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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 55 to 79 of 96. Go back in thread:
Posted by BGB on July 18, 2008, at 22:39:48
In reply to Re: Want to stop meds ... should I? » blueboy, posted by linkadge on July 18, 2008, at 15:37:54
>
> http://fathersforlife.org/suicides/US_suicide_deaths.htm
>
> Linkadge
Am I totally insane or is that article basically saying that the reason why more men kill themselves than women is because of the "feminization of America" and the "War of the Sexes"?I had absolutely no idea we guys were at war women! And since I'm gay, does that mean that I am a "victim" of the "feminization of America"????? Did women somehow convert me as a small child??? My dad said he knew I was queer by the time I was four years old. I'll betcha the feminine gestapo got me while I was being circumcised as a baby (as if getting circumcised wasn't terrible enough in and of itself)!!!
By the way, I'm totally joking here, before anyone goes off. I just thought that the article had a very....uh.....unique point of view. I can say with all certainty that I have never heard that theory before.
Link, I realize that you were referring to the article for the statistics, and I'm not making fun of you or your views (or trying to imply that those are necessarily *your* views), I promise! Sometimes I just need to be silly to keep my spirits up, and that article was great fodder. :-)
Posted by linkadge on July 18, 2008, at 23:25:47
In reply to Re: Want to stop meds ... should I? » linkadge, posted by SLS on July 18, 2008, at 19:27:35
I really don't see how this shows anything.
In the 15-44 range, most of the suicide rates are higher in 2003 than what they were in the 50's 60's and 70's. Infact, most in this range continue to rise and peak around 1995. This is well into the introduction of the MAOI's, TCA's, ECT, and even the SSRI's. You see a small decline from 1995 to 2003, but still, the rate is higher than what is was in the pre-antidepressant period.
In the 25-34 and 35-44 ranges its still higher now than what it was in the 60's. Again, this rate peaks at about 1995 (when AD's are widely available and used). In this category, it drops a little from 95-2000, but then increases again (not this is still in the pre-black box SSRI warning era). I.e. in this category you're still higher than what you were in the pre-AD periods, and you continue to increase dispite the introduction and use of various AD's.The *only* group that has shown a consistent decrease in suicide rates since 1950/1960 is in the 45+ category. This category has a strong pull on the overal statistic as it is unusually high in the 1950's and 60's. **But**, if you notice, in this category, the rate starts to substantially drop well before the use of antidepressants. In fact, this category drops from 20ish down to 15ish just into the 80's *before* the more widespread use of AD's.
The elevated level of suicide in this category could be a post war effect as you only see the elevated suicide rate in adults in this period.
I.e. if you just focus on the 45-64 rates for the 50's, 50's and 70's, you notice that the significanly high rate here is what is really whats shaping the overall *all ages* stat. And, if you realize that this significantly elevated rate drops *before* the widespread use of AD's you realize that this category has already dropped to approxaimatly the suicide rate it is now before the use of AD's. I.e. the 45-64 category has not changed much 1980-2003.
That is why it is misleading to look at the "all ages".
Overall however, I see is that in every age category you have a rate that is either higher now than what it was before AD's (1950-60's), or it has dropped *before* the widespread use of AD's.
Also, that many of the rates peak in the mid 90's when AD's were widely used. There is a small, nonsignificant drop in *some* categories from 1995-03, but still not to the level it was before antidepressants *and* some categories it increases again from 2000-2003 (still before the black box warning was issued).I certainly don't see any drops in suicide as a result of the antidepressant era, instead an increase from pre-AD era, and a steady increase throughout the AD era. The small decrease from 95 till present is just a microtrend and will only have meaning in another few decades.
Remember, the overall data doesn't mean anything as it is combining the effect of the elevated rate in group mentioned (44-65 1960-1970) which drops on its own before the widespread use of AD's.
Linkadge
Posted by linkadge on July 18, 2008, at 23:28:31
In reply to Re: Want to stop meds ... should I? » linkadge, posted by BGB on July 18, 2008, at 22:39:48
Yes, I was only refering to the article for the one graph. SLS however, provided a more detailed set of data which I discussed above. The page you mentioned was actually a link from a WHO article.
Anyhow, I didn't read the article and certainly don't know what it was suggesting.
Linkadge
Posted by linkadge on July 18, 2008, at 23:35:30
In reply to Re: Want to stop meds ... should I? » linkadge, posted by BGB on July 18, 2008, at 22:39:48
And since I'm gay.......
Welcome to the club. I am in it, but not certainly not the founder.
Linkadge
Posted by BGB on July 19, 2008, at 0:20:45
In reply to Re: Want to stop meds ... should I? » BGB, posted by linkadge on July 18, 2008, at 23:35:30
> And since I'm gay.......
>
> Welcome to the club. I am in it, but not certainly not the founder.
>
>
> LinkadgeOh my god, they got you, too??????????????
LOL! =)
Posted by SLS on July 19, 2008, at 5:16:47
In reply to Re: Thank you, everyone » maxime, posted by linkadge on July 18, 2008, at 22:39:07
> Well, of course it is up to you.
>
> It just seems to me that if your meds were really making you feel well, then you wouldn't aways be starting posts about how much you hate them and how much you want to discontinue them.That does not follow from logic, especially when you are dealing with an emotional being such as ourselves.
- Scott
Posted by SLS on July 19, 2008, at 5:32:21
In reply to Re: Want to stop meds ... should I?, posted by linkadge on July 18, 2008, at 23:25:47
The rise in the suicide rates from 1950-1970 are, of course, not because of treatment. I believe it is the result of an increase in psychosocial stress and socioeconomic factors during this time period.
Start looking at the suicide rates starting for the decade 1980-1990. Prozac made its appearance in late 1987. The public hype surrounding Prozac fostered an increase in the numbers of people treated for depression, but still mostly for women. The rate comes down further still as men become brave enough to seek treatment.
The chart makes perfect sense in describing the reduction in suicide rates since the advent of the SSRIs and the social acceptance of seeking treatment for depression.
- Scott
Posted by SLS on July 19, 2008, at 5:50:37
In reply to Re: Thank you, everyone » linkadge, posted by maxime on July 18, 2008, at 21:25:58
> > Was maxime on meds when she attempted suicide? Well?
> >
> > Linkadge
>
> I had only just started the Cymbalta at 30 mg. After my attempt it was raised to 60 mg.
>
> MaximeIt is possible, Maxime, that you followed a very common path towards improvement in depression. During weeks 2-3, one often begins to see an increase in energy and gains enough inertia to act on pre-existing suicidal thoughts and feelings, which had not changed very much by then.
- Scott
Posted by SLS on July 19, 2008, at 5:55:26
In reply to Re: Thank you, everyone » maxime, posted by SLS on July 19, 2008, at 5:50:37
Maxime,
After reading this thread, how have your feelings surrounding the discontinuation of treatment changed, if at all?
- Scott
Posted by blueboy on July 19, 2008, at 8:25:48
In reply to Re: Want to stop meds ... should I? » blueboy, posted by linkadge on July 18, 2008, at 15:37:54
> I don't think AD medication has made any significant drop in suicide rates. According to the following U.S. data, suicide rates have been steadily increasing since 1979 (and earlier). The increase peaked in the late 80's early 90's and has remained fairly constant since. If there has been a small drop in recent years, it is indeed a *very small* reduction, and certainly not a reduction to the levels of before 1979. I.e. if you look at the whole picture, there is nothing to suggest that antidepressant medication is at all responsable for the relatively miniscule drop in overal U.S. suicide rates.
>
> Take a look for yourself. Let me know if you have any data for a larger study period.
>I'll just go with a quote from my previous link, since it's from a major research facility.
<<"Suicide rates rose steadily from 1960 to 1988 when Prozac, the first SSRI drug, was introduced," said Licinio. "Since then, suicide rates have dropped precipitously, sliding from the 8th to the 11th leading cause of death in the United States."
Several large-scale studies in the United States and Europe also screened blood samples from suicide victims and found no association between antidepressant use and suicide.
"Researchers found blood antidepressant levels in less than 20 percent of suicide cases," said Licinio. "This implies that the vast majority of suicide victims never received treatment for their depression.">>
I'm not in a position to do the research to join a long debate about whether or not SSRI's have lowered the suicide rate. Even if they have dropped or risen "precipitously", so many health researchers have such a blind eye to regression analyses that I doubt anyone has proven a causal relationship. Or the lack of one.
I have really been shocked, since I've started looking at "medical research" in two fields: nutrition/general health and psychiatric treatment.
At the bottom of the barrel you have publications such as "Prevention", who immediately consider a causal relationship proven when any research claims to have found a coincidental relationship.
Sharing the "F-" status is the entire psychiatric profession, which continues to give ECT -- a profoundly dangerous and invasive procedure -- to 50,000 people per year just in the US. This has been going on for over 50 years, and yet, nobody has done even the most rudimentary study of effectiveness and side effects, despite anecdotal evidence of profound mental damage to patients.
The answer to the question, "Have SSRI's resulted in a statistically significant decrease (or increase) in suicide rates" is the same as many questions in psychiatry, which could be answered by adequate research: "I don't know and nobody has bothered to find out".
Posted by blueboy on July 19, 2008, at 8:44:32
In reply to Re: Want to stop meds ... should I? » blueboy, posted by linkadge on July 18, 2008, at 15:37:54
> Take a look for yourself. Let me know if you have any data for a larger study period.
>
> http://fathersforlife.org/suicides/US_suicide_deaths.htm
>I don't really want to be seen as making any sort of negative comment about any organization that someone belongs to. But I have to say, this organization seems to have a very strong and unusual point of view about a number of issues.
This can be useful to debate, having someone with an apparent axe to grind wade into the fray, because they have the energy to gather evidence on one side of the issue. However, I wouldn't rely on it as a source for a balanced overall view of an issue. Heck, I barely credit medical journals.
Here is an account of another study, this one carried out at the "Group Health Cooperative Center for Health Studies" (whatever that is -- they could be great or could be a bunch of kooks, I don't know) by a psychiatrist and a Ph.D.
They published an empirical study of 100,000 patients over a year showing a marked correlation between SSRI treatment and lowered suicide rate. They strongly imply, but don't claim to have proven, a causal relationship.
They also cite the hypothesis that AD's might precipitate suicide early in treatment due to improving brain chemistry.
Oops, sorry, almost forgot the link:
http://www.sciencedaily.com/releases/2007/07/070701094054.htm
Posted by linkadge on July 19, 2008, at 9:56:20
In reply to Re: Want to stop meds ... should I? » linkadge, posted by SLS on July 19, 2008, at 5:32:21
I don't think thats what it suggest at all. If you notice, there is no unanimous drop in rates for all groups in the 1995-2003 period. For instance, in the 34-65 groups there seems to be an increase in this period, dispite the so called increased proliferation of AD drugs. For instance, in the 45-64 group rates start to go back up from 1995 to 2003. In the 35-44 range there is no significant rise or fall from 1995-2003. I would expect the 35-65 age range to be the ones that saw the *most* increase in antidepressant prescriptions in this timeframe. You've got all the baby boomers hitting mid-life crisis at this point.
Nevertheless, there is no unanimous drop in suicide rates in the 1995-2003 period. It goes up in some groups and goes down in other groups.
I certainly don't see any significant support for the notion that antidepressants decrease suicide rates. The rates rise and peak, for whatever reason dispite the widspread use of antidepressants. By the mid 90's you've got prozac, paxil, zoloft, luvox, MAOI's, TCA's all on the market yet you've got a peak in suicide rates.
Even if the drugs became more available or more widely used in the 1995-2003 period, you only see drops in certain age groups, and there is no way to link the two events. Also, the relatively small decrease from 1995-2003 in certain age groups does not bring it anywhere near the rate it was before the advent of antidepressants.
Antidepressant enthusists have no idea why the suicide rate rose and peaked in the mid 90's yet they are somehow convinced they know why it has slightly declined (in certain age groups) since then? That doesn't make sense.
There is no way to suggest that the relatively small decrease in rates from 1995-2003 in certain age groups is an effect of antidepressant medication and not just a natural/random trend. Like I said, you see it go up in other age groups at the same time and in the groups that it drops it does not go down to a level it was in the pre AD period.
Linkadge
Posted by linkadge on July 19, 2008, at 9:57:37
In reply to Re: Want to stop meds ... should I?, posted by blueboy on July 19, 2008, at 8:44:32
Again, I was just using the page for the graph. I am not supporting (or even know for that matter) what the page is suggesting.
Linkadge
Posted by linkadge on July 19, 2008, at 10:01:29
In reply to Re: Thank you, everyone » SLS, posted by SLS on July 19, 2008, at 5:55:26
Its fine with me if maxime choses to take her meds.
I just wouldn't ask the question, "should I stop my meds" and not expect at least somebody to support this decision.
Unless you're just asking the question to get the response you want to hear. If thats the case then perhaps a better thread title would be "I need support to help me continue my meds"
Linkadge
Posted by SLS on July 19, 2008, at 13:23:20
In reply to Re: Thank you, everyone, posted by linkadge on July 19, 2008, at 10:01:29
> Its fine with me if maxime choses to take her meds.
>
> I just wouldn't ask the question, "should I stop my meds" and not expect at least somebody to support this decision.In my opinion, you are supporting a dangerous course of action. I'm sure you would expect at least one person to feel that way.
> Unless you're just asking the question to get the response you want to hear.
Is that an accusation, my dear Linkadge? You don't have a clue as to what I'm all about. This is tragic.
> If thats the case then perhaps a better thread title would be "I need support to help me continue my meds"
This thread is what it is.
- Scott
Posted by 49er on July 19, 2008, at 13:28:37
In reply to Re: Thank you, everyone, posted by linkadge on July 19, 2008, at 10:01:29
Hi,
The purpose of this post is not to respond to Maxime's original message since she has made her decision.
But as I keep stressing on these boards ( I know many people are sick of me saying it), if you decide to taper your meds, your best chance of success is to taper very slowly. The Paxil Progress boards, which is run by an RN, recommend 10% of the current dose every 3 to 6 weeks. That website is
http://www.paxilprogress.org. It is for any psych med issues in spite of what the name says.Most people taper way too quickly as many doctors are not up to date with withdrawal issues and taper their patients way too fast. As a result, withdrawal symptoms get confused for a return of the illness and patients stay on meds for life when they might have been able to get off.
Anyway, I was essentially given the message I had to be on meds for life. After the meds caused horrific side effects, including a hearing loss, I decided differently. I have tapered from 4 meds down to 2 and expect I will be off everything at the end of 2009 or sometime in 2010.
In spite of dealing with job instability and the death of my mother, I am doing better than I ever did on meds.
Obviously, everyone has to make their own decision regarding meds. But it is totally incorrect to assume that anyone with a serious depression needs to be on meds for life.49er
Posted by SLS on July 19, 2008, at 13:40:32
In reply to Re: Thank you, everyone, posted by 49er on July 19, 2008, at 13:28:37
> Obviously, everyone has to make their own decision regarding meds. But it is totally incorrect to assume that anyone with a serious depression needs to be on meds for life.
Do you think your position on this issue speaks to the majority of people with a history of recurrent or chronic depression?
- Scott
Posted by BGB on July 19, 2008, at 13:41:51
In reply to Want to stop meds ... should I?, posted by Maxime on July 16, 2008, at 20:48:26
First of all Maxie, congratulations to you on feeling better! Second of all, sorry to hijack your thread there...but that article was just too funny not to comment on. Getting back on topic, I think that it might be wise to get a second opinion before discontinuing anything. If you get the okay from two docs, why not try tapering down off of your meds, one at a time? You can always go back on them.
I once hit a horrible depressive episode and convinced myself that I'm not bipolar at all and just depressed. Thinking that it was making me worse, I tapered myself down off of Depakote (without my doctor's consent or knowledge) and had some really, really horrible consequences from it. It turns out that I am very, very bipolar and will probably have to stay on mood stabilizers for the rest of my life.
That's not to say I regret the decision; I did walk away with some knowledge...I promise you I'll never just decide to stop any drug all by myself again. However, if you have the support of a doctor, or even better, two doctors, I don't see the harm.
A suicide attempt (and being in a coma, for that matter) are very intense psychological events...who knows what that could have done to your brain??? We know so little. While it's very possible that this event caused true physiological changes in your brain chemistry, it's also possible that the changes are psychological in nature. That does not diminish their significance. This experience could have completely changed the way that you think. That might be exactly what you needed.
Whatever you decide, I just hope that you continue to feel well. It's great to hear a positive story here on PB!!!
Take care, Maxie!!!!
B =)
Posted by SLS on July 19, 2008, at 13:56:39
In reply to Re: Want to stop meds ... should I?, posted by BGB on July 19, 2008, at 13:41:51
> First of all Maxie, congratulations to you on feeling better! Second of all, sorry to hijack your thread there...but that article was just too funny not to comment on. Getting back on topic, I think that it might be wise to get a second opinion before discontinuing anything. If you get the okay from two docs, why not try tapering down off of your meds, one at a time? You can always go back on them.
The thing that concerns me, though, is that it very often takes 4 months to relapse after the discontinuation of treatment. By that time, one may become less responsive to what got them well in the first place. Having said that, I have done exactly what you suggest, and have been better off for knowing what drugs I need and at what dosages. However, it is still early in my response to treatment. I have not been in remission for more than a year. I think you can get a more immediate gage of how much you need a particular drug by doing this experimentation earlier rather than later. I would not suggest this course of action for anyone except myself. The risks I took were mine and my doctor's.
This stuff is highly speculative, but it is how I have experienced the illness and its treatment.
- Scott
Posted by BGB on July 19, 2008, at 14:08:03
In reply to Re: Want to stop meds ... should I? » BGB, posted by SLS on July 19, 2008, at 13:56:39
> The thing that concerns me, though, is that it very often takes 4 months to relapse after the discontinuation of treatment.
Excellent point. My mania returned full-force after a 50% reduction in my Depakote dose. However, I do know that depression is a whole lot different from mania, and often takes much longer to return after the discontinuation of medication. It's also much harder to treat than depression (for me, anyway). That is definitely something that should be considered.
Posted by Maxime on July 19, 2008, at 17:10:12
In reply to Re: Thank you, everyone » SLS, posted by SLS on July 19, 2008, at 5:55:26
> Maxime,
>
> After reading this thread, how have your feelings surrounding the discontinuation of treatment changed, if at all?
>
>
> - ScottThis thread has made me realise that changing or stopping my meds right could really mess me up. I need to wait until I have been out of my depression for longer. It's possible that I may never get off meds, and I can live with that as long as I am doing well. It was so frustrating to try every single med and combo and get little or no relief. I'm 39 years and I have been depressed since I was a child.
Maybe my suicide attempt did change something in my brain that has allowed meds to work. I don't know. I will never know.
For now, I am staying on my cocktail of meds. :)
Maxime
Posted by Maxime on July 19, 2008, at 17:14:54
In reply to Re: Want to stop meds ... should I?, posted by BGB on July 19, 2008, at 13:41:51
> A suicide attempt (and being in a coma, for that matter) are very intense psychological events...who knows what that could have done to your brain??? We know so little. While it's very possible that this event caused true physiological changes in your brain chemistry, it's also possible that the changes are psychological in nature. That does not diminish their significance. This experience could have completely changed the way that you think. That might be exactly what you needed.
>
> Whatever you decide, I just hope that you continue to feel well. It's great to hear a positive story here on PB!!!
>
> Take care, Maxie!!!!
> B =)Aw, thank you! I don't mind that the thread was highjacked. I like to see discussion and some valid points for both side of the argument have been made.
Very early on, when I started to experience relief (beginning of March) my psychiatrist that indeed the coma and all the seizures I had may have had a psychological effect on me. He said that when people escape death, that their mood can change. I don't really know if that is the case because I remember being very unhappy that I was still alive.
Anyhow, I am doing well now and trying to live my life as much as possible!
Maxime
Posted by linkadge on July 19, 2008, at 17:44:57
In reply to Re: Thank you, everyone » linkadge, posted by SLS on July 19, 2008, at 13:23:20
>In my opinion, you are supporting a dangerous >course of action. I'm sure you would expect at >least one person to feel that way.
Well thats your opinion.
>> Unless you're just asking the question to get >>the response you want to hear.>Is that an accusation, my dear Linkadge? You >don't have a clue as to what I'm all about. This >is tragic.
I wasn't refering to you.
>This thread is what it is.
I know thats why I'm not going to respond to such anymore.Linkadge
Posted by linkadge on July 19, 2008, at 17:59:41
In reply to Re: Thank you, everyone, posted by 49er on July 19, 2008, at 13:28:37
Thats for your reply and this is what I am refering to. People are so loaded up with the "standard" opinion pushed by doctors and drug companies they rarely dare to think for themselves. This is one issue I'm sure people know that I have with SLS. He believes that the only way people with depression can feel better is if they take their meds as prescribed by their doctor and continue to take them as prescribed by their doctor. SLS still has issues dispite following this plan to the T.
Anyhow, like 49er mentioned there are many times when people actually feel better getting off meds. In these cases its not a matter of not being sick or not having been sick, its a matter of the drugs are simply not providing sufficiant relief and for whatever reason they are making the patient feel worse. Psychatry doesn't have all the answers and if you start with the assumption that they do, it may be a long and hard lesson for you.
If people are constantly questioning the efficacy of their meds, if they are constantly unsure as to whether they are really feeling better or not then it might be for good reason. People have a brain and the only person who can tell whether the risk benifit profile for them is really in their favor is the patient. Don't say the Emperor is wearing cloths if you don't think he is. Don't let any babbler convince you to take a med that you don't want to take or try to tell you that they are working when they may not be working. There are many times that I have trusted my intuition and got off meds and have felt better in the long run.
Contrary to popular belief meds are not the only answer and it doesn't undermine the validity of your illness or your suffering to not be on medication. I think sometimes people feel that if "I'm not on meds than nobody will belive there is anything wrong with me".
Linkadge
Posted by linkadge on July 19, 2008, at 18:13:55
In reply to Re: Want to stop meds ... should I?, posted by BGB on July 19, 2008, at 14:08:03
Theres also something called rebound mania. If you take a mood stabilizer for long enough you can experience mania from the rapid discontinuation of the medication.
Some people take that as evidence that they do infact have bipolar disorder, but its important to note that rebound mania is *not* restricted to bipolar patients.
For instance, there are many case reports of lithium discontinuation causing rebound mania in patients who were not bipolar! (I.e. the patients were using lithium for depression agumentation!)
The point is that when you are on drugs, you are on drugs. If you discontinue any medication too quickly you can experience the homeostatic forces of your brain acting unrestrained. If you were on an anxiety drug, you can have rebound anxiety, if you were on a mood stabilizer you can experience instability etc. etc.
Heres another good example. Doctors know that if you come off anticonvulsants too quickly you can have a seizure - even if you're not using the drug for epilepsy. So, if you have a seizure coming off an anticonvulsant that you were using for migrane would you take that as evidence that you really do have epilepsy ?? Of course not.
Its really important to compare and contrast the episodes of drug induced behavior to previous behaviors. If the episode you had coming off depakote was very similar to past epsisodes you had while drug free, then this would be an indication that you are bipolar. If the episode you had coming off depakote was very much unlike any epsiode you have had previously, then you may want to rethink the notion that it is proof of bipolar.
Linkadge
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