way it once did is because I stopped taking it, not because it just stopped working. I know people that are on Zoloft or Prozac or Lexapro and have been for over 10 years and still feel fine on them.
Posted by morgan miller on July 25, 2010, at 21:29:50
In reply to Re: toxic crap, posted by morgan miller on July 25, 2010, at 21:14:31
You are obviously a very smart person. If you really want to get better and be better for yourself in the long run, give psychodynamic individual and group therapy a shot for a good amount of time and try some alternative treatments.
I would also try to get obsessed with proper exercise if you can and start eating a super healthy well rounded diet.
The only reason I'm suggesting these things is because you seem to have given up on the what is currently available as far as medication is concerned.
Posted by linkadge on July 25, 2010, at 21:32:32
In reply to Re: toxic crap » SLS, posted by bleauberry on July 25, 2010, at 20:25:37
>Drugs almost for sure didn't do you any favors, >but they didn't make you treatment resistant.
I disagree completely. What is so different from these drugs and street drugs? If you're taking SSRI's + Ritalin you're pretty much taking cocaine.
These drugs do alter the brain, and there is plenty of research to support this. I totally think long term use can lead to treatment resistance.
- Drugs altering neuroendocrine function.
Persistant alterations in neuroendrocrine
function could cause treatment resistance.
- TCA's unfavorably altering metabolic function
(abnormal insulin sensitivity can itself promote
depression)
- TCA's and SSRI's are associated with white
matter atrophy - (see 1)
- SSRI's in vitro cause motor neuron death (2)
in the study below paroxetine is much more
toxic to motor neurons than fluoxetine.
- In vitro, AD's can depleat neurotransmitter
neurotransmitter levels. The study below
links citalopram to decreased serotonin
synthesis. Also - you're not really "restoring"
dopamine by taking a stimulant with an SSRI. (3)
- Sertraline is pro-oxidant when taken with
anticonvulsants (4). Would this extend to other
SSRI's.
You can go on and on.Every drug takes its toll.
1.
http://stroke.ahajournals.org/cgi/content/full/39/3/857
2.
3.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0006797
4.
http://medind.nic.in/ibi/t04/i1/ibit04i1p43.pdf
Linkadge
Posted by linkadge on July 25, 2010, at 21:33:45
In reply to Re: toxic crap » SLS, posted by bleauberry on July 25, 2010, at 20:25:37
>Drugs almost for sure didn't do you any favors, >but they didn't make you treatment resistant.
Oh no, its murcury poisoning, or some yeast infection right?
Linkadge
Posted by linkadge on July 25, 2010, at 21:36:09
In reply to Re: toxic crap, posted by morgan miller on July 25, 2010, at 21:29:50
>I would also try to get obsessed with proper >exercise if you can and start eating a super >healthy well rounded diet.
You obviously don't know me that well. I already run about 10k a day and maintain a steady diet of mostly organic foods.
Linkadge
Posted by morgan miller on July 25, 2010, at 21:39:10
In reply to Re: toxic crap » SLS, posted by bleauberry on July 25, 2010, at 20:25:37
BB I have to disagree that medication trials probably are not at all responsible for making Scott's treatment more difficult. I have already had three psychiatrists, one who I really like and respect, tell me that medication trials may have made treating me more difficult. It is theorized that too many medication trials simply leaves the brain less "fresh" than it was before the trial. If one severe mixed manic episode or psychotic episode can change brain chemistry, it makes sense to me that some bad medication trials can do the same thing.
Posted by morgan miller on July 25, 2010, at 22:09:17
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 21:36:09
> >I would also try to get obsessed with proper >exercise if you can and start eating a super >healthy well rounded diet.
>
> You obviously don't know me that well. I already run about 10k a day and maintain a steady diet of mostly organic foods.
>
> Linkadge
>
>
>That's great, you must not be doing all that bad if you're able to run that far and that often. Since you are so concerned about your health you may want to consider the damage that running 6 miles that often can do to your body. I'm not just talking about musculoskeletal damage, I'm talking about oxidative stress and the toll you are taking on your heart and lungs. You talk about things being pro-oxidant, well that kind of exercise ends up being pro-oxidant and may do more harm than good in the long run. I suggest some weight training and more intense brief bursts of cardiovascular exercise. Interval training is one of the best things you can do for your heart and lungs.
Dude I can't even walk normally without discomfort right now let alone run, and exercise was the cornerstone of my physical and mental health for years. I think you might want to seriously consider finding a really good psychodynamic therapist and figuring out if you have any underlying self esteem issues. If you we don't truly love ourselves and our parents didn't give us what we needed in order to learn to love ourselves, there is a much greater chance that depression and anxiety will impact our daily lives. You probably won't listen to me though, why would you. Sorry man but you seem like a very stubborn dude. This may be a reason why you are not progressing to the point you would like to. Being stubborn and staying in denial are two things that will definitely hold us back.
Yep I may sound critical and judgmental, but you don't really give me any choice. You're right, I don't know you, but I'm saying it how I see it, as best I can through cybertext.
Posted by morgan miller on July 25, 2010, at 22:13:05
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 20:21:32
> >Then maybe you should not come on hear anymore.
>
> Executive decision?
>
> >You're just an angry bitter dude that will never >be happy.
>
> How incredably supportive.
>
> >I think you like the sadness and low self esteem >and anxiety. You don't know how to live without >it.
>
> You're right about not knowing how to live without it.
>
>
>
> Linkadge
>Sorry man, I admit I got a bit frustrated and probably should not have called you a bitter angry dude that will never be happy.
You have to see where I'm coming from though. I think you are smart enough to understand that when you come on a forum like this and say that you don't care what anyone here thinks, you might get a few negative reactions. Take some responsibility man.
Posted by violette on July 25, 2010, at 22:13:38
In reply to Re: toxic crap » bleauberry, posted by linkadge on July 25, 2010, at 21:32:32
Linkadge,
Whatdayagot about long-term use of benzodiazepens? (not including tolerance, dependence/withdrawal, or large doses)?
Posted by morgan miller on July 25, 2010, at 22:23:07
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 20:22:30
> >I care for my brain too much to perminantly screw it up now.
>
> Too late, already is.
>
>
> Thanks bro.
>
> LinkadgeDude! I think you know what I meant. Depression and anxiety and stress all can damage your brain especially when they are chronic. I'm thinking your brain just like many of ours has suffered some kind of damage as a result of chronic depression/anxiety/stress. Even a few week or month long major manic episode can alter brain chemistry. There is evidence that hippocampal volume may shrink as a result of chronic depression/anxiety/stress. I'm sure you are already aware of this. God knows what other things happen to our brains as a result of these chronic issues. Sorry if I was sounding negative or discouraging, I think you kinda pissed me off for a minute. I stand by the things I said I just could have kept them to myself or worded things differently.
Morgan
Posted by Dr. Bob on July 25, 2010, at 23:12:55
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 15:42:39
> You are a very frustrating man to deal with
>
> - Scott> I really don't give a crap what people on this board think.
>
> LinkadgePlease be sensitive to the feelings of others.
But please don't take this personally, this doesn't mean I don't like you or think you're bad people, and I'm sorry if this hurts you.
More information about posting policies and tips on alternative ways to express yourself, including a link to a nice post by Dinah on I-statements, are in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Thanks,
Bob
Posted by SLS on July 26, 2010, at 6:01:25
In reply to Re: toxic crap, posted by linkadge on July 25, 2010, at 15:42:39
> If the drugs are a good tradeoff for you, then by all means keep taking them
For many people, there is very little if any "tradeoff". Therefore, it is not an either-or scenario.
The decision to take medication is an individual and complex process as one takes into consideration a great many things, including the magnitude and persistence of dysfunction, psychic pain, and pattern of chronicity or recurrence. There really aren't many new drugs that are imminently available in the development pipeline. Waiting is a gamble of time. Not waiting is a gamble of untoward effect. For some people, waiting for spontaneous remission is an unacceptable alternative based upon symptom severity and temporal pattern of illness.
I can appreciate your decision to wait.
I do apologize for the remark I made regarding your being frustrating to deal with. It was meant to be a good-natured poking. I should have considered the possibility that you would not like being poked.
- Scott
Posted by SLS on July 26, 2010, at 6:06:46
In reply to Re: toxic crap » SLS, posted by bleauberry on July 25, 2010, at 20:25:37
I will try to keep an open mind.
How are YOU feeling? How would you rate your present state of mental health?
Be well.
- Scott
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