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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Joslynn on April 12, 2004, at 21:16:07
What does everyone think of this dr and his viewpoints about the dangers of SSRIs? His book is on http://www.prozacbacklash.com. I just saw him on a very scarey, negative law show (http://www.lawjournaltv.com) about litigation against drug companies for suicides and withdrawal symptoms regarding SSRIs. I watched the show on TV, and I am sure my old Mac would explode and go flying off into the stratosphere if I actually played the show on the computer, but if you are a techy you can try it.
Of course, it was three lawyers talking, all on the anti-SSRI side of the issue. Gloom and doom. They made it sound like the FDA and drug companies are feeding off each other, with doctors in the dark, and no one to protect us (except for the lawyers of course, gee what do you know).
But seriously, now I am all scared, not of the suicidal feelings, which I only felt BEFORE the meds, not after. It is more the threat of lingering, mysterious, unknown brain damage that scares me and withdrawal. My pdoc told me that Lexapro is not toxic or addictve, so then why are people getting withdrawals when they go off SSRIs? Tics? Corkscrew brain cells in mice? ahhh!
I am all scared now. I have been on SSRis--first on Celexa, then Lexapro--for almost three years. I was thinking of trying to go off them anyway (not on my own, under supervision of course) and now I am wondering if this is all the more reason?? I am a bit of a worrier, so if I am overreacting to this, I would love people's opinions.
I have had two episdoes of severe depression in my life w/ suicidal impulses in my life (no attempt) and the second episode required hospitalization. But now I am worried about the meds I am taking to avoid a third episode.
Thank you.
Posted by ace on April 12, 2004, at 22:17:18
In reply to scarey anti-SSRI web site, posted by Joslynn on April 12, 2004, at 21:16:07
Posted by Sebastian on April 12, 2004, at 22:38:53
In reply to scarey anti-SSRI web site, posted by Joslynn on April 12, 2004, at 21:16:07
They are safe. Like you said, they stoped you from suicide. I've been taking psychotropic drugs for 7 years now, with no ill effects. The withdraw is just your body re-adjusting. Just like when you started taking them, your body adjusted. If you do need to withdraw from meds take it very slowly.
Posted by Sebastian on April 12, 2004, at 22:43:44
In reply to Re: scarey anti-SSRI web site, posted by Sebastian on April 12, 2004, at 22:38:53
Just remember your moods will change when you go on or off a med of this type. Which could make you suicidal again. Thats why you should should take small steps on or off meds.
Posted by NotAddicted on April 13, 2004, at 0:07:34
In reply to Re: scarey anti-SSRI web site, posted by Sebastian on April 12, 2004, at 22:43:44
...is intended to do just that --- scare and alarm. And it is done for just about every med possible, if you look hard enough. Are you doing well on your med? If so, you are very lucky.
I'm on a benzo now for 3 years and have endured much in the way of alarmist, awful press and personal opinion. I had to throw all that "mess" away and realize what was good for me.
If you're doing good... try to ignore the nay sayers and "you'll be sorry" ers. If you want to come off... well, it sounds like your beginning thoughts are correct in that process.
We all have choices. I hope you don't make yours based on possible jaded information.
Good Luck
Posted by cubbybear on April 13, 2004, at 3:42:50
In reply to scarey anti-SSRI web site, posted by Joslynn on April 12, 2004, at 21:16:07
Heated discussion about this book comes up from time to time. I read it and liked it a lot, yet with some reservations. Perhaps there are some hidden dangers from the SSRIs, yet the statistics show that only Effexor and Paxil have been causing severe withdrawal problems in a significant number of people.
I contacted Glenmullen's message board to state that I wanted to see coverage of the MAOI anti-depressants in the book. He makes no mention of them, as if Parnate and Nardil don't even exist. These great ADs have been around for more than 40 years, so why did Glenmullen fail to mention them? I don't get it.As for warnings about suicide and irreversible CNS damage, I believe that there are ill-meaning people on both sides of the coin: those who resort to scare-mongering and hard-to-prove assertions, and those who would ram the SSRIs down everybody's throat (like the drug companies).
The truth lies somewhere in the middle.
Posted by crazychickuk on April 13, 2004, at 5:57:15
In reply to Re: scarey anti-SSRI web site, posted by cubbybear on April 13, 2004, at 3:42:50
FOr me it was fate i can not take ssri's for the life of me they do more damage to me than my anxiety, they raised my bp and hrt rate to a level where i had to be hospilized....
But if they work for you stick with them, stop reading up on them...
o know though that these drugs act like any other drugs for other illnesses such as warfin for blood clots etc you may need to be on them for the rest of your life to help you.. They are safe aslong as you are not suicidal if you are it clearly states on the leaflet any suicidel tendancy's talk to your doctor immediatly, if you are ofcourse worried then talk to you doctor, but bare in mind if they wernt safe they wouldnt be prescribed..
Take care
Posted by joslynn on April 13, 2004, at 8:36:21
In reply to Re: scarey anti-SSRI web site, posted by crazychickuk on April 13, 2004, at 5:57:15
Thanks all for the input!
I was tossing in bed obsessing about this last night, then I thought uh oh, what if I am obsessing about SSRIs because I am on SSRIs! Then I remembered, duh, I have always been a bit obsessive.
You can get into this whole worry cycle, especially when the rain is beating on the windows all night long.
Well, it is something I want to think about/read about more, but I don't think I will be making a knee jerk decision about it.
Thanks for the responses.
Posted by linkadge on April 13, 2004, at 9:09:36
In reply to Re: scarey anti-SSRI web site, posted by joslynn on April 13, 2004, at 8:36:21
A certain portion of the population have a certain MAO gene which means they naturally have much lower levels of MAO, this means they have higher levels of serotonin norepinephrine and dopamine.
Do these people's brain cells corkscrew in responce to their own naturally higher levels of serotonin, of course not. If you read closely the doses used in that study were 50-100 times the MAXIUMUM (80mg) human doses. Of course the brain cells are going to die with this amount. YOu faint if you get too much oxygen.
The idea is to bring your serotonin levels into a normal range, you know this is probably true when you start to feel better and I doubt there will be brain dammage as a consequence.
Linkadge
Posted by greywolf on April 13, 2004, at 10:25:23
In reply to scarey anti-SSRI web site, posted by Joslynn on April 12, 2004, at 21:16:07
Joslynn:
Take all that negative stuff with a grain of salt. SSRIs, like so many other medications, have short and long-term SEs that offset the benefits they bring to the table. And as with just about any drug, there may be super long-term SEs we don't know about yet.
But just rejecting meds that may work well for you out of hand is throwing the baby out with the bath water. Educate yourself with respect to what is known about the risks of particular drugs, then do a cost/benefit assessment based on your own needs, not on what others tell you those should be.
I have recently become irritated with a set of ads running in my area at the behest of some organization that hopes to convince people to stop "relying" on mental health medications. They can express themselves all they want, but I am bothered by the subtext of their ads: that using medications like SSRIs is a sign of personal weakness that the drug companies are exploiting. The campaign suggests not only that people who use these medications have something wrong with them from a maturity/moral fiber standpoint, but also that they are stupid enough to be duped by the drug companies. It's really offensive and I'm concerned that it will reinforce the negative stereotypes that prevent many people from seeking needed treatment. I wish that some mental health organizations would provide a counterpoint, but I don't see that happening.
So, bottom line: ignore the negativity and scare tactics. Educate yourself and make your own decisions in light of known or anticipated risks. Nothing is perfectly safe, not even water. Don't buy into this theory that life must be made risk-free, and that any meds that aren't absolutely, perfectly safe in perpetuity should be rejected. From my personal perspective, life is a heck of a lot less safe and less healthy without medications that provide important benefits. My asthma medications have obvious risks, but no one I know would suggest that I'd be better off without them. This issue should be treated similarly.
Posted by Racer on April 13, 2004, at 18:15:45
In reply to scarey anti-SSRI web site, posted by Joslynn on April 12, 2004, at 21:16:07
Those sites make me angry. It's hard enough to suffer from depression, but then these idiots come along and start shouting about how the drugs used to treat the disease are killing the poor victims...
Here's what I've learned in the last 15 years:
All the antidepressants, from MAOIs to TCAs to SSRIs and beyond have about the same level of efficacy. All of them have their own side effects. All of them work for about 40% of the people who take them.
The drawbacks to the MAOIs are pretty major. The dietary changes alone are so significant that it's a drug of last resort for most people. They also have a pretty high drug interaction rate, which is a concern if there's a chance you'll ever need to take another drug for anything at all. While they are life saving for a lot of people, for most depressed patients they're not worth the difficulties.
The TCAs are also about 40% effective, but they have a much more benign profile than the MAOIs. The problem is, they're pretty non-specific in what they do -- which neurotransmitters they effect, etc -- and so they cause a fairly high incidence of adverse effects. They are also a risk in overdose, so for profoundly depressed patients who are unsupervised during initial treatment, they may not be the best idea.
SSRIs have about the same level of effectiveness as the older ADs, but they have -- reletively speaking -- far fewer and more benign side effects.
The hype about suicide risk has been there since Prozac first came on the market. These people are shouting it so loud -- and they're shouting PART of the story, but not all of the story. The consensus in the psychiatric field seems to be that the risk of suicide is not from the drug per se. The risk is that SSRIs increase energy and motivation before complete remission from the depression happens. That means that there are a lot of people who feel well enough to ACT on their suicidal impulses, but don't feel well enough to function in their lives. When you first start taking an AD, of any sort, there's often an initial period when the placebo effect makes you think that you're feeling better. Then, that wears off, often before the ADs have really kicked in. Can't you imagine how devastating that is? Here you think you're going to get better, and one morning you wake up feeling just about as bad as you did before? Doctors, in general, don't discuss this with their patients. Patients who wake up with this sudden reversion to their depressed state -- but with more energy -- may think that they've failed, it was as hopeless as they'd thought, etc. Yes. Many of them do attempt or commit suicide. The psychiatric community has known this for decades. The highest risk for suicide isn't while a patient is lying on the sofa crying. It's when that patient gets up off the sofa and starts cleaning the house. The risk with SSRIs is part of the same phenomenon.
As for the rest of it, yeah, we're guinea pigs. Those drugs are studied for six to eight weeks for approval, and then doctors figure out over many years what else happens. Unfortunately, what's available is what's available. Which is worse? Depression, or the drugs? That's something only you can decide. Remember, the TCAs and MAOIs are understood a little better, but they have their own problems.
Personally, a good relationship with your doctor is about all I can offer as a suggestion to coming to terms with this.
Good luck.
Posted by harryp on April 14, 2004, at 3:13:55
In reply to scarey anti-SSRI web site, posted by Joslynn on April 12, 2004, at 21:16:07
Hi,
I'm looked over *Prozac Backlash*, and it really is excessively alarmist, in my opinion.
The unfortunate truth is that we simply DON'T KNOW much about the long-term effects (if any) of the SSRI's. I think Dr. Glenmullen is mostly addressing his book to the mildly depressed who would be better served by therapy or a change of lifestyle and who shouldn't be popping these drugs like candy. If you are suicidally depressed, you should take what you need.
That said, I am still more comfortable taking Parnate, and if I were a psychiatrist I would use tricyclics as a first line AD rather than SSRI's.
Posted by cubbybear on April 14, 2004, at 3:18:40
In reply to It's called PROPAGANDA » Joslynn, posted by Racer on April 13, 2004, at 18:15:45
> >
> The drawbacks to the MAOIs are pretty major. The dietary changes alone are so significant that it's a drug of last resort for most people. They also have a pretty high drug interaction rate, which is a concern if there's a chance you'll ever need to take another drug for anything at all. While they are life saving for a lot of people, for most depressed patients they're not worth the difficulties.
>
You make very good points in your post except that you seem to have been influenced by all the negative hype about MAOIs that paints these meds in very dire and dangerous terms. Be careful of exaggerations like "dietary changes are. . so major" and, regarding drug interactions, ". . .you'll ever need to take another drug for anything at all." To be exact, the MAOIs necessitate omissions in diet, rather than major changes in diet. There are definitely dangers from drug interactions but they don't encompass anything and everything, such as anti-biotics.
Posted by joslynn on April 14, 2004, at 8:38:29
In reply to Re: It's called PROPAGANDA » Racer, posted by cubbybear on April 14, 2004, at 3:18:40
Thanks for the info. People here obviously know their stuff. I feel less panicky about all this now. I will talk to my pdoc about it in a couple weeks when I see him again. He is usually good at explaining scientific things and I will see him for 50 minutes, so it should be a long discussion.
The scary thing is, if the doctors are not being given all the info...well no matter how good they are, they won't know the whole story.
I agree, it does seem like a lot of the anti-depressant camp are really saying that they should not be prescribed for ordinary life disappointments, not that they should be eliminated completely. I was suicidal and not sleeping or eating before I started taking them, so I think they were a good choice for me.
However, while I have had two severe depressions, they were very spread out, and in between I wasn't on meds. So the question is...do I really need them forever or will that second episode be the last, even if I go off meds? Unfortunately, there is no way to predict what will happen.
I wish there was some test where they could say, your depression was helped XX% by talk therapy, XX% by lifestyle changes and only X% by the meds. So you can stop taking the meds if you keep up the other changes.
But there is no test at this point to show that. I will have to find out first hand, if I really want to know. In a way, I am my own guinea pig.
Posted by terrics on April 14, 2004, at 16:11:10
In reply to It's called PROPAGANDA » Joslynn, posted by Racer on April 13, 2004, at 18:15:45
Well said. Especially the part about ones DR. Can I add that a really good pdoc knows his/her meds well. terrics
Posted by cubbybear on April 15, 2004, at 2:15:47
In reply to thanks!!, posted by joslynn on April 14, 2004, at 8:38:29
>> However, while I have had two severe depressions, they were very spread out, and in between I wasn't on meds. So the question is...do I really need them forever or will that second episode be the last, even if I go off meds? Unfortunately, there is no way to predict what will happen.
Right--there's never any way to predict how you'll feel (and, in my case, a new bout of depression is always triggered by stressful life circumstances), but unfortunately the statistics show that the likelihood of having a depressive relapse at some future date increases with every subsequent relapse (I think the term is "increases exponentially").
>
> I wish there was some test where they could say, your depression was helped XX% by talk therapy, XX% by lifestyle changes and only X% by the meds. So you can stop taking the meds if you keep up the other changes.It would be great if psychiatry and psychopharmacology made such quantifying possible, but as things now stand, it's still a lot of hit and miss, trial and error.
>
>
Posted by Racer on April 15, 2004, at 18:20:04
In reply to Re: It's called PROPAGANDA » Racer, posted by cubbybear on April 14, 2004, at 3:18:40
Those omissions can be pretty major for a lot of people! It really depends on your basic diet, and what you consider Real Food, which can be pretty heavily slanted towards those foods that have to be omitted from the diet. In the winter, we eat a lot of potato soup, with sour cream in it. Holidays we eat a kind of chicken stew made with sour cream. Having to remake holiday dinners to accommodate an anti-depressant would be major for me -- and I know I'm not alone. Mexican food has a lot of sour cream, for instance, and so do a lot of other traditional ethnic diets. So, I was thinking about myself and people like me, rather than thinking about meat and potato style eating habits that might just require putting butter or something else on the potatoes rather than sour cream. Does that make more sense?
I guess it's a cultural thing: if your culturally consisten dietary habits include a lot of the foods that need to be avoided while taking MAOIs, then going on them would be a very difficult decision to make.
Does that make more sense now? I really didn't want to give the impression that I'm anti-MAOI, because I've known people for whom they really are a life saving medication. For me, though, having to give up traditional family dinners that mean so much to me and offer so much comfort for me -- well, it would be very, very difficult to choose to take them.
Posted by cubbybear on April 16, 2004, at 2:01:40
In reply to LOL!! » cubbybear, posted by Racer on April 15, 2004, at 18:20:04
You've mentioned heavy use of sour cream in your diet. I know that the original diet guidelines for MAOIs indicated a prohibition on sour cream, but the revised guidelines from 1998 indicated that sour cream had "nil" tyramine. This was established through professional testing of many different cheeses. Perhaps you'd want to check this out for yourself if sour cream is your only concern. Sorry I can't provide the web address for the test results but it's been posted here in the past and I'm sure that someone else could direct you to it.
Posted by SDA on April 16, 2004, at 16:33:42
In reply to thanks!!, posted by joslynn on April 14, 2004, at 8:38:29
Linkadge is right; the amount of SSRI given to the mice in that study was up to 100x the maximum dosage. Could you imagine taking 20g of Zoloft for a week or so without even building up? That's 200 100mg tablets! No wonder the effects were similar to that of Ecstasy.
The poor mice...
My Dad has been on Zoloft for over 7 years, and is a very successful and innovative micro surgeon. He says that taking ADs has only improved his life.
Posted by Sad Panda on April 18, 2004, at 15:53:22
In reply to It's called PROPAGANDA » Joslynn, posted by Racer on April 13, 2004, at 18:15:45
Hi Racer, I'd disagree with your sweeping 40% efficacy statement.
>
> Here's what I've learned in the last 15 years:
>
> All the antidepressants, from MAOIs to TCAs to SSRIs and beyond have about the same level of efficacy. All of them have their own side effects. All of them work for about 40% of the people who take them.
>
> The drawbacks to the MAOIs are pretty major. The dietary changes alone are so significant that it's a drug of last resort for most people. They also have a pretty high drug interaction rate, which is a concern if there's a chance you'll ever need to take another drug for anything at all. While they are life saving for a lot of people, for most depressed patients they're not worth the difficulties.
>
> The TCAs are also about 40% effective, but they have a much more benign profile than the MAOIs. The problem is, they're pretty non-specific in what they do -- which neurotransmitters they effect, etc -- and so they cause a fairly high incidence of adverse effects. They are also a risk in overdose, so for profoundly depressed patients who are unsupervised during initial treatment, they may not be the best idea.
>
> SSRIs have about the same level of effectiveness as the older ADs, but they have -- reletively speaking -- far fewer and more benign side effects.
>Some AD's are above average & stand out to some degree. These would be the MAOI's Nardil & Parnate, the TCA's Clomipramine & Amitriptyline & the SSRI Zoloft.
MAOI's are less restrictive than you think, you could get through as much sour cream as you like provided it hasn't gone rotten. The dangers of a hypertensive crisis or serotonin syndrome is there & real, but the likelihood is overhyped. TCA's & SSRI's also have various drug interaction problems, so it's unfair to single out MAOI's for their drug interaction problems.
You can clump the SSRI's together to some degree, but their side effects all differ. Personally I would avoid Paxil & Luvox, while Zoloft is probably the safest & has the least amount of drug interactions.
Clumping TCA's together is wrong as no two are alike. Clomipramine & Amitriptyline are proven AD's that are superior to the SSRI's and are suitable for monotherapy. Desipramine & Nortriptyline are good to add on to SSRI's & may also be usefull for ADD sufferers. Doxepin & Trimpiramine in low doses are great for sleep & would be good for SSRI or MAOI induced insomnia. Clomipramine, Amitriptyline & Nortriptyline also are good for migraine sufferers & people that have neuropathic types of pain.
>
> The hype about suicide risk has been there since Prozac first came on the market. These people are shouting it so loud -- and they're shouting PART of the story, but not all of the story. The consensus in the psychiatric field seems to be that the risk of suicide is not from the drug per se. The risk is that SSRIs increase energy and motivation before complete remission from the depression happens. That means that there are a lot of people who feel well enough to ACT on their suicidal impulses, but don't feel well enough to function in their lives. When you first start taking an AD, of any sort, there's often an initial period when the placebo effect makes you think that you're feeling better. Then, that wears off, often before the ADs have really kicked in. Can't you imagine how devastating that is? Here you think you're going to get better, and one morning you wake up feeling just about as bad as you did before? Doctors, in general, don't discuss this with their patients. Patients who wake up with this sudden reversion to their depressed state -- but with more energy -- may think that they've failed, it was as hopeless as they'd thought, etc. Yes. Many of them do attempt or commit suicide. The psychiatric community has known this for decades. The highest risk for suicide isn't while a patient is lying on the sofa crying. It's when that patient gets up off the sofa and starts cleaning the house. The risk with SSRIs is part of the same phenomenon.
>SSRI's probably exsist because they are difficult to overdose on, where as the TCA's can cause heart problems in overdose realtively easily, so doctors are happy to hand out the SSRI's. Some people, especially children & teenagers can have a suicidal or violent reaction to SSRI's & this is being recognised & they are no longer recommended. TCA's, OTOH, don't seem to have this problem and pardoxially are actually safer than SSRI's.
Cheers,
Panda.
This is the end of the thread.
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