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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by stargazer2 on November 5, 2007, at 15:40:07
when it's incompletely treated it becomes more resistent to treatment. I have read this over and over in some articles but I cannot quote a source to verify it's veracity.
I have mentioned this to my pdoc since I have not had any successful treatment with meds that have really made me think this is medication that will work well over a long time.
I have little condfidence in any medication that can keep my depression under control "indefinate;y" or even for a few years. I think the longest I've gone in remission is two years.
Does anyone know of this theory of incomplete treatment making the depression more resistant the longer it is treated marginally?
I think alot of the periods I look at as being under control are actually periods where I am adding another med or changing a dosage of a med. I'm not really in remission since I haven't stopped adjusting the meds long enough to say "this is really working well".
Does anyone know what I'm asking...Stargazer
Posted by Phillipa on November 5, 2007, at 15:42:53
In reply to Who knows the theory about depression and..., posted by stargazer2 on November 5, 2007, at 15:40:07
Yup but don't have a source. For me when life is going good I'm not depressed and know it's not meds it's life circumstances. Does that make sense. Would like to follow you're thread. Love Phillipa
Posted by stargazer2 on November 5, 2007, at 22:33:32
In reply to Re: Who knows the theory about depression and... » stargazer2, posted by Phillipa on November 5, 2007, at 15:42:53
Phillipa, I just read the theory again in the "Psychology Today" link you sent me. I lost my post somewhere and had attached the link. Let me see if I can find it again. Here it is...
http://www.psychologytoday.com/articles/pto-2671.html
That gives a brief on what I am talking about. For those with depression who haven't had good control of it,the derpession will get more resistent and recur more often. My experience exactly.
SG
Posted by Phillipa on November 5, 2007, at 23:24:44
In reply to Re: Who knows the theory about depression and..., posted by stargazer2 on November 5, 2007, at 22:33:32
Stargazer and I've read it in other sources too the older we get the harder to treat depression. Anyone else find this true? Phillipa
Posted by stargazer2 on November 7, 2007, at 7:49:13
In reply to Re: Who knows the theory about depression and... » stargazer2, posted by Phillipa on November 5, 2007, at 23:24:44
Others?
Posted by Justherself54 on November 7, 2007, at 8:41:25
In reply to Treatment resistent depression/gets more resistent, posted by stargazer2 on November 7, 2007, at 7:49:13
I've battled the depression end of bipolar for over 20 years..all SSRI's have pooped out on me usually around the year mark..I used to have gaps as long as 2 - 3 years in between episodes where I was med free..now I haven't been able to achieve any sort of "remission" during the past 5 years..so something has definitely changed..
It's been incredibly frustrating to start to feel well, then see the symtoms of the dreaded poop out continuing even when the AD is augmented with "boosters"..
So I would have to say that as I get older, my depression is getting more treatment resistant..hence the trials with MAOI's..and now I feel I will never have those lovely periods in between where I didn't have take an AD and all the lovely side effects that come with each..
Kudos to each and every one of us that keep paying our ticket to get back on the med merry-go-round..hope springs eternal!
Posted by stargazer2 on November 7, 2007, at 15:25:43
In reply to Re: Treatment resistent depression/gets more resistent, posted by Justherself54 on November 7, 2007, at 8:41:25
Justherself...Have you read about the theory that when depression is treated less than completely, the depression gets more and more resiliant and becomes more difficult to treat. There seems to be actual brain changes in the hippocampus and in the neurons that affect the treatment and the symptoms of depression get alot worse too. There's no way to prove this unless your part of a research study that is looking at those changes.
What I would like to see are the articles that describe what changes happen in the brain as depression gets more and more resilient.
I have had depression for 30 plus years, on meds for twenty and my original treatment was one med, Nardil, followed by Marplan with successful COMPLETE resolution of my depression. Today due to changes in those meds as they have been reformulated from the original drug, they no longer work the same, so is it the drug that has changed or my brain.
After Marplan was taken off the market in 1994, I have gone through the merry go round but the only meds that worked were a Celexa, Wellbutrin and Adderall combination for a few years, then nothing.
So most of my efforts are in trying to find something that works, although none of them worked like Nardil and Marplan and I would consider all of my trials less than adequate and resulting in an incomplete response.
So I attribute my continuing depression on the incomplete treatment with meds that really didn't control the symptoms very well. For the past 2 years I have been seeing my pdoc every week and this is very odd to not get a good response that I can feel is really controlling the depression.
I have lost alot of hope in ever getting a complete response again.Depression is always lurking around the corner ready to pounce whenever it needs a victim.
I just can't seem to get a complete response anymore. Is it my age, the length of my depression, the wrong meds are being used or the meds have changed and are no longer the same as the original ones. I haven't a clue and neither does my doctor.I'm not sure what else i can do anymore.
Stargazer
Posted by Justherself54 on November 7, 2007, at 22:04:19
In reply to Re: Treatment resistent depression/Justherself, posted by stargazer2 on November 7, 2007, at 15:25:43
> Justherself...Have you read about the theory that when depression is treated less than completely, the depression gets more and more resiliant and becomes more difficult to treat. There seems to be actual brain changes in the hippocampus and in the neurons that affect the treatment and the symptoms of depression get alot worse too. There's no way to prove this unless your part of a research study that is looking at those changes.
>
> What I would like to see are the articles that describe what changes happen in the brain as depression gets more and more resilient.
>
> I have had depression for 30 plus years, on meds for twenty and my original treatment was one med, Nardil, followed by Marplan with successful COMPLETE resolution of my depression. Today due to changes in those meds as they have been reformulated from the original drug, they no longer work the same, so is it the drug that has changed or my brain.
>
> After Marplan was taken off the market in 1994, I have gone through the merry go round but the only meds that worked were a Celexa, Wellbutrin and Adderall combination for a few years, then nothing.
>
> So most of my efforts are in trying to find something that works, although none of them worked like Nardil and Marplan and I would consider all of my trials less than adequate and resulting in an incomplete response.
>
> So I attribute my continuing depression on the incomplete treatment with meds that really didn't control the symptoms very well. For the past 2 years I have been seeing my pdoc every week and this is very odd to not get a good response that I can feel is really controlling the depression.
> I have lost alot of hope in ever getting a complete response again.
>
> Depression is always lurking around the corner ready to pounce whenever it needs a victim.
> I just can't seem to get a complete response anymore. Is it my age, the length of my depression, the wrong meds are being used or the meds have changed and are no longer the same as the original ones. I haven't a clue and neither does my doctor.
>
> I'm not sure what else i can do anymore.
>
> StargazerI so relate to what you're saying..I asked my pdoc why I can't get back to where I was 5 years ago and asked if I now have brain damage..I wished I had paid more attention to his response..from what I remember him saying is no I don't have "brain damage" but the more relapses I have it causes damage to the neurtransmitters (or some such thing..I wasn't too swift that day). I'll have to bring it up to him again next time..and ask him if he has any studies he could lend me or point me to that substantiates this..like I say I was nowhere near being "on the ball".
I've been very med compliant and have given each of my "cocktails" a lengthy trial (unless the side effects were too bad)..some I've had excellent responses with..but they ALL, every oe of them, poop out..so something has changed in my brain chemistry..even at high doses, they lose effectiveness and seem to in shorter periods now..
It's scary, knowing that if Nardil fails, it's back to the drawing board that's been covered in from one end to the other with SSRIs, AP's, mood stabalizers and all the combinations I've tried..overwhelmes me!
I have life I want to live..I feel it in me..it's just being sat on by a big fat blob of depression that no drug or drug cocktail has been able to kick its *ss off me..
So as time goes by..self esteem goes in the cr*pp*r, self-isolation becomes more comfortable, social skills become very rusty, returning to work unrealistic..oh and let's not even bring family dynamics and being single into the mix..akkk
I'm just really rambling here..too much I think..Therei's a song from the movie Shirley Valentine called "The Girl Who Used to Be Me"..one line "I'd wish I'd find the girl I knew who used to be me"..that's been my goal..enuff said..
Posted by linkadge on November 8, 2007, at 9:43:26
In reply to Re: Treatment resistent depression Stargazer, posted by Justherself54 on November 7, 2007, at 22:04:19
Some researchers have argued that it is infact treatment of depression which is associated with increased chronicity.
Ie antidepressant use is associated with the disease becoming more chronic.
Linkadge
Posted by stargazer2 on November 8, 2007, at 15:31:13
In reply to Re: Treatment resistent depression Stargazer, posted by linkadge on November 8, 2007, at 9:43:26
So the treatment of depression causes chronicity,what if no treatment is given, what happens then...I am not sure if anything I do anymore helps or hurts me, it is so unclear what path to take with depression, other than ongoing medication treatment that does not help, so is doing nothing better?
Does anyone feel doing nothing for depression is better than chasing medication?
Stargazer
Posted by Phillipa on November 8, 2007, at 19:46:43
In reply to Re: Treatment resistent depression/Linkage, posted by stargazer2 on November 8, 2007, at 15:31:13
Stargazer I feel kind of that way as the more meds I tried at low doses the worse I felt. I feel the best when life circumstances are going well and relationships are also going well. I've watched for so long and it seems someone is always adding another med to make the one they are on work better. The ones who found that meds worked for them I e-mail with a lot and they are busy and happy cause they are involved with people and life. Hence always a low dose of an ad. Even my pdoc doesn't want me on a high dose of an ad. She knows anxiety is my problem and the ad's don't work with me. Others may react differently but my body doesn't like them at all. Phillipa
Posted by elanor roosevelt on November 8, 2007, at 22:45:44
In reply to Re: Treatment resistent depression/gets more resistent, posted by Justherself54 on November 7, 2007, at 8:41:25
and now I feel I will never have those lovely periods in between where I didn't have take an AD
sigh
i remember those times
even if i did keep looking over my shoulder
Posted by stargazer2 on November 11, 2007, at 21:19:31
In reply to Re: Treatment resistent depression/gets more resis, posted by elanor roosevelt on November 8, 2007, at 22:45:44
Bipolar disorder and recurrent major depression are life-long disabling illnesses that often first become clinically apparent in the late teenage years or early twenties. People who develop clinical mood disorders characteristically have milder, short-lived symptoms of mood disturbance prior to the onset of clinical illness. These sub-clinical disturbances represent a risk factor for the subsequent development of clinical disorders (Angst 2000; Aalto-Setala, 2002). A number of physiological abnormalities associated with depression persist after symptom resolution, suggesting that depression may cause a kind of biological “scarring” of the brain that can predispose to further episodes of illness.
Posted by 49er on November 17, 2007, at 8:58:45
In reply to Re: Treatment resistent depression/Linkage, posted by stargazer2 on November 8, 2007, at 15:31:13
Hi Stargazer,
I wanted to share my personal experience since it addresses the concerns you raised:
In 1995, I started psych meds for treatment of depression and ADHD. Except for a year and a half, the meds really weren't that great. But like alot of people on this board, I kept chasing that ultimate med.
Eventually, I realized on some level, these meds were not the answer and that chasing more of them was not going to change anything. But having been on meds for so long, I just didn't see what the alternatives were. And of course, I was scared that if I went off of them, I would fall apart.
My thinking changed when I was diagnosed with a mysterious hearing loss in 2005. In doing research, I found that hearing loss according to the Mosby's drug book, is a rare side effect for two of the Drugs I was on which is Wellbutrin and Remeron. As a aside, I have found that what is listed as rare side effect occurs alot more often than you think it does.
Needless to say, with a learning disability and ADHD, having a hearing loss was the last thing I needed to be worrying about. Also, it seemed that the tinnitus I already had which definitely was a side effect of Wellbutrin was also a sign of ear poisoning according to articles on ototoxicity.
Anyway, as soon as I moved to a less stressful job, which was in 2006, I decided to taper off of my psych med coctail. I am down to two meds and continue to do well in spite of dealing with crises like a near death in my family and finding a permanent job.
Stargazer, let me give you a specific example of how I am learning to cope without meds even though I am still on two of them. Right now, I am working a temp job that I am not very happy in.
If I was on my full complement of meds, I would just probably get real depressed and then not have any idea what was going on and simply say" Da--- those meds".
Knowing that I have to learn non med coping techniques, I keep telling myself that I have options and I am not stuck in this job if I don't want to stay there. I keep asking myself what is this depression telling you, what do you need to do.
Of course, people might say I was wrong in expecting meds to do this work for me and you're right about that. But in my opinion, what happens when you are placed on a psych med is that you subconciously no longer do the work to manage your life. It isn't because you are lazy or any of that stuff. It just happens. At least that was my experience as I am not saying this is true for everyone.
My advice to anyone considering going off of meds is to taper very very slowly. Not more than 10% of current dose every 3 to 6 weeks. I found I was able to go faster thanks to taking supplements but I think I am the exception.
I would also take good quality supplements, not the ones you buy at your local CVS. They do not need to cost a fortune. By the way, I do not work for any alternative health outfits.
I hope this helps Stargazer. Let me know if I can help in any wa.
49er
Posted by linkadge on November 17, 2007, at 20:06:04
In reply to Re: Treatment resistent depression/Linkage » stargazer2, posted by 49er on November 17, 2007, at 8:58:45
There are a number of psudo conclusions that people reach without sufficiant evidence.
Let me give you an example. A number of studies have shown that depression duration is associated with heart disease. They use this as an argument for treatment, when in reality, there are few studies that conclusivly show that treatment reduces the incidence of heart disease. Some antidepressants even appear to increase the risk of cardiac problems.
I think the same goes with depression. Sure depression is reccurrent, but do we really have conclusive data to suggest that treatment really does anything in the long run?
Linkadge
Posted by 49er on November 18, 2007, at 8:04:59
In reply to Re: Treatment resistent depression/Linkage, posted by linkadge on November 17, 2007, at 20:06:04
Hi Linkage,
Great point!
Take a look at this link:
Speaking on antidepressants the Vice President of The Swedish Psychiatric Association, Dr. Christina Spjut, said Sunday that "an immense number of persons get worse from this". She said that many persons take these drugs for years "where the antidepressant drugs make them continue to be depressed".
Posted by tecknohed on November 19, 2007, at 17:11:18
In reply to Who knows the theory about depression and..., posted by stargazer2 on November 5, 2007, at 15:40:07
No-one has mentioned talking therapies. The best reactions to antidepressants I've had have always been whilst I've been having some kind of talking therapy too, be it councelling or psychotherapy. Interestingly, when Nardil started loosing it's efficacy was not long after I stopped long term councelling.
Having someone impartial to talk to, even to just let go of the built up 'brain garbage' of the last week is IMO as essential as taking meds. If it all just builds & builds then that is going to cause pure psychological depression which meds will rarely help.
Meds are tools, thats all. They are NOT essential to the brain or body - you cannot get an SSRI deficiency! What you must do is take the first opportunity (when the med(s) first take effect) to begin building solid foundations - something to fall back on. Re-build broken relationships/friendships & careers/study. Find or create your goals. Try to get fit. Always look for ways to keep yourself entertained & make yourself laugh.
Sadly, if you leave it too long the meds poop out before you get a chance to do any of this. You just can't wait for a drug to do all this for you.
Unfortunitely its taken many years for me to figure this out, and like most of the people who are on these boards my response to ADs has deminished too. But I am finally learning what I have to do to survive MISERY.
Just my personal thoughts.
teck
Posted by bulldog2 on November 22, 2007, at 8:53:35
In reply to Re: Who knows the theory about depression and..., posted by tecknohed on November 19, 2007, at 17:11:18
There's no right or wrong answer concerning meds.Was talking to my p-doc about this the other day. Some people get better with just cbt and some need cbt abd meds. Also some get better with just meds. If depression is caused by faulty thinking than cbt may do the trick. But for some depression may be genetic and run in families or even brain injury. Depression probably has many causes. Doing it without meds is ideal but will not work for all. Also some people exercise, eat well and take supplements and still suffer from depression. I don't believe we'll ever find the silver bullet that cures all depressions. Just a symptom rather than a disease that can have many causes.
Posted by linkadge on November 23, 2007, at 21:23:55
In reply to Re: Treatment resistent depression/Linkage, posted by 49er on November 18, 2007, at 8:04:59
Thats a good point. Finally somebody with some sort of authority speaks out. Sometimes I think I am reading "The Emperor's New Cloths" over and over.
Linkadge
This is the end of the thread.
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