Posted by jumpy on March 20, 2003, at 17:31:46
In reply to Do we *all* need mood stabilizers w/ a..d.'s? , posted by jay on March 10, 2003, at 9:22:15
> I know, sounds like an 'outlandish' question. Also, please, I am not speaking from some Breggin kind-of (what I consider) "radical, irrational" viewpoint. But taking into account a few things:
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> a) 'First..do no harm' as our pal Hippocrates (sorta) said. The massive "popularity" of antidepressants, and both the massive amount of 'adverse effects' and seemingly lack of overall efficacy in their use in monotherapy. (I know..this is controversial, but even some of the most stringent pharmacologists admit that the singular use of antidepressants has brought on many complications along with their anywhere from '40 to 80' percent 'cure' rate...take your pick on the figures to believe.) There is even some numbers to indicate that some (quite a few, actually) who are treated with just an a.d. may get some harm in future responses. (This being those prone to 'rapid cycling', and who fall into any place on the bipolar spectrum.) I will admit some of my thinking on this is influenced by some of the research brought up by Jim Phelps. (Controversial, again, as always.)
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> b) The lack of overall effect of a major component of depression by monotherapy of antidepressants on suicide and suicidal ideation. The mood stabilizers, and lithium in particular, as well as the antipsychotics, still hold more efficacy towards suicidal ideation than antidepressants. Suicidal ideation is often a common link shared with depression (not always of course...and again I know...this is controversial...etc. etc.), and it seems that even if a person has had suicidal thoughts, many pdocs and docs will still prescribe an antidepressant without (or rather than) the more proven treatment of lithium, et al. I know this is deeply complicated, and it's a question of "treat the depression...it will (should) treat the suicidal ideation." But, again, the numbers show that mood stabilizers are more effective for suicidal ideation than antidepressants. That leaves wide open some very, VERY important questions of using antidepressants first-line for depression.
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> I know this all makes things so much more confusing and such, but I think we should be deeply concerned because millions are treated quite simply for depression with a singular antidepressant, a treatment that still seems to be rather 'scattered'. (In addressing a few but leaving so many symptoms/questions wide open.)
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> Please take into account the whole YMMV, controversial, etc. aspect of this. It's great to see these questions being asked in the halls of research clinicians, psychopharmacologists, etc, but even amongst the large population of psychiatrists and doctors, these questions seem to go passively by. Remember when you first went for treatment for your depression? How much of the spectrum of questions above did your pdoc or doc address, and how long did it take for you to ask some of these deeper questions? Even for those who have found some contented relief, there often was a *LOT* of suffering in between. What do you folks think?
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> JayGreat question Jay ... I just watched Dr. Post's Lecture on the Neurobiology of Bipolar disorder. He was talking about depression and the tremendous amount of brain cell death that occurs with each episode. He goes on to talk about lithium and how it increase all the growth factors in the brain. Maybe low dose lithium would help all of us ... prevent loss of millions of brain cells even in unipolar depression.
I am going to speak to my pdoc about going on low dose lithium ... would it be rational. (I have several family members with bipolar disorder). One ... to protect me against going into a manic cycle, two ... to encourage cell growth, three ... see if it help my chronic recurrent depression (some say all chronic, relapsing depressions are variants of bipolar illness ... cycling illnesses).
Great observations.
Jumpy
poster:jumpy
thread:207699
URL: http://www.dr-bob.org/babble/20030319/msgs/210989.html