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Dr. Bob is Robert Hsiung, MD,
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Posted by Dr. Bob on March 5, 2006, at 17:29:44
In reply to Re:New Idea: phillipa » cecilia, posted by Chairman_MAO on March 3, 2006, at 9:16:48
> All advertisements are lies
Please don't exaggerate or overgeneralize.
But please also don't take this personally, this doesn't mean I don't like you or think you're a bad person.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
And follow-ups regarding advertisements should be redirected to Psycho-Babble Social.
Thanks,
Bob
Posted by linkadge on March 5, 2006, at 17:36:32
In reply to Re: please be civil » Chairman_MAO, posted by Dr. Bob on March 5, 2006, at 17:29:44
With regards to the SSRI, heart study, I think this is another example of the difference between what doctors want antidepressants to be and what they are.
I guess they would want that when the depression has been treated that everything else will just fall into place, but it doesn't always happen that way.
Linkadge
Posted by Phillipa on March 5, 2006, at 18:48:38
In reply to Re: 150mg » Phillipa, posted by linkadge on March 5, 2006, at 17:06:08
Link you're right. And when someone's life changes for the better in their mind that is a potent reason to stop taking a med. I know myself when paxil at l0mg was working for me and I really felt well the fact that my Son was coming to live with us and he didn't like meds so I quit but I did have some brainzaps so did it slowly. And for the other poster Jay that is very intersting about the serotonin in the gut. That explains to me why I had diarrhea when I did first start to paxil. Love Phillipa
Posted by sdb on March 5, 2006, at 19:01:02
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS » sdb, posted by linkadge on March 5, 2006, at 17:26:45
I am not sure about cardiovascular risks and ssris involved. According to the new study there is definately a risk but in literature is even written the contrary exempli gratia:
----------------------------------------
Am J Cardiovasc Drugs. 2003;3(3):149-62.
Effect of selective serotonin reuptake inhibitors on platelet activation : can they prevent acute myocardial infarction?Schlienger RG, Meier CR.
Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology, University Hospital, Basel, SwitzerlandDepartment of Pharmacy, Institute of Clinical Pharmacy, University of Basel, Basel, Switzerland.
In recent years a large body of evidence from several longitudinal studies has emerged suggesting that depression is an independent risk factor for cardiovascular disease (CVD) and that the association between depression and increased CVD risk is not merely due to negative mood-driven behavior related with depression. Even though the underlying mechanisms are not well understood, several hypotheses and explanations have been proposed such as increased activation of the hypothalamic-pituitary-adrenal axis, abnormalities in the sympathoadrenal system, or abnormalities in platelet function. Platelet function abnormalities, including increased platelet reactivity, may predispose patients with depressive disorders to clotting diatheses and may explain their vulnerability to CVD.Serotonin secreted by platelets induces both platelet aggregation and coronary vasoconstriction. Even though serotonin itself is only a weak platelet agonist, it markedly enhances platelet reactions to a variety of other agonists. Several studies have shown that selective serotonin reuptake inhibitors (SSRIs) reduce platelet and whole blood serotonin concentrations after repeated doses, and could therefore exert an inhibitory effect on platelet activation. For that reason, it was hypothesized that SSRIs could have a protective effect against myocardial infarction (MI).Results from three currently available epidemiological studies assessing the risk of MI in patients treated with antidepressants, including SSRIs, are controversial with respect to a potential beneficial effect of SSRIs on CVD risk in depressed patients. However, there is evidence that exposure to SSRIs does not substantially increase the risk of CVD in patients. A recent randomized, double-blind, placebo-controlled, multicenter trial that evaluated the safety and efficacy of the SSRI sertraline in patients with major depression and acute MI or unstable angina suggested that sertraline is well tolerated and effective. Further epidemiological studies or longer-term clinical trials may shed more light on this issue, and answer the question conclusively, whether the effect of SSRIs on platelets or another mechanism translates into a decreased risk of CVD in depressed patients.
PMID: 14727927 [PubMed - in process]
Posted by SLS on March 5, 2006, at 19:21:41
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS, posted by sdb on March 5, 2006, at 16:03:43
Hi.
> consciousness is somehow connected to the body.
I agree. Mind and body are inextricable.
> Bad mood means an eventually higher risk for cardiovascular disease
Depression and cardiovascular disease are statistically associated. However, this by itself does not elucidate cause and effect. The article cited misses this important consideration.
> If ssris elevate mood it should diminish the risk for a cv disease.
One would like to think so, but this proposed cause and effect still does not discount other possibilities. Again, all that is stated in the article and many more like it is that there is a statistical correlation between depression and CV disease.
> On the other hand srris probably influence metabolism of the body
Without knowing any better, I would have to agree. Just witnessing the weight-gain produced by SSRIs is enough to infer greater risk for cardiovascular disease and mortality.
Personally, I think depression sets into motion many physiological processes that lead to an increase in the appearance of certain diseases. One can simply consider the excess stress produced by depression as a modulator of health and disease.
One of the things not addressed by the article is the number of years those with depression went untreated previous to the introduction of SSRIs. A whole lot of irreversible damage could have been produced by depression before treatment was initiated. Of course those taking SSRIs would die sooner. It would be these people who would have suffered damage by depression in the first place. There is no control group of people never having suffered from depression who were placed on SSRIs for the sake of this kind of study. I can think of several other scenarios that would account for the statistics presented in the article. The bottom line is that there is no basis for concluding cause and effect, only a demonstration of a statistical association.
- Scott
Posted by SLS on March 5, 2006, at 19:28:52
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS » sdb, posted by linkadge on March 5, 2006, at 17:26:45
> Then there is the alternate possability that SSRI's are dammaging the heart in a manner similar to certain serotonergic weight loss drugs, but I won't go there.
There's no reason not to go there. You make a very important observation. Of course the main difference between SSRIs and the diet drugs Pondamin and Redux is that the latter two are serotonin releasers and seem to act very differently in the body. I have never seen any evidence for SSRIs producing the same heart valvular pathologies as are seen with the serotonin releasers. However, this possibility should not be overlooked.
Good call.
- Scott
Posted by sdb on March 5, 2006, at 20:06:36
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS, posted by SLS on March 5, 2006, at 19:28:52
If a cause is not entirely known what instrument of measurement do you want to use except statistics?
>>same heart valvular pathologies as are seen with the serotonin releasers
Interesting.
>>I can think of several other scenarios that would account for the statistics presented in the article
Could you give me the other scenarios?
Thank you very much.
~sdb
Posted by TylerJ on March 5, 2006, at 22:43:26
In reply to Re: NASA's , SSRI, SNRI, etc. » TylerJ, posted by SLS on March 5, 2006, at 14:37:58
> > Scott,
> > What the Heck is an NASA?
> >
>
> lol
>
> I haven't a clue! I was hoping you might tell me!
>
> lol
>
> Occasionally, you will see the acronym "NARI". It stands for noradrenaline reuptake inhibitor. Noradrenaline is another term for norepinephrine.
>
> I guess I'll have to go another sleepless night wondering about "NASA". :-)
>
> I'm sure it has a very legitimate meaning that I will come to know with some measure of embarassment.
>
>
> - Scott
LOL...Thanks Scott, Let me know when you figure it out please :) Also Scott, I'm doing very well on Parnate, however I'm trying to learn as much as possible in case a problem occurs. What augmentation strategies do you recommend for Parnate, of course, only if needed? Thanks.Tyler
Posted by yxibow on March 6, 2006, at 3:25:22
In reply to Why did Yxi's post just disappear? » ed_uk, posted by ed_uk on March 5, 2006, at 17:25:47
> Your post just vanished. I'm confused.
>
> EdI've seen this happen. Its the board software, a mistake dare I say from the draconian gardener girl (this will probably earn me a slap on the wrist even though I believe in free speech and I have had a post moved with no explanation before), or a meteor crash.
Any way my point was that diphenyhdramine shouldn't be taken long term particularly for depressed patients because at least by my experience it creates a depressive hangover the next day. But as they say your miles may vary.
Posted by SLS on March 6, 2006, at 8:11:43
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS, posted by sdb on March 5, 2006, at 20:06:36
I just woke up, so I've got to give my Parnate-starved brain some time to warm up.
> If a cause is not entirely known what instrument of measurement do you want to use except statistics?
I was talking about the first study you introduced to the thread that infered that SSRIs produce heart disease.
There is absolutely nothing wrong with statistics. It is the pretension of being able to infer the cause and effect relationship that I had a problem with.
> >>same heart valvular pathologies as are seen with the serotonin releasers
> Interesting.Remember the Phen-Fen debacle? Fenfluramine is a potent serotonin releaser. It might block the reuptake to some extent as well, but is not generally known for doing so.
> >>I can think of several other scenarios that would account for the statistics presented in the article> Could you give me the other scenarios?
I knew you were going to ask for one.
What if nicotine or some other substance in tobacco were capable of producing cardiovascular disease - not too far-fetched. We then see that a greater percentage of people with depression smoke than people without depression (a statistical fact). Among the other things that it does, nicotine acts to release dopamine in reward centers of the brain. Depressed people like this. It is a form of self-medication. Soooo... a greater proportion of depressives will die of smoking-related cardiovascular disease than the rate seen in the general population. Of course, it is people with depression whom take SSRI antidepressants. Thus, a greater proportion of people taking SSRIs will die of CVD. See how that works?
> Thank you very much.
Thanks for helping me to get a few pistons to fire.
- Scott
Posted by linkadge on March 6, 2006, at 10:35:33
In reply to Re: NASA's , SSRI, SNRI, etc.}} linkadge, posted by sdb on March 5, 2006, at 19:01:02
I know, there have been studies that have shown the opposite. Though, its hard to say what I believe in anymore. They did some funny things to my heart rhythem at times.
Linkadge
Posted by linkadge on March 6, 2006, at 10:38:20
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS » sdb, posted by SLS on March 5, 2006, at 19:21:41
I would personally conclude the basis on the notion that my heart is involved, and if SSRI's users died sooner, than I would not like to be an SSRI user. Call me paranoid.
Linkadge
Posted by linkadge on March 6, 2006, at 10:39:45
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS, posted by SLS on March 5, 2006, at 19:28:52
But, SSRI's will indirectly enhance serotonin release, by desensitizing inhibitory autoreceptors. This is part of their mechanism.
Linkadge
Posted by Larry Hoover on March 6, 2006, at 10:41:14
In reply to Re: NASA's , SSRI, SNRI, etc. » Larry Hoover, posted by SLS on March 5, 2006, at 10:23:47
> Hi Larry.
>
> Nice to see your smiling face.
>
> :-)Thank you, kind sir. Always a pleasure, Scott. Though, I'm posting on Admin right now, and that ups the stakes considerably.
> > > CSF might be a better source of chemical markers.
>
> > Keyword "might". I only wish cerebro-spinal fluid was more accessible. The risks attaching to lumbar puncture are far too great to be adopted as part of routine practise. Unless some real evidence is available that way.
>
> LPs ain't much fun (unless they're made of vinyl). I had a handful performed on me when I was a research patient at the NIMH. You are right.Talk about guinea pig! Sir, your sacrifice in our collective need is genuinely appreciated.
> I don't see any putative markers yet identified in CSF to act as a practicable test for anything relating to the diagnosis and treatment of affective disorders. There are some associations between low MHPG and the effectiveness of NE reuptake inhibitors (TCAs), but not much else when last I looked, and I don't know what the coefficient of correlation was.
CFS provides an integrated measure of brain function, not specific to any mechanism or target section of the brain. Global measures just don't tell us anything useful....so far.
> Actually, I think low urine MHPG might be just as reliable (or unreliable) a marker.
I really don't think fluid testing will ever yield what we seek. fMRI. PET. I think those are the real deal. When we get those fine-tuned, we'll be doing non-invasive testing that yields not only site-specific data, but continuous data.
> > > If it is found that the etiologies of some mental illnesses are to be found in abnormal gene expression, perhaps microarrays will be helpful in diagnosing and determining treatment. We really aren't all that far from that now. (I guess it's all relative. It is still too far away to suit me).
>
> > If it's genetic, though, blood suits as a test medium. Saliva, even. Those genes, they be everywhere.
>
> Yes. However, it might be necessary to assay gene activity in a site-specific manner, which would mean taking samples of brain tissue. A gene can be turned on in one cell but not in another.Quite so. However, we can construct probe molecules, methinks. Ones which differentiate between e.g. non-methylated and methylated DNA. Or, perhaps better yet, transfer RNA, which is only active during protein synthesis, as I understand it. Combine the probe with imaging technology, and you have a real time measure of rate of protein synthesis?
> In addition, the proteins expressed by changes in gene activity might never appear extracellularly.
I think you need to be in the cytoplasmic realm, so that's why I think probes are the thing to use. If you take out t-RNA with your probe, there will still be the original homeostatic mechanism in operation, to ensure full expression of the activation signal. There's lots of redundancy, I would think.
> I really don't know enough about this stuff to speculate any further regarding the need to sample specific tissues to assay gene activity.
>
> Maybe I'm way off...
>
>
> - ScottI think we are on the threshold of non-invasive tissue sampling.....inferential tissue sampling.
Lar
Posted by Larry Hoover on March 6, 2006, at 10:54:26
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS » sdb, posted by linkadge on March 5, 2006, at 17:26:45
> Then there is the alternate possability that SSRI's are dammaging the heart in a manner similar to certain serotonergic weight loss drugs, but I won't go there.
>
> LinkadgeLink, I really appreciate your ability to analyze the evidence, but damaging the heart? I feel that's quite a stretch. If you look at incidence and mortality stats, there is no anomaly in the trends for heart disease. I think that over-availability of food is a rather large confound for your hypothesis.
What are you doing to yourself with your cocoa experiments?
In the most detailed analysis, I damage my heart by breathing. Every day, my heart ages a little more. Should I stop breathing?
I really appreciate your precautionary stance. I have done some very demanding thinking based on your conjectures and conclusions. But I see depression itself (correlations with hyperhomocysteinemia, atherosclerosis, et al) as the damaging agent. Depression damages the heart.
Lar
Posted by Larry Hoover on March 6, 2006, at 11:01:59
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS » sdb, posted by SLS on March 5, 2006, at 19:21:41
> > Bad mood means an eventually higher risk for cardiovascular disease
>
> Depression and cardiovascular disease are statistically associated. However, this by itself does not elucidate cause and effect. The article cited misses this important consideration.....> The bottom line is that there is no basis for concluding cause and effect, only a demonstration of a statistical association.
>
>
> - ScottAs the studied population already demonstrates that correlation, it would be necessary to show that there was a change in rate to conclude that SSRIs have an influence on that rate. We don't have data for that, but for brief periods where treated and untreated depressed are observed. Is extrapolation reasonable? No, not in my mind. It simply forces us to look more closely at the management of risk factors, now including one more variable. One which may or may not matter very much, when compared to the degree of influence conferred by other known variables.
Lar
Posted by SLS on March 6, 2006, at 11:03:24
In reply to Re: SSRIs and the heart » linkadge, posted by Larry Hoover on March 6, 2006, at 10:54:26
> Depression damages the heart.
This is sad, but I think true.
- Scott
Posted by deniseuk on March 6, 2006, at 11:05:27
In reply to Re: To Meri-Tuuli » deniseuk, posted by linkadge on March 2, 2006, at 8:30:59
Hi again,
I can't help but think that anyone who responds to placebos must either be very suggestable or not that depressed to start with.
But having said that I was watching this programme on telivision when they were looking at Faith Healing and placebo effects. They did a trial on people with parkinsons disease and they found people with parkinsons disease had their tremors reduced after receiving sham treatment. Apparently the power of expectation causes a release of dopamine or something.
Anyway, I've tried many medications, hypnotherapy, rTMS and never got a placebo off any of them. I wish I did.
Kind Regards....Denise
Posted by SLS on March 6, 2006, at 11:22:12
In reply to Re: measuring the brain » SLS, posted by Larry Hoover on March 6, 2006, at 10:41:14
> > LPs ain't much fun (unless they're made of vinyl). I had a handful performed on me when I was a research patient at the NIMH. You are right.
> Talk about guinea pig! Sir, your sacrifice in our collective need is genuinely appreciated.
Larry, I think you are the first person to say that to me. I can't help but to shed a few tears. I knew going in that I might end up giving much more than I would receive. That is exactly what happened.
Thank you.
- Scott
Posted by Larry Hoover on March 6, 2006, at 11:39:24
In reply to To Linkadge, posted by deniseuk on March 6, 2006, at 11:05:27
> Hi again,
>
> I can't help but think that anyone who responds to placebos must either be very suggestable or not that depressed to start with.I think your first argument is correct. I think there is a continuum of suggestability. Some have a great deal of it, and some have very little at all.
What has always amazed me, though, is why hypnotic suggestion isn't front and center. For those suggestable folk, there's no better way to connect with it. Or, am I presuming something without evidence? If placebo works without any other suggestion, then why not hypnosis?
Lar
Posted by Larry Hoover on March 6, 2006, at 11:43:00
In reply to Re: measuring the brain » Larry Hoover, posted by SLS on March 6, 2006, at 11:22:12
> > > LPs ain't much fun (unless they're made of vinyl). I had a handful performed on me when I was a research patient at the NIMH. You are right.
>
> > Talk about guinea pig! Sir, your sacrifice in our collective need is genuinely appreciated.
>
> Larry, I think you are the first person to say that to me. I can't help but to shed a few tears. I knew going in that I might end up giving much more than I would receive. That is exactly what happened.
>
> Thank you.
>
>
> - ScottWay back when, Scott, you asked me to love you. I haven't ever forgotten. And, some might argue that I'm not too bad at it.
You're most welcome, sir.
Lar
Posted by sdb on March 6, 2006, at 11:57:33
In reply to Re: SSRIs and the heart » linkadge, posted by Larry Hoover on March 6, 2006, at 10:54:26
>>I damage my heart by breathing. Every day, my heart ages a little more. Should I stop breathing?
I am glad that there is oxygen otherwise I would die because of my healthiness.
~sdb
Posted by ed_uk on March 6, 2006, at 13:32:26
In reply to Re: Why did Yxi's post just disappear? » ed_uk, posted by yxibow on March 6, 2006, at 3:25:22
Hi Yxi
>I've seen this happen.
I see your post got redirected to p-babble withdrawal. Funny, since we were no longer discussing withdrawal!
>Any way my point was that diphenyhdramine shouldn't be taken long term particularly for depressed patients because at least by my experience it creates a depressive hangover the next day.
Perhaps your reaction was unusual?
Ed x
Posted by linkadge on March 6, 2006, at 16:33:31
In reply to Re: SSRIs and the heart » linkadge, posted by Larry Hoover on March 6, 2006, at 10:54:26
Well, first of all, the cocoa has been a very positive experience. I have a few of my own gold standards; omega 3 is probably at the top followed closely by cocoa.
As far as antidepressants on cardiac function I am not suggesting that I know the answer. We do know that a few studies have linked the TCA's to increased mortality esp. in patients with pre-existing arythmia.
I think it is necessary to keep an open mind to all possabilities. For instance, SSRI's are sometimes used in IBS, but they can also cause increased rates of GI bleeding etc.
Like I mentioned above, SSRI's will eventually lead to an increased release of serotonin. The 5-ht2b receptors have been implicated in fenfluramine induced cardiac events (a metabolite is actualy a 5-ht2b agonist).
Nevertheless, an SSRI increasing agonism at all serotonin receptors, can induce an array of side effects including sexual function (overactivation of 5-ht2c) psychic anxiety (overactivation of 5-ht2a), may indeed increase the likelyhood of cardiac problems (overactivation of 5-ht2b).
http://www.nature.com/cgi-taf/DynaPage.taf?file=/nm/journal/v8/n10/full/nm764.html
As a side note...
Yes, I know. Chocolate may increase PEA, and increased PEA may lead to paranoid psychosis. :)Linkadge
Posted by linkadge on March 6, 2006, at 16:36:38
In reply to To Linkadge, posted by deniseuk on March 6, 2006, at 11:05:27
I think it is probably a combination of things. Life events, drug effects, placebo effect, and dozens of other factors probably come together to determine the likelyhood of response.
Linkadge
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