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Brain scans - fMRI, QEEG, PET, or SPECT - for psychiatric problems


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More on the Amen Clinics and their SPECT scans:

 

http://www.washingtonpost.com/lifestyle/magazine/daniel-amen-is-the-most-popular-psychiatrist-in-america-to-most-researchers-and-scientists-thats-a-very-bad-thing/2012/08/07/467ed52c-c540-11e1-8c16-5080b717c13e_story.html

 

Daniel Amen is the most popular psychiatrist in America. To most researchers and scientists, that’s a very bad thing.

By Neely Tucker August 9, 2012 Washington Post

 

....

At this point, you might think Daniel Amen is one of the most highly regarded psychiatrists in the land.

 

Not so. Officials at major psychiatric and neuroscience associations and research centers say his SPECT claims are no more than myth and poppycock, buffaloing an unsuspecting public.

 

None of the nation’s most prestigious medical organizations in the field — including the APA, the National Institute of Mental Health, the American College of Radiology, the Society of Nuclear Medicine and Molecular Imaging and the National Alliance on Mental Illness — validates his claims.

 

No major research institution takes his SPECT work seriously, none regards him as “the number one neuroscience guy,” and his revelations, which he presents to rapt audiences as dispatches from the front ranks of science, make the top tier of scientists roll their eyes or get very angry.

 

“In my opinion, what he’s doing is the modern equivalent of phrenology,” says Jeffrey Lieberman, APA president-elect, author of the textbook “Psychiatry” and chairman of Psychiatry at Columbia University College of Physicians and Surgeons. (Phrenology was the pseudoscience, popular in the early 19th century, that said the mind was determined by the shape of the skull, particularly its bumps.) “The claims he makes are not supported by reliable science, and one has to be skeptical about his motivation.”

 

“I think you have a vulnerable patient population that doesn’t know any better,” says M. Elizabeth Oates, chair of the Commission on Nuclear Medicine, Board of Chancellors at the American College of Radiology, and chair of the department of radiology at the University of Kentucky.

 

“A sham,” says Martha J. Farah, director of the Center for Neuroscience & Society at the University of Pennsylvania, summing up her thoughts on one of Amen’s most recent scientific papers.

 

“I guess we’re all amateurs except for him,” says Helen Mayberg, a psychiatry, neurology and radiology professor at Emory School of Medicine and one of the most respected researchers into depression and brain scanning. “He’s making claims that are outrageous and not supported by any research.”

 

“I can’t imagine clinical decisions being guided by an imaging test,” says Steven E. Hyman, former director of the National Institute of Mental Health and current director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard.

 

The APA, in fact, has twice issued papers that dispute “claims being made that brain imaging technology ... was useful for making a clinical diagnosis and for helping in treatment selections.”

 

The most recent paper was published last month. It was the work of 12 doctors who spent three years assessing the latest research. The summary: “There are currently no brain imaging biomarkers that are currently clinically useful for any diagnostic category in psychiatry.”

 

Four years ago, Robert Burton, the author and former associate chief of the department of neurosciences at the University of California at Mount Zion Hospital, wrote a harsh article on Salon.com about Amen’s work. The headline was “Brain Scam.” When recently told that Amen was still in business and grossed $20 million last year, Burton asked for the dollar figure to be repeated.

 

“Oh, my God,” he said. “Just oh, my God. At some point this gets to be obscene — that’s just my bias — but oh, my God.”

 

....

Meanwhile, the disconnect between Amen’s public image and professional reputation among the elite in the field has come to defy logic.

 

Few top researchers and scientists say that SPECT is anything but a research tool of limited clinical use in identifying strokes, brain injuries and the like. It is helpful in group studies, to say broad things about groups of patients, but not specific things about individual patients. And, researchers say, SPECT has largely since been surpassed by technologies such as PET and functional MRIs, which give images of far greater clarity. It’s no longer viewed as cutting edge.

 

The APA first debunked many of Amen’s SPECT claims in a 2005 report. In 2008, Carlat, the Tufts professor and author, went to California to test Amen’s clinic. He then wrote, in Wired Magazine, that the black-clad Amen looked “more like a Miami maitre d’ than a psychiatrist,” that the SPECT scan was “spectacularly meaningless” and that Amen’s analysis of it reminded him of a “shrewd palm reader.”

 

(Amen says Carlat asked to be scanned for free, refused to completely fill out medical forms and misrepresented the nature of the article he was writing.)

 

In 2010, Thomas Insel, director of the NIMH, wrote on his blog that while the technology “might be playing in prime time on some TV infomercials, brain-imaging experts say we’re not quite there yet.”

 

Earlier this year, Anissa Abi-Dargham, a highly regarded professor of clinical psychiatry and radiology at Columbia who has done extensive work with brain imaging, spoke at an APA symposium on the limits of SPECT. She listened to Amen’s hour-long lecture there.

 

Reached by phone recently, she said: “Had I known what this was, I would have never agreed to be part of it. It was not a scientific debate. It was propaganda for his clinics.”

 

Amen replies that the “pro-SPECT” side clearly won the debate: “People usually underestimate me when they debate me.”

 

....

Also see http://neurocritic.blogspot.com/2012/08/the-dark-side-of-diagnosis-by-brain-scan.html

 

In a comment on this post, Neuroskeptic said...

good post, the radiation exposure is perhaps the most scandalous part of all this. I don't know exactly what the risk of inducing a fatal tumour is for Amen's scans. But for comparison, a PET study I am involved in at the moment, has an estimated risk of about 1 in 4000 per subject. Which would make an estimated 18 cancer deaths if we had an n of 70000.

Also, I commented:

If you read the Yelp.com reviews of the various Amen clinics, you'll see lots of dissatisfied customers and interesting reports of half-baked treatment regimens.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I had the same spect scan with the same results!! It turned out i have lyme disease for a long time.good luck to you.

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  • 2 months later...

This is interresting...

 

When I had my adverse reaction, it felt like blood flow to the brain was compromised.

 

Alto, does blood flow of the brain return to normal? And toxic brain injury?

 

Do all of these things heal completely eventually? Or are we stuck with this damage

forever??

Was on Citalopram 20mg since Feb 2008 - switched to Paxil 20mg in August 2010

Tapered way too fast in April 2012 by skipping days. Taper completed in 6 weeks

Tried prozac 20mg for 3 days - felt spaced out, not better.

Tried 30mg Cymbalta for 2 days. SEVERE ADVERSE REACTION

Antidepressant free since 14 August 2012

Birth control on and off during this time - Last taken 18 June 2017 - Morning after pill 

Started mainly using 0.5mg Xanax beginning 2016 for severe panic attacks and anxiety due to trauma

Xanax on and off never more than 0.5mg at a time, never taking it 3 days in a row - used sparingly 

 

6 Years antidepressant free - Still in severe withdrawal with over 60 symptoms

Severe setback started May 2018 with no let up to date. Developed many new symptoms like tremors, inner vibrations, insomnia, visual distortions and dr/dp are 100x worse, i have severe sensitivity to movement, My dizziness and vertigo got worse and it now feels like im constantly rocking on a boat, my anxiety is sky high, suicidal idiation is back, i feel extremely brain damaged 

 

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The SPECT scans are invalid when it comes to withdrawal symptoms.

 

Yes, your blood flow will be normal. You will recover. Try to get gentle exercise, such as a half-hour of walking every day.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I encourage anyone considering any scan (MRI, SPECT, etc) to ask their (reputable) doctors what information the scan might reveal and how that information will clarify the clinical picture and treatment approach.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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.... that the black-clad Amen looked “more like a Miami maitre d’ than a psychiatrist,”

 

In general I've noticed how frequently private practice psychiatrists dress unusually (sometimes inappropraitely) given their position and credentials. I've met my doctor while he was wearing a hot yoga outfit. I had an appt w/ a shrink who sat cross-legged in a frog-shaped leather chair dressed in a SteveJobsHalloweenCostume. I've had an appts in which the doctor's attire led my mind to wonder if I was participating, unbeknownest, in a bit in a Wes Anderson movie.

 

It's the seal of approval generated by the 21st century stuff like the scans and the studies that was supposed to generate the respect for this field of medicine which has, historically, played the Rodney Dangerfield role.

 

About 50% of the male psychiatrists I have seen (I can't say the same for the women) present themselves in such a way I often think they appear like a Saturday Night Live carcicature of a psychiatrist. I almost think psychiatrists are aware of the absurdity of their profession and this awareness manifests by the unusual ways they express themselves relative to other physicians or professionals making comparable salaries.

 

/apologies for tangent

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Mine wears tweed jackets, cashmere turtlenecks, tailored pants, and tasseled loafers, but I don't hold that against him.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 3 months later...
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None have been shown to have any validity and are useless for diagnostic purposes. This includes the fMRI, QEEG, and SPECT scans promoted by the Amen Clinics.

 

American Medical Association Journal of Ethics, Farah et al 2012: Diagnostic Brain Imaging in Psychiatry: Current Uses and Future Prospects

In this article we review the current status of brain imaging for psychiatric diagnosis. Among the questions to be addressed are: why has diagnostic neuroimaging not yet found a place in psychiatric practice?....

 

Structural and functional studies reveal a high degree of variability within groups of healthy and ill subjects, often with considerable overlap between the distributions of the two groups [3]. In the language of diagnostic tests, imaging studies are generally not highly sensitive to the difference between illness and health....

 

While some physicians insist that they are able to use brain imaging now for psychiatric diagnosis, there is currently no reliable evidence supporting this view. On the contrary, there are many reasons to doubt that imaging will play a role in psychiatric diagnosis in the near future. As argued here, much psychiatric imaging research remains to be done to achieve sensitivity, specificity, and standardization of imaging protocols.

 

In addition, the nature of current psychiatric diagnosis may not even correspond to the categories of brain dysfunction that imaging reveals. Finally, the practical value of maintaining continuity in diagnostic classifications requires a cautious and incremental approach to redrawing diagnostic classifications on the basis of imaging research.

Am J Psychiatry. 2010 May;167(5):598.

Scientifically unfounded claims in diagnosing and treating patients.

Adinoff B, Devous M.

Dr. Amen claims that numerous psychiatric illnesses can be diagnosed and treatments prescribed based on resting single photon emission computerized tomography (SPECT) images. Dr. Leuchter correctly points out the absence of empirical data to support the claims of Dr. Amen. Several years ago, following conversations with Dr. Amen on how to address such concerns, the Brain Imaging Council of the Society of Nuclear Medicine offered Dr. Amen the opportunity to submit his analyses of a blinded set of SPECT scans (to have been prepared by the Brain Imaging Council) to determine how effective his technique is at correctly diagnosing subjects. Although this proposed study could have provided support for his approach, the offer was declined. Nevertheless, for more than two decades, Dr. Amen has persisted in using scientifically unfounded claims to diagnose and treat patients (over 45,000 by his own count).

American Journal of Psychiatry, Adinoff B, Devous M., 2010: Response to Amen Letter

As noted in our letter as well as in the book review by Leuchter (1), there is presently no evidence to support neuroimaging techniques to aid, substantiate, or otherwise illuminate the diagnosis or treatment of psychiatric disorders. The references offered by Dr. Amen do not suggest otherwise. Camargo (2) notes that "Brain SPECT in psychiatric disorders is still investigational. Despite considerable research interest in this area, specific patterns of the various diseases have not been definitely recognized." Although Carmago goes on to state that "perfusional and receptor imaging findings may be used as an additional diagnostic tool to guide clinicians searching for a definite diagnosis," no validated examples of this approach were provided. Brockman et al. also did not advocate the use of SPECT in clinical practice. In fact, Brockman et al. (3) specifically noted that the use of SPECT in predicting treatment response "is beyond the sensitivity of this method."

NIMH, Thomas Insel, 2010: Brain Scans – Not Quite Ready for Prime Time

 

Salon.com, 2008: Brain scam: Why is PBS airing Dr. Daniel Amen's self-produced infomercial for the prevention of Alzheimer's disease?

At the core of Amen’s crusade — both in print and on TV — is a type of functional brain imaging known as SPECT (single photon emission computed tomography), a radioisotope-enhanced CAT scan that measures blood flow in certain regions of the brain. Amen relies heavily on SPECT to make an early diagnosis of Alzheimer’s so that it can be prevented. But medical science does not support his view.

 

“SPECT scans are not sufficiently sensitive or specific to be useful in the diagnosis of A.D.,” neurologist Michael Greicius , who runs the Stanford University memory clinic, and has a special interest in the use of functional brain imaging in the diagnosis of A.D., tells me. “The PBS airing of Amen’s program provides a stamp of scientific validity to work which has no scientific validity.”

Carlat Psychiatry Blog, 2008: More on SPECT scans and Daniel Amen

 

sciencebasedmedicine.org, Hall, 2008: SPECT Scans at the Amen Clinic – A New Phrenology?

 

Quackwatch, Hall, 2007: A Skeptical View of SPECT Scans and Dr. Daniel Amen

 

 

Even the more sensitive fMRI scans show nothing useful for diagnosis, see Do fMRI brain scans show the mind in action?

 

Also see these topics

Neuroskeptic: People move around a lot during fMRI brain scans

 

Neuropsychiatrist Vaughan Bell on the trouble with brain scans

 

Psychiatry tries to drum up business for new drug research

 

Do fMRI brain scans show the mind in action?

 

Brain scanning: Lots of noise in those pretty pictures

 

SPECT scan results - need help!

 

1boringoldman.com Wary skepticism.....

 

Neuroscientist Daniel Bors: The dilemma of weak neuroimaging papers and What's wrong with neuroimaging studies of emotions

 

And lastly No recommendations for commercial programs to assist withdrawal

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Quantitative Electroencephalography or QEEG is a brain imaging technique used to diagnose psychiatric disorders. That it isn't used universally speaks to the fact that it has no known validity for this type of diagnosis. See this article http://blog.neulaw.org/?tag=qeeg

The QEEG has been used clinically to diagnose illnesses such as ADHD (Attention Deficit Hyperactivity Disorder) by giving “neurofeedback.” ADHD was characterized by a large number of slow brainwaves and a smaller amount of fast wave activity. Patients would in turn receive “neurofeedback training” for ADHD. However, scientists such as psychiatry professor at the State University of New York Upstate Medical University and ADHD expert Russell Barkley argued that neurotherapy from QEEG neurofeedback is similar to the placebo effect. However, neurotherapy supporters mention that Barkley’s research is funded by large drug companies (3). Either way, the fact that there is doubt and skepticism in the field is reason to worry for QEEG’s validity and confidence in its results.

Daniel Carlat in Wired http://www.wired.com/medtech/health/magazine/16-06/mf_neurohacks?currentPage=all

Looking through some of the papers that Prichep hands me at the end of my visit, I find the same pattern of inconclusive group average differences that make the Spect and PET findings so hard to interpret. According to UCLA neurologist Marc Nuwer, who assessed the QEEG field for the American Academy of Neurology, these findings mean little. "Running large numbers of statistical tests routinely causes large numbers of randomly encountered purported statistical abnormalities' that are of no clinical significance." The only way to see whether these so-called profiles are valid is to choose one derived from such studies and then see if the profile actually correlates with a diagnosis. The best study along these lines couldn't establish a correlation. Nuwer calls it "a total failure."

QEEG is one of the tests promoted by the Amen Clinics. If you have gotten sucked into this semi-scam, please be careful about paying a lot of money for useless testing and arbitrary treatment.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Thanks very much for putting this together Alto. I recently saw someone claiming that neuro-imaging had made all discussions of the socially constructed nature of psychiatric diagnoses irrelevant (specifically the arguments made by Thomas Szasz). The statement seemed absurd to me but I hadn't yet investigated brain imaging so I couldn't directly dispute it. Seems to me that the discoveries of brain imaging are really rather overstated by its proponents. And yet even if there were some observable differences between 'healthy' and 'unhealthy' brains, there would still be the question of how to interpret or categorize these differences, an inevitably social process. There are so many assumptions and fallacies underlying today's neurological reductionism that it's amazing how successful it is. I think it's safe to say that most of its success can be attributed to its profitability.

3 Years 150 mgs Effexor

2 month taper down to zero

3 terrible weeks at zero

Back up to 75 mgs

2 months at 75

6 or so months back to regular dose of 150 - was able to restabilize fine.

3 month taper back to zero

1 HORRENDOUS week at zero

2 days back up to 37.5

3 days back up to 75

One week at 150 - unable to stabilize.

Back down to 75 mgs

At 75 mgs (half original dose) and suffering withdrawal symptoms since October 2012.

 

"It is a radical cure for all pessimism to become ill, to remain ill for a good while, and then grow well for a still longer period." - Nietzsche

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There's a lot of government funding going into high-tech diagnostics such as brain scans and genomics. You can expect a great deal of hype coming out of the many studies that will be generated.

 

For now, brain scans for psychiatric diagnosis are a fad.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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There's a lot of government funding going into high-tech diagnostics such as brain scans and genomics. You can expect a great deal of hype coming out of the many studies that will be generated.

Yes, this concerns me a great deal, as I imagine it will lead to an even greater expansion of diagnostic psychiatry into everyday life. What's strange to me is all of the public enthusiasm surrounding these kinds of studies. It's as if people are clamoring for more social control.

3 Years 150 mgs Effexor

2 month taper down to zero

3 terrible weeks at zero

Back up to 75 mgs

2 months at 75

6 or so months back to regular dose of 150 - was able to restabilize fine.

3 month taper back to zero

1 HORRENDOUS week at zero

2 days back up to 37.5

3 days back up to 75

One week at 150 - unable to stabilize.

Back down to 75 mgs

At 75 mgs (half original dose) and suffering withdrawal symptoms since October 2012.

 

"It is a radical cure for all pessimism to become ill, to remain ill for a good while, and then grow well for a still longer period." - Nietzsche

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  • 1 month later...

I think we should be careful not to be inflexibly dismissive of brain scans. There's unquestionably something disturbingly reductive about many of the claims made for the scans, especially in trying to make the leap from imaging to psychiatric diagnosis and treatment. Amen is clearly a semi-charlatan. And there are all kinds of basic philosophical problems that attend trying to draw correspondences between imaging and mental or emotional states. The person isn't the brain. Yet most on this site also insist that the problems attending withdrawal aren't psychological but physiological---indeed, neurological---in nature. So there doesn't seem to be, in principle, any problem with using brain scans, or any other technology, to investigate neurological problems, though it's certainly the case that both technology and interpretation are in early stages.

 

I don't think all scans are a scam, and I suspect that PET, fMRI and QEEG can identify troubled areas, even if, at the moment, there aren't great therapeutic protocols that can be based on these scans.

 

Take, for instance, QEEG. QEEG, as far as I can tell, is useful mainly for guiding neurofeedback. I've been doing neurofeedback for probably 10 months now. I'm not entirely sure how much certain improvements can be attributed to time, and how much to neurofeedback, but "improvements" in my QEEG reflect improvements in some of my symptoms. (The subjective improvements were already noted well before the second QEEG "map" was done, 8 months after the first, so it's not a question of the map dictating whether I'm improved or not). It may be that certain brain scans are psychologically upsetting for people, if they think they reveal a "bad" brain, but to me it was actually comforting. My first map showed highly elevated waves---beta waves, in particular, which are associated with arousal---in numerous areas of the brain---elevations that aren't normally seen, according to my neuropsychologist, even in people with fairly high anxiety. It allowed me, first of all, to point to an "objective" measure of neurological distress. The first map basically convinced my psychiatrist, who was interested in neurofeedback, that this wasn't just a question of everyday anxiety and insomnia gone haywire. And this was the psychiatrist who first diagnosed SSRI withdrawal syndrome, so she understood the condition. Many neuropsychologists who use neurofeedback use it, fairly successfully, with problems like traumatic brain injury. (My neuropsych is actually the director of rehabilitation for a TBI center.) So they're not looking to sell you supplements, as I suppose Amen and co. do, based on QEEG. They are using the map to guide the feedback.

 

The question of the efficacy of neurofeedback for PAWS is another issue, one that I don't think I can currently adjudicate. Certainly my progress has been slower than non-medication damaged patients, but I'm also (as far as I can tell) a particularly bad case. But I just want to point out that here might be a case of brain maps being fairly useful. And these maps are pointing to real problems. You can look at numerous QEEGs of people with chronic lyme disease, which is bad where I live, and the maps are fairly consistent in showing problematically lowered brain waves across the board. The map doesn't tell you: you have lyme disease and nothing but lyme disease, but it points to problems in the brain that one attempts to address through neurofeedback.

 

Anyways, just some thoughts. This site is understandably hostile to many trends and "fads" in psychiatry, and is a living testament to the dangers of anti-depressants, but I'm not sure the entire world of brain scanning should be written off as a fad. Uncritical, techo-utopian (or dystopian!) endorsements of it, yes, but perhaps not the whole enterprise.

-300 mg Wellbutrin 2002-2005 (withdrew cold turkey with only mild complications)

-150 mg Wellbutrin, 10 mg Celexa 2006-2010

-Discontinued both cold turkey Jan 1 2011

-Unsuccessfully reinstated Celexa March 2011, but stuck with it until Jan 2012.

-Remeron 7.5 since Jan 2013---only thing that puts a dent in perpetual headache and "akathisia"

6.5 mg Lamictal since Dec 2012

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Agreed BinxBolling, I appreciate your observations here.

3 Years 150 mgs Effexor

2 month taper down to zero

3 terrible weeks at zero

Back up to 75 mgs

2 months at 75

6 or so months back to regular dose of 150 - was able to restabilize fine.

3 month taper back to zero

1 HORRENDOUS week at zero

2 days back up to 37.5

3 days back up to 75

One week at 150 - unable to stabilize.

Back down to 75 mgs

At 75 mgs (half original dose) and suffering withdrawal symptoms since October 2012.

 

"It is a radical cure for all pessimism to become ill, to remain ill for a good while, and then grow well for a still longer period." - Nietzsche

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Brain scans show something is going on, but many researchers over-reach in interpretation.

 

They are not at all helpful in diagnosing psychological states. They may be invaluable in diagnosing physiological changes in the brain, or in physical diseases.

 

Neurofeedback is another kettle of fish entirely.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I am a little curious as to how a fMRI or SPECT would align with my MRI. Not curious enough to pay a few thousand dollars.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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  • 4 months later...

I saw an autoimmune specialist last week who diagnosed CNS Sjogrens /lupus and gave me the option to do a PET scan because my MRI showed damage. I'm not clear what a PET or SPECT will reveal in this context so reading through this thread again.

 

The diagnostic workup was not definitive (bloodwork and salivary biopsy slightly positive, MRA normal). Not proceeding with therapy at this point, just FYI.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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I don't know if PET or SPECT is diagnostic for those illnesses. They may show physiological changes. This topic questions whether they are valid for showing psychological processes.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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The End of Neuro-Nonsense

Is the age of mindless brain research already over?

 

By Daniel Engber July 29, 2013, Slate.com

 

http://www.slate.com/articles/health_and_science/science/2013/07/neuroscience_hype_is_brain_science_still_trendy.html

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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The End of Neuro-Nonsense

Is the age of mindless brain research already over?

 

By Daniel Engber July 29, 2013, Slate.com

 

I read that on Slate... cool, huh?  Now if the word only filters down to docs in the trenches.

As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

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Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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I also read that article in Slate. I do think that these tests have their place, but certainly mostly for physical problems such as brain tumors and skull fractures and head injuries of a more massive type.

 

My husband does have a TBI acquired years ago. And although he could speak well, and walk, and do ordinary "things," over a period of a week after coming out of the hospital from his accident, his behavior, memory, sleep patterns, and reading ability showed that something "was not right."

 

And yet none of this showed up on any MRI at all or of course, an X-ray of his skull. And he also had a PET, and that also showed nothing. But he was profoundly injured as his brain had been shaken inside his skull numerous times during his accident, breaking up tiny nerves and blood vessels. And this is what constitutes a concussion, then the recovery period (called post concussion syndrome), and if sx continue past that period (it was 6 months at the time) a TBI, or closed head injury. And it is also the case that TBI can constitute a very visible injury to others and profound injuries that will show up on an MRI and other tests.

 

So he had several neuropsychology workups, 2 years of rehab, but still he was disabled. And I do believe that the SPECT had just come on as one of the newest neuroscience tests that was supposed to be able to finally see these tiny physical changes within the brain. But with all his testing and rehab attempts, it seemed to me like the situation was evident. And I lived with him 24 hours a day, and I could easily see how he had changed. I did not want him to be subjected to any more radiologic testing as he had had enough, and even a physical injury like this could not be seen at that time by all of that, and it was not pushed by any of his doctors except the neuropsychologist, and only to he and I as I tend to think it was still unknown if it really could see those minute, but nevertheless life altering injuries.

 

Things may have changed in this area for these tests and what they can see with regard to closed head injuries. I do not know. I know much more is recognized about the impact of concussions now than 15 years ago. But overall, I tend to see a lot of these tests from a radiologic risk also aside from neuro imaging in psychiatric practice.

 

Marie

On Xanax 10 years for anxiety, 2 mgs, night only. Attempted my own taper w/o understanding the dependency issues.

 

Researched and then understood the need for longer half life med. Doctor crossed me from X to klonopin 4 times in 6 months. Last time on X, she up dosed me to 3 mgs X.

 

On last cross attempt, ended up in ER with profound w/d sx from X. Got new doctor. Final cross to K, structured, slow was completed 6/5/12-12/5/12.

 

Attempting liquid micro taper from K. Difficulty with micro cuts; significant w/d sx requiring several weeks of holding after each cut. Also concerned if it's possible to use pill/liquid combo for dosing.

 

Hope I Meet Other Benzo Taperers Here! I have tried ADs in past. Could not tolerate them, gave up trying, none for over 12 years.

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Marie, thank you for sharing your experience. I wasn't aware that PET and SPECT were so different. I'm sorry for what you've both gone through.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Barbara,Thank you. I think that we as "lay people" have been sometimes led along by psychiatry in many ways. My husband did see a psychiatrist for his injuries for years, and we recently just changed his doctor as it seemed that after all the years of good management of all his sx, she suddenly said she needed "new" information or "updated" information.And this was surprising to me as she is/was the updating person herself, as we saw her regularly every 6 months for him. I challenged this idea of hers stating just that. In other words, with no evident changes, there was no need for this updating by subjecting him to new MRIs and new neuropych testing as it all had been done. I just saw this as a real attempt to introduce some of these tests again for no particular reason other than possibly leading to further compensation to her at his expense radiologically speaking.I'm not really sure how different the PET and SPECT testing is but i do know that the specscan as it was called, was originally designed to pick up those minute changes in the brain. I don't know if that is still the case, and dont know still that it even ever could, does or will, but I just caution all to avoid any attempts by any doctor to subject themselves to brain radiology tests unless there is some true medical need because of the radiological aspects.

 

And I just cant imagine a doctor ordering such testing for psychological purposes after my experiences and those of my husband.

 

Continual radiation to any part of the body is cumulative, and we all know how sensitive and important out brains are so this is where I am coming from.

 

Thank you again, Barbara for your compassion.

 

Marie

On Xanax 10 years for anxiety, 2 mgs, night only. Attempted my own taper w/o understanding the dependency issues.

 

Researched and then understood the need for longer half life med. Doctor crossed me from X to klonopin 4 times in 6 months. Last time on X, she up dosed me to 3 mgs X.

 

On last cross attempt, ended up in ER with profound w/d sx from X. Got new doctor. Final cross to K, structured, slow was completed 6/5/12-12/5/12.

 

Attempting liquid micro taper from K. Difficulty with micro cuts; significant w/d sx requiring several weeks of holding after each cut. Also concerned if it's possible to use pill/liquid combo for dosing.

 

Hope I Meet Other Benzo Taperers Here! I have tried ADs in past. Could not tolerate them, gave up trying, none for over 12 years.

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I have a perfectly normal brain according to my neurologist who was treating my headaches via MRI. I am shocked, but not really. I don't expect it to find any finer detail of what is going on after my psych history of bipolar and all the meds.

Finished slow taper on 4/6/14 from 20 mg to 6 beads over period of almost a year on Cymbalta and then quit cannabis around the time I DC'd Cymbalta.

Tried to go off completely 8/13 - 8/20 (didn't work) - Reinstated 10mg on 8/21/13

Off Adderall (2010 -2013) after 3.5 years since July 12th, 2013

Taking Tramadol 50 mg since 2007 for chronic pain

Lamictal 450 mg (from 2007 - 2009)

Lexapro (2004-2007 30 mg?)

Ambien (2009-2010)

Trazadone (2010-2011 for sleep)

2008-2010 -Trials of Wellbutrin, Paxil, Ritalin, Concerta, Effexor, Risperdal, Abilify, Seroquel, Trileptal

Earlier history includes - long courses of Tricyclics, Prozac, Wellbutrin, Paxil. Serzone, Celexa, Remeron, Zoloft for shorter periods.

Haldol, Lithium, Stelazine. Xanax, Clonipin, and Ativan have been used on and off, mostly Clonipin. Went through serious Xanax withdrawal a couple times in my life so far. Methadone (2003-2005 - psychiatrist/pain management doctor decided that was the first thing I ought to try for moderate chronic pain).  MS Contin 2005-2007 (aka Morphine)

 

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  • 1 year later...

Trying to piece this all together. I know our friends at the APA don't believe in using SPECT scans for psychiatric diagnoses. Fine, since those are mainly rubbish.

 

Let's say we even want to dispute the notion of toxic brain injury...

 

But what about genuine physical head injuries? Can SPECT show evidence of those?

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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Could look up SPECT scan and see but I was just reading in my new book about a new test called  "Diffused Tensor Imagaing"  

 

They are speaking about concussion in this part of the book 

 

"The effects of concussion are not confined to the point of impact any more then a hammer blow to a window breaks only the part of the window that is struck. the huge transfer of energy radiates throughout the brain. It can affect not only the cell bodies of the neurons but also the axons that connect neurons.  Axonal injury can be seen only with the new kind of scan call the diffused tensor imaging.  Since axons connect different brain areas damage to axons can cause problems in all those areas so that many functions - sensory motor movement cognition and mood... are affected regardless of where the initial impact occurred.  And perhaps this explains why people who have had blows to different parts of the head may have uncannily similar symptoms. 

 

My question would be do either of these scans show the area we suspect to have problems affecting the HPA... 

 

As for the blood flow issue I would not doubt it... have often thought inflammation was a part of what is going on in my head and blood flow both... that is just my big ideas nobody has actually said either was an issue.  

I have not had either of these scans. 

 

I cannot say if this relates to anything the OP is speaking  of but it is the latest scan showing maybe something more then the old ones... I don't know and I am too lazy to look it up ... my thinking is too low to absorb a lot so it would be difficult for me... easy to copy out of book one thinks but even that is a challenge. 

 

The brain sure does not want to give up it secrets... likely a good thing as some body would find a way to mess even more with our brains to make themselves money. 

peace all

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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My brain MRI shows stroke-like 'ischemic foci' in some lobe. Not sure if the drugs did that or the massive head impact when the nurse refused to let me lie down with a bp of 65/45 and I had a seizure....a few days after CTing Effexor et al.

 

I went on scholar.google.com to research effexor discontinuation, and found a case history of a women who was admitted for what looked like stroke but was then attributed to Effexor WD. Effuxor I mean.

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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My brain MRI shows stroke-like 'ischemic foci' in some lobe. Not sure if the drugs did that or the massive head impact when the nurse refused to let me lie down with a bp of 65/45 and I had a seizure....a few days after CTing Effexor et al.

I went on scholar.google.com to research effexor discontinuation, and found a case history of a women who was admitted for what looked like stroke but was then attributed to Effexor WD. Effuxor I mean.

You could read Grain Brain on that, as if you have extra time :). I have something like that too. My dad had a traumatic brain injury after a seven foot fall onto cement. The brain injuries show up loud and clear, even on a CT scan. It's not controversial at all.

1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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  • Administrator

I'd put my bets on the seizure.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I don't recall the exact words on my MRI it did say I was too young to have it... whatever it was something in the white matter... could be inflammation could be migraines since I have migraines it was an easy  out no further looking was done. 

Wonder what the new test would show but not likely to get it... 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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Will check out Great Brain. Thanks MQ :)

 

And Alto, the seizure led to my conking my head really really hard on concrete floor, so yeah. The main thing that has happened is I can't park properly unless I really think about it. I park 4' shy of the front of a parking space in parking lots! So something about depth perception... Plus I cannot "see" an item I am looking for. It is like I am blind to the one thing on a table I seek. Say it's a pen. If my regular pen is blue, but actually an orange one is on the table, I cannot see it. The next day I'll notice it by chance. Very weird, happens all the time, but not disabling. What I do is talk to myself and it works. I say "it is blue, elongated and silver at the top," then I can see it (if it's blue--if it is yellow I am SOL).

I consider all that minor...in comparison to WD.

 

BTDT it could even be ischemic foci because those are more common in the elderly, as far as I know.

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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  • 2 months later...
  • Administrator

http://www.healthnewsreview.org/2015/01/potential-biomarker-that-could-predict-caveats-about-psychiatric-brain-imaging-blogging-about-it/
 

“Potential biomarker that could predict”? – caveats about psychiatric brain imaging & blogging about it

 

The following is a guest blog post by Susan Molchan, MD.  Dr. Molchan is a psychiatrist in practice in Bethesda, Maryland. She also trained in nuclear medicine and did PET research at the National Institute of Mental Health, and worked as the program director for Biomarkers, Diagnosis, and Alzheimers Disease at the National Institute on Aging.

 

In a recent post on the New York Times Well blog, Dr. Richard Friedman describes an article from researchers at Emory University reporting a potential biomarker in the brain that would help psychiatrists direct depressed patients towards treatment to which they would more likely respond.”....

 

He reported striking brain differences in that the brightness of the part of the brain called the insula differed in those who responded or not to drug treatment, as compared to those who responded or not to cognitive behavioral therapy, in which the patient learns to modify thoughts and behaviors to allay symptoms.

 

The Emory researchers scanned their patients with positron emission tomography or PET, and randomized them to either an anti-depressant or cognitive behavioral therapy for 12 weeks, with the idea that they would look back at the scans to see if there was a difference among those who did and didn't respond to the two treatments. They started out with 82 patients, with 65 completing the protocol, pretty good for a depression study, where about one-third of patients tend to drop out. But then comes the red flag. Data from only 38 patients were used. The researchers had stated a priori that those to be included in the analysis would have clear outcomes and usable PET scans. They defined the clear outcomes clearly with depression scale criteria.  Less clear was how the researchers would define PET scans that were not usable.” Could they toss some scans they didnt like and on what basis?  The potential for bias is clear.

 

On the PET scans, six regions in the brain lit up to show a significant interaction between treatment and treatment outcome. Two regions, the right insula, and the left cuneus lit up the most.

 

Dr. Friedman said the results fit with other brain imaging studies, and as a reference cited a study from the Emory group from several years ago. The problem is, in that study, while brain regions also responded differentially to antidepressant and cognitive behavioral treatment, they responded differentially different as compared to the 2013 study.  While the 2013 study showed decreased activity in the insula in those who responded to CBT and increased activity in those who didnt (and vice versa for the drug), the 2007 study showed the opposite. This seems more a neurocontradiction, if the ultimate aim is to predict treatment response based on consistent brain patterns.

 

Dr. Friedman cites another article for context, to show that different patients with depression may respond differently based on clinical or historical or anatomical characteristics, that indicated patients with childhood trauma, which has been correlated with smaller hippocampi, do better with treatment with cognitive behavioral therapy as compared to drugs. The first author of this 2003 paper is Dr. Charles Nemeroff, and again this should have raised a red flag; for many in psychiatry and beyond, the name conjures a black stain. As reported in both newspapers and medical journals, Dr. Nemeroff was well known for misrepresenting information, with numerous infractions for not disclosing hundreds of thousands of dollars drug companies paid him, including while NIH funded his research to study their drugs. He finally had to resign as chair of psychiatry at Emory, and resign a journal editorship for publishing an article he authored lauding a product without disclosing that the products’ manufacturer paid him. He was also prohibited from applying for NIH grants for a number of years.

 

The astute retired psychiatrist who writes the blog 1 Boring Old Man (who was also at Emory) pointed out that an erratum had been published for the Nemeroff paper, invalidating the conclusion. The 1 Boring Old Man blogger commented about both the NYT Well blog and about journal policy:

“Should Dr. Friedman have known about all of that? or about the Conflicts of Interest in the original study? 
Probably
. Even if he doesnt keep up with the blogs here at the edge of the galaxy, quoting Dr. Nemeroff, particularly from a paper back in 2000 or 2003, is always risky business. And thats a widely known bit of information in the psychiatric community 
and elsewhere
. But thats not my central point. 
A paper like that should have been retracted from the literature, or at the least, retrospectively annotated on the Journals web-site by the Journal itself
.”

The inconsistencies across studies in brain imaging, which compare groups of patients highlight how challenging it will be to translate imaging findings to individual patients.  In an important and rare randomized, controlled trial using brain scans to direct treatment, Dr. Mayberg and colleagues targeted a region in the cingulate gyrus near the front of the brain that has shown fairly consistent changes in depression (although not in the study discussed by Dr. Friedman). Prior data had indicated these patients, who had increased activity in this area of the cingulate gyrus responded well to deep brain stimulation. This involves neurosurgeryactually implanting wire electrodes in the brain; its helped some patients with Parkinsons disease.

 

Unfortunately the study, called BROADEN (BROdmann Area 25 Deep brain Neuromodulation), was stopped in December 2013, when a futility analysis showed that the study would be unable to show a difference between sham surgery and deep brain stimulation.

 

Many high hurdles remain before we can make the leap from research studies of correlations and regressions to predictions of what will help in clinical medicine. Real world patients are never as clean as research subjects; they bring their co-morbid diseases. They take lots of drugs. They drink. They smoke. They dont tell the truth about what they drink and smoke. This all adds noise to the patterns on the scans, which complicates trying to discern their meaning.

....

Biomarkers mean tests, and invariably, especially when they involve imaging, expensive tests. Many tests in medicine today are overused, as were learned from campaigns such as Choosing Wisely, spearheaded by the American Board of Internal Medicine.

The colors and flash of the technology make brain scans seductive. They can also be very profitable to those who make careers out of them, to those who market them. All the more reason to look beyond the colorful splotches of light, to follow the money, for anyone advocating clinical use in psychiatry, any time soon.

....

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 4 weeks later...

I have been watching videos by Dr Daniel Amen. 

I realize he could be wrong and maybe boringoldman is on the money with saying follow the money to see who is profiting.  A bit disappointed and perplexed... I went looking for some proof. 

Does Daniel Amen have any published articles in peer-reviewed journals?
 There are 33 articles listed in Pubmed for which D.G. Amen is on the author list: Amen DG - PubMed

here is the link.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Amen+DG

 does it prove anything I am not sure... 

I can't shake the common sense idea that brains which are causing a lot of suffering have something to tell us... something.  Has he really found truth in his work he thinks he has but without peer review it is never going to trickle down to the masses where I live.  

 

I am still perplexed as I know journals to be full of conflicts as I found many in my travels 

 

  • Finally, a Brain Scan Diagnoses Mental Illness | Bipolar ...
    natashatracy.com/mental-illness-issues/brain-scan-diagnoses-mental-illness/
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    •  
    Jul 22, 2013 - Finally, a brain scan has been FDA-approved in the diagnosis of amental illness. More at the Bipolar Burble blog.
  • Different mental disorders cause same brain-matter loss
    https://med.stanford.edu/.../different-mental-disorders-cause-same-brain-...
    •  

    Feb 4, 2015 - A meta-analysis of 193 brain-imaging studies shows similar gray-matter loss in the brains of people with diagnoses as different as ...

    "

    Limitations of Brain Scans in Diagnosing Mental Illness

    Naturally, there are limitations to this approach. First off, there is always the problem of a false result from a brain scan – and, of course, there is a margin of error on brain scans, just like on every other test. That is why the FDA has said the above ADHD test should be used in conjunction with medical and psychological evaluations. Brain scans are more an adjunctive tool right now. We’re not sophisticated enough to rely on them totally (but that will come).

    The other limitation that’s clear to me is cost. Many people can’t afford to send their child for an expensive brain scan to diagnose a mental illness and even if everyone could afford it, there would be a shortage of equipment with that kind of demand. So, certainly this test is out of reach for many."

     

     

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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Has anyone here had any sort of weird reactions to the injections used to take these tests?  A lot of these scans require injections for contrast or for radiological effects.  I'm worried that I'll have some sort of bad reaction to the injections if my neurologist requests a PET scan or something.

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  • 3 weeks later...

This just in. Not all scans use this stuff, though.

 

http://gizmodo.com/left-in-the-brain-the-potentially-toxic-residue-from-m-1711902023

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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While looking up your link WC I found this..

MRI sniper scope lets us watch single cells crawling around inside your living brain

http://www.notey.com/external/2954145/mri-sniper-scope-lets-us-watch-single-cells-crawling-around-inside-your-living-brain-extremetech-neuroscience-technology-mri-medicine-brains-imaging-medical-imaging.html

 

Maybe what we are trying to learn about and heal are these older cells.. I don't know enough to guess. 

 

" Granted, like the elder orangutan sitting idle in his cage surrounded by rinds of fruit, many adult neurons don’t get up to moving about much. What these neurons, these seeming shadows of free and independent cells, now do instead is send curious neurites as far as the body will let them."

 

It would seem something could be done with this to help our cause.. if they knew our cause that is and cared to look

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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  • ChessieCat changed the title to Brain scans - fMRI, QEEG, PET, or SPECT - for psychiatric problems
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