Posted by West on July 23, 2008, at 17:01:38
In reply to Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 22, 2008, at 18:38:23
'Most of the new antidepressant drugs introduced in the last twenty years do not work effectively. The evidence about them presented to doctors, even in the most respected leading medical journals, is closer to advertising copy than it is to science. There is clear and incontrovertible evidence that scientific data and publications are controlled, manipulated and subverted by international pharmaceutical companies to an extent that would astonish most ordinary people, including doctors.'
Much of his damning of modern antidepressants is to do with smudging/shelving of data and ghostwriting of data, none of which is particularly new.
In fact the Lancet's studies disproving the effectiveness of the SSRIs and claiming them to be no more effective than placebo are thought to be false*. Views of this nature have gained popularity in medical journals and mainstream medical literature of late in the UK so that many practitioners (dangerously, in my view) presently subscribe to the peculiar and fashionable view that drugs for psychiatric conditions should be avoided wherever possible in favour of talking therapies and lifestyle changes (somehow the suggestion of fresh air and exercise doesn't give the impression of being taken seriously).
Doctors I have had experience with have put little faith in getting better on medication alone, and perhaps this is true of some people. Another still has said 'you know there's little evidence that any of these work at all'. Perhaps they are right, although there is a cruel irony in the production and marketing of drugs with negligible benefits on depression...only for patients to take them, not get better, and subsequently get the 'i told you so' treatment.
Suggestions have been made to me that not succeeding on antidepressants serves to reinforce the notion that I am not depressed, such is the pervading logic and sloppy complacency of doctors on the NHS. Their livelihood does not rely on creativity or resourcefulness; only that they prescribe the right drug in the right order out of a little book we call the BNF (british national formulatory) and try not to get their wires crossed in prescribing contraindicated substances: many successfully manage to balls even this up.
Anyway enough of the lecture. The point is that where some of these new drugs lack efficacy (i.e the SNRIs) others exist which do work, especially when combined and put to work on the uptake or selective agonism/antagonism of specific neurotransmitters: this is called psychopharmacology and not an art practiced with any conviction by any psychiatrist you're likely to come across.
For example, a pdoc adding wellbutrin to lexapro in the US is not an example of considered psychopharmacolgy, but merely bad science the type of which a six year old child could reasonably be taught to grasp.
We are downtrodden and misery-ridden enough as it is, so i won't include this:
Pharmaceutical companies justify their record profits by emphasising the cost of developing new drugs, yet the figures indicate that they only spend 10% on Research and Development (R&D), but they spend 30% of their budget on advertising. Furthermore, a sizeable chunk of that meagre 10% includes expenses to doctors who do very little actual research, but attend briefings, conferences and the like that are thinly disguised junkets (I have colleagues who participate in such activities). So the proportion of the 10% that is true research is much smaller even than it seems. In reality most companies are almost certainly doing far more development, of publicly (taxpayer) funded original research, than original research of their own. My analysis and summation of the situation is that pharmaceutical companies have been persistently and systematically deceiving us all and misrepresenting what they do, and how they do it, to their great financial benefit and everyone elses detriment. I expect some would argue that constitutes powerful evidence against the benefits of unregulated capitalist free enterprise: I find it hard to counter that argument. The main source of financial information concerning Big Pharma, i.e. pharmaceutical companies that I know of is Public Citizen Congress Watch (3) www.citizen.org/documents/Pharma_Report.pdf.
However sometimes feeling as though you fighting for something good, for virtue and truth, is useful when struggling with depression. Many of us are here precisely because we haven't found sufficient relief in these medicines, if that is what they are, or found fleeting benefit only to lose it again, or didn't really find it at all, but thought they did. It's not our fault, there is mass-ignorance at work surrounding the popular treatment of depression, starting at the root of these drugs in their inception which have largely been the result of coincidence or accident- the indications for which an agent is nearly always a secondary consideration.
In years from now people will look back with great sympathy for those who had to endure such dreadfully crude medicine, in the meantime it is up to us to remain extra vigilant and educate ourselves in all aspects of our respective conditions as patients and in many cases consumers.
Working with available tools, Dr. Gillman would suggest a combination of a tricyclic/reboxetine + sertraline:
'Furthermore, we also know that there is a congruent difference in the ability of amitriptyline / imipramine / clomipramine to precipitate serotonin toxicity. The above receptor affinity data clearly indicates that (at least for TCAs) potencies of less than one (i.e. Ki < 1 nM) are required for clinical effectiveness. It is therefore reasonable to suggest that in designing a dual action strategy it would be ideal to aim for those kinds of potencies in both pathways. Neither venlafaxine nor duloxetine come anywhere near that. Clomipramine definitely does, combinations like sertraline + nortriptyline, or sertraline + reboxetine very probably do...In my firm opinion none of the new drugs, and that includes the supposed dual action drugs venlafaxine (Efexor) and duloxetine (Cymbalta), actually work as well clomipramine.'
One other drug he seems to champion is Tranylcypromine with which he has treated over a thousand patients successfully (although he concedes insomnia is a problem in many). He even says it would be his first choice in friends or loved ones who fell ill.
* i have only somebody's word on this (although he is something of an authority)- would be interested if anyone could find anything to support it.
poster:West
thread:841488
URL: http://www.dr-bob.org/babble/20080718/msgs/841644.html