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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by IsoM on December 30, 2001, at 0:35:02
I don't know if anyone's ever heard of Dr. Sheldon H. Preskorn of the University of Kansas School of Medicine at Wichita. I haven't but there must be scads of pdocs out there who've written books, articles, & columns.
I came across his site in doing a search about diff SSRIs & thought someone may be interested in the information he provides on treating depression when one doesn't respond well to initial treatment. He mentions the combinations that can be used & the strategies used for treating adverse reactions as they arise. He gives a whole range of diff meds & augmentation that could help.
It's the first time I've found such detailed information in one place on the net. It may prove beneficial for those who'd like to discuss further treatments with their doctor. Now you may not need to ply her/him with so many questions that aren't always answered clearly by them.
The site is a chapter out of one of his books. If you're interested, go to the home page & look at the other book & columns he's written that are available on the net.
Cam, Elizabeth, Spike, & anyone else knowledgable, I'm curious what you may think.
http://www.preskorn.com/books/omd_s11.html
Posted by Cam W. on December 30, 2001, at 1:41:11
In reply to When One Doesn't Respond Well to ADs , posted by IsoM on December 30, 2001, at 0:35:02
IsoM - Preskorn's legit and respected. I don't know about this book, but it will be well researched and factual, if it is up to his past work. I haven't met him, but from his published work, he seems to know his stuff.
Surf around his website. It's worth it. I particularily like:
http://www.preskorn.com/columns.html
I have quoted him in lectures and have several papers authored by him (the most recent being in early 2000, though). I have also come across his name in textbooks, as well.
- Cam
Posted by stjames on December 30, 2001, at 11:30:19
In reply to Re: When One Doesn't Respond Well to ADs » IsoM, posted by Cam W. on December 30, 2001, at 1:41:11
>
> Surf around his website. It's worth it. I particularily like:
>
> http://www.preskorn.com/columns.html
>I like this part:
* As I discussed in an earlier column, I believe we should avoid defining patients by their illnesses. Joe suffers from schizophrenia rather than being a schizophrenic. In the same vein, it is his illness, rather than Joe, that is treatment refractory. Finally, the treatments have failed Joe rather than Joe failing them.1 "
As I like to say "You do not have to be your diagnosis."james
Posted by IsoM on December 30, 2001, at 13:09:09
In reply to Re: When One Doesn't Respond Well to ADs, posted by stjames on December 30, 2001, at 11:30:19
Yes, I read that quote of his & thought "this sounds like a doctor attuned to his patients." I was quite struck by that comment too.
> >
> > Surf around his website. It's worth it. I particularily like:
> >
> > http://www.preskorn.com/columns.html
> >
>
> I like this part:
>
>
> * As I discussed in an earlier column, I believe we should avoid defining patients by their illnesses. Joe suffers from schizophrenia rather than being a schizophrenic. In the same vein, it is his illness, rather than Joe, that is treatment refractory. Finally, the treatments have failed Joe rather than Joe failing them.1 "
>
>
> As I like to say "You do not have to be your diagnosis."
>
> james
Posted by IsoM on December 30, 2001, at 13:10:24
In reply to Re: When One Doesn't Respond Well to ADs » IsoM, posted by Cam W. on December 30, 2001, at 1:41:11
Posted by OldSchool on December 30, 2001, at 14:06:53
In reply to When One Doesn't Respond Well to ADs , posted by IsoM on December 30, 2001, at 0:35:02
> I don't know if anyone's ever heard of Dr. Sheldon H. Preskorn of the University of Kansas School of Medicine at Wichita. I haven't but there must be scads of pdocs out there who've written books, articles, & columns.
>
> I came across his site in doing a search about diff SSRIs & thought someone may be interested in the information he provides on treating depression when one doesn't respond well to initial treatment. He mentions the combinations that can be used & the strategies used for treating adverse reactions as they arise. He gives a whole range of diff meds & augmentation that could help.
>
> It's the first time I've found such detailed information in one place on the net. It may prove beneficial for those who'd like to discuss further treatments with their doctor. Now you may not need to ply her/him with so many questions that aren't always answered clearly by them.
>
> The site is a chapter out of one of his books. If you're interested, go to the home page & look at the other book & columns he's written that are available on the net.
>
> Cam, Elizabeth, Spike, & anyone else knowledgable, I'm curious what you may think.
> http://www.preskorn.com/books/omd_s11.htmlOne idea when one doesnt respond to meds is to have a SPECT scan and have it analyzed. Sometimes your doctor just cannot accurately diagnose you by going purely by "outward" behavioral symptoms, as is so common in clinical psychiatry. You might have unusual brain function unique only to yourself, detectable via high tech brain scans such as SPECT or PET. Unless you know where you stand as far as a correct dx goes, you probably wont be able to achieve effective treatment.
Poor diagnosis is a common cause of not responding well to your meds. Maybe you were misdiagnosed and are on the wrong type of meds. Or certain meds should be added to your cocktail which you currently are not taking. Or certain meds should be removed and replaced by other meds. Only SPECT and PET scans can really tell your doctor specifically whats going on deep inside that mentally ill brain of yours. Dont take that as a slight...if you have severe mental illness you have poor brain function.
Yes siree, those of us with major forms of mental illness have poorly functioning brains. Like it or not. SPECT can reveal the biological specifics and get you pointed on a more exact dx.
Old School
Posted by spike4848 on December 30, 2001, at 14:09:43
In reply to When One Doesn't Respond Well to ADs , posted by IsoM on December 30, 2001, at 0:35:02
> Cam, Elizabeth, Spike, & anyone else knowledgable, I'm curious what you may think.
> http://www.preskorn.com/books/omd_s11.htmlI read the parts of his sites and what he stated is pretty much standard, convenational psychiatry material. The section on side effects and receptor types is also fairly standard. The problem I have alway had is most receptor and neurotransmitter research is done on rat neurons ... obviously experiments on human neurons is next to impossible. And we really only know about 5% of the neuro transmitters in the brain. I think we will see alot of theories change in the next few years.
Scientists and doctors have a funny saying which I think maybe true, "Human's will never be so smart to understand all the details of our own brain." That is, the human brain is so amazing, so complicated ... it would be hard to image we will be able figure our own brain out.
Of all the augmentation stragies, I have seen a few trends. I have not heard of many sucess stories with buspar and pindolol. I have heard and seen many people improved vastly with the new antipsychotics. The question is it worth the weight gain and risk of tardive dyskinesia.
Spike
Posted by Cam W. on December 30, 2001, at 14:49:13
In reply to Dr Preskorn's Site, posted by spike4848 on December 30, 2001, at 14:09:43
Spike - I've talked to several researchers and pdocs who are now thinking that the weight gain caused by atypical may be irreversible in many cases, as are a fair number of Type II onset diabetes (with or without weight gain) that are seen with olanzapine and clozapine.
When you really think about this, the ramifications are very scary. The huge increase in secondary disorders due to every 5 lb increase in weight is frightening. Aside from glucose intolerance and the Type II thing, there are all of the potential cardiovascular complications. It begins to make mild TD look not so bad.
Let's hope their wrong, but so far the evidence is in their favor. - Cam
Posted by spike4848 on December 30, 2001, at 16:46:07
In reply to Re: Dr Preskorn's Site » spike4848, posted by Cam W. on December 30, 2001, at 14:49:13
I definately agree with you Cam! It is unforunate! People are even suggesting meds like glucophage in combo with the new antipsychotics.
Spike
Posted by Ed on December 30, 2001, at 16:53:11
In reply to Re: Dr Preskorn's Site » spike4848, posted by Cam W. on December 30, 2001, at 14:49:13
> Spike - I've talked to several researchers and pdocs who are now thinking that the weight gain caused by atypical may be irreversible in many cases, as are a fair number of Type II onset diabetes (with or without weight gain) that are seen with olanzapine and clozapine.
>
> When you really think about this, the ramifications are very scary. The huge increase in secondary disorders due to every 5 lb increase in weight is frightening. Aside from glucose intolerance and the Type II thing, there are all of the potential cardiovascular complications. It begins to make mild TD look not so bad.
>
> Let's hope their wrong, but so far the evidence is in their favor. - CamCam-- is Amisulpride within this group of atypical antipsychotics that may cause irreversible weight gain?
Posted by Cam W. on December 30, 2001, at 18:49:07
In reply to I agree Cam, posted by spike4848 on December 30, 2001, at 16:46:07
Spike - I heard Dr. Richard Petty out of Philadelphia talk about using Glucophage™ (metformin) to stop Zyprexa™ (olanzapine)-induced weight gain. He claims that it is not due to better glucose regulation, but some other mechanism of action. I'm not holding my breath. We tried it in a couple of people, but all the got was nausea and 20 lbs in 6 months. - Cam
> I definately agree with you Cam! It is unforunate! People are even suggesting meds like glucophage in combo with the new antipsychotics.
>
> Spike
Posted by Cam W. on December 30, 2001, at 18:51:33
In reply to Re: Dr Preskorn's Site, posted by Ed on December 30, 2001, at 16:53:11
> Cam-- is Amisulpride within this group of atypical antipsychotics that may cause irreversible weight gain?
Ed - I don't know. I am not that familiar with amisulpride. I have enough trouble trying to keep up with meds that are approved for use. I haven't seen amisulpride lumped in with the other atypicals at any of the conferences I have been to. - Cam
Posted by akc on December 31, 2001, at 6:27:59
In reply to Re: Dr Preskorn's Site » spike4848, posted by Cam W. on December 30, 2001, at 14:49:13
> I've talked to several researchers and pdocs who are now thinking that the weight gain caused by atypical may be irreversible in many cases, as are a fair number of Type II onset diabetes (with or without weight gain) that are seen with olanzapine and clozapine.
Cam,
Do you know of any links to articles reflecting the above? I would love to read more on this.
Thanks,
akc
Posted by Ed on December 31, 2001, at 9:46:13
In reply to Re: Dr Preskorn's Site » Ed, posted by Cam W. on December 30, 2001, at 18:51:33
> > Cam-- is Amisulpride within this group of atypical antipsychotics that may cause irreversible weight gain?
>
> Ed - I don't know. I am not that familiar with amisulpride. I have enough trouble trying to keep up with meds that are approved for use. I haven't seen amisulpride lumped in with the other atypicals at any of the conferences I have been to. - Cam
Posted by stjames on December 31, 2001, at 16:03:00
In reply to Dr Preskorn's Site, posted by spike4848 on December 30, 2001, at 14:09:43
> > Cam, Elizabeth, Spike, & anyone else knowledgable, I'm curious what you may think.
> > http://www.preskorn.com/books/omd_s11.html
>
> I read the parts of his sites and what he stated is pretty much standard, convenational psychiatry material.james here....
However, finding a doc that understands clinically meaningful drug-drug interactions (DDI)
invoved in polypharmacology is very hard.
Posted by Cam W. on December 31, 2001, at 18:31:57
In reply to Cam -- a question, posted by akc on December 31, 2001, at 6:27:59
Akc - A couple of studies are in progress to address this hypothesis, but right now it is just coffee time banter. The first papers specifically about irreversible weight gain will probably be published within 6 months (but, bacuase of the ethics involved, will be retrospective in nature, rather than prospective). - Cam
Posted by akc on December 31, 2001, at 19:00:19
In reply to Re: Cam -- a question » akc, posted by Cam W. on December 31, 2001, at 18:31:57
> Akc - A couple of studies are in progress to address this hypothesis, but right now it is just coffee time banter. The first papers specifically about irreversible weight gain will probably be published within 6 months (but, bacuase of the ethics involved, will be retrospective in nature, rather than prospective). - Cam
This will be asking alot, but you seemed a lot better connected to this type of research -- if you remember, could you clue me in if any of this does get published? I would really appreciate it.
thanks,
akc
Posted by Cam W. on January 2, 2002, at 6:44:55
In reply to Re: Cam -- a favor, posted by akc on December 31, 2001, at 19:00:19
This is the end of the thread.
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