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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 76 to 100 of 118. Go back in thread:
Posted by Phillipa on July 20, 2005, at 21:35:53
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 21:20:45
Thanks Scott. It was the MDD one that had me. It's so obvious though. The other two that I hadn't seen were OCPD and PMDD. BTW how is OCPD different than OCD? See they don't teach nurses any of this and I'd like to again work. I've talked with the NC Board of Nursing. Since I have an active license I can go back to work without a refresher course except all the major hospitals in Charlotte [hope to move there] require a refresher course. That means 2months of med/surg and 2mths minimum of course work on computer. Then if they hired me I would have to work full time for at least a few months. I don't think I could handle the stress of all this after being out of work for 8yrs. But I feel since psych is my bag that if I could wow them with what I know I stand a change of being hired. The stress of the full day of back and forth between hospitals and Board let me know that I still have it in me to fight to win but it left me emotionally drained. So now I question my ability to work. So, thanks to Carolina who has provided me with a lot of hospital numbers and Community Health tele numbers I can continue to look for a job that doesn't require the schooling. I feel this site provides more knowledge than any nursing course could. I just hope I can get my meds straight. Fondly, Phillipa
Posted by Jazzed on July 20, 2005, at 21:40:08
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 20, 2005, at 19:30:15
>
> I wish Larry Hoover were here to provide a links to his treatises of this question. I don't have the intellectual resources and knowledge to address this issue as intelligably and pursuasively as he did.Does this help?
http://www.healthyplace.com/Communities/Depression/news/teen_suicide.asp
http://my.webmd.com/content/article/75/89677.htm
http://my.webmd.com/content/article/79/96376.htm
http://www.uchsc.edu/news/bridge/2004/December%202004/suicide.html
Of course, there are plenty of sites which state just the opposite. So it comes down to whether or not you're inclined to use medications for yourself or your children. IMHO, if you opt for medication, I think it's a case of the right medication, for the right person, in the right dose, no matter what the age.
Jazzy
Posted by Jazzed on July 20, 2005, at 22:00:31
In reply to Re: Bad (but expected) news about ADs » SLS, posted by Jazzed on July 20, 2005, at 21:40:08
My own experience with ADs has been that the theraputic window is small. Again, that is for me. Too little didn't work, too much made things worse.
Teens/kids, unfortunately, are not always the ones who determine, or help determine, the dosage that might be effective. I got significantly depressed on various medications, suicidally so, fortunately that abated after the drug was withdrawn. I would guess, from that experience alone, that parents don't always have the information that kids can have an adverse reaction to their medication, and what they perceive as "bad" or "fussy" behavior could be a serious adverse reaction.
When I was a teen-ager, and seriously depressed, I was not given the choice of whether or not to take medication, or asked my opinion as to how the medications were affecting me. I can say that most of the effects were detrimental because I was given too much or the wrong medication (I don't know), not to mention I had a terrible psychiatrist.
Now, as an adult, I can choose to take them or not, to take something else or not. I wish there were a one size fits all answer to all mental illness.
Jazzy
Posted by Jazzed on July 20, 2005, at 22:07:36
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 21:20:45
> I really was not interested in the study at all, I was merely trying to find a statistic for canadian suicide.
>
> Do you have a more accurate statistic for the suicide rates in canada ?
>
> Sorry could not read all your post, have to go to work now.
>
>
> Linkadge
Sorry, once I got to reading that information, I got really carried away.There's a lot of information if you google, unfortunately, the stats vary from site to site as to whether rates are affected by ADs. From what I can gather, it appears that most sites are saying there appears to be "no direct correlation" between the use of SSRIs and the teen suicide rate.
I still maintain that it depends on the person, and whether they are accurately dosed with the correct medication for what ails them. Of course, I'm no scientist, I'm just going by my own experience, which is basically of no value to anyone other than myself (and my own kids should they ever need anything other than their ADD meds).
Jazzy
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.
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Dr. Bob is Robert Hsiung, MD,
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