![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
Posted by linkadge on December 4, 2010, at 16:26:53
In reply to Re: Do antidepressants induce chronicity? » ed_uk2010, posted by sigismund on December 4, 2010, at 14:49:32
For me, benzos seem to be much easier to go off and on than antidepressants.
Posted by ed_uk2010 on December 4, 2010, at 16:29:04
In reply to Re: Do antidepressants induce chronicity?, posted by linkadge on December 4, 2010, at 16:26:53
> For me, benzos seem to be much easier to go off and on than antidepressants.
Do you take them everyday for months on end though? I thought you used them short term and when needed.
Posted by Hombre on December 4, 2010, at 18:49:39
In reply to Do antidepressants induce chronicity?, posted by AlexanderfromDenmark on December 4, 2010, at 4:58:28
At least on that page, there's no discussion of why this may be happening, other than the implicit assumption that all ADs cause chronicity.
It's possible that people that medicate feel well enough to get back to work, to act like nothing is wrong anymore, when it is very likely that there are still many factors that are causing stress and therefore leading to chronic depression. Of primary importance are the emotional issues that seem to be ignored by most people dealing with depression.
The mind has a very powerful effect on health. PTSD is one example, where severe trauma alters the brain and causes a chronic hyper-alert state and a vulnerability to certain situations. It also causes a flattening of mood, depression, and insomnia. In this case, the original trauma itself caused changes to the brain and chronicity. While some people can eventually recover from this, many can not.
So stress itself can cause chronicity of mental illness.
Those who don't take ADs have to do other things to get well, reaching out to others, exercising, getting good rest, etc.
ADs and basically all drugs have side-effects, which means that they affect the body as whole. Some of the effects are positive, but some may actually hurt the body.
Instead of exploring how ADs might weaken the body, making it more vulnerable to stress, we just stop at the conclusion that ADs are bad. That's way too simplistic for any of us intelligent people to accept.
Posted by linkadge on December 4, 2010, at 19:35:35
In reply to Re: Do antidepressants induce chronicity?, posted by Hombre on December 4, 2010, at 18:49:39
>It's possible that people that medicate feel >well enough to get back to work, to act like >nothing is wrong anymore, when it is very likely >that there are still many factors that are >causing stress and therefore leading to chronic >depression. Of primary importance are the >emotional issues that seem to be ignored by most >people dealing with depression
Bingo.
Its like tearing a ligament, popping some opiates and walking around like nothing is the matter. Depression can often be a signal, that something in ones life must be changed.
Linkadge
Posted by sigismund on December 4, 2010, at 22:11:48
In reply to Re: Do antidepressants induce chronicity?, posted by linkadge on December 4, 2010, at 19:35:35
>Depression can often be a signal, that something in ones life must be changed.
Yes, and you may be quite unaware of what it is or why.
Posted by linkadge on December 5, 2010, at 7:38:39
In reply to Re: Do antidepressants induce chronicity?, posted by sigismund on December 4, 2010, at 22:11:48
>Yes, and you may be quite unaware of what it is >or why.
I liken the surge in antidepressant use to the surge in obesity. There is a tendancy to blame ones genes for obesity rather than looking at lifestyle factors that may be involved.
Its easier to believe you've got a "chemical imballance" than to accept the fact that life just blows sometimes and theres not a heck of a lot you can do about it.
Believing you are chemically imballanced, psychologically puts you back in the drivers seat (for the time being). But when the little buzz from the med wears off, and you return to the realization that life still sucks, then you're back to square one. Its maladaptive for an organism to feel great when there is something wrong. History not learned from is bound to be repeated.
To me, this would be the simplest explaination for treatment resistance. If you hate your life circumstances, theres only so much a medication can do to make them more tollerable.
Linkadge
Posted by Alexanderfromdenmark on December 5, 2010, at 7:42:39
In reply to Re: Do antidepressants induce chronicity?, posted by linkadge on December 5, 2010, at 7:38:39
> >Yes, and you may be quite unaware of what it is >or why.
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> I liken the surge in antidepressant use to the surge in obesity. There is a tendancy to blame ones genes for obesity rather than looking at lifestyle factors that may be involved.
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> Its easier to believe you've got a "chemical imballance" than to accept the fact that life just blows sometimes and theres not a heck of a lot you can do about it.
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> Believing you are chemically imballanced, psychologically puts you back in the drivers seat (for the time being). But when the little buzz from the med wears off, and you return to the realization that life still sucks, then you're back to square one. Its maladaptive for an organism to feel great when there is something wrong. History not learned from is bound to be repeated.
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> To me, this would be the simplest explaination for treatment resistance. If you hate your life circumstances, theres only so much a medication can do to make them more tollerable.
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>What do you do when your life circumstances, such as chronic illness, cannot be changed?
Posted by Hombre on December 5, 2010, at 9:18:09
In reply to Re: Do antidepressants induce chronicity?, posted by linkadge on December 5, 2010, at 7:38:39
But take it a step further, right? Stopping at life just sucks just leads to a sense of frustration, helpless, classic stagnation of thought/energy that is often at the heart of depression. It sucks the energy out of you, and eventually weakens the whole body.
That's why hope is a proven determinant of successful recovery and long-term remission - deciding that there is something that you can do, even if it is to admit that you may not be able to see certain options at the current time, but leave the door open for solutions in time...again, this is proven too be a strong factor in one's favor when battling depression.
Instead of getting caught up in the "facts", which are really our opinions, colored by experience and biochemistry, we decide to broach the subject when we are feeling better. We know how depression can create artificially negative thinking, so we have to accept that maybe sometimes we need to wait a bit, postpone huge generalizations until we can do so in a way that lets our creative energies flow again.
Sometimes letting go opens up room for the room for energy to move again, and then we can "ingest" new ideas. It's like when a nightclub is crowded, trouble will start. Instead of just letting in more people, the bouncer waits until some of the drunks leave. The new people have less competition at the bar and can order more drinks. Everyone wins.
> >Yes, and you may be quite unaware of what it is >or why.
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> I liken the surge in antidepressant use to the surge in obesity. There is a tendancy to blame ones genes for obesity rather than looking at lifestyle factors that may be involved.
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> Its easier to believe you've got a "chemical imballance" than to accept the fact that life just blows sometimes and theres not a heck of a lot you can do about it.
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> Believing you are chemically imballanced, psychologically puts you back in the drivers seat (for the time being). But when the little buzz from the med wears off, and you return to the realization that life still sucks, then you're back to square one. Its maladaptive for an organism to feel great when there is something wrong. History not learned from is bound to be repeated.
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> To me, this would be the simplest explaination for treatment resistance. If you hate your life circumstances, theres only so much a medication can do to make them more tollerable.
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Posted by linkadge on December 5, 2010, at 11:34:26
In reply to Re: Do antidepressants induce chronicity?, posted by Alexanderfromdenmark on December 5, 2010, at 7:42:39
>What do you do when your life circumstances, >such as chronic illness, cannot be changed?
Depends on the chronic illness, I guess. There are studies in which antidepressants are essentially useless in terminally ill cancer patinents.
Sometimes certain antidepressants can be useful for chronic pain, which indirectly improves quality of life in certain illnesses.
Posted by linkadge on December 5, 2010, at 11:51:56
In reply to Re: Do antidepressants induce chronicity?, posted by Hombre on December 5, 2010, at 9:18:09
>But take it a step further, right? Stopping at >life just sucks just leads to a sense of >frustration, helpless, classic stagnation of >thought/energy that is often at the heart of >depression. It sucks the energy out of you, and >eventually weakens the whole body.
No, I don't think that people should give up at "life sucks". I totally believe in hope. Thats what most of the people on this board are looking for. However, in certain cercumstances, by looking for the latest antidepressant cocktail are we just avoiding opportinuties for true recovery? I guess what I am saying, is that I believe we need to find hope in something that is *really* going to make a life changing difference.
>deciding that there is something that you can do,
Yeah, but at some point, don't people just get tired of the "new pill of the week" strategy for renewed hope? Is that really "doing something about it?
>We know how depression can create artificially >negative thinking, so we have to accept that >maybe sometimes we need to wait a bit, postpone >huge generalizations until we can do so in a way >that lets our creative energies flow again.
But, for many of us, we need more than just "a positive happy outlook". I don't beleive in the school of thought that says "have a happy outlook, and everything will start going you way". We need reason to know that life is worth living. Popping a pill might win a battle but, does it win the war?
Linkadge
Posted by sigismund on December 5, 2010, at 13:09:37
In reply to Re: Do antidepressants induce chronicity?, posted by Alexanderfromdenmark on December 5, 2010, at 7:42:39
>What do you do when your life circumstances, such as chronic illness, cannot be changed?
You try to find a place inside you that is beyond the suffering.
So you are still sick. But part of you is untouched by it.
That's what I think, anyway.
Posted by sigismund on December 5, 2010, at 13:11:03
In reply to Re: Do antidepressants induce chronicity?, posted by Hombre on December 5, 2010, at 9:18:09
That was nice.
Posted by sigismund on December 5, 2010, at 13:21:22
In reply to Re: Do antidepressants induce chronicity? » Alexanderfromdenmark, posted by sigismund on December 5, 2010, at 13:09:37
I was reading this article by a phenomenologist (which I'm only dimly acquainted with) and she was talking about her experience with chronic illness in terms like these.
She didn't imply she could escape the suffering.
She did talk about having found a place in herself where she felt OK, in spite of the fact that she was quite ill.
Mental illness is such that usually this is impossible, or nearly so.
Posted by europerep on December 5, 2010, at 16:12:33
In reply to Do antidepressants induce chronicity?, posted by AlexanderfromDenmark on December 4, 2010, at 4:58:28
First of all, I don't think one can have it both ways. Either antidepressants are effective in treating depression, thereby possibly prolonging the illness - or they aren't effective, but how would they then prolong the illness? I mean, it would be a possible, but complicated argument to make that antidepressants are actually ineffective in treating depression, *but* their action induces chronicity. It doesn't really make sense to me...
Then, this statement (from the article, without any backup) seems possibly questionable to me:
"Prior to the widespread use of antidepressants, depressed patients regularly got well, and many never suffered a second bout of major depression."
Also, if more people are depressed for longer periods of time now, one would think that suicide rates should go up, no? Maybe that's compensated by better preventive measures and such, but... I don't know.. I'm not really convinced.
Posted by linkadge on December 5, 2010, at 16:55:28
In reply to Re: Do antidepressants induce chronicity?, posted by europerep on December 5, 2010, at 16:12:33
>I mean, it would be a possible, but complicated >argument to make that antidepressants are >actually ineffective in treating depression, >*but* their action induces chronicity. It >doesn't really make sense to me...
I think there are a few mechanisms by which antidepressants could induce chronicicty.
>Also, if more people are depressed for longer >periods of time now, one would think that >suicide rates should go up, no?
Well, I think that antidepressants can improve depressive symptoms to the extent that suicide is prevented. But, I do think that they can prevent a full recovery by acting as an impediment to normal neuroendocrine function and/or induce a dependance in conjunction with preventing full recovery (a bunch of unsubstantiated words I know, but just my personal thoughts).
Linkadge
Posted by Bob on December 5, 2010, at 22:00:44
In reply to Do antidepressants induce chronicity?, posted by AlexanderfromDenmark on December 4, 2010, at 4:58:28
> This has probably been posted before, but I wondering about people's opinion.
>
> http://www.madinamerica.com/madinamerica.com/Depression.html
This thread is depressing.
Posted by Hombre on December 6, 2010, at 3:05:39
In reply to Re: Do antidepressants induce chronicity?, posted by linkadge on December 5, 2010, at 11:51:56
OK, yes I agree that sometimes we expect too much from antidepressants, or choose to ignore that our life might suck.
That's why I see recovery as a multilayered strategy, since I ascribe to a holistic view of the human organism.
From the base physical aspects, which almost always need attention, to our relationships with people around us, to our general outlook on our role in the world. Disease can enter from any of these levels, which are just descriptive, not necessarily set in stone, but once disease enters, it wreaks havoc at the other levels.
If you're tired all the time, stressed out, you will feel it physically and then it will start to wear on you emotionally. If that goes on long enough and you do not or are not able to stop it, it progresses to the next level where we really don't understand our purpose in life, what it all means, "spiritual" stuff.
Or maybe our problem is a bad relationship, and we get hurt/frustrated/angry, that will seriously damage our normal functioning and it will manifest again as physical symptoms and probably "spiritual", or our greater purpose that is beyond our immediate selves.
And of course, losing our bearings in life, being spiritually lost, will over time trickle down to damage our emotional and even physical well being.
Plugging one hole in the dyke is not enough; we have to address all the levels of our being if we really want to root out disease and be healthy.
Antidepressants may actually numb us, so even though we're not miserable, we aren't in touch with our feelings. We'll ignore those bad relationships and life frustrations, and we may ignore our bodies and its needs.
Again I agree with you, I just have this particular way of categorizing health and wholeness, maybe different from your own, but I think we can still agree on general principles.
The greatest healing I've experienced to date is at the level of the heart, to speak up to people that are abusing me, whether intentionally or not, and to honor my feelings. And also to ask forgiveness from those I've hurt, and to try to honor their feelings.
Sometimes that just hurts a lot, because I've been suppressing hurt for a long time. I may try to pray, to eat well, to take medications, but if I don't address my emotional issues, I am still vulnerable to illness. Or maybe I have guilt because I wronged someone else, and it's eating away at me because I am still aware at some level that the other person is hurting.
Chronicity is just a sign that we are still ill at some level, and though we may be able to temporarily adjust at other levels to feel comfortable, we have not attacked the root of the problem.
You can't really blame one method or another for causing chronicity. Drugs are powerful, and they change the body, the brain, hormones, and alter basic physiological functioning. The problem is that people act like antidepressants only alter a few neurotransmitters, and leave everything else untouched. That's just naive, but we can't help thinking that way because that's how the drugs are marketed, and that's what doctors tell us.
It's a very narrow-minded way of looking at things, and if we adopt that narrow outlook we will see no options and feel helpless, continuing to suffer, and will apply black and white thinking to things like medication.
> >But take it a step further, right? Stopping at >life just sucks just leads to a sense of >frustration, helpless, classic stagnation of >thought/energy that is often at the heart of >depression. It sucks the energy out of you, and >eventually weakens the whole body.
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> No, I don't think that people should give up at "life sucks". I totally believe in hope. Thats what most of the people on this board are looking for. However, in certain cercumstances, by looking for the latest antidepressant cocktail are we just avoiding opportinuties for true recovery? I guess what I am saying, is that I believe we need to find hope in something that is *really* going to make a life changing difference.
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> >deciding that there is something that you can do,
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> Yeah, but at some point, don't people just get tired of the "new pill of the week" strategy for renewed hope? Is that really "doing something about it?
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> >We know how depression can create artificially >negative thinking, so we have to accept that >maybe sometimes we need to wait a bit, postpone >huge generalizations until we can do so in a way >that lets our creative energies flow again.
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> But, for many of us, we need more than just "a positive happy outlook". I don't beleive in the school of thought that says "have a happy outlook, and everything will start going you way". We need reason to know that life is worth living. Popping a pill might win a battle but, does it win the war?
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Posted by europerep on December 6, 2010, at 6:32:33
In reply to Re: Do antidepressants induce chronicity?, posted by linkadge on December 5, 2010, at 16:55:28
> I think there are a few mechanisms by which antidepressants could induce chronicicty.
>Feel free to explain. I mean, how could ADs prevent homeostasis that leads to natural remission, if they don't "do the job", thereby making homeostasis obsolete? And if they "do the job", well then by definition they are effective.
Posted by sigismund on December 6, 2010, at 14:43:16
In reply to Re: Do antidepressants induce chronicity?, posted by Hombre on December 6, 2010, at 3:05:39
This is lovely
>and to honor my feelings. And also to ask forgiveness from those I've hurt, and to try to honor their feelings.
Posted by ed_uk2010 on December 6, 2010, at 15:00:33
In reply to Re: Do antidepressants induce chronicity? » Hombre, posted by sigismund on December 6, 2010, at 14:43:16
Sigi, are you checking your email? I want to talk to you.
Posted by sigismund on December 6, 2010, at 15:48:54
In reply to Re: Do antidepressants induce chronicity? » sigismund, posted by ed_uk2010 on December 6, 2010, at 15:00:33
>Sigi, are you checking your email? I want to talk to you.
Yes, Eddy, there's nothing there from you.
Babblemail is pretty unreliable, I think, although it is hard to be sure.
Posted by Hombre on December 6, 2010, at 20:55:33
In reply to Re: Do antidepressants induce chronicity?, posted by europerep on December 6, 2010, at 6:32:33
Not that anyone can explain how ADs affect the body fully, but taking them everyday will exert an influence on the body that will have effects over time. Some ADs cause sexual dysfunction, decreased libido and drive, urinary problems, insomnia, agitation, apathy, constipation - I've experienced all of these symptoms.
At first when I started my AD, I felt a gush of energy and a little anxiety, probably due to NE reuptake being inhibited. And that felt great. But I found that the energy was unstable, and it wasn't necessarily easy to concentrate on things.
Due to probably having what they call Bipolar II, I tend to have insomnia and get wound up at night. So I take an atypical antipsychotic for that. And this medication exerts another constant affect on my body, mostly a slowing of the metabolism, and a bit of mental dullness. I'd rather err on the side of sleeping well at night and not being agitated.
These medications help with my primary symptoms of depression and anxiety, but they are also pushing the balance of my body to a point where I get these unwanted side effects. That's probably due to certain constitutional weaknesses I brought with me before I even started taking medication.
So I have to exert counter pressure on a daily basis using supplements and herbs.
I feel like I need relatively large quantities of vitamins B and C, magnesium and zinc. Zinc on a daily basis seems to help with mental sharpness. I believe these vitamins help with neurotransmitter production and energy metabolism.
The magnesium seems key for overall energy and anxiety, and it is also involved in sex hormone production, which will affect drive, libido, sexual function, and even (fat burning) metabolism. Those are areas affected by the meds. It also helps with constipation; I will tend to feel bad if I am "backed up". Having regular BMs is also key to feeling well.
In order to target the specific side effects of the meds, which could lead me to feel depressed again, since my definition of depressed includes being too apathetic to initiate activity or not being able to focus enough to read, write, and think out complex problems, I need more specific measures.
I studied up on Chinese herbal medicine and compared my symptoms to the known patterns of imbalance in Chinese medicine. Chinese medicine doesn't focus on specific diseases as much as patterns of imbalance. It recognizes that there are so many different factors that could cause imbalance, either external or internal. So instead of trying to find a disease label, you try to tie your symptoms together in order to get an idea of the root cause.
The apathy, lack of libido/drive, urinary problems, and sexual dysfunction are classic symptoms of kidney deficiency. The kidneys in Chinese medicine represent adrenal and sex hormone function, along with the usual function of removing waste from the blood. This is of course an oversimplification, but it's good enough for the sake of discussion.
Based on this pattern, I chose a formula that has been used for hundreds of years and has a known effect. After a month or so, I definitely noticed a difference. You can't fake relief from the urinary or sexual side effects. You may be able to fake libido and drive, but in my case it was clear that the herbs exerted enough counterpressure to bring me back to a point of balance that I deemed acceptable.
These kidney herbs also help prevent apathy. One can look at this as finding a good balance between parasympathetic and sympathetic dominance. Apathy indicates being too relaxed, too Yin, as they say in chinese philosophy. So the kidney formula I take tonifies kidney Yang, and somehow this helps with drive and focus. I don't feel I need to understand things at a molecular level, because I can feel the difference.
As for the slowing of metabolism and possible weight gain from the atypical antipsychotic I take, I take another formula that enhances digestion and improves energy. As long as I eat well and get some exercise, I can maintain a good weight.
Looking back to about 3 years ago, before I ever took any medications, I was bloated, tired, and I had a pot belly. These could be indications of digestive weakness, so taking the herbs for digestion seems a good fit. I don't really have the pot belly, I have good physical energy to do exercise, and I am no longer bloated and puffy.
I have to take these herbs pretty much every day, because I am taking medication every day. They both seem to counter each other, so I can enjoy a higher quality of living. If I stop the herbs, after only a few days the old side effects start to come back, so now I know that I need to take the herbs daily as well.
But if someone were to experience such side-effects and not do something to counter them, I can imagine that over time, if that person's constitution was already vulnerable to certain weaknesses, the chronic use of medication could push things further out of balance. So the meds exert a positive influence in some ways, but they are also causing imbalances in other ways. That could lead to chronicity.
It's also possible that one's depression could be partially due to these constitutional imbalances in the first place. Poor digestion/absorption of nutrients, a nervous system that either over or under reacts to stress, and hormonal imbalances.
Doctor's really tend to overlook side-effects and consider them to be minor. I consider them to be important signs that should not be ignored. By addressing them, I inadvertently discovered that I could improve my overall feeling of wellness beyond what meds could give me. I feel that if I am to take strong medications on a daily basis, I should also be taking something else to counter their ill effects. Instead of piling on more medications with side effects, I choose to take herbs that have very little to no side effects, are safe to take on a daily basis, and are relatively inexpensive, at least in my POV. I'll gladly pay an extra $1 a day if it gives me quality of life and allows me to function at close to 100%.
> > I think there are a few mechanisms by which antidepressants could induce chronicicty.
> >
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> Feel free to explain. I mean, how could ADs prevent homeostasis that leads to natural remission, if they don't "do the job", thereby making homeostasis obsolete? And if they "do the job", well then by definition they are effective.
>
Posted by Hombre on December 6, 2010, at 21:03:47
In reply to Re: Do antidepressants induce chronicity? » Hombre, posted by sigismund on December 6, 2010, at 14:43:16
> This is lovely
>
> >and to honor my feelings. And also to ask forgiveness from those I've hurt, and to try to honor their feelings.I am really new to the emotional intelligence thing. I am the first to admit that I have always had problems with my emotions, and dealing with other people's emotions. For so long I took on other people's baggage and ignored my own needs. It's been a slow but steady road in terms of defining my boundaries, not letting people cross them, respecting other people's boundaries, and learning how to deal with conflict in a way that does not cause more harm. I'm still learning, obviously, and recent painful events have been an accelerated class on matters of the heart.
I do have religious convictions that guide me, but just using logic I can see that if nobody forgives anyone, we'll all just continue to poop on each other and no one wins. I am willing to sacrifice my idea of what I thought was true in order to free myself from this endless cycle of misery. I still have some things I need to forgive, and I know they will plague me until I do, but I also know that I might have to wait a bit before I am capable of this. So I don't beat myself up, and I try to own up to this and acknowledge this weakness, which according to my beliefs, can be overcome. It's knowing that the possibility is out there that keeps me hopeful, just as knowing that recovery was possible kept me going through med trial after med trial. To be honest, I did not actually believe that I could feel well, but I knew I could not presume to think that it was impossible. Again, I had to admit that maybe I didn't know everything, and that was my guarantee that things could get better. I just wasn't qualified to decide that I was permanently screwed up.
Posted by sukarno on December 15, 2010, at 12:30:18
In reply to Re: Do antidepressants induce chronicity? » ed_uk2010, posted by sigismund on December 4, 2010, at 14:49:32
The theory that BZDs can "cause" agoraphobia is, in my opinion, without any scientific merit. In addition, an abstract I read states that unmedicated PD patients have 20% less GABA activity than controls.
Agoraphobia is considered to be a complication of panic disorder that is not treated well enough with either pharmacotherapy or CBT, etc, according to the psychiatrists I've spoken with and the official information on panic disorder that I've read throughout the years.
Many people take BZDs for anxiety but because some develop agoraphobia later on does not prove causation in my opinion.
Doses of BZDs required to achieve remission in panic disorder are much higher than those needed for generalized anxiety disorder or other anxiety disorders. Unfortunately, many physicians and psychiatrists do not prescribe doses sufficient to achieve remission.
If alprazolam (Xanax) is prescribed at all for panic disorder, unfortunately it is prescribed in sub-therapeutic doses (0.250.5mg once or twice a day or as PRN) which could lead patients to believe the medication is not effective. It should be prescribed in a low dose on a TID or QID schedule and then increased slowly until the panic attacks resolve (in the clinical trials, doses of 56mg/day were used in the treatment of panic disorder).
BZDs in general make me much more social, less fearful and less inhibited, even after 20 years of nonstop use. This is good as I feel comfortable approaching people I don't know and initiating conversation. Prior to BZDs in the 1980s I was introverted and a nervous wreck. There would be no way I would talk to strangers or hang out in public places back then.
I firmly believe that benzodiazepines are under-utilized in our society. Despite being placed in Schedule IV of the Controlled Substances Act in the United States, I feel they are prescribed less often than drugs in Schedule II and III, which makes absolutely no sense whatsoever unless doctors actually believe that ADHD or chronic pain is worse than panic disorder or that anxiety is "all in the head" or "not serious enough" to warrant medication.
I've actually met a psychiatrist who said "you only need to change the way you think" to conquer panic disorder and depression. Oh really? Would they say that to someone with ADHD or chronic pain? How about someone with angina? Cancer? Diabetes?
Schedule IV medications have far less abuse potential than drugs in Schedules II and III, but it is easier to get methylphenidate, amphetamines and other psychostimulants, and opiates/opioids than BZDs. For example, there are pain clinics and pdocs who specialize in ADHD, but I've never heard of a panic disorder clinic. We badly need a special clinic of our own though.
As a doctor in the US state of Mississippi once told me in 2001, "The state medical board here is very backwards in their thinking. Unfortunately they believe doctors should only prescribe BZDs to patients on their death bed."
Strangely, many doctors are more accepting of cannabis (Schedule I), a drug with high abuse potential, than BZDs. I have a friend in Nevada who told me that doctors are recommending cannabis there even for "headache".
Even when cannabis was in the dark days of absolute prohibition my psychiatrists would sometimes just giggle when I mentioned my experience with cannabis when I was younger. They thought it was a benign drug, which it probably is, but it is abused much more often than any other illicit substance. I thought that abuse liability is the determining factor in whether or not to prescribe a psychotropic substance. Schedule IV drugs have less abuse liability than those in more strict schedules.
That said, I support medical cannabis, but it is much more abused than prescription drugs.
Posted by sukarno on December 15, 2010, at 12:34:52
In reply to Re: Do antidepressants induce chronicity?, posted by sukarno on December 15, 2010, at 12:30:18
Sorry, the dashes didn't show up. :-)
"in the clinical trials, doses of 56mg/day were used in the treatment of panic disorder"
That should be 5-6mg/day. If it was 56mg/day we'd have several comatose patients and Upjohn would have been in shambles. =P
This is the end of the thread.
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