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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by jerrympls on March 21, 2006, at 23:03:33
I REALLY do not like the growing trend of pdocs using antispychotics as firt-line treatments for depression and anxiety. It almost makes me a bit angry because it shows the blatant hypocrisy in treatment theories for depression. Doctors cling to the serotonin imbalance theory of depression, then put you on a med that hits multiple Dopamine receptors along with NE and serotonin receptors PLUS histamine receptors...yada yada yada. PLUS these antipsychotics have such strong side effects ranging from extreme weight gain to DIABETES!
Why do you all think more and more psychiatrists are turning to antipsychotics as firt-line treatments? And what do youthink of it?
Jerry
Posted by med_empowered on March 21, 2006, at 23:23:44
In reply to What's the deal with antipsychotics for depression, posted by jerrympls on March 21, 2006, at 23:03:33
If you look back to the 50s+60s, when the first antipsychotics rolled out, you see a kind of similar pattern. There was lots of money to be made, and the antipsychotics were psychiatry's true "wonder drugs"--they could tame the mad and calm the anxious. Plus, they were new and overpriced--just like todays antipsychotics. So, there was a lot of misuse of the APs--for aggressive kids, old people, anxious people, depressed people, what have you...and combo products, like Thora-Dex (thorazine and dexedrine) and Triavil (Elavil plus Trilafon).
It seems that the mind-numbing properties of the atypicals appeals to psychiatrists at some levels; in some papers they are referred to as "broad spectrum agents," which I think is pretty ridiculous. It seems that some people **do** respond well to AP+AD combos, at least in the short term; whats most disturbing is the amazing overuse of these drugs for...everything (they're even trying it now on ADHD which is strange..back in the days of Ritalin, ADHD was caused by too little dopamine; now I guess the idea is that its caused by too much?)
My guess is that this period of loving the atypicals will lead to some serious trouble down the road. These drugs still cause TD. And NMS. And they tend to cause diabetes, weight gain, and sometimes seizures. Plus...they're overpriced and not all that different from the old drugs. ALready, even the mainstream press has caught on--the NYT and others have done pieces on the over-hyping of the atypicals, and with all the $$$ insurers and state and federal agencies have pumped into these "wonder drugs," there's going to be some serious problems when these drugs don't pan out.
This was long and rambling but...I guess I think the whole AP thing is just a sign of arrogance, hypocrisy, and greed, which pretty much characterizes Big Pharma and many of the doctors who so gladly serve it at the expense of their patients.
Posted by jerrympls on March 21, 2006, at 23:35:06
In reply to APs for depression, posted by med_empowered on March 21, 2006, at 23:23:44
> This was long and rambling but...I guess I think the whole AP thing is just a sign of arrogance, hypocrisy, and greed, which pretty much characterizes Big Pharma and many of the doctors who so gladly serve it at the expense of their patients.Yep--I think you summed it all up right there.
Posted by Caedmon on March 21, 2006, at 23:48:34
In reply to What's the deal with antipsychotics for depression, posted by jerrympls on March 21, 2006, at 23:03:33
I guess I am less 'incensed', perhaps because I take low-dose Risperdal [risperidone] with minimal side effects and good success treating my depression and anxiety?
I don't know of many psychiatrists using APs as *firstline* Tx for neuroses. That sounds a bit much to me. I do think they can be helpful in some patients. I think it really just depends. I've always felt that there are no bad drugs, there is simply bad prescribing.
Posted by psychopharmacon on March 22, 2006, at 1:39:20
In reply to What's the deal with antipsychotics for depression, posted by jerrympls on March 21, 2006, at 23:03:33
I think antipsychotics could, to some extent, be useful to treat depression (at least if you don't mind weight gain.)
I'm no expert, so someone please correct me if I'm wrong here. Many antipsychotics are 5-ht2a and 5-ht2c antagonists, and blocking these serotonin receptor will lead to higher neurotransmission to dopamine receptors. Atypical antipsychotics also have less dopamine blocking properties than typical APs. So if you take low enough doses of atypicals, you will mostly experience 5-ht2 antagonism. The atypical APs sulpiride and amisulpride are different though. They don't have any 5-ht2 antagonist properties, but they are unique in that they at low doses block the presynaptic dopamine D2/D3 autoreceptors, which leads to an increase in dopaminergic transmission.
Also, APs are believed to counteract many of the side effects of SSRIs. Several people report better results with the combination of Prozac and Zyprexa or Seroquel, than with Prozac alone.
It's a real shame though, that there are not any dopaminergic antidepressants availible.
Posted by linkadge on March 22, 2006, at 10:00:48
In reply to Re: What's the deal with antipsychotics for depres » jerrympls, posted by psychopharmacon on March 22, 2006, at 1:39:20
Back in the day, cyproheptadine (periactin), a 5-ht2a/c antagonist was considered an antidepressant.
I feel that the atypicals may help depression insofar as they block 5-ht2 system, which may be of use in certain depressions.
The problem is, that they block dopamine receptors too, which is still going to lead potential problems down the road.
We have had a few pure 5-ht2 antagonists pass right through the pipelines probably because drug companies thought they couldn't reach enough people.
But, I think it is pretty stupid that in this day in age, we still have to rely on these dirty drugs when a more selective drug might be more usefull.
Linkadge
Posted by Phillipa on March 22, 2006, at 21:18:58
In reply to Re: What's the deal with antipsychotics for depres, posted by linkadge on March 22, 2006, at 10:00:48
Just like benzos the wonder drug of the 70's. But they have minimal side effects I'll take them any day over antipsychotics. And in my opinion they are not addictive maybe tolerance developes but I've never abused them what for? If the anxiety is relieved that's all I'm looking for. Fondly, Phillipa
Posted by deniseuk on March 23, 2006, at 11:47:04
In reply to What's the deal with antipsychotics for depression, posted by jerrympls on March 21, 2006, at 23:03:33
Hi Jerry,
I really don't think Psychiatrists are prescribing anti-psychotics as a first line treatment for depression. Mine never did initially, it was only after trying lots of ADs that were either not working or making me worse that I was prescribed Zyprexa on an add needed basis. I'm thankful for that because it's the only drug I can rely on to actually help.
Denise
Posted by med_empowered on March 23, 2006, at 20:29:34
In reply to Re: What's the deal with antipsychotics for depression, posted by deniseuk on March 23, 2006, at 11:47:04
here where I live, its a BIG thing--I even had a family doc giving me samples of Symbyax (prozac+zyprexa) !!! Its pretty ridiculous. Plus, whenever I go to a doc they always offer an antipsychotic for long-term use even in the absence of psychosis. Its ridiculous, really. I think maybe the US is worse about it then other places--I think pdocs here have a tendency to over-use the newest and most expensive drugs available.
Posted by Cairo on March 23, 2006, at 20:49:08
In reply to Re: What's the deal with antipsychotics for depres » jerrympls, posted by psychopharmacon on March 22, 2006, at 1:39:20
Low dose Seroquel added to Zoloft has helped my daughter's social phobia and brightened mood a bit more. Zoloft is more dopaminergic than some other SSRIs.
Cairo
Posted by ed_uk on March 26, 2006, at 15:39:05
In reply to APs for depression..., posted by med_empowered on March 23, 2006, at 20:29:34
Hi Med,
>I think maybe the US is worse about it then other places--I think pdocs here have a tendency to over-use the newest and most expensive drugs available.
Very true.
Ed
Posted by linkadge on March 27, 2006, at 13:09:58
In reply to Re: APs for depression... » med_empowered, posted by ed_uk on March 26, 2006, at 15:39:05
I think doctors need to keep perspective on AP side effects vs. benzo side effects.
A lot of doctors feel that it is safer to use an AP for anxiety than benzo, although I don't know what that is based on. AP's can have some nasty withdrawl effects too.
Linkadge
Posted by tizza on March 27, 2006, at 22:47:46
In reply to Re: APs for depression... » ed_uk, posted by linkadge on March 27, 2006, at 13:09:58
> I think doctors need to keep perspective on AP side effects vs. benzo side effects.
>
> A lot of doctors feel that it is safer to use an AP for anxiety than benzo, although I don't know what that is based on. AP's can have some nasty withdrawl effects too.
>
> LinkadgeCouldn't agree more, but what about the nasty BIG side effects compared to benzo's. AP's are just far, far worse for depression in my opinion from what I have personally experienced. Valium keeps me even, mogadon helps me sleep. I know that they are way easier to come of compared to SSRI's but seroquel and zyprexa, which are AP's are vile drugs and should ONLY be used for people suffering from psychotic disorders. Sorry about the rant but I feel very strongly about this because I should NEVER have been prescribed them and I nearly lost everything (family, friends, mind) because of them. They weren't designed for depression so why bother treating people with them who suffer from depression and anxiety. Paul
Posted by deniseuk on March 30, 2006, at 9:04:51
In reply to Re: APs for depression..., posted by tizza on March 27, 2006, at 22:47:46
I don't think you should generalise and say anti-psychotics aren't good for depression.
Antidepressants used to really help me but now they no longer work Zyprexa is the only thing that has helped lift my mood (I only take it now and again) but I thank God for it.
If my Psychiatrist had you strong belief that they're no good for depression then he wouldn't have prescribed it on an as needed basis and the only I would have felt that the only option left would have been suicide!
They do help some people's depression when all else fails so you can't say they're no good for depression per se.
Denise
Posted by jerrympls on March 30, 2006, at 20:26:04
In reply to Re: APs can help some people's depression!, posted by deniseuk on March 30, 2006, at 9:04:51
> I don't think you should generalise and say anti-psychotics aren't good for depression.
>
> Antidepressants used to really help me but now they no longer work Zyprexa is the only thing that has helped lift my mood (I only take it now and again) but I thank God for it.
>
> If my Psychiatrist had you strong belief that they're no good for depression then he wouldn't have prescribed it on an as needed basis and the only I would have felt that the only option left would have been suicide!
>
> They do help some people's depression when all else fails so you can't say they're no good for depression per se.
>
>
> DeniseI apologize if I came off as anti - anti-psychotic (heheh). I know they help MANY people. I was basically just trying to point out the fact that it seems as if antipsychotics are being used more and more as a first-line treatment or first choice in an augmentation therapy approach. And while they may help many people - undoubtedly - they also can make people musch WORSE too.
Jerry :-)
Posted by Caedmon on March 30, 2006, at 23:32:39
In reply to Re: APs can help some people's depression!, posted by deniseuk on March 30, 2006, at 9:04:51
>They do help some people's depression when all else fails so you can't say they're no good for depression per se.
I completely agree. I liked Risperdal (risperidone), it ranks up there with Valium (diazepam) as one of the better drugs I've tried. I think people sometimes get overly emotional about APs when they respond poorly.
Like almost everything with psych meds, it's not a black and white issue.
- C
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