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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 105. This is the beginning of the thread.
Posted by Phillipa on September 16, 2006, at 23:23:47
I've been thinking a lot and if they worked how come they poop out and many never respond to an ad again. Something is fishy. What do you all think? As everyone on the board has problems. I am quitting my ad and hopefully not trying anymore. For what? Can someone answer this? Thanks Phillipa ps the only meds I trust are benzos.
Posted by yxibow on September 17, 2006, at 0:20:03
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
> I've been thinking a lot and if they worked how come they poop out and many never respond to an ad again. Something is fishy. What do you all think? As everyone on the board has problems. I am quitting my ad and hopefully not trying anymore. For what? Can someone answer this? Thanks Phillipa ps the only meds I trust are benzos.
Its a loaded question, really. One has to remember that everybody on this board has a different disorder. Everybody. There are a lot of similarities between some, but everybody is biologicially different.
What we have is a series of case reports, usually more negative than positive, because the numerous positive reports aren't a felt need by most people to report. An antidepressant, anxiolytic, whatever, works, and there's no need to say more about it. What we see is when they don't work or dont work completely.
And what is "work" ? Its a complex set of chemistry that changes chemical imbalances in the brain for a period of time. With added psychotherapy and CBT, someone who suffers from disorder X, may be able to withdraw from medication for a period of time or maybe even for life. Those that suffer from lifetime biochemical imbalances, including a lot of us, will some day return again to medication though, to help another flareup in a completely different manifestation.
There are no perfect antidepressants or anxiolytics. What we have in 2006 is a far cry from the misknowledge that was present in 1956. Still, side effects abound, and it is a choice to take or not take medications. They don't always "work" in the sense that there will always be breakthrough depression. I have experienced breakthrough depression. At some point, you can't medicate any more because you create a toxic overload. That's where psychotherapy and CBT come in to help manage the other side, the human nature and "free will" that I had mentioned in a previous thread. There is free will trapped in the most hardened of cases, it just takes a very long time to dig at and a system of managing cases in an HMO oriented society doesn't allow for that, when it desperately needs it. We are all sapient, regardless of how "unnormal" we may feel. We are normal. We may have a biochemical imbalance, but that is just as "normal" as any other human affliction such as diabetes, MS, loss of limbs and motor control.Sometimes being sapient is cruel, as we are aware of our own mortality and our own mind being attacked from within. But our personality, our free will of expression is always there. Its just muted sometimes.
I'm glad you trust benzodiazepines as you and I know that they are the safest psychiatric medications when used as directed and not diverted.
But I would still encourage you to press on -- sometimes it takes more than one medication to help a case.
Yes, there are stories of antidepressants "pooping out". But for each of these stories there are, as I said, untold numbers of people who are helped from antidepressants who never bother to report their case. A past psychiatrist of mine was taking Prozac and I never knew that except for the NTSB report on his autopsy when he died in a small plane crash because he loved flying. He probably was a psychiatrist because he knew it intimately. That traumatically affected the hospital, but that isn't really the point -- the point is there are people walking out there on the street who are quietly taking medication and one assumes they're "normal", which is a very loaded word. Somewhere in all of us lies a "normality" waiting to be exploited in some way. There are no "cures" in psychiatry but there are medications and therapies which greatly help people carry on their lives and do something with the great and fascinating randomness of it.
Posted by James K on September 17, 2006, at 1:07:34
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
Phillipa, please hang on. Don't do anything drastic. I'd like to talk about some things with you. Hell. I'm against the meds, in general, but sudden changes don't work out the best. I'm just doing my best just now.
love,
James.
Posted by linkadge on September 17, 2006, at 9:01:57
In reply to Re: Tonight I don't feel that antidepressants work » Phillipa, posted by yxibow on September 17, 2006, at 0:20:03
I think that the number of people who are actually helped by the medications is overstated.
Some of the latest trials show that only something like %30 of people get any help, and more get help with placebo.
Linkadge
Posted by saturn on September 17, 2006, at 9:23:13
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 9:01:57
> Some of the latest trials show that only something like %30 of people get any help, and more get help with placebo.That's messed up. I'd think CBT or exercise could at least match that. Which trials are you referring to?
Saturn
Posted by linkadge on September 17, 2006, at 10:15:25
In reply to Re: Tonight I don't feel that antidepressants work » linkadge, posted by saturn on September 17, 2006, at 9:23:13
I suppose the STAR-D.
Linkadge
Posted by SLS on September 17, 2006, at 10:18:09
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 9:01:57
> I think that the number of people who are actually helped by the medications is overstated.
>
> Some of the latest trials show that only something like %30 of people get any help, and more get help with placebo.
I'll be the optimist.In clinical trials: With any single antidepressant, 65-70% improve with greater than a 50% reduction in rating scale scores. 35-40% achieve remission at 6 weeks. Again, this represents the likelihood that someone will respond to that specific antidepressant if tried.
Now, the thing is, these trials stop at 6 weeks. What if the 50% reduction responders were evaluated at 6 months? How many of them would go on to full remission? Hmm.
Placebo comes in at 25-30% Even though placebo usually comes in with statistically lower numbers than antidepressants, the rate is, in my opinion, too high for reasons that I have discussed along other threads. They involve selection criteria and the allowance of subjects who I do not believe meet the criteria for a properly diagnosed Major Depressive Disorder (MDD). Now. The thing is, these studies stop at 6 weeks. Placebo pattern responders, as identified by Quitkin et al., have been shown to relapse more frequently than true drug responders. They, too, are not followed beyond 6 weeks.
Remission rates with SNRI, SSRI, placebo: pooled analysis of major studies:
Br J Psychiatry. 2001 Mar;178:234-41. Related Articles, Links
Click here to read
Comment in:* Br J Psychiatry. 2001 Jul;179:79.
* Br J Psychiatry. 2002 Jan;180:82-3.
* Br J Psychiatry. 2004 May;184:452-3.
Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors.Thase ME, Entsuah AR, Rudolph RL.
University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213-2593, USA.
BACKGROUND: It had been suggested that the antidepressant venlafaxine, which inhibits reuptake of both serotonin and (at higher doses) noradrenaline, may result in better outcomes than treatment with selective serotonin reuptake inhibitors (SSRIs). AIMS: To compare remission rates during treatment with SSRIs or venlafaxine. METHOD: Data from eight comparable randomised, double-blind studies of major depressive disorder were pooled to compare remission rates (Hamilton Rating Scale for Depression score < or = 7) during treatment with venlafaxine (n = 851), SSRIs (fluoxetine, paroxetine, fluvoxamine; n = 748) or placebo (four studies; n = 446). RESULTS: Remission rates were: venlafaxine, 45% (382/851); SSRIs, 35% (260/748); placebo, 25% (110/446) (P: < 0.001; odds ratio for remission is 1.50 (1.3-1.9), favouring venlafaxine v. SSRIs). The difference between venlafaxine and the SSRIs was significant at week 2, whereas the difference between SSRIs and placebo reached significance at week 4. Results were not dependent on any one study or the definition of remission. CONCLUSIONS: Remission rates were significantly higher with venlafaxine than with an SSRI.
Publication Types:
* Meta-Analysis
PMID: 11230034 [PubMed - indexed for MEDLINE]
- Scott
Posted by jealibeanz on September 17, 2006, at 10:57:33
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
Did you start EMSAM? I know you were thinking about it.
Posted by yxibow on September 17, 2006, at 11:25:18
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 9:01:57
> I think that the number of people who are actually helped by the medications is overstated.
>
> Some of the latest trials show that only something like %30 of people get any help, and more get help with placebo.
>
> LinkadgeIt has always been shown that up to 30% of patients taking any antidepressant get their help just from believing in the medication. So is the placebo effect so bad, as long as there aren't noticeable side effects ?
Posted by linkadge on September 17, 2006, at 11:33:46
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 10:18:09
I'm not going to get started into the whole antidperessants do/don't work debate again.
My contention was essentially that statistics are generally significantly flawed in favor of the drugs. I don't think that the 60-70% of people respond stuff is at all acurate.
Linkadge
Posted by Phillipa on September 17, 2006, at 11:35:50
In reply to Re: Tonight I don't feel that antidepressants work, posted by jealibeanz on September 17, 2006, at 10:57:33
I have the emsam here but a lot of others have said that my anxiety is too high to handle this type of med. I couldn't even handle lexapro or cymbalta or prozac the list goes on and on and I've never had any type of remission at all. Last night I was reading the board and it seems that yes meds help bipolar or schizophrenia but I'm beginning to think sadness or unhappiness is more the cause and a pill can't cure it right? Love Phillipa ps I've love for someone to give me some hope. I am not trying to be negative just what's happened to me.
Posted by SLS on September 17, 2006, at 11:48:53
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 10:18:09
> I'll be the optimist.
>
> In clinical trials: With any single antidepressant, 65-70% improve with greater than a 50% reduction in rating scale scores. 35-40% achieve remission at 6 weeks. Again, this represents the likelihood that someone will respond to that specific antidepressant if tried.
>
> Now, the thing is, these trials stop at 6 weeks. What if the 50% reduction responders were evaluated at 6 months? How many of them would go on to full remission? Hmm.
>
> Placebo comes in at 25-30% Even though placebo usually comes in with statistically lower numbers than antidepressants, the rate is, in my opinion, too high for reasons that I have discussed along other threads. They involve selection criteria and the allowance of subjects who I do not believe meet the criteria for a properly diagnosed Major Depressive Disorder (MDD). Now. The thing is, these studies stop at 6 weeks. Placebo pattern responders, as identified by Quitkin et al., have been shown to relapse more frequently than true drug responders. They, too, are not followed beyond 6 weeks.The rest of us come here.
:-(
And get better using other drugs and drug combinations, and CBT, and supplements, and all sorts of other stuff!
:-)
- Scott
Posted by SLS on September 17, 2006, at 12:39:46
In reply to Re: Tonight I don't feel that antidepressants work » SLS, posted by SLS on September 17, 2006, at 11:48:53
Man, when I was responding to Parnate + desipramine for those 9 months, my whole conscious experience was altered. The world was different. It felt different I operated differently in it. My thoughts and feelings were changed. My behavior changed. My interactions with people changed. People reacted differently towards me. It was a different life. My bowel functions changed. My sense of taste changed. I lost my clumsiness. I lost my ataxia while walking. I regained by ability to read and comprehend. I began to read newspapers, magazines, and books for the first time in my life. My eyesight improved. I no longer felt cold all the time. My reaction time while driving improved. I no longer experienced heart palpitations. I no longer sighed on a regular basis. I no longer craved carbohydrates and overate. I no longer overslept. I became productive and industrious; learning to do electrical work, carpentry, and autobody, while reading about the mechanics and history of quantum physics. Of course, I worked a full-time job, went surf-fishing, remained married, and did a few other things that I would rather not disclose here. (Previous and subsequent to this treatment, I have remained lying on a couch, usually with the TV on for background companionship, as I stare into space or do some stuff on the Inernet).
Then I gradually became manic to the point of delusional thinking. The doctor discontinued treatment. I relapsed within 2 months. Prozac had just came out. The doctor put me on it. I did not respond. He avoided the previously effective treatment. He tried several other drug treatments. When another doctor eventually tried the Parnate + desipramine combination again, it did not work. The critical error made was not to return immediately to the original effective treatment. If he had, I probably would have been well today. Contrary to some of the rumors that run around, there are people who remain well on tricyclics and MAOIs for decades without suffering adverse effects.
So, here I am.
:-)
So, what was the point of this post?
I'll let you decide.
- Scott
Posted by Jimmyboy on September 17, 2006, at 13:26:30
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 12:39:46
Hey, I have come to the same conclusion as you Phillipa. I have been on probably 4 diffferent things or more in the past several months and it has just seemed to make the problems worse.. so I am quitting everything also and see how things go. I know that most people would probably think that is a bad idea, but I have been on medicien for 12 years and don;t even know what its like to not be on it.. maybe screwing my my brain chemicals so much is just exacerbating the problems.. I think it is very possible..
But I will say one thing I will stay on is the low dose of Klonopin I take. I trust that , it works and get no side effects, so I think its pretty benign...
But good luck with whatever your decison...
PS- Does anyone else think that, even though there is alot of positive things about this board ( and lots of knowledgeable people - I have learned so much!) That it can kind of be a crutch and remind you constantly that there is something "wrong" with you?? ]Anyway, just my thoughts
JB
Posted by Racer on September 17, 2006, at 13:46:17
In reply to Re: Tonight I don't feel that antidepressants work » SLS, posted by linkadge on September 17, 2006, at 11:33:46
>
>
> I don't think that the 60-70% of people respond stuff is at all acurate.
>Maybe it depends on your definition of "respond?"
My own experience says that it's probably accurate -- about 60 - 70% of people probably do respond to one or another drug. About that number will experience improvement on one or another of the meds on the market.
How many actually experience remission, of course, is a very different question.
I'm sorry none of the drugs you've tried have helped you, Link.
Posted by gardenergirl on September 17, 2006, at 14:10:34
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
Phillipa,
Ultimately, it doesn't matter one whit how anyone else did on any medication or combo. All that matters is what works for you. It can be helpful to hear others' experiences, and the information on this site is a valuable set of data to use in your own problem-solving. But it's not the only data, and it can't be generalized into "rules" or absolutes about any drug since we're all unique. I've found it's more effective to look at data from a variety of sources in making decisions.I wonder if you might find it helpful to track your symptoms for awhile to look for patterns. You could track your feelings or overall mood, thoughts, and symptoms, along with other factors such as sleep, diet, exercise, unusual or otherwise interesting events, etc. It doesn't have to be complicated. I've found that doing an exercise like this for a few weeks or a month or so helps me not only to find connections between HOW I'm doing and WHAT I'm doing, and it also helps me be more objective in deciding what's working and what's not.
When I am more depressed, I tend to focus on the negative stuff more and almost "forget" about the postives, so it skews my perspective toward the negative. Having more objective data and seeing it "on paper" counters that.
gg
Posted by Jost on September 17, 2006, at 14:41:39
In reply to Re: Tonight I don't feel that antidepressants work » Phillipa, posted by gardenergirl on September 17, 2006, at 14:10:34
The Star-d study showed that about 50% of people in the study had a remission with an initial antidepressant, either alone or plus a second AD, as a booster, or as a replacement.
They followed people for what?--six months? Someone would have to look back. I might later, if I get more enthusiastic.
Plus that was using only one AD plus a second (the choice for participants was whether to use the second AD as a boost or replacement)-- although of course, there might have been later loss of AD effect--- Remission is a high standard. More than that percentage had significant relief.
Emsam definitely works for me, despite my having tried lots of others, with bad side effects and no helpful effects (or not enough of a helpful effect to justify it).
So, there's reason for hope, and also there are many disappointments for many people along the way.
Jost
Posted by blueberry on September 17, 2006, at 16:32:12
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
The brain is very plastic and seems to me to have an extraordinary built-in ability to adjust and reconfigure itself no matter what influence it receives from a drug. For some people it happens fast and others slow, probably from built-in genetic instructions. I think after a while the brain figures out how to compensate for all that extra serotonin from an ssri and then poop-out occurs. And it adjusts to all other drugs too. The dopamine and opioid systems seem particularly sensitive and adjust radidly.
Imagine a virgin undrugged depressed brain. Then it gets under the influence of a drug and then receptors change in density and responsiveness, genes are altered, synapses are altered, and who knows what. Then take away that drug. Now the brain readjusts again, but not back to the original virgin version, as too many solid changes have occured for that to happen. The undrugged brain is now different than it originally was. Now introduce that same drug again, and it is working on a different brain than it was the first time, so it might not work.
Just my wild crazy totally unscientific thoughts on the matter.
I think in rare cases, maybe 10%, antidepressants truly work wonderfully for some magical accidental lucky reason. But for how long? I think the relapse rate for antidepressants is about 100%. It's just a matter of time. I think it is very wise for anyone who experiences a decent drug response to stick with it for the whole ride and don't rock the boat by changing drugs or doses.
And I agree with you...tonight I don't feel like antidepressants work either. The ones that used to work for me are nothing but useless or trouble now.
Posted by jealibeanz on September 17, 2006, at 16:37:09
In reply to Re: Tonight I don't feel that antidepressants work » jealibeanz, posted by Phillipa on September 17, 2006, at 11:35:50
Aren't there some who have done well on EMSAM who also have anxiety?
Posted by linkadge on September 17, 2006, at 16:42:02
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 12:39:46
>Man, when I was responding to Parnate + >desipramine for those 9 months, my whole >conscious experience was altered. The world was
>different. It felt different I operated >differently in it. My thoughts and feelings were >changed. My behavior changed. My interactions >with people changed. People reacted differently >towards me. It was a different life. My bowel >functions changed. My sense of taste changed. I >lost my clumsiness. I lost my ataxia while >walking. I regained by ability to read and >comprehend. I began to read newspapers, >magazines, and books for the first time in my >life. My eyesight improved. I no longer felt >cold all the time. My reaction time while >driving improved. I no longer experienced heart >palpitations. I no longer sighed on a regular >basis. I no longer craved carbohydrates and >overate. I no longer overslept. I became >productive and industrious; learning to do >electrical work, carpentry, and autobody, while >reading about the mechanics and history of >quantum physics.Thats what we call bipolar disorer.
Posted by linkadge on September 17, 2006, at 17:00:43
In reply to Re: Tonight I don't feel that antidepressants work, posted by blueberry on September 17, 2006, at 16:32:12
Does anyone have a link to the star*d anyway?
Besides, how many long term studies do we have on these drugs. PEople here keep saying that "all the respoders are out enjoying their lives". But even that is just assumption. We don't really have any clue as to the number of people who have long term remission from these drugs.
Heck, if you make your time frame small enough, you could probably include illegal drugs into the list of substances which could achieve remission.
Its just like that exercise vs. zoloft study. Oh sure, in the first few weeks you can get some impressive effects with an AD. But by the end of the study, the exercise group was doing better.
Drug companies like to make their studies short, because it favors their drug, but long term, who knows.
Long term they just burn you out. You can mess around all you want with the neurotransmitters, but you're still restricted to cellular energy and integrity. You overwork the cell for too long and you run into problems at the level of the mitochondria. We're probably all f'd at the cellular level now. Thats why we're all bipolar, and taking mood stabilizers cause we've overworked the individual cells by forcing them to overwork by bombarding them with ultrabiological levels of neurotransmitter. Sure that might get you over a hump, but then what? Then you're dependant on it just to function normally.
Thats why you hear of people who were never suicidal before taking AD's become suicidal when they decide to quit, because now, the dismal level of neurotransmitter left is not enought to acheive the task at hand. Just like when you quit steroids, your own hormones just don't cut it.
Linkadge
Posted by yxibow on September 17, 2006, at 18:48:52
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 17:00:43
> Does anyone have a link to the star*d anyway?
>
It was quite an interesting study
Posted by jealibeanz on September 17, 2006, at 19:31:29
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 17:00:43
whoaa... that's really negative! I still have a little hope left for pharmaceuticals.
Posted by Phillipa on September 17, 2006, at 19:54:59
In reply to Re: Tonight I don't feel that antidepressants work, posted by Jost on September 17, 2006, at 14:41:39
Jost are you the only one left doing well on EMSAM? Could you post you're current meds besides that one and side effects? And GG I know stress is the trigger for me. And last night as I read the board I was saddened greatly to see so many people leaving in such a short time. Love Phillipa
Posted by llrrrpp on September 17, 2006, at 20:35:42
In reply to Re: Tonight I don't feel that antidepressants work, posted by Jimmyboy on September 17, 2006, at 13:26:30
Phillipa,
I'm sorry you're having a hard time. I'm having a hard time too. I was feeling great-- got my CES-D from the 50's down to the teens.The medication is helping a lot. I have been able to get my work done, and I have been socializing a lot too. My appetite returned, and I have been sleeping better too.
Until the last few weeks. That's when my T started digging around in my psyche. Things are getting ugly. I am making some connections between my past and my present and my future, and it seems like I can no longer deny that it happened, and that it's a part of me.
Therapy is stirring up all kinds of uncomfortable and devastating feelings and memories. I honestly don't think I would be able to tolerate it if I weren't stable on medication. My pdoc, who is really excellent, has told me several times that the REAL work goes on in therapy; that medication helps make life and therapy tolerable until I learn what is making me sick.
So, I guess I haven't been on this board much lately, because I've been busy doing my work, and freaking out about therapy...
hmm
Hope you all get some relief, and have the presence of mind to document it when you're feeling it. Our memories only remember the bad times when we're down. Enjoy the views at the top of the rollercoaster. Might as well, right?-ll
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