![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by jono_in_adelaide on July 28, 2011, at 5:25:41
If antidepressants are as ineffective as some comentators and patients complain, why was there such a big drop in suicide rates at the tine Nardil and Tofranil were introduced?
I would say its because antidepressants work in major depression (the sort that drives people to suicide) but not in neurotic unhappiness (the sort that makes people complain but not off them self)
Posted by SLS on July 28, 2011, at 7:53:43
In reply to The 'antidepressants dont work' thing, posted by jono_in_adelaide on July 28, 2011, at 5:25:41
> If antidepressants are as ineffective as some comentators and patients complain, why was there such a big drop in suicide rates at the tine Nardil and Tofranil were introduced?
>
> I would say its because antidepressants work in major depression (the sort that drives people to suicide) but not in neurotic unhappiness (the sort that makes people complain but not off them self)I'm with you.
- Scott
Posted by Zonked on July 28, 2011, at 10:08:59
In reply to The 'antidepressants dont work' thing, posted by jono_in_adelaide on July 28, 2011, at 5:25:41
So many kinds of depression, so many treatments. Sometimes, I wonder if I'm a mix of the two types you mention, although that's a bit two dimensional. One of the things that keeps of hopeful, even in the worst moments of despair, is that treating depression is highly profitable for the pharmaceutical companies. These things we postulate about may one day become real treatments. Then on the other hand, cures are NOT profitable. I wonder what treatment for this illness (or illnesses with similar symptoms lumped under the same diagnoses) will look like in 20 years? Maybe a bit better. Have you ever been treated in the US, jono? If so, how would you compare treatment of affective disorders in Australia to treatment in the US? Just curious.
Posted by Phillipa on July 28, 2011, at 11:29:15
In reply to Re: The 'antidepressants dont work' thing, posted by Zonked on July 28, 2011, at 10:08:59
So no ad's unless you are suicidal? Now I'm more than confused. Maybe that is the solution. Phillipa
Posted by linkadge on July 28, 2011, at 12:08:31
In reply to The 'antidepressants dont work' thing, posted by jono_in_adelaide on July 28, 2011, at 5:25:41
>why was there such a big drop in suicide rates >at the tine Nardil and Tofranil were introduced?
says who?
Posted by morgan miller on July 28, 2011, at 12:24:52
In reply to The 'antidepressants dont work' thing, posted by jono_in_adelaide on July 28, 2011, at 5:25:41
Antidepressants work for all types of depression, just not all the time for all people suffering.
Posted by Christ_empowered on July 28, 2011, at 14:12:57
In reply to Re: The 'antidepressants dont work' thing, posted by morgan miller on July 28, 2011, at 12:24:52
I think part of the problem is that doctors select patients for drug treatment for "depression" when the patients might benefit from non-drug treatment and/or other forms of medication.
I've read, for instance, that a lot of what we call "depression" these days would have been called "anxiety" back in the days of barbiturates, meprobamate, and Valium. That might explain why so many "depressed" people benefit from low-dose neuroleptics--they're getting that tranquilization they need.
Even back when the TCAs and the MAOIs hit the scene, they still used other drugs (uppers, downers, upper+downer combos, tranquilizers, neuroleptics, etc.) to treat what we would today call "depression." I think that since the disease model hadn't evolved quite yet, those doctors may have been better at treating the specific problems, rather than treating based on a diagnosis.
Posted by linkadge on July 28, 2011, at 17:34:55
In reply to Re: The 'antidepressants dont work' thing, posted by morgan miller on July 28, 2011, at 12:24:52
>Antidepressants work for all types of depression,
That depends on how your classify your "types".
If they don't work for a particular individual, then it could be argued that they didn't work for his type of depression.
Linkadge
Posted by jono_in_adelaide on July 28, 2011, at 19:42:55
In reply to Re: The 'antidepressants dont work' thing, posted by Zonked on July 28, 2011, at 10:08:59
I'm not trying to blame the poor patients with neurotic subtypes of depression, its the fault of the doctors, who see pills as an easy way out, rather than trying to get to the bottom of their problems.
I said it a few days ago, but a co-workers wife left him, and a couple of days later, he started to itch all over, went to the doctor, and instead of reasurance, or advice, or an anthhistamine, or even a few Valium to help him over the crunch, he was prescribed a six month course of Paxil.
I doubt very much it would have done anything for his stress induced itching - but he was sensible enough not to take it
Posted by jono_in_adelaide on July 28, 2011, at 19:49:36
In reply to Re: The 'antidepressants dont work' thing, posted by Phillipa on July 28, 2011, at 11:29:15
"So no ad's unless you are suicidal? Now I'm more than confused. Maybe that is the solution. Phillipa"
No, I wouldnt say that, just that antidepressants need to be prescribed for the right reasons, for people with major depression, not just for people who are unhappy.
Remember in the 70's when half the western world was taking Valium and Librium for no real reason - now their kids are on Zoloft.
Posted by emmanuel98 on July 28, 2011, at 21:28:22
In reply to Re: The 'antidepressants dont work' thing, posted by jono_in_adelaide on July 28, 2011, at 19:49:36
I agree with this and so do most psychologists and social workers. There are a ton of unhappy people who are just unhappy, not depressed. I have sponsees in AA who are just going through a rough period because of jobs, relationships, getting sober, dealing with loss and grief without drugs and alcohol. They are all on SSRIs and the SSRIs do nothing for them at all.
I used to pooh-pooh depression, seeing it as self indulgence and self-pity. Until I got so depressed I barely got out of bed for three months. Then I came to respect the medical model of depression. But I think cases like mine are the exception, not the rule, of who walks into psych offices looking for help.
I mean people on this list want drugs for shyness, blushing, anxiety, worry. This is not what anti-depressants are for. Depression has just become this catch-all term for normal human unhappiness. Something therapists are better at helping with than psychopharmacologists.
Is it that people want a quick fix or that insurance companies want a quick fix? I can't tell. My insurance company will pay for a year of therapy without reauthorization. But maybe that's because I've been hospitalized so many times they want to keep me out of the hospital. I don't know if this is their regular policy.
Posted by linkadge on July 28, 2011, at 22:22:48
In reply to Re: The 'antidepressants dont work' thing, posted by emmanuel98 on July 28, 2011, at 21:28:22
>But I think cases like mine are the exception, >not the rule, of who walks into psych offices >looking for help.
I think thats a pretty pathetic statement. The "I have *true* depression. All those other loosers out there just need to get their acts together" mentality.
Linkadge
Posted by linkadge on July 28, 2011, at 22:28:39
In reply to Re: The 'antidepressants dont work' thing, posted by emmanuel98 on July 28, 2011, at 21:28:22
If antidepressants actually worked, and were completely safe, I'd say give them to anybody who wants them.
I think many doctors (at this point) do see them as placebos, and for that exact reason give them out liberally.
Antidepressants stopped working (for me) about the time I stopped thinking they worked. When research started to come out doubting the actual efficacy of the drugs, I started saying....hmmm, is this drug actually working. At this point I started to become depressed again.
It was a good little ignorant run I had with antidepressants, though.
Linkadge
Posted by Phillipa on July 28, 2011, at 22:32:31
In reply to Re: The 'antidepressants dont work' thing, posted by Christ_empowered on July 28, 2011, at 14:12:57
Exactly and in 1971 was put on valium and mepbrobamate and thrived. I had own Aerobics Dance business, raised three children, went through an eminent divorce, and also put self through RN school and graduated magan c*m laude. I just stopped the mep when didn't need it. Went off and on benzos and was med free for a lot of the time. When first ad prescribed as SSRI's new was the beginning of decline. And I refuse to raise doses. After 41 years tolerant but still will not. Phillipa
Posted by emmanuel98 on July 29, 2011, at 3:26:55
In reply to Re: The 'antidepressants dont work' thing » emmanuel98, posted by linkadge on July 28, 2011, at 22:22:48
> I think thats a pretty pathetic statement. The "I have *true* depression. All those other loosers out there just need to get their acts together" mentality.
>
> Linkadge
Thanks Linkadge. Supportive and helpful, as usual.
That's not what I meant. Seeing a therapist doesn't mean you're a loser who needs to get your act together. I see two therapists. Therapy is a powerful treatment for people who are unhappy, anxious, shy. SSRIs are not. And I wouldn't mind handing these out like candy for a placebo response, but in the cases I see, the p-docs keep upping the dosage and augmenting with other meds when there is no response except for more and more unpleasant side effects. There's a big difference between someone who is crippled by feelings of hopelessness and despair and someone who hates thier job and resents their family and doesn't know how to move on or accept the situation. The latter isn't a "loser", but it's not clear they are clinically depressed. They need help, but it's not clear they need drugs that alter their brain chemistry.I know a guy who is unhappy and confused about his life, but not really depressed. He takes about 3 anti-depresants which have so destroyed his libido, that his girlfriend left him. No placebo resonse either. He refuses to see a therapist, seeing that as "weak".
I won't take anymore drugs. I feel sure that the residual depression I've had since starting parnate is psychological in origin, not physiological. Instead, I see a p-doc for dynamic therapy and a SW for DBT. I also do a DBT group. My p-doc agrees with this and when I've gotten miserable, suggests I work harder at the DBT rather than trying to augment parnate with another drug. The parnate keeps me from falling into the vegetative state I was in when I started. But it doesn't make me happy. Anti-depressants are not happy pills.
Posted by SLS on July 29, 2011, at 7:03:36
In reply to Re: The 'antidepressants dont work' thing, posted by emmanuel98 on July 29, 2011, at 3:26:55
> I won't take anymore drugs. I feel sure that the residual depression I've had since starting parnate is psychological in origin, not physiological.
What are your reasons for believing this?
"Residual" indicates the persistence of a condition being treated. Either you continue to treat the residual as if it were an incomplete response to the treatment administered, or acknowledge that there are two conditions to be treated, which you are now doing. It would be nice to be assigned a diagnosis for a treatment that has been recommended. What psychological conditions are you being treated for?
We are probably in agreement that the biological state of the brain and the psychological state of the mind are inextricably connected and interact constantly. Major Depressive Disorder (MDD) can be triggered by acute trauma or chronic psychosocial stress. Conversely, dysfunctional thinking can be the product of MDD. Recovery from MDD often requires biological interventions combined with psychotherapy to clean up the mess left by the MDD.
- Scott
Posted by linkadge on July 29, 2011, at 11:58:48
In reply to Re: The 'antidepressants dont work' thing, posted by emmanuel98 on July 29, 2011, at 3:26:55
>There's a big difference between someone who is >crippled by feelings of hopelessness and despair >and someone who hates thier job and resents >their family and doesn't know how to move on or >accept the situation.
Yeah, but how do *you* know the difference between the two. I know a lot of clinically depressed people who put on a happy face, and downplay their own problems in public, but behind closed doors they really are clinically depressed. The kinds of information that is revealed to a physician may be very different than the kinds of information revealed to co-workers in public. So its not really possible for anybody to say...so and so is not *really* clinically depressed, they just need "therapy" and "acceptance" in their life.
>I know a guy who is unhappy and confused about >is life, but not really depressed.
Again...how do you know? Maybe the medications upgraded him from "clinically depressed" to "confused about his life"
Linkadge
Posted by emmanuel98 on July 31, 2011, at 19:40:49
In reply to Re: The 'antidepressants dont work' thing » emmanuel98, posted by SLS on July 29, 2011, at 7:03:36
i have a severe trauma history. I hae had years of dynamic therapy which helped me acknowledge and access this, but didn't help with controlling the emotional dysregulation I get whenever something goes wrong in my life. My p-doc strongly suggested DBT and I have found it very helpful. I meditate daily and have learned to be "in the moment" and gain some control. Sometimes the suicidal ideation gets out of control. I take 15mg of haldol when it does and when that doesn't work, I call my DBT therapist. I have still ended up in the hospital too much, but the stays have been shorter. Days rather than weeks.
> > I won't take anymore drugs. I feel sure that the residual depression I've had since starting parnate is psychological in origin, not physiological.
>
> What are your reasons for believing this?
>
> "Residual" indicates the persistence of a condition being treated. Either you continue to treat the residual as if it were an incomplete response to the treatment administered, or acknowledge that there are two conditions to be treated, which you are now doing. It would be nice to be assigned a diagnosis for a treatment that has been recommended. What psychological conditions are you being treated for?
>
> We are probably in agreement that the biological state of the brain and the psychological state of the mind are inextricably connected and interact constantly. Major Depressive Disorder (MDD) can be triggered by acute trauma or chronic psychosocial stress. Conversely, dysfunctional thinking can be the product of MDD. Recovery from MDD often requires biological interventions combined with psychotherapy to clean up the mess left by the MDD.
>
>
> - Scott
Posted by emmanuel98 on July 31, 2011, at 19:47:25
In reply to Re: The 'antidepressants dont work' thing, posted by linkadge on July 29, 2011, at 11:58:48
I "know" this mainly by sponsoring 4 people in AA. They are all on anti-depressants, yet none of them really meet the criteria for MDD. They are just bummed out about jobs, relationships,etc. I have one sponsee who is truly depressed -- no real content, just miserable. I have urged her to see a p-doc and therapist. The others, I have urged to do DBT type stuff. Meditating, practicing mindfulness and being in the moment, using the program to call people and keep connected and avoid isolation. I don't claim to know everything. But when you work with a sponsee you get to know them pretty intimately and get a sense of what is making them so unhappy.
Posted by Shes_InItForTheMoney on August 8, 2011, at 6:23:34
In reply to Re: The 'antidepressants dont work' thing, posted by linkadge on July 29, 2011, at 11:58:48
> >There's a big difference between someone who is >crippled by feelings of hopelessness and despair >and someone who hates thier job and resents >their family and doesn't know how to move on or >accept the situation.
>
> Yeah, but how do *you* know the difference between the two. I know a lot of clinically depressed people who put on a happy face, and downplay their own problems in public, but behind closed doors they really are clinically depressed. The kinds of information that is revealed to a physician may be very different than the kinds of information revealed to co-workers in public. So its not really possible for anybody to say...so and so is not *really* clinically depressed, they just need "therapy" and "acceptance" in their life.
>
> >I know a guy who is unhappy and confused about >is life, but not really depressed.
>
> Again...how do you know? Maybe the medications upgraded him from "clinically depressed" to "confused about his life"
>
> Linkadge
>
>People expect too much from pills. The truth is if your life circumstances where crud before meds, it's not going to be much different after taking meds. It's just small things that will change, like some sleeping habits, some energy, but everybody thinks meds should do all the work and people think they should turn into a superhero. Meds take away SOME symptoms...the rest is up to you.
Jay
Posted by Shes_InItForTheMoney on August 8, 2011, at 6:57:15
In reply to Re: Meds are only a fraction of the answer » linkadge, posted by Shes_InItForTheMoney on August 8, 2011, at 6:23:34
> > >There's a big difference between someone who is >crippled by feelings of hopelessness and despair >and someone who hates thier job and resents >their family and doesn't know how to move on or >accept the situation.
> >
> > Yeah, but how do *you* know the difference between the two. I know a lot of clinically depressed people who put on a happy face, and downplay their own problems in public, but behind closed doors they really are clinically depressed. The kinds of information that is revealed to a physician may be very different than the kinds of information revealed to co-workers in public. So its not really possible for anybody to say...so and so is not *really* clinically depressed, they just need "therapy" and "acceptance" in their life.
> >
> > >I know a guy who is unhappy and confused about >is life, but not really depressed.
> >
> > Again...how do you know? Maybe the medications upgraded him from "clinically depressed" to "confused about his life"
> >
> > Linkadge
> >
> >
>
> People expect too much from pills. The truth is if your life circumstances where crud before meds, it's not going to be much different after taking meds. It's just small things that will change, like some sleeping habits, some energy, but everybody thinks meds should do all the work and people think they should turn into a superhero. Meds take away SOME symptoms...the rest is up to you.
>
> JayAnd...."confused about life" is just part of being human. It is not a malady...c'mon! A couple of things....
Once people get a bit better on meds, therapy has been scientifically shown to hold it's own in scientific trials. I know as a social worker, talk therapy is very helpful for people, especially surrounding the sub-issues of abuse, alienation, lack of support network, f****ed up families, etc. Meds can lift the dismal basic lower brain dysfunctions and feelings behind depression and anxiety, but for many, only to a point.
The advanced human higher brain functions need more, and there is some really good research showing that not just therapy, but using higher brain capacity in exploring philosophy, different languages, and the whole experience of more advanced learning can stimulate the brain in protecting from further mental illness. I even know of a social worker in NYC who is working with a martial arts instructor to teach her clients martial arts. There is tons of support for the clients, and they come out feeling very much in control of their bodies and self and lives.
I know it is all not a simple answer, but man I know my time on earth will expire if I ever just wait around for some super-duper drug or combo to "save" me. We don't get these minutes back...they aren't "tacked" onto the end of our lives.
Jay
Posted by SLS on August 8, 2011, at 7:19:23
In reply to Re: Meds are only a fraction of the answer » Shes_InItForTheMoney, posted by Shes_InItForTheMoney on August 8, 2011, at 6:57:15
Tell me the same thing about cancer, and you've got a deal.
- Scott
Posted by sigismund on August 8, 2011, at 23:33:03
In reply to Re: Meds are only a fraction of the answer » linkadge, posted by Shes_InItForTheMoney on August 8, 2011, at 6:23:34
When the refugees we have imprisoned (to send a message to the people smugglers) are given ADs....the ADs actually don't work very well, so I read.
Posted by SLS on August 9, 2011, at 6:12:47
In reply to Re: Meds are only a fraction of the answer » Shes_InItForTheMoney, posted by sigismund on August 8, 2011, at 23:33:03
> When the refugees we have imprisoned (to send a message to the people smugglers) are given ADs....the ADs actually don't work very well, so I read.
What conditions were being treated? Are we looking at PTSD or MDD? Who knows how accurate were the diagnositic procedures to process such a large group of people. ADs work best to treat some conditions and not others.
- Scott
Posted by Shes_InItForTheMoney on August 10, 2011, at 16:04:03
In reply to Re: Meds are only a fraction of the answer » sigismund, posted by SLS on August 9, 2011, at 6:12:47
> > When the refugees we have imprisoned (to send a message to the people smugglers) are given ADs....the ADs actually don't work very well, so I read.
>
> What conditions were being treated? Are we looking at PTSD or MDD? Who knows how accurate were the diagnositic procedures to process such a large group of people. ADs work best to treat some conditions and not others.
>
>
> - ScottScott, I am not trying to argue with you. I would be very, very lost without my medication. But there is always the nurture component to nature. If you gave ad's to concentration camp victims (while in the camps, knowing they are going to die), drugs are not going to change their mindset or condition. No matter how bad your problems where before meds, they are still going to be there after meds, staring you straight in the face. Medications lift the dreadful symptoms so you may be able to deal with them better, but they do not give you interpersonal, communication, or people skills. And the sad fact is that many people on meds *don't* have these skills. (Especially the large number living in poverty, with little education.) Yes, medication *is* absolutely required. But,life-skills therapy, group and individual therapy have been shown to play a part in helping improve peoples lives who live with mental illness.
In fact, the research (Dr. Bruce Perry is a leader in this field) shows our temperaments are heavily influenced and shaped very early in life, from birth to 2 years of age. If you ever studied Developmental Psychology, you should know this.
Our mental health is very heavily influenced by our environments. It (environment) plays a big factor in determining our personal resilience and coping skills. It is not a "weakness", just proof that we have to get help to change our environments, just as much as we need meds to help lift the primordial physical pain depression can cause. Meds are mandatory and crucial in this. But many *also* need the interpersonal skills to change their environment and coping/life skills.
Jay
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.