![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 62 to 86 of 95. Go back in thread:
Posted by SLS on April 20, 2011, at 5:24:00
In reply to Re: the only way out » SLS, posted by morgan miller on April 19, 2011, at 21:34:05
Hi Morgan.
Thanks for the milk thistle links. Very interesting.
I have a saint of a benefactor whom has taken an interest in helping to heal me. He sent me a whole bunch of vitamins and supplements that includes milk thistle. He also invested hours in composing letters with citations to help educate me. I am very grateful for this individual's help.
I have become shy to ingesting "natural" substances simply because some have made me feel MUCH worse. P-5-P induced a suicidal state within a few hours of taking it early in the day. By evening, this state disappeared. Calcium and magnesium make me feel moderately worse. So does Deplin. I tried NAC a few years back, and I recall it made me feel worse as well. I am willing to try it again, perhaps at a reduced dosage. Vitamins and supplements contain a plethora of chemical substances. I have come to treat them with as much respect as I treat pharmaceuticals.
> Hope your journey towards wellness continues in the right direction.
Thanks Morgan, that means a lot to me.
- Scott
Posted by SLS on April 20, 2011, at 6:44:00
In reply to Re: the only way out » poser938, posted by 49er on April 20, 2011, at 3:45:38
Hi 49er.
> First of all, I am so sorry that you feel so distressed that you feel the need to commit suicide. As one who has dealt with withdrawal symptoms from psych meds, your feelings are totally understandable.
I think many people are confusing withdrawal with persistent changes in structure and function. In my experience and observation, drugs can often go in, make changes, and go out, leaving the system in a different state than when it went in. This is evidenced by several phenomena, including drug poop-out, post SSRI sexual and motivational deficits, and the loss of responsiveness to a drug following its discontinuation. These are not acute withdrawal symptoms. They are residual and persist long after drug discontinuation.
I agree with many of your recommendations for drug discontinuation, although I am still of the opinion that the rate of taper you suggest is too slow for most of the drugs being used in psychiatry.
- Scott
Posted by 49er on April 20, 2011, at 7:50:17
In reply to Re: the only way out » 49er, posted by SLS on April 20, 2011, at 6:44:00
Hi Scott
"I think many people are confusing withdrawal with persistent changes in structure and function. In my experience and observation, drugs can often go in, make changes, and go out, leaving the system in a different state than when it went in."So far, we're in agreement.
" This is evidenced by several phenomena, including drug poop-out, post SSRI sexual and motivational deficits, and the loss of responsiveness to a drug following its discontinuation. These are not acute withdrawal symptoms. They are residual and persist long after drug discontinuation. "
Poop out is not a withdrawal symptom in my opinion. That refers to the feeling that the drug has lost its effectiveness when you are taking it.
But regarding motivational and sexual dysfunction, they can either be withdrawal symptoms or residual depending on if they resolve or not which they do for some people. The problem is if they are residual, many psychiatrists will erroneously blame it on the person's label.
> I agree with many of your recommendations for drug discontinuation, although I am still of the opinion that the rate of taper you suggest is too slow for most of the drugs being used in psychiatry.
>
I vehemently disagree. I wish I had a nickle for how many times I have seen posts on boards like this one and others where it was clear to me the person had problems from tapering way too fast.What is the rush? The only issue I see where tapering slowly may not be a good thing is if the doctor feels the side effects are so life threatening that the person has to get off the drug immediately.
But even in cases like that, I have seen people have withdrawal symptoms that were so horrendous that i wonder if simply lowering the dose slowly would have lessened the problems.
After all, Jay Cohen, a psychiatrist who is not anti meds has said alot of side effects are from increasing meds too quickly and starting patients on too large of a dose.
I guess my question to you is what specific objections do you have regarding my plan being too slow?
49er
Posted by SLS on April 20, 2011, at 9:09:12
In reply to Re: the only way out » SLS, posted by 49er on April 20, 2011, at 7:50:17
> Hi Scott
>
> "I think many people are confusing withdrawal with persistent changes in structure and function. In my experience and observation, drugs can often go in, make changes, and go out, leaving the system in a different state than when it went in."
>
> So far, we're in agreement.
>
> " This is evidenced by several phenomena, including drug poop-out, post SSRI sexual and motivational deficits, and the loss of responsiveness to a drug following its discontinuation. These are not acute withdrawal symptoms. They are residual and persist long after drug discontinuation. "
>
> Poop out is not a withdrawal symptom in my opinion.I agree. I think you misunderstood me.
> That refers to the feeling that the drug has lost its effectiveness when you are taking it.
When poop-out occurs, something in the brain has changed. Perhaps it involves a type of overshoot that destabilizes the system. This change usually results in a resistence to responding to that same drug subsequently.
Withdrawal Effects vs Residual Effects: Not only are withdrawal effects time-limited, but they differ significantly in presentation.
"severe flulike symptoms - headache, diarrhea, nausea, vomiting, chills, dizziness and fatigue. There may be insomnia. Agitation, impaired concentration, vivid dreams, depersonalization, irritability and suicidal thoughts are sometimes occurring. These symptoms last anywhere from one to seven weeks and vary in intensity."
Not to mention the brain zaps.
> > I agree with many of your recommendations for drug discontinuation, although I am still of the opinion that the rate of taper you suggest is too slow for most of the drugs being used in psychiatry.
> >
> I vehemently disagree. I wish I had a nickle for how many times I have seen posts on boards like this one and others where it was clear to me the person had problems from tapering way too fast.I'm not advoacating abrupt discontinuation. However, when the situation arises where a doctor and patient elect to change medications, it is prohibitive to spend a year or more to taper the old drug before beginning the new drug.
> What is the rush?
Please see above.
Respectfully.- Scott
Posted by floatingbridge on April 20, 2011, at 10:43:01
In reply to Re: the only way out, posted by sigismund on April 20, 2011, at 1:06:12
sigi, yes, it's very true to my experience that meeting anger of that sort (hmmm, or any...?) with mine is a lose lose situation.
Yesterday, just by coincidence, I was able to meet my son's absolute rage with some equanimity. (That's the upside of being ill w/ stress-responsive ailmemts; I can't afford to get too upset:-/ )
I did need to use my 'voice of god'. Different than yelling. We really worked on the trigger event when he calmed down (a classmate interaction). Which was pretty rapid. Amazing. The rapidity w/which it subsided. He's a pretty sensitive boy. Quick to take umbrage.
Provocative is a very useful word. Here too, in my son's case; therefore I can picture your young daughter and the ice cream quite vividly.
Girls can be quite willful. Amazingly so. All the more surprising because, at least in the US it is schooled out of them regularly. Boys, well, they get, imho, too
much slack line early, (boys will be boys), only to have the heat turned up if they fail to perform in the early grades. Very confusing and harmful.E. B. White, writing as Templeton the Rat, while observing Avery in Charlotte's Web: what fantastic creatures boys are!
Having never been one, I'm inclined to agree.
Sigi, thanks so much. I am very glad to hear that your experience of depression was not so invasive. And that anxiety, well, that you seem to have a very workable relationship with it. I think I'm going to return the thread to poser. I feel like an absolute chatterbox. I'll visit social.
Posted by 49er on April 20, 2011, at 10:51:01
In reply to Re: the only way out » 49er, posted by SLS on April 20, 2011, at 9:09:12
49er- " Poop out is not a withdrawal symptom in my opinion."
SL - " I agree. I think you misunderstood me."
Wouldn't be the first time I misunderstood someone:)
"When poop-out occurs, something in the brain has changed. Perhaps it involves a type of overshoot that destabilizes the system. This change usually results in a resistence to responding to that same drug subsequently.""
Sorry for my elementary question but when you say overshoot, are you talking for example about an SSRI drug that is overloading the system with Serotonin?
> Withdrawal Effects vs Residual Effects: Not only are withdrawal effects time-limited, but they differ significantly in presentation.
>
> "severe flulike symptoms - headache, diarrhea, nausea, vomiting, chills, dizziness and fatigue. There may be insomnia. Agitation, impaired concentration, vivid dreams, depersonalization, irritability and suicidal thoughts are sometimes occurring. These symptoms last anywhere from one to seven weeks and vary in intensity."Uh, they can last alot longer than that. And they come and go.
<<I'm not advoacating abrupt discontinuation. However, when the situation arises where a doctor and patient elect to change medications, it is prohibitive to spend a year or more to taper the old drug before beginning the new drug.>>
I see your point. But again, I see too many situations where people were transitioned way too quickly from one drug to another and suffered horribly.
The problem is by doing this too quickly, you can't really access whether the person is on the right drug or not because withdrawal symptoms are confusing the issue.
49er
Posted by floatingbridge on April 20, 2011, at 11:03:08
In reply to Re: the only way out, posted by poser938 on April 19, 2011, at 8:10:08
> so i guess there are no thoughts on what could fix what the mirapex did to me? i guess what it did was kind of like a tolerance thing. that it stimulated my receptors to where they're not tolerant of dopamine anymore. i know they're not because i tried ritalin and tianeptine in the past hoping they would help, they only made me worse.. ritalin made me worse after just one dose. i've been
trying DXM (dextromethorphan) at 60mgs a day lately to see if it would help, but hasnt at all so far. its been a week since i started.poser,
Seems your post has sparked quite a discussion. How are you hanging in there?
I can second the need for supplemental support. In my case, krill oil (just another type of good quality fish oil) and a few other things (gaba and gaba promoting agents) are helpful. I recently added a melatonin mix, but only after a month or so of being stable on other supplements.
Not that I'm at all saying go out and get some vitamins. Actually, I also second some comments to add supplements very slowly. To my mind, you are pre-
disposed to being sensitive or perhaps drug and/or depressive state have heightened sensitivity.Some people report negative responses to fish oil. Besides, you are considering further medical intervention. You are in
a tough spot, it's very true, but not impossible. Do you take notes about your med trials responses and duration of usage? I find that helpful for getting perspective.Take good care. Please post how you are doing. I feel others would like to know, too.
Posted by SLS on April 20, 2011, at 12:45:35
In reply to Re: the only way out » SLS, posted by 49er on April 20, 2011, at 10:51:01
> 49er- " Poop out is not a withdrawal symptom in my opinion."
>
> SL - " I agree. I think you misunderstood me."
>
> Wouldn't be the first time I misunderstood someone:)
>
> "When poop-out occurs, something in the brain has changed. Perhaps it involves a type of overshoot that destabilizes the system. This change usually results in a resistance to responding to that same drug subsequently.""
>
> Sorry for my elementary question but when you say overshoot, are you talking for example about an SSRI drug that is overloading the system with Serotonin?I was just thinking out loud. Silly, I know. I was thinking along the lines of receptor downregulation continuing beyond the point that is necessary to maintain efficient neurotransmission. It would be a gene expression thing. Sorry for my elementary answer to a sophisticated question.
> > Withdrawal Effects vs Residual Effects: Not only are withdrawal effects time-limited, but they differ significantly in presentation.
> >
> > "severe flulike symptoms - headache, diarrhea, nausea, vomiting, chills, dizziness and fatigue. There may be insomnia. Agitation, impaired concentration, vivid dreams, depersonalization, irritability and suicidal thoughts are sometimes occurring. These symptoms last anywhere from one to seven weeks and vary in intensity."> Uh, they can last alot longer than that. And they come and go.
What are the most common symptoms to persist beyond 4 weeks?
If we were talking about Paxil at 40mg or Effexor at 300mg, approximately how long would it take to taper these drugs and reach total discontinuation using a the schema you recommend? A rough guess would be fine. 4 weeks? 12 weeks? 12 months?
> <<I'm not advocating abrupt discontinuation. However, when the situation arises where a doctor and patient elect to change medications, it is prohibitive to spend a year or more to taper the old drug before beginning the new drug.>>
> I see your point. But again, I see too many situations where people were transitioned way too quickly from one drug to another and suffered horribly.
>
> The problem is by doing this too quickly, you can't really access whether the person is on the right drug or not because withdrawal symptoms are confusing the issue.This is true. I guess one would rely on the notion that the period for withdrawal is time limited. I don't think a depressive rebound due to the discontinuation of antidepressants will usually last much beyond four weeks. I'm not absolutely sure, though. I think the answer to this question will depend upon which observations one is using to identify true withdrawal, and which are consistent with a syndrome of persistent post-discontinuation adverse effects. Although I have seen references to a time limit on withdrawal periods as a way of delineating adverse events, I have not seen any kind of scientific investigation to resolve this issue. I haven't looked, though.
- Scott
Posted by linkadge on April 20, 2011, at 17:18:33
In reply to Re: the only way out, posted by morgan miller on April 19, 2011, at 1:42:06
I've had no problem with benzodiazapines. I use about 2-3 a week, during stressfull times and when the stress subsides I just stop.
I'm not saying people don't have problems with benzos, just like people have problems with alcohol, but that doesn't mean that everybody who drinks will become an alcoholic.
I would advise people against projecting their own negative experiences on everybody.
I'd much prefer a benzo to an SSRI. I wish my doctor had just prescribed a benzodiazapine when I was anxious at 16. I have found them far less mind altering than SSRI's.
Linkadge
Posted by linkadge on April 20, 2011, at 17:43:08
In reply to Re: the only way out, posted by poser938 on April 19, 2011, at 8:10:08
>that it stimulated my receptors to where they're >not tolerant of dopamine anymore. i know they're >not because i tried ritalin and tianeptine in >the past hoping they would help, they only made >me worse.. ritalin made me worse after just one >dose.
Is this before or after the mirapex? Also your investigation is by far not diagnostic of anything. Ritalin has effects on norepinephrine too. Depression can depleat norepinephrine and dopamine rendering it less sensitive to monoamine reuptake. Ever consider that your catecholamine levels are just low (due to depression)?
Also, the sensitivity towards ritalin euphoria is not universal. People with ADHD oftentimes notice the side effect of *depression* from stimulants, yet they still work for ADHD. In mice, the sentivity to stimulants is dramatically influenced by levels of p11 (which is decreased in animal models of depression). When people are depressed, they get less reward from most things, including food, drugs, sex, whatever. Its also got to do with dynorphin and prodynorphin which are natural kappa agonists which are increased in animal models of depression.
When you take a stimulant, it increases the levels of dynorphin to try and reduce the dopamine's pleasurable effect. Interestingly, even though dynorphin has prodysphoric effects, it has potent anti-ADHD effects. Some theorize that its actually the natural dynorphin response that produces the antihyperkinetic effect of ritalin.
Dynorphin doesn't decrease dopamine responsivity it just decreases dopamine release. Dynorphin levels are increased in depression and also dramatically influence the behavioral responses to stimualants.
Also prolonged exposure to dopamine can actually produce depression. Read the following article. Dopamine is *not* the magic pleasure chemical. When mice are exposed to too much mesolimbic dopamine they get depressed! (And this is not due to a simple loss of dopamine responsiveness). The brain is wired to produce a depressive response to too much pleasure! Yes, this is because too much activation of mesolimbic dopamine actually turns on CREB and BDNF in these regions which produce behavioral depression! This is why dopamine blocking (or serotonin raising antidepressants, are generally effective), because, by boosting serotonin, they lower dopamine and hence CREB in this region, and reballance serotonin / dopamine (or so the theory goes).Stress can also increase dopamine release, and increase risk of psychosis and/or depression in susceptable individuals.
People here don't seem to get that! They just read some stupic oversimiplistic websites that say dopamine makes you feel good.
http://www.webmd.com/depression/news/20050728/dopamine-may-play-new-role-in-depression
In certain instances, dopamine mediates feelings of pleasure, but its not a simple dopamine = pleasure effect. Dopamine works in conjunction with many many other brain chemicals to mediate feelings of well being and reward.
For instance, SLS has noted that ritalin often makes his depression worse. Is this because his dopamine receptors are not sensitive??? Of course not necssarily, its because his particular biochemical problem is probably different.
Also, what one drug does one day, does not predict what it will do the next.
>i've been trying DXM (dextromethorphan) at 60mgs >a day lately to see if it would help, but hasnt >at all so far. its been a week since i started.Get your mind off this stupid oversimplistic dopaminergic theory.
Linkadge
Posted by floatingbridge on April 20, 2011, at 18:06:22
In reply to Re: the only way out, posted by linkadge on April 20, 2011, at 17:43:08
Linkage,
I'll be rereading this post. Thanks.
Not all of us have the mental gift to tear through this material. It's not always obstinacy. (Then, of course, there are informed debates between folks who disagree on the results of studies. And the way studies are designed.) I can write a poem, but can't remember the receptors. (I didn't say a good poem. Those, though, I can read.)
That's why I read other people's posts. They help me--like this one.
Thanks again.
:-)
And lifting a cup of coffee to you. Cheers!
Posted by linkadge on April 20, 2011, at 21:04:40
In reply to Re: the only way out » linkadge, posted by floatingbridge on April 20, 2011, at 18:06:22
Hey, I'm no neuroscientist.
I guess the point I'm trying to make is that its complex, and it makes no sense to me when somebody becomes so hard pressed on the notion that they are deficiant in this is that brain chemical.
Depression is so incredably complex. Why one drug works or doesn't, or works then doesn't is not fully understood by the most advanced individuals in the field. So I just don't know how on earth somebody could come on a site like this convinced (literally to the point of death) that their dopamine recepors are permanantly fried. I just don't get it.
Linkadge
Posted by linkadge on April 20, 2011, at 21:30:17
In reply to Re: the only way out, posted by linkadge on April 20, 2011, at 17:43:08
Depression (more than Just Dopamine!!)
There have been a kazillion different proposed targets for depression based on many of the kazzillion findings of abherant brain function in depressed patients. Studies of which include:
-Neurotransmitters (Serotin, Dopamine Etc)
-Neuromodulators (Gaba, Glutamate)
-Trace Amines (PEA, tryptamine, etc.)
-Neuropeptides (Neuropeptide Y, ghrelin)
-Opiate function (kappa, mu, delta, etc)
-Nerve Growth Factors (NGF, FGF, BDNF, GDNF)
-Signal Transduction (Protein Kinases)
-Ion Chanels (Calcium, Sodium, Potassium)
-Cellular Metabolism (ATP)
-Regulation of Apoptosis (BCL-2, Bax)
-Kinases (MAP kinases, stress induced kinases)
-HPA axis (and genes that regulate it)
-Immune function (TNF alpha)
-Cellular Adhesion Molecules
-Supporting Brain Cells (Glia)
-Structural (ie. grey matter changes)
-Cellular Morphology
-Antioxidant Defense Systems
-Genetics
-EnvironmentWhen you are depressed, there can be so much out of wack. What would make somebody conclude that they know the one (and only) possible problem (i.e. my dopamine receptors are not working properly)? Anhedonia is a core feature of depression. Depression is associated *many* *many* possible brain changes.
You can't change one of these systems without affecting the others. That mirapex induced some sort of shift in a bad direction doesn't mean that the problem lies with the inital target of the drug.
Thats like saying that the real problem (now) with the earthquake in Japan is at the subduction zone in the middle of the ocean.
Linkadge
Posted by floatingbridge on April 20, 2011, at 21:30:30
In reply to Re: the only way out » floatingbridge, posted by linkadge on April 20, 2011, at 21:04:40
I know it's silly, but once we tussled over the same issue. When I first came here and was responding brilliantly to dexedrine. That was before I became ill physically. Or illness presented itself.
I still don't know why it worked. I do suspect it lead to my present illness; However, dexedrine was like mental/emotional armor somehow. I put it on and felt powerful; in other words equal to anyone. Not better than.
Now it's an irritant.
Did you ever watch the Alien series of films? I forget which one, 2 maybe. Ripley (Soujourney Weaver's character) puts on this huge futuristic Cat (as in caterpillar truck) work suit to fight the alien.
*IronMan* for women, I imagine. I haven't seen it though.
I appreciate that you post what you read and explain it when asked. It's an act of generousity.
fb
Posted by floatingbridge on April 20, 2011, at 21:33:20
In reply to Re: the only way out, posted by linkadge on April 20, 2011, at 21:30:17
This would make good content for a babble FAQ.
For reals.
> Depression (more than Just Dopamine!!)
>
> There have been a kazillion different proposed targets for depression based on many of the kazzillion findings of abherant brain function in depressed patients. Studies of which include:
>
> -Neurotransmitters (Serotin, Dopamine Etc)
> -Neuromodulators (Gaba, Glutamate)
> -Trace Amines (PEA, tryptamine, etc.)
> -Neuropeptides (Neuropeptide Y, ghrelin)
> -Opiate function (kappa, mu, delta, etc)
> -Nerve Growth Factors (NGF, FGF, BDNF, GDNF)
> -Signal Transduction (Protein Kinases)
> -Ion Chanels (Calcium, Sodium, Potassium)
> -Cellular Metabolism (ATP)
> -Regulation of Apoptosis (BCL-2, Bax)
> -Kinases (MAP kinases, stress induced kinases)
> -HPA axis (and genes that regulate it)
> -Immune function (TNF alpha)
> -Cellular Adhesion Molecules
> -Supporting Brain Cells (Glia)
> -Structural (ie. grey matter changes)
> -Cellular Morphology
> -Antioxidant Defense Systems
> -Genetics
> -Environment
>
> When you are depressed, there can be so much out of wack. What would make somebody conclude that they know the one (and only) possible problem (i.e. my dopamine receptors are not working properly)? Anhedonia is a core feature of depression. Depression is associated *many* *many* possible brain changes.
>
> You can't change one of these systems without affecting the others. That mirapex induced some sort of shift in a bad direction doesn't mean that the problem lies with the inital target of the drug.
>
> Thats like saying that the real problem (now) with the earthquake in Japan is at the subduction zone in the middle of the ocean.
>
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> Linkadge
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Posted by Phillipa on April 20, 2011, at 23:35:55
In reply to Re: the only way out » linkadge, posted by floatingbridge on April 20, 2011, at 21:33:20
FB I love it!!!! Phillipa
Posted by huxley on April 21, 2011, at 0:48:49
In reply to Re: the only way out » huxley, posted by SLS on April 19, 2011, at 20:34:48
> Since you brought up this issue, I think it would be appropriate for you to attend to it yourself. I look forward to your contributions. Your list of unwanted effects should be specific for Abilify, since it is this drug that I chose to speak about. Citations are welcome.
>
>
> - Scott
>Scott, seing as you are playing internet Psychiatrist and making recomendations on what drugs people should take I think it is only right for you to also tell them the risks and side effects.
Things like Tardive dyskinesia should be included. Also the fact that there is an offical warning for abilfy that it may make people more depressed and suicidal.
I find that relevant for someone who has just mentioned that they are sucidal.
But I'm sure you will be providing regular follow up care on your suggestion to make sure that the patient doesn't take a turn for the worse?
We are not talking about treating acne here. What you suggest has the power to completly screw someones mind up. Just be careful.
Posted by 49er on April 21, 2011, at 2:45:57
In reply to Re: the only way out » 49er, posted by SLS on April 20, 2011, at 12:45:35
<<<I was just thinking out loud. Silly, I know. I was thinking along the lines of receptor downregulation continuing beyond the point that is necessary to maintain efficient neurotransmission. It would be a gene expression thing. Sorry for my elementary answer to a sophisticated question.>>>
You're not being silly as you made some points that challenged my brain which is a good thing. Uh no, you're answer is definitely not elementary.
Ok, gene expression thing makes sense.
SLS - <<<severe flulike symptoms - headache, diarrhea, nausea, vomiting, chills, dizziness and fatigue. There may be insomnia. Agitation, impaired concentration, vivid dreams, depersonalization, irritability and suicidal thoughts are sometimes occurring. These symptoms last anywhere from one to seven weeks and vary in intensity.">>>
49er - <<Uh, they can last alot longer than that. And they come and go.>>
SLS - <<What are the most common symptoms to persist beyond 4 weeks?>>
All of the above and there are many others.
<< If we were talking about Paxil at 40mg or Effexor at 300mg, approximately how long would it take to taper these drugs and reach total discontinuation using a the schema you recommend? A rough guess would be fine. 4 weeks? 12 weeks? 12 months?>>
Everyone is different as it depends on so many factors, including age, time on drugs, what type of drugs, and rate of taper.
I do know this - Even though I am still struggling with issues that I feel were due to being on psych meds, in my opinion they would have been a lot worse if I had tapered alot faster.
<<This is true. I guess one would rely on the notion that the period for withdrawal is time limited. I don't think a depressive rebound due to the discontinuation of antidepressants will usually last much beyond four weeks. I'm not absolutely sure, though. I think the answer to this question will depend upon which observations one is using to identify true withdrawal, and which are consistent with a syndrome of persistent post-discontinuation adverse effects. Although I have seen references to a time limit on withdrawal periods as a way of delineating adverse events, I have not seen any kind of scientific investigation to resolve this issue. I haven't looked, though.>>
In thinking more about your post, let me ask this question. You keep distinguishing between withdrawal symptoms and ones that are post discontinuation adverse effects.
Does it really matter and of so, why?
Unfortunately, you're not going to find any scientific references because physicians in general, not just psychiatrists, minimize adverse drug side effects.
49er
Posted by SLS on April 21, 2011, at 6:16:17
In reply to Re: the only way out, posted by huxley on April 21, 2011, at 0:48:49
> > Since you brought up this issue, I think it would be appropriate for you to attend to it yourself. I look forward to your contributions. Your list of unwanted effects should be specific for Abilify, since it is this drug that I chose to speak about. Citations are welcome.
> Scott, seing as you are playing internet Psychiatrist and making recomendations on what drugs people should take I think it is only right for you to also tell them the risks and side effects.
The burden of proof is on you, which is good because your arguments should be easy to make. Antipsychotics carry a burden of side effects, even irreversible and deadly ones. Statistics? You neglect this essential set of facts.
Remember aripiprazole (Abilify)? I asked you to list adverse effects specific to this drug. Please don't avoid my questions as I will try not to avoid yours.
In the medical literature contained on Medline, I found quite a few abstracts demonstrating that aripiprazole *reduces* the severity of tardive dyskinesia produced by other drugs. Reports of aripiprazole-induced tardive-dyskinesia are very, very rare, presumably because this drug is selective for limbic circuits rather than striatal circuits. I'll let you explain the importance of this salient biological observation. Yes. I'm giving you homework, which is something you should have done before making your proclamations and antagonizing me.
Speaking of which, of all the people on Psycho-Babble giving treatment recommendations, what makes me different that you should single me out. I find this amusing. I guess I should really be flattered, though.
Over the years, I have evaluated and reevaluated what I felt were the risks versus benefits of the various antipsychotics. I now favor their use for a variety of conditions, including some subtypes of depression.
> Things like Tardive dyskinesia should be included. Also the fact that there is an offical warning for abilfy that it may make people more depressed and suicidal.It "may"? Black Box labels often contains warnings that are global to a drug category, rather than specific to the drug containing them. So now you have the burden of producing statistics for aripiprazole.
We are not talking about acne? I guess you don't think people should be allowed to use any and every tool available just because the incidence of adverse events is higher for APs than it is for doxycyline? Cancer therapies are not innocuous by design. Are you to judge people suffering from mental illness and their treatment decisions to use APs or other drugs with undesirable side effects as being less eligible for relief from drug treatment than cancer patients?
It seems that you ignore the ability for people posting on Psycho-Babble to make well informed and deliberated treatment decisions; the first step being to ask questions. Who shall answer them? Their doctors? It is ironic that you should not give credit to doctors and their decision making processes in favor of your own. I do not think this to be valid advice. So, stop playing medical critic and continue to educate yourself. I will continue to educate myself as well.
Be careful.
- Scott
Posted by SLS on April 21, 2011, at 8:32:20
In reply to Re: the only way out » SLS, posted by 49er on April 21, 2011, at 2:45:57
Hi 49er.
> In thinking more about your post, let me ask this question. You keep distinguishing between withdrawal symptoms and ones that are post discontinuation adverse effects.
>
> Does it really matter and of so, why?In my way of thinking, facts always matter, even though we don't always know how to apply them at first.
You ask a really good question. I will need to think about it for awhile. Suffice it to say that distinguishing between acute withdrawal and chronic persistent symptoms might influence treatment decisions, especially when one takes depressive rebound into consideration. A more chronic course persisting for weeks or months beyond drug discontinuation is probably best treated by reinstating antidepressant treatment or psychotherapy. Such a chronic course has a good chance of reflecting a relapse of the original depressive disorder. Given this example, at what point would you suggest reinstating treatment for depression? How many weeks do you allow to pass during a drug taper before you elect to treat the reemergence of depression?
- Scott
Posted by Lou Pilder on April 21, 2011, at 9:22:41
In reply to Re: the only way out, posted by huxley on April 21, 2011, at 0:48:49
> > Since you brought up this issue, I think it would be appropriate for you to attend to it yourself. I look forward to your contributions. Your list of unwanted effects should be specific for Abilify, since it is this drug that I chose to speak about. Citations are welcome.
> >
> >
> > - Scott
> >
>
> Scott, seing as you are playing internet Psychiatrist and making recomendations on what drugs people should take I think it is only right for you to also tell them the risks and side effects.
>
> Things like Tardive dyskinesia should be included. Also the fact that there is an offical warning for abilfy that it may make people more depressed and suicidal.
>
> I find that relevant for someone who has just mentioned that they are sucidal.
>
> But I'm sure you will be providing regular follow up care on your suggestion to make sure that the patient doesn't take a turn for the worse?
>
> We are not talking about treating acne here. What you suggest has the power to completly screw someones mind up. Just be careful.
>
> Friends,
If you are considering being a discussant in this thread, I am requesting that you view the following video.
Lou
To see thiis video,
A. Pull up Gooogle
B.Type in
[youtube, Dr Gary Kohls, SSRI Drugs are]
> You will see a pic of Dr Kohls and the time is 7 min posted on March 2, 2009
Posted by huxley on April 21, 2011, at 18:41:56
In reply to Re: the only way out » huxley, posted by SLS on April 21, 2011, at 6:16:17
Scott, fact is you are giving advise to people to take powerful drugs when you don't know how they will react to them. It's dangerous and you don't seem to understand that.
I have taken abilfy before. Tell me how I reacted when I take abilfy?
Fact is your not a psychiatrist. (You do know this right?) It takes 8 years to become a psychiatrist and then they are bound by rules and regulations.You are clearly past reasoning with if you think Antipsychotics do not have serious adverse effects and that it is a regular occurence.
I have no problem with people taking them, it's their choice. They just should be made aware of the problems that can and do occur.
It's the least a 'doctor' can do.
Posted by Phillipa on April 21, 2011, at 19:23:06
In reply to Re: the only way out, posted by huxley on April 21, 2011, at 18:41:56
That's a class of meds personally I would never take. Tendency to becoming diabetic in family history so weight gain to be avoided at all costs. One time a 50mg of seroquel was given to me in a hospital and couldn't speak in the am could think no words would come out of mouth and almost fainted. Docs immediately pulled me off them. Of course that is just me. Phillipa
Posted by 49er on April 22, 2011, at 7:06:42
In reply to Re: the only way out » 49er, posted by SLS on April 21, 2011, at 8:32:20
Hi Scott,
The problem with saying that depressive rebound can best be treated by medication or psychotherapy is that it could be due to so many reasons that might not be conducive to those treatments. This is not a one size fits all type of deal.
For example, if someone has suffered vestibular damage as the result of being on psych meds and is depressed from that, reinstating the drugs that caused the problems would be very cruel.
Regarding psychotherapy, if that person can't even sit up straight without getting dizzy, then it would be useless. It seems the best remediation is some type of vestibular therapy.
I do understand your concerns about waiting too long. Many of us don't have the luxury of waiting it out since we have to earn a living to support ourselves.
Then again, many people who had horrific discontinuation syndromes including depression have posted about how time was really the only answer to resolving their situation. They said they were tempted to reinstate the meds but were so glad they didn't and are feeling great.
49er
Posted by SLS on April 22, 2011, at 7:35:51
In reply to Re: the only way out, posted by huxley on April 21, 2011, at 18:41:56
Huxley.
You bring up important issues. However:
Your choosing to target me personally and with such vehemence is little more than an ad hominem attack. You do not bother presenting facts, either about the science behind your arguments or your knowledge of the history and content of my posts.
I try not to offer opinion as fact. I often offer citations of medical literature in order to allow people to become aware of the science and clinical therapeutics as they currently exists. I have not acquired my knowledge by attending medical school. However, this has not precluded me from reading the same medical literature that doctors have read since 1983; much of it being contradictory.
You want me to guess as to how a particular drug affects you? Yeah, right. I have no facts to apply here. For all I know, it has produced in you profound akathisia. Here's one for you: What mental illness is your doctor attempting to treat that he should have chosen Abilify for you? We might like to know how a real live doctor treats his patients. *If* you and/or your doctor elected to stop taking Abilify because of adverse events or lack of therapeutic efficacy, why did your doctor not know in advance how it would affect you? How could you possibly take Abilify knowing what are the side effects of other drugs in the category of antipsychotics? You require more of me than you do your doctor or yourself. Why is that?
You have argued that people on Psycho-Babble offer suggestions without being doctors. This is an administrative matter that should be directed to the website operator. Why has he allowed this posting behavior for over a decade? I would be interested to know why myself.
Oh, yeah. Why don't you try reading my posts with a bit more care. It doesn't help anyone for you to opine regarding my posts without reading them more thoroughly first.
http://www.dr-bob.org/babble/20110418/msgs/983408.html
Huxley: "Scott, seing as you are playing internet Psychiatrist and making recomendations on what drugs people should take I think it is only right for you to also tell them the risks and side effects."
Scott: "The burden of proof is on you, which is good because your arguments should be easy to make. Antipsychotics carry a burden of side effects, even irreversible and deadly ones. Statistics? You neglect this essential set of facts."
There you go.
I would appreciate that you stop using ad hominem attacks and sarcasm regarding my character, motivations, and behaviors.
- Scott
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