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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Bob on February 18, 2010, at 16:55:13
Don't know if this has been posted before, but this article brings up issues that should be well known by now. Kinda scary that the apathy issue isn't considered an absolute given for a certain percentage of people by now.
Physicians Are Talking About: Selective Serotonin Reuptake Inhibitors and the Choice to Numb Out
Nancy R. Terry
Posted: 02/18/2010
Selective serotonin reuptake inhibitors (SSRIs), mainstays of psychopharmacology, effectively eliminate suicidal ideation -- not to mention feelings of exhilaration, caring, and desire.A recent study published in the British Journal of Psychiatry found that the majority of patients taking SSRIs experienced emotional detachment, feelings of indifference, personality changes, and a reduction in positive and negative emotions.[1]
Currently, tens of millions of patients in the United States take SSRIs daily. However, evidence pertaining to the long-term effects of these drugs is scant. "In a few decades, as many as 15% of the world's population might be on SSRIs," comments a psychiatrist. "Although the suicide rate might decrease, I wonder what the long-term effect will be."
The conjecture posited on Medscape's Physician Connect (MPC), an all-physician discussion board, launches a discussion about the apparent choice in SSRI use -- to be crippled by depression or functional and emotionally numb.
MPC contributors commented that their anecdotal experience aligns with that of the British study.
"In several patients on long-term SSRIs, I have noticed some subtle personality changes," says a psychiatrist. "Of course, there's no way of ascertaining cause and effect without a good, long-term study, but this is what I've observed: (1) SSRIs decrease pain (irritability, depression) but also seem to increase the threshold for what constitutes an exciting event (a person needs more novelty than previously for the same effect); and (2) SSRIs increase apathy and have the potential to decrease empathy."
"It would be unrealistic," adds another psychiatrist, "to think that taking a medication which significantly impacts a major neurotransmitter would not have, in some cases if not many, a significant effect on a person's personality, either short- or long-term." The psychiatrist comments that case studies documented in Peter Kramer's book Listening to Prozac indicate that SSRIs strongly impact a patient's feeling of "caring," which can affect the patient's relationships with friends and family.
An endocrinologist suggests that his colleagues view the film Numb, which documents filmmaker Phil Lawrence's struggle to stop taking the popular SSRI Paxil. In the trailer for the film, Lawrence says, "I'm flatlined. This isn't me. This is me on Paxil®."[2]
"These are the wonder drugs of psychiatry," argues a psychiatrist. "They continue to benefit people over the long term, even at low doses. They help with anxiety, much more robustly than with depression, but they help in depression too. If I had my way Prozac®, Zoloft®, and Celexa® would be sold over the counter." The psychiatrist comments that the life-time prevalence of depression is between 15% and 30%,[3] and most people remain untreated for fear of persecution and judgment formation about their need to take antidepressant drugs. Over-the-counter distribution, he reasons, would make SSRIs more readily available to people who need them.
"I disagree about the OTC [over-the-counter] issue," replies Stephen Grcevich, MD, a child and adolescent psychiatrist. "I think there are untoward effects of SSRIs that are still poorly understood, such as the very small but statistically significant risk of suicidal behavior in persons aged 25 and under. We also saw a subgroup of kids who displayed significant disinhibition and indifference to academics in a large, open-label, federally funded study looking at SSRI safety." He comments that he hopes to present the study data at the 2010 annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP).
An internist who frequently prescribes SSRIs, reports that she repeatedly experienced suicidal thoughts while taking an SSRI for depression. "I have been placed by my physician on Lexapro® 3 times. In each instance, my mood lifted and crying decreased. I could sleep. In 3 days' time, I started having thoughts that came out of the blue, such as 'I want to drive off this bridge.' Stopping the medication stopped the thoughts." She says that she tells her patients about this potential side effect, but no patient has related having a similar response.
"SSRIs and then SNRIs [serotonin noradrenaline reuptake inhibitors] nearly killed me," says an obstetrician/gynecologist. "They caused narcolepsy, and I fell asleep and drove off the road." He comments that his level of apathy while taking the drugs was so extreme as to appear parkinsonian. "In my opinion as a patient, mild to moderate depression should be treated by cognitive behavioral therapy, not meds."
A surgeon comments that, in many cases, SSRIs are given to patients who are only mildly depressed. "The drugs are given as mood elevators," he says. "We essentially are giving out the drug for the same reason people self-medicate or abuse alcohol."
"I do agree we are pushed to start meds too early on mild cases sometimes," says a family medicine physician. "We must ask the tough questions of patients about suicidal thoughts to determine the severity of their illness. Then start a multipronged approach to treatment and not just write a script and send them out the door."
A neurosurgeon comments that clearly there are a number of questions about SSRIs that need to be addressed:
Should we treat mild depression knowing the risks?
Are we educating patients about the possibility that they will experience apathy?
Are we increasing the risk for substance abuse in patients who attempt to counterbalance induced conditions of apathy and boredom?
Are the artificially high levels of serotonin caused by the use of SSRIs chronically changing the brain and making it impossible to withdraw from these drugs?
"I agree that higher doses and long-term use does blunt emotions," says a pediatrician. "I used Effexor® for about 7 years and tried to wean off during that time, but at very low doses would redevelop extreme sadness that resolved when I upped the dose." He says that working with his psychiatrist, he switched to Wellbutrin® and now experiences a wider range of appropriate emotions. "However, if I did not have another option, I would prefer Effexor® side effects over the chronic anxiety and sadness I experienced for much of my life without it."The authors of the British study reported a similar finding. Many participants in the study considered whether they should stop taking their medication, but viewed the side effects as preferable to the illness for which they were being treated.
"And that is the problem, isn't it?" comments an MPC contributor. "We just don't have meds that treat without some side effects."
Posted by linkadge on February 18, 2010, at 17:32:24
In reply to They're just figuring this out???, posted by Bob on February 18, 2010, at 16:55:13
Yeah, it always takes an official study before people take it seriously.
Linkadge
Posted by Bob on February 18, 2010, at 17:48:27
In reply to Re: They're just figuring this out???, posted by linkadge on February 18, 2010, at 17:32:24
> Yeah, it always takes an official study before people take it seriously.
>
> Linkadge
And even then it often doesn't really sink in for a long time to come.Some of the issues that seem to be REAL slow to sink in for these meds:
1- The severity and duration of withdrawal some can experience for certain meds. This is a big deal if you ask me and the awareness by prescribing docs isn't always there.
2- The fact that if somebody is on one of these meds for long enough the rate of sexual dysfunction goes up and up and up for far more patients than the tiny percentage the side-effect sheets indicate.
3- SSRI's can induce suicidality for anyone - even adults - in certain cases. Especially upon startup or an increase in dose.
4- Weight gain for certain meds is quite common if one takes these meds long term. This one may be better realized than the first three.
Can't think of any more right now so I'll stop my rant.
Bob
Posted by Phillipa on February 18, 2010, at 18:56:51
In reply to Re: They're just figuring this out??? » linkadge, posted by Bob on February 18, 2010, at 17:48:27
Explains why I can't give up the measily 50mg of luox. As even high doses of benzos leave me unable to sleep. Two weeks a couple years ago without luvox ended me in the ER. Gotta get off it. Also when on the 10mg of paxil and .25 of xanax drank 4-6 beers nightly to feel alive. Interesting this ties in with the other studies recently have read. And I have the book Listening to Prozac in my drawer in bedroom putting off reading will start tonight. Phillipa
Posted by Lou Pilder on February 18, 2010, at 19:17:53
In reply to Re: They're just figuring this out???, posted by Phillipa on February 18, 2010, at 18:56:51
> Explains why I can't give up the measily 50mg of luox. As even high doses of benzos leave me unable to sleep. Two weeks a couple years ago without luvox ended me in the ER. Gotta get off it. Also when on the 10mg of paxil and .25 of xanax drank 4-6 beers nightly to feel alive. Interesting this ties in with the other studies recently have read. And I have the book Listening to Prozac in my drawer in bedroom putting off reading will start tonight. Phillipa
Friends,
It is written here,[...luvox...Gotta get off it...].
But how can one get off of it? And to whom is the way to do it revealed?
Lou
Posted by Phillipa on February 18, 2010, at 21:15:02
In reply to Lou's response-phifteethrepsiks, posted by Lou Pilder on February 18, 2010, at 19:17:53
Lou I don't know other than just stop and see what happens? Any suggestions seriously? Tired of being sick and tired and unable to be what others expect me to be and that's how I used to be high functioning and never any fears at all. Phillipa
Posted by Lou Pilder on February 18, 2010, at 22:47:28
In reply to Re: Lou's response-phifteethrepsiks » Lou Pilder, posted by Phillipa on February 18, 2010, at 21:15:02
> Lou I don't know other than just stop and see what happens? Any suggestions seriously? Tired of being sick and tired and unable to be what others expect me to be and that's how I used to be high functioning and never any fears at all. Phillipa
Phillipa,
You wrote,[...I don't know other than just stop..Any suggestions..?...how I used to be...]
In my journey, I have seen a different way that has brought people out of death and into life. But there is great tribulation involved. This tribulation is a sign. It is the same sign as the sign of Jonah. And as Jonah was in the belly of a great fish, stopping the drug(s) will transport one to be in the Heart of the Earth. And those that overcome will be given a Crown of Life.
Now some may think that I mean that the Heart of the Earth is a grave. Not so, for I mean that the Heart of the Earth is possibly the most awful torment one could experiance.
If you would want to be deliverd from the Heart of the Earth, like Jonah was delivered from the belly of the great fish, then take this opportunity to post here and continue dialog. If you do not want to hear more, then reject this opportunity to know what has been revealed to me that could have one delivered from the Heart of the Earth.
Lou
Posted by linkadge on February 19, 2010, at 15:18:41
In reply to Re: They're just figuring this out??? » linkadge, posted by Bob on February 18, 2010, at 17:48:27
These are very good points. The problem is that the biggest voice that gets heard is that of the psychiatrists, doctors and drug companies. These parties livelyhood depends on the best portrayal of the medications.
To add to your list you could put: overall lack of efficacy too. The establishment wants people to believe depression is this cut and dry thing. You take a pill, everything is better. You take the drug and it works.
I think the sickest part is when the meds are prescribed so liberally to kids. Kid's brains are changing so rapidly that they often can't detect what a med is doing. Pair that with the lack of efficacy and research I can only ask why.
Linkadge
Posted by 49er on February 20, 2010, at 6:42:34
In reply to Re: They're just figuring this out??? » linkadge, posted by Bob on February 18, 2010, at 17:48:27
Hi Bob,
I definitely agree that even when there is a study about psych meds causing damage, it takes a lot time for it to sink in. And the cynical me thinks it will never sink in.
The the Newsweek article that questions the effectiveness of antidepressants. Many psychiatrists are questioning the study and claiming that in their experience, the drugs work.
Uh, don't they call that anecdotal evidence? Geez, they would turn the tables on me if I provided that type of argument but it is ok for them to do it.
And speaking of true evidence, a psychiatrist admitted to me in the comments section on the Newseek article that a true 5 year study does not exist that proves the effectiveness of ADS. Until that can be produced, how can you claim these drugs work?
As one tapering off of psych meds, I can definitely vouch for the fact that doctors are clueless. In all fairness, so are alternative folks. I feel very angry about this.
Regarding weight gain, I gained 30 pounds on SSRIS and my greatest fear was it would never end. As soon as I quit, the weight came off without my even trying.
Since I have tapered my meds, I have lost even more weight without trying. It is scary what these drugs do.
Now, who is ranting:)
Posted by linkadge on February 20, 2010, at 9:10:29
In reply to Re: They're just figuring this out??? » Bob, posted by 49er on February 20, 2010, at 6:42:34
There is a lot of critical data missing. I think people just believe in the whole system because it is a system. Somehow it established itself, and whether it works or not it is happening. The fact that it is happeneing makes people believe in it.
I.e. the logic..."why would people go to psychiatrists if they didn't do something?"
Its like when George Castanza of Seinfeld responds to Russle Dowripple's question:
-"Why will they watch it?"
-"Because its on T.V."
Linkadge
Posted by 49er on February 20, 2010, at 9:30:29
In reply to Re: They're just figuring this out???, posted by linkadge on February 20, 2010, at 9:10:29
> There is a lot of critical data missing. I think people just believe in the whole system because it is a system. Somehow it established itself, and whether it works or not it is happening. The fact that it is happeneing makes people believe in it.
>
> I.e. the logic..."why would people go to psychiatrists if they didn't do something?"
>
> Its like when George Castanza of Seinfeld responds to Russle Dowripple's question:
>
> -"Why will they watch it?"
>
> -"Because its on T.V."
>
> LinkadgeAs always Linkage, you're right on target. Great analogies.
Posted by Bob on February 20, 2010, at 15:34:35
In reply to Re: They're just figuring this out???, posted by linkadge on February 20, 2010, at 9:10:29
> There is a lot of critical data missing. I think people just believe in the whole system because it is a system. Somehow it established itself, and whether it works or not it is happening. The fact that it is happeneing makes people believe in it.
>
> I.e. the logic..."why would people go to psychiatrists if they didn't do something?"
>
> Its like when George Castanza of Seinfeld responds to Russle Dowripple's question:
>
> -"Why will they watch it?"
>
> -"Because its on T.V."
>
> Linkadge
Yes, I agree.I think this system fell into place because it seemed to be a better alternative to warehousing the mentally ill in institutions, and the drugs are unfortunately practically the only tools we have no matter how bad they might be.
Turns out giving people pills and letting them fend for themselves is massively cheaper than the more fastidious care of earlier decades as well.
It sucks, but there really are so few answers.
Posted by Bob on February 20, 2010, at 15:38:20
In reply to Re: They're just figuring this out??? » Bob, posted by 49er on February 20, 2010, at 6:42:34
> Hi Bob,
>
> I definitely agree that even when there is a study about psych meds causing damage, it takes a lot time for it to sink in. And the cynical me thinks it will never sink in.
>
> The the Newsweek article that questions the effectiveness of antidepressants. Many psychiatrists are questioning the study and claiming that in their experience, the drugs work.
>
> Uh, don't they call that anecdotal evidence? Geez, they would turn the tables on me if I provided that type of argument but it is ok for them to do it.
>
> And speaking of true evidence, a psychiatrist admitted to me in the comments section on the Newseek article that a true 5 year study does not exist that proves the effectiveness of ADS. Until that can be produced, how can you claim these drugs work?
>
> As one tapering off of psych meds, I can definitely vouch for the fact that doctors are clueless. In all fairness, so are alternative folks. I feel very angry about this.
>
> Regarding weight gain, I gained 30 pounds on SSRIS and my greatest fear was it would never end. As soon as I quit, the weight came off without my even trying.
>
> Since I have tapered my meds, I have lost even more weight without trying. It is scary what these drugs do.
>
> Now, who is ranting:)
>
>
>
>
I've have often had feelings of hopelessness in the past when I see a doctor and realize from the things he/she is saying that there is just no way for a human who doesn't have mental illness to fathom it. Heck, I go through crises and then a few days or weeks later I'm hard pressed to remember some of the acute issues I was facing unless I've written them down.Emotional states only live in the present.
Posted by Bob on February 20, 2010, at 15:47:20
In reply to Re: They're just figuring this out???, posted by linkadge on February 19, 2010, at 15:18:41
> These are very good points. The problem is that the biggest voice that gets heard is that of the psychiatrists, doctors and drug companies. These parties livelyhood depends on the best portrayal of the medications.
>
> To add to your list you could put: overall lack of efficacy too. The establishment wants people to believe depression is this cut and dry thing. You take a pill, everything is better. You take the drug and it works.
>
> I think the sickest part is when the meds are prescribed so liberally to kids. Kid's brains are changing so rapidly that they often can't detect what a med is doing. Pair that with the lack of efficacy and research I can only ask why.
>
> Linkadge
>
>
No doubt! How could I forget lack of efficacy? I guess it's such a pervasive, ubiquitous issue that I've almost come to accept it as a tacit operating assumption.I think many docs (pdocs at least) are aware on some level about the significant problems with the drugs but what is one to do or say? The drug companies certainly know what's going on of course. The unfortunate aspect of this in my eyes is, how is the state-of-the-art for treatment of mental illness going to advance if no one outside of those directly affected have any idea what's going on? The physical ailments such as cancer, diabetes, etc have much more awareness.
Posted by Lou Pilder on February 20, 2010, at 17:42:29
In reply to Re: They're just figuring this out??? » linkadge, posted by Bob on February 20, 2010, at 15:47:20
> > These are very good points. The problem is that the biggest voice that gets heard is that of the psychiatrists, doctors and drug companies. These parties livelyhood depends on the best portrayal of the medications.
> >
> > To add to your list you could put: overall lack of efficacy too. The establishment wants people to believe depression is this cut and dry thing. You take a pill, everything is better. You take the drug and it works.
> >
> > I think the sickest part is when the meds are prescribed so liberally to kids. Kid's brains are changing so rapidly that they often can't detect what a med is doing. Pair that with the lack of efficacy and research I can only ask why.
> >
> > Linkadge
> >
> >
>
>
> No doubt! How could I forget lack of efficacy? I guess it's such a pervasive, ubiquitous issue that I've almost come to accept it as a tacit operating assumption.
>
> I think many docs (pdocs at least) are aware on some level about the significant problems with the drugs but what is one to do or say? The drug companies certainly know what's going on of course. The unfortunate aspect of this in my eyes is, how is the state-of-the-art for treatment of mental illness going to advance if no one outside of those directly affected have any idea what's going on? The physical ailments such as cancer, diabetes, etc have much more awareness.
>Friends,
It is written here,[...the significant problems with the drugs...]
I am asking that if you are considering posting a response here or in parallel threads, to do a search for the following before you post here. If you could, then I could know that you may be aware of what is in the article and then I could be better able to communicate with you.
Lou
Key in;
Should Neuroleptic Drugs Be Banned?
The paper is by Lars Martensson, M.D.
Posted by Phillipa on February 20, 2010, at 19:40:26
In reply to Lou's request-lazmartnsun » Bob, posted by Lou Pilder on February 20, 2010, at 17:42:29
Seriously years ago read Peter Kramer's Listening to Prozac. Wasn't on an ad then. I just got it out of the library. It's mind boggling. Will open your eyes to how even a pdoc say the introduction of meds. Love Phillipa
Posted by Dr. Bob on February 21, 2010, at 12:13:37
In reply to Lou's reply-hrtverth » Phillipa, posted by Lou Pilder on February 18, 2010, at 22:47:28
> If you would want to be deliverd from the Heart of the Earth, like Jonah was delivered from the belly of the great fish, then take this opportunity to post here and continue dialog.
Please feel free to discuss deliverance, but please do so at Psycho-Babble Faith. Here's a link:
http://www.dr-bob.org/babble/faith/20080809/msgs/937547.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there. Thanks,
Bob
Posted by topcatclr on February 21, 2010, at 20:03:49
In reply to Re: Lou's request-lazmartnsun, posted by Phillipa on February 20, 2010, at 19:40:26
wtf
Posted by Phillipa on February 21, 2010, at 21:09:33
In reply to Re: Lou's request-lazmartnsun, posted by topcatclr on February 21, 2010, at 20:03:49
What do you mean? Phillipa
This is the end of the thread.
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