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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 23 to 47 of 47. Go back in thread:
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
Posted by linkadge on October 22, 2006, at 10:51:38
In reply to Re: neuroleptics+depression, posted by SLS on October 22, 2006, at 9:44:25
Well I guess then I should leave it at that. I think that the SSRI's are more mood stabilizers than antidepressants, but for the sake of things, I'll just leave it at that.
Linkadge
Posted by linkadge on October 22, 2006, at 11:00:48
In reply to Re: seroquel... » linkadge, posted by Meri-Tuuli on October 22, 2006, at 9:47:40
The way I see it is this. In order to maintain the validity of the whole antidepressant debate, researchers try to make out that these drugs only have effects in depressed people.
Ramping somebody up on a drug like cymbalta, and then just switching her to placebo is not right.
It doesn't matter if she was mentally healty or not. Even the most normal person's brain chemistry can be seriously thrown out of wack by such foolish actions. And the dumb thing, is that by blinding the whole thing, Tracy didn't even have the knowledge that she was being placed on placebo. Its hard enough to survive antidepressant withdrawl when you know thats what you're going through.Linkadge
Posted by ed_uk on October 22, 2006, at 12:58:01
In reply to Re: seroquel... » ed_uk, posted by SLS on October 22, 2006, at 9:31:18
Hi Scott
I found this article.........
Ed
Posted by SLS on October 22, 2006, at 13:12:03
In reply to Re: seroquel... » SLS, posted by ed_uk on October 22, 2006, at 12:58:01
> Hi Scott
>
> I found this article.........
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12172332&query_hl=1&itool=pubmed_docsumYuck. I wonder what SSP is. It must have certain distinguishing features. My friend has been on Seroquel 800mg for about 2 years now. So far, so good. What was interesting was that when she first added 50mg to ongoing treatment with Risperdal 2.0mg, she experienced an immediate antidepressant and energizing effect. It really cleared up her thoughts, too. She has bipolar disorder with mixed-states.
- Scott
Posted by ed_uk on October 22, 2006, at 15:22:59
In reply to Re: seroquel... » ed_uk, posted by SLS on October 22, 2006, at 13:12:03
Hi Scott
I wouldn't hesitate to try Seroquel again if you think it might help you. I'm glad it helped your friend.
Ed
Posted by Dr. Bob on October 24, 2006, at 1:58:54
In reply to Re: neuroleptics+depression..(and apathy), posted by willyee on October 21, 2006, at 9:06:13
> i really dont know how im supposed to word it,i know one way is the correct,so ill try,
Thanks for trying!
> I FEEL that counch comment was very mean and unfair.Hope i was to say feel,and not believe i dunno.
>
> what a mean generalization to put fourth"Feel" is definitely better than "believe". But I'm afraid "mean" could still lead that poster to feel accused. Here's something Dinah posted that I think explains this well:
http://www.dr-bob.org/babble/admin/20040112/msgs/320097.html
Keeping that in mind, could you please rephrase the above?
But please don't take this personally, this doesn't mean I don't like you or think you're a bad person.
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by Lindenblüte on October 25, 2006, at 8:19:50
In reply to Re: seroquel... » ed_uk, posted by SLS on October 22, 2006, at 9:31:18
> 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.
>4 weeks ago, my pdoc increased my seroquel from 50 mg, which I was using mainly to fall asleep, up to 300mg (titration took 10 days). Now I'm starting my 3rd week at 300mg.
The main symptoms I had prior to the increase included flashbacks, really strong startle reactions, intrusive thoughts, and acute dysphoric episodes where incidents from my childhood would come back to me flooding me in a panic of anxiety, where I just wanted to die, but I was paralysed. After such an episode, I felt like I had a bad hangover for a day or three, until the next episode.
In spring I had major depression. am taking 90mg cymbalta, which helped lift the depression. Therapy, however had taught me that feelings and emotions are okay, and that I could feel "safe" to feel and express emotions. Oops- once I opened the floodgate, I started "feeling" emotions in response to situations that I had never allowed myself to feel as a child. Hence the flashbacks, dysphoria.
pdoc upped my seroquel. No more intrusive thoughts. No more flashbacks. (well- these are about 96% reduced. Seriously, though. A miracle. I also have klonopin .5mg, which I may or may not take if I'm being triggered by something which may bring back bad feelings. I haven't really needed this but twice since I have reached the "therapeutic" dose of seroquel. Without the acute dysphoria/panic/dissociative episodes, I am feeling much better, able to be around people more, and don't feel so much anxiety or depression.
BOLDER 2 Study shows potent and fairly fast-acting AD effect of seroquel on bipolar depression (which is not my Dx, by the way). I've posted links before. in a hurry to find them again. sorry.
Linkadge, nice to see you around. I hope all is well. And I haven't been on this board in a week or two at least. I'm glad to have something to add.
-Li
Posted by Dr. Bob on October 28, 2006, at 13:20:01
In reply to Re: please rephrase that » willyee, posted by Dr. Bob on October 24, 2006, at 1:58:54
> Keeping that in mind, could you please rephrase the above?
I just wanted to make sure you didn't miss this because of the archive transition. Thanks,
Bob
This is the end of the thread.
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