![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 15 to 39 of 47. Go back in thread:
Posted by linkadge on October 20, 2006, at 18:22:40
In reply to Re: neuroleptics+depression..(and apathy) » linkadge, posted by Jay on October 20, 2006, at 15:42:44
Well, perhaps my statement was a bit of an overgeneralization. I suppose some people do find them effective for depression. Some people find that they make their depression worse.
Zyprexa was ok for sleep for me, but it seemed like such a high price to pay the next day, just for a med that got you to sleep.
One other consideration I heard somebody call into question was the following: While it is true that blockade of serotonin 5-ht2a/2c receptors will result in dopamine release in certain areas of the brain, the neuroleptic itself is going to block the some of the actions of that released dopamine, through dopamine receptor antagonism. So what is the net effect on receptor activation? I don't think we know.
Linkadge
Posted by Phillipa on October 20, 2006, at 19:09:50
In reply to seroquel..., posted by med_empowered on October 19, 2006, at 16:01:25
Why is schizophrenia being compared to depression? Anxiety leads to depression. Control anxiety and hence no depression at least that's the way it works for me. I guess I must be a wierdo. Love Phillipa
Posted by yxibow on October 21, 2006, at 1:59:24
In reply to Re: seroquel..., posted by Phillipa on October 20, 2006, at 19:09:50
> Why is schizophrenia being compared to depression? Anxiety leads to depression. Control anxiety and hence no depression at least that's the way it works for me. I guess I must be a wierdo. Love Phillipa
Everybody comes into this life with a different package... you're not a wierdo and you know that, Jan. What I think you're implying is that you have secondary depression concommittant with primary anxiety. That is, the fact that you have an anxiety disorder and you have challenged various medications, depresses and worries you. That isn't so hard to believe. But I would argue that medication is not the only part of a treatment plan in that case. Therapy can play a crucial role too.
Schizophrenia isn't per se being compared to depression at least from my take; it is just that some forms of psychotic depression, manic depression, and even MDD may require augmentation with a neuroleptic, hopefully an atypical to reduce the chance of EPS in affective disorder patients. And yes, I know, Ed, that atypicals carry a greater risk of diabetes. That is why it is important to have a collaborative relationship between your psychiatrist/psychopharmacologist and your general practitioner. I get regular screenings more than once a year. I also spend hard hours when I can in the gym and I attempt but dont always succeed to control my intake, which is definately enhanced in my opinion with Seroquel. This doesn't mean it can't occur all of its own; in fact it is. I'm fighting intake, and lipid changes as well. Excercise does do it, but I'm talking about flat out 15% grade walking at a clip in the gym. This isn't a one size fits all solution for some people -- genetics partially will determine diabetes risk in the first place.
Its a tradeoff; unknown to 2%+ or so TD risk (done with several studies, including a British journal), with lipid changes in -some- of the atypicals, or 10%, 20%, 30% TD risk, or more with high potency old line drugs.
Everything is a tradeoff; drugs that are meant to save peoples lives like chemotherapy, or amiodarone for arrythmia (the thought of my father having to inject himself for two weeks with that medication was mind boggling to say the least) which carries big side effects, it is an informed consent to take, and a choice to weigh sometimes between life with some negative outcomes, or death, which is entirely in the choices we make. I digress, but it is a frequent topic.-- tidings
Jay
Posted by linkadge on October 21, 2006, at 8:18:40
In reply to Re: seroquel... » Phillipa, posted by yxibow on October 21, 2006, at 1:59:24
The only think that will unveil the true likelyhood that atypical neuroleptics cause TD is time.
Linkadge
Posted by Jay on October 21, 2006, at 9:02:29
In reply to Re: neuroleptics+depression..(and apathy), posted by linkadge on October 20, 2006, at 18:22:40
> Well, perhaps my statement was a bit of an overgeneralization. I suppose some people do find them effective for depression. Some people find that they make their depression worse.
>
> Zyprexa was ok for sleep for me, but it seemed like such a high price to pay the next day, just for a med that got you to sleep.
>
>
>
> One other consideration I heard somebody call into question was the following: While it is true that blockade of serotonin 5-ht2a/2c receptors will result in dopamine release in certain areas of the brain, the neuroleptic itself is going to block the some of the actions of that released dopamine, through dopamine receptor antagonism. So what is the net effect on receptor activation? I don't think we know.
>
>
>
> Linkadge
Linkadge:I found Zyprexa works great with some of the more "stimulating" AD's, such as Effexor, but better with Prozac + Nortriptyline for me. Now, after a month or so use of it, up to the 10 mg mark, (which I take at bedtime), it seems to really help with my morning "dread", which is a kind of apathy. No, I am not no manic, "Whooopeee" type in the morning now, but I can get through things without feeling like ending it all right then and there, which was a symptom that has gone back many years. Even when I was a teen, early mornings where like swallowing shreds of glass while lugging around a 1 ton metal ball, and being peppersprayed right in the eyes at the same time.Add in the feeling like someone jared a pair of scissors into my back and kidneys, and made me drink a bottle of 120 proof vodka, and I think we are close.
Anyhow...you understand..I'm sure. :-) Even with the science, the mechanisms are at best, very loose and messy theories, obviously. Like you pointed out about the serotonin blockade and feedback loop. But, there is still some kind of "muking around" going on up there that seems to have some benefit, sometimes. The only evidence I honestly need, for anyone, is that if it relieves your symptoms, then it's done it's job. These meds are not mean't as, and are far from, a "cure". So I can have 5 out of 7 good days a week, rather then one single day, that's fine with me. But I would still try to reach for seven. Not "manic" days...just hum-ho days, with good and bad and all, but not falling to pieces. That is what I think some people gotta learn. Meds should not be used to induce some "manic" state, as I have seen happen on here.(And no, I don't mean with you, Linkadge. :)
Just IMHO...
Jay
Posted by willyee on October 21, 2006, at 9:06:13
In reply to Re: neuroleptics+depression..(and apathy) » linkadge, posted by Jay on October 20, 2006, at 15:42:44
> Well, I am *no* chemist, or claim to have ANY advanced knowledge about meds and such. Like many of us, I just like to investigate medications for their possible use....believing hope is eternal.(It is...)
>
> All atypical antipsychotics will not just make "..you sit on the couch and watch TV all day." and "feel less guilty about it." Just adding my personal experience (5+ years of AP use), Zyprexa + AD's can make for good sleep and for a nice day with a "calm" attitude. How? I of course don't know exactly. But I think it has to do with both down AND up regulation, a bit like Abilify, but not to the same degree. Zyprexa is shown to increase concentrations of Dopamine in certain parts of the brain. Risperdal works a bit on the serotonin system which seems to help with sleep. Right now I take a combo of Zyprexa and Risperdal, (plus AD's and MS's), and I function quite well. What I mean by that is that I still get upset over things I should, and I still get a bit angry, or tired, or sad, when I should. But it doesn't mean my whole world is falling apart like it did before medications! Man, THE WAY SOME PEOPLE POST FRIGHTENING STORIES really proves to me that, many people possibly don't, or haven't tried enough or a large enough combination of meds. If you think you have, I will challenge anyone to compare lists with me. :-)The following articles focus more on then just depression, but on the concept of apathy as suggested by Link. Here are a couple of articles I just had a bit of time, to paste.
>
> -----
> http://snipurl.com/zyw7
>
> Efficacy of atypical antipsychotics in depressive syndromes.
>
> Lilly France, 13 rue Pages, 92158 Suresnes cedex, France. [email protected] Quintin P,
> Thomas P.
>
>
> Depression is a frequent symptom in psychiatry, either isolated (major depression) or entangled with other psychiatric symptoms (psychotic depression, depression of bipolar disorders). Many antidepressant drugs are available with different pharmacological profiles from different classes: tricyclic antidepressants, monoamine oxydase inhibitors, selective serotonin reuptake inhibitors (SSRI). However, there are some limitations with these drugs because there is a long delay before relief for symptoms, some patients with major depression are resistant to treatment, there is a risk to induce manic symptoms in patients with bipolar disorders and these drugs have no effect on the psychotic symptoms frequently associated to major depression. The leading hypothesis for the search of more efficient new antidepressants has been the amine deficit hypothesis: noradrenaline and/or serotonin deficit and more recently dopamine deficit. Moreover, a dopamine deficit has been also hypothesized as the central mechanism explaining the negative symptoms of schizophrenia. These symptoms are the consequence of a deficit of normal behaviours and include affective flattening, alogia, apathy, avolition and social withdrawal. There is thus a great overlap between symptoms of depression and negative symptoms of schizophrenia. Atypical antipsychotics, in contrast with conventional neuroleptics, have been shown to decrease negative symptoms, most probably through the release of dopamine in prefrontal cortex, thus improving psychomotor activity, motivation, pleasure, appetite, etc. The dopamine deficit in cortical prefrontal areas was thus an unifying hypothesis to explain both some symptoms of depression and negative symptoms of schizophrenia. Studies in animal confirm this view and show that the association of an atypical antipsychotic drug and an SSRI (olanzapine plus fluoxetine) increases synergistically the release of dopamine in prefrontal areas. Moreover, most of the atypical antipsychotics have a large action spectrum, beyond the only dopamine receptors: their effects on the serotonin receptors--particularly the 5-HT2A and 5-HT2C receptors--suggest that their association to SSRI could be a promising treatment for depression. Indeed, SSRI act mainly by increasing the serotonin level in the synapse, thus leading to a non specific activation of all pre- and post-synaptic serotonin receptors. Among them, 5-HT2A/2C receptors have been involved in some of the unwanted effects of SSRI: agitation, anxiety, insomnia, sexual disorders, etc. The inhibition of these receptors could be thus beneficial for patients treated with SSRI. Amisulpride is an unique atypical antipsychotic that selectively blocks dopamine receptors presynaptically in the frontal cortex, possibly enhancing dopaminergic transmission. The antidepressant effect of amisulpride was shown in dysthymia in many clinical studies versus placebo, tricyclic antidepressants, SSRI or others. However, a shorter delay for symptom relief was not demonstrated for amisulpride as compared to comparative antidepressants. Other atypical antipsychotics (clozapine, olanzapine), which act on a large variety of receptors, have shown antidepressant effects--mainly in association with SSRI--in different psychiatric diseases: treatment-resistant major depression, major depression with psychotic symptoms and depression of bipolar disorders, with no increase of manic symptoms in this latter case. Moreover, the delay for symptom relief was greatly shortened. More comparative double-blind studies are required to confirm and to precise the antidepressant effects of atypical antipsychotics. Nevertheless, these studies suggest that atypical anti-psychotics could be of great value in depressive conditions reputed for their resistance to treatment with usual antidepressants. Particularly, new strategies emerge that combine atypical antipsychotics and antidepressants for greater efficacy and more rapid relief of depression symptoms.
>
> ----------------
> http://snipurl.com/zywb
>
> 1: J Neuropsychiatry Clin Neurosci. 2005 Winter;17(1):7-19.
>
> Apathy: why care?
> van Reekum R,
> Stuss DT,
> Ostrander L.
> Department of Psychiatry and Kunin-Lunenfeld Applied Reserch Unit, Baycrest Centre for Geriatric Care, University of Toronto, 3560 Bathurst St., Toronto, Ontario, M6A 2E1, Canada. [email protected]
>
> This review presents data showing that apathy is common across a number of disorders. Apathy is not only common, but is also associated with significant problems: reduced functional level, decreased response to treatment, poor illness outcome, caregiver distress, and chronicity. Preliminary evidence of treatment efficacy exists for dopaminergic drugs and for amphetamines. *Strong evidence of efficacy exists for acetylcholinesterase inhibitors in Alzheimer's disease, and for atypical antipsychotics in schizophrenia*. Frontal-subcortical system(s) dysfunction is implicated in the causation of apathy; apathy subtypes based on the various frontal-subcortical loops may thus exist. Further research involving diagnosis, pathophysiology, and treatment is suggested.
>
> -----
> Jay
>
>
>
>Wow link your perspective on drugs was so evident this time it brought this guy out to post an entire page,i agree with him too.I and Dr bob i really dont know how im supposed to word it,i know one way is the correct,so ill try,
I FEEL that counch comment was very mean and unfair.Hope i was to say feel,and not believe i dunno.
Anyway correcting yourself afterwards is always a plus,put the stabbing already poked.
Lol what a mean generalization to put fourth among people you know are struggling to get help.
Posted by Jay on October 21, 2006, at 9:20:28
In reply to Re: seroquel... » Phillipa, posted by yxibow on October 21, 2006, at 1:59:24
> > Why is schizophrenia being compared to depression? Anxiety leads to depression. Control anxiety and hence no depression at least that's the way it works for me. I guess I must be a wierdo. Love Phillipa
>
>
> Everybody comes into this life with a different package... you're not a wierdo and you know that, Jan. What I think you're implying is that you have secondary depression concommittant with primary anxiety. That is, the fact that you have an anxiety disorder and you have challenged various medications, depresses and worries you. That isn't so hard to believe. But I would argue that medication is not the only part of a treatment plan in that case. Therapy can play a crucial role too.
>
>
> Schizophrenia isn't per se being compared to depression at least from my take; it is just that some forms of psychotic depression, manic depression, and even MDD may require augmentation with a neuroleptic, hopefully an atypical to reduce the chance of EPS in affective disorder patients. And yes, I know, Ed, that atypicals carry a greater risk of diabetes. That is why it is important to have a collaborative relationship between your psychiatrist/psychopharmacologist and your general practitioner. I get regular screenings more than once a year. I also spend hard hours when I can in the gym and I attempt but dont always succeed to control my intake, which is definately enhanced in my opinion with Seroquel. This doesn't mean it can't occur all of its own; in fact it is. I'm fighting intake, and lipid changes as well. Excercise does do it, but I'm talking about flat out 15% grade walking at a clip in the gym. This isn't a one size fits all solution for some people -- genetics partially will determine diabetes risk in the first place.
>
>
> Its a tradeoff; unknown to 2%+ or so TD risk (done with several studies, including a British journal), with lipid changes in -some- of the atypicals, or 10%, 20%, 30% TD risk, or more with high potency old line drugs.
>
>
> Everything is a tradeoff; drugs that are meant to save peoples lives like chemotherapy, or amiodarone for arrythmia (the thought of my father having to inject himself for two weeks with that medication was mind boggling to say the least) which carries big side effects, it is an informed consent to take, and a choice to weigh sometimes between life with some negative outcomes, or death, which is entirely in the choices we make. I digress, but it is a frequent topic.
>
> -- tidings
>
> Jay
This is the other "Jay"..lol. I think Jay #1 has a great perspective on the atypicals.I'd like to add in my 2 bits here as well. There is a groundswell of thought combined with scientific based evidence (I know some of this because I work in a behavioural lab with Autistic kids) that within a few years, we may be looking at all mental illness' across the same spectrum. You can easily play "connect the dots" with symptoms from all, and the thinking is that the separation may not be as "separate" as we thought. Each "disorder" may shadow, or merge into others. The overlap between negative symptoms of Schizophrenia and depression is a good place to look. The positive symptoms look an awful like Psychotic Depression. Major Anxiety and Social Phobia share characteristics with the hypomanic dysphoric state of BP2. Hence, the anxiety and phobia are now being treated with Bipolar meds.
So, we are talking about 50 shades of grey here. Personally, I find diagnosis of little value. It's the *symptoms" that must be treated for relief.
Anyhow..just IMHO...
Jay (the other one:)
Posted by linkadge on October 21, 2006, at 11:56:33
In reply to Re: seroquel... » yxibow, posted by Jay on October 21, 2006, at 9:20:28
No no. Don't let me get in the way of what works for you.
I guess I'm just thinking about better tools for the future.
Linkadge
Posted by linkadge on October 21, 2006, at 12:06:19
In reply to Re: neuroleptics+depression..(and apathy), posted by willyee on October 21, 2006, at 9:06:13
Ok.
Essentially, I am saying that antipsychotics do more to reduce guilt and anxiety, than they do to reduce anhedonia.
I think the comment about the drugs not doing a whole lot for atypical depression type features is fair. When I am in an state of apathy, and all I want to do is sit on the couch all day, zyprexa doesn't do a whole lot for me. Thats all I am saying.
I am not saying that zyprexa makes you a couch potato, or that anyone who takes it is a couch potato. I am just saying that if apathy is your main symptom, I think that there are better drugs than the atypical antipsychotics. Thats what I am getting at.
If my comments don't apply to your situation, then I'd like to hear your comments.
If I offend a babbler then I am sorry, but I am not going to oppologise for offending a drug.
Linkadge
Posted by emme on October 21, 2006, at 12:19:59
In reply to Re: neuroleptics+depression..(and apathy), posted by linkadge on October 21, 2006, at 12:06:19
Hi Link,
>I am just saying that if apathy is your main symptom, I think that there are better drugs than the atypical antipsychotics. Thats what I am getting at.
I wonder if Abilify might be the exception to that, maybe due to the partial dopamine agonism. My personal experience is that it helps my apathy.
emme
Posted by linkadge on October 21, 2006, at 13:28:06
In reply to Re: neuroleptics+depression..(and apathy) » linkadge, posted by emme on October 21, 2006, at 12:19:59
There are always exceptions, and I am sure there are quite a few people who have found these medications usefull.
Its unfortunate that researchers can't better tease apart the theraputic effect from the effects which may detract.
Atypicals might be like 5 steps forward, 4 steps back.
In addition, theres not too much inscentive for more selective agents, since drug companies rather like when they have a single drug being used for everything.
The one drug fix all. Everbody gets better, but nobody gets better.
Linkadge
Posted by yxibow on October 21, 2006, at 14:18:33
In reply to Re: seroquel..., posted by linkadge on October 21, 2006, at 8:18:40
> The only think that will unveil the true likelyhood that atypical neuroleptics cause TD is time.
>
> LinkadgeClozaril, 1990. Unique agent. Almost no known reported TD cases. Unique from other atypicals in some ways. Definite EPS. Definite unpleasant side effects. "Gold standard" beyond Haldol. In the lab plus outpatient, around 19 years.
Risperdal was introduced in 1993 and so had to be in trials in 1990. 16 years. Some TD. Especially at high doses since its a chemical cousin of Haldol. Higher EPS.Zyprexa, 1996. Add a few years in trials, 13 years. Smaller amounts of TD, especially in a BJP psychiatric study of considerable amounts of patients that amalgamated it to about 1/2% per year. There has been at least a couple of new studies that have amalgamated all atypical antipsychotics (except in the elderly) to around the 2% range. Some EPS.
Seroquel, 1997, Add a few years in trials, 12 years. Minimal reports of TD, definate reports of somnolence. Lower EPS.
Yes, sometimes medications take longer to form conclusions -- old Mellaril is still out there with large QTc intervals while a campaign was staged against Geodon until it was again challenged with a 4,000 person study. I don't like the side effects with Seroquel but I take it for a particular reason. If I didn't have that reason (non psychotic in this case), I wouldn't be doing so.So atypicals basically have been around as long as SSRIs. You can take your conclusion from that as one wishes. Is a decade enough? Two? Three? If we back up two decades we're at the last benzodiazepine (except the patent extender Xanax XR). Three, around the last tricyclic.
tidings
-- Jay
Posted by linkadge on October 21, 2006, at 15:47:44
In reply to Re: seroquel... » linkadge, posted by yxibow on October 21, 2006, at 14:18:33
TD may take a while to manifest. If in part mediated by free radicals, then one might expect the dammage to be a function of time.
We are learning things now about the SSRI's that we had no idea of when they were first released.
Consider how long SSRI's were in clincial trials/development before the true incidence of sexual dysfunction was unveliled.
Linkadge
Posted by Phillipa on October 21, 2006, at 19:04:40
In reply to Re: seroquel..., posted by linkadge on October 21, 2006, at 8:18:40
Time correct which why I favor benzos as they have had that time. Love Phillipa
Posted by Phillipa on October 21, 2006, at 19:06:01
In reply to Re: seroquel... » Phillipa, posted by yxibow on October 21, 2006, at 1:59:24
Jay also just started with a therapist. Love Jan ps thanks for the answer
Posted by Meri-Tuuli on October 22, 2006, at 2:54:08
In reply to Re: seroquel..., posted by linkadge on October 21, 2006, at 15:47:44
> We are learning things now about the SSRI's that we had no idea of when they were first released.Or the risk of suicide in children/young people.
I was very shocked to find out from wikipedia regarding Cymbalta (which I know is not an SSRI and this is off topic now, but still):
'In one trial nearly a fifth of the volunteers testing Eli Lilly's antidepressant drug, duloxetine, dropped out after a 19-year old student committed suicide at a company laboratory. The student, Traci Johnson, was one of 25 healthy patients at an Eli Lilly clinic who were being given larger than therapeutic doses of duloxetine, which will be known as Cymbalta if it is introduced as an antidepressant. Four days before her death, Ms. Johnson was taken off Cymbalta and given a placebo
Four other patients who were given the drug during earlier trials also committed suicide, the company said.'
How on earth did the drug get approved??!?!?!?
If Cymbalta were a herb, my goodness, it'd be treated as if it were the most poisenous substance know to man! It never ceases to amaze me how supposedly 'safe' drugs, are actually pretty danergous. Actually, it never ceases to amaze me how greedy drug companies are. Drug development should be done by independant researchers at universities (for example) rather than profiteering drug companies who, IMHO, downplay side effects and convince us of the benefits.
Sigh.
Meri
Posted by yxibow on October 22, 2006, at 5:47:28
In reply to Re: seroquel... » linkadge, posted by Meri-Tuuli on October 22, 2006, at 2:54:08
>
> > We are learning things now about the SSRI's that we had no idea of when they were first released.
>
> Or the risk of suicide in children/young people.
>
> I was very shocked to find out from wikipedia regarding Cymbalta (which I know is not an SSRI and this is off topic now, but still):
>
> 'In one trial nearly a fifth of the volunteers testing Eli Lilly's antidepressant drug, duloxetine, dropped out after a 19-year old student committed suicide at a company laboratory. The student, Traci Johnson, was one of 25 healthy patients at an Eli Lilly clinic who were being given larger than therapeutic doses of duloxetine, which will be known as Cymbalta if it is introduced as an antidepressant. Four days before her death, Ms. Johnson was taken off Cymbalta and given a placebo
>
> Four other patients who were given the drug during earlier trials also committed suicide, the company said.'
>
> How on earth did the drug get approved??!?!?!?First, not everything in Wikipedia is 100% the truth or includes all facts. It is a wonderful resource but it is produced by committee with anybody capable of registering into write articles meeting their standards.
Second of all "greater than normal dose" is a key here, we do not know what "greater than normal is."
Third, less than credible sources reiterate this case throughout a google search, except for a neutral report from the New York Times.
I don't speak for the drug companies or for the fact that I take Cymbalta.
"Drug development should be done by independant researchers at universities (for example) rather than profiteering drug companies who, IMHO, downplay side effects and convince us of the benefits."Drug development is done by independent researchers at universities -- it is not done 100% exclusively within the labs of medical corporations or their subsidiaries. Positive research then may be sold by the university to a subsidiary lab.
Posted by Meri-Tuuli on October 22, 2006, at 6:09:52
In reply to Re: seroquel... » Meri-Tuuli, posted by yxibow on October 22, 2006, at 5:47:28
Hey!
> First, not everything in Wikipedia is 100% the truth or includes all facts. It is a wonderful resource but it is produced by committee with anybody capable of registering into write articles meeting their standards.Oh yes, of course I am completely aware of this fact. I was just using it as an *example* - I am under the impression that its widely believed that SSRIs increase the risk of suicide in young people/children, which wasn't know about when the drugs first came out, or perhaps it was known about, but perhaps this information was suppressed by the drug companies. Which is what I think Linkadge's post was referring to - ie often side effects become only apparent after, say, a decade of use.
> Second of all "greater than normal dose" is a key here, we do not know what "greater than normal is."
Still, someone *died* from this drug, in the clinical trials, and my point was that if what was being tested was say, a herb (or perhaps even a non-pysch med), then it would immediately get banned, or something.
Personally, it wouldn't surprise me if the drug company involved actually suppressed information relating to this incident or to the fact that they have know about its suicide inducing effects. This is pure speculation of course, but still. IMHO companies are notorious for supressing potentially damage inducing information - there are plenty examples from history.
> Drug development is done by independent researchers at universities -- it is not done 100% exclusively within the labs of medical corporations or their subsidiaries. Positive research then may be sold by the university to a subsidiary lab.
Of course I know this too but doesn't independent research pale in comparison to the sheer volume of research done by drug companies? - what I meant was that I would like to see *all* drug development being done by independent labs who just hold the interest of the patient most dear, rather than the interest of the shareholders.
I just want to have answers to my long list of questions regarding drug company practice.
Kind regards
Meri
Posted by SLS on October 22, 2006, at 8:53:13
In reply to Re: neuroleptics+depression, posted by linkadge on October 20, 2006, at 12:58:13
> SSRI's are more mood stabilizers, than they are antidepressants.
I can't agree with you here, especially when these drugs demonstrate an ability to produce a manic switch in people with bipolar disorder.
> They don't help you achieve your goals as much as they lower your standards.
For the short time I respond to SSRIs, I find the opposite to be true. Because my ability to function is so much higher and my motivation and interest to be active is higher, so are my levels of achievement. I find myself setting more and higher goals for myself.
> Some depression is sensitive to this kind of activity, while other depression is not.
Perhaps. However, I think we can also include in SSRI antidepressant effect scenarios those in which people become more energized and motivated and for whom "lowering standards" is not the mechanism of action.
> If you sit on the couch and watch TV all day, an antipsychotic isn't going to do much more than perhaps make you feel less guilty for sitting around.
Here, my personal experience deviates substantially from this characterization. I found that Risperdal, Zyprexa, Geodon, and Abilify all got me off the couch when they were first added to an antidepressant. Unfortunately, this energizing, antidepressant effect didn't last for more than a few weeks, but it was significant. Thereafter, lying on the couch was just as frustrating and guilt-producing as it ever was.
- Scott
Posted by linkadge on October 22, 2006, at 8:59:00
In reply to Re: seroquel... » linkadge, posted by Meri-Tuuli on October 22, 2006, at 2:54:08
Thats a good way to look at it. I don't understand it sometimes. How could anyone give anyone higher than theraputic doses of a powerful antidepressant, and then just switch them to placebo without tapering them off. Thats something I wouldn't do to my dog.
All in the name of science.
Linkadge
Posted by linkadge on October 22, 2006, at 9:02:40
In reply to Re: seroquel... » Meri-Tuuli, posted by yxibow on October 22, 2006, at 5:47:28
The tracy johnson controversy was fairly big. I heard the same story repeated on TV, and all over the net.
There was contoversy about her state of mental health. If I am not correct, Lilly tried to make it as if she was mentally ill, where her parents denied that. I'm not positive about that last bit though.
Linkadge
Posted by linkadge on October 22, 2006, at 9:11:56
In reply to Re: neuroleptics+depression, posted by SLS on October 22, 2006, at 8:53:13
>I can't agree with you here, especially when >these drugs demonstrate an ability to produce a >manic switch in people with bipolar disorder.
They can also produce a manic switch upon withdrawl, which could be seen as evidence for their stabilizing effects.
I would just argue that the majority of people who take SSRI's long term experience more of a leveling effect than a antideprssant effect. The "SSRI zombie" is emotionally resiliant, but emotionally flat.
They have been described previously as emotional anesthetics, capable of supressing intensinty of all forms of emotion.
Linkadge
Posted by SLS on October 22, 2006, at 9:31:18
In reply to Re: seroquel... » med_empowered, posted by ed_uk on October 19, 2006, at 16:18:59
Hi.
> >I seem to recall reading that seroquel has a tendency to induce dopamine supersensitivity (more so than other atypicals, I guess). I forget the mechanism..something about loose binding mixed with a short half-life
> I've read something similar. I think it was saying that people tended to relapse particularly rapidly when Seroquel was discontinued and that tolerance sometimes developed to its antipsychotic efficacy.
Did you see this stuff on the Internet?I was half-considering giving Seroquel another try. What you are saying has me a little concerned, though. Unfortunately, it almost makes sense that it can happen. Seroquel must be hopping on and off just about every D2 receptor there is. I don't know the details of what actually prompts upregulation, but perhaps this is relevant.
I know someone who is getting a real nice antidepressant effect from Seroquel. I tried it for about a week, but didn't like the irritability it produced. I wasn't real good about giving medication a fair trial at that point in time.
- Scott
Posted by SLS on October 22, 2006, at 9:44:25
In reply to Re: neuroleptics+depression » SLS, posted by linkadge on October 22, 2006, at 9:11:56
> > I can't agree with you here, especially when >these drugs demonstrate an ability to produce a >manic switch in people with bipolar disorder.
> They can also produce a manic switch upon withdrawl, which could be seen as evidence for their stabilizing effects.This is a phenomenon known to occur with TCAs and MAOIs, but not so much with SSRIs. I don't think this gives evidence to any mood stabilizing properties of these drugs either.
> I would just argue that the majority of people who take SSRI's long term experience more of a leveling effect than a antideprssant effect.
I wouldn't know about the majority...
Apathy and amotivation should probably be considered side effects of SSRIs and not a therapeutic effect. They occur in addition to an antidepressant effect rather than in place of.
- Scott
Posted by Meri-Tuuli on October 22, 2006, at 9:47:40
In reply to Re: seroquel..., posted by linkadge on October 22, 2006, at 9:02:40
Hey!
> There was contoversy about her state of mental health. If I am not correct, Lilly tried to make it as if she was mentally ill, where her parents denied that. I'm not positive about that last bit though.
Exactly! Lilly can't win either way -- if she were indeed mentally unhealthly, then what on earth where Lilly doing involving her in an inital trial that gave her greater than theraputic doses? Anything could happen! Well, which it did. And what does it say about then drug then? 'Oh its fine to take if you're mentally healthy, but if not, then hey, some people committed suicide on it, don't worry, take it anyway they used greater than theraputic doseages'.
And even if she were mentally healthy, she still committed suicide, as a result of the medication -- obviously this can't be proved outright (but what can?), but still.
I'm just questioning the practices and ethics of the drug companies.
Kind regards
Meri
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