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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 34 to 58 of 297. Go back in thread:
Posted by FredPotter on February 28, 2006, at 13:50:15
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by vainamoinen on February 28, 2006, at 12:41:19
Hegelian logic was cited by a previous poster to explain the prescribing of benzos. In their case the stages were (in the States):
(i) THE answer – prescribe for everyone with the mildest worry right through to patients with panic disorder (ironically Xanax seems to work best on extreme symptoms);
(ii) Demonize and try to ban them;
(iii)Use benzos carefully for some clearly defined disordersThe position with SSRIs and SNRIs is at an earlier stage of this process. (i) was and is taking place with a hint that (ii) is beginning to happen. Some drug trials have used a positive placebo (one with side-effects so the patient suspects if s/he's getting the real drug). I gather the SSRIs at least have an even poorer success rate under these conditions.
On the other hand, some further things need to be said. If there is such an illness as clinical depression (and some dispute that there is), a patient's prognosis might be muddied by people presenting with common-or-garden misery or grief, for which SSRIs were not designed and probably not very effective.
A final point is: most depressed people have "atypical" depression, for which SSRIs are not a good choice, MAOIs possibly being a better solution.
Despite the positive placebo remark above, it's possible there would be a more robust AD response tom SSRIs and SNRIs if they were prescribed for the right patients, hence setting stage (iii) in motion.
Any comments?
Fred
Posted by linkadge on February 28, 2006, at 14:47:32
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by FredPotter on February 28, 2006, at 13:50:15
I agree with you. The big thing with the SSRI's was that they were/are thought to be safe, or at least safer than the TCA's. Because of their presumed safety they've been dispersed like dandilion spores.
Many authors site the fact that TCA's were as effective if not more effective than the SSRI's. SSRI's were also popular because they fit hand in glove with the theory that depression was a disease related to low serotonin.
Theres no doubt in my mind that SSRI's did some weird and wonderfull things. But to call that an "antidepressant effect", I don't know.
Linkadge
Posted by TylerJ on February 28, 2006, at 15:04:58
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by linkadge on February 28, 2006, at 8:53:20
> To say that they don't work at all may be closed minded on my part. But I wouldn't call somebody an idiot just based on the fact that they dissagree with the efficacy suggested by the drug companies.
>
> A drug would need to keep me away from major depression for at least 6 months before I'd say it had any effect.
>
> Some of the initial effects of a drug may be due to its actions on sleep. We know, for instance that interupting REM sleep in depressed patients has a very acute antidepressant effect. Most antidepressants initally significantly reduce REM sleep. Some of the "most effective" enatidepressants reduce REM sleep the most, ie the MAOI's.
>
> But the body fights back hard. After a few months the body regains its REM sleep. You see drugs poop out a lot around the same time REM rebound occurs.
>
> So I guess what I am saying is that, wait 6 months, and if you are still as enthused about a particular drug, then maybe it is doing something.
>
> And who knows what it is your REM sleep is trying to do. Sure REM sleep is depressing, but maybe it is working on a much more solid an concrete solutions to your problems.
>
>
> Linkadge
>
>
>
>
Your entitled to your opinion just as I am. What I am trying to do is encourage Phillipa-she's vulnerable right now, and she certainly doesn't need someone to tell her the med she is on doesn't work. That's that persons opinion, but being a resident i personally think he shouldn't be telling someone who is suffering terribly as she is that the med she's on doesn't work...she doesnt need to hear that from anyone. On top of that Luvox DOES help SOME people-it helped me for about a year. You're right i shouldn't have called the guy an idiot...but again, when i come here my goal is to try to encourage and give people hope, we all need that, living w/ such a terrible ruthless desease!TylerJ
P.S. I am currently experiencing REM sleep and I still feel great. And you know what, if ANY drug helps me for even one freakin' week it's worth it to me cause I have been living in a pit for too damn long. (My opinion and how I feel...you know what they say about opinions :)
Posted by TylerJ on February 28, 2006, at 15:20:56
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 14:47:32
> I agree with you. The big thing with the SSRI's was that they were/are thought to be safe, or at least safer than the TCA's. Because of their presumed safety they've been dispersed like dandilion spores.
>
> Many authors site the fact that TCA's were as effective if not more effective than the SSRI's. SSRI's were also popular because they fit hand in glove with the theory that depression was a disease related to low serotonin.
>
> Theres no doubt in my mind that SSRI's did some weird and wonderfull things. But to call that an "antidepressant effect", I don't know.
>
>
> Linkadge
>
>
> TCA's are considered by most pdocs to be superior to ssri's and snri's your absolutely right. But as you know they are "dirty drugs" lot's of side-effects and of course can be deadly when taking an over-dose. I think this is the main reason (the over dose issue) that most docs shy away from them-plus ssri's and snri's are much cleaner drugs..i guess. I also agree that too many docs hand them out like candy. Tofranil saved my life 25 yrs ago-my first severe episode of depression, i was really bad off, only got out of bed for nearly 3 mos. to use the bathroom and shower and was hospitalized for a week for extensive tests-Diagnosis: Major depression w/ panic attacks, GAD, and OCD- disturbing thoughts no rituals. I also took ativan which helped me greatly. I was on Tof. for 5 yrs. and it worked pretty darn good. Nothing however has made me feel as well as Parnate. Take care.Tyler
>
Posted by linkadge on February 28, 2006, at 16:25:35
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » linkadge, posted by TylerJ on February 28, 2006, at 15:04:58
Thats where I disagree. I think that if a class of drugs has a particularly low sucess rate then the patient should know about it.
I would not tell somebody that the drug they're on is miraculous if I didn't think it were true. That can set somebody up for disaster.
P.S. How do you know you are experiencing REM sleep ?Linkadge
Posted by linkadge on February 28, 2006, at 16:35:29
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by TylerJ on February 28, 2006, at 15:20:56
I wish you the best success in your recovery.
I just see a pattern on this board and that is a tendancy to give the drugs merit that is not due to them, which can sometimes have negative consequences down the road.
I think it is wrong for a doctor to tell you that this drug will cure you, if it may do nothing at all. Because if doctors were honest about the drugs they dealt, then people would be forced to start to develop more diverse coping stradegies instead of putting their hopes in one single cure.So if somebody doesn't think a drug is doing anything, I'd say trust your intuition, ditch the drug, and try something else.
Linkadge
Posted by linkadge on February 28, 2006, at 16:38:48
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:35:29
When I took Remeron it made me very angry. I know now that is a possable side effect. At the time, my doctor told me that could not be true so I took the drug much longer than needed, and I lost a lot of friends because of my temper.
So, I think it is necessary to tell people the bare truth about a drug nomatter if you think that lying is what is best for them, becuse the truth is the only thing that can help long term.
Linkadge
Posted by Glydin on February 28, 2006, at 16:44:32
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:35:29
> I just see a pattern on this board and that is a tendancy to give the drugs merit that is not due to them, which can sometimes have negative consequences down the road.Really?
I tend to see the opposite.
Posted by TylerJ on February 28, 2006, at 17:18:09
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by linkadge on February 28, 2006, at 16:25:35
> Thats where I disagree. I think that if a class of drugs has a particularly low sucess rate then the patient should know about it.
>
> I would not tell somebody that the drug they're on is miraculous if I didn't think it were true. That can set somebody up for disaster.
>
>
> P.S. How do you know you are experiencing REM sleep ?
>
> Linkadge
>
> Well, It does work very well for some people, and it's very effective against OCD as well. And it did help me for a year so I believe in it from my own personal experience. It's also effective against panic disorder, and depression. Luvox
is in fact, is pretty much the same as
other ssri's Prozac, Zoloft,and Paxil-all excellent ssri's. For a partial responder adding Lithium or thyroid may help. Takes 4-6 wks for a a full response.As far as the REM sleep goes-my wife watches me when i sleep and can see my eyes moving back and forth very rapidly-just kidding:) Seriously, it is during REM sleep that dreaming occurs, and I am definitely dreaming. Adults spend about 25% of the night in REM phase. I have also had some nightmares and and they always occur during REM phase. I know you'll probably disagree, but I know I'm experiencing REM-and have done some study on sleep..and well i know what i believe to be true.
Tyler
Posted by TylerJ on February 28, 2006, at 17:26:56
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:35:29
> I wish you the best success in your recovery.
>
> I just see a pattern on this board and that is a tendancy to give the drugs merit that is not due to them, which can sometimes have negative consequences down the road.
>
>
> I think it is wrong for a doctor to tell you that this drug will cure you, if it may do nothing at all. Because if doctors were honest about the drugs they dealt, then people would be forced to start to develop more diverse coping stradegies instead of putting their hopes in one single cure.
>
> So if somebody doesn't think a drug is doing anything, I'd say trust your intuition, ditch the drug, and try something else.
>
> Linkadge
>
>
> Definitely, after a good trial usually 6 wks. I'm with you, stop wasting time w/ a drug that's not going to work for you, and try something else.Tyler
Posted by TylerJ on February 28, 2006, at 17:35:42
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:38:48
> When I took Remeron it made me very angry. I know now that is a possable side effect. At the time, my doctor told me that could not be true so I took the drug much longer than needed, and I lost a lot of friends because of my temper.
>
> So, I think it is necessary to tell people the bare truth about a drug nomatter if you think that lying is what is best for them, becuse the truth is the only thing that can help long term.
>
> Linkadge
>Yea, but just because a drug doesn't work well for YOU doesn't mean it won't work very well for someone else. i.e., Remeron was the best AD I had ever taken besides Parnate. It was very effective for 5 years. But just because it worked for me does not mean it will work for everyone...and just because it didn't work for you, etc, etc.
Tyler
Posted by tizza on February 28, 2006, at 18:45:53
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Jakeman, posted by linkadge on February 27, 2006, at 21:45:30
> Thats another issue. I could get max maybe 4 months of "effect" on an SSRI. Then nothing. Then withdawl, which I define as an expanse of time during which you feel equally as much worse from baseline as you did better on the drug.
>
> Hey, but at least I'm not bitter... :)
>
>
> LinkadgeHey link maybe you and I should get together and go bowling. That is exactly how I reacted to SSRI and effexor but I must concede that Luvox helped me the best and the longest, maybe around 10 to 12 months. None of the others helped any longer than 4 months at the most. Paul
Posted by jflange on February 28, 2006, at 21:00:08
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Jakeman on February 27, 2006, at 20:39:33
Three years on Zoloft and three years without the dreaded panic disorder. I think that's a success.
It's not a magic bullet, though. Like many, I have to do combo therapy with other meds.
It's still an imperfect science, alas!
jflange
Posted by cecilia on February 28, 2006, at 21:14:29
In reply to Yes, posted by jflange on February 28, 2006, at 21:00:08
They obviously work for some people, though none has ever worked for me. There's definitely a huge placebo effect, though it probably doesn't last beyond the 6 weeks of the trial for most people. (Of course in real life the placebo effect is even stronger because the person knows they're getting the real thing.) I definitely think only the person taking them , not a doctor or a friend can judge whether they're working. Plenty of people are miserable on the inside while appearing functional on the outside. Cecilia
Posted by FredPotter on February 28, 2006, at 21:26:31
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:38:48
When I first took Prozac years ago I complained to my Dr that I couldn't achieve orgasm. He said, "Sexual side-effects? That's a new one!"
Has anyone had this experience when they tell a Dr or psych what AD they're on? They give an avuncular chuckle and say, "You'll do just fine on Dothiepin" - or whatever the drug is. A psych on the opposite side of the world also said it to me regarding Nortryptilene. Perhaps it's only tricyclics which elicit this response
Posted by FredPotter on February 28, 2006, at 21:31:59
In reply to Re: Yes, posted by cecilia on February 28, 2006, at 21:14:29
> They obviously work for some people, though none has ever worked for me. There's definitely a huge placebo effect, though it probably doesn't last beyond the 6 weeks of the trial for most people. (Of course in real life the placebo effect is even stronger because the person knows they're getting the real thing.) I definitely think only the person taking them , not a doctor or a friend can judge whether they're working. Plenty of people are miserable on the inside while appearing functional on the outside. Cecilia
Thanks Cecilia this is a very good post. Good point about the placebo effect in real life. Also it is fairly well established that placebo effects fade with time. Is this what poop-out is?
Posted by Phillipa on February 28, 2006, at 21:43:37
In reply to Re: Yes, posted by cecilia on February 28, 2006, at 21:14:29
Cecelia how true. Thanks Phillipa
Posted by Phillipa on February 28, 2006, at 21:45:09
In reply to Re: Yes, posted by FredPotter on February 28, 2006, at 21:31:59
Fred now that's a really good question. Anyone to comment on that? Thanks Phillipa
Posted by Chairman_MAO on February 28, 2006, at 21:49:06
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
The only FDA-approved antidepressants that deserve that designation are the irreversible MAOIs.
There are other drugs that do this as well, but most people consider them "drugs of abuse".
In Goodman & Gilman's "Pharmacological Basis of Therapeutics", they state outright that the response rate of most antidepressants differs from placebo by the barest of margins. What this doctor said to you is reality.
Posted by Comet on February 28, 2006, at 21:52:07
In reply to Re: Yes, posted by cecilia on February 28, 2006, at 21:14:29
"I definitely think only the person taking them , not a doctor or a friend can judge whether they're working. Plenty of people are miserable on the inside while appearing functional on the outside. Cecilia"
I respectfully disagree with this. It is often the close people who know a person intimately who first notice improvement, whether it is from therapy or drugs whatever has happened to cause the improvement. I noticed before my ex how much better she was able to cope with the world and how much more stable she had become. When I remarked on it, she was surprised herself, but had to agree.
Posted by Phillipa on February 28, 2006, at 21:57:58
In reply to Re: Yes, posted by Comet on February 28, 2006, at 21:52:07
boy this is getting interesting. Love Phillipa
Posted by stargazer on February 28, 2006, at 22:44:32
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
Most of the SSRI's I have taken made me apathetic and emotionally dull, but in some cases that was preferable to feeling too much, as depression can do.
Looking back over the years of treatment with many AD's, all classifications, few with the exception of the MAO's had any clear and sustained effects for me.
Right now, I'm back off of all of the latest combination I was on: Wellbutrin 150, Adderall 20, Celexa 20 and Lamictal 100. In preparation of trying Marplan again, I had to come off everything, except Lamictal. I stopped all of the meds, including Lamictal, since it didn't seem to be doing anything in combination with the others. I did have some withdrawl symptoms, i.e. feeling foggy, unfocused, irritable, so I started taking Lamictal 100 mg alone. It seems to be doing something positive, unclear of the benefit, yet willing to wait before trying Marplan again.
Back in a holding pattern...where so many of us live our lives...waiting for the right one.
Posted by yxibow on March 1, 2006, at 1:44:03
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by Chairman_MAO on February 28, 2006, at 21:49:06
> The only FDA-approved antidepressants that deserve that designation are the irreversible MAOIs.
>
> There are other drugs that do this as well, but most people consider them "drugs of abuse".
>
> In Goodman & Gilman's "Pharmacological Basis of Therapeutics", they state outright that the response rate of most antidepressants differs from placebo by the barest of margins. What this doctor said to you is reality.
>
Just because I am assuming you get benefit from MAOIs I gather -- the last resort of antidepressants, which have dangerous issues with diet, does not mean that the millions of people by now who have taken SSRIs have not gotten at least some relief from them.By drugs of abuse, It would assume you're referring to the 19th century idea of using opiates to cure depression, which would verge on the edge of a practitioner losing their DEA license (yes, I know about the Oxycodone experiment on this board and I wish the individual well).
Antidepressants are tested in Phase trials that compare them to other antidepressants and p values . If their p value doesn't come within a statistical range, the Phase trials are usually halted.
I dont mean to insult you, but the statement seems to come out of left field. Not every antidepressant is right for every person. But I know of many people who have been helped by SSRIs.
We can all go back and forth bantering on this issue, but it does a disservice I think to those who are currently being helped by SSRIs on this board. I'm sure this won't be the last posting.
And I do agree with one of the earlier posts -- some people benefit greatly with minor augmentation of SSRIs with mild atypical antipsychotics.
Tidings and no bad feelings meant
Jay
Posted by nicky847 on March 1, 2006, at 10:14:44
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Chairman_MAO, posted by yxibow on March 1, 2006, at 1:44:03
From my experience...they help..but they're not a magic pill...for the first 2 months they probably make you feel worse than you did before...but if you stick it out you do begin to feel much better..
SSRIs work best as part of a total wellness program in my opinion...that means not only taking the med..but changing the way you think and above all else taking care of your body as best you can...i am consistently surprised how neglect of the body (thru too much stress, not enough rest) leads to depression, while caring for the body (resting, good diet, exercise, simplifying your life) leads to recovery
Posted by Chairman_MAO on March 1, 2006, at 10:32:38
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Chairman_MAO, posted by yxibow on March 1, 2006, at 1:44:03
Why not do a search on medline for opioids in depression, especially buprenorphine? There are plenty of studies documenting the efficacy of psychostimulants for depression, especially in the most debilitating cases (post-stroke, HIV, etc).
Why would it be malpractice to treat depression with an opioid? They are not teratologic in any way. Can you say that about all of these new drugs? I, for one, would rather be on morphine+d-amphetamine than Prozac+Zyprexa! There are many others here who would agree with me that SSRI withdrawal can be a more protracted misery than heroin withdrawal.
My statements only sound like they're coming out of left field if one is way too far to the [religious] right. Pharamcological Calvinism has no place in an enlightened society. What on earth does a doctor's DEA license have to do with which drug is the best therapy for a condition?
If you think that many--if not most--studies documenting SSRI efficacy (especially for anxiety disorders) are more sophistry than sophisticated, you need to read a little more. How can one do a study on an anxiolytic that takes 6+ weeks to work when most anxiety dissipates on its own within 6 weeks? SSRIs _INCREASE_ anxiety while attenuating the patient's concern about the anxiety.
Again, I can cite pages and pages of studies concerning the use of opioids, etc. in various mental illnesses. Did you know you can treat schizophrenia and acute psychosis with extremely high doses of clonazepam and the cholinergic galantamine...with virtually no untoward side effects (including sedation/cognitive impairment)?
Most opioids (meperidine and some others excluded) are antimanic, antipanic, antipsychotic, and antidepressant with no physical toxicity.The next time you're talking to the ghost of your dead best friend as it is threatening to possess you and use your body to kill your family unless you kill yourself, and you have a choice between relief from morphine or haloperidol (with the morphine working better), make sure to tell the physician to force the haloperidol on you. There's a bottle of benzotropine with your name on it, don't worry!
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