Posted by SLS on January 15, 2007, at 10:27:31
In reply to Re: Depressives' sensitivity to stimulants!, posted by med_empowered on January 14, 2007, at 16:48:54
> I think, like a lot of things in psychiatry, the stims for add, but not for depression practice isn't based on good science.
Bad science then? It seems to be based on something.
> Stims can be good antidepressants.
For what percentage of people suffering with MDD or BD do you think they would be good antidepressants?
> Since the 40s, they have been used widely, and often safely, for depression.
Why did they stop?
> I think psychiatry has taught that antidepressants are meds "specifically" for depression
I can see this. Remember, though, that it was the old-timers like Nathan Klein who got to see the differences in efficacy between amphetamine and imipramine who helped establish a trend in thought that these newer drugs better target affective disorders.
> (but not very good ones)
When they work, they can be miracle drugs for those who had suffered.
> and stimulants are "specifically" for ADHD.
There are plenty of doctors who have open minds when it comes to the use of psychotropics. I have seen quite a few. I think you'll find, though, that the majority have found through experience that amphetamine monotherapy does not produce a persistent antidepressant response for MDD and BD. If the clinical experience of experts represents bad science, I am often inclined to respect it. And yes, I have tried amphetamine monotherapy. I experienced an antidepressant effect for the first 3-4 hours after my first dose. That was about it, despite continued treatment at 20mg.
> The problem is, psychiatry isn't like real medicine,
Would this include diagnosis?
> where you have discrete disorders that respond to specific medications. You're dealing with a whole person here--feelings, thoughts, past, present, a whole brain--so there's going to be a lot of variability in terms of what works and what doesn't.
Most definitely. I'm glad to see that we are in agreement that there are treatments that do indeed work.
> Also, I think part of the problem is that in the 60s speed was so abused
Yes, it was.
> docs are slow to prescribe "addictive" substances,
Why the quotation marks given your above statement?
> and patients continue to suffer while paying out $$$ for ineffective treatment.
The only treatments that are ineffective are the ones that don't work. Sorry. But that's the state of the art - best guess trial and error. You don't think that deciding between Spiriva and Advair for COPD isn't an exercise in trial and error? Why should psychiatry be singled-out in this regard?
> I think it boils down to this: psychiatric patients get screwed.
Perhaps you are - not me, thanks.
> If you're a heart patient and your medication s/e suck, your doc works with you.
Ok.
> Depression? Bipolar? Schizophrenia? Stick with it. If you're in chronic physical pain, a reasonable doc will work with you, possibly with very strong, potentially addictive meds. Psychic Pain? Can't leave the house? Too apathetic to function? Too damn bad. Take your Paxil and shut up.
This has not been my experience with psychiatrists, and I don't think I could agree with such a generalization. If you have been treated this way, then you have not been given a fair opportunity to achieve wellness. You might consider using the Internet as a resource to find a competent and professional doctor who cares and is willing to work with you. There are plenty of them.
> That, I think, is the problem: shrinks really don't respect or value their patients.
Another generalization. How can such things be so universally accepted as fact? Bad science.
- Scott
poster:SLS
thread:721931
URL: http://www.dr-bob.org/babble/20070113/msgs/722494.html