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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 297. This is the beginning of the thread.
Posted by Phillipa on February 27, 2006, at 13:12:49
Was talking to a Medical Resident. He said the SSRI's and SNRI's are all hype. They may work for a few but not for the majority. Please some good experiences I'm fed up. Thanks Phillipa/ Jan
Posted by john berk on February 27, 2006, at 13:55:38
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
Hi Phillipa. when i first started prozac it took 5 month's to finally "kick in", i remember i went to my therapist, and just like a quote from Peter Kramers "listening to prozac" i proclaimed, "i feel better than well", she stifled a laugh, and i asked her why she seemed amused, and she apologized and said "well, as long as you have faith in your meds, they will work", i've been confused ever since.i really can't tell if i am better after 5 years on prozac or not, but i really am slightly tired of the med game, i'd love to hear some very positive feedback too, i have 2 friends who are completly med-resistant, why?, it baffles me....john
Posted by Emme on February 27, 2006, at 13:57:53
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
Friend #1: Desperate, severe depression. Stabilized on Paxil and after a while tapered off it and was okay.
Friend #2: Both she and her husband tolerate Paxil well and continue to benefit from it after being on it for several years.
Friend #3: Responded well to Paxil and without the awful weight gain he'd had on a tricyclic.
Relative: Last I heard, she did fine with Prozac.
Acquaintance: Got relief from panic attacks with zoloft.
So yeah, there are successes. I hope you find something that works for you.
emme
Posted by Racer on February 27, 2006, at 14:24:25
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
Actually, I had great luck with Paxil, for a couple of years, way back in the day. There are a lot of variables that come into it, but yes, in general, these meds do work for a significant number of people who take them.
If you'll forgive me for saying so, Phillipa, one thing that's getting in your way is your own anxiety about the medications. Like with Cymbalta -- the first time you took it, there was no problem, right? Later, though, when you had heard a lot of horror stories, you couldn't tolerate it at all -- how long did it last? Just a week, wasn't it? Yet, I'd bet that much or even most of that was psychological. You were EXPECTING problems, so you were hypervigilant, and if you look hard enough, you'll find something.
That isn't criticism, by the way. After the experiences I had before starting Cymbalta, I was so freaked out to take anything at all, that I was ready to stop after the first dose. As I recall, SLS got an email from me that day, saying I didn't think it would work out. And I know that chemist called me every single day for the first few weeks, to remind me that I wouldn't get any benefit from it unless I actually took it, and that most adverse effects go away after a few weeks. He was right, on both counts, and I stayed on it for over a year. And had few adverse effects on it, by the way.
The point is -- the psychological side of things counts, too, in terms of how well one responds to a drug. And it's possible to have great response to a drug, but refuse to use the benefits. (I've got a friend whose mood improves to within normal limits on SSRIs, but she still refuses to make any effort -- saying she's too sick to do anything. She can do all sorts of fun things, but nothing difficult or unpleasant. Can't afford to live, but still has a cleaning lady come in every week because she is "too sick to clean," that sort of thing. She'd tell you the SSRIs don't work well enough for her, would tell you she's "treatment resistant," but being around her you can see a distinct difference when she's taking them versus not.)
I guess what I'm trying to say is that the drugs do work, they work for a lot of people, and while they certainly don't work for everyone, they're still worth trying if one is depressed.
Posted by linkadge on February 27, 2006, at 15:09:45
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by Emme on February 27, 2006, at 13:57:53
I don't think they work at all. I think that what makes or breaks weather or not a drug works is the situation and support. Just because somebody is on a drug when they recover doesn't mean that the drug was what did it.
The only time that SSRI's worked for me was when I had support from family, friends, doctors, and therapists.
I've got just as many horror stories as anyone who has sucess stories.
Linkadge
Posted by linkadge on February 27, 2006, at 15:21:16
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by Racer on February 27, 2006, at 14:24:25
The thing that people don't realize is that people often recover on their own, (sorry for repeating myself.)
We all like to attribute our recovery to something that was within our control, cause that gives us a sence of control. But as some others may agree with me, that recovery can something just be the way the wind blows.
Consistant findings with regards to biochemical abnormalities in depressive disorders are rare.
I would not push anyone to take a medication if their gut told them something was wrong. Statistically, the drugs can make certain people more suicidal and so many doctors today are agreeing that "Don't Push" is a good stradegy.If you want actual scientific statistics, then we can look at clinical trials. While AD's work in clinical trials, a lot of the time they are on par with placebos.
Just my 3 cents.Linkadge
Posted by Emme on February 27, 2006, at 15:56:31
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by Emme on February 27, 2006, at 13:57:53
> Friend #1: Desperate, severe depression. Stabilized on Paxil and after a while tapered off it and was okay.
Friend #1: Same family and social circle as before Paxil. There were mprovements in his social life that kicked in after his depression improved.
> Friend #2: Both she and her husband tolerate Paxil well and continue to benefit from it after being on it for several years.
Friend #2: Given the same life circumstances, she is calmer and more balanced on meds. She's gone on and off enough to clearly know the difference.
> Friend #3: Responded well to Paxil and without the awful weight gain he'd had on a tricyclic.
Same friends, same family, same doctor, same job. Different drug.
> Relative: Last I heard, she did fine with Prozac.
Her husband and kids were always good. She said had a good life and was chronically depressed and anxious for no apparent reason. Enter Prozac.
At least for these folks, it's not coincidence.
Posted by Meri-Tuuli on February 27, 2006, at 16:28:21
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
Hey there, Philipa, well I have to say that I would have to agree with your doc and Link...I don't think they work for the vast majority of people. It makes me rather angry actually, because here in the UK where healthcare is free (well we pay alot of tax!), GPs will happily prescribe SSRIs because it is a hell of alot cheaper and easier to give us them rather than refer us for counselling, to a pdoc, etc etc. So its a cheap way out and not a very helpful one. And if one pill doesn't work, they will just try another one.
I'm sorry to say that they haven't done anything for me.
Posted by yxibow on February 27, 2006, at 17:00:19
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
> Was talking to a Medical Resident. He said the SSRI's and SNRI's are all hype. They may work for a few but not for the majority. Please some good experiences I'm fed up. Thanks Phillipa/ Jan
Prozac, Paxil, and definately Luvox all worked for me in different situations. I wouldn't trust the word of one Medical Resident who doesn't have a clinical practice, honestly, Jan. There have been bad things, sure, that have happened -- primarily because some places give GPs reign over prescribing psychiatric medications when psychopharmacologists/psychiatrists should be prescribing with some years of history behind them.
The comment about psychosomatic reading into side effects is not to be taken as an insult -- if one is not ready to take a drug, the placebo effect can work positively or negatively as much as 1/3 of the time.
Cymbalta still continues to keep me from being too suicidal or at all at times, so I would say that has a positive effect -- it doesnt do as much for my OCD repetitive thinking when my metabolism gets roaring, but one can't have it all.
The "hype" about kids killing themselves is, in, my opinion... hype. Sure, medicines that have not been adequately tested under 16/18 should not be given to those individuals -- but one also has to realize that a number of them would have been unfortunately predestined to take their lives or go on shooting sprees in those specific situations and cases that are over played in the media -- they were not too medicated, they were probably undermedicated or improperly medicated by psychiatrists with not enough skills. I took Prozac at 18 with no problems.
The biggest thing is that people don't stick to a particular SSRI long enough. As soon as upset stomach hits (which nearly all but the most recent ones) (5HT3), they drop the pill. This is callous, but they prefer to have a better sex life over depression (and I know, that can be depressing in itself, but medication is just not perfect -- it never ever will be, not at this stage of the 21st century), and they drop it because of that. So a drug that is meant to slowly develop signs of improvement over 2, 4, 6-12 weeks, is cast by the wayside as "useless" and nobody gets the benefits.
And what do we have by now, 6.. 7 if you count Anafranil, I forget... SSRIs, plus Cymbalta, which in my opinion is infinately better than Effexor in terms of side effects, but some people can stand caffeine like drugs and for them Effexor would be a godsend. So, no one SSRI can be the "right one" for someone. They all have ... the sites escape me at the moment, but if you look at the Ki/binding values for different 5HT receptors, different profiles.. and Zoloft is different because it touches Dopamine slightly, and Anafranil of course is a TCA.
And yes, they poop out sometimes. All drugs have that potential. But you can play the merrygoround and try a different SSRI and maybe even go back to the same one later, after a "holiday."
Don't give up. And no, I don't speak as the be all to end all of SSRIs. There are good and bad... but they've helped by now (prozac 1988 I think).. 18 patient years * # prescribed people, to some degree or another, to get on with their lives and to live them more productively. And in most cases with few outward signs that they are ever on a medication. There are millions of silent people in your workplace who are probably on one or another.
my 2c
Jay
Posted by tizza on February 27, 2006, at 17:03:47
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by yxibow on February 27, 2006, at 17:00:19
None of them helped me long term and my body can't tolerate them, I always got so many nasty side effects. At the end of the day they all ended up making me worse. Paul
Posted by linkadge on February 27, 2006, at 17:42:53
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by Emme on February 27, 2006, at 15:56:31
Well, just to play the devils advokate:
>Friend #1: Same family and social circle as >before Paxil. There were mprovements in his >social life that kicked in after his depression >improved.Depression resolved on its own, or due to the system of reassurance provided by a caring physician plus placebo effect.
>Friend #2: Given the same life circumstances, >she is calmer and more balanced on meds. She's >gone on and off enough to clearly know the >difference.She's gone on and off enought to know she's addicted.
>Same friends, same family, same doctor, same >job. Different drug.Different drug = new placebo with a less burdonsom side effect profile.
>Her husband and kids were always good. She said >had a good life and was chronically depressed >and anxious for no apparent reason. Enter Prozac.Again. Enters a system of support.
>At least for these folks, it's not coincidence.Theres no way to proove either way. The placebo effect is very strong. So strong, that study designers look for good ways to downplay their effects. I watched a show. Its funny to see how people will swear by their placebo's!
Linkadge
Posted by linkadge on February 27, 2006, at 17:50:52
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by yxibow on February 27, 2006, at 17:00:19
I don't think that the suicidiality induced by these meds has been downplayed at all. How can you downplay statistical information that suggests that the meds to infact increase suicidiality in certain populations. Effexor made me more suicidal. What good can come from trying to downplay that possability ?
I knew for a while that certain meds were making me suicidal. Nobody believed me. I would have been safer if I had that information available to me at the time.
Linkadge
Posted by linkadge on February 27, 2006, at 17:55:53
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by tizza on February 27, 2006, at 17:03:47
At the end of my SSRI run, not only had the drugs all but pooped out, I had one of the toughest decisions in my life to make. Would I stop the drug and go through all the raw emotions I tried to sweep under the carpet, or would I go onto something stronger?
Linkadge
Posted by fenix on February 27, 2006, at 18:03:30
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
They work well for the drug companies.
Posted by Sobriquet Style on February 27, 2006, at 18:34:45
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
>They may work for a few but not for the majority.
Probably quite true, question is, are you one of the few?
~
Posted by Comet on February 27, 2006, at 18:38:56
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
They are clearly not all "hype" - they work for plenty of people - not everyone probably not even most - but for many millions they work well. My sense is the depression and anxiety are incredibly complex problems that factor in a mix of biology and environment and personal history that make it nearly impossible to predict who these drugs will work for. I'm personally on an SSRI and definitely am having a mixed reaction. But I've known several people who responded incredibly well(including an ex-girlfriend who changed from being having a short temper, high strung and nearly impossible to deal with to perfectly sane and stable within a few weeks after taking Paxil or Celexa - and I, for one, was very grateful at the time for the existence of SSRIs)and others who dropped them after a relatively short time because they didn't like the side effects.
So yeah, it sucks that they aren't a magic bullet - but maybe that's too much to expect right now. But to say it's just hype is to say that the drug companies are selling snake oil and I just don't believe this is true.
Posted by Phillipa on February 27, 2006, at 18:50:20
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 27, 2006, at 15:21:16
Link that's exactly what the Resident said. That a placebo works as well as the meds. And this is not about me as I've been taking my luvox as prescribed without side effects and it doesn't do a thing positive or negative. Seriously this is not about me it was told to me be a Medical Resident just when I was starting to believe in the meds. He feels theraphy is much more beneficial. Fondly, Phillipa ps he said it's all about the money the pharmatical companies are making
Posted by yxibow on February 27, 2006, at 19:08:31
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by Phillipa on February 27, 2006, at 18:50:20
> Link that's exactly what the Resident said. That a placebo works as well as the meds. And this is not about me as I've been taking my luvox as prescribed without side effects and it doesn't do a thing positive or negative. Seriously this is not about me it was told to me be a Medical Resident just when I was starting to believe in the meds. He feels theraphy is much more beneficial. Fondly, Phillipa ps he said it's all about the money the pharmatical companies are making
A placebo will work as well as medication 1/3 of the time. This is very well known. SSRIs have a wide variety of reasons for taking them, so they have a wide variety of successors and failures. Panic Disorder, OCD, Depression, etc.
I'm assuring you, Jan, that you can believe what you want from a medical resident, but was this an M1, M2 ? There are 4 years of medical residency in general, sometimes less, sometimes more. Not to mention specialization of career goals towards psychiatry or towards 100s of other disciplines. Then you begin your practice and you build trust with other psychiatrists. You attend Grand Rounds. You take CEs. Trusting the words of a Medical Resident, though they may be a newly minted M.D., may have some words of wisdom, but not the wisdom of someone who has been through 15 years of practice. Trust me, because there are even differences in those who get beyond their apprenticeship.
And I'm no drug company shill, you know that Jan. SSRIs may not work for everyone -- there is treatment resistant depression. SSRIs work best for people with dysthimia, and modest to medium severe depression. For those with extreme depression, a tough choice to take an MAOI may be necessary. Its better than not being here and enjoying life -- life is for living. And there are other things besides MAOIs -- going back to a TCA, Remeron and a strict low calorie diet, Effexor, Celexa -- and maybe EMSAM if it comes out. There are drugs on the horizon too... some of them are only European oriented, so you may have to have a savvy doctor import them. There's always something. And then there's just plain old therapy. Which works, and works in conjunction with SSRIs as well, as I know with the horrible OCD I conquered before, with CBT.
I think while I respect the opinions of everyone who has contributed to this thread, the negativity towards an entire class of drugs does a disservice. But everyone is entitled to their own opinion, and I wish them well.
Posted by TylerJ on February 27, 2006, at 19:32:07
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
> Was talking to a Medical Resident. He said the SSRI's and SNRI's are all hype. They may work for a few but not for the majority. Please some good experiences I'm fed up. Thanks Phillipa/ Jan
Jan, I don't believe that at all! I've been on them all, and some did work for me. Paxil worked very well for 2 yrs., Zoloft for a year, it was so so, Remeron really helped me a lot for about 4 years. None of them has ever made me feel as good as I do on Parnate, however they did lift me out of my depression-especially Remeron (even though i gained 35 lbs.) Effexor has worked great for my Wife with post partum dep. Oh yea, Prozac worked well for me for awhile in the late 80's.
Hey, are you doing okay? What are you taking and for what if you don't mind. Take care.
Ty
Posted by Phillipa on February 27, 2006, at 19:46:58
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 27, 2006, at 19:32:07
Tyler I don't mind at all. Boy did I open a can of worms. This thread was meant to give everyone a chance to voice their opinion positive or negative. Acturally I am still looking for positive one. Right now I'm on 100mg of luvox. For depression yes I know it wasn't officially approved in the States for depression but only for OCD.But it is the oldest SSRI. And I am not afraid of it at all. I also am on valium had dropped to l0mg a day at night for sleep. When I told the pdoc he said to up it again. Keep posting people this is so educational and everyone is entitiled to their own opinion. So please post your experiences. And no a Resident is not an expert. The subject just became kind of a debate yeasteday so I decided to post the Thread. Love Jan/Phillipa
Posted by TylerJ on February 27, 2006, at 19:55:45
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » TylerJ, posted by Phillipa on February 27, 2006, at 19:46:58
> Tyler I don't mind at all. Boy did I open a can of worms. This thread was meant to give everyone a chance to voice their opinion positive or negative. Acturally I am still looking for positive one. Right now I'm on 100mg of luvox. For depression yes I know it wasn't officially approved in the States for depression but only for OCD.But it is the oldest SSRI. And I am not afraid of it at all. I also am on valium had dropped to l0mg a day at night for sleep. When I told the pdoc he said to up it again. Keep posting people this is so educational and everyone is entitiled to their own opinion. So please post your experiences. And no a Resident is not an expert. The subject just became kind of a debate yeasteday so I decided to post the Thread. Love Jan/Phillipa
Thanks Jan. So are you feeling good on Luvox? I hope that you are. SSRI's and SNRI's definitely work very well for lots and lots of people. One thing I forgot to mention is that I always needed High doses on these meds-but I didn't care and niether did my pdoc as long as they worked! You take care sweetie and i hope you are feeling great!! We all deserve that don't you think?
Love, Ty
Posted by Phillipa on February 27, 2006, at 20:01:44
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 27, 2006, at 19:55:45
Tyler so far just tired. No I don't feel good yet. Hoping to though. Love Jan
Posted by Glydin on February 27, 2006, at 20:22:38
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » TylerJ, posted by Phillipa on February 27, 2006, at 20:01:44
Yes, I believe a SSRI's works for me. I don't think it's a fluke. I do believe it is a chemical intervention that has made a new world for me.
Posted by Jakeman on February 27, 2006, at 20:39:33
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
> Was talking to a Medical Resident. He said the SSRI's and SNRI's are all hype. They may work for a few but not for the majority. Please some good experiences I'm fed up. Thanks Phillipa/ Jan
They have worked for me short-term. If anyone knows of long-term benefits (more than 6 months) please post the studies. I would be very interested.
warm regards ~Jake
Posted by linkadge on February 27, 2006, at 21:35:21
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by Phillipa on February 27, 2006, at 18:50:20
I noticed that after a while my brain adapted to what they were trying to do.
Either they pooped out, or my brain outsmarted them. My brain fought back against them. It found new ways to keep me depressed.
Another issue is that you don't know the whole story about people who are taking them. You can say, "oh look at so and so, s/he's doing great on such and such". But, you don't know what happens behind closed doors. When I was on them, I may have been rapid cycling. Sure, to the untrained eye, I appeared "better", but they were not positivly affecting my mental health, they were making things much worse, in many ways.
Linkadge
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