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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Anna Laura on July 16, 2002, at 0:18:20
My SPECT scan showed up basal ganglia hypofunction; i made a search on the net to refresh my old studies on SNC anatomy; basal ganglia it's a deep brain structure mainly involved with motor function and integration: its deterioration is involved in Parkinson Desease ; it might be also involved in anhedonia and apathy syndrome being the richest zone of dopamine receptors : highest receptor density and dopamine "production" (80% percent of brain's dopamine being "produced" there).
The doctor who interpreted my SPECT scan told me the results are consistent with my symptoms (anhedonia and apathy); such results also explained why i didn't respond to conventional AD treatment; i was quite relieved being confident i probably needed some dopaminergic augmentation.
But my relief was short-lasting. I called my current pdoc yesterday and she told me she was expecting a totally different picture (prefrontal lobe hypofunction i suppose); in her opinion basal ganglia hypofunction didn't mean much to her, being inconsistent with my symptoms !!!! (at that point i wanted to scream but i held on).
"But the doctor who saw my SPECT scan told me that the results WERE CONSISTENT with my symptoms" i muttered. "Well, yes, they might be....i should see the scan with my very eyes to give the right interpretation even though i've come to believe your mood disorder could be unrelated to dopamine depletion"- she told me.
I read somewhere basal ganglia hypofunction might be involved with ADHD which i had as a teen-ager and that eventually faded away as a young adult.
I'm 33 years old at the moment and don't have any ADHD symptoms what so ever (thanks god!); i was wondering if the SPECT could have shown some "traces" of my old disorder.
Don't know what to think anymore. I know i shouldn't rely on SPECT scan as a diagnostic tool, but i got so thrilled when i was told there was some objective explanation for my disorder!!!
Any of you guys have more clues/insights? I have an appointment fixed for July 25th and i dodn't know what i should expect anymore!Thanks for listening
Posted by cybercafe on July 16, 2002, at 4:03:08
In reply to SPECT SCAN CONFUSION, posted by Anna Laura on July 16, 2002, at 0:18:20
wow what is a SPECT and why did your doc want to have one done? ... i've got to get me one of those
you could always do a web search on "nucleus accumbens" and pleasure.. reward... joy... "ventral tegmental area" ... "globus pallidus" ....... i have long conjectured (and this is just conjecture) that all types of depression - lack of pleasure - involve hypostimulation of the brain's pleasure centers.. which i believe is the nucleus accumbens (considered by some to be part of the basal ganglia)... i believe there are serotonin projections to this area... but that serotonin also modulates the release of dopamine in this area... there was an article on biopsychiatry.com that said prozac and a TCA and ECT all increased the number of D2 receptors in the nucleus accumbens.... while an MAOI was shown to increase the amount of dopamine in the nucleus accumbens...
but i have read far too few studies to come to any general conclusions...
.... as for the neocortex... pre-frontal cortex.... i believe there are projections from the basal ganglia to the neocortex.. and back again... so perhaps this is implicated in emotion in an indirect fashion....
happy reading ;)
> My SPECT scan showed up basal ganglia hypofunction; i made a search on the net to refresh my old studies on SNC anatomy; basal ganglia it's a deep brain structure mainly involved with motor function and integration: its deterioration is involved in Parkinson Desease ; it might be also involved in anhedonia and apathy syndrome being the richest zone of dopamine receptors : highest receptor density and dopamine "production" (80% percent of brain's dopamine being "produced" there).
> The doctor who interpreted my SPECT scan told me the results are consistent with my symptoms (anhedonia and apathy); such results also explained why i didn't respond to conventional AD treatment; i was quite relieved being confident i probably needed some dopaminergic augmentation.
> But my relief was short-lasting. I called my current pdoc yesterday and she told me she was expecting a totally different picture (prefrontal lobe hypofunction i suppose); in her opinion basal ganglia hypofunction didn't mean much to her, being inconsistent with my symptoms !!!! (at that point i wanted to scream but i held on).
> "But the doctor who saw my SPECT scan told me that the results WERE CONSISTENT with my symptoms" i muttered. "Well, yes, they might be....i should see the scan with my very eyes to give the right interpretation even though i've come to believe your mood disorder could be unrelated to dopamine depletion"- she told me.
> I read somewhere basal ganglia hypofunction might be involved with ADHD which i had as a teen-ager and that eventually faded away as a young adult.
> I'm 33 years old at the moment and don't have any ADHD symptoms what so ever (thanks god!); i was wondering if the SPECT could have shown some "traces" of my old disorder.
> Don't know what to think anymore. I know i shouldn't rely on SPECT scan as a diagnostic tool, but i got so thrilled when i was told there was some objective explanation for my disorder!!!
> Any of you guys have more clues/insights? I have an appointment fixed for July 25th and i dodn't know what i should expect anymore!
>
> Thanks for listening
Posted by BekkaH on July 16, 2002, at 18:58:57
In reply to SPECT SCAN CONFUSION, posted by Anna Laura on July 16, 2002, at 0:18:20
Hi Anna Laura,
I'm going to have a SPECT scan in a few months, but I want to be off all meds for at least a month before I have the scan. I want the scan to show Baseline Me and NOT Me in med withdrawal. If I do it too soon after getting off meds, that's all it will show. How long were you off meds before having the scan? Are you in the New York City area, by any chance? Did your insurance cover the cost of the scan?
Bekka
Posted by Xevious on July 17, 2002, at 0:06:37
In reply to Re: SPECT SCAN CONFUSION, posted by BekkaH on July 16, 2002, at 18:58:57
Regarding the dissent between your pdoc and the physician who interpreted your SPECT, I'm assuming that the latter was a neuroscientist properly trained and specialized in brain imaging, whereas your psychiatrist is most likely NOT. In my opinion, physicians and ESPECIALLY psychiatrists are a rather opinionated and egotistic lot (with the occasional notable exception) and often get locked into their own points of view while simultaneously overstepping their areas of knowledge to dispense clinical advice.
The above is a grossly huge generalization, and hopefully an overstatement as well, but I wanted to get your attention! ;)
My advice is to get a second opinion on the SPECT (and no, your pdoc's opinion doesn't count) if you so desire from a neuroscientist specialized in brain imaging. Or find another doc willing to put you on a pstim trial to test the dopaminergic treatment theory, as these drugs really aren't the demonic agents that far too many doctors think they are. (Experience talking; you wouldn't believe how hard it was for me to find a doc/pdoc willing to treat my ADHD...)
I am most certainly biased on this issue, but then again, I'm a neuroscience student who previously suffered through a decade of docs and pdocs before self-diagnosing ADHD! (And to think that I can just stick my head in a scanner now...)
Good luck!
Posted by BekkaH on July 17, 2002, at 8:35:17
In reply to Re: SPECT SCAN CONFUSION, posted by Xevious on July 17, 2002, at 0:06:37
Hi. I think Xevious gave excellent advice. I'd place more weight on the interpretation given by the person who read the SPECT scan. I assume that was a neuroradiologist or a neuropsychiatrist. A second opionion is always a good idea, but it's preferable to get it from someone with a REAL Neurology background.
Posted by oracle on July 17, 2002, at 12:40:34
In reply to Re: SPECT SCAN CONFUSION, posted by BekkaH on July 16, 2002, at 18:58:57
Did your insurance cover the cost of the scan?
>
> BekkaNo one's insurance will cover this, it is experimental at best.
Posted by Anna Laura on July 17, 2002, at 21:10:57
In reply to Re: SPECT SCAN CONFUSION, posted by BekkaH on July 16, 2002, at 18:58:57
> Hi Anna Laura,
>
> I'm going to have a SPECT scan in a few months, but I want to be off all meds for at least a month before I have the scan. I want the scan to show Baseline Me and NOT Me in med withdrawal. If I do it too soon after getting off meds, that's all it will show. How long were you off meds before having the scan? Are you in the New York City area, by any chance? Did your insurance cover the cost of the scan?
>
> Bekka
Hi Bekka
I'm afraid i can't give you any valid information about the cost of the scan since i live in another country.
I was on meds while i took the scan.
(don't ask me why, both the neuroradiologist and my pdoc believed it wouldn't make much difference!).
I'm actually on a Wellbutrin+ Effexor combo.
Good luck for your scanAnna Laura
Posted by Anna Laura on July 17, 2002, at 21:35:48
In reply to Re: SPECT SCAN CONFUSION, posted by Xevious on July 17, 2002, at 0:06:37
> Regarding the dissent between your pdoc and the physician who interpreted your SPECT, I'm assuming that the latter was a neuroscientist properly trained and specialized in brain imaging, whereas your psychiatrist is most likely NOT. In my opinion, physicians and ESPECIALLY psychiatrists are a rather opinionated and egotistic lot (with the occasional notable exception) and often get locked into their own points of view while simultaneously overstepping their areas of knowledge to dispense clinical advice.
>
> The above is a grossly huge generalization, and hopefully an overstatement as well, but I wanted to get your attention! ;)
>
> My advice is to get a second opinion on the SPECT (and no, your pdoc's opinion doesn't count) if you so desire from a neuroscientist specialized in brain imaging. Or find another doc willing to put you on a pstim trial to test the dopaminergic treatment theory, as these drugs really aren't the demonic agents that far too many doctors think they are. (Experience talking; you wouldn't believe how hard it was for me to find a doc/pdoc willing to treat my ADHD...)
>
> I am most certainly biased on this issue, but then again, I'm a neuroscience student who previously suffered through a decade of docs and pdocs before self-diagnosing ADHD! (And to think that I can just stick my head in a scanner now...)
>
> Good luck!
Xevious,
Thanks a lot for your advice: i think i'll try to get a second opinion from another neuroradiologist before flying to the Neuroscience University Clinic next week .
I really don't understand why pdocs are so cautious about pstims or dopaminergic augmentation; they've been suspecting a dopamine-related problem since this Spring and i didn't get to try a dopaminergic med yet (just Wellbutrin:i'm on the 9th week trail and didn't do much).
I've been suffering from this anergic/anhedonic state for so long (since major depression remitted in 1995) that i can't stand it any longer !
Anhedonia really sucks.
I feel like my head it's being pushed down in a water pool and i choke and i can't breath; I've been holding my breath for so long that i feel i'm going crazy.Sorry for ranting
Thanks again
Anna Laura
P.S.Could you tell me what kind of pstim you're taking?
Posted by Xevious on July 17, 2002, at 21:50:46
In reply to Re: SPECT SCAN CONFUSION Xevious, posted by Anna Laura on July 17, 2002, at 21:35:48
Ugh. Anhedonia really does suck - I'm there with you. The other phrase that really describes my situation is "dysphoria," a term frequently applied to ADD folks that means about the same thing.
I wish I was near a SPECT sanner. Maybe I'll get into the UCLA Neuroscience program and will be able to take advantage of the facility... <wicked grin> What I *can* say is that my ADD (if it is indeed actually that) is part depression, part anxiety, part feeling really, really yucky, and a whole heck of a lot of spaceyness, fogginess and general cognitive de-lubrication. I've tried almost everything, but nothing worked nearly as well as my friend dopamine.
I'm currently on Adderall, and will be trying dextroamphetamine shortly. Methylphenidate (Ritalin) was horrible. I suspect that I will benefit most from a cocktail of dextroamphetamine and modafinil, but have yet to find a doctor willing to write the scripts. Adderall has been an absolute blessing, but I'm searching for perfection now... :)
Rant away! That's what most of us are here for! You described your symptoms so powerfully and viscerally; you need *some* relief, if only the small one that sharing with us can provide. Keep on trying; with that SPECT in hand, the answer can't be too far away...
:)
-Xevious
Posted by noa on July 18, 2002, at 17:08:19
In reply to SPECT SCAN CONFUSION, posted by Anna Laura on July 16, 2002, at 0:18:20
Sorry you are going through this confusion of MD opinions. I think the science of psychiatry is still so inexact that conflicting medical opinions happen all the time.
Hopefully, someday, new technologies like these scans will help to increase accuracy and precision in diagnosis, but at the moment, even these high tech tools are still only rough approaches--in fact, it is my impression that imaging scans like Spect are not yet considered diagnostic tools, because there is still too little data. For example, there haven't been enough studies or large enough samples to establish that a scan of an individual's brain will yield the kind of information needed for accurate diagnosis (ie, validity), or to establish consensus on how to interpret individual scans (inter-rater reliability).
So far, I think the technology has been helpful for looking at inter-group differences, but has not yet been validated as a tool for recognizing an individual's functional pathology. Part of the reason it will take a while to get enough data from a large enough sample is that the technology is expensive. Many of the studies have very small sample sizes.
BTW--was your scan part of a research study?
Posted by McPac on July 21, 2002, at 14:10:47
In reply to Re: SPECT SCAN CONFUSION, posted by Xevious on July 17, 2002, at 0:06:37
Xevious wrote, "ESPECIALLY psychiatrists are a rather opinionated and egotistic lot (with the occasional notable exception) and often get locked into their own points of view while simultaneously overstepping their areas of knowledge to dispense clinical advice."
Yes, without question, the vast majority of pdocs need to be burned alive..very, very slowly.
This is the end of the thread.
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