![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 56. Go back in thread:
Posted by linkadge on June 4, 2011, at 7:09:24
In reply to what I don't understand is..., posted by Christ_empowered on June 3, 2011, at 12:20:19
I would argue that many people are depressed because of a bad marrage, job, finiancial situation, etc. They want the drug to make all that go away, but its not going to happen.
For many, theres a lot deeper work that needs to be done. IMHO
Linkadge
Posted by linkadge on June 4, 2011, at 7:11:03
In reply to Re: Do we expect too much of antidepressants today? » jono_in_adelaide, posted by SLS on June 2, 2011, at 6:27:48
>It is thought by some that this illness in >particular has a rate of response of 85% when >any and all existing psychotropics are to be >considered as potential therapies in the >practice of polypharmacy.
Oh, of course. You could select some group in which they worked 100% of the time!
Linkadge
Posted by linkadge on June 4, 2011, at 7:14:21
In reply to Re: Do we expect too much of antidepressants today?, posted by hyperfocus on June 2, 2011, at 17:48:20
>Antidepressants do not make you happy AFAIK. >They just normalize your emotional response.
I didn't know numb was normal. But, I guess if you're emotions have gone haywire, numb feels more normal.
Linkadge
Posted by linkadge on June 4, 2011, at 7:16:54
In reply to Re: Do we expect too much of antidepressants today? » SLS, posted by hyperfocus on June 2, 2011, at 20:32:41
>Clinical studies show a mean of only 1.7 new >girlfriends acquired unfortunately.
Well, thats great if you're a heterosexual or lesbian.
Linkadge
Posted by SLS on June 4, 2011, at 7:43:02
In reply to Re: don't change your life - change your drug, posted by linkadge on June 4, 2011, at 7:09:24
> I would argue that many people are depressed because of a bad marrage, job, finiancial situation, etc. They want the drug to make all that go away, but its not going to happen.
>
> For many, theres a lot deeper work that needs to be done. IMHO
>
> Linkadge
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.
- Scott
Posted by SLS on June 4, 2011, at 7:47:07
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 7:11:03
> >It is thought by some that this illness in >particular has a rate of response of 85% when >any and all existing psychotropics are to be >considered as potential therapies in the >practice of polypharmacy.
>
> Oh, of course. You could select some group in which they worked 100% of the time!
>
> Linkadge
>
How would you be able to select such a population? If someone comes up with a way to predict treatment response for subtypes of depression, that would be a monumental step forward. I believe that it will happen sooner than later.From time to time, let us assume that the investigators know what they are doing when executing a RCT.
- Scott
Posted by SLS on June 4, 2011, at 7:50:08
In reply to Re: Do we expect too much of antidepressants today? » hyperfocus, posted by linkadge on June 4, 2011, at 7:14:21
> >Antidepressants do not make you happy AFAIK. >They just normalize your emotional response.
>
> I didn't know numb was normal. But, I guess if you're emotions have gone haywire, numb feels more normal.
>
> Linkadge
I think Hyperfocus is right. This has been my own observation when I compare the operation of my psyche when depressed versus non-depressed.- Scott
Posted by SLS on June 4, 2011, at 7:53:32
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 7:16:54
> >Clinical studies show a mean of only 1.7 new >girlfriends acquired unfortunately.
>
> Well, thats great if you're a heterosexual or lesbian.
>
> Linkadge
Touché
- Scott
Posted by linkadge on June 4, 2011, at 9:40:26
In reply to Re: don't change your life - change your drug » linkadge, posted by SLS on June 4, 2011, at 7:43:02
I think is very difficult to tell whether something is MDD or simply a natural reaction to major life stressors. Some doctors would argue that there is no difference, and both warrant the same treatment.
I think some people subconsiously avoid adrressing the things in their life that they feel that they can't change, are too difficult to change, or that they don't want to change.
Linkadge
Posted by linkadge on June 4, 2011, at 9:41:56
In reply to Re: Do we expect too much of antidepressants today? » linkadge, posted by SLS on June 4, 2011, at 7:47:07
>From time to time, let us assume that the >investigators know what they are doing when >executing a RCT.
Oh, I think they know what they're doing. They're trying to establish the efficacy of biological psychiatry.
Linkadge
Posted by SLS on June 4, 2011, at 10:34:08
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 9:41:56
> >From time to time, let us assume that the >investigators know what they are doing when >executing a RCT.
>
> Oh, I think they know what they're doing. They're trying to establish the efficacy of biological psychiatry.
>
> Linkadge
>
>Hi.
Do you doubt that there are cases of depressive illness that are biological, or is it that you don't feel that current treatment is efficacious, or both?
- Scott
Posted by SLS on June 4, 2011, at 10:36:37
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 9:41:56
> >From time to time, let us assume that the >investigators know what they are doing when >executing a RCT.
>
> Oh, I think they know what they're doing. They're trying to establish the efficacy of biological psychiatry.
Have they been successful?
- Scott
Posted by floatingbridge on June 4, 2011, at 11:18:12
In reply to Re: don't change your life - change your drug » SLS, posted by linkadge on June 4, 2011, at 9:40:26
> I think is very difficult to tell whether something is MDD or simply a natural reaction to major life stressors. Some doctors would argue that there is no difference, and both warrant the same treatment.
> I think some people subconsiously avoid adrressing the things in their life that they feel that they can't change, are too difficult to change, or that they don't
want to change.
>
>
>
> LinkadgeHi Link,
I agree people in general are somewhat at the very least subconciously avoidant, yet do majority really break down? Self-collusion serves a protective function. Avoidance is not the right word here--sounds willfully rational and most people are an aggregate of more than their rational self.
I know we're talking theory here, since PB represents a heterogeneous dx population, and I understand your main meaning. When the great societal urge to have someone else do one's recovery for them started, at least in the states, I don't know. There was the excitement in science that relief was within reach for a spectrum of ailments. When does that coincide with the rise of corporate interests in creating a market greater than the need? But at PB the need is pretty real in all it's variables.
Many at AA walk that fine line given in
the Serenity Prayer. The only widely available medicine when Bill W began AA was alcohol. People would risk drink wood alcohol during prohibition. The rise of gout in Europe during the 14th(?) Century coincided with the importation of sugar, a rich persons' substance that
was documented to cause exotic physical
changes in the consumer.Drug addicts, alcoholics. What are they
doing? There's some genetics to be
explored as a society from which science springs reexamines it's moral assumptions.However, the 12 steppers, religious and community groups help quite a bit in aiding people in coping with lives they might not have chosen or somehow cannot otherwise change.
Some people work awfully hard, you know, the lives of quiet desperation line. Someone shows them something pretty, a little bottle of sky blue pills and says here take one. You'll feel so much better, and there's no unsightly mess to deal with. Until one is kicked around by such seductions once or twice, it looks like a great deal.
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.
Go forward in thread:
Psycho-Babble Medication | 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.