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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Bob on March 2, 2010, at 22:12:21
This time it's in JAMA.
http://www.scientificamerican.com/article.cfm?id=antidepressants-do-they-work-or-dont-they
Posted by willey on March 3, 2010, at 0:07:09
In reply to Another indictment of antidepressants..., posted by Bob on March 2, 2010, at 22:12:21
No insult,but its like ping pong with articles of such,for every anti drug or toxic article,theres a pro one to match.
I recomend dig deeper,use google scholar option in search and you can get some very good info as well.
These articles here when i did pay close attention,had me running like a chicken with head cut off,meds r bad,meds r good,now i find there is no easy answer,doses,brands,specfic meds,etc all play a role in how dangerous a drug is to use.
Posted by CrAzYmEd on March 3, 2010, at 9:40:16
In reply to Re: Another indictment of antidepressants..., posted by willey on March 3, 2010, at 0:07:09
Once again a study found that SSRI's arent very effective.
However SSRI's could be very effective when augmented with other stuff, trying SSRI's 1 by 1 as a solo therapy is a bad idea, as they may work very well in combination with buspirone (wich further raises serotogenic transmission) or other stuff.
Posted by Phillipa on March 3, 2010, at 10:46:59
In reply to Re: Another indictment of antidepressants..., posted by CrAzYmEd on March 3, 2010, at 9:40:16
The articles I posted also are from Jama just delivered via my nursing newsletter but from same source. Phillipa
Posted by SLS on March 3, 2010, at 11:51:30
In reply to Re: Another indictment of antidepressants..., posted by CrAzYmEd on March 3, 2010, at 9:40:16
I think that most clinical investigations of antidepressants suffer from a lack of specificity when selecting subjects. I believe that too many people are included whom don't have the biological illness being studied. Often, the diagnosis of Major Depressive Disorder is left to the administration of primitive questionnaires comprised of 21 questions or less. No biological tests are given. Hopefully, this will change soon as more diagnostic markers are discovered. It is interesting that, statistically, people with more severe depressive symptomatologies respond better to antidepressant treatment. My guess is that these subjects are more likely to have Major Depressive Disorder. Therefore, the greater the proportion of the study population to present with severe depression, the more the results will demonstrate a greater effectiveness of drug treatment versus placebo.
- Scott
Posted by jedi on March 3, 2010, at 12:31:30
In reply to Re: Another indictment of antidepressants..., posted by SLS on March 3, 2010, at 11:51:30
Scott,
Very thoughtful comment. I could not agree more. For many patients with mild depression or the blues, the family doctors are doing a disservice by passing out the SSRIs. For those of us who have been in true major depression, there is no doubt that antidepressants work. If I would have been given a placebo instead of Nardil 12 years ago, I would not be here to write this little blurb. Thanks for your knowledge and sharing it with the rest of us.
Jedi
> I think that most clinical investigations of antidepressants suffer from a lack of specificity when selecting subjects. I believe that too many people are included whom don't have the biological illness being studied. Often, the diagnosis of Major Depressive Disorder is left to the administration of primitive questionnaires comprised of 21 questions or less. No biological tests are given. Hopefully, this will change soon as more diagnostic markers are discovered. It is interesting that, statistically, people with more severe depressive symptomatologies respond better to antidepressant treatment. My guess is that these subjects are more likely to have Major Depressive Disorder. Therefore, the greater the proportion of the study population to present with severe depression, the more the results will demonstrate a greater effectiveness of drug treatment versus placebo.
>
>
> - Scott
Posted by europerep on March 3, 2010, at 14:47:21
In reply to Re: Another indictment of antidepressants..., posted by willey on March 3, 2010, at 0:07:09
"six high-quality trials"..
right.. they might as well go with one..
Posted by bleauberry on March 3, 2010, at 17:11:57
In reply to Another indictment of antidepressants..., posted by Bob on March 2, 2010, at 22:12:21
To followup on what SLS said, and I totally agree with what he said, there is even more.
Studies are very particular about who they choose. Been depressed before? Not eligible. Suicidal right now? Not eligible. Any other known health problems? Not eligible. Any past drug use? Not eligible.
Except for the few treatment resistant studies, the majority of clinical studies basically rule out the majority of realworld people. It is no wonder they get better results than the doctor does, and no wonder the doctor scratches his head wondering why he can't get the same results as clinical studies.
The clinical studies do not have the same sample of people that walk in and out of doctors' offices everywhere everyday. The samples are cherrypicked, which automatically right from the get-go makes the results biased and unreliable.
For sure better diagnostics are needed. I can't tell you how many stories, hundreds, I have seen of people who saw their longstanding depression vanish on things like: antibiotics, antifungals, chelation drugs, and even oddball things that would seem to have no relation, such as herbs like Burdock, Saw Palmetto, Coptis,...I mean, in all of these cases, there was a physical disease that was impacting the brain in such a way as to cause the feeling of depression. And in all of these cases there was not a diagnosis. There was a patient and/or a doctor that discovered the real problem by accident when treating for something else or treating something on a hunch.
Diagnostics aren't there. To rule common depression causes out, the best way is to challenge them with real blind trials of fairly safe and inexpensive protocols and see what happens.
Otherwise, we just stay sick and don't get better.
Posted by Phillipa on March 3, 2010, at 21:11:37
In reply to Re: Another indictment of antidepressants..., posted by europerep on March 3, 2010, at 14:47:21
I'm currently reading for the second time Listening To Prozac. Seems the doc Kramer is very attuned to his patients. He started off thinking psychotheraphy was it and now he's concerned with what he feels could be changing of personality from meds from what might not be normal for that person. Now the patients on insisting on continuing on the med as if they stop they go back to being who they were before and they don't like it. That's where at now so to be continued..... Phillipa
Posted by topcatclr on March 3, 2010, at 23:47:30
In reply to Re: Another indictment of antidepressants..., posted by bleauberry on March 3, 2010, at 17:11:57
Not again, how many times will we have these lame discussions. They ARE NOT PLACEBOS! They are very powerful, and for many people, very effective meds. The right patient with the right drug. An actual patient with an actual drug! God i am so sick of this topic It is very clear these meds are really only for the more severe problems. Doctors give them to people who really don't need them.That is why the results vary so much. Take your meds and try to enjoy life people! Obsessing about this here is half the problem. Cripes!
Posted by bulldog2 on March 4, 2010, at 8:12:29
In reply to Another indictment of antidepressants..., posted by Bob on March 2, 2010, at 22:12:21
> This time it's in JAMA.
>
> http://www.scientificamerican.com/article.cfm?id=antidepressants-do-they-work-or-dont-theyThey just use the generic word antidepressant. What categories did they use? Did they use tcas,maois,snris and maois? Until I would know if all categories were used I would automatically discount the study.
Posted by CrAzYmEd on March 4, 2010, at 15:27:57
In reply to Re: Another indictment of antidepressants..., posted by topcatclr on March 3, 2010, at 23:47:30
> Not again, how many times will we have these lame discussions. They ARE NOT PLACEBOS! They are very powerful, and for many people, very effective meds. The right patient with the right drug. An actual patient with an actual drug! God i am so sick of this topic It is very clear these meds are really only for the more severe problems. Doctors give them to people who really don't need them.That is why the results vary so much. Take your meds and try to enjoy life people! Obsessing about this here is half the problem. Cripes!
SSRI's are far from powerfull and not much better then placebo, this is confirmed in several meta analysissen.
Augmentation strategies are the key, stahl's heroic combo's for example.
Trying SSRI's as monotherapy is useless.
Posted by SLS on March 4, 2010, at 15:39:55
In reply to Re: Another indictment of antidepressants..., posted by CrAzYmEd on March 4, 2010, at 15:27:57
> Trying SSRI's as monotherapy is useless.
Not for everyone. I have observed people in real life who have responded robustly to SSRI monotherapy. Seeing is believing. I must therefore question the validity of the meta-analyses you allude to.
- Scott
Posted by Justherself54 on March 4, 2010, at 18:32:06
In reply to Re: Another indictment of antidepressants... » CrAzYmEd, posted by SLS on March 4, 2010, at 15:39:55
I agree Scott..I used to respond robustly and had periods of great success on SSRI's..it's the damn poop-out and not working again the second go-round. I wish "they" could get that one figured out.
Posted by gman22 on March 4, 2010, at 19:18:37
In reply to Another indictment of antidepressants..., posted by Bob on March 2, 2010, at 22:12:21
SLS is correct. SSRI's can be very effective. I have seen paroxetine work wonders in some people, including myself. (I just choose a different treatment because of side effects). I have also seen them fail to work at high doses in some people. It just depends on the individual. I am glad that they are part of the overall arsenal of meds available.
Posted by Bob on March 4, 2010, at 19:23:05
In reply to Re: Another indictment of antidepressants..., posted by gman22 on March 4, 2010, at 19:18:37
> SLS is correct. SSRI's can be very effective. I have seen paroxetine work wonders in some people, including myself. (I just choose a different treatment because of side effects). I have also seen them fail to work at high doses in some people. It just depends on the individual. I am glad that they are part of the overall arsenal of meds available.
If you don't mind me asking, what was the other treatment you settled on when you didn't like the side effects of the SSRIs?
Posted by gman22 on March 4, 2010, at 23:09:15
In reply to Re: Another indictment of antidepressants... » gman22, posted by Bob on March 4, 2010, at 19:23:05
Low dose sertraline (25mg) with 50mg nortriptyline.
No side effects at all, with a very robust response.
Paxil worked very well but with the cost of weight gain, delayed orgasm and some lethargy (even at low doses of 10-20mg.)
Posted by topcatclr on March 5, 2010, at 0:13:26
In reply to Re Bob., posted by gman22 on March 4, 2010, at 23:09:15
SSRI's are far from powerfull and not much better then placebo, this is confirmed in several meta analysissen.
They COMPLETELY eliminate anxiety for me. For antidepressant relief i need an SNRI like Cymbalta. To say they are a "Placebo" is so funny it's barely worth a response! Your response is a "Placebo"!
Posted by Dr. Bob on March 6, 2010, at 9:01:16
In reply to Re: Re Bob., posted by topcatclr on March 5, 2010, at 0:13:26
Posted by bulldog2 on March 6, 2010, at 14:41:02
In reply to Another indictment of antidepressants..., posted by Bob on March 2, 2010, at 22:12:21
> This time it's in JAMA.
>
> http://www.scientificamerican.com/article.cfm?id=antidepressants-do-they-work-or-dont-theyI think you could make this indictman of many categories of meds. The mind has a powerful power to stimulant the immune system and heal the body/mind. We go to the doctor for a sore thoat and we get an antibiotic and your sore throat goes away. The sore throat would probably have healed on its own.So the placebo effect is a real thing.
I was watching a program that showed medicine men healing people. The peopke believed in the rituals of the med man and than the power of the mind took over.
Obviously not every drug is just placebo effect but we can't discount the power of the mind to help heal us.
Posted by topcatclr on March 6, 2010, at 20:42:15
In reply to Re: Another indictment of antidepressants..., posted by bulldog2 on March 6, 2010, at 14:41:02
Since all of you believe these meds are placebos, i have no idea why there is a need to discuss them. After all they do nothing!
Posted by Lou Pilder on March 7, 2010, at 17:38:42
In reply to Re: Another indictment of antidepressants..., posted by topcatclr on March 6, 2010, at 20:42:15
> Since all of you believe these meds are placebos, i have no idea why there is a need to discuss them. After all they do nothing!
topcatclr,
You wrote,[...I have no idea why there is a need to discuss them (psychotropic drugs)
Here is a link to a video of a young lady that had taken psychotropic drugs prescribed to her.
I would like this video to be shown to people before they would take a prescribed psychotropic drug. You see, what you are going to see if you click on the link and also click on the other parts on the side, is what happened to me when I was given a prescribed psychotropic drug. The condition that you see can be unreversable. In my case, I was delivered from what you see by divine accomplishment.
Lou
http://www.youtube.com/watch?v=8QTedhJOinE
Posted by Phillipa on March 7, 2010, at 20:00:48
In reply to Lou's response-nohoneighd? » topcatclr, posted by Lou Pilder on March 7, 2010, at 17:38:42
Lou what was the name of the psychotropic med? Phillipa
Posted by jedi on March 8, 2010, at 2:36:48
In reply to Lou's response-nohoneighd? » topcatclr, posted by Lou Pilder on March 7, 2010, at 17:38:42
Lou, the lady in the video, Mariana Pandolfi, has Parkison's disease. Are you saying you were cured of Parkinson's by divine accomplishment? Parkinson's disease is generally idiopathic and caused by loss of the production of dopamine in the brain. This disease is chronic and progressive. My uncle had early onset Parkinson's and I watched him die a slow and not so pretty death.
JediFrom Wikipedia-Motor symptoms of Parkinson's Disease:
Four symptoms are considered cardinal in PD: tremor, rigidity, bradykinesia and postural instability.[1]* Tremor normally has a frequency between 4 and 6 Hz (cycles per second) and is the most apparent and well-known symptom.[1] It is most commonly a rest tremor: maximal when the limb is at rest and disappearing with voluntary movement and sleep; it is a pronation-supination tremor that is described as "pill-rolling".[1] Tremor affects to a greater extent the most distal part of the extremity and is typically unilateral at onset.[1] Though around 30% of PD sufferers do not have tremor at disease onset most of them would develop it along the course of the disease.[1]
* Rigidity: defined as joint stiffness and increased muscle tone. In combination with a resting tremor, this produces a ratchety, "cogwheel rigidity" when the limb is passively moved.[1] It may be associated with joint pain, such pain being a frequent initial manifestation of the disease.[1]
* Bradykinesia and akinesia: the former refers to slowness of movement while the latter to the absence of it.[1] It is the most characteristic clinical feature of PD and it produces difficulties not only with the execution of a movement but also with its planning and initiation.[1] The performance of sequential and simultaneous movements is also hindered.[1] Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude.
* Postural instability: failure of postural reflexes, along other disease related factors such as orthostatic hypotension or cognitive and sensory changes, which lead to impaired balance and falls.[1] It usually appears in the late stages of PD.[1]Other motor symptoms include:
* Gait and posture disturbances:
o Shuffling gait:[1] gait is characterized by short steps, with feet barely leaving the ground. Small obstacles tend to cause the patient to trip.
o Decreased arm-swing.[1]
o Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
o Camptocormia:[1] stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk.[2]
o Festination:[1] a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
o Gait freezing: also called motor blocks, is a manifestation of akinesia.[1] Gait freezing is characterized by a sudden inability to move the lower extremities which usually lasts less than 10 seconds.[1] It may worsen in tight, cluttered spaces, when attempting to initiate gait or turning around, or when approaching a destination.[1] Freezing improves with treatment and also with behavioral techniques such as marching to command or following a given rhythm.[1]
o Dystonia:[1] abnormal, sustained, painful twisting muscle contractions, often affecting the foot and ankle (mainly toe flexion and foot inversion) which often interferes with gait.
o Scoliosis[1]
* Speech and swallowing disturbances.
o Hypophonia:[1] soft speech.
o Monotonic speech: Speech quality tends to be soft, hoarse, and monotonous.[1]
o Festinating speech: excessively rapid, soft, poorly-intelligible speech.
o Drooling: most likely caused by a weak, infrequent swallow.[1]
o Dysphagia: impaired ability to swallow; which in the case of PD is probably related to an inability to initiate the swallowing reflex or by a too long laryngeal or oesophageal movement.[1] Can lead to aspiration pneumonia.
o Dysarthria[1]
* Other motor symptoms:
o Fatigue
o Hypomimia:[1] a mask-like face
o Difficulty rolling in bed or rising from a seated position.[1]
o Micrographia:[1] small, cramped handwriting.
o Impaired fine motor dexterity and motor coordination.[1]
o Impaired gross motor coordination.
o Akathisia: an unpleasant desire to move.
o Reemergence of primitive reflexes.[1]
> You wrote,[...I have no idea why there is a need to discuss them (psychotropic drugs)
> Here is a link to a video of a young lady that had taken psychotropic drugs prescribed to her.
> I would like this video to be shown to people before they would take a prescribed psychotropic drug. You see, what you are going to see if you click on the link and also click on the other parts on the side, is what happened to me when I was given a prescribed psychotropic drug. The condition that you see can be unreversable. In my case, I was delivered from what you see by divine accomplishment.
> Lou
> http://www.youtube.com/watch?v=8QTedhJOinE
>
Posted by Lou Pilder on March 8, 2010, at 6:33:23
In reply to Re: Lou's response-nohoneighd? » Lou Pilder, posted by jedi on March 8, 2010, at 2:36:48
>
> Lou, the lady in the video, Mariana Pandolfi, has Parkison's disease. Are you saying you were cured of Parkinson's by divine accomplishment? Parkinson's disease is generally idiopathic and caused by loss of the production of dopamine in the brain. This disease is chronic and progressive. My uncle had early onset Parkinson's and I watched him die a slow and not so pretty death.
> Jedi
>
> From Wikipedia-Motor symptoms of Parkinson's Disease:
> Four symptoms are considered cardinal in PD: tremor, rigidity, bradykinesia and postural instability.[1]
>
> * Tremor normally has a frequency between 4 and 6 Hz (cycles per second) and is the most apparent and well-known symptom.[1] It is most commonly a rest tremor: maximal when the limb is at rest and disappearing with voluntary movement and sleep; it is a pronation-supination tremor that is described as "pill-rolling".[1] Tremor affects to a greater extent the most distal part of the extremity and is typically unilateral at onset.[1] Though around 30% of PD sufferers do not have tremor at disease onset most of them would develop it along the course of the disease.[1]
> * Rigidity: defined as joint stiffness and increased muscle tone. In combination with a resting tremor, this produces a ratchety, "cogwheel rigidity" when the limb is passively moved.[1] It may be associated with joint pain, such pain being a frequent initial manifestation of the disease.[1]
> * Bradykinesia and akinesia: the former refers to slowness of movement while the latter to the absence of it.[1] It is the most characteristic clinical feature of PD and it produces difficulties not only with the execution of a movement but also with its planning and initiation.[1] The performance of sequential and simultaneous movements is also hindered.[1] Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude.
> * Postural instability: failure of postural reflexes, along other disease related factors such as orthostatic hypotension or cognitive and sensory changes, which lead to impaired balance and falls.[1] It usually appears in the late stages of PD.[1]
>
> Other motor symptoms include:
>
> * Gait and posture disturbances:
> o Shuffling gait:[1] gait is characterized by short steps, with feet barely leaving the ground. Small obstacles tend to cause the patient to trip.
> o Decreased arm-swing.[1]
> o Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
> o Camptocormia:[1] stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk.[2]
> o Festination:[1] a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
> o Gait freezing: also called motor blocks, is a manifestation of akinesia.[1] Gait freezing is characterized by a sudden inability to move the lower extremities which usually lasts less than 10 seconds.[1] It may worsen in tight, cluttered spaces, when attempting to initiate gait or turning around, or when approaching a destination.[1] Freezing improves with treatment and also with behavioral techniques such as marching to command or following a given rhythm.[1]
> o Dystonia:[1] abnormal, sustained, painful twisting muscle contractions, often affecting the foot and ankle (mainly toe flexion and foot inversion) which often interferes with gait.
> o Scoliosis[1]
> * Speech and swallowing disturbances.
> o Hypophonia:[1] soft speech.
> o Monotonic speech: Speech quality tends to be soft, hoarse, and monotonous.[1]
> o Festinating speech: excessively rapid, soft, poorly-intelligible speech.
> o Drooling: most likely caused by a weak, infrequent swallow.[1]
> o Dysphagia: impaired ability to swallow; which in the case of PD is probably related to an inability to initiate the swallowing reflex or by a too long laryngeal or oesophageal movement.[1] Can lead to aspiration pneumonia.
> o Dysarthria[1]
> * Other motor symptoms:
> o Fatigue
> o Hypomimia:[1] a mask-like face
> o Difficulty rolling in bed or rising from a seated position.[1]
> o Micrographia:[1] small, cramped handwriting.
> o Impaired fine motor dexterity and motor coordination.[1]
> o Impaired gross motor coordination.
> o Akathisia: an unpleasant desire to move.
> o Reemergence of primitive reflexes.[1]
>
>
> > You wrote,[...I have no idea why there is a need to discuss them (psychotropic drugs)
> > Here is a link to a video of a young lady that had taken psychotropic drugs prescribed to her.
> > I would like this video to be shown to people before they would take a prescribed psychotropic drug. You see, what you are going to see if you click on the link and also click on the other parts on the side, is what happened to me when I was given a prescribed psychotropic drug. The condition that you see can be unreversable. In my case, I was delivered from what you see by divine accomplishment.
> > Lou
> > http://www.youtube.com/watch?v=8QTedhJOinE
> >
> jedi,
You wrote,[...The lady in the video...Parkinson's disease...]
There is that neuroleptic drugs can induce Parkinson's disease. I would like for you to click on the link here in order for us to have further dialog here.Here is a link concerning neuroleptic drugs inducing that type of disorder. I would like for you to examine the citations at the end of the text and to look at the other parts of the video, I think parts 5-8, of the lady and see the comments that others made concerning that her condition could have been from taking neuroleptic drugs, prescribed.
Lou
http://en.wikipedia.org/wiki/Tardive_dyskinesia
>
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