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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by dj on November 14, 2000, at 16:11:21
Just glanced at this, came across it when scanning a few sites. I'd be interested in hearing from SLS or some who might be inclined to give it a bit more of a look than I have time to and comment accordingly.
A couple of brief excertpts from there:
"graduated from Indiana University (1982 - Phi Beta Kappa) and Indiana University School of Medicine (1986) and completed my psychiatry training in 1990 at Wright State University/ Wright Patterson Air Force Base on an Air Force scholarship. I am board certified in psychiatry. I have had additional training in psychoanalysis. I currently live and practice in Juneau, Alaska.
Me, reluctantly doing a press interview
I write the "Current Trends" feature of Journal of Ethical Human Sciences and Services. I am on the board of the National Association of Rights Protection and Advocacy and the International Center for the Study of Psychiatry and Psychology.
I used to believe and practice biological psychiatry, so I have an idea how seductive it is to believe in the magic of pills -- especially when you have serious doubts that you have anything else worthwhile to offer. But now I hold onto the belief that life is more meaningful than chemicals, and that there is no drug that can match the power of human connection.
My views of psychiatry are influenced by psychoanalysis which guides me to see even the most perplexing symptoms as meaningful, and by my Christian faith which guides me to view humans as much more than biology."
and
"Brain serotonin2 receptors in major depression: A positron emission tomography study. Yatham L, Liddle P, Shiah I, Scarrow G, Lam R, Adam M, Zis A, Ruth T, Arch Gen Psychiatry, 2000: 47:850-858.
Because "the precise nature of alterations in the 5-HT system that underlie depressive symptoms still remains elusive," the authors used PET scans to measure serotonin receptor binding. They found that depressed subjects had significantly decreased 5-HT2 receptor binding potential in several areas of the brain. This finding was "counterintuitive" to the authors. "One would expect to find an increase in brain 5-HT receptors associated with major depression." Why? Because "effective antidepressant treatments reduce brain 5-HT2 receptors." The authors therefore propose a new hypothesis: The brain, on its own, down-regulates serotonin receptors as a way of compensating for depression. Antidepressants "accelerate" this down regulation.
A simpler explanation, by far, would be that the abnormalities were caused by antidepressants -- not depression. All but one (of 20) subjects had recently been on antidepressants, with only a two-week washout period required (5 weeks for Prozac). Interestingly, subjects with a history of substance or alcohol abuse within the past six months were excluded. The authors give no explanation of why they would expect "substances" to affect the brain for six months, but antidepressants for only two weeks. They cite another study similar to this one, except that it required subjects to be off of antidepressants for six months. That study found no difference between depressed and non-depressed subjects."
Posted by dj on November 14, 2000, at 16:18:14
In reply to Interesting site: Skeptical Psychiatrist..SLS, etc, posted by dj on November 14, 2000, at 16:11:21
http://home.gci.net/~dougs/antidepr.htm
"Role of Norepinephrine in Depression, by Delgado P, and Moreno F. J ClinPsychiatry 2000; 61[suppl 1]: 5-12
If patients on SSRI's are deprived of serotonin, they tend to become depressed again, whereas those on desipramine become depressed when deprived of norepinephrine. This suggests that SSRI's have their mechanism of action through the serotonin system, and desipramine through norepinephrine. However, "the neurobiologic basis of depression remains unknown." The same studies that gave the above results also found, contrary to the authors' hypothesis, that unmedicated depressed patients as well as healthy volunteers were unaffected by being deprived of either serotonin or norepinephrine. This suggests that antidepressants "work" not by correcting chemical abnormalities, but by creating them (the sensitivity to such deprivation is abnormal). Antidepressants mask depression. When the mask is lifted, the depression is still there.> > > > > > >
Brain serotonin1A receptor binding measured by positron emission tomography with [11C]WAY-100635: Effects of depression and antidepressant treatment, by Sargent P, Kjaer K, Bench C, Rabiner E, Messa C, Meyer J, Gunn R, Grasby P & Cohen P. Arch Gen Psychiatry. 2000;57:174-180
Many believe depression to be caused by decreased serotonin neurotransmission, however, "the precise nature of this putative deficit has remained elusive." This study briefly reviewed existing data and formed the hypothesis that "5-HT1A receptor binding would be decreased in depressed subjects... both at presynaptic... and postsynaptic sites..., and that long-term SSRI treatment would further reduce 5-HT1A receptor binding in the raphe nuclei." This seems to be saying that antidepressants worsen the abnormality in the raphe nuclei, but in so doing, make things better elsewhere..."
Posted by JohnL on November 15, 2000, at 5:02:17
In reply to Interesting site: Skeptical Psychiatrist..SLS, etc, posted by dj on November 14, 2000, at 16:11:21
This pdoc's insights are interesting. I personally do not appreciate doctors however who take one-sided views of things. I think that's more appropriate in politics but not medicine. Sometimes doctors, like this one, get the two confused. Just my opinion.
It seems to me that the doctor's job is to get the patient well. The purpose of a phsycian's job is to use whatever tools he/she has available to end the patient's suffering. Pure and simple. Right?
If a doctor can do that with pschoanalysis, fine. If a doctor can do it with pills, fine. If one is not working, revert to the other. And vica versa. If conventional psychopharmacology is not working, revert to the Jensen method. If the Jenson method is not working, then revert to conventional techniques. Whatever works. If one tool isn't working, use one of the other tools instead. For any doctor to rule out the use of an available tool is negligent, egotistical, and political in my mind. If they rule out any tools, they have forgotten the entire purpose of their chosen profession. That's just how I see it.
My favorite pdoc, now retired, had this open-minded approach I really really appreciated. He really didn't care what drug or what counseling technique would work, just as long as we eventually found something that worked. Why or how it worked was unimportant to him. On every visit, he always told me the same thing, "This is as good as anything else. Anything's possible." How true that is, at least in my opinion anyway. And his. He by the way had much higher credentials and decades of experience over the skeptical psychiatrist mentioned for this discussion. He was well versed in all psychoanalysis as well as psychopharmacology. He was in practice even before antidepressants were discovered. He had no preference. Whatever worked. Each patient was different. Anything was possible. He clearly understood the role of his profession...get the patient well utilizing all the tools at his disposal.
The skeptical pdoc's theory of downregulating serotonin receptors makes sense. But I remind myself, it's just a theory. It is no better and no worse than any other theory. It's just a theory. The idea that the brain can readjust itself makes sense. My Grandmother suffered a 7 year long depressive bout (7 years, think about it) that suddenly remitted on its own. Poof. All gone. No reason. Just happened. But to think that everyone's brain is capable of readjusting itself in every case I think is far fetched. Clearly it seems to me that many people's brains are not capable of self adjusting in a degree substantial enough to make a difference. Some yes, some no. Regardless of how psychotherapy of psychopharmacolgy work, they can both dramatically speed up the process. Why take endure 7 years of pain when it's possible to feel better in 2 or 4 weeks instead?
There are no clear answers, no fool-proof theories, and no sure-fire remedies for everyone. Everyone's different. Anything's possible. I've seen it and I believe it. The doctor should use all available options. If he/she takes sides and preferences, he/she should probably go into politics instead.
John
Posted by Peter S on November 15, 2000, at 13:03:49
In reply to Re: Interesting site: Skeptical Psychiatrist..SLS, etc, posted by JohnL on November 15, 2000, at 5:02:17
John,
I agree! Wouldn't it be nice if the world was black and white: drugs bad, therapy good; drugs good, therapy bad. Anyone who has strong opinions like that (eg Peter Breggin)tend to be more intersted in politicizing or self aggrandizing than actually finding out what might work for individual patients. If it works then do it!
Peter
> This pdoc's insights are interesting. I personally do not appreciate doctors however who take one-sided views of things. I think that's more appropriate in politics but not medicine. Sometimes doctors, like this one, get the two confused. Just my opinion.
>
> It seems to me that the doctor's job is to get the patient well. The purpose of a phsycian's job is to use whatever tools he/she has available to end the patient's suffering. Pure and simple. Right?
>
> If a doctor can do that with pschoanalysis, fine. If a doctor can do it with pills, fine. If one is not working, revert to the other. And vica versa. If conventional psychopharmacology is not working, revert to the Jensen method. If the Jenson method is not working, then revert to conventional techniques. Whatever works. If one tool isn't working, use one of the other tools instead. For any doctor to rule out the use of an available tool is negligent, egotistical, and political in my mind. If they rule out any tools, they have forgotten the entire purpose of their chosen profession. That's just how I see it.
>
> My favorite pdoc, now retired, had this open-minded approach I really really appreciated. He really didn't care what drug or what counseling technique would work, just as long as we eventually found something that worked. Why or how it worked was unimportant to him. On every visit, he always told me the same thing, "This is as good as anything else. Anything's possible." How true that is, at least in my opinion anyway. And his. He by the way had much higher credentials and decades of experience over the skeptical psychiatrist mentioned for this discussion. He was well versed in all psychoanalysis as well as psychopharmacology. He was in practice even before antidepressants were discovered. He had no preference. Whatever worked. Each patient was different. Anything was possible. He clearly understood the role of his profession...get the patient well utilizing all the tools at his disposal.
>
> The skeptical pdoc's theory of downregulating serotonin receptors makes sense. But I remind myself, it's just a theory. It is no better and no worse than any other theory. It's just a theory. The idea that the brain can readjust itself makes sense. My Grandmother suffered a 7 year long depressive bout (7 years, think about it) that suddenly remitted on its own. Poof. All gone. No reason. Just happened. But to think that everyone's brain is capable of readjusting itself in every case I think is far fetched. Clearly it seems to me that many people's brains are not capable of self adjusting in a degree substantial enough to make a difference. Some yes, some no. Regardless of how psychotherapy of psychopharmacolgy work, they can both dramatically speed up the process. Why take endure 7 years of pain when it's possible to feel better in 2 or 4 weeks instead?
>
> There are no clear answers, no fool-proof theories, and no sure-fire remedies for everyone. Everyone's different. Anything's possible. I've seen it and I believe it. The doctor should use all available options. If he/she takes sides and preferences, he/she should probably go into politics instead.
> John
Posted by JahL on November 15, 2000, at 17:14:21
In reply to Re: Interesting site: Skeptical Psychiatrist..SLS, etc, posted by JohnL on November 15, 2000, at 5:02:17
For any doctor to rule out the use of an available tool is negligent, egotistical, and political in my mind. If they rule out any tools, they have forgotten the entire purpose of their chosen profession. That's just how I see it.
>
Hear, hear.
Please try telling this to English pdocs. Today I had an appointment @ Maudesley, the UK's top affective disorders clinic. I was told that in order to cure my 17yr unremitting depression I should "stop smoking pot & start planning yr life" (great advice for someone currently planning their own death). I was offered only more A/Ds (I've tried 15) or ECT. Naturally I told the pr*ck where he could stick his advice & walked out.Anyway I've had enough of English pdocs & their quaint theories of reactive depression. Tomorrow, at great expense no doubt, I'm booking a REAL pdoc in the US of A!
Getting back to the original question, hopefully my new pdoc will prescribe lots of lovely, hardcore meds, MEDS THAT I NEED FOR AN ORGANIC (.'. treated with physical means) CONDITION.
That's all,
Jah.
Posted by SLS on November 16, 2000, at 20:28:15
In reply to Re: Interesting site: Skeptical Psychiatrist..SLS, etc, posted by JohnL on November 15, 2000, at 5:02:17
Hi John.
How are you?
I would prefer that you address first this question in any reply you may post.
:-)
> This pdoc's insights are interesting. I personally do not appreciate doctors however who take one-sided views of things. I think that's more appropriate in politics but not medicine. Sometimes doctors, like this one, get the two confused. Just my opinion.
Mine too.
In clinical medicine, I am not a big fan of "schools-of-thought" or "philosophies". These are the politics of intellect. They produce a reduction in the eclectic approach that I deem as currently necessary to heal people.
> It seems to me that the doctor's job is to get the patient well. The purpose of a phsycian's job is to use whatever tools he/she has available to end the patient's suffering. Pure and simple. Right?
RIGHT!!!
> If a doctor can do that with pschoanalysis, fine. If a doctor can do it with pills, fine. If one is not working, revert to the other. And vica versa. If conventional psychopharmacology is not working, revert to the Jensen method. If the Jenson method is not working, then revert to conventional techniques. Whatever works. If one tool isn't working, use one of the other tools instead. For any doctor to rule out the use of an available tool is negligent, egotistical, and political in my mind. If they rule out any tools, they have forgotten the entire purpose of their chosen profession. That's just how I see it.
Me too.
> My favorite pdoc, now retired, had this open-minded approach I really really appreciated. He really didn't care what drug or what counseling technique would work, just as long as we eventually found something that worked. Why or how it worked was unimportant to him.
I agree with this when it comes to general clinical practice. CLINICAL medicine is an art, not a science.
> On every visit, he always told me the same thing, "This is as good as anything else.
In my opinion, the current state of clinical psychopharmacology allows for educated guesses as to which treatments have a more favorable potential for efficacy in a particular case and which have less. Even without any source of state-of-the-art information, a good clinician has a basis for choosing one treatment over another based upon his clinical experience.
> "Anything's possible." How true that is, at least in my opinion anyway.
In my way of thinking, not all things are possible.
> He clearly understood the role of his profession...get the patient well utilizing all the tools at his disposal.
Given my experiences in life, this is crystal clear to me as well.
Hopefully, he will do no harm (from the Hypocritical Oath). Medicine, like many other human endeavors, is best practiced with caution.
> The skeptical pdoc's theory of downregulating serotonin receptors makes sense.
It makes sense to me too.
> But I remind myself, it's just a theory. It is no better and no worse than any other theory.
I strongly disagree. All theories are not created equal.
My theory as to why I am able to read this is that there is an expulsion of graviton-compressed spider eggs, the mean diameter of of which is no larger than that of the strange-quark, from the phosphor elements of my video screen; small enough to penetrate my cornea, yet energetic enough to stimulate my rods, and to a lesser degree, my cones (this accounts for why the text appears to me as black and white), the source of which is a wolf spider nest formerly located on an Earth in an alternate universe that was sucked up by a worm-hole and transported into the video-card of my computer.
> It's just a theory.
Yes it is. Prove me wrong.
> The idea that the brain can readjust itself makes sense.
That it does so is a fact.
> My Grandmother suffered a 7 year long depressive bout (7 years, think about it) that suddenly remitted on its own. Poof. All gone. No reason. Just happened.
This is why current psychiatric medicine refers to a bout of depression as an "episode". Very often, an episode resolves without intervention. If episodes recur, the medical term for this scenario is "recurrent depression". This is not at all unusual.
> But to think that everyone's brain is capable of readjusting itself in every case I think is far fetched.
If you mean that not everyone's brain is capable of readjusting itself without intervention is obvious. If you mean that not everyone's brain is capable of a plastic adjustment (good or bad) resulting from its exposure to a specific psychotropic, I have yet to read of a single instance of this.
> Clearly it seems to me that many people's brains are not capable of self adjusting in a degree substantial enough to make a difference. Some yes, some no. Regardless of how psychotherapy of psychopharmacolgy work, they can both dramatically speed up the process. Why take endure 7 years of pain when it's possible to feel better in 2 or 4 weeks instead?
Yes. (sigh)
> There are no clear answers, no fool-proof theories, and no sure-fire remedies for everyone.
Yes. (sigh)
Thanks for your wonderful post.
Sincerely,
Scott
Posted by S Howard on November 18, 2000, at 23:58:17
In reply to Interesting site: Skeptical Psychiatrist..SLS, etc, posted by dj on November 14, 2000, at 16:11:21
This line of reasoning makes me uncomfortable. It reminds me of some religious sects that believe prayer will cure all ills, and they gather around a child with, say, appendicitus, watching him writhe in pain, and they pray away until the appendix ruptures and the child dies. To me, this is outright torture and murder.
-Gracie on Stone Hill
Posted by pullmarine on November 20, 2000, at 2:07:46
In reply to Re: Interesting site: Skeptical Psychiatrist..SLS, etc, posted by S Howard on November 18, 2000, at 23:58:17
>
> This line of reasoning makes me uncomfortable. It reminds me of some religious sects that believe prayer will cure all ills, and they gather around a child with, say, appendicitus, watching him writhe in pain, and they pray away until the appendix ruptures and the child dies. To me, this is outright torture and murder.
> -Gracie on Stone Hill
This is the end of the thread.
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