Posted by linkadge on January 31, 2010, at 15:35:17
In reply to Re: Is Suicide Ever A Viable Option?, posted by Sigismund on January 31, 2010, at 14:51:16
>Why not? Surely not because of the efficacy of >psychiatric treatment
Thats it. Sometimes I feel that the treatment of depression is just not a priority. The research shows that a good proportion of patients are not getting better, that patients are not achieving remission, that patients are relapsing etc. Bipolar depression is also very difficult to treat effectively - and is probably a higher risk of suicide than unipolar.
Many of the 'effective drugs' are not safe for long term administration IMHO. Atypical antipsychotics, TCA's and ECT, have various toxicities, many of which would be unacceptable in other brances of medicine. If I took my seroquel daily like a good patient, where would I be in 20 years from now. Probably an insulin resistant diabetic.
I am discouraged about the lack of progress. In the last 10 years I don't really see the kind of improvement one might expect.
There are so many leads they could take. There are dozens of phytochemicals which could be used as templates for synthetic drugs. For instance, resveratrol, quercetin, hyperforin and turmeric have various cellular, immunilogical and neurotransmitter targets that could be more intesivly investigated.
What happened with RU486? It was supposed to be 'fast tracked' for depression like 10 years ago. What have we got since 2000? Cymbalta, escitalopram and abilify? Is that it? My doctor doesn't even prescribe escitalopram since he says citalopram is as effective. And head to head trials suggest that cymbalta is consistently inferior to effexor or even fluoxetine. Plus, I've got a book here from 1983 "drugs and the brain" solomon h. snyder which lists citalopram as a promising new antidepressant. So our top antidepresants today were known about like 30 years ago.
Suicide is the 2nd leading cause of death in young people. It outkills cancer. Think of the mony poured in to cancer research. I would be suprised if depression research gets 1/50th of that. For ever person that kills themselves theres probably a dozen more that feel like doing it on a daily basis, which is worse than death itself.
In the 90's there was so much hope for biological psychiatry. The SSRI's and atypicals were the magic bullits. People were starting to believe that science was getting a grip on depression. In the past 10 years a lot of that has fizzled away. I think a lot of psychiatrists are discouraged too - when the best they can offer their patients is paxil and zyprexa combos. And they have to deal with all the backlash about whether these drugs even work. I feel that psychiatrists are just going through the motions these days. There isn't that spark of inthusiastic belief that this is a real illness that can be treated safely and effectively.
Even things like ECT have come under heavy fire in the last 10 years. Studies have been released casting serious doubt on the boasted 70% remission rate. Studies released suggesting that most patients relapse and that reports of memory loss were not properly assessed.
The FDA is just taking no risks when it comes to depression. All that gets approved are drugs with the same mechanisms of action namely monoamine reuptake inhibitors.
I'd rather see drugs get approved then recalled than not approved at all.
Linkadge
poster:linkadge
thread:935487
URL: http://www.dr-bob.org/babble/20100122/msgs/935519.html