![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 77 to 101 of 102. Go back in thread:
Posted by laima on August 14, 2006, at 20:45:49
In reply to Re: Optimistic part » laima, posted by Phillipa on August 14, 2006, at 20:37:03
> True. So then in reality there are no meds that work for a great lenght of time? Love Phillipa
Isn't that the million dollar question? :)
Posted by linkadge on August 14, 2006, at 20:47:02
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 18:10:04
Not to bring any undue insult to those little white powdered donuts.
Linkadge
Posted by linkadge on August 14, 2006, at 20:49:12
In reply to Re: Optimistic part » linkadge, posted by laima on August 14, 2006, at 20:30:38
So even if you felt better than well for a few years, and then poop out, guess what, you're going to feel worse than well for a while when it comes time to drop the drug.
Linkadge
Posted by linkadge on August 14, 2006, at 20:56:49
In reply to Re: Optimistic part » laima, posted by Phillipa on August 14, 2006, at 20:37:03
Its difficult to say. I think that people who have used these meds to treat genuine mental ilnesses probably get more mileage out of them.
Why? I think it comes down to homeostasis. The brain always tries to get to homeostasis which is proably the healthiest state of mind. If you feel better than well, your brain will start to try and counteract that. But if you are using the drug to move to a more normal state of mind, the brain might work to accomodate the drug rather than reject it.
It seems to be the case with stimulants too. When they're used for genuine attention problems, there is a case put forward that you don't see as much poop out.
Linkadge
Posted by Phillipa on August 14, 2006, at 21:28:34
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 20:56:49
Well to me this says that if I haven't ever achieved remission from an AD I may as well eat donuts? A lot cheaper. Love phillipa
Posted by laima on August 14, 2006, at 22:52:10
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 20:49:12
Yes!!! I wish someone told me that on day one!! I was prescribed loads of *weird* antidepressents with bad side effects after breaking up with a loser of a boyfriend when I was a college freshman (late 80's), and next thing you know I've got years of prescription use and am no better off. Probably worse off- right off the bat I can say at least one of the pre-prozac drugs I used briefly permanently changed my metabolism. Think of it- naive 17 year old breaks up with boyfriend and thinks life is therefore over- experts prescribe powerful mind altering drugs as the solution. Too bad they didn't try putting me into intensive counseling first. That's what should have happened. Before the antidepressents, I suffered mostly bouts of mild depression as well as normalish adolesent angst, but definately, my mood issues became much, much worse and more serious later on-after drugs, specifically, after prozac konked out on me some 10 years later. Similarly, my anxiety was much milder and more manageable before I became mixed up with long term use of strong benzodiazapines. There might be a cause and effect here- or there might not be. But regardless, while all of these drugs can useful and valuable of course, they are nothing to consider casually!This has been my experience, others might have different experiences and perspectives.
> So even if you felt better than well for a few years, and then poop out, guess what, you're going to feel worse than well for a while when it comes time to drop the drug.
>
> Linkadge
Posted by laima on August 14, 2006, at 22:59:56
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 20:49:12
I should be careful what I say- I've got a lot of muddled and mixed feelings on the topic of these drugs. Bottom line though, is that I think they are serious and not simple. Nothing to fool around with casually.
Posted by laima on August 14, 2006, at 23:03:11
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 20:56:49
> It seems to be the case with stimulants too. When they're used for genuine attention problems, there is a case put forward that you don't see as much poop out.I don't know- I was diagnosed with attention deficit disorder, it seemed to fit, ritalin helped tons--then it konked out after about 2 years. It devolved into inducing a state of passive fixation only.
Posted by laima on August 15, 2006, at 9:23:17
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 18:07:55
> I don't understand "better than well".
Now that I think of it, the term might have also been used to express just how well a depressed person could respond to the "miracle of prozac"...we'd have to go back and dig up the book and/or some of the old articles to verify.
Yes, a healthy dollop of reasonable and realistic skepticism doesn't hurt as we evaluate drug claims and hype!
Posted by Dinah on August 15, 2006, at 9:29:48
In reply to Re: Optimistic part » linkadge, posted by laima on August 14, 2006, at 23:03:11
I've been on Provigil for daytime sleepiness, and not only did I have to up the dose to the maximum my doctor prescribed but it's not working as well as it used to.
The worst part is that my baseline is now way worse than it was. If I skip a dose, I'm flat on my face snoring all day.
The same seems to be true with antianxiety medication. It used to be that anxiety was a problem, but now it's debilitating without the medications. And that was even true when I weaned off them.
I'm a great supporter of medications, but in some ways they scare me.
Posted by Dinah on August 15, 2006, at 9:31:27
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 18:07:55
I have to agree there.
I can only guess that Kramer wrote that book at the very beginning. Over time, surely the sexual side effects alone would cause otherwise happy enough people to decide they weren't better than well.
Posted by laima on August 15, 2006, at 10:37:16
In reply to Re: Optimistic part » laima, posted by Dinah on August 15, 2006, at 9:29:48
Sounds like your experiences are much like my own.
"Baseline"- I like your word choice- I'd definately say mine is lower now for the conditions I originally started using medications for, too. I don't know how to make sense of it all, what to think. Obviously the medications are very useful and have an important role for many people-including me at certain points- but at the same time, they scare me as well. I'm also a little concerned that some of them were originally prescribed a tad bit casually, in my own case, anyway. I'm miffed that I was constantly assured throughout my late teens and twenties that prozac was harmless and benign and perfectly safe to take for the rest of my life, etc., "as insurance". In retrospect, I wish I had been tapered off of it long before it pooped out. I wonder what would have happened. I'm particularly miffed that I was reassured many times by several doctors that it was perfectly fine to take klonopin for years--and now I've got a real problem with it, in that it's lost effectiveness, I crave it, and can't seem to cut it out for long. There have been times that I've even asked someone else to hold on to it for me due to my craving, and that is scary. I'm well into a taper plan right now...and it's going really good so far...but I'm still scared that it could turn right back around if something happens or if I give in and goof up. So now I've got these mood issues which are no longer terribley responsive to drugs, and I feel low on options. Not sure what to do- but I'm definately more interested in a healthy lifestyle and nutrition and so on than I used to be--not to mention Linkadage's neurogenesis list! Some of that stuff seems to really help, and I've developed a keen appreciation of how nuanced and delicate the brain is. (Though paradoxically, I am aware of the good news that that the brain can also be very resiliant and adaptable.) Definately, developing an aggressive excercise program has been particularly helpful to me for managing depression, anxiety, and to boost my energy levels and help with general fogginess; I also imagine I'm sweating away toxins (?). In any case, that habit is helping me to feel more empowered and less utterly helpless or victim-like. But the whole topic is confusing and frustrating.
> I've been on Provigil for daytime sleepiness, and not only did I have to up the dose to the maximum my doctor prescribed but it's not working as well as it used to.
>
> The worst part is that my baseline is now way worse than it was. If I skip a dose, I'm flat on my face snoring all day.
>
> The same seems to be true with antianxiety medication. It used to be that anxiety was a problem, but now it's debilitating without the medications. And that was even true when I weaned off them.
>
> I'm a great supporter of medications, but in some ways they scare me.
Posted by laima on August 15, 2006, at 10:39:26
In reply to Re: Optimistic part, posted by linkadge on August 14, 2006, at 18:07:55
> I think it is evident (for many people who wanted on the "feeling better than well" bandwagon) that even this does not come without conseqence.I keep thinking about how Freud was a cocaine enthusiast. General all purpose brain tonic and enegizer, indeed!
Posted by pulse on August 15, 2006, at 12:37:31
In reply to Re: Optimistic part » linkadge, posted by laima on August 15, 2006, at 10:39:26
true re: cocaine as an erengy wonder tonic. however, before that, we had morphine and the opium eaters touted ...and accepted as standard - do no harm - by many doctors for their patients. of course, we also had habituation set in for many, if not most.
now, we have bupe being used to treat depression.
are we, then, coming full circle?
i used to be such an advocate of psychotropic meds: ads, stabilizers, aps. now, i am fast becoming close to an anti-meds advocate. what the stabilzers, then the ads, did to my Gi tract is very scary. i feel for all those who have the same or other side-effects that, now, never go away.
i am in the camp that thinks the cortisol connection makes most sense, but i am extremely doubtful i will see meds based on that in my lifetime.
in gereral, it's scary when the docs, inventors, and researchers admit they don't really know for sure how any of our current meds work or why.
i'm not sure we are all that better off than freud's cocaine or the earlier morphine & opium. absinthe, anyone? i am NOT being facetious.
i apologize in advance if this possibly could have triggered anyone.
pulse
Posted by laima on August 15, 2006, at 13:07:18
In reply to Re: Optimistic part/ Possible Trigger(?) » laima, posted by pulse on August 15, 2006, at 12:37:31
Hopefully the drugs we have now are safer than the morphine, cocaine, halcion, etc of the past- at least there is some testing and questioning going on, for example. But it's enlightening to be aware of the history of there being a pattern of "new wonder cure or tonic without any side effects introduced, whoops, there are some side effects, on to the next one". We should obviously be careful about what we take and be as informed as possible, weigh the pros and cons of the possible risks of our medications in relation to our own circumstances. Also, I noticed that Dr.s and researchers are far more willing to admit that they often have no idea of how the drugs work than are the marketing teams.I think the medications can be very valuable and life-saving when used wisely and judiciously, but they are not casual!
Lots of neurotransmitters such as seratonin in the GI tract, by the way. Hence, for example, an ssri is not just active in the brain...
> true re: cocaine as an erengy wonder tonic. however, before that, we had morphine and the opium eaters touted ...and accepted as standard - do no harm - by many doctors for their patients. of course, we also had habituation set in for many, if not most.
>
> now, we have bupe being used to treat depression.
>
> are we, then, coming full circle?
>
> i used to be such an advocate of psychotropic meds: ads, stabilizers, aps. now, i am fast becoming close to an anti-meds advocate. what the stabilzers, then the ads, did to my Gi tract is very scary. i feel for all those who have the same or other side-effects that, now, never go away.
>
> i am in the camp that thinks the cortisol connection makes most sense, but i am extremely doubtful i will see meds based on that in my lifetime.
>
> in gereral, it's scary when the docs, inventors, and researchers admit they don't really know for sure how any of our current meds work or why.
>
> i'm not sure we are all that better off than freud's cocaine or the earlier morphine & opium. absinthe, anyone? i am NOT being facetious.
>
> i apologize in advance if this possibly could have triggered anyone.
>
> pulse
Posted by linkadge on August 15, 2006, at 16:33:53
In reply to Re: Optimistic part » linkadge, posted by laima on August 15, 2006, at 10:39:26
>I keep thinking about how Freud was a cocaine >enthusiast. General all purpose brain tonic and >enegizer, indeed!
And you'll get posters for Vin Mariani, which states that some odd thousand licenced doctors attest to its safety etc.
"The Emperor's New Cloths" ??
Linkadge
Posted by linkadge on August 15, 2006, at 16:42:46
In reply to Re: Optimistic part/ Possible Trigger(?) » pulse, posted by laima on August 15, 2006, at 13:07:18
Marketing and testing aside, it really comes down to the fact that a drug appears to be helpfull today, but theres no guarentee a drug will be helpfull tomorrow.
Its all about the test of time. Only time can demonstrate what a drug is really doing.
A drug can be approved with only very basic testing IMO, it only need to be shown effective for over so many months.
I see prozac as a longer acting cocaine. So tollerance doesn't build overnight, but it still builds.
We just havn't had the drugs around for long enough to know.
When a drug makes you feel good, its very easy to slip into thinking that it is doing something good for you.
You can take amphetamines and feel great, but that doesn't mean some very nasty thing aren't happening below the surface. Cocaine asside, we were still routinely prescribing amphetamines for depression 50 years ago.
Linkadge
Posted by pulse on August 15, 2006, at 17:35:55
In reply to Re: Optimistic part/ Possible Trigger(?), posted by linkadge on August 15, 2006, at 16:42:46
linkage - good point. forgot to mention the amphetamine's and their substantially long-prescribed time-frame. i agree all is about the test of time. also drugs approved with quite minimal testing. that disturbs me greatly!
re: prozac- again it 's never pooped out on me or lost it's efficacy. i just can no longer tolerate even it's GI side-effects, they never go way now, over and increasingly, the last 3 yrs. they were formerly the least harmful to me and went away within 2 wks.yes, laima, i well know about the scads of serotonin receptors in the gut. that's primarily what i've been talking about re: my own gut problems. as soon as i quit ads or combos of ads....or, for that matter, also, stabilizers - when i've had them as part of a cocktail - or seroquel or trazadone for sleep, or, finally, any of the prescription sleep aids, my stomach problems completely disappear. that's more than enough proof for me. someone posted awhile back that if you have depression plus GI troubles, you are basically s*rewed! i couldn't agree more. i'm always surprised i don't see it posted about more here at pb, because my therapist has had not one client with mdd who also doesn't have some degree & form of ibs. not one. perhaps the few posts are because it can be an embarrassing and sickening topic.
linkage, as a former connoisseur of cocaine, i can tell you that prozac's not a teensy bit like a long-lasting cocaine, serotonin more involved than dopamine in cocaine or not.
Posted by laima on August 15, 2006, at 17:48:14
In reply to Re: Optimistic part/ Possible Trigger(?), posted by linkadge on August 15, 2006, at 16:42:46
Yes- and you know they still are prescribing amphetamines for resistant depression occasionally. It's not easy--sometimes there's a choice of being in hell or trying a drug-using a drug, to relieve that, but which might cause other issues later. When prozac first came out I recall so many people saying things like, "I don't care if it turns out that they find this shaves 20 years off my life, at least I have one now!". Now it turns out even prozac wasn't a "cure"; one ends up constantly trying to catch up...but of course sometimes the alternative isn't so good either. I mean- the amphetamines, prozac- all of them- have prevented millions of suicides and re-jump-started lives, I am certain. What compassionate person would deny a someone with debilitating panic attacks or agoraphobia a benzodiazapine, or advise a person who feels uttterly washed out or even contemplating suicide to avoid antidepressants? I think the pros and cons of drugs can be very complex, and people's circumstances vary. And drugs can often work much faster and dramatically than nutritional approaches, and they can be the very boost to induce necessary lifestyle changes...I think one definate problem is that the drugs are developed "for profit", they are very expensive to develop, and the companies obviously then want to sell as many of them as possible in order to make their ventures "worthwhile". I wonder, for a drastic example, which company would be motivated to develop a "cure" that a person could take and be done with? The marketing people don't exactly do a good job of spelling out the complexities, seriousness, and risks of the substances they are peddeling. I suspect this results in over-prescription or inappropriate prescription. I rather wish the industry was not for profit, funded by grants, say. However, I guess we are lucky to at least have the options we do have and try not to dwell on this.
> Marketing and testing aside, it really comes down to the fact that a drug appears to be helpfull today, but theres no guarentee a drug will be helpfull tomorrow.
>
> Its all about the test of time. Only time can demonstrate what a drug is really doing.
>
> A drug can be approved with only very basic testing IMO, it only need to be shown effective for over so many months.
>
> I see prozac as a longer acting cocaine. So tollerance doesn't build overnight, but it still builds.
>
> We just havn't had the drugs around for long enough to know.
>
> When a drug makes you feel good, its very easy to slip into thinking that it is doing something good for you.
>
> You can take amphetamines and feel great, but that doesn't mean some very nasty thing aren't happening below the surface. Cocaine asside, we were still routinely prescribing amphetamines for depression 50 years ago.
>
>
> Linkadge
>
>
>
>
>
Posted by laima on August 15, 2006, at 17:51:48
In reply to Re: Optimistic part/Possible Trigger:link;laima, posted by pulse on August 15, 2006, at 17:35:55
Have you considered by-passing your gut altogether and trying something radically different, such as botox or the new magnetic treatment?> re: prozac- again it 's never pooped out on me or lost it's efficacy. i just can no longer tolerate even it's GI side-effects, they never go way now, over and increasingly, the last 3 yrs. they were formerly the least harmful to me and went away within 2 wks.
>
> yes, laima, i well know about the scads of serotonin receptors in the gut. that's primarily what i've been talking about re: my own gut problems. as soon as i quit ads or combos of ads....or, for that matter, also, stabilizers - when i've had them as part of a cocktail - or seroquel or trazadone for sleep, or, finally, any of the prescription sleep aids, my stomach problems completely disappear. that's more than enough proof for me. someone posted awhile back that if you have depression plus GI troubles, you are basically s*rewed! i couldn't agree more. i'm always surprised i don't see it posted about more here at pb, because my therapist has had not one client with mdd who also doesn't have some degree & form of ibs. not one. perhaps the few posts are because it can be an embarrassing and sickening topic.
>
> linkage, as a former connoisseur of cocaine, i can tell you that prozac's not a teensy bit like a long-lasting cocaine, serotonin more involved than dopamine in cocaine or not.
Posted by Phillipa on August 15, 2006, at 19:08:52
In reply to Re: Optimistic part » Dinah, posted by laima on August 15, 2006, at 10:37:16
Same here as far as benzos are concerned. I don't crave them but they don't work the same. Now they put me to sleep or definitely don't relax me. Love Phillipa
Posted by Phillipa on August 15, 2006, at 19:15:16
In reply to Re: Optimistic part » laima, posted by Phillipa on August 15, 2006, at 19:08:52
When I drank beer 5-6 each night with.5xanax I felt great. I've said this before. And I accomplished so much. Maybe go back to this again? Love Phillipa
Posted by linkadge on August 15, 2006, at 19:27:57
In reply to Re: Optimistic part/Possible Trigger:link;laima, posted by pulse on August 15, 2006, at 17:35:55
Sorry, I didn't mean long acting cocaine in its mood effects, more that it is a drug that can improve mood, but tollerance can develop (over a longer timeframe though)
Linkadge
Posted by linkadge on August 15, 2006, at 19:31:47
In reply to Re: Optimistic part/ Possible Trigger(?) » linkadge, posted by laima on August 15, 2006, at 17:48:14
To be completely honest, no study has been able to conclude that antidepressants reduce the rate of suicide.
http://biopsychiatry.com/suicide.html
OTOH, the only two drugs that have consistantly proven to lower suicide risk have been lithium and clozapine.
Linkadge
Posted by laima on August 16, 2006, at 10:45:20
In reply to Re: Optimistic part/ Possible Trigger(?) » laima, posted by linkadge on August 15, 2006, at 19:31:47
That's interesting- but I still maintain that some of them can be "lifesavers", even if studies or statistics don't necessarily reflect that. I would also like to gently (friendly) point out that statistics and studies can be shaded or skewed, depending on what data are included or excluded, how those decisions are made, etc.I'd say prozac "saved my life" when it came out because before I tried it, a whole smattering of tricyclics failed miserabley, and I really saw no future for myself whatsoever. I became obsessed about death at age 17-18, vaguely religious, and even repeatedly asked god to let me die in my sleep. Wondered if I could get "lucky enough" to mysteriously die in my sleep from an unknown cause. Briefly messed around with ouji board in effort to determine what age I'd die at. So no, no suicide attempt- but scary and weird stuff. When I started prozac and it kicked in, all that behavior and those thoughts vaporized; I developed (and carried out!) exciting plans for the future, college turned out to be fun and successful, etc. But I doubt this would make it into any researcher's book as a "suicide prevention".
After prozac konked out on me some 10 years later, similar experiences with a stimulant and then later with another antidepressent. No more "asking god to die", but more feeling like "story of my life obviously is over because I'm such a collasal failure, and yet I'm stuck with otherwise perfect health and another 40-50+ years to endure, etc." Drugs were the bullets that vaporized that kind of thinking before it had a chance to spiral too badly, and allowed me to initiate positive life adjustments and so on. But these experiences would never be classified as official "suicide preventions" either, I am sure- especially since there were no official suicide attempts or plans.
Ever notice, when someone is very depressed, psychiastrists will ask, "Do you contemplate suicide? Do you have a plan? DO YOU HAVE A PLAN? No, well, what about risky behavior? Ever run into traffic instead of waiting for the light?...etc." This suggests to me that maybe they think there can be an unconscious element , ie a "death wish". (Note- NOT talking about Freud's subconscious-and I hope you actually don't know what I am talking about :)
Back to Kramer- if it turns out to be accurate that depressed brains are not like "normal" brains, and if repeated episodes of depression make one permanently vulnerable, if depression isn't "curable"- well, I figure, best then try to figure out how to keep it under control and in remission as best as possible via lifestyle, "neurogenesis considerations", and generally staying informed and paying attention to triggers. When things get rough, perhaps the invaluable role of drugs can be to help get back on track (?) And to keep in mind that their effects likely won't hold up, not to rely on them without trying to make other life adjustments. Sure, it sucks to not have a "normal" brain, to possibly have a chronic condition, to have to make any adjustments at all--and I'm sure people with cancer or heart disease or any number of other chronic conditions are feeling something similar.
I dare speculate- perhaps the upside of so many psychiatric drugs eventually fizzeling out might be that it's evidence that the brain has a lot of capability to grapple with and overcome or neutralize a foreign substance which enters it??? Maybe?
Not sure about a lot of this- I imagine lots of people here can easily shoot these un-fully-gelled thoughts full of holes-I'm still trying to make sense of it all so I can come to peace with myself and live as good and satisfying rest of my life as possible. Whatever drug use and abuse is in my past, (plenty of both)-whatever regretful things happened-- already happened and there is nothing I can do about any of it now other than to consider, and then attempt to move on. (I guess this is where quality therapy and strengthening support systems comes in...)
ps- is clozapine same as clonazapam/klonopin? I'll look up that as well as the study you cite, I'm curious about it. Thanks.
> To be completely honest, no study has been able to conclude that antidepressants reduce the rate of suicide.
>
> http://biopsychiatry.com/suicide.html
>
> OTOH, the only two drugs that have consistantly proven to lower suicide risk have been lithium and clozapine.
>
> Linkadge
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.