![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 88 to 112 of 116. Go back in thread:
Posted by Larry Hoover on April 19, 2008, at 16:44:39
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 10:30:17
> Anyhow, the point is with these drugs, is that it doesn't matter how much you talk to people about their lack of established efficacy, you are still going to get people who refuse to look at good science like this.
Well, the question of good science is one not clearly ascribed to him, but Kirsch found that antidepressants were more effective than placebo, p <.001. Kirsch himself established efficacy.
Moreover, when presented with scientific arguments as to why e.g. failed studies are not meaningful, you dismiss the argument outright. What part of scientific analysis suits you? What part of the limitations of post hoc analysis will you accept? Only those bits that fit in with your own beliefs, apparently.
> Then you get those babblers who are resorting to the very devices they condemn. The very babblers that suggest that single case reports are weak seem return to the logic that "they work for me, and that's all that matters".
Same goes for those who claim they didn't work. Unfortunately, the plural of anecdote is not data. That's why I rely on the science.
> As mentioned it includes data that the drug companies conveniently left out which increases its validity beyond any one single study or any previous subgroup of *more positive* released trial data.
The same dataset has been studied and analyzed ad nauseum. There is no new finding in Kirsch's analysis, but for the post hoc application of a new and arbitrary standard of clinical significance. However, to limit the data used for such an analysis to this small grouping of ancient papers suits his purpose, as he already new what he'd "discover". That is intellectually dishonest. Period.
> Even those of you who publicly dismiss this study are probably saying to themselves "man, this really sucks".
No, I'm saying this Kirsch paper really sucks. It is meaningless, but for its propaganda value. NICE did a far better job of it, and before he published.
> The clinical trial is unfortunately the only real way to scientifically establish the efficacy of antidepressants.
Antidepressants superior to placebo, p <.001.
> Other forms of persuasion are not scientific and therefore don't mean a whole lot.
Then, I guess we're finished. p <.001.
> When people make certain faulty conclusions, it tends to stick even in the face of contradictory information.
Why is it that this thread only includes accusations of belief perseverence and faulty conclusions, when applied to those who don't accept that placebos are as efficacious as antidepressants?
> Another thing to consider is this: Most people are here because their antidepressant is not working the way they would like it to. That's why I take their proclamations with a grain of salt. Many of the people here arguing may just be doing so to re-establish their faith in the drugs. It's like...it seems like you're more trying to convince yourself. Its just like my brother at Bible college. Even he admits that arguing for Christianity bolsters his faith when even he is doubting it. After all, arguing a particular point of view is the first step to believing it.
That argument doesn't apply to me.
> The idea that it is hard to distinguish antidepressants from placebos is not new and has long preceded this study.And has always failed when put to critical thinking tests. Only people like Kirsch, who can ignore his own antidepressants significantly better than placebo result, one chance in 1000 (or less) that it is not a "real difference", support the equivalence theory. I asked people to look at Kirsch's graphs, and it is just as obvious in a pictorial form. The two are non-equivalent, and you can see that clearly.
> What always surprises me though is that if this kind of meta analysis occurred for a cholesteral lowering drug ie. you found out that you were taking a certain cholesterol lowering drug that was generally no better than placebo, most people would note get all defensive.Cholesterol is measured in different ways than is depression. Notwithstanding that limitation, antidepressants are significantly better than placebo, p <.001.
> Probably because there isn't the same kind of surge in introspection upon initiation of a cholesterol drug.
No. Probably because mental illness is inferential.
> The argument for endogenous depression is a valid one. But, provide me any data anywhere that the current line of antidepressants addresses any one proven chemical imbalance. For instance, the majority of the findings suggest that SERT activity is in fact low in depression. You're not targeting any imbalance by giving SERT inhibitors to these individuals. Other studyies suggest that NET is low and even MAO is decreased.
Depression is a symptom, not a disease of one etiology. Let us postulate that depression has three distinct causes. If we were unable to distinguish the three forms, and treated all of them as if they were homogenous, would it be a surprise to discover that response was limited? If equally prevalent, a given mode of treatment would at most reach 33% of the subjects. That hypothetical is nothing more than my attempt to illustrate that a failure to discriminate etiologies of depression must limit efficacies of treatment(s). Nobody ever argued that drugs work for all depressives, but the clear evidence is that they robustly work for some of them. And, as the combination of e.g. psychotherapy and antidepressant works better than either one alone, that convincingly shows (IMHO) that there is more to antidepressant response than simply obtaining placebo response.....otherwise, therapy plus antidepressant would be the same as therapy alone.
> People can, and often do feel better off drugs.
Plural of anecdote not data, again.
> This is in no way a sign that their depression is not due to some biochemical abnormality. Like mentioned above, it would seem reasonable to me that an individual with an already abnormally low level of the serotonin transporter takes a drug that lowers it further, they may just feel worse. I know severely depressed individuals who simply feel worse on drugs period. Psychiatry does not have all the tools and all the answers.
Of course not. But the answer is found by doing the experiments required.
> If anything I would hope that some of the current studies could help liberate certain individuals. You see people on this board who have never (or rarely) helped by an antidepressant, yet they somehow feel that the drugs work and there is something wrong with them when they don't. I would hope that data like this would be liberating. I.e. perhaps by seeing that they don't work for others too, they might stop beating themselves up about the issue and go look for answers somewhere else.
Further experimentation is indeed the answer. Including different drugs, also, IMHO. No point limiting treatment opportunities based on thought experiments.
> So, I digress. The establishment of a solid logical arugument does not depend on the ability to convince of any one individual. The more I am away from babble the more I realize how much "GroupThink" goes on here.I'm not one of those. Just for the record.
> One person talks about a drug then all of a sudden another person needs it. Also, the more time you spend on a board discussing drugs, the more you don't see the other ways that you can address your problems. Petting a dog will raise your serotonin you know.
Assuming that serotonin levels are the issue. You argued alternative mechanisms, earlier. ;-)Whatever works, works.
> Its just like some of the issues brought up by Bulldog. Many people are just at their wits end in terms of who to believe about who has the answers for their problems. Believing that prescription antidepressants are the only ways to solve your problems is seductively convenient.
Dismissing them outright is dangerous, IMHO. Look at what happened to child suicide rates as a result of the warnings. Better management is the answer, not drug avoidance.
> It allows you to narrow your focus and disregard other useful information. It makes life easy, or does it?
I'm not sure you're being fair to your readers.
> If the drugs work for you, then great: live happily ever after. For the rest of us, don't be so surprised and upset when you're not getting prozac.com type results.
Not sure what your point is here.
> Trust yourselves for a change, and reflect critically upon data like this. It may be more liberating than you know.
That's all I've been doing, reflecting critically. And Kirsch has not met his burden.
> Anyhow, I just thought I'd stop by and say hi.Hi, link. Sorry I didn't greet you earlier. I was caught up in debate. You are missed.
> To somebody who was on lithium, zoloft, depakote, zyprexa, clonazepam and ritalin, (all at once) and told by top psychiatrists that I will never be able to live medication free, diet, exercise, and certain supplements have gone a long way.There are many many positive lifestyle changes that can impact symptoms and vulnerabilities. I'm glad you've found some relief.
> Obviously not all cases are like this, but the point I am trying to make is to never stop rethinking and reasessing exactly what the meds are and are not doing for you.
>
> LinkadgeBest to you, link.
Lar
Posted by bulldog2 on April 19, 2008, at 18:24:04
In reply to Re: Question For Scott » bulldog2, posted by SLS on April 19, 2008, at 15:13:16
> Hi Bulldog2.
>
> This is conjecture:
>
> > Currently doing deplin + Sam-e and getting a decent response thought not in remission.
>
> Deplin can take 2-3 months to begin working. I think a brief "blip" response in the first week might indicate that things are heading in the right direction. Deplin produces an increase in S-AMe. Not only do I feel that the S-AMe is unecessary, it might even produce some dysphoria.
>
> > Could I get by with a lower dose of Nardil such as 45 mg.
>
> I would lower the dosage of Nardil only if you are having a difficult time tolerating side effects. I don't believe that you can lower an effective dosage of Nardil by adding Deplin.
>
> > Also at lower doses is there less chance of a hypertensive crisis if I eat the wrong foods.
>
> Sort of. The only thing is, this is probably at a dosage significantly lower than is necessary to maintain an antidepressant effect. In reality, it depends on the percentage of MAO being inhibited in the gut. I don't happen to know what the threshold is for reducing the tyramine reaction.
>
> I apologize if I didn't get to your questions earlier.
>
>
> - Scott
>
>Currently not on any ads. Thinking of starting Nardil. I was just wondering if I am elevating neurotransmitters via deplin if I might get by on less Nardil?
Posted by Phillipa on April 19, 2008, at 18:45:08
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 19, 2008, at 13:48:44
Bulldog was told to go off the motrin as it is incompatible with luvox according to drug checker moderately so for internal bleeding, etc. So extra strength tylenol was prescribed and a massage and heat. No massage as don't have the funds. Oh mention a narcotic here and you have grown two heads. Did you know they are addictive? This is the question you're asked by pdocs, internists, endos. And the sad thing is percocet low dose relieved any anxiety for me. And it had taken two years for endo to get his numbers right. But blueaberry posted numbers don't count it's how you feel. My neice's endo in another state says the exact same thing. Love Phillipa
Posted by Phillipa on April 19, 2008, at 19:10:30
In reply to Wierd Some I know In real Life Feel Better off ADs, posted by Phillipa on April 14, 2008, at 13:40:46
Amazing how a simple question by me elicited so many debates. All I wondered was why some people get better and feel better when there docs decide to discontinue them. A number of posters no longer post as they no longer need ad's. One found their answer in progesterone cream. So I still believe in my opinion that physical causes can cause depression and once treated ad's no longer needed from real live people. And I see them interact daily and teach school, care for families etc. So for some a trigger set off a depression life situation or medical. This is my conclusion. Great debate though and so much knowledge. Phillipa
Posted by Shadowplayers721 on April 20, 2008, at 8:26:44
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by Larry Hoover on April 19, 2008, at 16:44:39
Posted by bulldog2 on April 20, 2008, at 8:53:43
In reply to Re: Wierd Some I know In real Life Feel Better off ADs, posted by Phillipa on April 19, 2008, at 19:10:30
> Amazing how a simple question by me elicited so many debates. All I wondered was why some people get better and feel better when there docs decide to discontinue them. A number of posters no longer post as they no longer need ad's. One found their answer in progesterone cream. So I still believe in my opinion that physical causes can cause depression and once treated ad's no longer needed from real live people. And I see them interact daily and teach school, care for families etc. So for some a trigger set off a depression life situation or medical. This is my conclusion. Great debate though and so much knowledge. Phillipa
That is certainly another good option. Join an anti-aging clinic and let them balance all your hormones. Myofacial release massage therapy to get rid of all your muscle spasms and get everything aligned properly. I'm sure these are available in your area.Only buy organice food so you have no additives in your food.
Posted by linkadge on April 20, 2008, at 9:04:23
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by Larry Hoover on April 19, 2008, at 16:44:39
>Well, the question of good science is one not >clearly ascribed to him, but Kirsch found that >antidepressants were more effective than >placebo, p <.001. Kirsch himself established >efficacy.
I'm sorry, I don't have time to review the data right now. I don't exactly agree with the conclusions you are reaching, but I can't say more until I review certain data myself. From what I understand this study reveals more when disected.
>Same goes for those who claim they didn't work. >Unfortunately, the plural of anecdote is not >data. That's why I rely on the science.
Statistical significance can mean different things in different contexts.
>The same dataset has been studied and analyzed >ad nauseum.
Thats why the conscensus is that antidepressants are only marginally better than placebo.
>No, I'm saying this Kirsch paper really sucks. >It is meaningless, but for its propaganda value. >NICE did a far better job of it, and before he >published.
NICE already suggests that for mild/moderate depression the benifit/risk ratio for antidepressants is poor.
>Antidepressants superior to placebo, p <.001.
From what I understand, in most trials analyzed, the difference between drug and placebo was not enough to exceed an arbitrary threshold established by NICE.
>And has always failed when put to critical >thinking tests. Only people like Kirsch, who can >ignore his own antidepressants significantly >better than placebo result, one chance in 1000
>(or less) that it is not a "real difference", >support the equivalence theory.You really think Kirsh was the first one to suggest that the difference between AD's and placebos is small. Kirsh's applicaton of a 'clinical significance' threshold is not arbitrary. Didn't he borrow it from NICE?
>Nobody ever argued that drugs work for all >depressives, but the clear evidence is that they >robustly work for some of them.And placebos work for others.
>And, as the combination of e.g. psychotherapy >and antidepressant works better than either one >aloneThat is certainly not a repeated finding. It is, however, logical. If you were in a study that gave half the patients two placebos (two supposed AD's) and the other have one placebo. Who do you think would fair better? Its all relative.
>that convincingly shows (IMHO) that there is >more to antidepressant response than simply >obtaining placebo response
Placebo + CBT also works better than placebo alone.
>....otherwise, therapy plus antidepressant would >be the same as therapy alone.
Well logically therapy plus placebo should be the same as therapy alone, but it isn't.
>Plural of anecdote not data, again.
But I am not claiming its data. When you make a case statement that is what is meant to be.
>Further experimentation is indeed the answer. >Including different drugs, also, IMHO. No point >limiting treatment opportunities based on >thought experiments.
>Assuming that serotonin levels are the issue. >You argued alternative mechanisms, earlier. ;-)>Whatever works, works.I'm not here to tell people not to take what they believe helps them.
>Dismissing them outright is dangerous, IMHO. >Look at what happened to child suicide rates as >a result of the warnings. Better management is >the answer, not drug avoidance.
Thats a separate issue. Don't get me started. Its called relative deprivation. SSRI's have no proven antisuicide effect. Take a look at say, overall US data on child suicide rates from 1950-2003 what do you see?
Linkadge
Posted by SLS on April 20, 2008, at 12:33:56
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 20, 2008, at 9:04:23
I'm sure people have noticed that I'm having a bit of fun not seriously debating the issues surrounding the effectiveness of standard antidepressants. I don't really care to research psychiatric stuff anymore. I have no reason to at this juncture.
Mission accomplished. I did a hell of a good job.
It is not terribly important to me what anyone else believes, so long as it doesn't impact on my supply of effective mediation.
Besides, I have already argued these same issues before and have made my points eloquently. It was easy. The truth speaks for itself. The same people seem never to remember the results of previous debates. My previous posts can, hopefully, be found in the archives. It is easy to argue against the fallacy that drugs don't work. That's because they do. Isn't that silly? These drugs work, and some people want to argue them into disappearance. And all in the name of wanting to help me and you get well. How altruistic. <grin>
Antidepressants work. They can even bring people into complete remission. I just thought someone ought to know. It might be a matter of life and death.
Don't be a lemming following the pied-piper off a cliff. Often, people kill themselves before they reach bottom. Let the piper play his only one instrument alone.
- Scott
Posted by bulldog2 on April 20, 2008, at 13:08:52
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 20, 2008, at 12:33:56
feeling better off of meds is not the same as complete remission which is the goal of any treatment protocol. Many feel somewhat better for a while only to relapse later. There are probably millions of untreated people who drag themselves through each day feeling no joy or happiness. What does one do when all alternatives are exhausted? So you've tried diet and exercise, fish oil, sam-e, sjw, cbt etc and you still feel joyless. If you're lucky you may respond to one of the above.But some don't for one reason or another. So what are the options? A dreadful unhappy life and just accept that's the best you can do or try meds. Some on meds could not go to school or take part in a joyful life without them. I know meds don't work for everyone but let's not dismiss them as one of the options to explore.Also depressed people who are not in remission are more likely to self medicate with alcohol and or drugs.This is a complicated issue and can't be decided by individual stories.
Posted by SLS on April 20, 2008, at 13:52:56
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 20, 2008, at 13:08:52
> feeling better off of meds is not the same as complete remission which is the goal of any treatment protocol. Many feel somewhat better for a while only to relapse later. There are probably millions of untreated people who drag themselves through each day feeling no joy or happiness. What does one do when all alternatives are exhausted? So you've tried diet and exercise, fish oil, sam-e, sjw, cbt etc and you still feel joyless. If you're lucky you may respond to one of the above.But some don't for one reason or another. So what are the options? A dreadful unhappy life and just accept that's the best you can do or try meds. Some on meds could not go to school or take part in a joyful life without them. I know meds don't work for everyone but let's not dismiss them as one of the options to explore.Also depressed people who are not in remission are more likely to self medicate with alcohol and or drugs.This is a complicated issue and can't be decided by individual stories.
Agreed.For so many of my 25 years of failed treatment, I would try to keep 1-3 alternatives in waiting beyond my treatment at the time. That helped me push on. In this way, I always had a legitimate reason to have hope. Sighted hope. There were many time when I figured that I would have to carry on until some unknown new treatment came around. I had blind hope at these times. Where else could I possibly derive the drive to persist? I don't know. I really can't guarantee anything to anyone based upon my successful treatment, except that I made it my business to live long enough to see this day. 25 years. Hey, I might relapse by the time I get done typing this sentence. I have no guarantees for myself.
Let us not forget though, that where non-bipolar depression of the type you you describe, there are often depressive thought styles and situational sadnesses to be dealt with. The thing that always frustrates me is that we use one word, "depression" to describe both biological and psychological phenomena. It is important to understand that where non-bipolar depression is concerned, there is a spectrum of contribution. Some are all biological. Some are all psychological. But most of these depressions probably persist because of the interaction of both.
I don't know what to say.
I think most people here know that I pray that we all get well; even the trolls. In my 25 years of treatment, I have learned that more people can get well than fail to get well with the treatments that are currently available. This will be more true with each new treatment that becomes available.
There is so much to be done. In the meantime, make it your business to stay as positive and constructive as possible. As impaired as I was, I made it my moment by moment goal to use all of what God gave me to work with.
- Scott
Posted by bulldog2 on April 20, 2008, at 14:23:24
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 20, 2008, at 13:52:56
Do you find it difficult to eat out? You never really now what they put in the food. At home I can control things. Any weight gain on Nardil?
Posted by SLS on April 20, 2008, at 14:37:53
In reply to To Scott - Diet On Nardil, posted by bulldog2 on April 20, 2008, at 14:23:24
> Do you find it difficult to eat out?
No. But I do have to ask the restaurant staff what kinds of cheese they use. The processed cheeses have never given me a problem. American and mozzerella are OK. Blue cheese is definitely contraindicated. Parmesan is out. (Not to be confused with parmigiana, which is a style of dish using mozzarella).
> Any weight gain on Nardil?
Nardil + nortriptyline are particularly difficult drugs to maintain weight on. However, now that I am responding to treatment so well, I believe my BMR has increased. I am now losing the weight that I had put on. I did have to change my eating habits. Small, more frequent meals. When I lose 40 lbs, I'll let you know. I really did not watch my caloric intake previously. Eating large dinners really did me in. There is a tendency towards carbohydrate cravings. Eat some and wait 10 minutes to see if your hunger doesn't abate. It should.
- Scott
Posted by Phillipa on April 20, 2008, at 19:31:28
In reply to Re: Wierd Some I know In real Life Feel Better off ADs, posted by bulldog2 on April 20, 2008, at 8:53:43
Bulldog I have seen a few chiropractors during nursing school although felt well shoulder pain elicited a visit to one. Wonderful the stimulating divice he used and manipulations. Problem now with that is my vertabrae forced the last chiro to say he would no longer treat me go to an ortho. Did and what a mistake. Heard there was good one here don't if accepts medicaire. Did get a heating pad again and that helps. Organic food is a waste of money in my opinion although I am a healthy eating can't justify the higher costs. And those people I spoke of are truly happy, smiling faces, outside planting flowers, hosting parties. The behavior is proof to me that for some it is quite possible. Love Phillipa
Posted by Racer on April 20, 2008, at 19:51:12
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by Larry Hoover on April 19, 2008, at 16:44:39
> >... the plural of anecdote is not data.
That one line cracked me up. I laughed so hard my husband had to come out to see what caused those strange sounds -- and while he didn't laugh out loud, he smiled quite broadly.
Thank you for both a very good point made, and a very good laugh.
And, of course, for your well reasoned arguments in this thread.
Posted by Dr. Bob on April 21, 2008, at 8:55:53
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 20, 2008, at 13:52:56
> I do not want to inhabit a playground for people with personality disorders.
>
> Betula> You have an entirely naive belief in what transpires during peer review.
>
> Lar> Larry is the only one with any brains here
>
> Linkadge> The same people seem never to remember the results of previous debates.
>
> Don't be a lemming following the pied-piper off a cliff.
>
> ScottPlease don't post anything that could lead others to feel accused or put down.
But please don't take this personally, either, this doesn't mean I don't like you or think you're bad people.
I encourage anyone who has questions about this or about posting policies in general, or is interested in alternative ways of expressing themselves, to see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Thanks,
Bob
Posted by 49er on April 21, 2008, at 17:26:09
In reply to They just don't work. FACT., posted by Betula on April 16, 2008, at 11:51:18
For those you not familiar with my story, I am a long term user of antidepressants who started tapering off of my meds in 2006 due to developing horrific side effects. Withdrawal hasn't been easy even doing it very slowly but I definitely feel alot better. I wanted to respond to the various issues that were raised.
Effectiveness - Lar, I am going to even attempt to refute you on Kirsh's studies because I would lose big time <smile>. However, the Star-D study revealed a 33% success rate which isn't exactly stellar. Some researchers were even mentioning a lower rate but to be fair, I will leave at at the 33% rate.
On the National Institute of Mental Health Website, it states a 50% success rate for a 50% reduction of symptoms. If you're going for complete remission, the success rate is even lower.
If those figures were alot higher, than I might think Kirsh was off target. But in light of that fact they aren't and because of the arguments presented by Linkage and Betula, I definitely agree with him.
I also think effectiveness has a different meaning for everyone.
Some might say they were effective for me. But as Betula mentioned about SSRIS, these meds made me so apathetic that I let so many things slide in my life. But what is scarier is I didn't realize what these meds were doing until I started tapering.Jealousy - I am not jealous at all of people whose meds work. To be honest, I am thankful everyday that I saw the light on what these meds were doing to me before it was too late. I suffered a mild to moderate hearing loss from Remeron, tinnitus, memory loss, executive function problems, and worsening in general of LD symptoms.
I have read on other boards that people would still chose meds for a good quality of life even if they knew there were be horrific side effects down the road. Well, in the 12 years, I was on meds, I really only had 1.5 great years. So I don't feel that is a reasonable trade-off.
Relapses - I hate to sound like broken record but in my opinion, which is backed by the registered nurse who runs the Paxil Progress Boards, most withdrawal symptoms are commonly confused as a relapse. Doctors unintentionally advocate a way too fast tapering system.
Whether I am a bad influence and discouraging people - To quote Bob, Don't necessarily believe everything you hear. Your mileage may vary. The only posts I take responsibility for are my own.
Obviously, everyone on this board has to make up their own mind what works for them. But please don't accuse me of being a troll because I chose a different path. We all want the same thing even if we go about it differently.
49er
Posted by Phillipa on April 21, 2008, at 19:09:20
In reply to Re: They just don't work. FACT., posted by 49er on April 21, 2008, at 17:26:09
Exactly the same thing that happened to my next door neighbor. She weaned off the ad's and now needs less of the high dose xanax she'd been on for years. Her energy level is incredible. And she's a teacher. Love Phillipa ps the weaning was from the same pdoc I saw who had me doing the same thing. She did it. I quit too early.
Posted by Larry Hoover on April 21, 2008, at 19:11:50
In reply to Re: They just don't work. FACT., posted by 49er on April 21, 2008, at 17:26:09
You know what? My intent was not to convince anyone to believe in drugs. It was to clear up the erroneous statements being made in the guise of being scientific findings. The truth is in the data.
It seems to me that people believe what they want to believe, notwithstanding the truth.
> Effectiveness - Lar, I am going to even attempt to refute you on Kirsh's studies because I would lose big time <smile>. However, the Star-D study revealed a 33% success rate which isn't exactly stellar. Some researchers were even mentioning a lower rate but to be fair, I will leave at at the 33% rate.
Just for the record, the main outcome measure of STAR*D: "The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%."
I think you will find the remission rate was 67%, not 33%.
> On the National Institute of Mental Health Website, it states a 50% success rate for a 50% reduction of symptoms. If you're going for complete remission, the success rate is even lower.
And what is the practical alternative? There is no placebo treatment protocol available to the general public. It is an artefact of the double-blind drug trial process.
> If those figures were alot higher, than I might think Kirsh was off target.
My argument is not with respect to the magnitude of the response to drugs, it is that is superior to placebo.
> But in light of that fact they aren't and because of the arguments presented by Linkage and Betula, I definitely agree with him.
What specifically do you agree with?
> I also think effectiveness has a different meaning for everyone.
And it's hard to understand another's success, if you have not tasted of it yourself. I do understand.
> Some might say they were effective for me. But as Betula mentioned about SSRIS, these meds made me so apathetic that I let so many things slide in my life. But what is scarier is I didn't realize what these meds were doing until I started tapering.
I don't stay on them, for just those reasons.
> Jealousy - I am not jealous at all of people whose meds work. To be honest, I am thankful everyday that I saw the light on what these meds were doing to me before it was too late. I suffered a mild to moderate hearing loss from Remeron, tinnitus, memory loss, executive function problems, and worsening in general of LD symptoms.
I want to raise another concern of mine, one that is seldom appreciated. Antidepressants have never been shown to be complete treatments for the symptoms of depression. Functional MRI and SPECT scans of brain function both show that regions of dysfunction remain, even if the subject is in full remission of depressive symptoms. Antidepressants drive normalization of some functions, but the underlying disease process continues in other respects. Appart from tinnitus (which can come from NSAIDS, as an example), the symptoms you describe can be ascribed to depression. I'm not saying that they are depression, and not drug-related. I'm suggesting that there is no way to discriminate between the options.
> I have read on other boards that people would still chose meds for a good quality of life even if they knew there were be horrific side effects down the road. Well, in the 12 years, I was on meds, I really only had 1.5 great years. So I don't feel that is a reasonable trade-off.
I wish you'd had greater success.
> Relapses - I hate to sound like broken record but in my opinion, which is backed by the registered nurse who runs the Paxil Progress Boards, most withdrawal symptoms are commonly confused as a relapse. Doctors unintentionally advocate a way too fast tapering system.That's why we're here, to offer better advice. ;-)
> Whether I am a bad influence and discouraging people - To quote Bob, Don't necessarily believe everything you hear. Your mileage may vary. The only posts I take responsibility for are my own.
>
> Obviously, everyone on this board has to make up their own mind what works for them. But please don't accuse me of being a troll because I chose a different path. We all want the same thing even if we go about it differently.
>
> 49erI'm glad you joined the discussion.
Lar
Posted by Larry Hoover on April 21, 2008, at 19:19:54
In reply to I think you should know... » Larry Hoover, posted by Racer on April 20, 2008, at 19:51:12
> > >... the plural of anecdote is not data.
>
> That one line cracked me up. I laughed so hard my husband had to come out to see what caused those strange sounds -- and while he didn't laugh out loud, he smiled quite broadly.
>
> Thank you for both a very good point made, and a very good laugh.You're welcome. I regret, I am not the originator. I can't remember were I first saw it, but it stuck in my brain.
> And, of course, for your well reasoned arguments in this thread.
Thank you.
Lar
Posted by bulldog2 on April 21, 2008, at 19:57:05
In reply to Re: I think you should know... » Racer, posted by Larry Hoover on April 21, 2008, at 19:19:54
Another thought on the subject..Maybe the fact that one felt so much better when off of them (ADS)shows they did work to some degree. One felt depressed enough to go on a med for a period of time..The depression improves but one is still left with annoying side effects. You stop the ad and you now have no side effects so you feel even better..
Now the question is now that you have stopped your ad do you feel better than before even starting the med? AD's don't have to be used permanently by everyone. Some are useful for short term situations. Maybe they shock the brain out of depression the way that ect might do.
Posted by Phillipa on April 21, 2008, at 20:05:56
In reply to Re: I think you should know..., posted by bulldog2 on April 21, 2008, at 19:57:05
Bulldog that is a good thought I like it. My example is a person who experienced corneal problems and her eyes crossed and she had surgery which corrected the problem but it flung her into depression at the time. She just continued on the meds. Now it's a thing of the past and she's physically fine. Like a cancer patient that is in remission maybe? Love Phillipa
Posted by Phillipa on April 21, 2008, at 20:45:43
In reply to Re: They just don't work. FACT., posted by 49er on April 21, 2008, at 17:26:09
49er could you post the link to the paxil support group please as have samples would like to check it out thanks Phillipa
Posted by undopaminergic on April 22, 2008, at 6:41:19
In reply to Question For Scott, posted by bulldog2 on April 19, 2008, at 15:02:40
>
> Currently doing deplin + Sam-e and getting a decent response thought not in remission.
>Have you tried adding pyridoxine, NADH, and other important vitamins and cofactors?
Why Sam-e, by the way? SAMe would be more appropriate, as it's an acronym for S-adenosylmethionine, which refers to methionine with an adenosyl-group attached at the sulphur (S) atom.
Posted by bulldog2 on April 22, 2008, at 6:55:18
In reply to Re: Question For Scott, posted by undopaminergic on April 22, 2008, at 6:41:19
> >
> > Currently doing deplin + Sam-e and getting a decent response thought not in remission.
> >
>
> Have you tried adding pyridoxine, NADH, and other important vitamins and cofactors?
>
> Why Sam-e, by the way? SAMe would be more appropriate, as it's an acronym for S-adenosylmethionine, which refers to methionine with an adenosyl-group attached at the sulphur (S) atom.Might be dropping both for a while..Deplin becomes SAMe so it is overkill to run both. Also noticed just the deplin alone was causing agitation and insomnia..Running Memantine with the deplin was muddying the waters. Will clean out and restart memantine.
Posted by undopaminergic on April 22, 2008, at 10:04:01
In reply to Re: Question For Scott » bulldog2, posted by SLS on April 19, 2008, at 15:13:16
>
> > Also at lower doses is there less chance of a hypertensive crisis if I eat the wrong foods.
>
> In reality, it depends on the percentage of MAO being inhibited in the gut. I don't happen to know what the threshold is for reducing the tyramine reaction.
>Probably the worst thing to do with regard to minimising the inhibition of gut and liver MAO is to take a single large oral dose of a MAOI, as that would lead to the highest concentrations of the inhibitor precisely in the gut and liver, before the drug is absorbed into the blood stream and greatly diluted.
Since the type A isoform of MAO predominates in the gut, MAO-B preferring inhibitors are less effective at increasing sensitivity to dietary tyramine. However, the subtype selectivity of MAOIs is dose-dependent.
Transdermal and sublingual absorption can be used to reduce exposure of gut/liver MAO to the inhibitor, while maintaining efficacy and possibly reducing the effective dose - especially in the case of highly metabolised MAOIs such as selegiline. Divided oral doses should theoretically reduce gut drug concentration in comparison with a single oral dose.
Co-administration of noradrenaline reuptake inhibitors (NRIs) reduces the sensitivity to tyramine that has been absorbed into the blood stream. In the selection of a NRI, it's important to avoid those also potently inhibiting serotonin reuptake. There is a shortage of information available on this strategy, due to long-standing fears that this combination might precipitate serious hypertensive reactions.
There is some evidence that the slow-acting rasagiline-derived MAOI (and acetylcholinesterase inhibitor) ladostigil can be taken orally without significantly affecting gut MAO while achieving high degrees of brain MAO-A and -B inhibition. Of course, this compound is still only available as the raw active ingredient.
Finally, it should be noted that there are differences in individual vulnerabilites. In studies using the 12 mg/24 h selegiline patch, 3 people (of 11) had significant (>30 mmHg) hypertensive responses to 25 mg doses of oral tyramine, whereas some required well over 90 mg. Co-administration of food increased the effective dose of tyramine by more than 100 mg. According to the same source (EMSAM prescribing info), a high-tyramine meal contains up to 40 mg.
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