My Three Shrinks Podcast 45: Guest Ray DePaulo on Treatment Resistant Depression

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We are pleased AGAIN to have the head of Johns Hopkins Psychiatry, Dr. J. Raymond DePaulo, joining us here to talk this week about treatment resistant depression (TRD), bipolar disorder, favorite quotes, and words we don't like.

Dr. DePaulo joined us on the last podcast (#44) and talked about cosmetic psychopharmacology, among other things.

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April 13, 2008: #45 Guest Dr. Ray DePaulo on Treatment-Resistant Depression

Topics include:

• Treatment-Resistant Depression. How is it defined (~10:00 min into the podcast)? Is there a magic bullet? Treatment strategies (don't give up; remember lithium; use proven agents; get 2nd and 3rd opinions; do psychotherapy).
  
  
• Nellie, the Hypothetical Patient. Let her know what we know about treatment, and what we don't.
  
  
• "Alternative" Treatments. St. John's wort; SAMe (s-adenosylmethionine); omega-3 fatty acids; ketamine; vagal nerve stimulation (VNS); deep brain stimulation (DBS); psychosurgery (cingulotomy).
  
  
• Cognitive Therapy. Many different types.
  
  
• Words which are Unliked by the Podcasters. Alternative treatment. Mood stabilizer. Antidepressant. Antipsychotic. Hallucinogen. Psychosis. Neurosis. Organic. Schizophrenia. Nervous breakdown. Mood Swings.
  
  
• Quotations We Like.
  "There's only two types of music: good music and bad music." Fran Liebowitz
  "Eighty percent of success is showing up." Woody Allen
  "Expect more of yourself and less of others; you'll be disappointed less." Unknown
  "Life is unfair; the sooner you figure that out, the happier you will be." Unknown (Lilya said it in 2003 on a recovery forum)
  "A good clinician is someone who makes prudent decisions based on insufficient information." Ray DePaulo (I think)
  "Experience is what we call it when we were looking for something else." Federico Fellini
  "Good decisions are based on experience. Experience is based on bad decisions." probably Mark Twain
  "'Experience' is simply the name we give our mistakes." Oscar Wilde
  "Science is a process of conjecturing and refuting what is thought to be universal, therefore a theory can only be considered 'scientific' if it is falsifiable," paraphrasing Karl Popper.
  "It's a short step from the penthouse to the outhouse." Unknown (many found)
  "It's a short step from Who's Who to Who's He." Unknown
  "There ain't no such thing as a free lunch," or TANSTAAFL, by Robert A. Heinlein.
  "When Momma ain't happy, no one's happy." Apparently, an old southern saying.
  "For every aphorism, there is an opposite aphorism that's equally true." Unknown
  "Children can be happy when their parents are miserable. But a parent is never happier than her unhappiest child." Laura Lippman
  "Data is not knowledge, and knowledge is certainly not wisdom." Unknown
  
  
• Drugs in the Drinking Water. Brief mention of last month's AP story finding all sorts of pharmaceuticals in numerous municipal water supplies.
  
  
• Books we are reading.
  -Ray: "Saint Augustine", by Garry Wills.
  -Roy: "Valis", by Philip K. Dick. (Ben was reading it on "Lost".)
  -Clink: More listening to an opera about Carmen, a famous female sociopath.
  -Dinah: "How Doctors Think", by Jerome Groopman.
  
  

Dr. DePaulo's most recent book is Understanding Depression.

There are three audiences for this authoritative book: people who think they may be depressed, those whose condition has already been diagnosed and are in treatment, and those who are concerned about someone who is either in treatment or probably needs to be.

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Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well (mythreeshrinksATgmailDOTcom). This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.

My Three Shrinks Podcast 44: Guest J. Raymond Depaulo MD

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We are pleased to have the head of Johns Hopkins Psychiatry, Dr. J. Raymond DePaulo, joining us here to talk about diagnoses, labels, and the ethics of using drugs to enhance one's cognitive skills (a fascinating discussion).

Dr. DePaulo joins us on the next podcast as well (#45) to talk about treatment-resistant depression, bipolar disorder, favorite quotes, and words we don't like. That should be up by April 6.

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March 30, 2008: #44 Guest Dr. Ray DePaulo

Topics include:

• NYT: The Ethics of Artificial Brain Enhancement, by Benedict Carey. On using cognitive enhancers, like Adderall, Vyvanse, and Provigil, to perform better. The article quotes NIDA's Nora Volkow, who wrote, "Even though stimulants and other cognitive enhancers are intended for legitimate clinical use, history predicts that greater availability will lead to an increase in diversion, misuse and abuse." Dr. DePaulo addresses the treatment of symptoms (eg, inattention in pilots) vs diagnoses, on the bases of functional impairment and subsequent consequences. Be sure to listen to the part around 24 minutes, where we discuss the ethics of a hypothetical drug that increases IQ by 30 points.
  
  
• Diagnosis in Psychiatry. Also some comments on ADHD vs Bipolar diagnosis, which led into an interesting discussion about the nature of diagnosing psychiatric "syndromes" in the absence of a definitive diagnostic aid, like a blood test or brain scan.
  Other references and topics mentioned by Dr DePaulo: Kraepelin. // Quote from Paul McHugh: "A good clinician in Psychiatry is someone who makes prudent decisions based on insufficient information." // Judy Rapoport's 1978 study of stimulants in normal kids. // The history of "ADHD" and "minimal brain dysfunction". // Labels and diagnoses. // William Styron // Kraepelin's Manic-Depressive Insanity.
  
  
• Prison Health Care. Clink compares correctional psychiatry capabilities with those in free society and wonders why care can be provided in jails and prisons yet we are the only country still without some sort of national health care.
  
  
• JAMA: Loss of Serendipity in Psychopharmacology, by Donald Klein. Article in the March 5 issue of JAMA. "This Commentary on the psychopharmacological revolution focuses on 2 mysteries: fostering medication discovery and finding out how they work."
  

Dr. DePaulo's most recent book is Understanding Depression.

There are three audiences for this authoritative book: people who think they may be depressed, those whose condition has already been diagnosed and are in treatment, and those who are concerned about someone who is either in treatment or probably needs to be.

Credit: At the end is a few seconds of "Manic Monday" by The Bangles [iTunes, Amazon].

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Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well (mythreeshrinksATgmailDOTcom). This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.