Sunday, April 13, 2008

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.


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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