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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 32 to 56 of 56. Go back in thread:
Posted by violette on June 4, 2011, at 13:57:49
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
When Tofranil first came onto the market, it was generaly accepted that it was very effective in endrogenous depression, modestly effective in reactive or neurotic depression, and useless in depression due to inadequate personality.
Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
Are we expecting too much?
_______________________________
Yes, chronic depression can be a side effect of an underlying personality issue that results from lack of getting what we needed as a child (think attachment psychology).
But psychology isn't as relevant to psychiatry anymore, which is expected. Even so, part of the problem is that psychiatrists just don't have the knowledge today as they did when they were actually taught about childhood development and how the mind works. They just put you on pills, regardless of your underlying issues. They either are not trained to do it, or are just ignorant. I am not anti-pill, but i do think many people should be treated for the psychological issues at the same time.
Despite all the biolgical research, emotions are significant. In fact, one of the major causes of chronic depression can be related to how the idealized view of yourself, due to narcissistic deficiency, doesn't match the more realistic view. The greater the gap, the more likely you will have distortions and as a result, a rough time getting better. For those with larger gaps, the distortions prevent them from seeing this.
For people who were able to function well as young adults, depression tends to set in after a relationship, career, or other attachment fails them, and the realize they do not have the self esteem they once thought and develop a neurotic view of themself.
When you suffer loss such as this, the idealized view that you once used to compensate crashes, and you get a glimmer of how you really feel about yourself, and defense mechanisms deteriorate. It's emotional, and this requires an emotional treatment-another human being who, through the relationship, builds up healthy narcissim that caused the depression in the first place. And they work with you so that you are comfortable with the realistic view of yourself, minus the distortions and childhood filters, which translates to life outside of therapy.
Posted by sigismund on June 4, 2011, at 14:22:36
In reply to Re: Do we expect too much of antidepressants today?, posted by violette on June 4, 2011, at 13:57:49
> chronic depression can be a side effect of an underlying personality issue that results from lack of getting what we needed as a child
And as an adult. Humans are adaptive, malleable and within limits get used to anything. But even though it feels normal, it may not be ideal. And it can be very hard to know what it is we need in our relations with the world and others. Lots of modern culture is not helpful with this.
Posted by SLS on June 4, 2011, at 18:46:31
In reply to Re: Do we expect too much of antidepressants today?, posted by violette on June 4, 2011, at 13:57:49
> > Are we expecting too much?
>
> _______________________________
>
> Yes, chronic depression can be a side effect of an underlying personality issue that results from lack of getting what we needed as a child (think attachment psychology).
Is there any way to tell the difference between a biogenic depression and a psychogenic depression?
- Scott
Posted by sigismund on June 4, 2011, at 19:19:53
In reply to Re: Do we expect too much of antidepressants today? » violette, posted by SLS on June 4, 2011, at 18:46:31
>Is there any way to tell the difference between a biogenic depression and a psychogenic depression?
Does it in practice matter?
If biogenic depression cannot easily be cured by drugs, and if psychogenic depression cannot easily be cured by therapy.........
And then again, if biogenic depression could be helped by therapy and psychogenic depression could be helped by drugs.........
Maybe I don't understand the mind/body thing well. I assume that anyone in distress has some biological corresponding disorder, if we knew how to find it.
Posted by Phillipa on June 4, 2011, at 20:00:29
In reply to Re: don't change your life - change your drug » SLS, posted by linkadge on June 4, 2011, at 9:40:26
Oh does this ever fit me!!!! Phillipa
Posted by Phillipa on June 4, 2011, at 20:12:56
In reply to Re: Do we expect too much of antidepressants today?, posted by violette on June 4, 2011, at 13:57:49
Violette good to see you again. Lost self-esteem with loss of nursing. My value in life was missing due to a rotten pdoc who valued himself and his reputation more as the pdocs I worked with called him out when I let them know he allowed me to drink beer nightly with my meds. He hospitalized me took me off the med that seemed to do something and changed it and said "no you don't want to go back to work". Idiot me said no I don't. He had power over me in my mind. And to boot the cause of severe anxiety at time was a thyroid change in me. How I regret the day I let him put me on disability. And now at 65 too old to return to school and back could never take the lifting. So I feel that yes bipolar, schizophrenia are biological but quite a few depressions are situational. Phillipa
Posted by SLS on June 4, 2011, at 20:14:43
In reply to Re: Do we expect too much of antidepressants today? » SLS, posted by sigismund on June 4, 2011, at 19:19:53
> >Is there any way to tell the difference between a biogenic depression and a psychogenic depression?
>
> Does it in practice matter?
Of course it does. Once an easily administered test for MDD becomes available, we will see that those cases testing positive for biological markers are more apt to respond to medications than to psychotherapy. In the meantime, we must rely upon the keenness of a psychiatrist's diagnostic skills to differentiate between MDD and other presentations of depressed mood that are less apt to respond to medications.> If biogenic depression cannot easily be cured by drugs,
If. That depends on the individual case.
> and if psychogenic depression cannot easily be cured by therapy.........
I think most people who have experienced both types of depression can tell you how very differently they feel and how they respond to various treatments differently. One interesting point to note is that a diagnosis of MDD need not present with depressed mood. Lack of interest is an alternative criterion in the DSM. For me, anergia, amotivation, loss of interest, and cognitive impairments predominate. Depressed mood does not. In other words, MDD can exist without depressed mood. So if depressed mood is not required as a symptom of MDD, then what exactly is "depression"?
I admire Violet's knowledge and understanding of interpersonal dynamics and psychotherapy. For some people, it will work miracles to improve cognition and emotional processing. For others, it will be of no help at all, simply because the wrong illness is assumed.
I know I say this often, but the brain determines the mind as the mind sculpts the brain. The two are inextricable. Yet, each must be evaluated separately. It is not so much of a paradox as it is a recipricol relationship. Psychiatrists should understand this relationship and determine the best treatments for the illnesses they identify.
- Scott
Posted by floatingbridge on June 4, 2011, at 20:23:16
In reply to Re: Do we expect too much of antidepressants today? » SLS, posted by sigismund on June 4, 2011, at 19:19:53
May I just piggyback on the question (SLS) and the reply/musings (Sigi)?
And add thought drifts on morality and will, legitimacy of MI and depression, whether biogenic or neurotic?
They are vital questions, obviously for everyone from the afflicted to the researcher but not dividing lines
between real people and suffering.> >Is there any way to tell the difference between a biogenic depression and a psychogenic depression?
>
> Does it in practice matter?
>
> If biogenic depression cannot easily be cured by drugs, and if psychogenic depression cannot easily be cured by therapy.........
>
> And then again, if biogenic depression could be helped by therapy and psychogenic depression could be helped by drugs.........
>
> Maybe I don't understand the mind/body thing well. I assume that anyone in distress has some biological corresponding disorder, if we knew how to find it.
Posted by floatingbridge on June 4, 2011, at 20:39:53
In reply to Re: Do we expect too much of antidepressants today? » sigismund, posted by SLS on June 4, 2011, at 20:14:43
> Of course it does. Once an easily administered test for MDD becomes available, we will see that those cases testing positive for biological markers are more apt to respond to medications than to psychotherapy. In the meantime, we must rely upon the keenness of a psychiatrist's diagnostic skills to differentiate between MDD and other
presentations of depressed mood that are less apt to respond to medications.
>Thank goodness for scientific minds.
>
> I admire Violet's knowledge and understanding of interpersonal dynamics and psychotherapy.Me too.
>
> I know I say this often, but the brain determines the mind as the mind sculpts the brain. The two are inextricable. Yet, each must be evaluated separately. It is not so much of a paradox as it is a
recipricol relationship. Psychiatrists should understand this relationship and determine the best treatments for the illnesses they identify.
>I haven't heard this from you before. Or maybe so aptly put. I'm still unpacking this thread in my mind.
I think sigi's post is not distantly aligned.
Thanks to many for much good food for thought.
fb
Posted by floatingbridge on June 4, 2011, at 20:53:03
In reply to Re: don't change your life - change your drug » linkadge, posted by SLS on June 4, 2011, at 7:43:02
> This is why MDD must be differentiated from the scenarios you describe. An accurate diagnosis is the goal. I wonder if DMS V will be any better than the anemic DMS IV regarding distinguishing depressive disorders from depression that is predominately psychogenic. A question that has occurred to me lately is whether or not antidepressants can help with situational or psychogenic
depression. Maybe they can. I have never seen a study addressing this issue. Make the presence of MDD or BD an
exclusion rather than an inclusion.
>
>
> - ScottI read recently about a proposed therapeutic window in which psych meds significantly help a certain percentage. With long term treatment, a large percentage of these initial responders worsen.
This is not hard science, but I wonder if such phenomena are part of treating psychogenic based illnesses past this proposed window.
I think about this often.
Posted by Phillipa on June 4, 2011, at 21:44:38
In reply to Re: don't change your life - change your drug » SLS, posted by floatingbridge on June 4, 2011, at 20:53:03
FB that was kind of what the link with all the info about depression taught me. That the time for being on an ad was one year. Isn't it odd that the clinical trials are for weeks and not years? Guess cause not meant for long term use. Just guessing here. Phillipa
Posted by sigismund on June 4, 2011, at 23:47:24
In reply to Re: don't change your life - change your drug » SLS, posted by floatingbridge on June 4, 2011, at 20:53:03
I don't know anything about that test Scott spoke of to determine the difference between psychogenic and biogenic.
It does make sense to me though (but again, this may not be the point) that something can start off psychogenic and end up very much biological.
But perhaps I am confusing severity with biology, which is how doctors often see it, IME.
Posted by floatingbridge on June 5, 2011, at 2:27:17
In reply to Re: don't change your life - change your drug, posted by sigismund on June 4, 2011, at 23:47:24
> I don't know anything about that test Scott spoke of to determine the difference between psychogenic and biogenic.
Do you mean iit exists? I can only imagine genetic markers. Like the suspicion that add and BP share a genetic arm (if that's even a term.) My knowledge just falls off a cliff here.
I did read that a fairly common med, geez, darn I can look it up, like tetregol can cause a severe, even fatal type of neural necrosis. There is a simple genetic test to assess one's risk. In Taiwan, this test is required by law before prescribing. The US continues to dispense knowing this test was available.
Someone reccommended that I be given a genetic test to let me know whether I would even respond to ssri/snri's. That way I wouldn't need to endure rounds of trials of a common class AD. But I already have. My memory is so poor, but it was posted in a thread called tardive dyskenisa. I probably missed all
the flaws in the study. Even in my glory days, I never did think that way. I should read it again.
>
> It does make sense to me though (but
again, this may not be the point) that something can start off psychogenic and
end up very much biological.
>I feel like living proof of the above. That
is why ptsd research interests me. What does make a person vulnerable?
Certainly not simply events themselves.> But perhaps I am confusing severity with biology, which is how doctors often
see it, IME.I don't know. Maybe so. Maybe I am, too. I sense a diffetence, sometimes, that some illnesses seem more 'hardwired'. If that can be tested for, than a person's treatment can be swifter, preventing further suffering and even trauma around treatment.
I don't know why things got so bad for me at one point. I suppose it is
something like Violette said, a certain dissonance becaume too great. It
certainly became very biological. I lost control. Like something you wrote about a depression dx being losing meaning. Whatever happened, I have never fully
come back.Then again biogenic mental illnesses, BP
and schizophrenia are in my family. I also endured insomnia as a child, but not necessarily from the hypervigalence
prompted by abuse. Is a controlversial illlness such as borderline disorder at all biogenic? If so, what percentage of an illness is biogenic?If a test is found, would one treat a biogenic illness before it presented? And how? This maybeva poor analogy, but their is the test to assess the risk of
breast cancer. I know a woman who had prophylactic mastectomies when she
received her results.There is genetics and there is expression, if I am using the term properly.
Apologies for the typos.
Posted by SLS on June 5, 2011, at 6:29:55
In reply to Re: don't change your life - change your drug, posted by sigismund on June 4, 2011, at 23:47:24
Hi Sigismund.
> I don't know anything about that test Scott spoke of to determine the difference between psychogenic and biogenic.
>
> It does make sense to me though (but again, this may not be the point) that something can start off psychogenic and end up very much biological.I TOTALLY agree with you. However, I believe that one must have a psychobiological vulnerability for this to happen.
What is "IME"?
- Scott
Posted by SLS on June 5, 2011, at 6:35:02
In reply to Re: don't change your life - change your drug » sigismund, posted by floatingbridge on June 5, 2011, at 2:27:17
> Then again biogenic mental illnesses, BP
> and schizophrenia are in my family. I also endured insomnia as a child, but not necessarily from the hypervigalenceInsomnia as a teen is one of the first stages of MDD and BD, as are agitation and hostility.
- Scott
Posted by sigismund on June 5, 2011, at 13:28:09
In reply to Re: don't change your life - change your drug » sigismund, posted by SLS on June 5, 2011, at 6:29:55
Hi Scott
IME is in my experience.
We are all aware of those studies you hear about how say bullied kids end up with biologically measurable markers somewhere or other.
I was wondering if the issue is one of cause and effect. I'm worried when it comes to cause and effect. I don't suppose I can say what I would like to say....that there is no such thing, the way forward is the way back and so on? Of course people have very real biological things that cause effects in consciousness and function. And vice versa.
I need some tea. Last night's gabapentin makes me foggy. Not a bad drug for sleep though. I slept 7 hours rather than 4.
Posted by sigismund on June 5, 2011, at 13:31:47
In reply to Re: don't change your life - change your drug » floatingbridge, posted by SLS on June 5, 2011, at 6:35:02
Dealing with the unremitting hostility of a teenager long term without medicalising it is, IMO, one of my achievements as a parent.
We shall see, I guess.
Posted by floatingbridge on June 5, 2011, at 23:35:49
In reply to Re: don't change your life - change your drug, posted by sigismund on June 5, 2011, at 13:31:47
> Dealing with the unremitting hostility of a teenager long term without medicalising it is, IMO, one of my achievements as a parent.
>
> We shall see, I guess.My hunch is that the evidence is in and that your teenager is doing brilliantly.
You, however, take the medicine :-/
"Let me sleep, and dream of sheep...."
Posted by sigismund on June 6, 2011, at 1:00:43
In reply to Re: don't change your life - change your drug » sigismund, posted by floatingbridge on June 5, 2011, at 23:35:49
Terrible things can happen with the application of a diagnosis. Once you have it you start your explanations.....Oh, I have such and such and such and such made me do it. I think this is common with bipolar 2. Maybe I think that because it didn't exist 30 years ago. No one would do this with (say) yin deficiency. We are bewitched by language.
It's so easy to medicalise things. I knew of a kid who stayed in bed for more than 6 months and wouldn't go to school. I said to the worried parent that it was quite understandable, and that if I had a kid like that (at a pinch) we might be able to read Dostoyevsky together.
As it turned out, the kid left all the yobs and bogans here and went to Italy and is fine. There is nothing crazy about not wanting to get out of bed. The world can be immensely depressing.
Posted by sigismund on June 6, 2011, at 1:04:17
In reply to Re: don't change your life - change your drug » floatingbridge, posted by sigismund on June 6, 2011, at 1:00:43
For example there are all these life coach types (probably mainly on Oprah) who will tell you that bliss is your natural state, it already exists within you, and if you do not feel it it is your fault.
This is really unhelpful and entirely culturally specific. You could not imagine someone from the former communist block thinking like this.
Posted by floatingbridge on June 6, 2011, at 2:29:22
In reply to Re: don't change your life - change your drug » floatingbridge, posted by sigismund on June 6, 2011, at 1:00:43
Well, yes. And then....
I certainly wished someone paid attention when I didn't get out of bed in High School.
Attention would have been good. That's just my case. A dear friend was very hurt by over-controlling parents who medicated her, imo, because she was fringe and gay :(
However, had my anxiety been identified early, well it's possible I wouldn't have
washed ashore Babble Island. But this whole argument disolves--that kind of care would have involved different parents.Who knows (if anyone is reading this) the term for generational pathological behavior?
Ihope your children can see the wonderful person you are.
Posted by jono_in_adelaide on June 6, 2011, at 6:42:26
In reply to Re: don't change your life - change your drug » sigismund, posted by sigismund on June 6, 2011, at 1:04:17
> For example there are all these life coach types (probably mainly on Oprah) who will tell you that bliss is your natural state, it already exists within you, and if you do not feel it it is your fault.
>
> This is really unhelpful and entirely culturally specific. You could not imagine someone from the former communist block thinking like this.I always think that bliss might well live within them, but they have obviously vever had a deep melancholic depression, or any other serious psychological problem. Walk a mile in my shoes and all that.
I'm lucky, i have a pretty bure biological depression, which responds extremely well to NARI type drugs, but i see so many people given and taking SSRI's because they are dissatisfied with life, love and the universe..... basicly the same reason half the housewives in Australia were taking Valium and Librium in the 70's - because their doctors feel they need to do somthing, and arnt sure what else they can do.
Posted by sigismund on June 6, 2011, at 11:25:19
In reply to Re: don't change your life - change your drug » sigismund, posted by floatingbridge on June 6, 2011, at 2:29:22
My version of leaving them alone would be to make sure that other things left them alone.
Like certain schools.
I suppose it means to protect them.It reminds me of the Anglican evening service.
I think it goes something like 'Protect us from all anxiety and all the terrors of the night'.
I think Eliot had a hand in that.
Posted by floatingbridge on June 6, 2011, at 11:56:05
In reply to Re: don't change your life - change your drug » floatingbridge, posted by sigismund on June 6, 2011, at 11:25:19
Well, that's the boat I am currently in with my son. Wish me luck.
Posted by desolationrower on June 11, 2011, at 14:31:51
In reply to Re: don't change your life - change your drug, posted by sigismund on June 5, 2011, at 13:31:47
At work i see people's finances when they are at risk of forclosure. Usually due to unemployment. Sometimes there are entries for the drug store.
I think reducing the suffering is good, but i am sad when it just reduces it enough so people can 'get by'. There is a lot to be angry and irritable about. THough, the sort of politics you get from mental function in those quandrants usually isn't pleasant, just tribalistic and self-defeating.
i don't think source of depression is isolatable. The perception, interpretation, categorization, of the world is what the brain does. You don't exist in the world, but your understanding of it.
anyway, your genes and the emergent properties of society don't want you to be happy. its work to keep your self and community functioning positively.
-d/r
This is the end of the thread.
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