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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 41. Go back in thread:
Posted by laima on January 13, 2007, at 16:04:31
In reply to Re: Do people feel medications help or mask sympto, posted by notfred on January 13, 2007, at 15:43:29
I think the drawbacks of masking would be evident if and when the meds konk out. They do konk out for a lot of people, so real cures would be worth pursuing.> Whichever it is I could care less as I have been in remission for over 20 years with just a few breakthru depressive episodes. This statement would suggest they treat but I do not spend time wringing my hands over is issue. It works, move on.
Posted by SLS on January 14, 2007, at 7:05:23
In reply to Re: Do people feel medications help or mask sympto, posted by laima on January 13, 2007, at 16:04:31
> I think the drawbacks of masking would be evident if and when the meds konk out. They do konk out for a lot of people, so real cures would be worth pursuing.
But I don't think that the fact that meds konk out is de facto proof that they only mask symptoms. Such can also occur if symptom relief is the result of remission of the illness itself. Note that remission does not equate to cure. As with so many other illnesses, antidepressant treatment can produce a complete remission rather than a partial mitigation of selected symptoms. And as is also true with other illnesses, treatments sometimes fail to remain effective indefinitely, in which case there is a relapse into illness. This failure to produce an indefinite remission does not make the remission any less complete. It does not all of a sudden warrant us to redefine the remission as symptom-masking.
Yes, a cure is worth pursuing, but so is remission. Too many people experience incomplete responses to treatment with residual symptoms. This is not good enough. I encourage people to continue to explore treatment refinements until they find something that hits closer to the target and brings about remission. It is my impression from the results of the STAR*D study that at least 66% of people can attain remission after only 4 drug trials. Think of the possible combinations of drugs we have to work with and the number of trials that represents. I think the odds are in one's favor that they will eventually find something that works well if they are persevering.
- Scott
Posted by naughtypuppy on January 14, 2007, at 9:48:34
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
I call it the antidepressant vs anathesia effect. Tegrol made me so apathetic that I didn't know that I was depressed. I just couldn't get off the couch and attend to daily affairs.
Posted by Phillipa on January 14, 2007, at 18:22:02
In reply to Re: Do people feel medications help or mask sympto, posted by SLS on January 14, 2007, at 7:05:23
Scott and who better to say that than you. Love Jan
Posted by laima on January 15, 2007, at 17:43:19
In reply to Re: Do people feel medications help or mask sympto, posted by SLS on January 14, 2007, at 7:05:23
Yes, good point, a remission is nothing to turn one's nose up at.
The more I think about it, the more it seems to me that the answer to the remission/cover up symptoms question is probably varied and fuzzy. There's probably some of both, and of course, everyone's circumstances are a little different. After experiencing dramatic poop-outs for both prozac (extended to inefficacy of other SSRIs) and benzos, I'm not going to hold my breath- but will take what good opportunities I get. I have a doctor who won't make any promises about how long the therapeutic effects of drugs will last, and I'm finally heeding his urgings to work at therapy and making improvements in my lifestyle. Just no guarentees in life.
Posted by notfred on January 16, 2007, at 17:55:46
In reply to Re: Do people feel medications help or mask sympto » SLS, posted by laima on January 15, 2007, at 17:43:19
"The more I think about it, the more it seems to me that the answer to the remission/cover up symptoms question is probably varied and fuzzy."
Remission is a very specific word. Google it.
It is not related to "cover up".
Posted by laima on January 16, 2007, at 19:14:06
In reply to Re: Do people feel medications help or mask sympto, posted by notfred on January 16, 2007, at 17:55:46
Yes, I know very well it's a different word and don't need to google it. Perhaps it was my fuzzy punctuation that was confusing. We were debating whether medications covered up symptoms OR helped induce remission, and I concluded that they can do both, either, or neither. In other words, perhaps pointless to debate since there isn't an absolute answer that fits everyone. Well, I've got my copy of Eats, Shoots and Leaves sitting here next to me, maybe I'll look into it.
> "The more I think about it, the more it seems to me that the answer to the remission/cover up symptoms question is probably varied and fuzzy."
>
>
> Remission is a very specific word. Google it.
> It is not related to "cover up".
>
Posted by shadowplayers721 on January 16, 2007, at 19:54:10
In reply to Do people feel medications help or mask symptoms?, posted by leo33 on January 12, 2007, at 20:06:57
IMO, people with drug addiction take a drug to the totally numb out and it's a cycle. It's complicated. It's a roller coaster controlled by the user. Drug addiction is not a form of functioning.
Antidepressants don't give a high to me. They try to level me to function. In other words, I am not bottoming out in depression. I don't feel it's masking my depression. I feel it's actually treating it. I don't know if I explained this well. better go back to the shadows>>>>>>
Posted by Quintal on January 16, 2007, at 20:01:20
In reply to Re: Do people feel medications help or mask sympto » notfred, posted by laima on January 16, 2007, at 19:14:06
"Eats, Shoots and Leaves" Great book.
Q
Posted by Quintal on January 16, 2007, at 20:04:41
In reply to Re: Do people feel medications help or mask sympto, posted by shadowplayers721 on January 16, 2007, at 19:54:10
>IMO, people with drug addiction take a drug to the totally numb out and it's a cycle.
I take codeine to help me function better. It generally takes my pain away and leaves me sanguine. Is codeine really treating my depression or simply masking it? What's the difference?
Q
Posted by SLS on January 16, 2007, at 20:22:07
In reply to Re: Do people feel medications help or mask sympto » shadowplayers721, posted by Quintal on January 16, 2007, at 20:04:41
> >IMO, people with drug addiction take a drug to the totally numb out and it's a cycle.
>
> I take codeine to help me function better. It generally takes my pain away and leaves me sanguine. Is codeine really treating my depression or simply masking it? What's the difference?What is the constellation of symptoms associated with your disorder?
- Scott
Posted by shadowplayers721 on January 17, 2007, at 0:27:28
In reply to Re: Do people feel medications help or mask sympto » shadowplayers721, posted by Quintal on January 16, 2007, at 20:04:41
Well, I feel you have much wisdom deep inside to give an answer to the proposed question. If I were your true inner self without any inner critic to comment at the side, what would be my answer to you from this question?
"Is codeine really treating my depression or simply masking it?"
Posted by laima on January 17, 2007, at 0:50:53
In reply to Re: Do people feel medications help or mask sympto » laima, posted by Quintal on January 16, 2007, at 20:01:20
It's nice, isn't it? :)How'd you get it to turn into a link like that?
I think I was supposed to do that, too. I forgot.> "Eats, Shoots and Leaves" Great book.
>
> Q
Posted by notfred on January 17, 2007, at 9:29:54
In reply to Re: Do people feel medications help or mask sympto » notfred, posted by laima on January 16, 2007, at 19:14:06
I am not sure what the qualifications for remission in depression are, in many illnesses it is quite specific. There is a DSM code for major depression in remission, which is one of my Dx'es at present.
I suspect as with other illness time without any illness is a factor.
Posted by Quintal on January 17, 2007, at 10:34:16
In reply to Re: Do people feel medications help or mask sympto » Quintal, posted by SLS on January 16, 2007, at 20:22:07
I have no specific diagnosed disorder at present, though I was diagnosed with bipolar II years ago and BPD has been suggested. Asperger's Syndrome sounds more likely to be the underlying problem with the anxiety and depression that results from poor communication (in real life) and the isolation it causes.
Q
Posted by Quintal on January 17, 2007, at 10:51:44
In reply to Re: Do people feel medications help or mask sympto » Quintal, posted by laima on January 17, 2007, at 0:50:53
You need to put the book title in double, double quotes and the server will search Amazon and give you a choice of matching titles when you submit your post.
http://www.dr-bob.org/babble/faq.html#amazon
Q
Posted by Quintal on January 17, 2007, at 11:06:24
In reply to Re: Do people feel medications help or mask sympto, posted by shadowplayers721 on January 17, 2007, at 0:27:28
>Well, I feel you have much wisdom deep inside to give an answer to the proposed question. If I were your true inner self without any inner critic to comment at the side, what would be my answer to you from this question?
>
>"Is codeine really treating my depression or simply masking it?"
My point was:>What's the difference?
SSRIs didn't help much but they did lave me numb and apathetic after a short while. They are the drugs that supposedly 'treat' the allegedly medical biochemical problem of anxiety and depression. Codeine revives my spirits and helps me cope with life better, yet opiates are considered to be drugs of abuse with little or no therapeutic potential in psychiatry by some people here. To me the difference seems arbitrary and usually reflects the politics of the individual poster.
Q
Posted by laima on January 17, 2007, at 12:03:38
In reply to Re: Do people feel medications help or mask sympto » laima, posted by Quintal on January 17, 2007, at 10:51:44
Posted by bulldog2 on January 17, 2007, at 13:10:54
In reply to Re: Do people feel medications help or mask sympto » shadowplayers721, posted by Quintal on January 17, 2007, at 11:06:24
I believe in cases where there is a remission the traditional ads do actually work. If they were just masking symptoms they would work from day one. Also from the day you stop them you would relapse into depression when in fact people often go months or years before they have another depression.It would seem their use somehow changes the brain's chemistry and there's many theories as to how they work.
As to the use of opiates or stimulants as ads that's a grey area to me. They often work right away but only work as long as you take them and often need increasing doses to maintain their effect. So maybe I would say they mask symptoms the way an opiate masks pain when in fact whatever is causing the pain (arthritis for instance) is still present.
Posted by Quintal on January 17, 2007, at 14:44:58
In reply to Re: Do people feel medications help or mask sympto, posted by bulldog2 on January 17, 2007, at 13:10:54
>As to the use of opiates or stimulants as ads that's a grey area to me. They often work right away but only work as long as you take them and often need increasing doses to maintain their effect. So maybe I would say they mask symptoms the way an opiate masks pain when in fact whatever is causing the pain (arthritis for instance) is still present.
Well for many people depression does recur when they stop taking their AD and there's often a withdrawal syndrome (which can be severe) to boot if they do so abruptly. It's also a common experience for ADs to 'poop out' and require higher doses to maintain the antidepressant effect or a switch to another drug - could this be a different manifestation of tolerance to the effects of changes in brain chemistry?
When I was taking antidepressants and benzos my life seemed wonderful while they worked. It was only when I was forced to stop them I found it was an illusion. My life had been deteriorating but I couldn't see it and didn't much care either because I was feeling so good.
The pattern of drug use was different but I in many ways I behaved in a similar way as I did when taking drugs of abuse except antidepressants and benzos are legal, obtained from a doctor's prescription and therefore tolerated, but for many years opiates and cocaine were used in a similar fashion and were recommended (and used) by doctors. Are drugs of abuse simply more rapidly acting and effective antidepressants with less abuse potential?
Q
Posted by bulldog2 on January 17, 2007, at 15:34:32
In reply to Re: Do people feel medications help or mask sympto » bulldog2, posted by Quintal on January 17, 2007, at 14:44:58
The pattern of drug use was different but I in many ways I behaved in a similar way as I did when taking drugs of abuse except antidepressants and benzos are legal, obtained from a doctor's prescription and therefore tolerated, but for many years opiates and cocaine were used in a similar fashion and were recommended (and used) by doctors. Are drugs of abuse simply more rapidly acting and effective antidepressants with less abuse potential?
Q
Good point. Drugs of abuse are so rapidly acting that people are more likely to chase the euphoria they may induce. Interesting that you bring up this point. I was talking to someone who was on parnate years ago and he said he felt he was always high on the drug and finally discontinued it for that reason. But even if ads only address the symptoms sometimes one may need them to get over a tough patch in their lives.It's kind of ironice how docs seem to view certain drugs as having a moral stigma attached to them as opposed to certain psychotropic that they hand out like candy.
Posted by Quintal on January 17, 2007, at 15:50:58
In reply to Re: Do people feel medications help or mask sympto, posted by bulldog2 on January 17, 2007, at 15:34:32
> Are drugs of abuse simply more rapidly acting and effective antidepressants with less abuse potential
I think I meant:
Are drugs of abuse simply more rapidly acting and effective antidepressants with *greater* abuse potential?
> I was talking to someone who was on parnate years ago and he said he felt he was always high on the drug and finally discontinued it for that reason. But even if ads only address the symptoms sometimes one may need them to get over a tough patch in their lives.It's kind of ironice how docs seem to view certain drugs as having a moral stigma attached to them as opposed to certain psychotropic that they hand out like candy.Yes, I abused Parnate myself - only found out it could be abused after I experimented with it myself but my pdoc said in a letter to my GP that he thinks I requested Parnate for that purpose. My GP still prescribes it for me anyway but I no longer use it but that's only because they won't give me a benzo to calm the jitters.
Q
Posted by notfred on January 17, 2007, at 17:18:22
In reply to Re: Do people feel medications help or mask sympto, posted by notfred on January 17, 2007, at 9:29:54
> I am not sure what the qualifications for remission in depression are, in many illnesses it is quite specific. There is a DSM code for major depression in remission, which is one of my Dx'es at present.
> I suspect as with other illness time without any illness is a factor.2 months with no symptoms qualifies full remission,
partial remission is where there are no symptoms but it has not been 2 months. Per the DSM.
Posted by notfred on January 17, 2007, at 17:22:05
In reply to Re: Do people feel medications help or mask sympto, posted by bulldog2 on January 17, 2007, at 13:10:54
"opiate masks pain when in fact whatever is causing the pain (arthritis for instance) is still present."
Yep, but if the pain med is a NSAID, or includes a
NSAID this would also treat the underlying illness.
Posted by shadowplayers721 on January 19, 2007, at 3:17:29
In reply to Re: Do people feel medications help or mask sympto » shadowplayers721, posted by Quintal on January 17, 2007, at 11:06:24
To me, the actual defining of the type and level of depression is key. However, I believe we are still in the dawn of understanding depression. I have read a long time back a few other posters stating that opiates helped their depression too. I have no doubt that it did and does. Opiates and SSRI's work on the central nervous system.
One problem with the opiates is the risk of psychological and physical addiction component. Wherein, the user will steadily try to achieve the same sense of euphoria once experienced with a small amount of the opiate. Opiate dosing to treat the depression without falling into that cycle for millions of people would be very difficult. In addition, there would be the risk of respiratory depression and over dosage issue.
Opiates do have a strong stigma attached to addiction as far back as the opium dens in China.
SSRI's do not give this same sense of euphoria or we would have SSRI's dens. As you stated, they can make you feel numb. Others, describe this as the poop out. The SSRI's are given to reduce the level of intensity of depression and anxiety. Of course, the reduction is very individual. Reducing the severity of depression does not appear to be masking to me.
Perhaps, creating a new variety of poppies without addiction potential and risk of respiratory depression would be something of the future for depression tx.
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Dr. Bob is Robert Hsiung, MD,
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