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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by linkadge on March 17, 2011, at 17:13:35
A number of times, people on this site use the notion that we on this board are treatment resistant, and that in the "general population" antidepressants work fantastically.
I disagree and I agree very much with this article by John McManamy (has the bipolar support site mcmanweb.com). John is a bipolar indivudal who has developed a website which, in my opinion proposes a very balanced view of medications. Please read the article.
http://www.mcmanweb.com/antidepressants.html
Posted by sigismund on March 17, 2011, at 18:21:28
In reply to Its not just us, posted by linkadge on March 17, 2011, at 17:13:35
>in the "general population" antidepressants work fantastically.
Yes. I have always wondered how they are so sure of that.
Posted by Phillipa on March 17, 2011, at 19:53:28
In reply to Re: Its not just us, posted by sigismund on March 17, 2011, at 18:21:28
Not for me but never mania in over 15 years it was in the 60's the barbituates and valium used. That's my experience only. Phillipa
Posted by Bob on March 18, 2011, at 0:23:44
In reply to Re: Its not just us, posted by sigismund on March 17, 2011, at 18:21:28
> >in the "general population" antidepressants work fantastically.
>
> Yes. I have always wondered how they are so sure of that.I have heard this from many health providers as well - how fantastically everyone else does on their meds. It's really annoying and I have a hard time believing it in many cases.
Posted by sigismund on March 18, 2011, at 0:56:59
In reply to Re: Its not just us » sigismund, posted by Bob on March 18, 2011, at 0:23:44
No one has evidence.
It's a position fixed by subjective factors, such as the need to have something for which to hope.
Posted by sigismund on March 18, 2011, at 1:01:11
In reply to Re: Its not just us, posted by sigismund on March 18, 2011, at 0:56:59
Or that we live under a benevolent and enlightened dispensation.
Posted by bleauberry on March 18, 2011, at 4:38:35
In reply to Its not just us, posted by linkadge on March 17, 2011, at 17:13:35
From what I have seen within the offices of the many doctors I have seen, they must privately be scratching their heads in puzzlement wondering why they don't get the same results the clinical trials got.
Of course, taking a look at the details of clinical studies, the answers are obvious....they didn't get very good results.
I think there is a place somewhere between general medicine and psychiatry where there is an empty void. The place where MDs don't know the answers, aren't trained to be detectives, so completely bypass that aspect and shuttle the patient off to a different field entirely....psychiatry. Within that void that is being ignored are the more common causes of depression. They remain untreated. Many of them do not respond well to psych meds, primarily because those meds are just so far off target from the real problem, or respond negatively to psych meds.
I believe psych meds have their place. But to cure a disease, not. In my opinion, calling depression a disease is a fundamental mistake similar to a judge sentencing an innocent prisoner to a life of solitary confinement without parole. It isn't a disease. It is a symptom. The disease was not even casually investigated, except maybe for a thyroid test at most.
IMO
Posted by Toph on March 18, 2011, at 10:19:21
In reply to Its not just us, posted by linkadge on March 17, 2011, at 17:13:35
Percentages, statistics generalities notwithstanding, my step-daughter became clinically depressed and stopped functioning. She began to take a regimine of anti-dpressants and after some time has recovered to the point where she is aceing her exams again. Hope? Yes. Results? Definitely. What's next? Unfortuneately we're back to hope.
Incidently I am bipolar I and find it dubious that an antidepressant can induce a unipolar depressant into a permanent bipolar condition as McMan suggests.
Posted by linkadge on March 18, 2011, at 10:20:58
In reply to Re: Its not just us » sigismund, posted by Bob on March 18, 2011, at 0:23:44
>I have heard this from many health providers as >well - how fantastically everyone else does on >their meds. It's really annoying and I have a >hard time believing it in many cases.
They have to sell their buisness. They also have the perfect cover for not being able to provide real life testimonials. Namely, they can't break professional confidentiality.
Also, I have been to a doctor who has told me that most patients he treats end up on a medication merry go round.
Posted by linkadge on March 18, 2011, at 12:20:13
In reply to Re: Its not just us, posted by Toph on March 18, 2011, at 10:19:21
>Hope? Yes. Results? Definitely. What's next? >Unfortuneately we're back to hope.
What do you mean, the medications stopped working for your daughter? Also, to play the devils advocate...people do get better while on medications, what we'd like to know is how often the medication is responsible.
>Incidently I am bipolar I and find it dubious >that an antidepressant can induce a unipolar >depressant into a permanent bipolar condition as >McMan suggests.
It doesn't need to be perminanat. It just needs to be long enough for the doctor to conlcude you're bipolar and stick you on mood stabilizers to be taken indefinately.
Also, manic episodes can cause perminant damage to the brain. There are many medical cases of where damage to the brain results in affective instability. Alzheimers patients are not necessarily bipolar, but some of the neurological deterioration is associated with inability to proprerly regulate a range of emotions.
Antidepressant use is associated with loss of grey and white matter. Bipolar patients have deficicts in cortical grey matter, and some researchers hypothesize this affects the ability of patients to regular emotion.
Linkadge
Posted by Phillipa on March 18, 2011, at 20:23:18
In reply to Re: Its not just us, posted by linkadge on March 18, 2011, at 12:20:13
Wouldn't the loss show up on an MRI of brain? Phillipa
Posted by linkadge on March 18, 2011, at 21:09:54
In reply to Re: Its not just us » linkadge, posted by Phillipa on March 18, 2011, at 20:23:18
It does.
Linkadge
Posted by Phillipa on March 18, 2011, at 21:44:53
In reply to Re: Its not just us » Phillipa, posted by linkadge on March 18, 2011, at 21:09:54
So if my last MRI of brain was okay no lost gray matter? Phillipa
Posted by linkadge on March 19, 2011, at 8:00:17
In reply to Re: Its not just us » linkadge, posted by Phillipa on March 18, 2011, at 21:44:53
Well, it depends what they're looking for, and what they're measuring.
Linkadge
Posted by morgan miller on March 19, 2011, at 23:41:10
In reply to Re: Its not just us, posted by sigismund on March 17, 2011, at 18:21:28
I've said something like what you are saying here. Never did I say that the general poplution has "fantastic" results with antidepressant. I also don't think anyone else here said the same thing. Maybe I never made myself clear, but I believe that there are many many people out there that do very well on antidepressants without major side effects or major issues with discontinuing antidepressants. I never said that the people that are treatment resistant or have long term side effects from antidepressant treatment are confined to psychobabble. What I did say, was that psychobabble attracts these people and is in no way reflective of there being a large part of the population that has the same issues presented here on this site. The way I see it, the majority, not the large majority but the majority, of people find success with antidepressants and maintain that success for a long time. I have no way of proving this but I believe about 65 percent of people find an antidepressant that they respond very well to.
Unfortunately, I do not think that most people do what they should be doing as far as diet, exercise, therapy, maintaining a healthy social life and other lifestyle habit while they are in remission and healthy to reduce the chances of medication "poop out" and/or falling ill again.
Posted by morgan miller on March 19, 2011, at 23:46:28
In reply to Re: Its not just us, posted by Toph on March 18, 2011, at 10:19:21
>Incidently I am bipolar I and find it dubious that an antidepressant can induce a unipolar depressant into a permanent bipolar condition as McMan suggests.
Sometimes very bright people come up with some very wacky ideas. If this ever appears to actually be the case, I am quite positive it is because the person did have something going on genetically that predisposed them to some type of bipolar behavior that would have shown up and probably did just unnoticed in some form or another.
We should never underestimate the ability of our brain and psyche to heal and recover.
Posted by morgan miller on March 19, 2011, at 23:49:12
In reply to Re: Its not just us, posted by linkadge on March 18, 2011, at 10:20:58
As usual, cynicism arises from people that are constantly suffering without long term success in finding relief from treatment. Psychobabble is a place that attracts and is the home of chronic sufferers. The many people that have suffered before or but are no longer, are not seeking out help and posting about there good lives on the internet, they simply have no reason to.
Posted by morgan miller on March 19, 2011, at 23:52:35
In reply to Re: Its not just us, posted by linkadge on March 18, 2011, at 12:20:13
>Antidepressant use is associated with loss of grey and white matter.
Do you have any solid literature/studies to show this?
How do we know the loss in grey and white matter was not a result of the illness?
Posted by Phillipa on March 20, 2011, at 0:22:39
In reply to Re: Its not just us » linkadge, posted by morgan miller on March 19, 2011, at 23:52:35
From depression or other illnesses such as MS? I also see the majority of folks in real life respond to ads as I ask and talk a lot and people just say if ask which one they are on and they are working and seem happy. So?? I think there is a lot of merit in what your're saying. When I joined back about five years ago I don't feel people posted so much about tx resistance. Just general questions on meds. Phillipa
Posted by linkadge on March 20, 2011, at 15:41:39
In reply to Re: Its not just us » linkadge, posted by morgan miller on March 19, 2011, at 23:52:35
>Do you have any solid literature/studies to show >this?
>How do we know the loss in grey and white matter >was not a result of the illness?
Here is one of the studies I read.
http://stroke.ahajournals.org/cgi/content/full/39/3/857
Linkadge
Posted by Phillipa on March 20, 2011, at 19:03:12
In reply to Re: Its not just us, posted by linkadge on March 20, 2011, at 15:41:39
Sounds like culprits are TCA's to me. Phillipa
Posted by Phillipa on March 20, 2011, at 19:08:52
In reply to Re: Its not just us, posted by morgan miller on March 19, 2011, at 23:41:10
But this study I posted in it's own thread feels that leads to Stroke risk???? Phillipa
From Medscape Medical News > Psychiatry
Antidepressants May Be Linked to Increased Stroke Risk
Underlying Mechanisms Unclear, Researchers Say
Fran LowryAuthors and Disclosures
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Watch her inspirational video March 16, 2011 Antidepressant use may be associated with an increased risk for stroke, according to new research published online March 15 in the American Journal of Psychiatry.Senior author Susan Shur-Fen Gau, MD, PhD, professor and chairperson of the department of psychiatry at National Taiwan University, Taiwan, said the results "lend evidence to support our hypothesis that acute exposure to antidepressants, particularly those with high inhibition of the serotonin transporter, increases the stroke risk," Dr. Gau told Medscape Medical News.
Depression is known to be an independent risk factor for stroke, but whether treating depression with antidepressants reverses this risk is not known, the study authors, led by Chi-Shin Wu, MD, from Far Eastern Memorial Hospital, Taipei, Taiwan, write.
Concerns about the cerebrovascular effects of antidepressants have increased since a growing body of evidence has shown that antidepressants particularly selective serotonin reuptake inhibitors may induce bleeding complications and vasoconstriction of the large cerebral arteries, the study authors note.
To shed more light on whether the risk for cerebrovascular events was associated with the use of antidepressant medications, Dr. Wu and coauthors conducted a case-crossover study of 24,214 patients with stroke who were enrolled in the National Health Insurance Research Database in Taiwan from 1998 to 2007.
"The case-crossover design is one method for examining the effect of transient exposures on acute outcomes. In this study design, each patient serves as his or her own control," they write.
The researchers compared rates of antidepressant use during case and control time windows of 7, 14, and 28 days.
The analysis showed that the mean age at stroke onset was 68.6 years (SD, 12.0). Nearly half (48.3%) of the study subjects were women, 36.3% had mood disorders, and 75.9% had ischemic strokes.
Fewer Prescriptions, Greater Risk
Antidepressant use in the 2 weeks before the stroke was associated with a 48% higher risk for stroke (95% confidence interval, 1.37 1.59). However, there was no association with the number of antidepressant prescriptions in the previous year, the study authors note.
In addition, there was no statistical association between antidepressant use in the 2 weeks before the stroke and stroke risk for patients with 3 to 5 prescriptions in the previous year.
However, patients who had more than 6 antidepressant prescriptions had a lower stroke risk and those who had 1 or 2 prescriptions had the greater stroke risk, the study authors report.
Use of antidepressants with high inhibition of the serotonin transporter was associated with a greater risk for stroke than use of other types of antidepressants.
"Our findings are compatible with those of studies showing that a high inhibition of the serotonin transporter has a more potent antiplatelet effect and is associated with a higher risk of abnormal bleeding in other organ systems," the investigators write.
They add that a surprising finding was that high-potency serotonin inhibitors were associated with a greater risk for ischemic stroke. They suggest "antidepressant-induced vasoconstriction" as a possible mechanism.
Paradoxical Finding?
Still, they point out, the use of low-potency inhibitors of the serotonin transporter is associated with an excess risk for any stroke type.
"Thus, other underlying mechanisms for stroke risk in relation to antidepressant use warrant further investigation," the study authors write.
They also found that long-term users of antidepressants may actually be protected against stroke, adding that the interpretation of such a finding is "not clear."
The investigators also note that the case-crossover design of the study means that the frequency of exposure to antidepressant medication changes over time and also that their results may have been influenced by the confounding factors of acute indications, such as abrupt emotional distress.
In addition, there are several limitations inherent in using claims databases, including an inability to accurately measure adherence.
Despite these limitations, the study authors conclude that their results have major clinical and public health implications.
They recommend starting antidepressants at low doses and monitoring for adverse effects, particularly in individuals at risk for cerebrovascular events, because the stroke risk appears to be dose related and noted in the first few prescriptions.
Contradictory Findings?
Commenting briefly on this study for Medscape Medical News, Lee H. Schwamm, MD, professor of neurology at Harvard Medical School, Boston, Massachusetts, and a spokesman for the American Academy of Neurology, said the study design was very complex and that certain aspects of the study appeared to be contradictory.
"They write that the use of an antithrombotic increased risk of stroke 2.6-fold but that multiple prescriptions for antidepressants decrease the risk. I also worry about unmeasured confounders," he said.
Dr. Gau reiterated the recommendation for close monitoring of patients newly started on antidepressant medication.
"We recommend starting antidepressants at low dosages and closely monitoring the side effects for initial prescriptions, particularly for individuals at risk for cerebrovascular events. These high-risk patients are advised to use other antidepressants than antidepressants with a high affinity for the serotonin transporter to treat their depression," she said.
Dr. Wu reports financial relationships with Eli Lilly and Astellas. Dr. Schwamm has disclosed no relevant financial relationships.
Am J Psychiatry. Published online March 15, 2011.
Posted by morgan miller on March 20, 2011, at 22:17:02
In reply to Re: Its not just us, posted by linkadge on March 20, 2011, at 15:41:39
>In light of potential antithrombotic effects of SSRIs, we hypothesized that participants taking SSRIs and other serotonergic antidepressants in the period between the initial and follow-up MRI scans would be less likely to show worsening white matter compared with participants not taking antidepressants.
This was the last sentence in the introduction paragraph.
I imagine in youthful healthy individuals that exercise regularly and live a fruitful lives any risk would either be lowered or eliminated. The fact that these were unhealthy elderly patients must have played some role in the findings of this study.
Morgan
Posted by morgan miller on March 20, 2011, at 23:06:49
In reply to Re: Its not just us, posted by morgan miller on March 20, 2011, at 22:17:02
> >In light of potential antithrombotic effects of SSRIs, we hypothesized that participants taking SSRIs and other serotonergic antidepressants in the period between the initial and follow-up MRI scans would be less likely to show worsening white matter compared with participants not taking antidepressants.
>
> This was the last sentence in the introduction paragraph.OOps. This is what I meant to post..
>In this study, we did not find less frequent worsening white matter among SA users compared with nonusers of antidepressants as we hypothesized. We in fact observed a statistically insignificant effect of SA use in a direction opposite to our hypothesis. However, we did find that TCA users were more likely to experience worsening white matter compared with non-users of antidepressants. We note that a previous CHS study found no link between depression score and worsening white matter.11
It does appear that maybe TCAs are the AD's that carried the risk of white matter loss.
Posted by Phillipa on March 21, 2011, at 19:40:45
In reply to Re: Its not just us, posted by morgan miller on March 20, 2011, at 23:06:49
That is what I also got out of original article. Phillipa
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