![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 68 to 92 of 95. Go back in thread:
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
Posted by linkadge on April 22, 2011, at 7:50:24
In reply to Re: the only way out, posted by huxley on April 21, 2011, at 0:48:49
>We are not talking about treating acne here. >What you suggest has the power to completly >screw someones mind up. Just be careful.
No, you're *absouletly* right! There is currently more evidence for Acutaine causing depression / suicide than Abilify!!
Linkadge
Posted by SLS on April 22, 2011, at 7:56:37
In reply to Re: the only way out » SLS, posted by 49er on April 22, 2011, at 7:06:42
> 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.I agree with you. I guess I did not word my post efficiently enough. Withdrawal depressive rebound is by definition a feature of acute withdrawal and not of chronic presentation. I would not advocate reinstating an antidepressant during the period of withdrawal if there are no compelling reasons to do so. However, I believe that chronic depression persisting beyond this acute phase of withdrawal argues for continued treatment.
The point at which we differ substantially is the interpretation of post-withdrawal depression. Is it relapse? I tend to think so.
> This is not a one size fits all type of deal.
I agree. In psychiatry, few things do fit all.
> 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.That's just common sense. Why would you think I would argue for such a thing?
> Regarding psychotherapy, if that person can't even sit up straight without getting dizzy, then it would be useless.I disagree about the worth of psychotherapy in this situation. I think CBT can work to help the patient recognize spontaneous negative or intrusive thoughts as the illness warps perceptions. It is a form of reality testing. If, however, you are suggesting that MDD is a biological illness that can prevent people from functioning effectively, I think we have a deal.
One of the problems I see with the extended taper you advocate is that it extends the period that one is to suffer from chronic withdrawal. Although I would not recommend an abrupt discontinuation, I think a schema that requires more than a year to reach discontinuation is counterproductive.
- Scott
Posted by linkadge on April 22, 2011, at 8:14:19
In reply to Re: the only way out » huxley, posted by SLS on April 22, 2011, at 7:35:51
I don't know how this whole argument attempted to simplify itself into another med/anti-med argument.
The decision to take or not take psychiatric medications is a very personal one. Psychiatric medications (like all medications) have side effects, and anyone should be completely cautioned against possible side effects *and* given an *accurate* incidence of these side effects.
There are many new side effects and complications that emmerge over time with any given medical treatment. It is scientifically and ethically appropriate to consider any side effect possible and record the incidence of such.
Yes, there are real risks associated with psychiatric medications. Unfortunately, we're not at the stage where we can fully tell when a particular medication might harm and when it might help.
In spite of risks, there are people for whom the benefit / risk ratio is high enough for them to continue therapy with certain psychiatric medications.
Those who advocate for a broad scale ban on any/all psychiatric medications have likely not considered fully the extent of beneifit to some patients.
I think when you go on boards like paxilprogress, you see more patients asking "why wasn't I warned" rather than "ban this drug (and all like it) forever". I agree that people should be warned. If 1/10 users develop persistant anhedonic symptoms after discontinuing an SSRI, this should be noted (perhaps against the backdrop incidence of depressed patients (not taking medications) who display similar symptoms after extended periods).
Those who have suffered adversly should be given airplay as should those who have benefitted. Hopefully the proponderance of evidence will help guide those who are considering medication therapy.
My original counter point was that if you have sufferent chronic depression, then statistically speaking it will return (**often in a deteriorating course**). So, a past medication may not be completely to blame for ones current state.
Linkadge
Posted by 49er on April 22, 2011, at 8:31:14
In reply to Re: the only way out » 49er, posted by SLS on April 22, 2011, at 7:56:37
Hi Scott,
The problem in my opinion is if you taper too quickly, the chronic withdrawal period will usually last alot longer than if someone took longer to taper, You're not reducing the amount of suffering in my opinion and actually are prolonging it. I know you don't agree so I will leave it at that.
If someone is depressed due to having vestibular disturbances from psych meds, that is not MDD.
In my opinion, you really have to be careful about that since people can be screwed for life with an inaccurate mental illness label such as not getting health insurance and being kept from desirable jobs.
Anyway, I think we're getting way off topic and I am not really sure there is much more to say. Then again, every time I make that type of statement, something will come up that I have to respond to:)
49er
Posted by SLS on April 22, 2011, at 8:41:57
In reply to Re: the only way out » SLS, posted by 49er on April 22, 2011, at 8:31:14
49er,
Your observations and conjecture are valuable. I wouldn't want you to feel that I don't take your points of debate seriously and with consideration.
> If someone is depressed due to having vestibular disturbances from psych meds, that is not MDD
When you use word "depressed" here, do you mean the type of sadness or despondency that can occur due to unfavorable life circumstance (situational)? Is this person depressed about having vestibular disturbances? If so, then this is likely not to be MDD.
- Scott
Posted by huxley on April 22, 2011, at 20:13:50
In reply to Re: the only way out » huxley, posted by SLS on April 22, 2011, at 7:35:51
YEh well I guess the situation I am now in,
trapped in a hell created by an antipsychotic and unable to stop it due to severe withdrawal effects and the need to go on in life
and support my family makes me an angry person sometimes.I can't stand by and watch someone casually recommend someone try an antipsychotic like it is vitamin pill.
I would like you to stop recommending people take antispsychotics when you admit that you have no idea what it will do to them. Or at least
warn them that it is a very potent medication which can have severe side effects.Sure they can be used in a situation where the benefits outweigh the risks.
But how you can deduce that from reading a post or two I don't know.
I reserve the right to use sarcasm.
Have a good day sir.
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