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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 80 to 104 of 118. Go back in thread:
Posted by linkadge on July 21, 2005, at 15:30:18
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by Jazzed on July 20, 2005, at 22:07:36
My main problem with AD's is that they cause so much dysregulation that it is hard to tell what they do, if anything.
Think of it this way. I am in school. If I can't sleep, think, concentrate, then I am going to do poorly. That alone will make me depressed.
If I don't take them, I might do better, which might help my confidence and my mood.
They don't fit well into my lifestyle at all. And I find their side effects so disruptive at times, it is hard to tease out any antidepressant effect.
Linkadge
Posted by SLS on July 21, 2005, at 19:53:12
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 19:38:34
> That is assuming that receptor dysregulation is the cause of depression.
What *exactly* the problem is doesn't make antidepressants work any less.
Actually, we don't even know enough to say that the primary site of abnormality *isn't* rectified by antidepressants. Again, though, this makes no less real the complete remission of an illness that antidepressants can produce.
- Scott
Posted by rod on July 21, 2005, at 20:00:40
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 19:53:12
> > That is assuming that receptor dysregulation is the cause of depression.
>
> What *exactly* the problem is doesn't make antidepressants work any less.
>
> Actually, we don't even know enough to say that the primary site of abnormality *isn't* rectified by antidepressants. Again, though, this makes no less real the complete remission of an illness that antidepressants can produce.
>
>
> - Scott
>*signed*
regardsroland
Posted by SLS on July 21, 2005, at 20:00:55
In reply to Re: About my post..and Suicide..., posted by Jakeman on July 20, 2005, at 20:08:46
Hi, Jake.
> > > Then we have to worry about the fact that long-term effects (>6 monthes) have not been tested.
> >
> > I'm sorry, I'm a little confused here. The long-term effects of what have not been tested?
> >
>
> I meant the long-term effects of antidepressants have had little study. It's my understanding that clinical trials are usually less than six months.This is true of most studies. Unfortunately, most of the clinical trials that involve antidepressants have rarely exceeded 10 weeks. However, there have been a few longitudinal studies that have followed people for five years and more. One of the most important findings of such studies is that the dosage of an antidepressant that successfully treats the depression acutely is the same dosage that should be used for long-term maintenance.
What sorts of things are you interested in discovering with long-term studies? Just curious.
- Scott
Posted by SLS on July 21, 2005, at 20:05:28
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 20:11:24
> "Let's keep things simple - empirical. Some compounds are antidepressants. Some are not. What we see through imaging is instructive, but not yet predictive"
>
> Yes, exactly. Some compounds are antidepressants. The ones that make rats swim longer in a tank are antidepressants. That doesn't say much.
>
> LinkadgeCome on, those are only paradigms that are used for screening compounds for *potential* antidepressants. They are not designated as being antidepressants at this stage of investigation. Their potential as antidepressants is tested further in human studies. They don't become antidepressants until they show efficacy in human beings.
- Scott
Posted by SLS on July 21, 2005, at 20:09:37
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 20:19:09
> ADs have reduced the rate of adolescent suicide, despite the fact that they have produced suicide in a small percentage.
> ---------------------------------------------
>
> Just because certain youths don't commuit suicide on the drugs doesn't mean that the drugs prevented suicide. Many times people just get better.At what rate? How does this rate of spontaneous remission compare with the observered rates of suicide prevention that these drugs demonstrate?
Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers
http://www.nimh.nih.gov/healthinformation/antidepressant_child.cfm
- Scott
Posted by SLS on July 21, 2005, at 20:20:46
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 20:25:39
> That is correct. These drugs have not been tested nearly as long as we take them for.
Nor have most other drugs once they are approved. Am I missing your point? No guarantees. There is always some degree of uncertainty as to the long-term effects of a drug once it is approved. That's why there are COSTART reporting and Phase IV investigations.
> We have a panic attack at the notion that our drugs might stop working one day, and that we might not be able to take them indefinately, and yeild the same results.
Yup.
The same with drugs for AIDS, cancer, diabetes, hypertension, heart-failure, Parkinsons...
> As a result we cling to the notion that these drugs are fixing some deficiancy,
How do we know that they are not?
> because that notion leads us to believe that their workings are more natural. Why do we buy into the chemical imballence theory?
Because it reflects what we have observed clinically and investigationally.
> Mainly because it comforts us.
It never comforted me. I *wanted* my suffering to be 100% psychological because it meant that *I* was in control of my destiny. It was within my power to get well using psychotherapy and hard work. I was *extremely* pissed off when I discovered it was biological.
> Comfort us it may, but save us it will not. As if, knowing how the drug works will keep it working.
Exactly. Empirical. Things work or they don't. Antidepressants work.
- Scott
Posted by SLS on July 21, 2005, at 20:27:49
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by Jazzed on July 20, 2005, at 20:36:59
Hi Jazzed.
I agree with you.
I come across more claims of a decreasing rate of suicide than I do an increasing rate of suicide. However, things are more complicated when trying to evaluate the success rate of medical intervention. In any event, I thought the following was instructive:
Preventing Suicide: Individual Acts Create a Public Health Crisis
http://www.healthyplace.com/Communities/Depression/nimh/suicide_5.asp
- Scott
Posted by linkadge on July 21, 2005, at 20:34:33
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 19:53:12
"Again, though, this makes no less real the complete remission of an illness that antidepressants can produce"
I could accept the fact that an adequate explaination hasn't been found if they worked.
A lack of explaination to their workings also befuttles issues such as poop-out, and potential neurotoxicity.Linkadge
Posted by thealmighty on July 21, 2005, at 20:45:48
In reply to Re: Long post (sorry) » linkadge, posted by Jazzed on July 20, 2005, at 21:27:25
hey
Posted by SLS on July 21, 2005, at 20:45:55
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 20:34:33
> > "Again, though, this makes no less real the complete remission of an illness that antidepressants can produce"
> I could accept the fact that an adequate explaination hasn't been found if they worked.
> A lack of explaination to their workings also befuttles issues such as poop-out,
Give them a chance!
What do you think these neuroscientists and psychiatric investigators are doing, staring at the screen savers on their computers?
> and potential neurotoxicity.
Which drugs carry this potential?
Is there any data to support the statements that antidepressants produce neurotoxicity?
- Scott
Posted by linkadge on July 21, 2005, at 20:46:34
In reply to Re: About my post..and Suicide... » Jakeman, posted by SLS on July 21, 2005, at 20:00:55
"One of the most important findings of such studies is that the dosage of an antidepressant that successfully treats the depression acutely is the same dosage that should be used for long-term maintenance. "
That is what was claimed for benzodiazapines 30 years ago.
That again is buying into the whole flawed theory. What doctors claim of the drug, and what the drug actually turns out to be, are two totally different things.
Psychiatrists would like an antidepressant to be a drug that:1) Works
2) Continues to Work (no poop out / tollerance)
3) Is safe
4) Produces few side effects
5) Non addicting (requires no dose escalation)This is what doctors *want* an antidepressant to be. But no drug meets this criteral.
1) They sometimes work and sometimes don't
2) They can poop out, people can become tollerant
to their effects. This board is proof of that.
3) We have no idea of their long term safety.
I am proof of safety issues that docotors
never anticipated.
4) They produce many side effects, some of which
we might not even be aware.
5) Often require dose escalation, augmentation,
and have withdrawl bad enough to be common
household knowledgeLinkadge
Posted by linkadge on July 21, 2005, at 20:50:21
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:05:28
"They don't become antidepressants until they show efficacy in human beings."
And they become antidepressants even if they don't show efficacy in human beings. Drug companies just keep testing the drug till they find one study that shows "sufficant evidence"
Drug companies could show that breakfast sausage was an antidepressant if they wanted to.
Linkadge
Posted by linkadge on July 21, 2005, at 20:52:05
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 21, 2005, at 20:09:37
Unmedicated depression usually remits within a year. Rarely longer. Antidepressants are taken on average much longer than a year. Antidepressnats worsen the course of the illness.
Linkadge
Posted by SLS on July 21, 2005, at 20:54:42
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 20:46:34
> "One of the most important findings of such studies is that the dosage of an antidepressant that successfully treats the depression acutely is the same dosage that should be used for long-term maintenance. "
>
> That is what was claimed for benzodiazapines 30 years ago.
>
> That again is buying into the whole flawed theory. What doctors claim of the drug, and what the drug actually turns out to be, are two totally different things.
Work in this area is not new:1: J Affect Disord. 1993 Mar;27(3):139-45. Related Articles, Links
Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression.Frank E, Kupfer DJ, Perel JM, Cornes C, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ.
Department of Psychiatry University of Pittsburgh School of Medicine, PA 15213.
Recent evidence points to the prophylactic efficacy of maintaining recurrent unipolar patients on the same dose of antidepressant medication that was used to treat the acute episode (Frank et al., 1990; Kupfer et al., 1992). Therefore, the question of whether such patients should be tapered to a lower maintenance dose after successful resolution of an acute episode is clearly important. In this report we describe a small randomized clinical trial in which patients were assigned to either full-dose or half-dose maintenance treatment for a period of 3 years. Survival analysis suggests that superior prophylaxis can be achieved with a full-dose as compared to a half-dose maintenance treatment strategy (p < 0.07). Mean survival time for the full-dose subjects was 135.17 (SE 19.75) weeks as compared to 74.94 (SE 19.78) weeks (median of 43.1 weeks) for the half-dose subjects. We conclude that for patients who have suffered several recurrences, full-dose maintenance treatment is the more effective prophylactic strategy.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 8478502 [PubMed - indexed for MEDLINE]
- Scott
Posted by linkadge on July 21, 2005, at 20:58:06
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:20:46
I was *extremely* pissed off when I discovered it was biological.
Have you ever heard the statement "I never knew I was depressed untill I took prozac" I believe it is a line from Kramer's "Listening to Prozac",I think a lot of people could be convinced that they have had some sort of chemical imballence if you give them the right dose of the right "high octane mood brightener". You don't need to be depressed for these drugs to have an effect. Just like you don't need to have ADD for Ritalin to enhance your concentration. It comes with a price however.
Linkadge
Posted by linkadge on July 21, 2005, at 20:59:04
In reply to Re: Bad (but expected) news about ADs » Jazzed, posted by SLS on July 21, 2005, at 20:27:49
Reduced suicide rate could also be a result of the effect of being "treated".
Linkadge
Posted by SLS on July 21, 2005, at 21:02:42
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 20:50:21
> > "They don't become antidepressants until they show efficacy in human beings."
> Drug companies could show that breakfast sausage was an antidepressant if they wanted to.I disagree with this premise, despite understanding the cynicism that society has developed towards the pharmaceutical industry more recently.
- Scott
Posted by linkadge on July 21, 2005, at 21:08:35
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:45:55
"What do you think these neuroscientists and psychiatric investigators are doing, staring at the screen savers on their computers?"
Probably developing another SSRI.
"Which drugs carry this potential? "The neuroleptics, certain anticonvulsants, and any drug which we haven't proven to be non neurotoxic.
Is there any data to support the statements that antidepressants produce neurotoxicity?Yes, my walking problems, neck twisting, brain zaps, and of course the lack of information suggesting that the meds are non-neurotoxic.
Although I don't like Breggin that much. He does point to certain studies of neurotoxicity, that have not been adequately countered in my oppinion.
Linkadge
Posted by linkadge on July 21, 2005, at 21:14:47
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:54:42
Well full dose is always going to be better than half-dose. That doesn't proove that full dose is always sufficiant. Some of U.S. most prominant psychitrits have talked about the issues of poop-out. Poop-out is not uncommon.
Linkadge
Posted by thealmighty on July 21, 2005, at 21:31:52
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 21:14:47
linkage
isn't this board supposed to about biological treatments and support for those seeking it.
why not go to the alternative board and post.
everyone knows meds are far from perfect, but the number of those helped by them is 10 fold greater than those hurt by them. if there is no such thing as a chemical imbalance, then why do some drugs cause depression?
your posts could potentially prevent someone from seeking good treatment for a disease that kills 15 percent of it's sufferers.
Posted by SLS on July 21, 2005, at 21:37:13
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 21, 2005, at 20:52:05
> Unmedicated depression usually remits within a year. Rarely longer.
Where did you get this information from?
What about recurrent depression?
> Antidepressants are taken on average much longer than a year.
"much"?
How much longer?
It has been shown that the risk of relapse into depression rises if one does not continue with antidepressants for at least 6-9 months after remission is achieved, with some doctors suggesting 12-14 months for more severe cases. Upon the premature discontinuation of an antidepressant, for those who do relapse, this usually occurs withing the first 4 months.
There are many variables to be taken into consideration when deciding how long to continue treatment for.
> Antidepressnats worsen the course of the illness.
Unipolar disorder? In most cases, I would disagree with this. It is an interesting idea that should be looked at, but with chronic or recurrent depression, there is little better choice than to intervene biologically.
Bipolar disorder? Sometimes. This depends on several factors, not the least being the coadministration of a mood-stabilizer.
1: Br Med Bull. 2001;57:145-59. Related Articles, Links
Continuation and maintenance therapy in depression.Paykel ES.
Department of Psychiatry, University of Cambridge, UK.
This paper reviews longer term treatment for unipolar depression. Antidepressant continuation for prevention of early relapse has been routine for many years. Recent evidence supports a longer period of 9 months to 1 year after remission. Antidepressants are also effective in maintenance treatment for recurrent depression, and are indicated where there is clear risk of further episodes. Antidepressant withdrawal after continuation and maintenance should always be gradual, over a minimum of 3 months and longer after longer maintenance periods, to avoid withdrawal symptoms or rebound relapse. Trials of interpersonal therapy in the prevention of recurrence show some benefit, but effects are weaker than those of drug and additional benefit in combination is limited. There is better evidence for effects of cognitive therapy in preventing relapse and an emerging indication for its addition to antidepressants, particularly where residual symptoms are present.
Publication Types:
Meta-AnalysisPMID: 11719914 [PubMed - indexed for MEDLINE]
- Scott
Posted by SLS on July 21, 2005, at 21:44:52
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 21:08:35
> "What do you think these neuroscientists and psychiatric investigators are doing, staring at the screen savers on their computers?"
>
> Probably developing another SSRI.
>
>
> "Which drugs carry this potential? "
>
> The neuroleptics, certain anticonvulsants, and any drug which we haven't proven to be non neurotoxic.Let's stick to antidepressants.
Has levofloxacin been proven to be non neurotoxic? Should we discontinue using it for this reason?
> > Is there any data to support the statements that antidepressants produce neurotoxicity?
> Yes, my walking problems, neck twisting, brain zaps, and of course the lack of information suggesting that the meds are non-neurotoxic.I'm sorry that you suffer. I really am.
- Scott
Posted by Jakeman on July 21, 2005, at 21:55:50
In reply to Re: About my post..and Suicide... » Jakeman, posted by SLS on July 21, 2005, at 20:00:55
> What sorts of things are you interested in discovering with long-term studies? Just curious.
>
Efficacy. I remember when Prozac came out in the '80's with much fanfare..and shortly after it got much media attention including a picture of the capsule on the cover of Newsweek. There seemed to be an attitude that this was the magic pill. No one talked about whether or not its effect was lasting. As far as I know, Lilly has never admitted to the now widely reported poop-out phenomenon. And why should they? They didn't test the drug for long-term use.My guess if that much of the back-lash against the psychiatric profession these days is partly due to the fact that people discover that these wonder drugs don't last. I'm not against SSRI's or any other pharmacolgical approaches. I hope it's a start in the right direction that will bear more fruitful results in the future.
BTW, when is that segeline patch coming out? :-)
warm regards ~Jake
Posted by SLS on July 21, 2005, at 22:05:09
In reply to Re: About my post..and Suicide... » SLS, posted by Jakeman on July 21, 2005, at 21:55:50
Hi Jake.
> > What sorts of things are you interested in discovering with long-term studies? Just curious.
> Efficacy. I remember when Prozac came out in the '80's with much fanfare..and shortly after it got much media attention including a picture of the capsule on the cover of Newsweek. There seemed to be an attitude that this was the magic pill. No one talked about whether or not its effect was lasting. As far as I know, Lilly has never admitted to the now widely reported poop-out phenomenon. And why should they? They didn't test the drug for long-term use.
You are exactly right. It would be nice to know at what rate poop-out occurs. One fact has become evident, though. Effexor does not poop-out as often as the SSRIs and brings more people to remission. I am still of the opinion that the TCAs poop out less often than SSRIs, and might even produce a more robust treatment response.
> My guess if that much of the back-lash against the psychiatric profession these days is partly due to the fact that people discover that these wonder drugs don't last.
I think there are several aspects to these drugs that leave them as being less than wonder drugs.
> I'm not against SSRI's or any other pharmacolgical approaches. I hope it's a start in the right direction that will bear more fruitful results in the future.
That's where I'm coming from.
> BTW, when is that segeline patch coming out? :-)I am as clueless as you. Maybe early next year?
- Scott
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Dr. Bob is Robert Hsiung, MD,
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