![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Phil on April 28, 2013, at 9:13:13
http://www.clickbipolarblog.com/2013/04/you-and-i-we-just-dont-want-to-get.html
Posted by Phillipa on April 28, 2013, at 10:50:00
In reply to You and I, we just don't want to get better, posted by Phil on April 28, 2013, at 9:13:13
Phil love your blogs and what you say is true!! Phillipa
Posted by Twinleaf on April 28, 2013, at 14:53:47
In reply to You and I, we just don't want to get better, posted by Phil on April 28, 2013, at 9:13:13
You are expressing what many people feel who have been struggling for a long time with depression. Many people on these boards have wondered whether anhedonia and an inability to use time in a satisfying and goal-directed way are a part of having a depressive illnesses, a result of medication, or both.
While I do think both causes are real, I tend to focus more on the medications, as it is an area where one has more choices. I think the SSRIs and related drugs are the ones which tend to cause anhedonia and lack of motivation by far the most. If they are an important part of successful, or at least helpful, treatment, I think it is very important to try to balance them with medications and treatments which increase the presence of dopamine in the prefrontal areas. It's my understanding, admittedly incomplete, that dopamine in those areas is vital for a sense of meaning in life, hopefulness (even in the presence of difficulties), and goal-directed activities. I'd really like to know what other posters' views are on this topic.
I thought the "not wanting to get well" excuse got retired 50 years ago, along with other discredited Freudian ideas like penis envy! (this is from someone with a wonderful, very helpful contemporary psychoanalyst).
Posted by Beckett on April 28, 2013, at 21:06:30
In reply to Re: You and I, we just don't want to get better, posted by Twinleaf on April 28, 2013, at 14:53:47
Do you know medications that increase dopamine in the prefrontal area? I thought maybe a stimulant. My doc just reccommeded ect, however, I found a tms center in my town. I don't know what to do.
Phil, I hear you. I feel stuck and tangled. Thanks for the blogs. I look forward to them.
Posted by Twinleaf on April 28, 2013, at 21:21:54
In reply to Re: You and I, we just don't want to get better » Twinleaf, posted by Beckett on April 28, 2013, at 21:06:30
I don't know a lot about it, and am hoping others will contribute. The four things which have worked for me are TMS, tianeptine, meditation and therapy. I found out that I metabolized dopamine too quickly, and serotonin too slowly by genetic testing. For me -and I do want to emphasize that it's just me - getting off SSRIs made me feel much better. Not entirely depression-free, at first, but much more proactive and more like my old self. The genetic testing is not very comprehensive, as yet, but it really can help in the choice of medications. I think more and more psychiatrists are starting to use it.
Posted by Phillipa on April 28, 2013, at 21:36:28
In reply to Dopamine..., posted by Twinleaf on April 28, 2013, at 21:21:54
Mine just did it with swab his wife & he did as well. Was free medicaire paid for it. No results yet
Posted by Beckett on April 28, 2013, at 21:41:03
In reply to Dopamine..., posted by Twinleaf on April 28, 2013, at 21:21:54
I wonder if tianeptine will be made available in the US. I don't do well on SSRI's or snri's. I'm currently on lithium and klonopin. When I got off the AD's I felt we'll for awhile. Now the anhedonia appeared. I've never really know what it was till now.
Twinleaf, may I ask you how depressed you were when you received TMS? I've read many of your posts and know it really worked for you. I feel like maybe I'm too bad off for TMS to work for me.
Posted by Twinleaf on April 28, 2013, at 22:00:01
In reply to Re: Dopamine... » Twinleaf, posted by Beckett on April 28, 2013, at 21:41:03
Before my initial 3-week course of treatment, I had a score of 38 on the Mongomery-Asberg scale - that is "severe". Now, 8 years later, I have scores of between 1 -4. I do continue with everything, including one TMS treatment every 4 months, plus therapy which is now less frequent. It has all helped so much that I don't dare stop any of it!
TMS can work even with very severe depression. I'm assuming the new deep TMS may be even more effective, although I don't know about the pain aspect. I do like how safe it is.
Good luck to you in whatever you try!
Posted by Beckett on April 28, 2013, at 22:23:48
In reply to Re: Dopamine..., posted by Twinleaf on April 28, 2013, at 22:00:01
Thank you Twinleaf for the information and encouragement.
Posted by Meatwood_Flack on April 28, 2013, at 23:25:20
In reply to You and I, we just don't want to get better, posted by Phil on April 28, 2013, at 9:13:13
I think part of the shortcomings of mental health care is that it is carried out by people who don't truly understand what it's like to need mental health care. The same could be said of cancer patients. I've had three different therapists and, of those, only one who was selfless enough to try to question our way down to the roots. The other two were basically cheerleaders. "Do what you love" and that sort of thing, even if you've told them a dozen times that you don't love anything anymore. Before my depressive episode hit 15 months ago, I spent 2-3 hours a night making music only to wake up one morning to find that didn't work anymore.How could I expect anyone assigned to me to understand that? I think we are so used to the idea that there is, or should be, order in the universe that we expect anyone with a master's degree in psychology to be able to provide it. But one thing I've learned from my own dark night of the soul is that the brain is too powerful to be understood, let alone mastered. Sometimes medication helps. For me, I have yet to see such a benefit. So the idea of someone without the benefit of my experience being able to help me navigate through it just seems preposterous, although well intentioned. I don't blame them for their lack of understanding, anymore than I would blame a doctor treating me for cancer for their lack of understanding of the experience of a cancer patient. I've become accustomed to being misunderstood. But I also came to grips with the reality that therapy is nothing more than two people trying to understand each other. My depression is an experience I could have never imagined had I not gone through it. The fact that my therapists do not understand only makes sense, a fact that makes it harder to trust a new therapist. After all, what do they know about how you feel? It's a very individual experience. Very tough waters to navigate, both for us and for those we seek out for guidance.
Posted by SLS on April 29, 2013, at 7:18:45
In reply to Re: Dopamine..., posted by Twinleaf on April 28, 2013, at 22:00:01
> Before my initial 3-week course of treatment, I had a score of 38 on the Mongomery-Asberg scale - that is "severe".
That's a hellish number.
> Now, 8 years later, I have scores of between 1 -4.
That is astonishing.
> TMS can work even with very severe depression.
Yes, but how often does it work for someone who has failed multiple drug trials?
> I'm assuming the new deep TMS may be even more effective,
That's what I am hoping for. I had been expecting a more robust improvement in depression at this juncture. If I get "stuck", I would be very interested in deep TMS.
- Scott
Posted by Twinleaf on April 29, 2013, at 10:04:28
In reply to Re: Dopamine... » Twinleaf, posted by SLS on April 29, 2013, at 7:18:45
Scott
From what you have written in the past, the medications you are on have definitely helped - just not enough for a workable remission. I would think TMS, maybe the new deep version if you can get it, has a good chance of being helpful.
For me, the TMS, medication and therapy have played equally important parts in getting into remission. I feel that I have to keep them all going in order to stay in remission, although now the TMS is much less frequent and the therapy less intense.
I do wish you luck in whatever you try. Be sure to post about it here.
Posted by baseball55 on April 29, 2013, at 19:56:27
In reply to Re: You and I, we just don't want to get better, posted by Meatwood_Flack on April 28, 2013, at 23:25:20
I don't think a good therapist needs to have experienced depression anymore than a good doctor needs to have experienced diabetes. They are clinicians. They see multiple patients over many years and, if they are empathic as they must be to do this kind of work, they come to know how depression looks, feels, responds. I think any experienced clinician can empathize and work with mental illness without having experienced it themselves. just as any good gp can work with diabetic patients without having diabetes themselves and any good oncologist can work with cancer patients without having had cancer themselves.
You may have had bad experiences with clinicians but I have had nothing but good experiences.
> I think part of the shortcomings of mental health care is that it is carried out by people who don't truly understand what it's like to need mental health care. The same could be said of cancer patients. I've had three different therapists and, of those, only one who was selfless enough to try to question our way down to the roots. The other two were basically cheerleaders. "Do what you love" and that sort of thing, even if you've told them a dozen times that you don't love anything anymore. Before my depressive episode hit 15 months ago, I spent 2-3 hours a night making music only to wake up one morning to find that didn't work anymore.How could I expect anyone assigned to me to understand that? I think we are so used to the idea that there is, or should be, order in the universe that we expect anyone with a master's degree in psychology to be able to provide it. But one thing I've learned from my own dark night of the soul is that the brain is too powerful to be understood, let alone mastered. Sometimes medication helps. For me, I have yet to see such a benefit. So the idea of someone without the benefit of my experience being able to help me navigate through it just seems preposterous, although well intentioned. I don't blame them for their lack of understanding, anymore than I would blame a doctor treating me for cancer for their lack of understanding of the experience of a cancer patient. I've become accustomed to being misunderstood. But I also came to grips with the reality that therapy is nothing more than two people trying to understand each other. My depression is an experience I could have never imagined had I not gone through it. The fact that my therapists do not understand only makes sense, a fact that makes it harder to trust a new therapist. After all, what do they know about how you feel? It's a very individual experience. Very tough waters to navigate, both for us and for those we seek out for guidance.
Posted by Phil on April 30, 2013, at 10:14:12
In reply to Re: You and I, we just don't want to get better, posted by baseball55 on April 29, 2013, at 19:56:27
In a speech that's on YouTube by KRJ she kind of stuttered a bit when talking about young doctors and their ability to diagnose patients and then she backed off a bit.
When I left my psychiatrists office that I was seeing years ago, I would walk across the room to see a therapist who would start in, why do you need to take that sh*t man(his words). The psychiatrist was awful and awfully stupid. The therapist? Never went back.
I moved to Austin soon after. For the most part, in my experience, there are more good in both professions but not by much, 60/40 maybe. Why else would my bipolar be misdiagnosed for twenty years by five psychiatrists?
Posted by baseball55 on April 30, 2013, at 19:36:23
In reply to Re: You and I, we just don't want to get better » baseball55, posted by Phil on April 30, 2013, at 10:14:12
I've had two therapists (one a p-doc) and they've both been great. My p-doc is not that big on diagnosis. These drugs are not that well targeted that it matters whether you're bipolar 1, bipolar 2, atypical depression, MDD. It's all the same trials of drug combos anyway. He once said that I'm probably bipolar 3-b or whatever.
> In a speech that's on YouTube by KRJ she kind of stuttered a bit when talking about young doctors and their ability to diagnose patients and then she backed off a bit.
> When I left my psychiatrists office that I was seeing years ago, I would walk across the room to see a therapist who would start in, why do you need to take that sh*t man(his words). The psychiatrist was awful and awfully stupid. The therapist? Never went back.
> I moved to Austin soon after. For the most part, in my experience, there are more good in both professions but not by much, 60/40 maybe. Why else would my bipolar be misdiagnosed for twenty years by five psychiatrists?
Posted by Dinah on May 7, 2013, at 8:14:59
In reply to Re: You and I, we just don't want to get better » baseball55, posted by Phil on April 30, 2013, at 10:14:12
> I moved to Austin soon after. For the most part, in my experience, there are more good in both professions but not by much, 60/40 maybe. Why else would my bipolar be misdiagnosed for twenty years by five psychiatrists?
You're way more generous than I am. I think the truly good therapists and pdocs are no more than ten percent. The truly competent may make up another thirty percent, tops.
But I don't limit that to merely these two specialties. I find a doctor I really admire seldom enough to consider them pearls beyond price. I can only think of one specialty, dermatology, where I found more than one of the rare creatures.
On the other hand, I suppose if you spread that to include "good enough" for any specific person, then the percentage could conceivably rise.
Perhaps the best of the best don't congregate in New Orleans. I have no experience elsewhere.
Posted by baseball55 on May 9, 2013, at 19:36:42
In reply to Re: You and I, we just don't want to get better » Phil, posted by Dinah on May 7, 2013, at 8:14:59
Maybe they congregate in Boston. I have never seen a bad doctor here. My husband saw one. My daughter has been extremely well-cared for here compared to Canada, where she lives now. And I have seen lots of doctors and social workers, having been hospitalized several times. I only had one doctor who was sort of a dork, but not mean or unkind, just not very competent. And he had my regular p-doc, who was much more experienced, come into the hospital for a meeting. So he realized he was in over his head.
This is the end of the thread.
Psycho-Babble Social | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.