Posted by Larry Hoover on December 15, 2005, at 0:21:20
In reply to Re: Dr. Tracy on SSRIs.., posted by linkadge on December 14, 2005, at 22:05:08
> >We're arguing a semantic distinction, about our >interpretation of another person's words
> >Localized serotinergic activation can be, on a >relative scale, high or low. I am arguing >against a global "elevated serotonin" state, as >postulated by the under-educated Tracy.
>
> I see you did not read the link that I put up.I read it. There was no evidence presented that the pre-synaptic neuron would release identical amounts of serotonin under both transporter conditions, nor any evidence presented that COMT or MAO-A concentrations were the same.
> The state that SSRI's induce would be very similar to that of an individual who posesses the double short varient of the serotonin transporter gene.
There is no evidence to reach that conclusion. It is a conceivable hypothesis, but it has never been tested.
The only easily tested hypothesis which arises from this heterogeneity of SERT promoter regions is to determine if SSRI response is different under the three natural populations. It may well explain why SSRIs don't work for everybody. Or part of the why.
> Dr. Tracy argues that SSRI's cause depression and suicide.
SSRIs are depressogenic?
Suicide rates are falling.
http://www.afsp.org/statistics/USA.htmThere is one drug with extremely powerful suicidal potentiation. Alcohol. I won't waste space here, but I have all kinds of data on that.
There is no autopsy evidence for SSRI potentiation of suicide. But alcohol? Huge. Widely available, without a prescription.
> This link that I put up is research showing how lifetime depressive episodes correlate with the serotonin transporter gene. This research supports her theory that taking an SSRI (and thus lowering SERT activity) could cause depression, alcoholism etc.
No, it doesn't. It links a homozygous gene to those events. Not SSRIs.
>
> >We can mess with the brain, with drugs, and >produce unnatural states. Tracy was implying an >innate condition, "excess serotonin", or however >she phrased it, was the underlying etiological >factor in mental diseases of all sorts.
>
> That may be. If we discovered the antidepressant effects of Tianeptine beofore that of SSRI's we might have the same hypothesis.Or Tianeptine might work on homozygous short-short SERTs?
I strongly reiterate. There is no pathological excess serotonin state.
> >Whether that's your theory or hers, I disagree. >I don't think anyone knows the mechanism, but it >most certainly won't be as simple as that.
>
> Many doctors think that the rem sleep depriving mechanisms are key force in their behavioral effects. Quite a few agents (for instance Surmontil) which have no effect on monoamine uptake, but do reduce REM sleep, are effective antidepressants.In so many words, it's like trying to construct a platypus. These pieces, these analogies, do no demonstrate that SSRIs do or do not do similar things. Those are untested hypotheses. Having an hypothesis is proof of nothing. Tracy would have you believing her theory because of plausibility of its constituent hypotheses.
> >It's a meaningless phrase. That's my point. It >contributes nothing, except perhaps, hooking the >naive mind.
>
> If any drug were capable of mimicing some the catastrophic alterations in cognition an sentience that are evident in old age, I'd like to know about it. For instance, smoking will age you prematurely. Knowing that is not meaningless.Getting back to how this phrase came into our discussion, Tracy claims that this "excess serotonin" state causes premature aging. You seem to have just contradicted that, quite explicitly.
>
>
> >Which differs so substantially across the >population it is more reasonably a genetic trait >(susceptibility) than a drug effect.
>
> I was not the first one to suggest the connection between the subjective effects of antidpressants and LSD. Many experienced LSD users have likened the effects of LSD to antidepressants. Studies show that fluoxetine potentiates the discrimintive stimulus effects of LSD.
>
> See the abstract at:
>
> http://www.antidepressantsfacts.com/prozac-lsd.htmNo, not potentiation. "...all data were compatible with additivity of effects rather than true potentiation."
Like alcohol and benzos.
> These reports are more than just coincidences. There are biochemical reasons that the drugs can produce similar states of mind. And that is important information, when faced with the task of sorting out some of the behavioral states that have been linked to SSRI use.
>
> >I am an outlier. Me. I've had very bizarre drug >effects, when compared to normalized data. My >bizarre response to a drug demonstrates nothing,
> >other than I should avoid the drug.
>
> But we are talking about experiences that have happened to more than just one person. We are also talking about experiences that may be partially explained by studies like the one above which show how these two agents can produce similar behavioral states.The one above was about dogs. I wonder just what the dogs said to describe their experiences.
And, individual idiosyncratic reactions happen all the time. Read almost any monograph. "People with sensitivity to X class substances should not use this medication.", or such like. It's not an indictment of the drug. Or even the class of drugs. It's about being responsible about what you ingest.
> >She wants to blame the drug for all aberrant >behaviour. And I'm still waiting for the >explanation part.
>
> And I am still waiting for the explaination for how antidepressants actually help depression.How? Who the heck knows that?
> Since there is not much of a solid theory for that, I can't pick too many holes in arguing the
> negation.That's what I meant earlier about mechanistic arguments. They really are pointless.
Native peoples used to make a special tea from twigs of red willow, to relieve pain. Following a traditional prayer and invocation, the medicine man would administer the decoction, believing that he had facilitated the transfer of the willow spirit to the afflicted party. Often, the pain went away.
Other people, with different beliefs, discovered salicylic acid in willow bark, derived a synthetic form, and made a near-bankrupt German dye chemist named Bayer very rich.
Both were effective treatments, with entirely different mechanisms.
> >Her generalizations amount to hyperbole without >any reasonable support.
>
> Hyperbole without any reasonable support? We've got two drugs. One inhibits the reuptake of serotonin, and the other increases the uptake of serotonin. Both are "effective antidepressants".That's not hyperbole. And we don't know why. But we do know that they work. Empirical evidence.
> Vitamin C either prevents scurvey, cures scurvey, or neither.
In different circumstances, each phrase is true.
>
> >That is false, bizarre, fear-mongering, >meaningless.
>
> Fear mongering, maybe. I see it as a necessary counterballence, in a world of "pop this".How about promoting better medical management. More personal interaction with caregivers. Providing critical information for true informed consent. No fear-mongering required.
> After 8 months off of 100mg of zoloft, I am still relearning how to walk properly.
I'm sorry that is true for you. I must resort to logical analysis. Post hoc ergo propter hoc is a fallacious interpretation, a good part of the time.
You may have other medical concerns.
> >Oh, but you snipped the part about "the gummy >gooey glossy substance". I thought that was so >relevant.
>
> Like I said. I don't agree with everything she says. But I do agree with her main argument that SSRI's can sometimes induce abnormal and frankly dangerous states of mind.Sometimes, they do. And if appropriate precautions had been taken, and corrective action initiated at the first sign of trouble, I think that many of the most serious outcomes would simply never have happened.
When Szasz et al emptied the asylums, the enabling belief that permitted such a drastic change in medical management was that medication alone would suffice. But, what inevitably also happened was that contact with caregivers was totally disrupted. And this idea, that medicine through pharmacepia had reached a golden age, enveloped the entire culture. I remember Prozac hitting the front cover of Time magazine. I still have it, somewhere. Pure propaganda. Everyone bought into it. But nobody wants to take responsibility for it. That's how the Holocaust came about.
> >This woman makes what amount to emotional >appeals. Her theories contain vague expressions >which can be taken in many ways. There is a >plausibilty to what she says. But nowhere, does >she offer the data, the observations, the >physical evidence, to support even her core >allegations. What baby?
>
> Thats not true. For example, she talks about how the worker for Lilly ended up resigning due to her decision to make a firm stance against the safety of SSRI's.I didn't listen to the whole interview.
> She also referres to studies in which patients given SSRI's reported increased hostility and suicidal behavior.I have read through some of the complete clinical trial data for some of the SSRIs. We're talking reports of over 500 pages. The raw data. And I'm convinced, just as the recent task force was convinced, that methodological deficiencies in many studies are so profound, that concluding anything about suicidal induction during the studies is questionable. The studies were not designed to collect that sort of information. The way the information was extracted from the raw data was flawed. In one study I analyzed, which suggested a six-fold increase in suicidality in adolescents using Paxil, the detailed analysis revealed that there were no suicidal gestures attributable to Paxil, and the only true suicidal act was in the placebo group. If you want to see that, I'll dig it up and show it to you.
> If forget her name, but she referred to one of the key scientists who was involved in the idenficiation of the serotonin reuptake mechanism, who referred to the SSRI's as monster drugs. These are real people, with real credability who agree with her on different levels.I have no problems with people holding different opinions. I have problems with people making unfounded allegations, i.e. those without underlying evidence. I'm an empiricist. The data are the only truth we have. All else is interpretation.
> >As I said earlier, let the data speak for >themselves.
>
> Let it.Good. Agreed there.
> >No, not that I've seen.
>
> Ok, maybe not the exact same things. But ther "are" very intellegent people who do not agree that these drugs cary the safety that is assumed by most doctors. There are intellegent people who believe that the drugs can induce suicidal thinking and behavior. Do you want to know who some of these people are?Link, I have very closely followed the research. I read every study on this subject. The recent Healy and Martinez studies were rather compelling. If there is a suicidal signal, it is brief, early, and small. Medical management can handle these issues.
> There are scientist out there right now who are developing animal models of antidepressant induced mania and rapid cylcing. Some of this research is on www.neuransmitter.net. While Dr. Tracy is extreme. I don't thing she is out of the ballpark.
She's in the ballpark. She's the candy floss.
> >Would you kindly present her evidence? I've seen >none. I am totally serious.
>
> Well, for starters, she said that SSRI's can induce psychotic states. I mentioned above some information on researchers who are studing the propensity of SSRI's to induce mania.They can induce psychosis, yes. They can trigger mania, certainly.
> Researchers create links between some of the genes affected by stimulants, and antidepressants, to try and sort out some of the findings. These are obviously *very expensive* studies to undertake, and would not be done if there was indeed "no evidence"
I was meaning her evidence. Her hypotheses are not directly connected to evidence. I'm being generous. Myrrh oil? All mental illness is sugar related? (or something like that)
> >Perhaps we should agree to disagree?
>
> I am happy with anyone who agrees that the safety of SSRI's is not a closed case.
>
> LinkadgeIt's far from closed. And I am not trying to shut the door. I'm trying to lay a solid foundation of empirical evidence, and put to rest hyperbole and fear-mongering.
Lar
poster:Larry Hoover
thread:587690
URL: http://www.dr-bob.org/babble/20051211/msgs/589225.html