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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Meltingpot on December 30, 2012, at 16:57:42
I've never quite got how taking meds and having therapy together is better than having one or the other. Surely if you are taking medication to help you feel better while you are having therapy you are not dealing with the same issues.
For instance if you are having terrible, anxiety that is not associated with anything and then you take a medication that makes the anxiety subside then when you go or the therapy in this calm, altered state you are not having to deal with the issue because it is no longer there.
I can understand how therapy can help if you are having relationship problems or financial problems or grief problems but not really for depression or anxiety which doesn't seem to have an underlying cause.
Denise
Posted by baseball55 on December 30, 2012, at 20:10:51
In reply to Therapy and meds as a package, posted by Meltingpot on December 30, 2012, at 16:57:42
For me, anyway, there was an underlying cause, though I was not aware of it. Apart from dynamic issues, I exacerbated bouts of depression (anxiety was never a problem for me) with feelings of hopelessness -- this will never get better, I will never be well, this has to end, I can't stand this.
Or course, if you're stable on meds, then that's not a problem. But most people on this forum aren't stable on meds. If they were, they wouldn't be here, right?
Posted by Meltingpot on December 31, 2012, at 8:33:17
In reply to Re: Therapy and meds as a package, posted by baseball55 on December 30, 2012, at 20:10:51
Hi,
But how has knowing what the underlying cause been, been of any use to you?
It is good that you have found therapy a usefull tool. So do you think that you would be able to come off all medication and use what you have learnt from therapy instead?
Denise
Posted by Phil on December 31, 2012, at 16:43:42
In reply to Re: Therapy and meds as a package, posted by Meltingpot on December 31, 2012, at 8:33:17
I don't think you are a candidate for therapy. No law saying anyone has be open to it.
Posted by baseball55 on December 31, 2012, at 18:47:34
In reply to Re: Therapy and meds as a package, posted by Meltingpot on December 31, 2012, at 8:33:17
> Hi,
>
> But how has knowing what the underlying cause been, been of any use to you?
>
> It is good that you have found therapy a usefull tool. So do you think that you would be able to come off all medication and use what you have learnt from therapy instead?Everyone's different, but for me, knowing the underlying causes was important because I had been incapable of even acknowledging something was wrong. I was completely trapped in this armor of -- I'm fine, I don't need you, leave me alone. With the result that I was very alone and my two close relationships (with my husband and daughter) were falling apart. If I hadn't dealt with that, I doubt I would have sought help as the depression got worse and would just have killed myself.
But in dealing with the depression itself, what helped was DBT, which is not about underlying causes but about learning how to live and cope with pain. How to accept and try to develop some distance through mindfulness and meditation techniques. So now I can say -- okay, I am depressed right now, what does this feel like, let me sit with this without it overwhelming and frightening me.
As I said before, this doesn't mean meds aren't useful too. But most people (at least for me and for many on this list) do not achieve full remission on meds. I had tried them all, had seen some of the best and most experienced Harvard Medical School doctors around. But I couldn't get better and, more significant for me, I couldn't cope with being depressed. I slipped from just feeling bad and being unmotivated, to complete and utter hopelessness and suicidality. DBT has taught me how not to go there. But lamictal helps as well. I don't see any problem with using both.
Posted by Emme_V2 on December 31, 2012, at 22:20:56
In reply to Therapy and meds as a package, posted by Meltingpot on December 30, 2012, at 16:57:42
> I've never quite got how taking meds and having therapy together is better than having one or the other. Surely if you are taking medication to help you feel better while you are having therapy you are not dealing with the same issues.
>
> For instance if you are having terrible, anxiety that is not associated with anything and then you take a medication that makes the anxiety subside then when you go or the therapy in this calm, altered state you are not having to deal with the issue because it is no longer there.
>
> I can understand how therapy can help if you are having relationship problems or financial problems or grief problems but not really for depression or anxiety which doesn't seem to have an underlying cause.
>
>
> DeniseI think there are lots of ways a therapist can help even if you've already cleaned out the cobwebs from any baggage you have (and most humans do have some baggage just by virtue of being human) and there don't seem to be any clear underlying causes.
1. A therapist who has a working relationship with your psychiatrist can help track your symptoms and provide an extra pair of eyes. Chances are you'll see your therapist more than your pdoc, and the extra feedback can help your pdoc.
2. He or she can help figure out patterns or indications that you're starting to slip so that you can mobilize your support system and contact your doctor if needed, hopefully shortening the duration of a relapse or nipping it in the bud.
3. He or she can help develop coping strategies for when you're in a depression.
4. She or he can provide moral support when you're way down (life support mode), holding hope for your when you feel you don't have any.
5. She or he can help you deal with debris from having experienced depression. I think having terrible depression is kind of traumatizing in its own way. You may feel like talking about what your experience has been like or discussing fears related to the illness itself.
6. You may need some coaching to plan to regain your life once you are doing better.
7. Even if you don't have major relationship or other issues, sometimes it's still nice to have some thoughts on new ways to deal with challenging situations as they come up.
Therapy really only provided items 1, 3, and 4 for me when my depression was bad. It was helpful in other ways when medication had brought my depression down to something more manageable. I'd say about 80% of remission for me is medication. But that other 20% is pretty useful, and I think therapy is a good place to help take you from remission to remembering who you really are and healing your spirit. Just some thoughts.
emme
Posted by SLS on December 31, 2012, at 23:56:35
In reply to Therapy and meds as a package, posted by Meltingpot on December 30, 2012, at 16:57:42
You ask great questions.
For many people, it was chronic psychosocial stress that forced the biological system into a state of dysregulation that later manifested as depression and anxiety. If those stresses (depressive pressure) remain unresolved, drug treatments might not produce long-lasting results. Psychotherapy can address those unresolved issues that may be allowing for the psychopathology to persist.
Psychotherapy might not be useful to you at all.
I like very much what Emme_V2 has to say.
For me, I asked for psychotherapy to:
1. Help me survive and not commit suicide during the periods in which the biological depression remained severe. I was helped by using coping strategies like CBT (cognitive behavioral therapy) and IPT (interpersonal therapy).
2. Resolve as many psychological issues as possible in advance of finding a successful biological treatment so that I would be more responsive that treatment and give remission every chance of continuing long-term.
3. Clean up the psychological debris left in the wake of the destruction of one's psyche by chronic depressive thinking.
Depression itself is stressful to the system. The stress > depression > stress > depression cycle becomes very much entrenched into the psychobiology of someone with a chronic depressive disorder. It is a very destructive and self-reinforcing feedback loop. Depression makes people depressed.
Denise, you are extraordinarily resilient. I would not discourage you from seeking psychotherapeutic treatment, but I have no reason to believe that it is essential for you to attain remission.
- Scott
Posted by metamorphosis on January 1, 2013, at 18:13:17
In reply to Re: Therapy and meds as a package » Meltingpot, posted by Phil on December 31, 2012, at 16:43:42
I think it is a great combo. for some. I was taking group c.b.t./a.c.t. therapy. The only way I could feel semi-comfortable in the class, was with Klonopin. It gave me enough anxiolytic effect to where I could learn certain coping mechanisms and life skills. Plus I was able to interact with the people in class and contribute. Which helped my self-esteem. It gave me a chance to get out and meet new people. Many of whom had some of the same mental health issues.
Posted by jono_in_adelaide on January 2, 2013, at 0:49:30
In reply to Re: Therapy and meds as a package » Meltingpot, posted by SLS on December 31, 2012, at 23:56:35
"Clean up the psychological debris left in the wake of the destruction of one's psyche by chronic depressive thinking"
Acording to the shrinks, my depression and anxiety were purely biological, and i certainly didnt have any "issues" I felt that I wanted to discuss ("lay back and tell me about your mother" type stuff) but I am prety sure that over the time when my anxiety and depression were severe and not adequatly treated i have picked up some negative beheiviors etc which therpay could help with - i hope to address them this year, perhaps with CBT
Posted by Zyprexa on January 10, 2013, at 20:31:49
In reply to Re: Therapy and meds as a package, posted by jono_in_adelaide on January 2, 2013, at 0:49:30
I think my docs knew they could not help me. And that is why talk therapy didn't work. I remember explaining my whole situation, and doc just looked out the window and said what a beautiful day. Pissed me off royaly. Shortly after he stoped taking my insurance.
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