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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Phillipa on May 28, 2012, at 10:15:50
After reading above thread on suicide started wondering if there is a passive suicide since I can't be bothered with worrying anymore nor seeking out any new docs or treatments. Like I just don't care anymore. As go to one doc something else wrong. So why bother. Just wait and do nothing? Phillipa
Posted by Phil on May 28, 2012, at 13:25:58
In reply to What Is Passive Suicide?, posted by Phillipa on May 28, 2012, at 10:15:50
I was lazy and stole this from another site.
Active suicide is when you make an effort to kill yourself, e.g. you shoot yourself, hang yourself, etc.
Passive suicide is when you don't make the effort to stay alive and so in effect let yourself be killed. For example refusing life saving medical treatment. You're not actively killing yourself but you are intentionally putting yourself on a course to death.
Suicidal thoughts can also be classified in the same manner.
eg.
Active suicidal thoughts:
"I want to shoot myself in the head"
Passive suicidal thoughts:
"Life is really worth living"
Posted by Twinleaf on May 28, 2012, at 13:33:33
In reply to What Is Passive Suicide?, posted by Phillipa on May 28, 2012, at 10:15:50
Phillipa, these thoughts are really distorted thinking caused by the depression you have. If you were not depressed, you would not feel that things were hopeless because you are in your sixties and have a few health problems, none of which are catastrophic. You would be finding many things to enjoy and be proud of.
You have been posting about how much pain and distress you are experiencing for several years, and it is clear to us what a very difficult time you have been having. I think it's safe to say that everyone genuinely empathizes with you, and hopes for the very best for you. But for reasons that aren't clear, you have so far avoided taking any steps to get adequate medication or psychotherapy to deal with problems which are almost certainly not going to go away by themselves. This is, of course your choice, and, while those who have gotten to know you might hope for something different and better for you, we do have to abide by your decision.
Are you aware that you are almost the only person on Babble who is not making an active, continued effort to overcome your depression? I mean that, while you make tremendous efforts to be active, exercise, and have satisfying interactions with people every day, you do not seek out effective medical or psychological treatment as do the vast majority of other posters. We all know that depression is a hard condition to treat, and that most people have to try many things. But almost everyone here IS trying everything they possibly can - Scott certainly comes to mind as someone who has made extraordinary, continuous efforts over many years, and almost every poster exhibits much of the same determination and courage. Why not have a bit more of an open mind about more effective treatment? I do believe that many people can recover completely with the right combination of therapy and medication, and even more can recover partially, so that their depression is much milder and more manageable, and interferes much less with their enjoyment of life. You don't yet know what wonderful possibilities there might be for you.
I apologize for speaking so candidly, but it is very hard to see you suffering and yet not taking an effective first step.
Posted by Phil on May 28, 2012, at 14:23:53
In reply to What Is Passive Suicide?, posted by Phillipa on May 28, 2012, at 10:15:50
> After reading above thread on suicide started wondering if there is a passive suicide since I can't be bothered with worrying anymore nor seeking out any new docs or treatments. Like I just don't care anymore. As go to one doc something else wrong. So why bother. Just wait and do nothing? Phillipa
I should have read your whole post. Sorry you are in that space, Phillipa. I can't tell you what to do. I'd see a psychiatrist because I think they offer the best shot at feeling better.
Do you do therapy?
Posted by Phillipa on May 28, 2012, at 20:45:36
In reply to Re: What Is Passive Suicide? » Phillipa, posted by Phil on May 28, 2012, at 14:23:53
I see a pdoc who says leave meds alone. Asked if needed theraphy he said no. He says Ocd. Keep meds the same. Phillipa
Posted by Twinleaf on May 28, 2012, at 21:08:36
In reply to Re: What Is Passive Suicide?, posted by Phillipa on May 28, 2012, at 20:45:36
Do you think he's right?
Posted by Cecilia on May 29, 2012, at 5:29:16
In reply to Re: What Is Passive Suicide?, posted by Twinleaf on May 28, 2012, at 13:33:33
Twinleaf, I don't know how many meds or attempts at therapy Phillipa has engaged in. I do know how many I have, and as someone else who has given up and is another person at Babble who is no longer making an "active continued effort to overcome my depression" I can only say that comments like yours HURT. Again, I can't speak for Phillipa, only for myself, but your comments just felt like a slap in the face. Blame the victim, as though depressed people don't already blame themselves every day. Maybe most people who have given up don't spend much time at Psycho Babble, but I am quite sure there are many of us who have tried pretty much everything there is to try. I know there's always something new; I haven't tried vilazodone, maybe at some point I will, but the odds of it working when dozens of other meds have failed are not exactly favorable, to say the least. Maybe someday they will invent new meds that are actually significantly different from the old ones, but like Phillipa I am over 60 and the chances of this happening in my lifetime are pretty remote. So yes, I suppose it's passive suicide, ignoring your insurance companies endless reminders to get a mammogram and the like. Active suicide takes a lot more courage than I have. I've been depressed my whole life and I wish regularly I had done it when I was young and avoided a
lifetime of pain, but I didn't have the courage. And for those who are going to write in, "it gets better", no it doesn't always. That's reality. I think we're all doing the best we can. Cecilia
Posted by Twinleaf on May 29, 2012, at 6:29:40
In reply to Re: What Is Passive Suicide? » Twinleaf, posted by Cecilia on May 29, 2012, at 5:29:16
It is certainly not my intention to hurt. If I thought she had tried everything, I of course would not say anything. I know there are some people who have tried just about everything, without success; from what you say, you are one of them. I do understand what a terrible situation that is. But from what Phillipa has written, she has tried several ADs in very low doses only, and has not had long- term psychotherapy. When she took the Montgomery-Asperg self- rating test, she reported a moderate, not severe, level of depression. It appears to me that there are several promising courses of action which she has not yet tried. If she had tried them, and they had not helped, I would of course not say anything.
Posted by Twinleaf on May 29, 2012, at 6:44:04
In reply to Re: What Is Passive Suicide? » Twinleaf, posted by Cecilia on May 29, 2012, at 5:29:16
It is certainly not my intention to hurt. If I thought she had tried everything, I of course would not say anything. I know there are some people who have tried just about everything, without success; from what you say, you are one of them. I do understand what a terrible situation that is. But from what Phillipa has written, she has tried several ADs in very low doses only, and has not had long- term psychotherapy. When she took the Montgomery-Asperg self- rating test, she reported a moderate, not severe, level of depression. It appears to me that there are several promising courses of action which she has not yet tried. If she had tried them, and they had not helped, I would of course not say anything.
Posted by SLS on May 29, 2012, at 8:07:22
In reply to Re: What Is Passive Suicide? » Twinleaf, posted by Cecilia on May 29, 2012, at 5:29:16
> Twinleaf, I don't know how many meds or attempts at therapy Phillipa has engaged in. I do know how many I have,
Of course, I don't know what treatments you have tried so far. I sometimes wonder if the majority of psychiatrists lack the imagination to treat difficult cases like yours.
Have you already tried the MAOI + TCA + lithium strategy? How about Wellbutrin + Abilify + Lamictal? Effexor + TCA? Even if you have tried these, I am guessing that I can come up with a rational treatment strategy that you have not yet tried. However, that does not negate the litany of treatment failures that you have thus far experienced. My treatment failures have been demoralizing. However, I did not give up as long as I felt that there were logical alternatives that I had not yet tried. Perhaps you no longer feel that there are any remaining alternatives for you. Perhaps you no longer give a damn even if there are.
I pretty much gave up last November when I felt that I had tried everything. It was my first time to feel this way. It was logical to give up and try to accept that my remaining years would be lived in solitude and without any reward for surviving. Well, my doctor didn't give up. He thought that I should try a drug called prazosin (Minipress). It is an old drug indicated to treat hypertension. He said that my descriptions of childhood traumas might indicate that there is a PTSD component driving my depression. I thought that he was reaching too far for an explanation. I almost didn't try prazosin because of this. Happily, I was proven wrong. All I could think to say was, "Well I'll be damned." I have been improving ever since.
I am not suggesting that you to do anything. I am not suggesting that you are somehow weak for giving up. Of course, I hope that this is only a temporary state of mind for you. However, if it is not, that's okay, too. I can understand that you are the victim of learned helplessness. This is a very real consequence of an unrelenting depression. I understand if you feel hopeless. It is very possible that there are to be no treatments that exist in your lifetime that will help you. Without knowing your treatment history, I am doubtful that this will be true, though. There are just too many permutations of drug combinations to lead me to believe that you have tried EVERYTHING. Of course, there are treatments that do not involve medication. I wouldn't know if any of these would be indicated in your case.
These are the medications that I am taking currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300mg
prazosin 12 mgNone of these drugs are redundant, and they all seem to complement each other. When I attempt to discontinue any one of these drugs, I relapse. When I try to reduce the dosage of any of these drugs, I relapse. It only took 31 years to get it right. I am extremely fortunate.
When one is depressed, it is difficult to find any positive energy to work with. This lack of positive energy begins on day 1 of depression. It is just the way that our psychobiology works. It is a heroic feat to maintain a positive attitude in the midst of the depressive state. I can't account for how anyone would maintain such an attitude as the years of depression and failed treatments accumulate.
- Scott
Posted by Phillipa on May 29, 2012, at 10:20:37
In reply to Re: What Is Passive Suicide? » Cecilia, posted by SLS on May 29, 2012, at 8:07:22
As for myself and having seen many many pdocs over the last 15 years as wasn't anything but mildly anxious til then. I was first diagnosed with thyroid disease, then chronic lymes disease, then menopause, hormones taken, not synthetic bioidentical and of course thyroid meds, I was in many group theraphies and saw numerous therapists over the years. Was in the hospital once for a month to treat anxiety and then get pic line for IV rocephin for lymes. At the time after lumbar punctures my extremly high ANA led to both infection control doc and rheumatologist treating me. It was suggested that I could have a "mish Mash" of many autoimmune diseases. Still to this day test positive for lymes. But even after calling the health dept in this area was told it's impossible so they refused to add me to the data line for lymes. One doc slammed the written positive for 6 bands of bordella sp? on his desk and said forget it you don't have it. I was on 250mg of luvox and felt good for a few weeks. Ad's never helped me. Benzos did but not no longer work. The trauma I've experienced is from the medical profession and their uncaring attitudes. I do believe that life circumstances play a big role in at least my situation. Having a husband who regrets marrying me as he's 13 years younger than me also doesn't help as he holds it against me that I can't do what he can. Also I warned him that I would age quicker and that the age difference was to big. He didn't listen and in a weak moment I married him. And Bingo one week later I was sick for first time in life. Now pain when doing anything is biggest factor so attend PT again today which don't want to do as last time the guy said if no improvement it can't help you and in three more weeks he will decide to send me back to the neuro surgeon. Also need the crown now and no dentist will call back as cash only and they know only haved medicaire and united healthcare. Oh my husband is still holding me responsible to pay for his two years a go. $800 after paying for two insurances for me on SSRI leaves me with not much to live on. Let alone medications. Enough stress. Phillipa
Posted by alchemy on May 29, 2012, at 15:58:32
In reply to Re: What Is Passive Suicide? » Twinleaf, posted by Cecilia on May 29, 2012, at 5:29:16
> Twinleaf, I don't know how many meds or attempts at therapy Phillipa has engaged in. I do know how many I have, and as someone else who has given up and is another person at Babble who is no longer making an "active continued effort to overcome my depression" I can only say that comments like yours HURT. Again, I can't speak for Phillipa, only for myself, but your comments just felt like a slap in the face. Blame the victim, as though depressed people don't already blame themselves every day. Maybe most people who have given up don't spend much time at Psycho Babble, but I am quite sure there are many of us who have tried pretty much everything there is to try. I know there's always something new; I haven't tried vilazodone, maybe at some point I will, but the odds of it working when dozens of other meds have failed are not exactly favorable, to say the least. Maybe someday they will invent new meds that are actually significantly different from the old ones, but like Phillipa I am over 60 and the chances of this happening in my lifetime are pretty remote. So yes, I suppose it's passive suicide, ignoring your insurance companies endless reminders to get a mammogram and the like. Active suicide takes a lot more courage than I have. I've been depressed my whole life and I wish regularly I had done it when I was young and avoided a
> lifetime of pain, but I didn't have the courage. And for those who are going to write in, "it gets better", no it doesn't always. That's reality. I think we're all doing the best we can. CeciliaI agree Cecilia. I'm almost 30 years of feeling depressed, 25 years of trial and errors. If I would have known then that I would still be in this place...not good. I wish I had the courage, I think about ending it all of the time. It must be a personality thing that makes it harder to actually go through with it. My mom & a friend say that they admire my strength to keep pushing along. I think it would take more strength for me to end it.
I don't remember this, but in the begining my mom said she would hold me as a cried not knowing what was wrong. It's amazing how many drugs they have come up with, but that doesn't guarantee that they will work for everyone.
Of course there is a part of me that has a tiny bit of hope. But as I get older and go through more med trials (usually suffer through), the less hope I have.
Posted by Twinleaf on May 30, 2012, at 13:02:50
In reply to Re: What Is Passive Suicide? » Cecilia, posted by SLS on May 29, 2012, at 8:07:22
I think everyone here has a good understanding of, and empathy for, states of mind such as hopelessness, as well as of more positive, hopeful states. We have all probably been in both more than once. I feel that it can be a very helpful function of Babble to encourage others when they are really down - to point out to them that there are useful things they have not yet tried ( if this is true). To me, Scott's posts are especially inspiring, because, after 30 years of trying everything he and his pdoc could think of, and not having much success at all, his pdoc tried prazosin, and, against all the odds, it is really helping. Phillipa seems to be going through such a painfully low, hopeless state, and yet she has not tried nearly as many medications as Scott, nor has she been in long-term psychotherapy, as he has. It is very painful to me, personally, to read her posts describing her very real distress, without the addition of a constructive plan (not yet tried) which might have a chance of helping her feel much more hopeful and able to enjoy life. It is most probably time for me to stop reading them.
Posted by Phillipa on May 30, 2012, at 21:42:16
In reply to Re: What Is Passive Suicide?, posted by Twinleaf on May 30, 2012, at 13:02:50
Twinleaf I don't like being talked to in the third person I am here. Through the years I have been on many meds most not mentioned here. It's sad there is no pyschotherapy around here. I wonder if there is in most areas as the insurance companies now see therapy as something to be used on a short term basis. And since my pdoc whom I've had probably more than most through the years don't feel that meds are that helpful. And with the warnings that have been added to medications. Seems that a good number of them are now prescribing doses of meds lower. As an English poster once wrote in his country people are allowed one medication. I would not buy meds online. Especially without a prescription. This thread was in response to the thread on active suicide that another poster posted as I think when read it this was mentioned. I personalized it. Right now eliminating physical pain of structural stuff in my back is a higher priority. As feel pretty good til pain hits. My research lately focuses on this. And currently actively involved in PT and diligently doing the prescribed excercises at home. No meds are recommended for this. Relearning core body movements is. Phillipa
Posted by Cecilia on June 1, 2012, at 4:54:43
In reply to Re: What Is Passive Suicide? » Cecilia, posted by SLS on May 29, 2012, at 8:07:22
Prasozin is an interesting idea; I haven't been diagnosed with PTSD, though I certainly had a lousy childhood. Lousy from loneliness and anxiety mainly, no big traumas, at least that I remember, no repressed memories emerged in 7 years of therapy. I already take atenolol for hypertension, which does have a modest anti anxiety effect, not sure what the difference between beta blockers like it and alpha blockers like prazosin is.
But I just don't get HOW you are able to tolerate the huge doses of medication you take. Over the years the lists you've given sound like nightmares. 80 mg of Parnate? Without a doubt the very worst week of my life was the week I took a low dose of Parnate. That PLUS 150 mg of Nortriptyline? Plus all the others. I know everybody's metabolism is different but your combinations sound
worse than cancer chemotherapy. I've tried dozens of meds but the only things that have ever actually helped were benzos. I have forced myself to go through adequate trials of lots of meds with horrible side effects and given up on others that were just too horrible to continue. I think some of my trials were just ways of punishing myself for being depressed. Certainly therapy was.Of course the other thing I don't understand is how it would change my life if I weren't depressed. I have no concept of the absence of depression. I had to retire from my job, which gave me at least some feeling of being useful in the world, because of arthritis. I'm in constant pain. I have no one who loves me, no real friends, no one who would particularly care if I were dead. Still, I'm terrified of death. And unfortunately, that's the one thing that's absolutely guaranteed in life.
Anyway, glad you found something that worked; hope it continues. Cecilia
Posted by SLS on June 1, 2012, at 7:36:27
In reply to Re: What Is Passive Suicide?, posted by Cecilia on June 1, 2012, at 4:54:43
If it means anything to you, I recognize how horrendous your life has been. One of the things that helped me stay alive was the fact that I had experienced some brief (3 days) responses to antidepressants and one longer period (9 months) in remission. Ever since my first response to imipramine in 1982, I have held tightly to the memories of these these brief "awakenings". During these times, I became convinced that a life without depression was worth living. How enriching, rewarding, and exciting it can be - fun, even. You have never experienced these things in your life. This tugs at my heart. It is not fair.
There is no lack of bravery in choosing to survive depression and endure the gray, depressed mood, melancholic thoughts, lack of vitality, frustration, anxiety, and the psychic pain. I hear many say that it is a coward who avoids suicide. I have been suicidal a few times myself. I, too, felt that I was somehow weak for not following through with it. I was simply too afraid for my consciousness to reach its irrevocable end. Interestingly, I never made a plan to commit suicide. I wouldn't know how to go about it. Most times, I fought hard against thoughts of suicide. I don't like losing. I refused to do the research necessary to figure out the most assured and painless method to euthanize myself, regardless of how humane that might be.
I am not so much afraid of death as I am of never having lived.
> Prasozin is an interesting idea; I haven't been diagnosed with PTSD, though I certainly had a lousy childhood.
My doctor makes a distinction between PTSD resulting from acute traumatic events and PTSD resulting from chronic abuse and neglect. He calls this "developmental PTSD". Neglect, in particular, can be a potent inducer of depression. Essentially, my doctor is of the belief that this developmental PTSD is what can drive certain cases of depression, even though no direct connection is perceived by the afflicted person. In my way of thinking, it is because the young brain develops within the milieu of this chronic abuse and neglect. The result is a derangement in the dynamics of those circuits involved in mood and cognition. Once it emerges, the depression becomes self-reinforcing biologically, and grows beyond any sense of childhood trauma and neglect that might yet be unresolved psychologically. In many cases, even when these issues are resolved, the depression persists biologically when it is too late for the brain circuits to be easily rerouted and reregulated. An older brain is less plastic than a young brain. The earlier psychotherapy is applied, the greater are the chances that persistent positive changes can be made.
It is possible that prazosin will demonstrate usefulness in treating developmental PTSD depression as it is now recognized for treating other forms of PTSD. Prazosin is a relatively benign drug. For most people, I doubt tolerability will be an issue with its use. Startup side effects can include dizziness, fatigue, muscle weakness, and somnolence. I found that these things disappeared after one or two weeks. Prazosin might be more effective as an augmenter of antidepressants than it is as monotherapy. For me, prazosin doesn't work unless I continue to take the other drugs in my treatment regime.
I truly hope that you are able to find reasons that allow you to renew the positive energy you once had to pursue an effective treatment for your depression. When the reservoir runs dry and the positive attitude is beaten out of you, this is very difficult. It won't happen overnight.
I wish I could do more.
I wish you good luck in all that you choose to do.
- Scott
Posted by Phillipa on June 1, 2012, at 12:33:19
In reply to Re: What Is Passive Suicide?, posted by Cecilia on June 1, 2012, at 4:54:43
Cecelia same here benzos, and the arthritis and pain and RN was my life. I am still trucking on. Right now waiting to begin our buying expedition of the day. Then fight pain ride bike and walk and do the PT excercises. Then back to internet work. Nice to meet you. Phillipa
This is the end of the thread.
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