![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 39 to 63 of 67. Go back in thread:
Posted by utopizen on October 23, 2008, at 22:43:34
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by utopizen on October 23, 2008, at 21:29:00
Just use ECT. 90% Efficacy rate, and for most, it works within a week's time, worst case, within the month.
If I had any idea how pathetically simple it all was, I would have done it, if I had to do it all over again. And I am in remission.
It's not worth the wait, the gambling game, of med trials for years and years.
1 year is fine. After that, if a doc isn't considering ECT, it's either the patient won't consent, or the doc's rationale is fundamentally grounded by hysteria, and little else. The APA fully supports its safety and efficacy.
Posted by greywolf on October 24, 2008, at 20:59:06
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by utopizen on October 23, 2008, at 22:43:34
> 1 year is fine. After that, if a doc isn't considering ECT, it's either the patient won't consent, or the doc's rationale is fundamentally grounded by hysteria, and little else. The APA fully supports its safety and efficacy.
That statement is a gross oversimplification in my view. I've got a great psychiatrist who uses ECT, but is also very forthcoming regarding its short- and long-term risks. Which is why although ECT remains an option for me, he recommended trying VNS surgery first. ECT may have an undeservedly bad rep to a certain extent, but there are practical drawbacks to its use that are well recognized by professionals.
I'm glad it worked well for you. But I'm not sure that it is fair to suggest that people who choose not to go the ECT route are being irrational or hysterical.
Continued good health to you.
Greywolf
Posted by Bob on October 24, 2008, at 21:09:56
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by greywolf on October 24, 2008, at 20:59:06
> > 1 year is fine. After that, if a doc isn't considering ECT, it's either the patient won't consent, or the doc's rationale is fundamentally grounded by hysteria, and little else. The APA fully supports its safety and efficacy.
>
> That statement is a gross oversimplification in my view. I've got a great psychiatrist who uses ECT, but is also very forthcoming regarding its short- and long-term risks. Which is why although ECT remains an option for me, he recommended trying VNS surgery first. ECT may have an undeservedly bad rep to a certain extent, but there are practical drawbacks to its use that are well recognized by professionals.
>
> I'm glad it worked well for you. But I'm not sure that it is fair to suggest that people who choose not to go the ECT route are being irrational or hysterical.
>
> Continued good health to you.
>
> Greywolf
>
I have to side with Greywolf here. I had 21 treatments of ECT and it was, in retrospect, devastating. Many people are helped by this procedure, but there is a real percentage of people who do not do well with it. I personally believe that a patient should enter into ECT treatments with care and under close supervision. This is one of the problems I think was implicated in my case was that the ECT doctors and my psychiatrist were not very communicative. Unfortunately, people who feel they need ECT are often helpless and vulnerable at this point and I'm not sure how a patient could "manage" their own care.- Bob
Posted by Sigismund on October 24, 2008, at 23:08:25
In reply to Re: Exotic Meds for Treatment Resistant Depression » greywolf, posted by Bob on October 24, 2008, at 21:09:56
This is what my psych said about ECT to me, more or less.
'I was taught that the one treatment that was successful for depression was ECT, and when I was a registrar I ordered it for some patients, and when I taught, I taught the same thing. And it was only later that I realised that I had *never* seen the results I had been told of and told others about.'
Posted by shasling on October 26, 2008, at 15:49:25
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by utopizen on October 23, 2008, at 21:29:00
> > Xyrem isn't exactly the same thing anyway. They changed the molecular formula just a teensy bit, but it was enough to eliminate the euphoria. Just makes you sleepy.
> >
>
> ???
>
> Who told you this?
>
> Anyhow, no.
>
> As I recall, and so can the entire dorm that evacuated one cold night when some drunk kid pulled a fire alarm, I was so elated on the stuff, I was grinning off into space. While everyone else was sober enough to realize they had just woken up at 3 AM to a fire alarm on a weeknight.
>
> Even the drunk kids were giving me weird looks.
>
> Yes, it'll give you elation, at a high enough dose. Which is the therapeutic dose. Before that dose, you get dysphoria. And insomnia. Fun combo, for a sedative, eh?
>
> Oh, did I mention my friends thought on certain mornings I was so depressed to talk to, it would make a widow at a funeral concerned my mood wasn't as great as hers? The docs call that special number "Morning anxiety."
>
>
> Also:
>
> IT'S CONTRAINDICATED IN DEPRESSION.
>
> You have depression already, and that 8% dysphoria figure suddenly becomes guaranteed at 100% to you. Keep in mind, depressed patients in all of the trials this data comes from are screened out, and do not enter.
>
> Drugs can have a completely different effect on you when you have depression they wouldn't otherwise have.
>
>
> It will only compound your problem. Period. It's clinically established to aggravate existing cases of depression. It's even black boxed to prevent patients with mood disorders from getting it prescribed, because it's so likely to cause dysphoria in these patients.
>
>
> DO NOT DO IT. learn from my pathetic stupid waste of a college year.Nobody told me this; you can look them up and see that the molecular formula is slightly differently from GHB, I think one more carbon atom and one less oxygen, something like that. From having used GHB - back when it was legal of course - and now being a long time Xyrem user I can attest they are not identical. My Xyrem experience is: small dose brings a little energy, mid dose: somewhat inebriated but not euphoric, therapeutic dose: sleep. But to each his own. Not worth a debate breaking out.
Posted by mbluett on October 26, 2008, at 18:13:19
In reply to Re: Exotic Meds for Treatment Resistant Depression » azalea, posted by Ant-Rock on October 1, 2008, at 20:17:34
> > Xyrem (trade name for GHB) is currently marketed in the US by Jazz Pharmaceuticals.
> >
> Thank you for that info Azalea.
>
> I think you need a diagnosis of narcolepsy to get a script.
> It's a great band-aid anti-depressant, but not a long term solution. It got me through a whole summer of hell a few years back, with no withdrawal of any kind.
>
> Thank you again for responding.
>
> AnthonyI must agree that Xyrem (GHB) is the powerful 'exotic' medication I have ever used. I have been on various AD's and combo's. Small doses of GHB taken throughout the day create a feeling of calm alertness. It also elevated my mood to the point where it is a joy and privilege to feel alive.
It has been discovered that our brains have GHB receptors, as we produce it endogenously (inside our bodies). How it could be banned as a natural supplement, licensed and then sold as a pharmaceutical is criminal.
If used properly, I think this chemical has the potential to give hope to many that have never felt true relief and joy before.
It warrants more investigation......
Posted by shasling on October 26, 2008, at 18:58:52
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by utopizen on October 23, 2008, at 21:29:00
> > Xyrem isn't exactly the same thing anyway. They changed the molecular formula just a teensy bit, but it was enough to eliminate the euphoria. Just makes you sleepy.
> >
>
> ???
>
> Who told you this?Well aside from personal experiance as i mentioned,anyone who used GHB much much prior to xyrem,would remember that common recreational dosages ranged from 1g - 2g,....3 grams and a little above would be your average sleep dose.
5 grams for example would surly put most users to sleep.Now for xyrem a 9 gram is a commonly used dose,a 9 gram dose of the pre xyrem era would possably kill someone.
There tons of ways to make GHB,its A simple process,gbl a common element is used in most non xyrem versions due to the simplicity of the kitchen like chemistry.However it can surly be made without it by real chemistry and lab equipment.
Main thing is GHB at 3-5 grams was a serious thing,xyrem goes much higher then that.
Now i cant speak for everyone,and if someone finds it euphoric then they simply do,however even at the "talk about sleep sight" where xyrem is discussed constatly most people there hardly know its ghb and just speak about how well it works with little to no mention of any recreational feel.
FYI" Xyrem is also not the first med version of ghb,in italy it was called Alcover and it was a prescription drug used to treat drug abuse.
Posted by utopizen on October 26, 2008, at 20:00:11
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by greywolf on October 24, 2008, at 20:59:06
> I'm glad it worked well for you. But I'm not sure that it is fair to suggest that people who choose not to go the ECT route are being irrational or hysterical.
>
> Continued good health to you.
>
> Greywolf
>thanks...
i didn't quite mean to be so, well, hyperbolic (though I was)...
it's only natural for one side of an argument to desire to use some sense of inflatation... I'm just, frankly, bitter for not even the matter being raised as an option. And I'm a pretty informed consumer of my health, so, I used some pretty top docs and knew of it (though dismissed it as something reserved for "those people.")
Problem: I _was_ one of "those people," (whatever that means) it was reserved for the folks where the state is so pathetic, the risks are deserved.
Yes, there are risks. I'm not an M.D., so, your doc is more informed as to what those are.
Frankly, if I just accepted my depression was depression earlier in things, I probably would have mentioned it to my doc earlier, instead of being in denial until it was so pathetic I couldn't pretend to myself it was something else, like narcolepsy or something.
A lot of my depression may have even been fueled by my own vague fear of depression itself, which led me to have such great anxiety when it did strike. (How bad would I get? Was there any turning back?, etc.)
so, yeah. I see your point. I just think it has to be at least discussed, and glad to see your doc is mature and objective enough to at least weight the cards on the table. That's rare, and I wish I at least had such a health discussion with my doc.
For me, I feel, ECT was sort of the elephant in the waiting room I thought we weren't discussing, because it was being ordered for that _other_ patient. I think one of the heartening things, though, about my entrance to the hospital was (although it was just a night) I felt like I got to stop acting like I didn't have something. I think that occupied a lot of my mental energy-- worrying I'd be like _that_ patient if it didn't get better fast enough.
When one's expectations of where one's health are humbled, it can be rather therapeutic in and of itself. The idea, for instance, one is in such a low state, the risk of short-term memory loss for a bit, for instance, is brought into its proper perspective.
I might be naive to minimize the risks so much as I did, you're right... it's not what I meant to say.
anyhow, best of health to you too =)
wife of former Presidential candidate Michael Dukakis has a great memoir, in which she focuses on her personal experience of regular ECT. I encourage some folks to read it, although ultimately, understand like all medical treatments for depression, including pills/surgical devices, it has some serious risks.A well-regarded, often cited peer-reviewed cohort study reviewing the lifespans of patients who were mentally ill and received psychotropics concluded that on average, people who take psychotropics died 20 years before their normal counterparts who hadn't.
obviously, that raises lots of critical arguments, but no one can claim being on a drug for one's lifetime is going to make u live longer than folks who never require treatment.
so, there's risks across the board, and the whole notion ECT is some extreme treatment, but aren't as safe as medical implants that weren't available 8 years ago is silly. a lot of the vague nerve implants for depression have raised new side effects previously unknown, including uncontrollable tics just as Aricept is now reporting.
ECT, we've had it since the 40's. Yes, there's side effects. But at least we know what those are. (well, not me, really, but you know what I mean) ;)
Posted by utopizen on October 26, 2008, at 20:10:52
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by shasling on October 26, 2008, at 18:58:52
not sure of ur point... anyhow...
as for "Alcover," there's good reason why it was stopped. And it too was initially used by very ambitious, far too creative patients and their docs for off-label uses that didn't work out as planned.
ultimately, there's never going to be a cure for depression. as my p-doc once said, "there's no cures in this business."
there are treatments, and there are remission.
the docs who have chased the "cures" are notoriously ambitious ones, filled with humbling disappointments. Freud once referred to his experiment of treating cocaine as a means to cure his friend's heroin addict as the greatest mistake of his life. He said it simply turned him into an addict of two drugs instead of one.
Weight in the obvious fact there is an indisputable link between substance disorders and mood disorders, and you're making an already vulnerable population at risk for getting addicted to something that can not only worsen their depression with its risk for mood lability, and you'll wind up convincing someone on the board hear desperate for relief into a "treatment" that will worsen their mood, make their mood more erratic than it is already, bring about bouts of AM anxiety, etc., etc.--- and that's assuming they are strong enough not to get addicted to the stuff.
Posted by utopizen on October 26, 2008, at 20:24:45
In reply to Re: Exotic Meds for Treatment Resistant Depression » greywolf, posted by Bob on October 24, 2008, at 21:09:56
sometimes, it's important to remember, the benefits outweighs the risks when the risk is doing nothing.
It's helpful to keep in mind some of ECT's greatest opponents (not tying you in here personally) perhaps owe their great means to be such vocal opponents to it, and have the energy to do it, partly due to their very experience with ECT.
Moreover, those with mood disorders (again, you excluded personally) may be more likely to reflect on past events with relatively poor perspective than many others.
So it's tough to argue where perspective is in relation to one's past, when the fact remains that the argument is about a treatment that's very purpose is to grant perspective in cases where none presently stand.
So if you personally stand today, and regret ECT, perhaps you do so with balanced perspective. And you regret that you did not have such balanced perspective going into things, because you might not have taken ECT otherwise, had you had a more balanced perspective at the time.
So even if you presently do have a perspective balanced enough and healthy enough to weight in ECT objectively as anyone else, even as a former user of it, it remains impossible to argue the mere chance such a perspective is not in some fashion ultimately derived from the very thing that is being argued against ECT itself.
A perfect example is a chief beneficiary of ECT, Thomas Eagleton. Yes, his personal ambitions for entering the White House were stifled directly due to ECT use. Yet the guy's life was undoubtedly helped by it and his life wasn't over because of the VP controversy... he remained in the Senate until the 80's, before retiring on his own accord. Yet he donated to Scientology, convinced he was a victim of the thing that rescued him from the throws of despair. (I'm not him, but by his own accounts, he was in remission and led a productive life well beyond his three treatments).
Ultimately, nothing is a magic bullet, and time, and other factors, all play a role. These are just some candid reflections.
Posted by greywolf on October 26, 2008, at 20:45:08
In reply to re: ECT » Bob, posted by utopizen on October 26, 2008, at 20:24:45
> sometimes, it's important to remember, the benefits outweighs the risks when the risk is doing nothing.
>
> It's helpful to keep in mind some of ECT's greatest opponents (not tying you in here personally) perhaps owe their great means to be such vocal opponents to it, and have the energy to do it, partly due to their very experience with ECT.
>
> Moreover, those with mood disorders (again, you excluded personally) may be more likely to reflect on past events with relatively poor perspective than many others.
>
> So it's tough to argue where perspective is in relation to one's past, when the fact remains that the argument is about a treatment that's very purpose is to grant perspective in cases where none presently stand.
>
> So if you personally stand today, and regret ECT, perhaps you do so with balanced perspective. And you regret that you did not have such balanced perspective going into things, because you might not have taken ECT otherwise, had you had a more balanced perspective at the time.
>
> So even if you presently do have a perspective balanced enough and healthy enough to weight in ECT objectively as anyone else, even as a former user of it, it remains impossible to argue the mere chance such a perspective is not in some fashion ultimately derived from the very thing that is being argued against ECT itself.
>
> A perfect example is a chief beneficiary of ECT, Thomas Eagleton. Yes, his personal ambitions for entering the White House were stifled directly due to ECT use. Yet the guy's life was undoubtedly helped by it and his life wasn't over because of the VP controversy... he remained in the Senate until the 80's, before retiring on his own accord. Yet he donated to Scientology, convinced he was a victim of the thing that rescued him from the throws of despair. (I'm not him, but by his own accounts, he was in remission and led a productive life well beyond his three treatments).
>
> Ultimately, nothing is a magic bullet, and time, and other factors, all play a role. These are just some candid reflections.
I am personally not a proponent or opponent of ECT. It remains an option for me, but my psychiatrist, who is well-regarded in my area, has explained that his primary concern is the memory loss risk and, specifically, how that risk will affect my ability to continue to work at my particular job.Consequently, we chose to go the VNS route. And believe me, that isn't a piece of cake, but it makes more sense for me personally at this point in time.
Greywolf
Posted by shasling on October 26, 2008, at 23:30:38
In reply to 'there's no cures in this business' » shasling, posted by utopizen on October 26, 2008, at 20:10:52
Im sorry if my post came off as advocating the use of it.I wont get into it any longer as i already stole from the posters thread and again im sorry for that as well.
Posted by utopizen on October 27, 2008, at 1:59:07
In reply to re: ECT » utopizen, posted by greywolf on October 26, 2008, at 20:45:08
> Consequently, we chose to go the VNS route. And believe me, that isn't a piece of cake, but it makes more sense for me personally at this point in time.
>
> Greywolf
As someone who has used neither, nor has any clinical knowledge in anything, I trust your doctor's expertise in the subject far more than mine.I was largely focusing on abstract reflections of those who are more Scientology about matters of psychiatric stuff in general.
Honestly, I used a med combo that was off-beat, in combination with just a really good and supportive group of friends and Professors... and it worked.
The memory loss side effect is a valid concern. It is an actual side effect. The debate is largely as to whether it's debilitating.
For a police officer, who must recall important recent events that could determine the fate of an accused criminal, it's important.
Politicians have been more ideal candidates, because the risk of forgetting someone's name or policy memo's details have to be weighted against the risk of appearing as a loose cannon while in the public eye a big risk, given the nature of their job's stress and depression's tendency to reduce one's resiliency.
I'm not arguing that memory loss is a problem regardless of vocation... but as someone with rather gifted memory, I've noticed a lot of otherwise healthy, normally-function individuals have some of the most pathetic, distorted, grainy memories I've ever encountered.
If they recall fundamental, extremely recent events I witness alongside with them whatsoever. Which is quite often not something to assume.
So, a lot of it is something that a doctor a wise as yours likely requires to weight in to a person's unique circumstances. I'm just talking aloud here... I think it's a fascinating discussion, and admire your unique insights to things.
hope you do well with it
Posted by utopizen on October 27, 2008, at 2:00:31
In reply to Re: 'there's no cures in this business', posted by shasling on October 26, 2008, at 23:30:38
> Im sorry if my post came off as advocating the use of it.I wont get into it any longer as i already stole from the posters thread and again im sorry for that as well.
>
>
>
>oh I didn't mean that, not you... I might have gotten impression, I'm not sure. I tend to see things as rather abstract myself, so don't mean to personalize issues when I happen to use "add name of poster" box to subject.
take care
Posted by utopizen on October 27, 2008, at 2:13:03
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by Sigismund on October 24, 2008, at 23:08:25
> This is what my psych said about ECT to me, more or less.
>
> 'I was taught that the one treatment that was successful for depression was ECT, and when I was a registrar I ordered it for some patients, and when I taught, I taught the same thing. And it was only later that I realised that I had *never* seen the results I had been told of and told others about.'
>
Clinically speaking, this seems interesting, but, only more of a reason to consider visiting a hospital with a reputable, ethical policy that happens to have a unit specializing in ECT.McLean Hospital happens to have quite good success with it, and they have doctors who perform the stuff. As for the data, it's been out since the 1940's.
It's true docs these days are unlikely to do much more than refer a patient to a specialist... but the data that is published has to be peer-reviewed, and if he has some particular issue with the data, he ought to submit competing data and let that be known to his peers in a paper.
a lot of my concern, again, is not whether ECT is not advertised as super safe and all (all treatments incur a risk), but that it's not even brought up and approached in treatment-refractory cases to begin with. It may not be a perfect option, but it's still an option, and any discussion is healthy to have, as we are having hear.
I'm a student, so in my case, I'm not sure what exactly the risk of memory loss, if it did occur, would have. Most of my peers seem to not have memory to begin with...
I routinely find things I shared in witnessing rather vividly--
basic, fundamental things, like, my very attendance at a 3-hour meeting, where I introduce myself to everyone there and there's only 7 members present.
A week later, 2 of the 7 argue whether I appeared, in front of me, to the others who were at the meeting with me. People with poor memory don't even seem to quite question the validity of it, even. So, memory is a very, very relative standard. Especially recent memory recall.
I'm not a cop. Even if I had ECT, and had memory loss, no one's going to jail over my memory. I think we are more sensitive to such things, because we take ourselves so seriously. And that has to do with the fact we tend to be more serious types. Nothing wrong with that.
But, seriously, no one's life is on the line if I can't recall something recently, if I were to experience that side effect at all. I'm not that important at moment, or ever quite have been. I took myself too seriously.
Posted by elanor roosevelt on October 27, 2008, at 23:13:46
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by utopizen on October 27, 2008, at 2:13:03
can i do this and live to tell the tale?
Posted by Questionmark on October 28, 2008, at 17:36:19
In reply to combining parnate and adderall?, posted by elanor roosevelt on October 27, 2008, at 23:13:46
Possibly if you take an extremely low dose of adderall, but you very well might feel pretty lousy even if you don't die or need hospitalized. I've tried tiny bits of Adderall with Nardil-- as well as tiny amounts of Parnate with Nardil, incidentally-- and both made me feel an unpleasant anxious uncomfortable fatigue and overall general malaise each time. Ritalin with Nardil, however, has always been perfectly fine and seems to feel about the same as usual-- strangely enough. I imagine it must be a greater noradrenergic effect from Adderall and Parnate than from Ritalin.
So, anyway in conclusion, i would advise against trying Adderall with Parnate, but cautious use of low-dose Ritalin with it may be worth a try.> can i do this and live to tell the tale?
Posted by Ant-Rock on October 28, 2008, at 18:39:45
In reply to combining parnate and adderall?, posted by elanor roosevelt on October 27, 2008, at 23:13:46
> can i do this and live to tell the tale?
I added 1/2 adderall ext-release to my 60mg parnate just the other day.
The adderal didn't help depression wise, and the only noticeable effect was increased anxiety, uncomfortable feeling as if drinking too much coffee with parnate.
I am now on 70mg parnate.
Anthony
Posted by greywolf on October 28, 2008, at 18:44:52
In reply to Re: combining parnate and adderall?, posted by Questionmark on October 28, 2008, at 17:36:19
What's the point of risking something like this? The potential for self-injury does not appear to outweigh any potential benefit.
Please be careful experimenting with a drug like Parnate.
Greywolf
Posted by elanor roosevelt on October 28, 2008, at 20:06:13
In reply to Re: combining parnate and adderall?, posted by greywolf on October 28, 2008, at 18:44:52
which stimulants are often used in conjunction with parnate?
i'm not on parnate
and did not have s successful time when i was on it
later i was advised that a higher dose and a stimulant might have made it right
Posted by greywolf on October 29, 2008, at 3:26:10
In reply to Re: combining parnate and adderall?, posted by elanor roosevelt on October 28, 2008, at 20:06:13
> which stimulants are often used in conjunction with parnate?
>
> i'm not on parnate
> and did not have s successful time when i was on it
> later i was advised that a higher dose and a stimulant might have made it right
>
>
I don't know the answer to that question. My psychiatrist (along with many others) treating bipolar with a major depression component will not go the stimulant route. I'm just concerned about any experimentation with Parnate. It must interact adversely with at least a couple dozen drugs.Greywolf
Posted by azalea on October 30, 2008, at 9:29:16
In reply to Re: combining parnate and adderall?, posted by elanor roosevelt on October 28, 2008, at 20:06:13
What dose of Parnate were you taking?
> which stimulants are often used in conjunction with parnate?
>
> i'm not on parnate
> and did not have s successful time when i was on it
> later i was advised that a higher dose and a stimulant might have made it right
>
>
Posted by dapper on October 31, 2008, at 1:28:56
In reply to 'there's no cures in this business' » shasling, posted by utopizen on October 26, 2008, at 20:10:52
I can only imagine in the scientific field over the past couple centuries that numerous problems that have since been overcome were once thought to be impossible to fix. To say their will never be a cure is a little hard for me to accept. We know a lot about the brain and are learning at a fast pace, but the truth is the field is in its infancy. It may not be for decades or a century to come, but depression, and other afflictions which cause one mental discomfort, will one day be a thing of the past. With genetic mapping, I believe certain genes will show themselves to be markers for depression and the like. One day manipulation of said problem genes will be nothing more than visiting the doctors office.
Posted by JadeKelly on November 1, 2008, at 20:35:25
In reply to Re: 'there's no cures in this business', posted by dapper on October 31, 2008, at 1:28:56
Well then, its time we all start taking a drop or two of seleligine so we can be around for that day...
Posted by JadeKelly on November 1, 2008, at 20:43:06
In reply to combining parnate and adderall?, posted by elanor roosevelt on October 27, 2008, at 23:13:46
> can i do this and live to tell the tale?
NO!!!!!!Please Don't do that.
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Dr. Bob is Robert Hsiung, MD,
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