Training with depression? Long term prognosis? Training with depression? Long term prognosis? - Page 5

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  1. #41
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    • texas starting strength seminar september 2020
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    Quote Originally Posted by johnst_nhb View Post
    Jfsully, please forgive me for this but I am not aware of your credentials. Please understand I am not asking in order to slag on them, I literally just don’t know.

    I find your posts valuable and interesting,

    Are you an endocrinologist? Psychiatrist? GP?
    He's a psychiatrist, and we're happy to have him here.

  2. #42
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    Quote Originally Posted by johnst_nhb View Post
    “ Feeling low after your dog dies is not abnormal or a medical condition.”

    That in and of itself is true. But it seems like you should know that one shouldn’t flippantly dismiss “feeling low” outright.

    What if you are not getting over it? What if you are just not shaking it like you KNOW you should be? Like, you unexpectedly don’t feel like you have the tools to cope, even though your daily life is fine...and you used to have those tools.

    What if you read that nightmare poem, ”The Rainbow Bridge????”

    I’m no doctor and I’ve never been clinically depressed. But after a major trauma (not my dog, but that will be worse) I was “severely situationally depressed.” I simply could not shake it for almost 4 years. I went to the edge but it was not for me. But in the words of the great David Lee Roth, I stood and looked down. I had no time to mess around.

    I functioned just fine, maintained my career (albeit not at the very top of my game, but successful) but I could not understand why the “me” I always was, was not the “me” I currently was. I was sad as hell and felt like I was in a tar pit.

    I finally went to a doc, got test checked a few times and I was far <200. Given my athletic background, my doc said, “how in the hell do you lift 4x per week?” (I hired Jim Steel a while back and still use his program).

    Long-winded point being, physically I was doing well. Mentally I was not.

    A clinical dose of test cyp., after about 6 weeks, changed my fucking life (yes n=1, but n=1 is all that matters to me.) It can’t be ignored. There’s no benefit physically (physique) at my dose (a mere standard 100mg/week), nor does there need to be, but holy mother of god did getting my levels in normal range allow me to be myself.

    For some men, this is the answer.

    Jfsully, please forgive me for this but I am not aware of your credentials. Please understand I am not asking in order to slag on them, I literally just don’t know.

    I find your posts valuable and interesting,

    Are you an endocrinologist? Psychiatrist? GP?
    I'm a psychiatrist.

    I think you can see the difference between being "bummed after losing your dog" and "your life stops and you feel paralyzed and helpless for 4 years after losing your dog." (I paraphrase) One is a normal reaction, not mental illness. The other could be considered illness, ie a depressive episode triggered by a profound loss, and in your case probably exacerbated or perpetuated by low T. It's academic at this point, but I think you may have met criteria for depression (in the clinical sense) at that time. It may have been that in your case you were at risk of a depressive episode (in the clinical sense) and that the loss of your dog and/or the drop in T were tipping points that led to something more severe than normal grief.

    The point, obviously, is that there are normal experiences of sadness/fatigue/loss that in some ways resemble depressive episodes as part of a mood disorder, but are clearly not an illness that would need medical treatment. My point did not have to do with whether losing your dog qualified you or disqualified you from being described as depressed.

    If your T levels were far below normal, and taking supplemental T restored you to your normal level of function (or maybe allowed you to continue to function with a normal instead of a superhuman effort to do so), then I don't think it's debatable whether the testosterone helped you, or whether the low T caused or at a minimum significantly contributed to your difficulties. Both are clearly true.

  3. #43
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    Quote Originally Posted by jfsully View Post
    I'm going to leave it alone after this (hopefully) but my agenda in this thread is to encourage OP to work with his psychiatrist to find a med or med combination that works for his depression and psychosis without causing intolerable side effects, start or continue psychotherapy, and keep training.
    This thread has been a fascinating read for me and much of what Dr. JFSully has said is what my psychiatrist prescribed for me.

    I was referred to a psychiatrist by my psychologist. As a matter of fact, she would not continue to treat me unless I saw a psychiatrist. The psychiatrist had me change my diet to a more protein focused diet as opposed to a carbohydrate focused diet. He told me to get into the gym and start lifting weights and to work towards lifting heavier weights, to continue working with my therapist, to take the medication he prescribed to me and to continue seeing him once a week.

    In a matter of months I went from an insurmountable darkness/despair to being able to enjoy a sunny day.

  4. #44
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    Quote Originally Posted by jfsully View Post
    Thanks, Rip. I have not had a bad experience prescribing T because I don't prescribe it. I also haven't seen a patient have a bad outcome from TRT, although we know there are small but real risks with that treatment. I've had a few guys who stopped coming to see me after starting TRT. I have, however, seen more guys who came to me for depression after TRT was insufficient, even if it helped somewhat.
    I've been thinking about this, so let's quit beating around the bush here, and let me state my position. It has been my experience as an advisor -- not as a doctor -- that TRT benefits "depression" at essentially every level of severity, from mild symptoms to suicidal ideation to even acrophobia. And the effects are apparent in no more that 72 hours if the dose is high enough. There are essentially zero acute adverse effects, from even a very high dose in a male. There are very few possible chronic adverse effects described by an honest review of the literature, certainly as compared to the commonly prescribed SSRIs which don't actually work in cases of mild depression. Test is a naturally present hormone, SSRIs are not.

    So, I don't really understand the reluctance to try TRT on patients that come in the office complaining of symptoms of depression. Seems to me that the sensible thing to do would be to go to the meds locker, get out 400 mg of test cypionate, stick it in the guy's asscheek, talk to him some more, and tell him to call you back Friday with a report. It may not fix everything, but it makes some things better the vast majority of the time, and the downside of trying it is essential nothing. If nothing else, the placebo effect would be powerful enough to mitigate a 3-day delay in jamming antipsychotics into the guy, and it might just make them unnecessary. Maybe. Possibly. Seems like it would be worth a try. Why not? Seriously, why not?

  5. #45
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    Quote Originally Posted by Mark Rippetoe View Post
    I've been thinking about this, so let's quit beating around the bush here, and let me state my position. It has been my experience as an advisor -- not as a doctor -- that TRT benefits "depression" at essentially every level of severity, from mild symptoms to suicidal ideation to even acrophobia. And the effects are apparent in no more that 72 hours if the dose is high enough. There are essentially zero acute adverse effects, from even a very high dose in a male. There are very few possible chronic adverse effects described by an honest review of the literature, certainly as compared to the commonly prescribed SSRIs which don't actually work in cases of mild depression. Test is a naturally present hormone, SSRIs are not.

    So, I don't really understand the reluctance to try TRT on patients that come in the office complaining of symptoms of depression. Seems to me that the sensible thing to do would be to go to the meds locker, get out 400 mg of test cypionate, stick it in the guy's asscheek, talk to him some more, and tell him to call you back Friday with a report. It may not fix everything, but it makes some things better the vast majority of the time, and the downside of trying it is essential nothing. If nothing else, the placebo effect would be powerful enough to mitigate a 3-day delay in jamming antipsychotics into the guy, and it might just make them unnecessary. Maybe. Possibly. Seems like it would be worth a try. Why not? Seriously, why not?
    Rip, the reason I don't prescribe testosterone is not because I don't believe in it or because I disagree with your basic point here. It's because I'm a psychiatrist, and it is outside the scope of my practice. Maybe it shouldn't be outside my scope, for all the reasons you have stated, but the fact is that starting and monitoring TRT was not part of my training, and there are medicolegal risks to practicing medicine outside of guidelines and what is accepted practice for your specialty. I live and work in a metropolitan area, with literally dozens of hospitals and academic medical centers in driving distance, so finding a GP, endocrinologist, urologist, or "healthy aging clinic" willing to do TRT is not at all hard to do for my patients, and i do suggest that when appropriate. If I was in a more isolated area and TRT wasn't that available, I might get trained up and offer it myself.

    This discussion has been challenging and eye-opening for me, and I do by best to remain teachable and open to different ideas and approaches, so your suggestions and thoughts are not falling on deaf ears and will affect my practice.

  6. #46
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    You're a stand-up guy, JF. Thank you.

  7. #47
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    Quote Originally Posted by Mark Rippetoe View Post
    I've been thinking about this, so let's quit beating around the bush here, and let me state my position. It has been my experience as an advisor -- not as a doctor -- that TRT benefits "depression" at essentially every level of severity, from mild symptoms to suicidal ideation to even acrophobia. And the effects are apparent in no more that 72 hours if the dose is high enough. There are essentially zero acute adverse effects, from even a very high dose in a male. There are very few possible chronic adverse effects described by an honest review of the literature, certainly as compared to the commonly prescribed SSRIs which don't actually work in cases of mild depression. Test is a naturally present hormone, SSRIs are not.

    So, I don't really understand the reluctance to try TRT on patients that come in the office complaining of symptoms of depression. Seems to me that the sensible thing to do would be to go to the meds locker, get out 400 mg of test cypionate, stick it in the guy's asscheek, talk to him some more, and tell him to call you back Friday with a report. It may not fix everything, but it makes some things better the vast majority of the time, and the downside of trying it is essential nothing. If nothing else, the placebo effect would be powerful enough to mitigate a 3-day delay in jamming antipsychotics into the guy, and it might just make them unnecessary. Maybe. Possibly. Seems like it would be worth a try. Why not? Seriously, why not?
    Because TRT is generally seen as a lifelong commitment, and one that does come with health risks and things that need to be monitored, stuff like hematocrit and lipids for example. If a large acute dose makes the guy feel better, what happens when it wears off - does he come back for another shot? And then when his endogenous production of test is shut down, and may not recover, what does he do? And if he's a young person wanting to have children and it messes with his fertility, what then?

    I also have read lots of accounts from people where TRT _hasn't_ helped their depression and in some cases it's worsened it because they find themselves now dependent on it for life, dealing with side effects (granted, some of this due to the amount of inappropriate protocols and non experienced doctors prescribing it).

    Don't get me wrong here, I'm an advocate for TRT where it's warranted, and I don't agree with the reluctance to prescribe it / stigma associated with it. But it's still not something to be taken lightly and the medical community is right to be cautious about it IMO.

  8. #48
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    Quote Originally Posted by BenM View Post
    Because TRT is generally seen as a lifelong commitment, and one that does come with health risks and things that need to be monitored, stuff like hematocrit and lipids for example.
    This is obviously up to the patient. If a guy has been suffering from depression for months or years, and 400mg of test cyp restores his sanity in 2 days, I suppose you'd argue that since sanity is afterward a lifetime commitment, it's just not worth the risk of a elevated H&H (something that certainly as hell doesn't always happen, and if it does is managed by blood donation) to keep doing what makes your sanity possible.

    If a large acute dose makes the guy feel better, what happens when it wears off - does he come back for another shot?
    Is this a serious question? What if a guy has high blood sugar, and a shot of insulin makes it go down? What does this guy do? Suck it up so he doesn't have to "go back" for another shot?

    And then when his endogenous production of test is shut down, and may not recover, what does he do?
    It does recover -- you don't know what you're talking about. But let's say it doesn't: it wasn't high enough to keep him free of the symptoms he came in the office for, so I guess you want him depressed with his test at 175, since that's endogenous.

    And if he's a young person wanting to have children and it messes with his fertility, what then?
    Then he comes off the test, gets the old lady settled, and goes back on.

    I also have read lots of accounts from people where TRT _hasn't_ helped their depression and in some cases it's worsened it because they find themselves now dependent on it for life, dealing with side effects (granted, some of this due to the amount of inappropriate protocols and non experienced doctors prescribing it).
    Lots?? Please share.

    Don't get me wrong here, I'm an advocate for TRT where it's warranted, and I don't agree with the reluctance to prescribe it / stigma associated with it. But it's still not something to be taken lightly and the medical community is right to be cautious about it IMO.
    You seem to be taking several things rather lightly, like the long-term effects of even mild depression. The medical community is right to be cautious if there are risks associated with the administration of a drug. Yet somehow, Lipitor and Prozac have escaped your notice.

    This really is an amazingly stupid post. Try harder next time.

  9. #49
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    This is a from a friend who wishes to remain private, but wanted you to know some things:

    I too have issues. I have acrophobia and claustrophobia that have gotten bad over the years. My fears fucked with my life. I work in maintenance in a heavy industrial setting where my job demands that I climb up on roofs and ladders and in crawl spaces. A few years ago I got so scared I almost fell off a ladder I was on near the ceiling, over 20' in the air. My knees became so wobbly and my mind started racing around so fast and I knew I was going to fall if I didn't immediately get down. I grabbed the ladder firmly and somehow got to the bottom and I was dripping in sweat. I couldn't get in an MRI without a large dose of valium. My family has a serious history of illness. My grandfather had early onset dementia. My father has diagnosed personality disorder. Four of my siblings have been involuntarily admitted for psychiatric treatment. I was off of my testosterone when I had my problem on the ladder because I had run out for some reason and had not gotten my prescription refilled. I will not do that again.

    After I got my prescription refilled I had to go on the roof for repairs on the cooling system. To my surprise I had no issues and I was so surprised I went to the edge of the roof 25 feet up and looked down many times and walked across the edge many times to see if it came back. I was surprised that my symptoms had almost disappeared. I was still scared so I was careful, but I felt it was normal fear. I could do my job. My claustrophobia is greatly diminished now. I know testosterone has helped me. I think the good doctor who is posting here may should look into getting his certifications for TRT. It probably won't help all his patients, but I'd be shocked if it didn't help a good chunk of them for very little cost in money and side effects. My insurance covers it and I only pay $10. This $10 is the best bang for the buck I have seen in medicine.

  10. #50
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    Quote Originally Posted by Mark Rippetoe View Post
    This is obviously up to the patient. If a guy has been suffering from depression for months or years, and 400mg of test cyp restores his sanity in 2 days, I suppose you'd argue that since sanity is afterward a lifetime commitment, it's just not worth the risk of a elevated H&H (something that certainly as hell doesn't always happen, and if it does is managed by blood donation) to keep doing what makes your sanity possible.
    No but I'd argue that that's something that needs to be discussed with the patient first, as well as the potential other options, so that they can make an informed decision.

    Is this a serious question? What if a guy has high blood sugar, and a shot of insulin makes it go down? What does this guy do? Suck it up so he doesn't have to "go back" for another shot?

    It does recover -- you don't know what you're talking about. But let's say it doesn't: it wasn't high enough to keep him free of the symptoms he came in the office for, so I guess you want him depressed with his test at 175, since that's endogenous.
    Yes it's a serious question - you can't just keep dosing him with 400mg of test every 3 days. And once he goes back to a 'normal' TRT dose, he might feel like shit again.

    As far as the HPT axis goes, there are cases where it won't recover (especially in older guys) and while it is recovering, the guy will suffer from all the low test symptoms and more. This is why enhanced bodybuilders do PCT afterwards. What I want is for people to get healthy in the most sustainable way, and for medicine to properly diagnose and treat issues rather than taking the 'throw darts at the board and see what sticks' approach, which is what you seem to be advocating.

    Then he comes off the test, gets the old lady settled, and goes back on.
    Hang on, you just accused me of wanting him to get off test and feel terrible again. But now you're saying that's what he should do. This is somewhat confusing.

    Lots?? Please share.
    Spend some time on TRT forums like Excel Male and have a look. You should have lots of great knowledge to contribute, you are on it as well aren't you? I am. I went right down the rabbit hole before I started.

    You seem to be taking several things rather lightly, like the long-term effects of even mild depression. The medical community is right to be cautious if there are risks associated with the administration of a drug. Yet somehow, Lipitor and Prozac have escaped your notice.
    Having suffered from depression in the past (and taken SSRIs for it) I can assure you I am not. Testosterone did help me. But I had to do lots of other things in conjunction with it and I still suffer from bouts of the blues - it is dangerous to suggest that it's a magic hormone that will magically rid someone of the black dog for good.

    This really is an amazingly stupid post. Try harder next time.
    Sure. About as stupid as an aging strength coach in his own private fiefdom postulating opinions about the way the medical system should operate, just so he can enjoy berating and insulting anyone who may (even slightly) disagree with him.

    It probably went straight over your rhynophymic head, but I am not actually disagreeing with you that testosterone can be very helpful in treating depression for those who have low T. I'm just arguing that it needs to be prescribed with some caution, as part of a holistic approach, and not as a first line treatment.

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