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Dr. Bob is Robert Hsiung, MD,
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Posted by Comet on February 27, 2006, at 18:38:56
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
They are clearly not all "hype" - they work for plenty of people - not everyone probably not even most - but for many millions they work well. My sense is the depression and anxiety are incredibly complex problems that factor in a mix of biology and environment and personal history that make it nearly impossible to predict who these drugs will work for. I'm personally on an SSRI and definitely am having a mixed reaction. But I've known several people who responded incredibly well(including an ex-girlfriend who changed from being having a short temper, high strung and nearly impossible to deal with to perfectly sane and stable within a few weeks after taking Paxil or Celexa - and I, for one, was very grateful at the time for the existence of SSRIs)and others who dropped them after a relatively short time because they didn't like the side effects.
So yeah, it sucks that they aren't a magic bullet - but maybe that's too much to expect right now. But to say it's just hype is to say that the drug companies are selling snake oil and I just don't believe this is true.
Posted by Phillipa on February 27, 2006, at 18:50:20
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 27, 2006, at 15:21:16
Link that's exactly what the Resident said. That a placebo works as well as the meds. And this is not about me as I've been taking my luvox as prescribed without side effects and it doesn't do a thing positive or negative. Seriously this is not about me it was told to me be a Medical Resident just when I was starting to believe in the meds. He feels theraphy is much more beneficial. Fondly, Phillipa ps he said it's all about the money the pharmatical companies are making
Posted by yxibow on February 27, 2006, at 19:08:31
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by Phillipa on February 27, 2006, at 18:50:20
> Link that's exactly what the Resident said. That a placebo works as well as the meds. And this is not about me as I've been taking my luvox as prescribed without side effects and it doesn't do a thing positive or negative. Seriously this is not about me it was told to me be a Medical Resident just when I was starting to believe in the meds. He feels theraphy is much more beneficial. Fondly, Phillipa ps he said it's all about the money the pharmatical companies are making
A placebo will work as well as medication 1/3 of the time. This is very well known. SSRIs have a wide variety of reasons for taking them, so they have a wide variety of successors and failures. Panic Disorder, OCD, Depression, etc.
I'm assuring you, Jan, that you can believe what you want from a medical resident, but was this an M1, M2 ? There are 4 years of medical residency in general, sometimes less, sometimes more. Not to mention specialization of career goals towards psychiatry or towards 100s of other disciplines. Then you begin your practice and you build trust with other psychiatrists. You attend Grand Rounds. You take CEs. Trusting the words of a Medical Resident, though they may be a newly minted M.D., may have some words of wisdom, but not the wisdom of someone who has been through 15 years of practice. Trust me, because there are even differences in those who get beyond their apprenticeship.
And I'm no drug company shill, you know that Jan. SSRIs may not work for everyone -- there is treatment resistant depression. SSRIs work best for people with dysthimia, and modest to medium severe depression. For those with extreme depression, a tough choice to take an MAOI may be necessary. Its better than not being here and enjoying life -- life is for living. And there are other things besides MAOIs -- going back to a TCA, Remeron and a strict low calorie diet, Effexor, Celexa -- and maybe EMSAM if it comes out. There are drugs on the horizon too... some of them are only European oriented, so you may have to have a savvy doctor import them. There's always something. And then there's just plain old therapy. Which works, and works in conjunction with SSRIs as well, as I know with the horrible OCD I conquered before, with CBT.
I think while I respect the opinions of everyone who has contributed to this thread, the negativity towards an entire class of drugs does a disservice. But everyone is entitled to their own opinion, and I wish them well.
Posted by TylerJ on February 27, 2006, at 19:32:07
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
> Was talking to a Medical Resident. He said the SSRI's and SNRI's are all hype. They may work for a few but not for the majority. Please some good experiences I'm fed up. Thanks Phillipa/ Jan
Jan, I don't believe that at all! I've been on them all, and some did work for me. Paxil worked very well for 2 yrs., Zoloft for a year, it was so so, Remeron really helped me a lot for about 4 years. None of them has ever made me feel as good as I do on Parnate, however they did lift me out of my depression-especially Remeron (even though i gained 35 lbs.) Effexor has worked great for my Wife with post partum dep. Oh yea, Prozac worked well for me for awhile in the late 80's.
Hey, are you doing okay? What are you taking and for what if you don't mind. Take care.
Ty
Posted by Phillipa on February 27, 2006, at 19:46:58
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 27, 2006, at 19:32:07
Tyler I don't mind at all. Boy did I open a can of worms. This thread was meant to give everyone a chance to voice their opinion positive or negative. Acturally I am still looking for positive one. Right now I'm on 100mg of luvox. For depression yes I know it wasn't officially approved in the States for depression but only for OCD.But it is the oldest SSRI. And I am not afraid of it at all. I also am on valium had dropped to l0mg a day at night for sleep. When I told the pdoc he said to up it again. Keep posting people this is so educational and everyone is entitiled to their own opinion. So please post your experiences. And no a Resident is not an expert. The subject just became kind of a debate yeasteday so I decided to post the Thread. Love Jan/Phillipa
Posted by TylerJ on February 27, 2006, at 19:55:45
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » TylerJ, posted by Phillipa on February 27, 2006, at 19:46:58
> Tyler I don't mind at all. Boy did I open a can of worms. This thread was meant to give everyone a chance to voice their opinion positive or negative. Acturally I am still looking for positive one. Right now I'm on 100mg of luvox. For depression yes I know it wasn't officially approved in the States for depression but only for OCD.But it is the oldest SSRI. And I am not afraid of it at all. I also am on valium had dropped to l0mg a day at night for sleep. When I told the pdoc he said to up it again. Keep posting people this is so educational and everyone is entitiled to their own opinion. So please post your experiences. And no a Resident is not an expert. The subject just became kind of a debate yeasteday so I decided to post the Thread. Love Jan/Phillipa
Thanks Jan. So are you feeling good on Luvox? I hope that you are. SSRI's and SNRI's definitely work very well for lots and lots of people. One thing I forgot to mention is that I always needed High doses on these meds-but I didn't care and niether did my pdoc as long as they worked! You take care sweetie and i hope you are feeling great!! We all deserve that don't you think?
Love, Ty
Posted by Phillipa on February 27, 2006, at 20:01:44
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 27, 2006, at 19:55:45
Tyler so far just tired. No I don't feel good yet. Hoping to though. Love Jan
Posted by Glydin on February 27, 2006, at 20:22:38
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » TylerJ, posted by Phillipa on February 27, 2006, at 20:01:44
Yes, I believe a SSRI's works for me. I don't think it's a fluke. I do believe it is a chemical intervention that has made a new world for me.
Posted by Jakeman on February 27, 2006, at 20:39:33
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
> Was talking to a Medical Resident. He said the SSRI's and SNRI's are all hype. They may work for a few but not for the majority. Please some good experiences I'm fed up. Thanks Phillipa/ Jan
They have worked for me short-term. If anyone knows of long-term benefits (more than 6 months) please post the studies. I would be very interested.
warm regards ~Jake
Posted by linkadge on February 27, 2006, at 21:35:21
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by Phillipa on February 27, 2006, at 18:50:20
I noticed that after a while my brain adapted to what they were trying to do.
Either they pooped out, or my brain outsmarted them. My brain fought back against them. It found new ways to keep me depressed.
Another issue is that you don't know the whole story about people who are taking them. You can say, "oh look at so and so, s/he's doing great on such and such". But, you don't know what happens behind closed doors. When I was on them, I may have been rapid cycling. Sure, to the untrained eye, I appeared "better", but they were not positivly affecting my mental health, they were making things much worse, in many ways.
Linkadge
Posted by linkadge on February 27, 2006, at 21:39:38
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by yxibow on February 27, 2006, at 19:08:31
"A placebo will work as well as medication 1/3 of the time."
I'd like to believe that 2/3's of SSRI trials show that they're superior to placebo. I remember reading something that prozac fared better than placebo in closer to 1 in 10 clinical trials. But the truth, we will never know, because isn't it law that drug companies can keep this information private ?
Linkadge
Posted by linkadge on February 27, 2006, at 21:45:30
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Jakeman on February 27, 2006, at 20:39:33
Thats another issue. I could get max maybe 4 months of "effect" on an SSRI. Then nothing. Then withdawl, which I define as an expanse of time during which you feel equally as much worse from baseline as you did better on the drug.
Hey, but at least I'm not bitter... :)
Linkadge
Posted by 10derHeart on February 27, 2006, at 21:51:57
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
Prozac worked really well for me for MDD for two years.
I have also been on Strattera for over two years with minimal to no side effects, and it does control many of my ADD symptoms better than anything else I tried (or that my CV system could tolerate)
I may well be an exception, unfortunately. I feel blessed that these meds worked quickly and well. I disagree with the resident saying they are 'all hype.' Actual changes in the brain have been observed and measured, that's not made up. And some people have been helped.
Hang in there, Phillipa
Posted by linkadge on February 27, 2006, at 21:57:39
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by 10derHeart on February 27, 2006, at 21:51:57
But thats the thing. Placebo's can and do produce strong and real changes in brain activity too. Cognitive behavioral therapy also can change brain chemistry.
Some authors speculate that the side effects of a medication cue the user to know the drug has set in, and then their imagination and hope does the rest.
I don't know if I'd go that far, but I would say that for many people, they're not all they're cracked up to be.
Linkadge
Posted by erik98225 on February 27, 2006, at 23:04:54
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
They certainly do work. I can't live without Lexapro.
Posted by TylerJ on February 28, 2006, at 0:28:10
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » TylerJ, posted by Phillipa on February 27, 2006, at 20:01:44
> Tyler so far just tired. No I don't feel good yet. Hoping to though. Love Jan
You will, just stick with it..Luvox is a very safe drug and it is a very effective antidepressant! There's always going to be idiots that are gunna say this or that.I think that was really irresponsible for that guy to tell you they don't work-he's full of you know what. we have to be careful of who we listen too.. i trust my pdoc,he'll actually tell me if he thinks a drug doesn't work very well. And guess what, he really likes Luvox! :)
Love, Ty
Posted by linkadge on February 28, 2006, at 8:53:20
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 28, 2006, at 0:28:10
To say that they don't work at all may be closed minded on my part. But I wouldn't call somebody an idiot just based on the fact that they dissagree with the efficacy suggested by the drug companies.
A drug would need to keep me away from major depression for at least 6 months before I'd say it had any effect.
Some of the initial effects of a drug may be due to its actions on sleep. We know, for instance that interupting REM sleep in depressed patients has a very acute antidepressant effect. Most antidepressants initally significantly reduce REM sleep. Some of the "most effective" enatidepressants reduce REM sleep the most, ie the MAOI's.
But the body fights back hard. After a few months the body regains its REM sleep. You see drugs poop out a lot around the same time REM rebound occurs.
So I guess what I am saying is that, wait 6 months, and if you are still as enthused about a particular drug, then maybe it is doing something.
And who knows what it is your REM sleep is trying to do. Sure REM sleep is depressing, but maybe it is working on a much more solid an concrete solutions to your problems.
Linkadge
Posted by vainamoinen on February 28, 2006, at 12:41:19
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 28, 2006, at 0:28:10
Alone they don't do sheeeit for me. They work great for a week or two then poop out. I've tried many alone or in combination.
Let me see here...imipramine, desipramine, doxepin, prozac, zoloft, paxil, effexor, remeron, wellbutrin, nefazadone, reboxetine, selegiline. All to no avail.
But when taken with Seroquel like I do now, straight up rocket fuel. Prozac+Seroquel = :)
Posted by FredPotter on February 28, 2006, at 13:50:15
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by vainamoinen on February 28, 2006, at 12:41:19
Hegelian logic was cited by a previous poster to explain the prescribing of benzos. In their case the stages were (in the States):
(i) THE answer – prescribe for everyone with the mildest worry right through to patients with panic disorder (ironically Xanax seems to work best on extreme symptoms);
(ii) Demonize and try to ban them;
(iii)Use benzos carefully for some clearly defined disordersThe position with SSRIs and SNRIs is at an earlier stage of this process. (i) was and is taking place with a hint that (ii) is beginning to happen. Some drug trials have used a positive placebo (one with side-effects so the patient suspects if s/he's getting the real drug). I gather the SSRIs at least have an even poorer success rate under these conditions.
On the other hand, some further things need to be said. If there is such an illness as clinical depression (and some dispute that there is), a patient's prognosis might be muddied by people presenting with common-or-garden misery or grief, for which SSRIs were not designed and probably not very effective.
A final point is: most depressed people have "atypical" depression, for which SSRIs are not a good choice, MAOIs possibly being a better solution.
Despite the positive placebo remark above, it's possible there would be a more robust AD response tom SSRIs and SNRIs if they were prescribed for the right patients, hence setting stage (iii) in motion.
Any comments?
Fred
Posted by linkadge on February 28, 2006, at 14:47:32
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by FredPotter on February 28, 2006, at 13:50:15
I agree with you. The big thing with the SSRI's was that they were/are thought to be safe, or at least safer than the TCA's. Because of their presumed safety they've been dispersed like dandilion spores.
Many authors site the fact that TCA's were as effective if not more effective than the SSRI's. SSRI's were also popular because they fit hand in glove with the theory that depression was a disease related to low serotonin.
Theres no doubt in my mind that SSRI's did some weird and wonderfull things. But to call that an "antidepressant effect", I don't know.
Linkadge
Posted by TylerJ on February 28, 2006, at 15:04:58
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by linkadge on February 28, 2006, at 8:53:20
> To say that they don't work at all may be closed minded on my part. But I wouldn't call somebody an idiot just based on the fact that they dissagree with the efficacy suggested by the drug companies.
>
> A drug would need to keep me away from major depression for at least 6 months before I'd say it had any effect.
>
> Some of the initial effects of a drug may be due to its actions on sleep. We know, for instance that interupting REM sleep in depressed patients has a very acute antidepressant effect. Most antidepressants initally significantly reduce REM sleep. Some of the "most effective" enatidepressants reduce REM sleep the most, ie the MAOI's.
>
> But the body fights back hard. After a few months the body regains its REM sleep. You see drugs poop out a lot around the same time REM rebound occurs.
>
> So I guess what I am saying is that, wait 6 months, and if you are still as enthused about a particular drug, then maybe it is doing something.
>
> And who knows what it is your REM sleep is trying to do. Sure REM sleep is depressing, but maybe it is working on a much more solid an concrete solutions to your problems.
>
>
> Linkadge
>
>
>
>
Your entitled to your opinion just as I am. What I am trying to do is encourage Phillipa-she's vulnerable right now, and she certainly doesn't need someone to tell her the med she is on doesn't work. That's that persons opinion, but being a resident i personally think he shouldn't be telling someone who is suffering terribly as she is that the med she's on doesn't work...she doesnt need to hear that from anyone. On top of that Luvox DOES help SOME people-it helped me for about a year. You're right i shouldn't have called the guy an idiot...but again, when i come here my goal is to try to encourage and give people hope, we all need that, living w/ such a terrible ruthless desease!TylerJ
P.S. I am currently experiencing REM sleep and I still feel great. And you know what, if ANY drug helps me for even one freakin' week it's worth it to me cause I have been living in a pit for too damn long. (My opinion and how I feel...you know what they say about opinions :)
Posted by TylerJ on February 28, 2006, at 15:20:56
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 14:47:32
> I agree with you. The big thing with the SSRI's was that they were/are thought to be safe, or at least safer than the TCA's. Because of their presumed safety they've been dispersed like dandilion spores.
>
> Many authors site the fact that TCA's were as effective if not more effective than the SSRI's. SSRI's were also popular because they fit hand in glove with the theory that depression was a disease related to low serotonin.
>
> Theres no doubt in my mind that SSRI's did some weird and wonderfull things. But to call that an "antidepressant effect", I don't know.
>
>
> Linkadge
>
>
> TCA's are considered by most pdocs to be superior to ssri's and snri's your absolutely right. But as you know they are "dirty drugs" lot's of side-effects and of course can be deadly when taking an over-dose. I think this is the main reason (the over dose issue) that most docs shy away from them-plus ssri's and snri's are much cleaner drugs..i guess. I also agree that too many docs hand them out like candy. Tofranil saved my life 25 yrs ago-my first severe episode of depression, i was really bad off, only got out of bed for nearly 3 mos. to use the bathroom and shower and was hospitalized for a week for extensive tests-Diagnosis: Major depression w/ panic attacks, GAD, and OCD- disturbing thoughts no rituals. I also took ativan which helped me greatly. I was on Tof. for 5 yrs. and it worked pretty darn good. Nothing however has made me feel as well as Parnate. Take care.Tyler
>
Posted by linkadge on February 28, 2006, at 16:25:35
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » linkadge, posted by TylerJ on February 28, 2006, at 15:04:58
Thats where I disagree. I think that if a class of drugs has a particularly low sucess rate then the patient should know about it.
I would not tell somebody that the drug they're on is miraculous if I didn't think it were true. That can set somebody up for disaster.
P.S. How do you know you are experiencing REM sleep ?Linkadge
Posted by linkadge on February 28, 2006, at 16:35:29
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by TylerJ on February 28, 2006, at 15:20:56
I wish you the best success in your recovery.
I just see a pattern on this board and that is a tendancy to give the drugs merit that is not due to them, which can sometimes have negative consequences down the road.
I think it is wrong for a doctor to tell you that this drug will cure you, if it may do nothing at all. Because if doctors were honest about the drugs they dealt, then people would be forced to start to develop more diverse coping stradegies instead of putting their hopes in one single cure.So if somebody doesn't think a drug is doing anything, I'd say trust your intuition, ditch the drug, and try something else.
Linkadge
Posted by linkadge on February 28, 2006, at 16:38:48
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:35:29
When I took Remeron it made me very angry. I know now that is a possable side effect. At the time, my doctor told me that could not be true so I took the drug much longer than needed, and I lost a lot of friends because of my temper.
So, I think it is necessary to tell people the bare truth about a drug nomatter if you think that lying is what is best for them, becuse the truth is the only thing that can help long term.
Linkadge
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