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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on February 18, 2007, at 18:58:23
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by Squiggles on February 18, 2007, at 18:48:36
Parnate was an effective drug for me. It was very intense though. I had a spontanious hypertensive crisis which probably scared my doctor into never prescribing it again.
It is unfortunate.
Linkadge
Posted by Quintal on February 18, 2007, at 19:05:51
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 18:58:23
Did he not give you nifedipine? What happened exactly and how much were you taking? I took it with Klonopin which might have mitigated some of the stimulant effect. I took 80-120mg and had no problems with hypertensive crises - it did raise my blood pressure a bit after each dose though. How high did your blood pressure go?
Q
Posted by linkadge on February 18, 2007, at 19:44:16
In reply to Re: Why Most New Antidepressants Are Ineffective » linkadge, posted by Quintal on February 18, 2007, at 19:05:51
Well, I got up to 40mg. I was following the diet to a T. One day, within about an hour, my heart just started to speed up and up. I went to a walk in clinic, and they gve me some sedatives which didn't do anything. I was not anxious about anything except of course what was going on.
It was the fastest my heart has ever gone.
My BP was 150+.
It was just that it happened so abruptly.
Linkadge
Posted by Quintal on February 18, 2007, at 20:39:17
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 19:44:16
I don't mean to patronize you link, but do you think that could have been a panic attack triggered and exacerbated by Parnate? I think they'd more likely have given you hypotensives rather than sedatives if they thought it was a hypertensive crisis. When I quit Klonopin cold turkey my psychiatric nurse took my blood pressure and it was 176/~100 from having repeated panic attacks. What is the threshold for a hypertensive crisis?
I wonder if having an MAOI in your system can exacerbate symptoms of panic with adrenaline and noradrenaline being broken down more slowly?
Q
Posted by linkadge on February 18, 2007, at 21:11:58
In reply to Re: Why Most New Antidepressants Are Ineffective » linkadge, posted by Quintal on February 18, 2007, at 20:39:17
The thing was that I was in a good mood. I actually felt unusually happy that day.
I've also never really had a panic attack. I have lingering chronic anxiety, but no real panic attacks.
I suppose anything is possable, its just that it was such a foreign experience. (It was also within an hour of eating, if that makes a difference)
Linkadge
Posted by Quintal on February 18, 2007, at 21:44:31
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 21:11:58
>(It was also within an hour of eating, if that makes a difference)
It might do. Sounds more like it could have been a mild hypertensive reaction to something you ate rather than a spontaeous hypertensive crisis. What had you been eating?
Q
Posted by willyee on February 18, 2007, at 23:07:12
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 21:11:58
Link email me at brklyn234@yahoo.com
Posted by munificentexegete on February 19, 2007, at 5:50:10
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by Squiggles on February 18, 2007, at 7:31:45
> I don't know if everything that is said by
> this camp is true. I read materials like Robert
> Whitaker's book, and can't help but feel indignant about this medical area. But then, I never really know whether the problem is the drugs, or the sloppy treatment and lack of understanding in applying them.
>
> Squigglesits a good book that one
although it is not written by
a prof in the area, it
nevertheless seemed to
read itself very quicklyhe is now in court
testifying in the
zyprexa lawsuiti think bleuler
put it best when he
said:I am convinced that in schizophrenia
it is this very surveillance which awakens, increases, and maintains
the suicidal drive.
Only in exceptional cases
would any of our patients
commit suicide, if they
were permitted to do as they wished. And even if a few more killed themselves – does this reason justify the fact that we torture hundreds of patients and aggravate their disease?
Posted by Squiggles on February 19, 2007, at 6:26:19
In reply to Re: Why Most New Antidepressants Are Ineffective » Squiggles, posted by munificentexegete on February 19, 2007, at 5:50:10
> its a good book that one
> although it is not written by
> a prof in the area, it
> nevertheless seemed to
> read itself very quicklyIt's an excellent book. He's a good writer
and a good researcher.
>
> he is now in court
> testifying in the
> zyprexa lawsuit
>Hmm... i'll have to look up what's wrong
with Zyprexa.
> i think bleuler
> put it best when he
> said:
>
> I am convinced that in schizophrenia
> it is this very surveillance which awakens, increases, and maintains
> the suicidal drive.
> Only in exceptional cases
> would any of our patients
> commit suicide, if they
> were permitted to do as they wished. And even if a few more killed themselves – does this reason justify the fact that we torture hundreds of patients and aggravate their disease?There is no doubt in my mind, that during a mental crisis, even someone who is not chronically mentally ill, can be driven to actions which he would not otherwise commit, if care is not taken in treatment. Mental illness is a high-maintenance disease. But it *is* a disease.
Squiggles
Posted by FredPotter on February 19, 2007, at 22:23:50
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by Squiggles on February 19, 2007, at 6:26:19
It says in New Scientist that antidepressant treatment is "only about 80% effective". As if...
Posted by Squiggles on February 20, 2007, at 7:18:59
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by FredPotter on February 19, 2007, at 22:23:50
I was having a discussion with a friend
yesterday. He does not take antidepressants
but does take medication for cardiovascular
disease. Like psychiatric patients though,
he is constantly complaining about the side
effects and the many things he used to be
able to do and cannot anymore.And it occurred to me, that many people
who have been stabilized on anti-depressants
and hate the side effects, as much or more than
their families, their employers, and friends do,
*actually* expect to be better than well.But when you look at the hospital situations
50, 60, 100 and more years ago, you realize
that such people rarely lived a life outside
the confines of an asylum or cloister or some
sort, and had very seriously debilitating treatments.So, i asked myself, if possibly we are not
expecting too much. If possibly, our culture
has excluded the possibility of toleration for the sick and the effects of their medication. For example, if you gain weight, or get sleepy, or develop diabetes, or whatever from drugs that you MUST take, you and your doctor will be hounded into the 7th circle of medical hell.So, I say, chill, until something better comes up. If the drugs made you feel perfect, it is unlikely that there would be so much activism, and wars against the drugs. (That doesn't mean that corruption and stupidity are not with us in the drug corps. and medical field)-- those diseases are with us forever.
Squiggles
Posted by linkadge on February 20, 2007, at 7:36:51
In reply to Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:18:59
We are a very comercial society. We expect to get our money's worth so to speak.
The drug companies have only fed the underlying misconception that happiness can be bought in pill form.
As human beings we also tend to become acoustomed to whatever we have and to want more.
If you look apart from mild and moderate depression however, I think there is still a trend for higher response in severe depression with the TCA's and MAOI's.
The SSRI's were sucessfull in that they were the first antidepressant that could be dispersed like dandilion spores to the general public.
Kind of like the Ford-T model of antidepressnats.
Linkadge
Posted by Squiggles on February 20, 2007, at 7:56:12
In reply to Re: Are we culturally primed to expect too much? » Squiggles, posted by linkadge on February 20, 2007, at 7:36:51
> The SSRI's were sucessfull in that they were the first antidepressant that could be dispersed like dandilion spores to the general public.
>
> Kind of like the Ford-T model of antidepressnats.
>
>
> Linkadge
>Are you suggesting that the SSRIs are weaker
ADs- with less side effects?Squiggles
>
Posted by Larry Hoover on February 20, 2007, at 8:01:53
In reply to Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:18:59
Simple answer. Yes.
People want to go on doing the same things they've always done, and thinking the same thoughts they've always thought, and expecting novel outcomes. Pills aren't going to have the effects some people expect of them.
That doesn't mean there is a behaviour or a thought or a collection of behaviours and thoughts that will make a difference, but you still have to look.
Lar
Posted by Quintal on February 20, 2007, at 8:49:34
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:56:12
>Are you suggesting that the SSRIs are weaker
>ADs- with less side effects?Many people (myself included) find the SSRIs are weaker antidepressants with *more* side effects.
Q
Posted by linkadge on February 20, 2007, at 9:34:37
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:56:12
>Are you suggesting that the SSRIs are weaker
>ADs- with less side effects?Thats exactly what I am suggesting :)
Linkadge
Posted by bulldog2 on February 20, 2007, at 9:37:47
In reply to Re: Are we culturally primed to expect too much?, posted by Quintal on February 20, 2007, at 8:49:34
There are a couple reasons that the ssris appeal to doctors. They don't have to worry about lethal overdose as with tcas. They don't have to worry about hypertensive crisis as they do with maois. Also there's the convenient once a day dosing with ssris. So the ssris are much easier to manage and less to worry in the near term for the physician. The reality is we don't know the long term effects of chronic elevation of just serotonin. The sexual sides which we know are very prevalent were never brought out in early studies of ssris.
Posted by linkadge on February 20, 2007, at 9:43:39
In reply to Re: Are we culturally primed to expect too much?, posted by linkadge on February 20, 2007, at 9:34:37
The TCA's I tried were definately more effective. The side effects were tollerable it was just that I couldn't get my mind past the possable consequences of their toxicity, ie cardiac and otherwise.
Linkadge
Posted by laima on February 20, 2007, at 9:48:46
In reply to Re: Are we culturally primed to expect too much?, posted by bulldog2 on February 20, 2007, at 9:37:47
Tricky question, do we expect to much from medications. Perhaps, sometimes? Not always. Depends what one asks. Feeling like a euphoric million bucks every single day isn't realistic or normal, but depression isn't normal either. A normal life will have ups and downs. I really like my own doctor's philosophy, because it seems balanced and realistic: "medications are a powerful and valuable tool- when they work, don't squander the opportunity, or expect them to make up for terrible lifestyle choices. Examine your sleeping, eating, and other habits. Look at stress. Watch the alcohol, get exercise, be sure to have some fun". etc.
Posted by Quintal on February 20, 2007, at 9:49:24
In reply to Re: Are we culturally primed to expect too much?, posted by bulldog2 on February 20, 2007, at 9:37:47
>The sexual sides which we know are very prevalent were never brought out in early studies of ssris.
That's what I mean about SSRIs actually having more disruptive side effects. It's not only the sexual numbing that causes problems in relationships (as well as being frustrating and annoying), it's the emotional numbing too. All of these side effects lead to me discontinuing SSRIs, while Parnate not only lacked them, it seemed to enhance my enjoyment of life.
I worry that the idea that MAOIs have more severe side effects would lead some people to think they necessarily wouldn't be able to tolerate MAOIs because they can't tolerate the 'weaker' SSRIs. Not true.
Q
Posted by laima on February 20, 2007, at 10:18:58
In reply to Re: Are we culturally primed to expect too much?, posted by Quintal on February 20, 2007, at 9:49:24
Yes- you know I read an article several years ago about how long-term users of ssris were having difficulty with emotional aspects of relationships/forging bonds. It was so long ago though, that I have no clue where I read this. Does anyone remember any such article?> That's what I mean about SSRIs actually having more disruptive side effects. It's not only the sexual numbing that causes problems in relationships (as well as being frustrating and annoying), it's the emotional numbing too.
Posted by bulldog2 on February 20, 2007, at 12:03:28
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by FredPotter on February 19, 2007, at 22:23:50
Here's another link about the theory of serotonin and depression.
http://medicine.plosjournals.org/archive/1549-1676/2/12/pdf/10.1371_journal.pmed.0020392-S.pdf
Posted by Brutus1 on February 20, 2007, at 14:24:17
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by bulldog2 on February 20, 2007, at 12:03:28
So where does an atypical SSRI fit in this discussion?
"In a study comparing the effects of fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine on extracellular concentrations of serotonin, dopamine, and norepinepherine in the prefrontal cortex, only fluoxetine showed robust and sustained increases in extracellular concentrations of norepinephrine and dopamine after acute systemic administration,[13] suggesting that fluoxetine is an atypical SSRI"
Personally I have never tried it, but I'll bet most posters on this board have. (And please, I'm not advocating SSRI's TCA's, MAOI's etc. We are all wired differently with numerous root causes and numerous levels of comorbidity.)
It's been around 20 plus years. There has to some meta data to support it's efficiency one way or another (or most likely both :))
B
Posted by Chairman_MAO on February 20, 2007, at 15:02:10
In reply to Why Most New Antidepressants Are Ineffective, posted by bulldog2 on February 17, 2007, at 13:07:07
Thanks for posting such a great article. It's nice to know that a professional has written something along the lines of what I've been thinking for years. Everyone should note what he says about MAOIs and tranylcypromine.
Posted by Squiggles on February 20, 2007, at 15:27:55
In reply to Re: Are we culturally primed to expect too much?, posted by Quintal on February 20, 2007, at 9:49:24
I think the problem with the MAOIs is not
that people would not prefer them to SSRIs
if they are indeed "cleaner", but that the
dietary restrictions really pose a threat.It may not be a big threat -- it may have been
overblown or overbroadcaster or exaggerated;
i know that has happened with the "narrow
therapeutic index" of lithium (really exaggerated and not compared to other drugs with a toxic or
narrow therapeutic index). But, put the idea into people's heads with enough medical articles and everyone will be less likely to use them.In such cases, the drug companies should do something to enhance the marketability of a good drug. For example, with lithium I asked some drug companies if the could use a portable detector for home use for lithium blood levels to get feedback. Who knows maybe it will happen someday.
Squiggles
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Dr. Bob is Robert Hsiung, MD,
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