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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by Converted on May 19, 2009, at 8:05:33
I've always been highly skeptical of the claimed efficacy of SSRIs, for reason that most of you are probably familiar with. These include (1) selective publication of study results by pharmaceutical companies, (2) numerous studies showing similar efficacy to placebos, (3) scanty evidence for the monoamine hypothesis of depression, and (4) aggressive and deceptive SSRI marketing practices by pharmaceutical companies.
But after my depression became so severe that it cost me my job this February, I finally sought psychiatric help out of desperation. I told the doctor that I would take Zoloft as she recommended, but that I had no confidence it would work. Omitting many important details, the short story is that over 14 weeks (with the addition of Wellbutrin) I slowly but surely progressed from constant suicidal ideation to emotional stability; furthermore, I now feel more emotionally sound than I have in perhaps 5 years.
Now I don't know what to think about these meds!
Posted by SLS on May 19, 2009, at 9:14:36
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
> I've always been highly skeptical of the claimed efficacy of SSRIs, for reason that most of you are probably familiar with. These include (1) selective publication of study results by pharmaceutical companies, (2) numerous studies showing similar efficacy to placebos, (3) scanty evidence for the monoamine hypothesis of depression, and (4) aggressive and deceptive SSRI marketing practices by pharmaceutical companies.
>
> But after my depression became so severe that it cost me my job this February, I finally sought psychiatric help out of desperation. I told the doctor that I would take Zoloft as she recommended, but that I had no confidence it would work. Omitting many important details, the short story is that over 14 weeks (with the addition of Wellbutrin) I slowly but surely progressed from constant suicidal ideation to emotional stability; furthermore, I now feel more emotionally sound than I have in perhaps 5 years.
>
> Now I don't know what to think about these meds!
Why bother thinking at all?Your comments regarding skepticism are lucid and make for good debate.
It is what it is. You are feeling better. Do what works.
- Scott
Posted by Phillipa on May 19, 2009, at 10:39:48
In reply to Re: A converted SSRI skeptic » Converted, posted by SLS on May 19, 2009, at 9:14:36
Hey I think it's great. You're one of the ones they work for. Just continue doing what you doing. Love Phillipa
Posted by Relapse on May 19, 2009, at 12:16:30
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
converted,
Man I am happy to hear it. I'm on 150mg. The real kick that seemed to get mine going was augmenting with 600mg of lithium. I also take 200mg of Seroquel. I have tried about every ssri over the last 15 years and Zoloft seems to be the only one that works for me. This is certainly not scientific, but I think Zoloft has become the most prescribed ssri because it works relatively well on a wide range of symptoms. I know there are other factors, generic, age of drug, marketing etc. But still it seems to be the more successful ssri. That said, it is subject to poop out. With the help of the "staff" here at PB - as mine starts to slip, I will be looking at some of the older drugs to rotate to. Then keep Zoloft in my back pocket to come back to if the other drugs lose there effectiveness. Hope it keeps working for you.
David
Posted by SLS on May 19, 2009, at 12:42:27
In reply to Re: A converted SSRI skeptic, posted by Relapse on May 19, 2009, at 12:16:30
> converted,
> Man I am happy to hear it. I'm on 150mg. The real kick that seemed to get mine going was augmenting with 600mg of lithium. I also take 200mg of Seroquel. I have tried about every ssri over the last 15 years and Zoloft seems to be the only one that works for me. This is certainly not scientific, but I think Zoloft has become the most prescribed ssri because it works relatively well on a wide range of symptoms. I know there are other factors, generic, age of drug, marketing etc. But still it seems to be the more successful ssri. That said, it is subject to poop out. With the help of the "staff" here at PB - as mine starts to slip, I will be looking at some of the older drugs to rotate to. Then keep Zoloft in my back pocket to come back to if the other drugs lose there effectiveness. Hope it keeps working for you.
> David
If you begin to get diminishing returns, you might think about adding either Wellbutrin or nortriptyline to the Zoloft before searching for another SRI drug (includes SSRIs, Effexor, Pristiq, and Cymbalta)
- Scott
Posted by Zana on May 19, 2009, at 14:31:52
In reply to Re: A converted SSRI skeptic » Relapse, posted by SLS on May 19, 2009, at 12:42:27
Don't forget my personal favorite: Provigil. Underutilized, I swear.
Zana
ps Pristiq is an SSRI/SNRI.
Posted by SLS on May 19, 2009, at 15:29:10
In reply to Re: A converted SSRI skeptic, posted by Zana on May 19, 2009, at 14:31:52
> Don't forget my personal favorite: Provigil. Underutilized, I swear.
Hmm. You might be right about that. I know someone for whom it has been a life saver.
> ps Pristiq is an SSRI/SNRI.
I use the the acronym "SRI" to denote any of the drugs with strong serotonin reuptake inhibition properties, which includes the SNRIs. I usually do not think of clomipramine as a SRI, but it certainly qualifies. Sometimes, the categorization of antidepressant drugs as it is now seems primitive in that each drug has so many different and varying properties (many of which have yet to be elucidated). Each "SSRI" is a drug with properties different from all the others. This is why it makes sense to have as many drugs as possible available in the psychiatric arsenal. I am not averse to having more SSRIs come to market. There are always people who will respond to new drug whom did not respond to the others. How does it hurt anyone to have more drugs of the "same type" available? I don't care if a drug is labeled a "me too" drug by the lay public. To practitioners of medicine and their patients, it is another tool to work with.
- Scott
Posted by desolationrower on May 19, 2009, at 17:26:46
In reply to Re: A converted SSRI skeptic, posted by SLS on May 19, 2009, at 15:29:10
> > Don't forget my personal favorite: Provigil. Underutilized, I swear.
>
> Hmm. You might be right about that. I know someone for whom it has been a life saver.
>
> > ps Pristiq is an SSRI/SNRI.
>
> I use the the acronym "SRI" to denote any of the drugs with strong serotonin reuptake inhibition properties, which includes the SNRIs. I usually do not think of clomipramine as a SRI, but it certainly qualifies. Sometimes, the categorization of antidepressant drugs as it is now seems primitive in that each drug has so many different and varying properties (many of which have yet to be elucidated). Each "SSRI" is a drug with properties different from all the others. This is why it makes sense to have as many drugs as possible available in the psychiatric arsenal. I am not averse to having more SSRIs come to market. There are always people who will respond to new drug whom did not respond to the others. How does it hurt anyone to have more drugs of the "same type" available? I don't care if a drug is labeled a "me too" drug by the lay public. To practitioners of medicine and their patients, it is another tool to work with.
>
>
> - Scottanother sri is another sri you have to give 4 weeks to before you get through them all and your pdoc agrees to let you try somethign other than an sri
-d/r
Posted by sowhysosad on May 19, 2009, at 19:32:38
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
It's interesting that there was no "placebo effect" at all in your case as you didn't expect it to work, and yet it did!
> I've always been highly skeptical of the claimed efficacy of SSRIs, for reason that most of you are probably familiar with. These include (1) selective publication of study results by pharmaceutical companies, (2) numerous studies showing similar efficacy to placebos, (3) scanty evidence for the monoamine hypothesis of depression, and (4) aggressive and deceptive SSRI marketing practices by pharmaceutical companies.
>
> But after my depression became so severe that it cost me my job this February, I finally sought psychiatric help out of desperation. I told the doctor that I would take Zoloft as she recommended, but that I had no confidence it would work. Omitting many important details, the short story is that over 14 weeks (with the addition of Wellbutrin) I slowly but surely progressed from constant suicidal ideation to emotional stability; furthermore, I now feel more emotionally sound than I have in perhaps 5 years.
>
> Now I don't know what to think about these meds!
Posted by linkadge on May 19, 2009, at 19:40:05
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
Good luck dealing with SSRI poop out.
Linkadge
Posted by SLS on May 19, 2009, at 20:23:37
In reply to Re: A converted SSRI skeptic, posted by linkadge on May 19, 2009, at 19:40:05
> Good luck dealing with SSRI poop out.
>
> Linkadge
Good luck in not dealing with SSRI success stories.
- Scott
Posted by SLS on May 20, 2009, at 4:47:18
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
Someone mentioned SSRI poop-out.
We know that this is a possibility, but not an inevitability.
Take one step at a time. Even Nardil poops-out for a sizable percentage of users. So even the mighty MAOIs are capable of losing their efficacy over time.
I wish you good luck - just plain old sincere good luck.
- Scott
Posted by sowhysosad on May 20, 2009, at 5:34:53
In reply to Re: A converted SSRI skeptic » linkadge, posted by SLS on May 19, 2009, at 20:23:37
> > Good luck dealing with SSRI poop out.
> >
> > Linkadge
>
>
> Good luck in not dealing with SSRI success stories.
>
>
> - ScottQuite!
How sad that some people can't celebrate others' success in treating their depression (not to mention the fact that many people never experience anything approaching "poop-out").
I'm really pleased you're in remission Converted. What an inspiring story.
Posted by raisinb on May 20, 2009, at 22:04:46
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
I'm a big fan of Zoloft. And the Zoloft + Wellbutrin combo also worked very well for me. Zoloft has been the only thing that's worked for me consistently and well. I'm glad you are feeling so well!
Posted by floatingbridge on May 20, 2009, at 22:23:43
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
> I've always been highly skeptical of the claimed efficacy of SSRIs, for reason that most of you are probably familiar with. These include (1) selective publication of study results by pharmaceutical companies, (2) numerous studies showing similar efficacy to placebos, (3) scanty evidence for the monoamine hypothesis of depression, and (4) aggressive and deceptive SSRI marketing practices by pharmaceutical companies.
>
> But after my depression became so severe that it cost me my job this February, I finally sought psychiatric help out of desperation. I told the doctor that I would take Zoloft as she recommended, but that I had no confidence it would work. Omitting many important details, the short story is that over 14 weeks (with the addition of Wellbutrin) I slowly but surely progressed from constant suicidal ideation to emotional stability; furthermore, I now feel more emotionally sound than I have in perhaps 5 years.
>
> Now I don't know what to think about these meds!Wow! I mean, I'm sorry that you've had a long, difficult time, but to experience meds success so quickly--that's truly great.
Candace
Posted by Neal on May 23, 2009, at 1:27:04
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
Talking in the abstract here and not recommending any changes or be a killjoy.
Scientifically speaking, 14 weeks is almost 4 months and I seem to remember reading something about the course of most depressive episodes running 4 to 6 months. My question is: Is there a chance this individual's depression could have gotten better on it's own in that amount of time?
Posted by SLS on May 23, 2009, at 5:35:38
In reply to Re: A converted SSRI skeptic, posted by Neal on May 23, 2009, at 1:27:04
> Talking in the abstract here and not recommending any changes or be a killjoy.
>
> Scientifically speaking, 14 weeks is almost 4 months and I seem to remember reading something about the course of most depressive episodes running 4 to 6 months.I wasn't aware of this statistic.
> My question is: Is there a chance this individual's depression could have gotten better on it's own in that amount of time?
Of course.
That's one reason why it is so important to develop a historical life chart of prior illness. If there hasn't been any previous episodes of depression, it is reasonable to treat for 6-9 months once remisson is achieved. Of course it might take several weeks to reach the point of remission.
If there is another occurrence, the treatment protocol can be reinitiated, with treatment of 12-18 months. However, if the depression recurs more than 3 times or if the depression is chronic, long-term treatment is indicated. I guess that means a few years to indefinite.
The attending doctor might decide that the patient is depressed, but that he might not fit the criteria nor have the history to indicate a diagnosis of major depressive disorder. He might, instead, recommend that psychotherapy is an appropriate treatment. If the doctor is really good, he will schedule a follow up appointment in 6 months for a reevaluation.
- Scott
Posted by Neal on May 24, 2009, at 18:08:12
In reply to Re: A converted SSRI skeptic » Neal, posted by SLS on May 23, 2009, at 5:35:38
Thanks Scott
And as follow up to my post and to anyone reading, I don't mean to imply that ADs don't work. I am proof that they do.
I was just trying to work out an obscure point of curiosity, which I'm probably belaboring.
Posted by SLS on May 24, 2009, at 19:29:02
In reply to Re: A converted SSRI skeptic » SLS, posted by Neal on May 24, 2009, at 18:08:12
> Thanks Scott
>
> And as follow up to my post and to anyone reading, I don't mean to imply that ADs don't work. I am proof that they do.
>
> I was just trying to work out an obscure point of curiosity, which I'm probably belaboring.
No. Not at all. I neglected to address the question of whether or not it makes sense to wait some amount of time before deciding that a biological treatment is necessary. I guess the main criteria is safety. If someone is not likely to harm himself or others, I guess it really doesn't hurt to wait if that were their wish. Of course, it is sometimes surprising to learn how close someone has come to suicide without anyone around them knowing it.I fully appreciate the desire to avoid medical treatment. I would if I thought I had no better choice. However, my medical history and case profile leave me with few alternatives.
I rejected my very first antidepressant treatment when I was 15 years old. My GP gave me Pamelor (nortriptyline) to address my complaints of depression and fatigue. I hated the idea of taking any drug, and stopped taking it within the first week. I thought I was smart. One of the side effects listed for nortriptyline was hypoglycemia. I had already been diagnosed with hypoglycemia, and I didn't think it made sense to take a drug that would exacerbate it. Little did I realize that the depression was the real culprit in producing my feelings of fatigue rather than hypoglycemia. I think everyone was diagnosed with hypoglycemic back then, anyway.
As the years progressed, so did my symptomology. One day, I experienced a paroxysmal switch into severe depression, and that was the beginning of decades of unrelenting bipolar depression. I was 17, and was in the middle of a math class. It happened that quick. It wasn't until I was 22 that I even heard of biological affective disorders. I had been to a few psychotherapists previously without any improvement. All I had to do was to read the book "Mood Swing" by Ronald Fieve, and everything came together for me. Everything made sense. I went to a depression research program at Columbia Presbyterian in New York. They diagnosed me as having atypical unipolar depression. I had never shown any manic episodes up until then, so this seemed quite appropriate to me.
The bottom line is that I had already been chronically and severely depressed for 5 years by the time I was diagnosed. I couldn't live that way, so the decision to accept their antidepressant drug treatment seemed like the best course of action. I didn't want to wait any longer than I already had.
One of the things that angered me once I discovered what illness I had was that it was beyond my control to work my way out of it psychologically. If Columbia had told me that I might get well with some new type of psychotherapy, I would have done so in order to avoid taking drugs. I didn't want to be tethered to some foreign substance in order for me to live a happy and productive life. It was a matter of control. I wanted to be independent of all external agents, which included drugs and psychotherapy. However, I was willing to do as much remediation as was necessary to gain this independence.
I was convinced that I had an affective disorder before being officially diagnosed by Michael Liebowitz. I needed to wait a few months between diagnosis and beginning treatment. During that time, I began to observe my illness as objectively as possible. It was a no-brainer to see that I had a biological illness because I was an ultra-rapid cycler. Switches between euthymia and depression occurred every 11 days like clockwork. The amount of time it took to switch from one pole to the other was an astounging 30-45 minutes. Yes. By the time I was to be treated, I was fully ready to accept drug therapy.
I don't fault anyone for wanting to wait-out a depression. I would just recommend that one does not fix blame upon themselves for feeling depressed. It might perpetuate the depression or make it worse. It doesn't matter whether the cause for the depression is biological or psychological, the depression is the culmination of events that shape the way someone evolves as a human being, much of which occurs beyond the control of the individual.
The decision to treat or not to depression with drugs is a multifactorial one. It depends on so many variables. I would not recommend a single treatment protocol for each person who describes themselves as being depressed.
- Scott
Posted by linkadge on May 24, 2009, at 20:28:11
In reply to Re: A converted SSRI skeptic » Neal, posted by SLS on May 24, 2009, at 19:29:02
I cylcle between severe depression and euthymia too - all the time. It is quite dramatic. I refuse to call it bipolar disorder however (for starters because I've been on every mood stabilizer and they don't do anything) but also because not all doctors think this is bipolar.
I think I have recurrent breif depression. I've also had much more sucess treating my moods ad lib with different agents than I have by taking mood stabilizers on a regular basis.
Linkadge
Posted by Neal on May 26, 2009, at 23:26:42
In reply to Re: A converted SSRI skeptic » Neal, posted by SLS on May 24, 2009, at 19:29:02
_
The reason I originally asked the question about how do you know if the AD worked or if it was "time's healing hand" was that I was once in a similar situation and later I wondered about it, that's all. But generally I've been a quick responder, in on case about 3 days to a week between the pits and feeling much better.I certainly don't advise anyone not to seek treatment or wait it out. In some cases the wait can be months, but I have read that episodes are "episodes", ie. they have a time window. But anyone with more than one episode is taking a chance if they don't seek treatment, as they tend to get longer.
BTW, how's it been goin lately? I know you were having a hard time for a while.
_
Posted by SLS on May 27, 2009, at 5:37:11
In reply to Re: A converted SSRI skeptic » SLS, posted by Neal on May 26, 2009, at 23:26:42
> BTW, how's it been goin lately? I know you were having a hard time for a while.
Well, I'm not in too bad a shape. I am looking for much more, though. If I were even 50% improved, I would return to work. The addition of memantine (Namenda) proved to be a failure. In fact, it made me feel significantly worse. When I came off of it, I had to wait a few days for my condition to rebound, as memantine has such a long half-life (60-80 hours). This time, I experienced a rebound improvement that lasted for 2-4 days. It was nice while it lasted. I see my doctor today. I'm going to ask to try Topamax again. The last time I tried it, I had not been on Parnate and nortriptyline, so I consider it a new trial.
Thanks for asking.
:-)
- Scott
Posted by Neal on May 28, 2009, at 1:48:27
In reply to Re: A converted SSRI skeptic » Neal, posted by SLS on May 27, 2009, at 5:37:11
you should get some kind of medal for what you do on this board . . . you've affected lives for the better, mine included. I hope you remember that from time to time.
Posted by SLS on May 28, 2009, at 4:55:26
In reply to Re: A converted SSRI skeptic » Neal, posted by SLS on May 27, 2009, at 5:37:11
Hi Neal.
Thanks for the flattering complements. If I genuinely help even one person, that is plenty of reward for me. It is good that you said something, though. I often think my words travel the Internet without much import.
I started a thread below raising the possibility that being switched to a generic version of Lamictal last month might be the culprit in my not feeling so well. I have decided to take the original brand name version for a week to see what happens. I have some 150mg tablets that I can split. I had been doing well at 200mg per day. Now, I have to reevaluate my negative experience while I was taking memantine (Namenda). Was it the generic lamotrigine or the memantine that made me feel worse? It is quite possible that it was both. I am going to add back the memantine at some point to find out. If that proves unsuccessful, then I can move on to adding Topamax (topiramate). After that, I don' know what to do. Maybe I'll actually let my doctor do all the talking next time. :-)
- Scott
Posted by Elanor Roosevelt on May 31, 2009, at 21:02:40
In reply to A converted SSRI skeptic, posted by Converted on May 19, 2009, at 8:05:33
I now feel more emotionally sound than I have in perhaps 5 years.
>
>
This is great news
I hate Zoloft myself but it helped one of my sisters for over 20 yearsenjoy
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