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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 56. This is the beginning of the thread.
Posted by jono_in_adelaide on June 2, 2011, at 0:22:15
When Tofranil first came onto the market, it was generaly accepted that it was very effective in endrogenous depression, modestly effective in reactive or neurotic depression, and useless in depression due to inadequate personality.
Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
Are we expecting too much?
Posted by Christ_empowered on June 2, 2011, at 3:17:25
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
the psychiatric profession, I think, is largely to blame.
We're told that every new antidepressant (and now "atypical" antipsychotic) is capable of fixing depression, anxiety, etc. The market is flooded with do-it-all "antidepressants" that have been pushed on people suffering from all sorts of maladies.
The psychiatric profession and the drug industry are largely responsible for the marketing of unhappiness as "mental illness." We have TV commercials (at least in the US) reminding us that "depression hurts" and hinting that pill X will be able to wash away our misery. Its a big lie.
Posted by SLS on June 2, 2011, at 6:27:48
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
> When Tofranil first came onto the market, it was generaly accepted that it was very effective in endrogenous depression, modestly effective in reactive or neurotic depression, and useless in depression due to inadequate personality.
>
> Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
>
> Are we expecting too much?We are taught to expect too much.
I agree with C_E. If anything, it is doctors who have unrealistic expectations of antidepressants without the the scientific evidence to support their practices. These notions are, of course, transferred to patients who have nothing else but
the doctor's expertise and opinion to rely on.The scientific evidence demonstrates that antidepressants can be effective to treat properly-diagnosed major depressive disorder (MDD). It is thought by some that this illness in particular has a rate of response of 85% when any and all existing psychotropics are to be considered as potential therapies in the practice of polypharmacy.
- Scott
Posted by Lou Pilder on June 2, 2011, at 7:09:43
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
> When Tofranil first came onto the market, it was generaly accepted that it was very effective in endrogenous depression, modestly effective in reactive or neurotic depression, and useless in depression due to inadequate personality.
>
> Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
>
> Are we expecting too much?jono_in_adelaide
You wrote,[...are we expecting too much?...]
Here is a video that I am requestingthat you view.
Lou
To see this video:
A. pull up Google
B. Type in:
[youtube, April 24 2010, Why antidepressants do not work
If this is correct, a presentation by DR Mark Hyman MD will be seen
Posted by Lou Pilder on June 2, 2011, at 7:15:29
In reply to Lou's request- » jono_in_adelaide, posted by Lou Pilder on June 2, 2011, at 7:09:43
> > When Tofranil first came onto the market, it was generaly accepted that it was very effective in endrogenous depression, modestly effective in reactive or neurotic depression, and useless in depression due to inadequate personality.
> >
> > Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
> >
> > Are we expecting too much?
>
> jono_in_adelaide
> You wrote,[...are we expecting too much?...]
> Here is a video that I am requestingthat you view.
> Lou
> To see this video:
> A. pull up Google
> B. Type in:
> [youtube, April 24 2010, Why antidepressants do not work
> If this is correct, a presentation by DR Mark Hyman MD will be seen
>
correction:
To see the video after pulling up Google, type in:
[youtube, why antidepressants do not work for treating depression, March 2 2008
this could bring up a picture of Dr Hyman
Lou
Posted by jono_in_adelaide on June 2, 2011, at 7:20:53
In reply to Re: Lou's request-correction, posted by Lou Pilder on June 2, 2011, at 7:15:29
Good points people - I think big pharma have encourgaed depression to become a synonym ofr unhappiness, in order to sell more of their pills, and that doctors and us patients have been all too happy to swallow their hype
Posted by bleauberry on June 2, 2011, at 10:06:30
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
> When Tofranil first came onto the market, it was generaly accepted that it was very effective in endrogenous depression, modestly effective in reactive or neurotic depression, and useless in depression due to inadequate personality.
>
> Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
>
> Are we expecting too much?Yes. They are not even reliable for endogenous simply because there are a variety of unrelated biological causes that the med may or may not have any impact on. For example if someone is feeling depressed, foggy, and fatigued due to gluten intolerance but they have no clue they are gluten intolerant, there is no amount of tweeking serotonin, NE, or DA that is going to impact that situation robustly. Just one of several similar examples.
Posted by Phillipa on June 2, 2011, at 11:20:28
In reply to Re: Do we expect too much of antidepressants today?, posted by bleauberry on June 2, 2011, at 10:06:30
Hence the Happy Pill. My Sister years ago went on paxil don't know why and all her friends and they called they their happy pills those and their benzos. I always wondered why they didn't make me happy? Phillipa
Posted by floatingbridge on June 2, 2011, at 12:32:33
In reply to Re: Lou's request-correction, posted by jono_in_adelaide on June 2, 2011, at 7:20:53
Joni, I agree with what's been said about marketing conditioning consumers, about psychiatry educating itself and the lay population by it's (often very underwritten by pharma) research, and one more thing: people always hope for a cure. Many people want to be sold a solution one can swallow.
Let me use an I statement: I certainly
did. Can't say I still don't. Just been knocked about too much to keep skepticism from setting in.
Posted by sigismund on June 2, 2011, at 13:14:44
In reply to Re: Lou's request-correction, posted by jono_in_adelaide on June 2, 2011, at 7:20:53
Now they are going to boot people off the disability pension because depression these days is treatable.
I was never impressed by the new hype. Any drug that made you feel half way good was out.
Posted by hyperfocus on June 2, 2011, at 17:48:20
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
I'd have to say no. I think at some point people who have gone through a long period of crushing sadness or grief or hopelessness, or have experienced severe anxiety for a long time, come to realize that what they are feeling is not normal and has gone beyond the normal human response to trauma or loss or stress, and needs to be treated medically. Antidepressants do not make you happy AFAIK. They just normalize your emotional response. That's all that people with MI want, generally. If you think taking an AD will make your life wonderful then you may not need to be on an AD. I don't take meds for social phobia to make me be the life of the party and have 5 girlfriends - I take them so I can go to the supermarket and not feel like I've got three heads and five eyes. I don't expect ADs to make me feel wonderful and glorious - I'd just like to wake up in the morning and not feel this huge weight of sadness and bad memories of inconsequential events ten years in the past crushing me all the time.
>Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
A lot of the time dissatisfaction, disaffection, misery and sadness is caused by the illness we have. So it's logical to believe that if the illness is gone we can at least try to do the things that bring us satisfaction and happiness. There's no guarantees in this life but at least when I roll the dice I'd like them to be fair and not loaded. That's not expecting too much.
What I would say is that doctors need to go deeper and test for things like dissociation and bipolar and psychosis etc., together with disorders like PTSD which can be co-morbid with or simply the cause of clinical depression and anxiety. People classified with TRD might need a deeper exploration of their illness and different kinds of medication besides ADs. Also recovering from any long debilitating illness requires a lot of psychological, behavioral, emotional, spiritual/philosophical work.
Posted by SLS on June 2, 2011, at 18:12:48
In reply to Re: Do we expect too much of antidepressants today?, posted by hyperfocus on June 2, 2011, at 17:48:20
> I don't take meds for social phobia to make me be the life of the party and have 5 girlfriends...
Damn! But my doctor promised! Now, I'm really depressed.
:-/
- Scott
Posted by floatingbridge on June 2, 2011, at 18:56:55
In reply to Re: Do we expect too much of antidepressants today? » hyperfocus, posted by SLS on June 2, 2011, at 18:12:48
:+)
Posted by hyperfocus on June 2, 2011, at 20:32:41
In reply to Re: Do we expect too much of antidepressants today? » hyperfocus, posted by SLS on June 2, 2011, at 18:12:48
Clinical studies show a mean of only 1.7 new girlfriends acquired unfortunately. Either your doctor is overly optimistic or they haven't read the latest data.
Posted by emmanuel98 on June 3, 2011, at 0:04:54
In reply to Re: Do we expect too much of antidepressants today? » SLS, posted by hyperfocus on June 2, 2011, at 20:32:41
There are people in AA who object to psych meds as "happy pills" that keep people from the real, painful work of growth and change through the 12 steps. These people have obviously never themselves suffered from MDD. Anti-depressants are not happy pills. I expected them to be when I first started seeing a psychiatrist. I expected that they would substitute for my opiate and alcohol addiction. But they didn't make me happy. They just made me a little less angry and irritable.
My own p-doc has given up on anti-depressants for me. He is not into trying drug after drug. If an SSRI doesn't work, he doesn't then try every SSRI on the market. He goes to a new class of drugs. So far I have failed on SSRI's, SNRIs, TCAs and most mood stabilizers. I do well on AAPs, but get dangerously fat. MAOIs pulled me out of a near catatonic depression, but haven't made me feel happy at all. I still get severely depressed, but haven't spent days in bed since I started the MAOI.
My p-doc is now convinced that my only hope to stay alive is DBT. DBT is hard work. I called 40 people before I found a DBT practicioner willing to take on a patient with severe SI.
Now, my main fear is that I don't have the fight in me to commit to DBT.I get annoyed at these ads that suggest MDD is easily treatable with happy pills like lexapro. That hasn't been my experience.
Posted by SLS on June 3, 2011, at 4:18:28
In reply to Re: Do we expect too much of antidepressants today?, posted by emmanuel98 on June 3, 2011, at 0:04:54
Hi E.
> There are people in AA who object to psych meds as "happy pills" that keep people from the real, painful work of growth and change through the 12 steps. These people have obviously never themselves suffered from MDD. Anti-depressants are not happy pills. I expected them to be when I first started seeing a psychiatrist. I expected that they would substitute for my opiate and alcohol addiction. But they didn't make me happy. They just made me a little less angry and irritable.
Have you tried combining Zoloft with Trileptal and possibly adding lithium? If you go with an MAOI, you could still add these other drugs.
I think most of us on PB recognize that a healthy brain does not guarantee a healthy mind. Neither does a healthy mind guarantee happiness. People on PB almost never describe antidepressants as being "happy pills". This is a mischaracterization of clinical effects of these drugs.
- Scott
Posted by SLS on June 3, 2011, at 8:08:23
In reply to Re: Do we expect too much of antidepressants today?, posted by emmanuel98 on June 3, 2011, at 0:04:54
Have you tried combining Zoloft with Trileptal and possibly adding lithium? If you go with a switch from Zoloft to an MAOI, you could still add the Trileptal and lithium.
- Scott
Posted by Christ_empowered on June 3, 2011, at 12:20:19
In reply to yes, but..., posted by Christ_empowered on June 2, 2011, at 3:17:25
...why we keep getting more and more over-priced, ineffective pills on the market.
I mean, personally, I'm reasonably lucky, as crazy goes. I take Abilify, I'm not psychotic. I take Celexa, my social phobia and psychotic depression get better. But I can't Celexa forever, because it makes me too apathetic to function. I doubt I'm the only one in this situation.
I find the whole "antidepressant" concept misleading. Really? Anti-sad pills? Sign me up, please.
My current shrink refers to Celexa as a "tranquilizer." That's the sort of thinking that needs to come back into psychiatry--pills that calm people down, pills that perk people up, basic stuff. "Antidepressant" ? Please. If antibiotics failed as much as "antidepressants" do, they would have been abandoned long ago. If anti-epileptic drugs worked as miserably as "antidepressants," epilepsy would either be crippling or science would have moved on to other forms of treatment.
Not only is that term "antidepressant" misleading, I think it gives the false sense that this pill acts specifically on depression and is effective, when that's simply not the case.
Posted by linkadge on June 4, 2011, at 7:09:24
In reply to what I don't understand is..., posted by Christ_empowered on June 3, 2011, at 12:20:19
I would argue that many people are depressed because of a bad marrage, job, finiancial situation, etc. They want the drug to make all that go away, but its not going to happen.
For many, theres a lot deeper work that needs to be done. IMHO
Linkadge
Posted by linkadge on June 4, 2011, at 7:11:03
In reply to Re: Do we expect too much of antidepressants today? » jono_in_adelaide, posted by SLS on June 2, 2011, at 6:27:48
>It is thought by some that this illness in >particular has a rate of response of 85% when >any and all existing psychotropics are to be >considered as potential therapies in the >practice of polypharmacy.
Oh, of course. You could select some group in which they worked 100% of the time!
Linkadge
Posted by linkadge on June 4, 2011, at 7:14:21
In reply to Re: Do we expect too much of antidepressants today?, posted by hyperfocus on June 2, 2011, at 17:48:20
>Antidepressants do not make you happy AFAIK. >They just normalize your emotional response.
I didn't know numb was normal. But, I guess if you're emotions have gone haywire, numb feels more normal.
Linkadge
Posted by linkadge on June 4, 2011, at 7:16:54
In reply to Re: Do we expect too much of antidepressants today? » SLS, posted by hyperfocus on June 2, 2011, at 20:32:41
>Clinical studies show a mean of only 1.7 new >girlfriends acquired unfortunately.
Well, thats great if you're a heterosexual or lesbian.
Linkadge
Posted by SLS on June 4, 2011, at 7:43:02
In reply to Re: don't change your life - change your drug, posted by linkadge on June 4, 2011, at 7:09:24
> I would argue that many people are depressed because of a bad marrage, job, finiancial situation, etc. They want the drug to make all that go away, but its not going to happen.
>
> For many, theres a lot deeper work that needs to be done. IMHO
>
> Linkadge
This is why MDD must be differentiated from the scenarios you describe. An accurate diagnosis is the goal. I wonder if DMS V will be any better than the anemic DMS IV regarding distinguishing depressive disorders from depression that is predominately psychogenic. A question that has occurred to me lately is whether or not antidepressants can help with situational or psychogenic depression. Maybe they can. I have never seen a study addressing this issue. Make the presence of MDD or BD an exclusion rather than an inclusion.
- Scott
Posted by SLS on June 4, 2011, at 7:47:07
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 7:11:03
> >It is thought by some that this illness in >particular has a rate of response of 85% when >any and all existing psychotropics are to be >considered as potential therapies in the >practice of polypharmacy.
>
> Oh, of course. You could select some group in which they worked 100% of the time!
>
> Linkadge
>
How would you be able to select such a population? If someone comes up with a way to predict treatment response for subtypes of depression, that would be a monumental step forward. I believe that it will happen sooner than later.From time to time, let us assume that the investigators know what they are doing when executing a RCT.
- Scott
Posted by SLS on June 4, 2011, at 7:50:08
In reply to Re: Do we expect too much of antidepressants today? » hyperfocus, posted by linkadge on June 4, 2011, at 7:14:21
> >Antidepressants do not make you happy AFAIK. >They just normalize your emotional response.
>
> I didn't know numb was normal. But, I guess if you're emotions have gone haywire, numb feels more normal.
>
> Linkadge
I think Hyperfocus is right. This has been my own observation when I compare the operation of my psyche when depressed versus non-depressed.- Scott
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