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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 43 to 67 of 118. Go back in thread:
Posted by SLS on July 20, 2005, at 2:24:09
In reply to Re: Bad (but expected) news about ADs, posted by Nickengland on July 19, 2005, at 16:23:12
> One thing to remember is (and this is my experience) with anti-depressants - they are not "pro happiness" pills.
Perfect!
This is great. I never thought to put it that way, but you are absolutely right.
I think this is where a great deal of miscommunication take place amongst people when they enter a discussion regarding antidepressants and mental illness in general.
Thanks!
- Scott
Posted by SLS on July 20, 2005, at 2:33:40
In reply to Re: Here we go again..., posted by linkadge on July 19, 2005, at 16:30:42
> > "When I responded well to antidepressants, it certainly did "bust" the underlying illness, not just selected symptoms."
> No offence, but that is impossable for you to know.I am somewhat offended, only because you are asserting something that *you* couldn't possibly know.
> Didn't these majic pills make you manic ?
After 6 months of uninterrupted euthymia, yes.
I am bipolar, remember? How does becoming manic nullify the global effect of remission that the antidepressants produced for me?
> Even though sinequan made my mother manic, and sent her into a downward spiral of psychwards, dirty antipsychotics, and experimentational mood stabalizing agents, she still contends that it was a gift from god, and that it cured her.
> Why does she say this?
Have you ever asked her?
> Because if she says otherwise, the last 20 years of her life have been lived in vain.
Was this her answer?
- Scott
Posted by SLS on July 20, 2005, at 2:55:39
In reply to Re: About my post..and Suicide... » med_empowered, posted by Jen Star on July 19, 2005, at 17:54:37
> I think it's dangerous to get too "into" any one method to cure something as fragile and mysterious (even to the best neurologists and researchers!) as the human mind.
It is the brain that seems to be working improperly in most cases of properly diagnosed MDD, and certainly in BD. The mind just naturally follows. Actually, this can work the other way around as well. Actually, both can work simultaneously. However, affective disorders, the brain gets stuck somehow and proceeds to deteriorate further on its own. If you interrupt the cycle of dysregulated brain -> dysfunctional mind by tickling the brain, you sometimes see an almost instantaneous resolution of the dysfunction in mind dynamics.
> If we focus on drugs to the exclusion of religion, meditation, etc, we are losing out.
Any healthy person can benefit from these things. They may not be at all necessary in most cases of MDD, but they can certainly help. I think psychotherapy can sometimes accelerate recovery from depression, and certainly help prevent relapses in many people.
> But I think in general we as a society are starting to overmedicate in general
I think I would agree with you on this. It is a very popular theme at the moment.
> I believe that mental illness is real.It definitely is.
However, I think some people get hung-up in pondering the abstractions of what are normal and abnormal behaviors for a particular culture at a particular time such that they would nullify the existence of mental illness.
> I'm just not sure that our drugs really work to "fix" it.
I think that most of our current treatments probably work by producing compensatative changes in the brain rather than producing a true cure. However, this should not dissuade someone from believing that these therapeutic mechanisms, whatever they may me, actually can produce a full remission, and not simply manage sets of symptoms.
> I hope that as tech. advances, our drugs become more refined and can really help the majority of people.
I'm sure we all do. Damned drugs.
- Scott
Posted by SLS on July 20, 2005, at 3:02:17
In reply to Re: About my post..and Suicide..., posted by Jakeman on July 19, 2005, at 21:03:54
> I do think sociology plays into this,
In a big way. This is unfortunate, but true.
> not just biology.
It is hard to separate the two. If we look at stress in general, we know that it can affect adversely if not generate things like hypertension, heart disease, cancer, immunosupression, diabetes, etc. These are all biological disorders. So is MDD (more or less).
- Scott
Posted by SLS on July 20, 2005, at 3:05:20
In reply to Re: About my post..and Suicide... » Phillipa, posted by Jakeman on July 19, 2005, at 21:17:27
> Then we have to worry about the fact that long-term effects (>6 monthes) have not been tested.
I'm sorry, I'm a little confused here. The long-term effects of what have not been tested?
- Scott
Posted by SLS on July 20, 2005, at 3:09:14
In reply to Re: Here we go again... » Jazzed, posted by SLS on July 20, 2005, at 2:18:11
Posted by Jazzed on July 20, 2005, at 7:35:37
In reply to Re: Here we go again... » Jazzed, posted by SLS on July 20, 2005, at 2:18:11
> I agree with you on all points. I guess you must be brilliant too.
>
> ;-)
>
>
> - Scott
>LOL, you are too funny Scott!
Posted by Jazzed on July 20, 2005, at 7:41:35
In reply to Re: About my post..and Suicide... » Jakeman, posted by SLS on July 20, 2005, at 3:02:17
>>If we look at stress in general, we know that it can affect adversely if not generate things like hypertension, heart disease, cancer, immunosupression, diabetes, etc. These are all biological disorders. So is MDD (more or less).
>
>
This is an excellent point, Scott.
Jazzy
Posted by linkadge on July 20, 2005, at 16:38:46
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 20, 2005, at 1:53:18
I don't think that study shows anything.
Suicide rates go up and down like a yo-yo.
Plus, if what you are saying is true, then this study has no merrit as well (since as you are proposing that we did not record suicides too well in the past)
The link between antidepressants and suicidal behavior was so strong, that England basically banned their use in children. Are you saying that they based their decision on nonsence ?
Canadian suicide rates increased
http://fathersforlife.org/health/cansuic.htm
US suicide rates decreased (although very insignificantly)Linkadge
Posted by linkadge on July 20, 2005, at 16:49:44
In reply to Re: Here we go again... » linkadge, posted by SLS on July 20, 2005, at 2:33:40
What I am saying is this. Heroin masks pain. Say someone had broken their leg. They take heroin, and suddenly there is absolutely nothing concivably wrong with them.
It is not that I am undermining your ability to determine your state of wellness, it is just that I am underminning the ability of humans to determine their state of illness.
Suppose you had a shrunken prefrontal cortex, and this was the true reason for your melancholy. If the drug makes you feel better, do you think it has restored the prefrontal volume ? Not necessarily. The prefrontal cortex turns on reward areas in the presence of reward, but the reward areas can be turned on artificially, creating a seemless, and compltetely natural sence of well being. Are you cured, of course not.
AD's rarely change brain anatomy (and when they do, it is extremely slowly). My mother said that sinequan worked over night. And while subjective relief was attained overnight, there was nothing to proove that she was indeed cured. No offence to you, I am just saying that we as humans are dumb.Linkadge
Posted by linkadge on July 20, 2005, at 16:54:13
In reply to Re: About my post..and Suicide... » Jen Star, posted by SLS on July 20, 2005, at 2:55:39
In your own words.......
"I think that most of our current treatments probably work by producing compensatative changes in the brain rather than producing a true cure."
now how can this co-exist with
"When I responded well to antidepressants, it certainly did "bust" the underlying illness, not just selected symptoms. It cured everything."
Posted by linkadge on July 20, 2005, at 17:02:31
In reply to Re: About my post..and Suicide... » SLS, posted by linkadge on July 20, 2005, at 16:54:13
Ok, so we know that AD's might produce some changes on a PET scan. This does not really justify their use and safety. I am sure that other drugs, like say a speedball would do something remarkably similar.
Linkadge
Posted by Phillipa on July 20, 2005, at 17:32:03
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 17:02:31
Okay, so my ignorance is showing again but what does MDD stand for? Fondly, Phillipa
Posted by mworkman on July 20, 2005, at 17:32:55
In reply to Bad (but expected) news about ADs, posted by med_empowered on July 19, 2005, at 13:53:07
>hey. I was just checking out yahoo news, and it >turns out theres a growing feeling that ADs >aren't that great. A British study was cited >which found: 1) anti-depressants, by and large, >dont' do so well in placebo-controlled trials. >There are positive studies, but factoring in >all good, available data points to a very weak >anti-depressant effect at best....2) the entire >concept of an anti-depressant is flawed. The >researchers theorize that anti->depressants "work" by controlling some symptoms >of depression--by stimulating or sedating, >controlling anxiety, inducing sleep, that kind >of thing--rather than through some >magical "depression busting" mechanism. Their >conclusion?
Is this growing feeling based on just one study? Is this talking about all AD's, or just SSRI's? And yes there is no "magical "depression busting" mechanism". Most people know that taking an AD doesn't just magically make them less depressed.
>Maybe more people should do drug-free >depression treatment involving social support >and community integration rather than drugs. >The American Psychiatric Association calls it >a "radical sociological theory of depression".
Just like you and many sociologists consider the psychiatric medical profession radical in thier ways.
> As a budding sociologist, I can tell you >that "mental illness" is itself largely a >concept, one dependant upon the social context >in question; given this, it makes sense to >approach the disorder at an individual and >social level rather than a medical one. Its >also worth noting that the APA receives >millions of dollars in funding each year from >Big Pharma and individual psychiatrists are >often very well compensated by drug companies.
Yes, this would make sense to a " budding sociologist" or maybe you just have a case of tunnel vision and can't see the whole picture, just the side your sociology studies have shown you.
Posted by linkadge on July 20, 2005, at 17:49:39
In reply to Re: Bad (but expected) news about ADs, posted by mworkman on July 20, 2005, at 17:32:55
What is the whole picture ?
According to:
http://www.biopsychiatry.com/antidepskep.htm
"Two of the largest and most reputable trials found only negligible differences between tricyclic antidepressants and placebo."
Posted by SLS on July 20, 2005, at 18:36:44
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 16:38:46
Hi Linkadge.
> I don't think that study shows anything.
>
> Suicide rates go up and down like a yo-yo.As was previous mentioned, I think sociological variables play a significant role in the rates of mental illness (not necessarily suicide) in a population. As the stress in a population increases, as seems to have happened in western society in general, I think the rate of depression increases.
> Plus, if what you are saying is true, then this study has no merrit as well (since as you are proposing that we did not record suicides too well in the past)No. What I am proposing is that mental illness and suicides are more apt to be reported now than they were 100 years ago. Thus, if rates have suicide have decreased, or even stabilized within the milieu of increased reporting, then the true rate of suicidal has actually decreased with the advent of antidepressants.
> The link between antidepressants and suicidal behavior was so strong, that England basically banned their use in children.
This is unfortunate. Antidepressants have also decreased the rate of suicide in adolescents. I do feel that psychotherapy should be the first line therapy in pediatric depression unless severe psychomotor retardation is present. Pediatric bipolar disorder presents a particularly difficult quandry. If not treated biologically, it will only get worse.
Adolescent antidepressant-induced suicides could be prevented by educating the patient that they could possibly feel worse, and that this should be reported promptly. They should also be monitored particularly closely with weekly visits to the doctor. I don't like the idea of serving the developing brain a meal of Prozac any more than you do. We don't yet know what the consequences are.
> Are you saying that they based their decision on nonsence ?
I think they based their decision as much on political pressure and panic as they did by a naturalistic study of the phenomenon.
> Canadian suicide rates increased
> http://fathersforlife.org/health/cansuic.htmPerhaps the socialized medical system of Canada doesn't lend itself to prompt and robust intervention in cases of depression. This has been the impression I get from the posters here, particularly you.
> US suicide rates decreased (although very insignificantly)
According to the literature I encounter on the Net, I invariably come across statements to the contrary; that the rates of suicide has decreased, particularly since the advent of the SSRIs and the increase in the percentage of people seeking treatment. It is illogical to conclude otherwise. Even if we just consider the impact of lithium, we both agree that it prevents suicide at a significant rate. How could the rate not be reduced significantly?
It is my guess that the rates of depression has increased over the last few decades as the stresses of societal day to day living has increased. However, it is also my guess that the percentage of these people committing suicide while taking antidepressants has decreased considerably. In other words, these drugs work. Prospective studies designed to observe probands longitudinally is a much better way to assess this hypothesis than using gross population statistics.
-----------------------------------------------------
1: Arch Suicide Res. 2005;9(3):279-300. Related Articles, Links
Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years' follow-up.Angst J, Angst F, Gerber-Werder R, Gamma A.
There is no data on the variation in the suicide risk over lifetime and on the suicide-preventive effect of the long-term treatment of mood-disorder patients with antidepressants and neuroleptics. Our research focused on 186 unipolar (D), 60 bipolar II (Dm), 130 nuclear bipolar I (MD), and 30 preponderantly manic patients (M/Md); that were followed-up from 1963 to 2003. By 2003, 45 (11.1%) of the 406 patients had committed suicide. Suicide rates were highest among D patients (Standardized Mortality Ratio, SMR = 26.4), MD (SMR = 13.6), Dm (SMR = 10.6) and lowest among M/Md patients (SMR = 4.7). Prospectively, the suicide rate decreased over the 44 years' follow-up; Lithium, neuroleptics and antidepressants reduced suicides significantly. Long-term treatment also reduced overall mortality, and combined treatments proved more effective than mono-therapy.
PMID: 16020171 [PubMed - in process]
---------------------------------------------------------
- Scott
Posted by SLS on July 20, 2005, at 18:40:08
In reply to Re: Here we go again... » SLS, posted by linkadge on July 20, 2005, at 16:49:44
> It is not that I am undermining your ability to determine your state of wellness, it is just that I am underminning the ability of humans to determine their state of illness.
I guess you'll just have to trust me on this one, Linkadge. I can tell the difference, even with my eyes closed.
:-)
- Scott
Posted by SLS on July 20, 2005, at 18:53:08
In reply to Re: About my post..and Suicide... » SLS, posted by linkadge on July 20, 2005, at 16:54:13
> In your own words.......
>
> "I think that most of our current treatments probably work by producing compensatative changes in the brain rather than producing a true cure."
>
> now how can this co-exist with
>
> "When I responded well to antidepressants, it certainly did "bust" the underlying illness, not just selected symptoms. It cured everything."
I guess *I'm* "busted".:-)
I am guilty of poor wording in an attempt to make a point. The point is, the entire syndrome resolves as one truly does achieve and experience full remission. The compensation might be as simple as changes in receptor numbers and the downstream events that produce them. Sometimes, I conceptualize antidepressant response as a resetting of the thermostatic feedback values. If you push the system one way or the other - for example 5-HT reuptake inhibition versus acceleration - the system is forced to compensate in such a way as to recreate the proper dynamics. The proper dynamics *is* the "busting" of the illness. For some people, this re-regulation remains intact, even after the antidepressant is removed. Perhaps this is the "cure".
- Scott
Posted by SLS on July 20, 2005, at 18:57:08
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 17:02:31
> Ok, so we know that AD's might produce some changes on a PET scan. This does not really justify their use and safety. I am sure that other drugs, like say a speedball would do something remarkably similar.
How sure are you?
Let's keep things simple - empirical. Some compounds are antidepressants. Some are not. What we see through imaging is instructive, but not yet predictive.
- Scott
Posted by SLS on July 20, 2005, at 19:11:20
In reply to Re: Bad (but expected) news about ADs, posted by mworkman on July 20, 2005, at 17:32:55
> Most people know...
Most?
How did you arrive at this assertion?
> ...that taking an AD doesn't just magically make them less depressed
Of course it does.
Someone smarter than me said something to the effect of "Antidepressants might resolve the depression, but they are not 'get-happy' pills."
Antidepressants will not resolve the psychological issues that existed before the depression began. After the depression magically resolves with antidepressants, all of those issues are still there waiting for you to work on. These might include a depressive thought-style. The greater your success at working on your happiness, the less your chance of relapse into depression.
- Scott
Posted by SLS on July 20, 2005, at 19:19:06
In reply to Re: About my post..and Suicide... » linkadge, posted by Phillipa on July 20, 2005, at 17:32:03
Just a few:
MDD = major depressive disorder
BD = bipolar disorder
BPD = borderline personality disorder
OCD = obsessive compulsive disorder
OCPD = obsessive compulsive personality disorder
PTSD = post traumatic stress disorder
PMS = premenstrual stress syndrome
PMDD = premenstrual dysphoric disorder
GAD = generalized anxiety disorder
SAD = seasonal affective disorder
SP = social phobia
SA = social anxiety disorder
PD = panic disorder
Posted by linkadge on July 20, 2005, at 19:21:54
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 20, 2005, at 18:36:44
"Antidepressants have also decreased the rate of suicide in adolescents."
Any proof of this? Aren't you essentially saying the exact opposite to what the FDA has spend the last year concluding ??
Linkadge
Posted by SLS on July 20, 2005, at 19:23:34
In reply to Re: Bad (but expected) news about ADs » mworkman, posted by linkadge on July 20, 2005, at 17:49:39
> What is the whole picture ?
>
> According to:
>
> http://www.biopsychiatry.com/antidepskep.htm
>
>
> "Two of the largest and most reputable trials found only negligible differences between tricyclic antidepressants and placebo."Unfortunately, the abstract doesn't specify which two. I would love to scrutinize them.
- Scott
Posted by SLS on July 20, 2005, at 19:30:15
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 19:21:54
> "Antidepressants have also decreased the rate of suicide in adolescents."
>
> Any proof of this? Aren't you essentially saying the exact opposite to what the FDA has spend the last year concluding ??I wish Larry Hoover were here to provide a links to his treatises of this question. I don't have the intellectual resources and knowledge to address this issue as intelligably and pursuasively as he did.
Bottom line:
ADs have reduced the rate of adolescent suicide, despite the fact that they have produced suicide in a small percentage.
1000 suicidal youths
700 AD preventions
10 AD inductionsYield: Reduced rate of suicide when treated with antidepressants. Right?
- Scott
Posted by linkadge on July 20, 2005, at 19:38:34
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 20, 2005, at 18:53:08
That is assuming that receptor dysregulation is the cause of depression.
Even this has been disputed. For instance, some AD's decrease 5-ht2a receptor function, but ECT actually upregulates 5-ht2a receptors.
ECT is clinically more effective, so one might suggest that 5-ht2a upregulation is necessary for remission.
http://www.vakkur.com/psy/MOOD/TSLD121.HTM
I've seen similar findings reported elsewhere.
The fact that tianeptine, and SSRI's are both clinically effective is as crazy as saying that vitamin C prevents scurvy, and vitamin C deficiancy prevents scurvey.
Linkadge
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