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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by linkadge on December 8, 2007, at 16:27:27
This guy has a website about various treatments for psychiatric disorders.
He doesn't seem to care much for lamotrigine.
http://www.modern-psychiatry.com/lamotrigine.htm
Comments?
Linkadge
Posted by LlurpsieNoodle on December 8, 2007, at 18:14:58
In reply to check out this lamotrigine blurb, posted by linkadge on December 8, 2007, at 16:27:27
I guess my insurance is paying an awful lot for a placebo...
He didn't mention that the pills are more bitter than sugar placebo. heart-breakingly bitter.
I had a depressive episode following withdrawal from cymbalta and was started on an aggressive taper of lamictal. I do think it helped slightly, but eventually I found myself on an atypical (now abilify) and an AD (zoloft). Which leads me to my thread of "poundage and redundant meds" I feel like the lamictal is redundant.
thanks for the link linkadge
-Ll
Posted by yxibow on December 8, 2007, at 19:10:47
In reply to Re: check out this lamotrigine blurb » linkadge, posted by LlurpsieNoodle on December 8, 2007, at 18:14:58
> I guess my insurance is paying an awful lot for a placebo...
>
> He didn't mention that the pills are more bitter than sugar placebo. heart-breakingly bitter.
>
> I had a depressive episode following withdrawal from cymbalta and was started on an aggressive taper of lamictal. I do think it helped slightly, but eventually I found myself on an atypical (now abilify) and an AD (zoloft). Which leads me to my thread of "poundage and redundant meds" I feel like the lamictal is redundant.
>
> thanks for the link linkadge
>
> -LlWell you can believe anything you want from a single doctor but I happen to personally know someone being helped by Lamictal and numerous people on here with bipolar and other anxiety disorders as well.
And sure, there will be people who won't be helped by an AED. There are at least half a dozen common ones out there, one will have some minor effect. Maybe they'll have no effect because your transmitters just don't respond to Ca and Na gate voltage regulators. Maybe you're not bipolar or someone who responds to bipolar oriented medication.
Second of all while I suspect this doctor is mostly a vegetarian (yay, just personal opinion), his food advice is a bit conflicting. Omega-3s are great, but in fact mercury doesn't just exist in the Great Lakes.
Vegetarians do not suffer from B-12 withdrawal, this is a perpetuated myth, as the vitamin can stay in the body for a decade, and is in your morning cereal and most fortified foods.
Sodium is necessary for intracellular branching and there is nothing wrong with the ceiling set by the government. What's wrong is that unfortunately due to processed food we end up eating 4g a day often instead of 2g. Some foods are naturally high in sodium, like tomatoes, or tomato paste (unsalted).
This doctor has a bit of an agenda -- oh, I'm sure he's done his case study research and backs it up but there are other aspects which are kind of fuzzy. Don't believe everything one reads on the net unless it has a HON code or similar thing like Emedicine/WebMD/NIH/Pubmed etc.
Posted by Racer on December 8, 2007, at 19:30:22
In reply to Re: check out this lamotrigine blurb » LlurpsieNoodle, posted by yxibow on December 8, 2007, at 19:10:47
I'd like to add that this piece used some loaded words and phrases to "discredit" Lamictal as a useful medication. Calling some of the studies "Junk Science" is hardly objective, and generally leads me to believe that there's an agenda involved.
Also, and to me most important, some people improve when they take Lamictal. Period. I don't even think it matters if there's any scientific proof that the Lamictal causes the improvement, or how it does it -- I think it matters that people feel better. Isn't it nice that there's another tool in the bag of tricks our doctors have for us?
Of course, I also think that a lot of doctors get enthusiasms for specific drugs, and prescribe them more frequently than others. Natural human behavior, even if it's sometimes not helpful for the individual sitting across the desk. And I've read a lot of studies of Lamictal which show it to be kinda questionable in effectiveness. But -- well, see what I said above. Some people who take it feel better. And that really is the bottom line. If it works for you, that's really all that matters.
Thanks for writing a much more coherent post than I could manage tonight, Yxibow. You said your piece very well.
Posted by Phillipa on December 8, 2007, at 20:10:09
In reply to I agree with much you wrote » yxibow, posted by Racer on December 8, 2007, at 19:30:22
Gave both at separate times lamictal and trileptal to help anxiety with benzos and an ad at a low dose. Phillipa
Posted by bleauberry on December 8, 2007, at 20:24:30
In reply to check out this lamotrigine blurb, posted by linkadge on December 8, 2007, at 16:27:27
Formal clinical claims by FDA and others concerning lamictal is that it "delays" but does not prevent the onset of the next depressive episode. In most cases those few people who do find massive benefit with lamictal relapse rather quickly when compared to others who had massive benefits from prozac, lithium, zyprexa, klonopin, effexor, or whatever.
Scouring my memory of the last decade and a half at babble, there were a number of people who got very good long lasting results with a number of common psych meds discussed here all the time, but lamictal was not one of them.
Posted by linkadge on December 8, 2007, at 20:28:59
In reply to I agree with much you wrote » yxibow, posted by Racer on December 8, 2007, at 19:30:22
From what I understand, this doctor is speaking independantly.
In many ways, I think the once presumed proof of spectacular efficacy of lamotrigine was helping to mould people's view of its effectivness. You know, the emperor's cloths are beautiful.
I know a few people who felt that it was working well, then when they heard how little data there was supporting its efficacy, seemed to feel it didn't really help them!
Anyhow
Linkadge
Posted by linkadge on December 8, 2007, at 20:40:16
In reply to Re: check out this lamotrigine blurb, posted by bleauberry on December 8, 2007, at 20:24:30
The thing that bothers me is that if you go on to the GSK clinical trial registry, you see the results of all clinical trials investigating the psychiatric uses of lamotrigine. That one indication (delaying recurrence of depression or whatever) was like the only positive trial among dozens of other failed trials.
It seems kind of cheekey to me to test the drug for every single possible indication. By sheer chance, one of those trials will fair better than placebo. If you retested the drug for that particular indication, I wonder if it would pass?
Linkadge
Posted by yxibow on December 8, 2007, at 23:51:19
In reply to Re: I agree with much you wrote, posted by linkadge on December 8, 2007, at 20:28:59
> From what I understand, this doctor is speaking independantly.
>
> In many ways, I think the once presumed proof of spectacular efficacy of lamotrigine was helping to mould people's view of its effectivness. You know, the emperor's cloths are beautiful.
>
> I know a few people who felt that it was working well, then when they heard how little data there was supporting its efficacy, seemed to feel it didn't really help them!
>
> Anyhow
>
> Linkadge
But that's the point that was alluded in previous comments. If its "working" even if its no better than dextrose and magnesium stearate then why spring it upon them that it isn't. That sound sort of cruel too. 30% of drugs will "work" even if it is a placebo.Now, if you want to say well it will rot them with SJS and all that, fair game -- have the psychiatrist give sugar samples.
Posted by linkadge on December 9, 2007, at 0:08:00
In reply to Re: I agree with much you wrote » linkadge, posted by yxibow on December 8, 2007, at 23:51:19
I agree. I am being evil.
What I do think is sad is the patient who gains no benifit only side effects, but continues taking the drug out of faith in system.
That was me for two years. I took drugs that I wasn't feeling better on, under the insistant pressures of doctors that this was the only way to recover and/or stay recovered. I suffered a lot, and I trusted people, that was unfair.
Linkadge
Posted by polarbear206 on December 9, 2007, at 9:45:45
In reply to Re: I agree with much you wrote, posted by linkadge on December 9, 2007, at 0:08:00
Lamictal has helped many people. You can read the many success stories on remedyfind, psyche central and bipolar world. I think that it probably works better for those with bipolar type II who are more depression dominated. I know it saved my life and I tried different mood stabilizer and most of them made me feel druged. It's not going to work for everyone of course, but I don't think its fair to the others who have benefited from it. After all there is always two sides to the story. Sorry it didn't work for you. I hope that new posters to this site will not be scared or lose hope if they are considering it.
PB
Posted by linkadge on December 9, 2007, at 11:33:38
In reply to Re: I agree with much you wrote, posted by polarbear206 on December 9, 2007, at 9:45:45
I am not here to discredit anyones experiences, but without positive placebo controlled clinical trials, there is no proof that the med is actually working.
The fact that it has "worked" for people doesn't mean that it actually does anything. Placebo response to psychiatric drugs is very high, so when I see that the majority of lamotrigine clinical trials fail to show any statistical significance I start to wonder.
Linkadge
Posted by Racer on December 9, 2007, at 13:53:17
In reply to Re: I agree with much you wrote, posted by linkadge on December 9, 2007, at 11:33:38
>
> The fact that it has "worked" for people doesn't mean that it actually does anything. Placebo response to psychiatric drugs is very high, so when I see that the majority of lamotrigine clinical trials fail to show any statistical significance I start to wonder.
>
> LinkadgeFirst of all, I wonder what criteria is being used to "prove" that "Placebo response to psychiatric drugs is very high?" I won't waste my energy asking for citations for that statement. I'll only state that I am skeptical, and that the criteria used to assess any response will necessarily affect the outcome of any study.
So, when you state that "the majority of lamotrigine clinical trials fail to show any statistical significance," I would ask for details of study design, and how that design might influence outcome.
Your posts seem very negative about medication efficacy. I wonder, then, why you continue to take medications, if you are so pessimistic regarding their use?
Posted by linkadge on December 9, 2007, at 14:37:18
In reply to I guess it comes down to the question you ask » linkadge, posted by Racer on December 9, 2007, at 13:53:17
>First of all, I wonder what criteria is being >used to "prove" that "Placebo response to >psychiatric drugs is very high?"
I am not sure what you mean. The fact that it can be often difficult to establish a superiority of certain medications to placebo is fairly well known.
>I won't waste my energy asking for citations for >that statement. I'll only state that I am >skeptical, and that the criteria used to assess >any response will necessarily affect the outcome >of any study.
For instance, it is true that more than half of all SSRI clinical trials fail to demonstrate superiority of drug over placebo. I insert no interpretation to that, its simply what it is.
>So, when you state that "the majority of >lamotrigine clinical trials fail to show any >statistical significance," I would ask for >details of study design, and how that design >might influence outcome.
The GSK clinical registry is open to the lay public. You can go on, and review the trials if you like.
>Your posts seem very negative about medication >efficacy.
Well, I am only really discussing lamotrigine. The reason being that, like the gabapentin fiasco, I think it is usefull to routeenly discuss the effects of certain medications.
I think people diserve effective treatments. So, I was really wanting to discuss these aspects of lamotrigine.
Linkadge
Posted by seldomseen on December 9, 2007, at 19:04:49
In reply to check out this lamotrigine blurb, posted by linkadge on December 8, 2007, at 16:27:27
I think the author is correct in saying that lithium is still the gold standard in bipolar disorder treatment.
However, do a pubmed search on lamotrigine and there are several studies that indicate it is an effective drug. Of course there are several studies that say it isn't better than lithium or jsut plain didn't work at all (a lot of it depends on what outcome was measured).
Personally speaking however, my mom wouldn't take lithium, but decided lamictal was okay (after she became convinced that she probably wouldn't get a fatal rash) and improved markedly.
I would add one final thing. No study, no matter how well designed, how big, or how long lasting can ever say what a particular drug will do in a particular patient. They can only determine the likelihood of an event occurring. It's a numbers game.
Seldom
Posted by linkadge on December 9, 2007, at 20:28:04
In reply to Re: check out this lamotrigine blurb » linkadge, posted by seldomseen on December 9, 2007, at 19:04:49
The more trials that are made available, the more acurate predictions can become.
No number of clinical trials can give a definitive representation of true drug effect, but as such trials increase, we can approach such a statistic.
Linkadge
Posted by yxibow on December 10, 2007, at 1:55:25
In reply to Re: check out this lamotrigine blurb, posted by linkadge on December 9, 2007, at 20:28:04
> The more trials that are made available, the more acurate predictions can become.
>
> No number of clinical trials can give a definitive representation of true drug effect, but as such trials increase, we can approach such a statistic.
>
> LinkadgeThere's only a certain number of people who can be practically recruited for a final trial, and it usually runs around 4,000 for a phase III drug that is trying to get the total confidence of the agencies. They're contracted to centers in all sorts of places, central and eastern europe, asia, south america, etc... its often a global effort.
Its through enough statistics predictions that you get an aggregate of millions of patient-hours of exposure from I-IV.
This is the end of the thread.
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