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Dr. Bob is Robert Hsiung, MD,
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Posted by Chairman_MAO on March 2, 2006, at 21:23:37
In reply to Re: Yes » Chairman_MAO, posted by zeugma on March 2, 2006, at 20:30:29
It makes no sense to me to say that it treats mild anxiety after six weeks. Mild anxiety often comes and goes on its own in about that long. More than one psychiatrist I've talked to has told me that buspirone is "the most expensive placebo on the market". My psychopharmacology professor at Syracuse University told me that it was a failed attempt at developing an antipsychotic that was sold for anxiety in order to recover development costs. If you do enough studies on something, by change you will get a difference from placebo. They only have to show the studies that succeed to the FDA, and voila--your treatment for anxiety. What do you use for anxiety? If anything, I'll bet its not buspirone...
Anxiolytic drugs are those which relieve anxiety upon administration. Benzodiazepines, barbiturates, many antipsychotics, opioids, phenelzine's GABA-T inhibitng metabolite, kavalactones, mirtazapine...even hydroxyzine, diphenhydramine, and trazodone are more anxiolytic than buspirone. Valproate is more of an anxiolytic than buspirone. SSRIs are not anxiolytics, either. They attenuate felt emotion and lessen the number of thoughts coming into consciousness (in most people). Calling them anxiolytics is like calling an anesthetic an analgesic. Sure, if you can't feel ANYTHING, you won't be in pain. The reason many people feel more anxious when starting an SSRI is because they INDUCE ANXIETY. Then, after you adjust to that 4-6 weeks later, you no longer feel the SSRI-induced anxiety, but the emotional anesthetic effect is still maintained. Thus, it seems like something "kicked in". It takes a lot longer to realize what really happened, but I'll bet a lot of people who have taken these medications will agree with me. One may argue that benzos et. al. do this in a way that feels differently. Well, at least that way FEELS CALMER and is directly correlated with the administration of the drug.
Sure, it has an action: a 5ht1a partial agonist, too-weak-to-matter dopamine blockade, and mCPP's actions. "Placebo" does not mean "devoid of any effects". It does have those effects; if you take too much buspar, they become strong enough to notice (I drank grapefruit juice once by accident with it and had quite a bad time). It feels horrible. It is simply not an anxiolytic drug. Buspirone can help with certain SSRI side effects quite well in some cases and can speed an antidepressant response. And yes, in animal models 5ht1a agonists screen as anxiolytic. However, no one ever asked the rats how they were feeling.
A benzodiazepine will calm someone in psychosis, as will Seroquel, et. al. 2g of buspirone will do nothing (maybe induce dizziness and vomiting).
Is there anyone here who had crippling anxiety that was unmanageable, sought pharmacological treatment, and then found relief from buspirone?
The placebo effect is so powerful that it is present even when investigating treatments for very serious disorders that often involve extreme pain, discomfort, etc. That being the case, does it make sense to deem buspirone anxiolytic given that it has virtually no subjective effect at clinical dosages?
Posted by FredPotter on March 2, 2006, at 21:24:48
In reply to Re: Yes » linkadge, posted by Chairman_MAO on March 2, 2006, at 15:45:56
Thanks Chairman. As always an interesting post. One thing puzzles me. I don't find benzos effective against anxiety. Not like alcohol. Unfortunatey I had to stop drinking
Fred
Posted by Chairman_MAO on March 2, 2006, at 21:40:47
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by tizza on March 2, 2006, at 20:58:09
The answer to this is in this history of the diagnosis. ADHD used to be only for children, who never WANTED to take the speed. It was dispensed to them largely for the purposes of eliminating normal behaviors in healthy children (usually male) that parents and teachers found undesirable. Amphetamine, at the right dose, has a calming effect in MOST PEOPLE! It's just that some people have a very hard time functioning unless they are in that state, as their default state doesn't mesh with life tasks well; those are the people we say have ADHD. Only much later did psychiatrists extend this category to adults, and many psychiatrists debate that it does not exist in adults. It is no cooincidence that most psychiatrist will try to treat adults with ADHD with TCAs, wellbutrin, and strattera first--because dispensing any drug you WANT to take is against the doctrine of pharmacological calvinism.
In the case you describe, you are admitting that a tranquilizer makes you feel more tranquil. There is nothing illogical about the situation; the confusion only comes from a conflation of terms. Yes, diazepam is a DEPRESSANT, meaning it enhances the function of GABA--an inhibitory neurotransmitter--at GABA(A) receptors. This DEPRESSES--or slows down--certain neural activity in limbic system projections, decreases acetylcholine release (muscle relaxation, relief from "thought-frenzied" states, etc. DEPRESSION is a term that refers to a complex state in which one is persistently hopeless, suicidal, loses interest in things that once were enjoyable, cannot experience pleasure, etc. People that are depressed do not have DEPRESSED nervous systems. That is, it is quite possible for a depressed person to be agitated and sleepless.
The SSRI made you crave alcohol because it induced anxiety and inhibited DA release, which is calming. The neurological substrate in the not-really-paradoxical stimulant response involves an increase in the amount of DA at the synapse when the neurons are at rest. This results in increased activation of postsynaptic autoreceptors, which inhibits DA release. Thus, the receptors are more stimulating while resting, yet the amplitude of their reponse to activation is lessened. Thus, you have less impulsive, reactive activity--more focus. Dig it?
At high doses, the amount of excess DA present at the synapse overcomes the feedback mechanism's ability to compensate, and you have the effects classically associated with stimulants.
Posted by wildcard11 on March 2, 2006, at 21:40:55
In reply to Re: Yes, posted by linkadge on March 2, 2006, at 20:50:03
Posted by zeugma on March 2, 2006, at 21:59:11
In reply to Re: Yes » zeugma, posted by Chairman_MAO on March 2, 2006, at 21:23:37
> It makes no sense to me to say that it treats mild anxiety after six weeks. Mild anxiety often comes and goes on its own in about that long. More than one psychiatrist I've talked to has told me that buspirone is "the most expensive placebo on the market". My psychopharmacology professor at Syracuse University told me that it was a failed attempt at developing an antipsychotic that was sold for anxiety in order to recover development costs. If you do enough studies on something, by change you will get a difference from placebo. They only have to show the studies that succeed to the FDA, and voila--your treatment for anxiety. What do you use for anxiety? If anything, I'll bet its not buspirone...>>
Far from it. Clonazepam is the only reason I can engage in trivial pleasantries with anyone. My social anxiety is extreme.
>
> Anxiolytic drugs are those which relieve anxiety upon administration. Benzodiazepines, barbiturates, many antipsychotics, opioids, phenelzine's GABA-T inhibitng metabolite, kavalactones, mirtazapine...even hydroxyzine, diphenhydramine, and trazodone are more anxiolytic than buspirone. >>Buspirone is certainly not anxiolytic. If anything it is an antidepressant.
Valproate is more of an anxiolytic than buspirone. SSRIs are not anxiolytics, either. They attenuate felt emotion and lessen the number of thoughts coming into consciousness (in most people). Calling them anxiolytics is like calling an anesthetic an analgesic. Sure, if you can't feel ANYTHING, you won't be in pain. The reason many people feel more anxious when starting an SSRI is because they INDUCE ANXIETY. Then, after you adjust to that 4-6 weeks later, you no longer feel the SSRI-induced anxiety, but the emotional anesthetic effect is still maintained. Thus, it seems like something "kicked in". It takes a lot longer to realize what really happened, but I'll bet a lot of people who have taken these medications will agree with me. One may argue that benzos et. al. do this in a way that feels differently. Well, at least that way FEELS CALMER and is directly correlated with the administration of the drug. >>
I think SSRI's are anxiolytic for some. I have seen it. I have seen people who were preoccupied with suicide suddenly end their preoccupation. Of course, a dulling effect (going by what I've seen) sets in that is not very satisfactory. My impression is that SSRI's are better for OCD than depression. I think they are poor drugs long term because they destroy sleep architecture. I have seen sevrely demotivating effects that i do not consider therapeutic. But maybe in OCD this is the therapeutic effect.
>
> Sure, it has an action: a 5ht1a partial agonist, too-weak-to-matter dopamine blockade, and mCPP's actions. "Placebo" does not mean "devoid of any effects". It does have those effects; if you take too much buspar, they become strong enough to notice (I drank grapefruit juice once by accident with it and had quite a bad time). It feels horrible. It is simply not an anxiolytic drug. Buspirone can help with certain SSRI side effects quite well in some cases and can speed an antidepressant response. And yes, in animal models 5ht1a agonists screen as anxiolytic. However, no one ever asked the rats how they were feeling.
>
The rats have terrible alexithymia. Shame about that...I take buspirone because it blocks REM quickly, so I don't get hit with sleep paralysis because nortriptyline kicks in too slowly. My pathology is like that of what used to be called "cholinergic rebound," only not AD-induced (I know, I spent years living in a hole without AD's or anxiolytics and got as many brain zaps at bed time as anyone experiencing Effexor or Paxil withdrawal).
> A benzodiazepine will calm someone in psychosis, as will Seroquel, et. al. 2g of buspirone will do nothing (maybe induce dizziness and vomiting).
>
Over 30 mg buspirone induces a suspiciously AP-like fatigue (and I have some kind of narcolepsy so any elevation above baseline fatigue quite literally has me sleeping 20 hours at a time). Buspirone is not an anxiolytic, but we have to use the words marketers use; i'll accept that it's a failed antipsychotic with antidepressant effects. I use it to block REM, quickly. I am under constant REM pressure. It does help with this.
> Is there anyone here who had crippling anxiety that was unmanageable, sought pharmacological treatment, and then found relief from buspirone?Not me. Some of those who have treated me had that hope, but this country does not have wise policies re benzodiazepine guidelines. It seems things are even worse in the UK. The fact of the matter is that psychiatry is a branch of the creative nonfiction that has taken hold of this country, and hopefully people will become interested in more veridical forms of medical pursuit. But I won't hold my breath for that to happen, and in the meantime I have to do soemthing about my cholinergic system.
> The placebo effect is so powerful that it is present even when investigating treatments for very serious disorders that often involve extreme pain, discomfort, etc. That being the case, does it make sense to deem buspirone anxiolytic given that it has virtually no subjective effect at clinical dosages?>>
Well, you can define the illness so the pill will treat it. Generalized Anxiety Disorder is an 'interesting' diagnosis. I have yet to hear of anyone who had that as their sole pathology. Studies involving buspirone do require a certain disregard for the meanings of the words used to write them. There are some abstracts I could quote if I wasn't so f*cking tired. They are actually funny, at least if you aren't breathless from a panic attack.
-z
Posted by Chairman_MAO on March 2, 2006, at 21:59:25
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » SLS, posted by linkadge on March 2, 2006, at 20:48:06
linkadge: Nardil never pooped out for me. I did lose the initial euphoria and subsequently much of the energy boost, but it never stopped helping my social phobia, anxiety, and depression at least 50% (social phobia more like 75%-100% depending upon the situation). This was 10 months after starting it. Probably would've lasted at least 5-10 years, if not forever. It is the only AD that actually felt like it did anything resembling "correcting" a problem. Of course, that is all subjective. By "correct the problem" I mean that I was able to enjoy life!
I went off of it to try amphetamine because I was having problems holding down a job due to concentration problems (which exist on no meds). Nardil improved it somewhat, but not enough. I am beginning to think that I just have to find whatever occupation allows me to be a space cadet, compensate as best as I can, and take nardil again. If I can just get far enough to find a doctor that will Rx amphetamine WITH the Nardil, then my pharamcological nightmare will be over.
Posted by FredPotter on March 2, 2006, at 22:03:24
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Chairman_MAO, posted by linkadge on March 2, 2006, at 20:01:17
I'm a statistician and a jazz pianist. I haven't noticed that 225 mg Effexor with 2.5 mg Zyprexa impairs me in any way. Of course, I haven't replicated myself, so how can I tell?
Posted by Chairman_MAO on March 2, 2006, at 22:13:52
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by FredPotter on March 2, 2006, at 22:03:24
The perceiver and the perceived are one and the same. Your playing is part and parcel of your evaluation of the music you play (less so if you listen to it recorded, which you should do if you havent) Perhaps it doesn't impair you. Perhaps you were overly obsessive so now the net result is you play better. Or, perhaps you aren't having as many fine-grained emotional perceptions related to your music as you once were, and so no longer notice what would have previously stood out as "off" or otherwise undesirable.
If an SSRI can numb people's loins, I imagine it could do something analogous with other sensual pursuits, such as playing music. If I may wax Freudian for just one bittersweet moment: Libidinal energy is involved in both examples.
It could be that the sexual dysfunction of SSRIs is, as psychiatrist Elio Frattaroli wrote in "Healing the Soul in the Age of the Brain", "[reducing libidinal energy] is not a side effect, but rather the primary effect [of SSRI drugs]"
Drunk people often do not notice they are slurring their words. Now, of course you aren't impaired like that at all. Just a thought experiment ...
Posted by zeugma on March 2, 2006, at 22:50:36
In reply to Re: Yes » Chairman_MAO, posted by zeugma on March 2, 2006, at 21:59:11
Buspirone can help with certain SSRI side effects quite well in some cases and can speed an antidepressant response. And yes, in animal models 5ht1a agonists screen as anxiolytic. >>
there is an issue here with where the threshold would be put for a substance to be anxiolytic/ antidpressant.
sometimes a little bit counts, even in severe illnesses.
-z
Posted by Chairman_MAO on March 2, 2006, at 23:18:15
In reply to Re: Yes, posted by zeugma on March 2, 2006, at 22:50:36
I'm not sure what you mean...
Following your suggestion, one should be able to employ the "benzodiazepine antipsychotics" in paranoid schizophrenia, for the benzodiazepines definitely lessen feelings of fear, worry, suspicion, paranoia, and other lawn orniments residing in front of Mental Misery Manor. In fact, at high enough doses (provided the patient is kept away with other meds), they can stop it altogether. Are they antipsychotics?
Depression can feature anxiety, and depression can be caused by anxiety. However, if you treat such anxiety with an anxiolytic, the anxiety is gone quickly, yet the depression remains. If buspar is used in that circumstance, after 4-6 weeks (at ueber-doses) the depression might improve to the point where there's not as much anxiety (or in this case I think "worry" is better). Does that mean buspar is an anxiolytic? What it means, really, is that buspar isn't ANYTHING. Did it get rid of the depression or anxiety? No. It just "improved" both. And I wonder if that has anything to do with the way SSRIs "improve" things...
It is a weak 5th1a partial agonist with some other properties. It should be labelled as a REM sleep control drug, if anything.
or did I miss your point
Posted by tizza on March 2, 2006, at 23:34:33
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » tizza, posted by Chairman_MAO on March 2, 2006, at 21:40:47
> The answer to this is in this history of the diagnosis. ADHD used to be only for children, who never WANTED to take the speed. It was dispensed to them largely for the purposes of eliminating normal behaviors in healthy children (usually male) that parents and teachers found undesirable. Amphetamine, at the right dose, has a calming effect in MOST PEOPLE! It's just that some people have a very hard time functioning unless they are in that state, as their default state doesn't mesh with life tasks well; those are the people we say have ADHD. Only much later did psychiatrists extend this category to adults, and many psychiatrists debate that it does not exist in adults. It is no cooincidence that most psychiatrist will try to treat adults with ADHD with TCAs, wellbutrin, and strattera first--because dispensing any drug you WANT to take is against the doctrine of pharmacological calvinism.
>
> In the case you describe, you are admitting that a tranquilizer makes you feel more tranquil. There is nothing illogical about the situation; the confusion only comes from a conflation of terms. Yes, diazepam is a DEPRESSANT, meaning it enhances the function of GABA--an inhibitory neurotransmitter--at GABA(A) receptors. This DEPRESSES--or slows down--certain neural activity in limbic system projections, decreases acetylcholine release (muscle relaxation, relief from "thought-frenzied" states, etc. DEPRESSION is a term that refers to a complex state in which one is persistently hopeless, suicidal, loses interest in things that once were enjoyable, cannot experience pleasure, etc. People that are depressed do not have DEPRESSED nervous systems. That is, it is quite possible for a depressed person to be agitated and sleepless.
>
> The SSRI made you crave alcohol because it induced anxiety and inhibited DA release, which is calming. The neurological substrate in the not-really-paradoxical stimulant response involves an increase in the amount of DA at the synapse when the neurons are at rest. This results in increased activation of postsynaptic autoreceptors, which inhibits DA release. Thus, the receptors are more stimulating while resting, yet the amplitude of their reponse to activation is lessened. Thus, you have less impulsive, reactive activity--more focus. Dig it?
>
> At high doses, the amount of excess DA present at the synapse overcomes the feedback mechanism's ability to compensate, and you have the effects classically associated with stimulants.
>
>
> Yes I do get *persistently hopeless, suicidal, loses interest in things that once were enjoyable, cannot experience pleasure* when I'm suffering a severe bout of depression and VERY *agitated and sleepless* so when I take SSRI's this get magnified greatly and my friends beg me not to take them because I turn very aggressive and get extermly self destructive. I appreciate your response, thankyou. The Val keeps GAD and social phobia in check and if I feel like I'm sliding back into a black hole I just up my Val dose and it seems to get me through. Still having major trouble with the self loathing though, I'm just starting CBT for that. 6 months effexor free WOO HOO oh and I use mogadon (nitrazepam) for insomnia. It's the best thing I have ever taken for that except seroquel which left me a drooling idiotic mess. Paul
>
>
>
>
Posted by tizza on March 2, 2006, at 23:40:15
In reply to Re: Yes » zeugma, posted by Chairman_MAO on March 2, 2006, at 23:18:15
Depression can feature anxiety, and depression can be caused by anxiety. However, if you treat such anxiety with an anxiolytic, the anxiety is gone quickly, yet the depression remains.
I have been dx both ways maybe that's why I have been on the drug merry go round for so many years and still after a sh*t load of drugs, benzo's seem to be the only ones that work for me but I have never tried buspar. Paul
Posted by cecilia on March 3, 2006, at 0:41:34
In reply to Re:New Idea, posted by Phillipa on March 1, 2006, at 15:57:26
I think it's better to have a truth board, not just a positive board. People new to meds hear more than enough lies from doctors and advertisements.. At least here they can hear a variety of different experiences and know they're not alone when they experience a side effect their doctor says doesn't exist. Cecilia
Posted by tizza on March 3, 2006, at 1:37:49
In reply to Re:New Idea: phillipa, posted by cecilia on March 3, 2006, at 0:41:34
I am still flummoxed that there is drug advertising allowed, is there really advertisments for antidepressants? I'm not sure about this but it is not permitted here with the exception of Paracetamol (acetaminophen), asprin or ibuprofen and that's about it. Australia has very strict advertising controls. I'd drop dead if I saw an ad for Effexor or Prozac, either in print, a magazine, billboards or on TV. Someone please tell me this is not true. Paul. I'd have to aquaint myself in the ways of becoming a graffitti artist.
Posted by wildcard11 on March 3, 2006, at 7:56:22
In reply to Re:Is advertising Meds allowed in the US?, posted by tizza on March 3, 2006, at 1:37:49
yes~it's true. i'd guess half of the commercials i see are for A/D's and they are the same. they show someone who is down and then after they have taken the advertised med. and they are happy go lucky and life is perfect. it's a joke if you ask me but *most* docs i know of are all to ready to rx any A/D w/o further monitoring (general practitioners)...if you know what to say, you can get anything here. that's just my little opinion on it.
Posted by linkadge on March 3, 2006, at 7:59:23
In reply to 150mg (nm) » linkadge, posted by wildcard11 on March 2, 2006, at 21:40:55
I find it hard to believe that you dropped 150 mg of effexor cold turkey and were on no other antidepressant and experienced 0 withdrawl symptoms. Thats just skeptical me.
If you went onto another antidepressant after you stopped effexor then that doesn't cound cause they can block eachothers withdrawl effects.
Linkadge
Posted by tizza on March 3, 2006, at 8:13:13
In reply to Re: 150mg, posted by linkadge on March 3, 2006, at 7:59:23
> I find it hard to believe that you dropped 150 mg of effexor cold turkey and were on no other antidepressant and experienced 0 withdrawl symptoms. Thats just skeptical me.
>
> If you went onto another antidepressant after you stopped effexor then that doesn't cound cause they can block eachothers withdrawl effects.
>
>
> Linkadgei went from 150 to 75mg of effexor for 2 months to level out and then tapered from there, pure hell.
*If you went onto another antidepressant after you stopped effexor then that doesn't cound cause they can block eachothers withdrawl effects.*
That's why I had no withdrawals from citalopram when I switched to Luvox. I'm sure it would have been yet another horror story to add to the list. Why do GP's and pdocs keep you going from one SSRI to another, if it doesn't work after 3 different attempts then strike 3 you're out!!!! Paul
Posted by wildcard11 on March 3, 2006, at 8:27:06
In reply to Re: 150mg, posted by linkadge on March 3, 2006, at 7:59:23
Well i know for a fact that i did and had NO withdrawal effects. not everyone has the same chemical make up so why is that so hard to believe? any A/D i have ever been on i quit cold and been okay (not recommending it w/o dr. approval). i have had 1 relapse after being off effexor xr for 45 days but that was some time ago. i went from 225 to 150 to 0 and am doing good. hell, i wouldn't doubt i'm the exception to the rule as i always have been..lol
Posted by wildcard11 on March 3, 2006, at 8:36:18
In reply to Re: 150mg » linkadge, posted by wildcard11 on March 3, 2006, at 8:27:06
>let me add this~i did take 225, then the next day drop to 150, then the next day take 75 and then none in case that 3 day period could be the difference.
Posted by Chairman_MAO on March 3, 2006, at 9:16:48
In reply to Re:New Idea: phillipa, posted by cecilia on March 3, 2006, at 0:41:34
All advertisements are lies, as none of the conditions that the medications purport to treat exist as the entities that the advertisements claim, i.e. medical conditions witn clearly defined biological etiologies. If any of these conditions were actually biological, it would no longer be psychiatric. The problems are suffering are very real; they just aren't medical diseases. The psychiatric slight-of-hand is necessary to make giving drugs for mental illness compatible with the doctrine of pharmacological calvinism.
Posted by Chairman_MAO on March 3, 2006, at 9:20:59
In reply to Re:Is advertising Meds allowed in the US?, posted by tizza on March 3, 2006, at 1:37:49
Sounds like Oz is the place I want to be, then. You mean there is a trace of scruples left in public policy? Somehow, in the United States, it is OK to directly market drugs to patients yet tell them they must get a permission slip from a doctor in order to take them. We are supposed to have a free market, yet the advertisers are playing a rigged game.
"Babylon system is a vampire, sucking the blood of the sufferers..."
--Bob Marley
Posted by Chairman_MAO on March 3, 2006, at 9:25:09
In reply to Re:Is advertising Meds allowed in the US? » tizza, posted by wildcard11 on March 3, 2006, at 7:56:22
The only AD they won't advertise right off the bat are MAOIs. Those you have to jump through flaming hoops while juggling baby seals to get permission to take. It is easier to get an Rx for d-amphetamine.
Yes, there are potentially life-threatening effects. What does that matter if you feel like killing yourself when you aren't on the medication?The commercials are basically saying in so many words "this drug works just like the first time you took [illlict drug of choice]".
Posted by linkadge on March 3, 2006, at 9:31:44
In reply to Re: 150mg » linkadge, posted by wildcard11 on March 3, 2006, at 8:27:06
I just find that hard to believe. How long before you went onto another antidepressant ? Don't mean to be a dweeb, but I'd just have to see it to believe it.
Effexor is so addicting for some people that they have to start counting the pelets in the 37.5mg capsules.Linkadge
Posted by linkadge on March 3, 2006, at 9:33:02
In reply to oh » wildcard11, posted by wildcard11 on March 3, 2006, at 8:36:18
Thats still very suprising. Not sying its not possable, but just very suprising.
Linkadge
Posted by Chairman_MAO on March 3, 2006, at 9:49:05
In reply to Re: oh » wildcard11, posted by linkadge on March 3, 2006, at 9:33:02
Many people do not get withdrawal symptoms. I feel a lot of it has to do with the perceived psychological need for the medication.
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