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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Phillipa on November 9, 2011, at 20:47:50
Seems treatment resistance could be related to a patients reluctance to get better. Treat Psychology Issues That Underlie the Medication not working. Is secondary gain involved? Phillipa
http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1946385?pageNumber=1
Posted by Emme-V2 on November 9, 2011, at 21:14:49
In reply to TX Resistance Mind or Body Or Both?, posted by Phillipa on November 9, 2011, at 20:47:50
Hmmm.....let's see...the article talks about readiness to change huh?
Let's tally up the symptoms of severe depression:
Unendurable psychic agony
Terrible sleep disturbances of all sorts
Bone weary fatigue broken up by restless anxiety
Cognitive difficulties
Intrusive thoughts of suicide
Loss of one's past because you can't remember ever feeling pleasure
Loss of one's future because you can't imagine not being in painOh yeah, I was more than ready to jettison all that, and I suspect all seriously depressed people are. Desperate to feel better. And was I ever delighted when I hit remission, but the meds would poop out. It took a lot of med trials to find something that has helped for the long haul. Relief from depression meant my life could then change for the better.
I just don't buy the "blame the victim" mentality in that article. I'll stop there.
Posted by SLS on November 10, 2011, at 8:02:48
In reply to TX Resistance Mind or Body Or Both?, posted by Phillipa on November 9, 2011, at 20:47:50
> Seems treatment resistance could be related to a patients reluctance to get better. Treat Psychology Issues That Underlie the Medication not working. Is secondary gain involved? Phillipa
>
>
> http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1946385?pageNumber=1
I am sure that some people do have counterproductive psychodynamic relationships with their drug therapies. The questions are, though, how many treatment resistant people fall into this category and how are they identified. Just because a theory makes sense, this does not ensure its validity. The next steps for these doctors would be to produce statistics of associations, establish cause and effect, and suggest psychobiological mechanisms. I would be scared to death if this psychodynamic model for treatment resistance became the prevailing explanation such that treatment decisions would be based upon it.When I was being treated by the research team at Columbia-Presbyterian in 1983, they concluded that my treatment resistance was possibly due to psychological factors. They required me to go for psychotherapy for six months before continuing to treat me biologically. I told them that I would go to any psychologist they chose for an evaluation, but I would not commit to psychotherapy without first demonstrating a need for it through the establishment of a relevant diagnosis. Afterall, I had already underwent several years of failed psychotherapy using different therapists.
The article cites "nocebo" as an example of treatment resistance. However, it explains that this applies to side-effects and makes no attempt to relate this to a lack of treatment response. Obviously, if a patient is not adherent to treatment due to nocebo expectations, this will affect treatment outcome. Is this what is meant by "treatment-resistance"? This certainly qualifies as being resistant to treatment. However, I don't believe that all cases of treatment-resistance are the products of resistance-to-treatment.
How many people posting on Psycho-Babble are reluctant to get better, despite searching unceasingly for treatments that will end their suffering? I don't know about everyone else, but I welcome the time I spend in remission of depression.
- Scott
Posted by Phillipa on November 10, 2011, at 11:37:15
In reply to Re: TX Resistance Mind or Body Or Both?, posted by SLS on November 10, 2011, at 8:02:48
I posted this as had shown it to my husband last night and his response to me was it's you you refuse to change. So was hoping you also would see it as I did. I hate taking what is prescribed and nothing changes. I wake up and say okay will be better and sometimes it is. I push myself and then get criticised for that. So How do I change? I've gone to theraphy many times. I've done their exposure theraphy and it doesn't work for me. Seems less or more of a med I take doesn't make a difference so he convinced me it was me hence I woke feeling guilty and worse. I'm so glad you read the article the way I also did. Sometimes I more than question pdocs. I know how I feel. Thanks for helping dispel this what I would like to cll myth. Phillipa
Posted by Phillipa on November 10, 2011, at 19:27:18
In reply to Re: TX Resistance Mind or Body Or Both?, posted by Phillipa on November 10, 2011, at 11:37:15
I read this differently now Scott your response as later in the day my mind works better. I see what you mean I think if the patient doesn't take the prescribed dose the doc prescribes than the patient is resistant to treatment. It's when they take the prescribed amount don't improve or worsen that it's biological treatment resistance. Phillipa
This is the end of the thread.
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