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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 91 to 115 of 118. Go back in thread:
Posted by linkadge on July 21, 2005, at 20:46:34
In reply to Re: About my post..and Suicide... » Jakeman, posted by SLS on July 21, 2005, at 20:00:55
"One of the most important findings of such studies is that the dosage of an antidepressant that successfully treats the depression acutely is the same dosage that should be used for long-term maintenance. "
That is what was claimed for benzodiazapines 30 years ago.
That again is buying into the whole flawed theory. What doctors claim of the drug, and what the drug actually turns out to be, are two totally different things.
Psychiatrists would like an antidepressant to be a drug that:1) Works
2) Continues to Work (no poop out / tollerance)
3) Is safe
4) Produces few side effects
5) Non addicting (requires no dose escalation)This is what doctors *want* an antidepressant to be. But no drug meets this criteral.
1) They sometimes work and sometimes don't
2) They can poop out, people can become tollerant
to their effects. This board is proof of that.
3) We have no idea of their long term safety.
I am proof of safety issues that docotors
never anticipated.
4) They produce many side effects, some of which
we might not even be aware.
5) Often require dose escalation, augmentation,
and have withdrawl bad enough to be common
household knowledgeLinkadge
Posted by linkadge on July 21, 2005, at 20:50:21
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:05:28
"They don't become antidepressants until they show efficacy in human beings."
And they become antidepressants even if they don't show efficacy in human beings. Drug companies just keep testing the drug till they find one study that shows "sufficant evidence"
Drug companies could show that breakfast sausage was an antidepressant if they wanted to.
Linkadge
Posted by linkadge on July 21, 2005, at 20:52:05
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 21, 2005, at 20:09:37
Unmedicated depression usually remits within a year. Rarely longer. Antidepressants are taken on average much longer than a year. Antidepressnats worsen the course of the illness.
Linkadge
Posted by SLS on July 21, 2005, at 20:54:42
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 20:46:34
> "One of the most important findings of such studies is that the dosage of an antidepressant that successfully treats the depression acutely is the same dosage that should be used for long-term maintenance. "
>
> That is what was claimed for benzodiazapines 30 years ago.
>
> That again is buying into the whole flawed theory. What doctors claim of the drug, and what the drug actually turns out to be, are two totally different things.
Work in this area is not new:1: J Affect Disord. 1993 Mar;27(3):139-45. Related Articles, Links
Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression.Frank E, Kupfer DJ, Perel JM, Cornes C, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ.
Department of Psychiatry University of Pittsburgh School of Medicine, PA 15213.
Recent evidence points to the prophylactic efficacy of maintaining recurrent unipolar patients on the same dose of antidepressant medication that was used to treat the acute episode (Frank et al., 1990; Kupfer et al., 1992). Therefore, the question of whether such patients should be tapered to a lower maintenance dose after successful resolution of an acute episode is clearly important. In this report we describe a small randomized clinical trial in which patients were assigned to either full-dose or half-dose maintenance treatment for a period of 3 years. Survival analysis suggests that superior prophylaxis can be achieved with a full-dose as compared to a half-dose maintenance treatment strategy (p < 0.07). Mean survival time for the full-dose subjects was 135.17 (SE 19.75) weeks as compared to 74.94 (SE 19.78) weeks (median of 43.1 weeks) for the half-dose subjects. We conclude that for patients who have suffered several recurrences, full-dose maintenance treatment is the more effective prophylactic strategy.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 8478502 [PubMed - indexed for MEDLINE]
- Scott
Posted by linkadge on July 21, 2005, at 20:58:06
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:20:46
I was *extremely* pissed off when I discovered it was biological.
Have you ever heard the statement "I never knew I was depressed untill I took prozac" I believe it is a line from Kramer's "Listening to Prozac",I think a lot of people could be convinced that they have had some sort of chemical imballence if you give them the right dose of the right "high octane mood brightener". You don't need to be depressed for these drugs to have an effect. Just like you don't need to have ADD for Ritalin to enhance your concentration. It comes with a price however.
Linkadge
Posted by linkadge on July 21, 2005, at 20:59:04
In reply to Re: Bad (but expected) news about ADs » Jazzed, posted by SLS on July 21, 2005, at 20:27:49
Reduced suicide rate could also be a result of the effect of being "treated".
Linkadge
Posted by SLS on July 21, 2005, at 21:02:42
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 20:50:21
> > "They don't become antidepressants until they show efficacy in human beings."
> Drug companies could show that breakfast sausage was an antidepressant if they wanted to.I disagree with this premise, despite understanding the cynicism that society has developed towards the pharmaceutical industry more recently.
- Scott
Posted by linkadge on July 21, 2005, at 21:08:35
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:45:55
"What do you think these neuroscientists and psychiatric investigators are doing, staring at the screen savers on their computers?"
Probably developing another SSRI.
"Which drugs carry this potential? "The neuroleptics, certain anticonvulsants, and any drug which we haven't proven to be non neurotoxic.
Is there any data to support the statements that antidepressants produce neurotoxicity?Yes, my walking problems, neck twisting, brain zaps, and of course the lack of information suggesting that the meds are non-neurotoxic.
Although I don't like Breggin that much. He does point to certain studies of neurotoxicity, that have not been adequately countered in my oppinion.
Linkadge
Posted by linkadge on July 21, 2005, at 21:14:47
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 20:54:42
Well full dose is always going to be better than half-dose. That doesn't proove that full dose is always sufficiant. Some of U.S. most prominant psychitrits have talked about the issues of poop-out. Poop-out is not uncommon.
Linkadge
Posted by thealmighty on July 21, 2005, at 21:31:52
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 21:14:47
linkage
isn't this board supposed to about biological treatments and support for those seeking it.
why not go to the alternative board and post.
everyone knows meds are far from perfect, but the number of those helped by them is 10 fold greater than those hurt by them. if there is no such thing as a chemical imbalance, then why do some drugs cause depression?
your posts could potentially prevent someone from seeking good treatment for a disease that kills 15 percent of it's sufferers.
Posted by SLS on July 21, 2005, at 21:37:13
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 21, 2005, at 20:52:05
> Unmedicated depression usually remits within a year. Rarely longer.
Where did you get this information from?
What about recurrent depression?
> Antidepressants are taken on average much longer than a year.
"much"?
How much longer?
It has been shown that the risk of relapse into depression rises if one does not continue with antidepressants for at least 6-9 months after remission is achieved, with some doctors suggesting 12-14 months for more severe cases. Upon the premature discontinuation of an antidepressant, for those who do relapse, this usually occurs withing the first 4 months.
There are many variables to be taken into consideration when deciding how long to continue treatment for.
> Antidepressnats worsen the course of the illness.
Unipolar disorder? In most cases, I would disagree with this. It is an interesting idea that should be looked at, but with chronic or recurrent depression, there is little better choice than to intervene biologically.
Bipolar disorder? Sometimes. This depends on several factors, not the least being the coadministration of a mood-stabilizer.
1: Br Med Bull. 2001;57:145-59. Related Articles, Links
Continuation and maintenance therapy in depression.Paykel ES.
Department of Psychiatry, University of Cambridge, UK.
This paper reviews longer term treatment for unipolar depression. Antidepressant continuation for prevention of early relapse has been routine for many years. Recent evidence supports a longer period of 9 months to 1 year after remission. Antidepressants are also effective in maintenance treatment for recurrent depression, and are indicated where there is clear risk of further episodes. Antidepressant withdrawal after continuation and maintenance should always be gradual, over a minimum of 3 months and longer after longer maintenance periods, to avoid withdrawal symptoms or rebound relapse. Trials of interpersonal therapy in the prevention of recurrence show some benefit, but effects are weaker than those of drug and additional benefit in combination is limited. There is better evidence for effects of cognitive therapy in preventing relapse and an emerging indication for its addition to antidepressants, particularly where residual symptoms are present.
Publication Types:
Meta-AnalysisPMID: 11719914 [PubMed - indexed for MEDLINE]
- Scott
Posted by SLS on July 21, 2005, at 21:44:52
In reply to Re: About my post..and Suicide..., posted by linkadge on July 21, 2005, at 21:08:35
> "What do you think these neuroscientists and psychiatric investigators are doing, staring at the screen savers on their computers?"
>
> Probably developing another SSRI.
>
>
> "Which drugs carry this potential? "
>
> The neuroleptics, certain anticonvulsants, and any drug which we haven't proven to be non neurotoxic.Let's stick to antidepressants.
Has levofloxacin been proven to be non neurotoxic? Should we discontinue using it for this reason?
> > Is there any data to support the statements that antidepressants produce neurotoxicity?
> Yes, my walking problems, neck twisting, brain zaps, and of course the lack of information suggesting that the meds are non-neurotoxic.I'm sorry that you suffer. I really am.
- Scott
Posted by Jakeman on July 21, 2005, at 21:55:50
In reply to Re: About my post..and Suicide... » Jakeman, posted by SLS on July 21, 2005, at 20:00:55
> What sorts of things are you interested in discovering with long-term studies? Just curious.
>
Efficacy. I remember when Prozac came out in the '80's with much fanfare..and shortly after it got much media attention including a picture of the capsule on the cover of Newsweek. There seemed to be an attitude that this was the magic pill. No one talked about whether or not its effect was lasting. As far as I know, Lilly has never admitted to the now widely reported poop-out phenomenon. And why should they? They didn't test the drug for long-term use.My guess if that much of the back-lash against the psychiatric profession these days is partly due to the fact that people discover that these wonder drugs don't last. I'm not against SSRI's or any other pharmacolgical approaches. I hope it's a start in the right direction that will bear more fruitful results in the future.
BTW, when is that segeline patch coming out? :-)
warm regards ~Jake
Posted by SLS on July 21, 2005, at 22:05:09
In reply to Re: About my post..and Suicide... » SLS, posted by Jakeman on July 21, 2005, at 21:55:50
Hi Jake.
> > What sorts of things are you interested in discovering with long-term studies? Just curious.
> Efficacy. I remember when Prozac came out in the '80's with much fanfare..and shortly after it got much media attention including a picture of the capsule on the cover of Newsweek. There seemed to be an attitude that this was the magic pill. No one talked about whether or not its effect was lasting. As far as I know, Lilly has never admitted to the now widely reported poop-out phenomenon. And why should they? They didn't test the drug for long-term use.
You are exactly right. It would be nice to know at what rate poop-out occurs. One fact has become evident, though. Effexor does not poop-out as often as the SSRIs and brings more people to remission. I am still of the opinion that the TCAs poop out less often than SSRIs, and might even produce a more robust treatment response.
> My guess if that much of the back-lash against the psychiatric profession these days is partly due to the fact that people discover that these wonder drugs don't last.
I think there are several aspects to these drugs that leave them as being less than wonder drugs.
> I'm not against SSRI's or any other pharmacolgical approaches. I hope it's a start in the right direction that will bear more fruitful results in the future.
That's where I'm coming from.
> BTW, when is that segeline patch coming out? :-)I am as clueless as you. Maybe early next year?
- Scott
Posted by linkadge on July 22, 2005, at 6:30:53
In reply to Re: About my post..and Suicide..., posted by SLS on July 21, 2005, at 22:05:09
I am not against effective treatments. But I would have like to known 5 years ago, that dispite medication, my depression would return full force, and that I might be left with seemingly permanant side effects of the drugs.
Then I might have chosen other routes, such as SJW which, although had weaker initial AD effects compared to pharmacudicals may have placed a kinder long term burden on the CNS.
I would have chosen other routes, and I think that knowing then what I know now, would have put me in a more mentally healthy position today. For many reasons, I would not recomend these drugs to others. Unfortunatley that was most evident to me when I discontinued.
Linkadge
Posted by SLS on July 22, 2005, at 8:42:12
In reply to Re: About my post..and Suicide..., posted by linkadge on July 22, 2005, at 6:30:53
> I am not against effective treatments. But I would have like to known 5 years ago, that dispite medication, my depression would return full force, and that I might be left with seemingly permanant side effects of the drugs.
I like to have known 18 years ago that the removal of the only drugs that ever brought me to remission would eventually lead to resistance to that same treatment. I would have demanded that my doctor not try substituting other treatments. Unfortunately, my doctor was too smart for his own (my own) good, and thought he had the brain all figured out. He crossed me over to the then brand new Prozac, which didn't work. He insisted, however, that the terrain of my brain had changed, and that I didn't need the potency of the original drug combination to respond to. He was a smart man, he just made dumb decisions. Alas, here I am.
> Then I might have chosen other routes, such as SJW which, although had weaker initial AD effects compared to pharmacudicals may have placed a kinder long term burden on the CNS.
"may" have placed? I don't think anyone knows enough about either SJW or the brain to be able to say such a thing. This idea has an appeal to some because they view "natural" is "gentler". There might be some data to support your claim, but I don't know of any, especially when concentrated extracts are used. Hemlock is natural. Skin exudations of South American tree frogs are natural. It has been found to be a nociceptive 200 time stronger than morphine. It can and kill pain and the patient both if not used properly. "Natural" is not always safer or less of a "burden" on the body.
> I would have chosen other routes, and I think that knowing then what I know now, would have put me in a more mentally healthy position today.
This is quite possible. It is difficult to know for sure. Were you being treated properly for the pathology you actually have or have you been misdiagnosed and mistreated? Did you ever need psychotropics in the first place? Correct me if I'm wrong, but you seem to have been doing pretty well without medication.
> For many reasons, I would not recommend these drugs to others. Unfortunatley that was most evident to me when I discontinued.
I think each of us has our own bias based upon our personal experience with antidepressant medication. Again, though, I have been around clinical settings for reasons other than my own treatment, and have seen many people experience almost magical changes in their affect and function, despite having been chronically depressed for years.
I think one of the major problems with the perceived effectiveness of these drugs is that many people for whom a psychogenic depression presents are being treated biologically at the exclusion of psychotherapy. A depressive thought-style that preceded the depression will not resolve once a medication is given. This leads to disappointment and perhaps even a condemnation of pharmacopsychiatry. From the other angle, there are some people who had no psychopathology prior to the onset of their biological depression. Depression influences negatively perceptions and thought-styles. If not treated promptly these biological pressures damage one's psychology. When the medication resolves the biology, there is a damaged psychology to attend to. If it is not, a relapse of psychobiological depression is more likely, and a disappointment in the effectiveness of pharmacotherapy with antidepressants ensues. Recovery from depression (and other mental illnesses) requires a multimodal approach. An illness of the brain affects the health of the mind. An illness of the mind influences the health of the brain. Both mind and body should be attended to for maximal therapeutic benefit.
- Scott
Posted by SLS on July 22, 2005, at 11:01:09
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 22, 2005, at 8:42:12
Antidepressants Induce Remission in Most Patients
NEW YORK (Reuters Health) Jul 08 - Results from 3 consecutive trials confirm the effectiveness of antidepressants in inducing remission for more than 90% of depressed patients, according to a report in the June Journal of Clinical Psychiatry.Dr. Frederic M. Quitkin and colleagues from Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York examined remission rates in 171 outpatients treated with second-generation antidepressants and in 420 outpatients treated with first-generation antidepressants.
More than half the patients treated with a second-generation antidepressant were in remission, the authors report, and 9 of 20 patients treated with a second drug. Five of 13 patients treated with a third drug were in remission.
Overall, two-thirds of the patients entered into the trials were in remission, the report indicates. Among the patients who either remitted or received 3 treatment drugs, 93% were in remission.
Among patients treated with a first-generation antidepressant, 205 of 342 were in remission after the first drug treatment. The researchers note that 37 of 67 (55%) of patients who received a second drug and 12 of 24 patients who received a third drug were in remission.
Overall, then, 65% of those treated with a first-generation antidepressant were in remission, the results indicate. Among the patients in this group who either remitted or received 3 treatment drugs, 96% were in remission.
"Our data suggest that correctly diagnosed depressed patients who receive 3 adequate trials of antidepressant medication have an approximately 90% chance of achieving a state of remission," the authors conclude.
"We could find no systematic analysis of why patients leave treatment," the investigators add. "A major challenge is motivating depressed patients to continue treatment."
J Clin Psychiatry 2005;66:670-676.
Posted by linkadge on July 22, 2005, at 15:40:32
In reply to Re: About my post..and Suicide..., posted by SLS on July 22, 2005, at 11:01:09
The data collected from 3 trials?
Linkadge
Posted by linkadge on July 22, 2005, at 16:28:42
In reply to Re: About my post..and Suicide..., posted by linkadge on July 22, 2005, at 15:40:32
I think a lot of people could do a lot better than they think without medications.
Some studies show that EPA is as effective as standard antidepressants for some. It is being investigated now as a potential prescription product. I certainly attain some help from it.
Just because I don't rely on pharmacudicals does not undermine the degree of my illness. I think people try to use this as a way to guage other people's illness. I have been hospitalized three times, seen 7 psychiatrists, 5 doctors, 3 counsellers, and was once "convinced" that I needed 5 medications to get by. I have been on 33 different psychiatric meds over the years, and I was offered ECT at one point.
But playing the "this is how sick I am" game is dumb, because it mentally locks you into a position. If you're convinced you're sick, then sick you'll stay.
I am doing better than I was. I am not happy by any strech of the imagination, but I am doing better.
Oh and I got the information that most depressions do not last longer than a year from the book "Drugs and the Brain" by Solomon H. Snyder.
-------------------------------------------
Some interesting Abstracts
-------------------------------------------
Spatial learning and physical activity contribute to the induction of fibroblast growth factor: neural substrates for increased cognition associated with exerciseWheel running alters serotonin (5-HT) transporter, 5-HT1A, 5-HT1B, and alpha 1b-adrenergic receptor mRNA in the rat raphe nuclei.
Biol Psychiatry. 2005 Mar 1;57(5):559-68.
BACKGROUND: Altered serotonergic (5-HT) neurotransmission is implicated in the antidepressant and anxiolytic properties of physical activity. In the current study, we investigated whether physical activity alters factors involved in the regulation of central 5-HT neural activity. METHODS: In situ hybridization was used to quantify levels of 5-HT transporter (5-HTT), 5-HT(1A), 5-HT(1B), and alpha(1b)-adrenergic receptor (alpha(1b) ADR) messenger ribonucleic acids (mRNAs) in the dorsal (DRN) and median raphe (MR) nuclei of male Fischer rats after either sedentary housing or 3 days, 3 weeks, or 6 weeks of wheel running. RESULTS: Wheel running produced a rapid and lasting reduction of 5-HT(1B) mRNA in the ventral DRN. Three weeks of wheel running decreased 5-HTT mRNA in the DRN and MR and increased alpha(1b) ADR mRNA in the DRN. After 6 weeks of wheel running, 5-HTT mRNA remained reduced, but alpha(1b) ADR mRNA returned to sedentary levels. Serotonin(1A) mRNA was increased in the MR and certain DRN subregions after 6 weeks only. CONCLUSIONS: Data suggest that the central 5-HT system is sensitive to wheel running in a time-dependent manner. The observed changes in mRNA regulation in a subset of raphe nuclei might contribute to the stress resistance produced by wheel running and the antidepressant and anxiolytic effects of physical activity. [Abstract]I like the line:
"Wheel running produced a rapid and lasting reduction of 5-HT(1B) mRNA in the ventral DRN"
Linkadge
Posted by SLS on July 22, 2005, at 16:33:11
In reply to Re: About my post..and Suicide..., posted by linkadge on July 22, 2005, at 15:40:32
> The data collected from 3 trials?
171 outpatients treated with second-generation
420 outpatients treated with first-generationPretty big n.
Dr. Quitkin was one of my doctors when I was being treated at Columbia Presbyterian in 1982-1983. He has had a long and consistent career directing the unit. He has seen or included in his investigations the cases of *thousands* of patients. I'm sure he was just putting into black-and-white an investigation to help substantiate what his 30+ years as a professional have taught him. I doubt he would risk his career at this juncture. I don't know for sure, though.
* Note that the majority of people were treated with first generation antidepressants, and not SSRIs.
- Scott
Posted by SLS on July 22, 2005, at 16:56:07
In reply to Re: About my post..and Suicide..., posted by linkadge on July 22, 2005, at 16:28:42
> I think a lot of people could do a lot better than they think without medications.
It's nice to speculate.
> Some studies show that EPA is as effective as standard antidepressants for some.At supra-nutritional dosages, it becomes an allotropic treatment.
> It is being investigated now as a potential prescription product. I certainly attain some help from it.
Yup. Allotropic.
> Just because I don't rely on pharmacudicals does not undermine the degree of my illness.
Do you feel I did that? If you do, please direct me to my post and quote the verbiage that I used.
> I think people try to use this as a way to guage other people's illness.
Probably.
> I have been hospitalized three times, seen 7 psychiatrists, 5 doctors, 3 counsellers, and was once "convinced" that I needed 5 medications to get by. I have been on 33 different psychiatric meds over the years, and I was offered ECT at one point.
Some people even determine that a person does not have the illness they have been diagnosed as having just because they don't respond to the drugs used for that indication.
> > But playing the "this is how sick I am" game is dumb, because it mentally locks you into a position.
I don't understand why you are saying this along this thread.
> If you're convinced you're sick, then sick you'll stay.
Hopefully, no one with a disease will ever be convinced of it so that their doctors can effectively treat them.
I'm sorry, Linkadge. No way does that make sense to me.
> I am doing better than I was. I am not happy by any strech of the imagination, but I am doing better.
As was mentioned before, pharmacotherapy does not bring happiness, it only attends to the biological component of MDD or BD that might be getting in the way of pursuing it. Happiness is something that you must work at, even in the absence of depression. Drugs are not "get-happy" pills. They are not "anti-problems" pills. They are merely biological "anti-depressants". :-)
> Oh and I got the information that most depressions do not last longer than a year from the book "Drugs and the Brain" by Solomon H. Snyder.
OK. Thanks. I'll see if I can pull something off the Web. He might be right.
- Scott
Posted by linkadge on July 22, 2005, at 17:53:07
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 22, 2005, at 16:56:07
At supra-nutritional dosages, it becomes an allotropic treatment.
Actually, thats they're not in supra nutritional doses. 1 gram of EPA was found more effective than more in this study.
http://biopsychiatry.com/eicosdep.htm
It is possable to consume this ammount from diet.
Linkadge
Posted by linkadge on July 22, 2005, at 17:55:11
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 22, 2005, at 16:56:07
"Some people even determine that a person does not have the illness they have been diagnosed as having just because they don't respond to the drugs used for that indication."
Oh, like yourself ?
Linkadge
Posted by SLS on July 22, 2005, at 19:23:37
In reply to Re: About my post..and Suicide..., posted by linkadge on July 22, 2005, at 17:55:11
> "Some people even determine that a person does not have the illness they have been diagnosed as having just because they don't respond to the drugs used for that indication."
>
> Oh, like yourself ?That's exactly who I had in mind when I wrote that.
- Scott
Posted by linkadge on July 22, 2005, at 19:55:39
In reply to Re: About my post..and Suicide..., posted by SLS on July 22, 2005, at 19:23:37
No, I wasn't really trying to take a cheepshot :)
Don't get me wrong, I am totally pro-recovery.
I have totally wondered about DHEA supplementation in bipolar depression. Both lithim and olanzapine lower DHEA, perhaps other mood stabalizers do too. It has shown a posative benefit for the negative symyptoms in schistophrenia.
My mother is basically in a fairly bad bipolar depression. She is just taking lithium and mellaril. But too much mellaril in my oppinion.
I'd like to see her on a lithium olanzapine combo.
Linkadge
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