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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by cybercafe on May 26, 2003, at 21:26:40
Comments?
For 4 months my doc told me I couldn't have an antidepressant despite my feeling very very bad. Finally he mentioned that it was because I smiled in his office, and depressed people don't smile.
Is there any truth to this, or do you guys also go from lows to feeling normal depending on environment (pdoc visits are very significant, very positive events in my life, as they are my best hope for getting better)
Posted by Snoozy on May 26, 2003, at 21:51:56
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
Rubbish! I think it's possible to be severely depressed, yet still have some moments of "normalcy", however few and far between. More importantly, we're socially conditioned, especially females, to smile in certain situations. It's just an automatic reflex for some - not a sincere smile, but something.
> Comments?
>
> For 4 months my doc told me I couldn't have an antidepressant despite my feeling very very bad. Finally he mentioned that it was because I smiled in his office, and depressed people don't smile.
>
> Is there any truth to this, or do you guys also go from lows to feeling normal depending on environment (pdoc visits are very significant, very positive events in my life, as they are my best hope for getting better)
Posted by Dinah on May 26, 2003, at 22:09:32
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
It seems rather odd to me. Doctors tend to hand out antidepressants like candy. Even during my few episodes that were clearly clinical depression, I did smile on occasion, and laugh on occasion. I mean, apart from all else, it's possible to have those reactions on an external basis while feeling quite different on the inside. Most of us have a "front" we can show to the world. And your average pdoc knows that. Perhaps he's talking about more than a simple smile?
Any chance of seeing a second doctor for a consult?
Posted by Devilot on May 26, 2003, at 22:38:02
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
Depressed people don't smile? Bull! Being in customer service, and being an actor, even in my worse bouts of depression, I smile. If you have a doc that says they aren't giving you meds cause you smile, they're not telling you something else. Like maybe they don't think you're really depressed, or maybe they think something else. If I were you, I'd talk a bit more with this doc and find out what the real deal is.
PS Keep smiling. Smiles are free, and contagious.
:)
Posted by shar on May 27, 2003, at 1:07:55
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
oh, god.
I smiled with delight when I finally found, after much research, the method of suicide right for me. And, I *was* delighted because it was a lot of hard work. My therapist understood that my smile did not mean I was not "truly" depressed.
Depression may be a state that overwhelms us, especially when we are alone, but rarely to the exclusion of other emotions, including happiness, however transitory. Including, in fact, ALL the other emotions that humans come equipped with.
I smile and laugh. Many smiles are perfunctory, part of my learning how to survive when I was young (smiling was better than the alternative though seething was just below). Many smiles are from delight, and a good joke always brings a laugh. There is, for example, much good humor from the people here at PSB, many of whom are severely depressed.
Has this person ever treated depressed people before? How many? Does this therapist not know that smiles might not be expressions of happiness, but serve many other purposes (some mundane, and some critically important to making it through the family alive or keeping a job?).
Sorry for the intensity of my response, but that is simply not to be tolerated. I don't believe 'not smiling' is a diagnostic criterion from the DSM IV or V or whatever we're up to at this point.
Is this therapist extremely young and inexperienced?
Shar
Posted by Greg on May 27, 2003, at 7:36:01
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
Oh my Lord, what a load of horse crap! We depressives are very well versed in disguising our moods. Whether it be to our employer or co-workers, neighbors, friends, family members, we can always put on a smile. Sometimes they're even real. It's not impossible for us to find things to smile about. We're depressed, not dead. My spirits used to pick up all the time when I knew I was going to see my therapist because I knew I would always feel better after my sessions with him. I often smiled at him, and laughed too. But he never doubted that the issues I have were real.
I don't know where this doc of yours received his training, but I find it hard to believe that this is something that was taught. As Shar said, is this person new to the profession and very young? And as Dinah said, you should get a second opinion. I can't help but think that there's far more to this than what's been told to you. I would ask your doc to be more forthcoming with you. I mean, it's too ignorant a statement to even think about standing on it's own.
Good luck and let us know what happens.
Greg
Posted by fallsfall on May 27, 2003, at 7:52:57
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
I smile, too. But I am severely depressed.
8 years ago just before I went into the hospital I was walking down a hallway at work and one of the secretaries stopped and said "You don't look like that smile is genuine". She was completely right. I was miserable, but noone could see.
Sometimes I smile because it lets me pretend that things are OK - so I can make it through some minutes easier.
My Pdoc looks at how I move and act to assess how I'm doing, but whether I am smiling or not is a very tiny part of that assessment.
You might print out these responses and give them to him and see what he says. I agree with the rest, though, if he says you aren't depressed because you are smiling you need a new pdoc.
Good luck!
Posted by tina on May 27, 2003, at 8:24:36
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
when I am severely depressed, I don't smile. I just can't feel that instinct inside me. It disappears. But, when I am mildly to moderately depressed, I smile now and then. It's a social thing. The "Smile so no one knows you're hurting inside" sort of thing.
I think your doc needs to hit the books before attempting to treat you.
Posted by cybercafe on May 27, 2003, at 15:36:53
In reply to Re: Depressed people don't smile » cybercafe, posted by Snoozy on May 26, 2003, at 21:51:56
> Rubbish! I think it's possible to be severely depressed, yet still have some moments of "normalcy", however few and far between. More importantly, we're socially conditioned, especially females, to smile in certain situations. It's just an automatic reflex for some - not a sincere smile, but something.
It's all very confusing to me. I feel quite normal or even excited when doing more stimulating things. Maybe this is just my ADD. But I don't want to get out of bed in the morning or leave the house.
Thanks a lot guys for the support. I can't tell you how much it means to me. My doctor is very very competent and seems caring as well so it is really tough for me to write off what he says as baseless.
I find it really scary how many times my well-being has depended on me having both the knowledge and the courage to go against a doctor.
I mean if it weren't for the internet where would I be today???
I remember going to support groups in real life and looking around the room and realizing that without internet access these guys are going to endure soooo much unnecessary suffering.
Posted by cybercafe on May 27, 2003, at 15:48:20
In reply to Re: Depressed people don't smile » cybercafe, posted by Dinah on May 26, 2003, at 22:09:32
> It seems rather odd to me. Doctors tend to hand out antidepressants like candy. Even during my few episodes that were clearly clinical depression, I did smile on occasion, and laugh on occasion. I mean, apart from all else, it's
Well I guess when you're bipolar there's more of a danger in handing out ADs.
I dunno I can be really really down but I *know* that I have been this way before and ADs will make me better. So when I go to the doc and expect to get an AD I feel a great wave of relief wash over me ... relief and hope. Doesn't everyone?
It's weird.... I mean I feel very anxious around everyone but I feel relaxed around my doc. How many people feel like this I wonder. It's like a totally different experience than interacting with people on an everyday basis.
>possible to have those reactions on an external basis while feeling quite different on the inside. Most of us have a "front" we can show to
Damn it's so easy to second guess yourself. Maybe if things were different I wouldn't need an AD. Like if I had a lot more money, a girlfriend, or if I took a little more ritalin and ativan. Hmmmmmmm....
>the world. And your average pdoc knows that. Perhaps he's talking about more than a simple smile?
My whole demeanor is probably one of optimism.
> Any chance of seeing a second doctor for a consult?
Nope. But ultimately I think we each can only rely on ourselves :(
I find that kind of scary.
Posted by cybercafe on May 27, 2003, at 15:55:26
In reply to Re: Depressed people don't smile » cybercafe, posted by Devilot on May 26, 2003, at 22:38:02
> Depressed people don't smile? Bull! Being in customer service, and being an actor, even in my worse bouts of depression, I smile. If you have a doc that says they aren't giving you meds cause you smile, they're not telling you something else. Like maybe they don't think you're really depressed, or maybe they think something else. If I were you, I'd talk a bit more with this doc and find out what the real deal is.
Thanks for replying dude.
What is depression like to you? Do you guys still go out and do things, on occasion?
Like I'll force myself to go out to a club or to go to martial arts class and feel good when I do.
When my depression is milder I'll go lift weights or do cardio.
Does "real" depression involve not getting out of bed or not leaving the house ever?
> PS Keep smiling. Smiles are free, and contagious.
> :)Thanks for the support :)
Posted by Dinah on May 27, 2003, at 16:02:50
In reply to Re: Depressed people don't smile, posted by cybercafe on May 27, 2003, at 15:48:20
Ah, gotcha. Yes, that's what I was aiming for. If he thinks you have bipolar tendencies he's going to be careful about AD's and probably not going to give them without a mood stabilizer. Makes more sense now.
Posted by cybercafe on May 27, 2003, at 16:18:09
In reply to Re: Depressed people don't smile » cybercafe, posted by shar on May 27, 2003, at 1:07:55
> I smiled with delight when I finally found, after much research, the method of suicide right for me. And, I *was* delighted because it was a lot of hard work. My therapist understood that my smile did not mean I was not "truly" depressed.
Wow. That sounds terrible. I hope you're doing much better now?
> I smile and laugh. Many smiles are perfunctory, part of my learning how to survive when I was young (smiling was better than the alternative though seething was just below). Many smiles are from delight, and a good joke always brings a laugh. There is, for example, much good humor from the people here at PSB, many of whom are severely depressed.
Thanks for replying bro :) I'm glad to know I'm not alone or totally off base.
I remember an unusually large number of people in support groups IRL were doing stand up comedy. I don't know what to think of that...
> Has this person ever treated depressed people before? How many? Does this therapist not know that smiles might not be expressions of happiness, but serve many other purposes (some mundane, and some critically important to making it through the family alive or keeping a job?).This guy is really really competent. Probably one of the best in the city.
I had a strange experience the last time I was there. I used to have some idealistic notion of doctors as always being right. But at that moment I clued into the fact that this guy was too busy to remember what meds I was on. And after the smile comment I smiled again because it again brought on the .... earth-shattering idea that.... even though docs are very smart and very knowledgable... ultimately whether or not you are going to make it through this depends on yourself. (because they are too damn busy!) ...
that... you can do better for yourself if you put in a tiny bit of time and effort to organize and research and contemplate... your case
very scary... but very empowering too
> Sorry for the intensity of my response, but that is simply not to be tolerated. I don't believe 'not smiling' is a diagnostic criterion from the DSM IV or V or whatever we're up to at this point..... i think when your self-esteem is really low you tend to look up to and idealize other people. So my interactions with my doc are very intense and my standards are very high because I idealize other people so much! So I certainly understand where you're coming from
It just blows my mind to finally realize that ... hey... we're actually pretty smart ourselves :)
Which is incredible to think... considering how much these guys learn in med school
> Is this therapist extremely young and inexperienced?
No. I have had some very prestigious doctors do some very dumb things :)
Posted by cybercafe on May 27, 2003, at 16:31:30
In reply to Re: Depressed people don't smile » cybercafe, posted by Greg on May 27, 2003, at 7:36:01
> Oh my Lord, what a load of horse crap! We depressives are very well versed in disguising our moods. Whether it be to our employer or co-workers, neighbors, friends, family members, we can always put on a smile. Sometimes they're even
Yes! people are always telling me to smile more.. and i'm always trying to force it
>real. It's not impossible for us to find things to smile about. We're depressed, not dead. My spirits used to pick up all the time when I knew I was going to see my therapist because I knew I would always feel better after my sessions with him. I often smiled at him, and laughed too. But he never doubted that the issues I have were real.
Thanks bro :) I really needed to hear that. My time with my pdoc is the happiest time of the week. I'm glad to know that's somewhat normal :)
> I don't know where this doc of yours received his training, but I find it hard to believe that this is something that was taught. As Shar said, is this person new to the profession and very young? And as Dinah said, you should get a second opinion. I can't help but think that there's far more to this than what's been told to you. I would ask your doc to be more forthcoming with you. I mean, it's too ignorant a statement to even think about standing on it's own.
I think my doc is one of the best out there. But I also have come to realize these guys are just too bloody busy .. especially when it comes to us complicated cases (anxiety + ADHD + bipolar).
Ummm... he DID give me the antidepressant ...... but it took 4 months of NEEDLESS SUFFERING to get it.
The thing is............. for 4 months he never mentioned "i'm not giving it to you cuz you are smiling" but instead came up with a bullshit medical reason why I couldn't take it. It was only after 4 months that the real reason slipped out.
I always tried to be the best patient I could be (low self-esteem again) and was totally honest with my doc (low self-esteem again) I don't know why he felt he had to lie to me?????
I mean if he had been honest about why he wasn't giving me the med I could have given him the reasons why I thought i needed it ... like I could have filled out a HAMD or a GAF or document my symptoms .. which in my opinion were VERY SERIOUS and would clearly indicate to any doc who is interested in open and free discussion .. honesty.. that i am in desperate need of an AD.
For god sakes i have been on and off them enough to know what feeling normal feels like and what feeling depressed feels like.Yeah it's cool to say "you're not depressed because you're smiling" but it's not cool to make up some bullshit medical excuse because it's easier than an open dialogue ...
> Good luck and let us know what happens.Uh.... from now on I treat myself with visits to doctors for consultation purposes only ...
Posted by cybercafe on May 27, 2003, at 16:35:55
In reply to Re: Depressed people don't smile » cybercafe, posted by Dinah on May 27, 2003, at 16:02:50
> Ah, gotcha. Yes, that's what I was aiming for. If he thinks you have bipolar tendencies he's going to be careful about AD's and probably not going to give them without a mood stabilizer. Makes more sense now.
Yep... I wonder if he thinks I'm trying to get high or something stupid like that.
I just want to be able to get out of bed for goddsakes :)
Posted by Ted on May 27, 2003, at 16:37:22
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
> Comments?
>
> For 4 months my doc told me I couldn't have an antidepressant despite my feeling very very bad. Finally he mentioned that it was because I smiled in his office, and depressed people don't smile.
Call the medical licensing board in your state/province and explain the situation to them. After that, your pdoc won't be smiling anymore. :-)Ted
Posted by zenhussy on May 27, 2003, at 19:18:53
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
> Comments?
>
> For 4 months my doc told me I couldn't have an antidepressant despite my feeling very very bad. Finally he mentioned that it was because I smiled in his office, and depressed people don't smile.
>
> Is there any truth to this, or do you guys also go from lows to feeling normal depending on environment (pdoc visits are very significant, very positive events in my life, as they are my best hope for getting better)Cybercafe,
Craziest thing I've ever heard come out of a pdoc's mouth. Does this person just do your meds? Or are they doing your therapy as well?
Either way I would consider finding a different pdoc. I wouldn't put up with such a ridiculous statement like that.
I have major clinical depression and upon occassion I actually smile (gasp!).
I hope you have a different therapist than this dolt and can talk it over with someone with better perspective than the pdoc.
Good luck and smile whenever you feel like it or don't. You have whatever feelings you have (they're yours) and never let a doctor tell you otherwise. Sorry you had to go through this.
zenhussy
Posted by Devilot on May 27, 2003, at 20:24:23
In reply to Re: Depressed people don't smile, posted by cybercafe on May 27, 2003, at 15:55:26
Depression to me is definitely disabling at times. I don't want to leave my bed let alone the house. Going to work is horrible because I have to act so much so people will think I'm 'normal' and leave me to do my job, which in itself is extremely difficult most days, but I too force myself to get through it. Most nights after work I'm either online, or drinking, or I dive into my risperdal to get some sleep. Sleep seems to be one of the things that helps me not feel so depressed, but, ironically, it causes more of the problems in my life that make me more depressed.
At any rate, I'll continue to smile, and hope that we can all have moments of happiness that outweigh the down spells.
Ciao for now.
Posted by shar on May 28, 2003, at 21:26:54
In reply to Re: Depressed people don't smile, posted by cybercafe on May 27, 2003, at 16:35:55
> Yep... I wonder if he thinks I'm trying to get high or something stupid like that.
>Cyber:
If you discover an AD that gets you high, PLEASE let me know the name of it!!:)
Shar
Posted by cybercafe on May 29, 2003, at 1:31:08
In reply to Re: Depressed people don't smile » cybercafe, posted by shar on May 28, 2003, at 21:26:54
>
> > Yep... I wonder if he thinks I'm trying to get high or something stupid like that.
> >
>
> Cyber:
> If you discover an AD that gets you high, PLEASE let me know the name of it!!
>
> :)paxil, parnate (less so), and possibly celexa ... but it's a very long process like 2 months or more ... effexor doesn't get me high :(
Posted by noa on May 29, 2003, at 17:15:49
In reply to Depressed people don't smile, posted by cybercafe on May 26, 2003, at 21:26:40
>>For 4 months my doc told me I couldn't have an antidepressant despite my feeling very very bad. Finally he mentioned that it was because I smiled in his office, and depressed people don't smile.
>>Is there any truth to this, or do you guys also go from lows to feeling normal depending on environment (pdoc visits are very significant, very positive events in my life, as they are my best hope for getting better)
Comment: I am appalled. His statement is utter nonsense.
Has he not ever heard of "Atypical Depression" ("atypical" btw, is a misnomer but such it is dubbed). One of the distinctions of "atypcial" depression is "MOOD REACTIVITY"--ie, the person can react to social interaction, laugh at a joke, etc. vs. the previously held notion that all depressed people are totally impervious to attempts to get them to brighten up a bit in social interaction.
Here is a good article to read:
Atypical Depression Actually Very Typical
Correct Treatment May Depend on Proper Diagnosis
by Nancy SchimelpfeningURL:
http://depression.about.com/library/weekly/aa082901.htmI am rather appalled because this is such a well known concept and diagnosis!!
Check out some other doctors!!
This is the end of the thread.
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