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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Phillipa on September 28, 2011, at 20:04:11
Maybe the trend is now going to move the opposite way as off label use of atipical antipsychotics found minimal improvement and some resulted in death. Phillipa
From Medscape Medical News > Psychiatry
Off-Label Atypical Use: Few Benefits, Serious Adverse Effects
Deborah BrauserAuthors and Disclosures
September 27, 2011 Off-label use of atypical antipsychotics may do more harm than good, a new meta-analysis suggests.
A combined analysis of more than 150 efficacy trials showed significant increases in behavioral symptom scores for dementia in the elderly after they were treated with aripiprazole, olanzapine, or risperidone; benefits for nonelderly patients with generalized anxiety disorder (GAD) after they received quetiapine; and benefits for patients with obsessive-compulsive disorder (OCD) after receiving risperidone augmentation.
However, analysis of more than 200 adverse outcome studies showed that treatment-related adverse events, including death, were common in these patient groups.
"Besides the small but statistically significant effect found for dementia, the other improvements were a bit smaller than we expected, with moderate effects for GAD and OCD," lead author Alicia Ruelaz Maher, MD, psychiatrist at the Akasha Center for Integrative Medicine in Santa Monica, California, and assistant clinical professor in psychiatry at the University of California, Los Angeles, School of Medicine, told Medscape Medical News.
Dr. Alicia Ruelaz Maher"As for the other conditions that these medications commonly treat, we just did not find enough of an effect. And despite olanzapine being known to cause weight gain, I was surprised to find it was not effective in causing weight gain in eating disorders," said Dr. Maher, who is also a clinical adjunct at the RAND Health Southern California Evidence-Based Practice Center in Santa Monica.
She noted that the study is the "largest study of its kind on this subject," and prompted clinicians to reconsider the way they prescribe atypical antipsychotics.
"I think the biggest takeaway is that instead of just prescribing blindly, we now have evidence to guide us. There are certainly times when the cost-benefit analysis would go towards using medication, but I would hope that the side effects are kept in mind."
The study appears in the September 28 issue of JAMA.
Doubling of Off-Label Use
"Atypical antipsychotic medications are approved for marketing and labeling by the US Food and Drug Administration (FDA) for treating schizophrenia, bipolar disorder, and depression under drug-specific circumstances," write the researchers.
However, these medications "are commonly used" off-label to treat dementia, anxiety, OCD, eating disorders, substance abuse, and posttraumatic stress disorder.
"We've been noticing that off-label use is increasing. In fact, over the past several years it has doubled," said Dr. Maher.
"Some clinicians feel that if a medication is effective in treating 1 condition, it might also be effective in treating others. And that often works, especially in psychiatry. However, there are also plenty of instances where off-label use was determined to be useless or even harmful."
To evaluate the benefits and safety of these medications for off-label use, the investigators examined data from 162 trials with efficacy outcomes conducted through May 2011.
"Controlled trials comparing an atypical antipsychotic medication (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, asenapine, iloperidone, or paliperidone) with placebo, another atypical antipsychotic medication, or other pharmacotherapy for adult off-label conditions were included," report the researchers.
"Clozapine was excluded due its almost exclusive use for schizophrenia," they add.
Minimal Efficacy
A total of 231 large observational studies were also examined that assessed adverse events and included at least 1000 patients each.
The efficacy review included 14 placebo-controlled trials that evaluated elderly patients with dementia who had symptoms such as psychosis, mood alterations, and aggression.
Overall results showed that aripiprazole, olanzapine, and risperidone showed small but significant effect changes, ranging from 0.12 to 0.20. Quetiapine showed an effect change of 0.11, but this was not deemed significant.
There was a difference of 3.41 points in the pooled Neuropsychiatric Inventory total score for dementia behavior symptoms between treatment with antipsychotics and with placebo. However, this was below the 4-point improvement threshold "considered to be the minimum clinically observable change," report the researchers.
In combined analysis of trials evaluating GAD, a "favorable response" was defined as showing at least 50% improvement on the Hamilton Anxiety Rating Scale. Overall results showed that quetiapine was associated with a 26% greater likelihood of a favorable response at 8 weeks than placebo.
Augmentation with risperidone after not responding to other treatments was associated with a 3.9-fold greater likelihood than placebo of a favorable response (showing at least a 25% improvement on the Yale-Brown Obsessive Compulsive Scale) for patients with OCD.
The study authors note that "evidence does not support" using olanzapine to treat eating disorders, or using any antipsychotic medications to treat substance abuse. Furthermore, they add, "[t]he level of evidence is mixed regarding personality disorders and is moderate for an association of risperidone with improving [posttraumatic stress disorder]."
Rethinking Off-Label Use
Adverse events in elderly patients included an increased risk for death (pooled odds ratio, 1.54) and urinary tract symptoms overall, stroke for risperidone, and extrapyramidal symptoms for olanzapine and risperidone compared with placebo.
In the nonelderly, treatment-related adverse effects from antipsychotics included weight gain (especially with olanzapine), extrapyramidal symptoms, fatigue, sedation, and akathisia for aripiprazole.
"This systematic review demonstrates evidence for the efficacy of atypical antipsychotic medications for only a few of the off-label conditions that are currently being treated," write the researchers.
"This evidence should prove useful for clinicians considering off-label prescribing...and should contribute to optimal treatment decision-making for individual patients with specific clinical symptoms and unique risk profiles."
Dr. Maher added that she hopes this leads to clinicians examining each patient's individual needs.
"For example, if a patient already has kidney problems, then urinary tract symptoms might be a bigger issue than in someone who doesn't. It's just really about looking at the individual."
However, she also noted that although moderate levels of evidence were found for some of these conditions, further research might bring about changes in the results.
"We need to use this information and be wary of prescribing when it isn't warranted; but also we need to keep looking at this issue in future studies."
A Complicated Decision
"While meta-analysis studies are always useful, one doesn't make treatment decisions based on just 1 [study]," Anthony Rothschild, MD, Irving and Betty Brudnick endowed chair and professor of psychiatry at the University of Massachusetts Medical School in Worcester, and director of the Center for Psychopharmacologic Research and Treatment, told Medscape Medical News.
Dr. Anthony Rothschild"Overall, there were some new, interesting things. And their findings that some of the newer, atypical antipsychotics helped with behavioral symptoms in dementia, [GAD], and augmentation in [OCD] is all useful information," said Dr. Rothschild.
He noted that although the investigators' report of adverse events and risks with these medications was also helpful, it really comes down to what a clinician thinks is right.
"The clinician with a patient in their office has to weigh the benefits vs the risks for that individual person. For example, the investigators found a small but significant benefit in symptoms of dementia for some of the medications. But that was coupled with a small but significant increased risk of death. So clinicians have to make a judgment, and it's a complicated decision."
Dr. Rothschild said it was interesting that the analysis did not find any therapeutic benefit for using olanzapine in eating disorders, or any of the atypicals for substance abuse.
In addition, he voiced concerns that the investigators did not include studies that examined these medications for patients with psychotic depression, which commonly involves delusions.
"It's quite a prevalent condition; epidemiologic studies show 15% to 18% of people with depression have this form of it. But it's not even discussed in this article, which is curious because all treatment of it is off-label. There is currently no medication or medication combination that has FDA approval for treating it, but other studies have written that atypical antipsychotics are useful in combination with an antidepressant. It would have been nice if [these investigators] had included a paragraph or 2 on this debilitating disorder."
He noted that the question of why certain studies were included and others were not is an issue with any meta-analysis.
"That's why you wouldn't just hang your practice on 1 article. You have to take the totality of all the evidence. And I'd say a study like this adds to our knowledge base when it comes to making that complicated risk-benefit analysis," concludes Dr. Rothschild.
The study was supported by the Agency for Healthcare Research and Quality and by the Department of Veterans Affairs. All but 1 study author disclosed no relevant financial relationships. Coinvestigator David Sultzer, MD, disclosed having received research support from Eli Lilly and consulting fees from RAND Corporation. Dr. Rothschild reported having received grant support from the National Institute of Mental Health, Cyberonics, Takeda, and St. Jude; and having served as a consultant to Dey Pharma, Eisai Medical, GlaxoSmithKline, Eli Lilly, Noven Pharmaceuticals, Pfizer, and Shire Pharmaceuticals. However, he said that of these relationships, only the National Institutes of Health grant was in the area of antipsychotics. He also receives royalties from American Psychiatric Press for several of his books, including The Evidence-Based Guide to Antipsychotic Medications.
JAMA. 2011; 306:1359-1369.
Posted by jono_in_adelaide on September 29, 2011, at 0:10:35
In reply to Off-Label Antipsychotics May Not Be Safe, posted by Phillipa on September 28, 2011, at 20:04:11
I guess when you're suffering, even a moderate improvement is worthwhile, and, it might be that extra moderate improvement, added to that produced by an SSRI or bonzo or whatever, that turns life from a burden to a joy.
I think we need to remember that drugs arnt risk free - taking 2 Advil for a headache has risks associated with it, but when you have a splitting headache, the risks are usualy considered worth taking for the releif it gives, and the same principal applies here, atleast thats how I see it.
That said, I think a lot of drugs given to dementia patients arnt for the benifit of the patient, but to make them easier for the staff of the care facility to manage, which isnt good.
Posted by Christ_empowered on September 29, 2011, at 1:22:51
In reply to Re: Off-Label Antipsychotics May Not Be Safe, posted by jono_in_adelaide on September 29, 2011, at 0:10:35
I think this is a problem that pops up when we let doctors decide treatment. Think about it: we supposedly have a free market economy, but we let docs (many of whom are paid by drug companies) decide what pill(s) to give to people. Is it any surprise that they often go for the most expen$ive, latest and greatest medication, even if its off-label and racks up enormous drug costs and causes side-effects?
I think the answer would be to ditch the Rx system and let docs act more as guides in drug selection than the ultimate decision-makers. Or pharmacists. Or just let consumers buy whatever they feel will help them and that they can afford on an open market. That's capitalism in action.
Posted by Dinah on September 29, 2011, at 11:01:58
In reply to Off-Label Antipsychotics May Not Be Safe, posted by Phillipa on September 28, 2011, at 20:04:11
>> In combined analysis of trials evaluating GAD, a "favorable response" was defined as showing at least 50% improvement on the Hamilton Anxiety "Rating Scale. Overall results showed that quetiapine was associated with a 26% greater likelihood of a favorable response at 8 weeks than placebo.
Augmentation with risperidone after not responding to other treatments was associated with a 3.9-fold greater likelihood than placebo of a favorable response (showing at least a 25% improvement on the Yale-Brown Obsessive Compulsive Scale) for patients with OCD." <<
They aren't going to lead with this, for sure. Admitting that Risperidone helps those who have not been helped by other treatments? Who's funding/running this story?
Also, there is no attempt at all to segregate the sort of patients who are most likely to respond well to AP treatment.
Drug companies aren't the only ones with an agenda.
It makes me furious that they do these studies on a group as wide as depression, or anxiety, or whatever, without dividing people up at all by type. It's like saying that casts are only helpful to ten percent of those with leg injuries, when the other ninety percent of injuries may not involve a broken leg.
To the people it's helpful with, it's very helpful. It can be a lifesaver, or at least make life worth living.
Posted by SLS on September 29, 2011, at 11:44:58
In reply to What a biased title, posted by Dinah on September 29, 2011, at 11:01:58
> >> In combined analysis of trials evaluating GAD, a "favorable response" was defined as showing at least 50% improvement on the Hamilton Anxiety "Rating Scale. Overall results showed that quetiapine was associated with a 26% greater likelihood of a favorable response at 8 weeks than placebo.
>
> Augmentation with risperidone after not responding to other treatments was associated with a 3.9-fold greater likelihood than placebo of a favorable response (showing at least a 25% improvement on the Yale-Brown Obsessive Compulsive Scale) for patients with OCD." <<
>
> They aren't going to lead with this, for sure. Admitting that Risperidone helps those who have not been helped by other treatments? Who's funding/running this story?
>
> Also, there is no attempt at all to segregate the sort of patients who are most likely to respond well to AP treatment.
>
> Drug companies aren't the only ones with an agenda.Yup.
You should visit us more often, Dinah. :-)
One thing negative about risperidone and the other AAPs is that they seem to increase the risk of fatality in elderly Alzheimers patients. I think risperidone has been cited the most often.
I have an agenda.
I would like to see more people with mental illnesses be treated successfully. Every drug is a tool. The more tools that become available, the greater will be the probability that more people will get well. Until better medications are brought to market, we will need every one of those that are currently available. Safety and adverse effects must always be evaluated for each drug to be used and for each patient to be treated.
I would not advocate removing drugs that are pieces of crap, as long as they are safe. Reboxetine and moclobemide are crap, yet there are a few people who do well on them. If the drug company wants to continue selling the stuff, why stop them?
- Scott
Posted by Dinah on September 29, 2011, at 14:11:19
In reply to Re: What a biased title » Dinah, posted by SLS on September 29, 2011, at 11:44:58
I think I'm just as upset with what appears to be junk science, though to be fair it might just be reported that way.
Reading your typical science news from mainstream sources, it leads one to wonder if there are any true scientists out there at all. People who want to know facts, and not draw unwarranted conclusions from them. The first thing my son learned in middle school science was how to see problems with the reports of studies in media. Attribution errors, bias, etc. Bless his science teacher.
But I readily admit that the problem may lie more with reporters looking for a good headline than with the actual studies.
But really....
If I have a handful of life lessons I really want to impart to my son, one will be sunk cost theory, and one will be correlation does not mean causality.
Ok. Enough ranting. For now anyway. :)
(It might be fun to start an ongoing "Stupid Science News" thread. And perhaps "From the Science Journal Duhhhhh....")
Posted by Dinah on September 29, 2011, at 14:16:50
In reply to Re: What a biased title » Dinah, posted by SLS on September 29, 2011, at 11:44:58
And did they mention dosing with the elderly patients and Risperdal? I know nursing homes like to keep their patients compliant. And you don't have to have dementia to feel like you're being kept against your will in a nursing home. A family member was taken from her home against her will when she was admittedly a bit dotty, but managing with help from neighbors and family, and taken to an out of state nursing home. They took her attempts to escape as signs of her dementia. I took them as signs of her sanity. I wouldn't be at all surprised if they didn't overprescribe drugs to keep her nice and quiet. It's not even unreasonable, given that they are caring for a number of patients, all of whom who benefit from an environment relatively free of disruptions. Does .5 mg of Risperdal up the chances for death? Or all we talking about the doses routinely given to Alzheimers patients to enhance compliance?
Posted by SLS on September 29, 2011, at 15:09:51
In reply to Re: What a biased title, posted by Dinah on September 29, 2011, at 14:16:50
> And did they mention dosing with the elderly patients and Risperdal? I know nursing homes like to keep their patients compliant. And you don't have to have dementia to feel like you're being kept against your will in a nursing home. A family member was taken from her home against her will when she was admittedly a bit dotty, but managing with help from neighbors and family, and taken to an out of state nursing home. They took her attempts to escape as signs of her dementia. I took them as signs of her sanity. I wouldn't be at all surprised if they didn't overprescribe drugs to keep her nice and quiet. It's not even unreasonable, given that they are caring for a number of patients, all of whom who benefit from an environment relatively free of disruptions. Does .5 mg of Risperdal up the chances for death? Or all we talking about the doses routinely given to Alzheimers patients to enhance compliance?
Next time I happen upon one of these studies, I will try to keep your questions in mind. The initial reports describing an increase in fatalities when risperidone was used in DAT patients were very alarming.
- Scott
Posted by Phillipa on September 29, 2011, at 18:22:32
In reply to Re: What a biased title » Dinah, posted by SLS on September 29, 2011, at 15:09:51
Unfortunately these are the studies that I get from Nursing for RN's Physicians, And Pharmacists, To get their CEU's. What worries me is that as people age the liver doesn't process the meds the same anymore. So does your doc get Ceu's from sites as this which do print out and supply a certificate. Or does he/she attend classes. Thanks for all the insight. Phillipa
Posted by morgan miller on September 30, 2011, at 1:00:05
In reply to What a biased title, posted by Dinah on September 29, 2011, at 11:01:58
But Dinah, these drugs are overprescribed and should only be used as a last resort. A regular at the organic store I work at now has diabetes after being on Abilify. She can't take it anymore and realizes she should have been offered other treatements before Abilify. Docs are f*ck*ng AAP coo coo for cocoa puffs dude. It's f*ck*ng out of control.
Morgan
Posted by morgan miller on September 30, 2011, at 1:09:26
In reply to Re: What a biased title » Dinah, posted by SLS on September 29, 2011, at 11:44:58
Scott, how about we finally start focusing on raising awareness to the importance and impact of parenting on the early development of a child's psyche and brain chemistry/function. Let's start facing the harsh truths. The more we focus on drugs being the cure, the more we lose site of what we should really be focusing on-prevetion. I'm not saying the need for drugs will be eliminated, not at all, I'm just saying that I believe much of the need for medication will be greatly diminished if we work on changing the world.
How much has psychiatry helped you in your life Scott? How far has it gotten you out of the rabbit holes you keep falling into? Dude, don't get me wrong, I'm all for medication, I take them myself. But, in a different world, with parents that were sound of mind and able to give their children what they needed(and themselves what they needed), I would not have struggled as I have, and would not have needed as much medication as I have, I can guarantee that.
Morgan
Posted by morgan miller on September 30, 2011, at 1:11:55
In reply to Re: What a biased title » Dinah, posted by SLS on September 29, 2011, at 15:09:51
Oh geeze, may have made a bit of an inflammatory post. Scott, I was just making a point. I hope no offense was taking. I sure did not meant to piss you off at all. I just get a bit fiesty sometimes and impulsively spit out whatever comes to mind. Peace..
Morgan
Posted by SLS on September 30, 2011, at 6:07:22
In reply to Re: What a biased title, posted by morgan miller on September 30, 2011, at 1:11:55
> Oh geeze, may have made a bit of an inflammatory post. Scott, I was just making a point. I hope no offense was taking. I sure did not meant to piss you off at all. I just get a bit fiesty sometimes and impulsively spit out whatever comes to mind. Peace..
>
> Morgan
No problem. As always, I agree with your thoughts on the critical importance of environment on the development of many cases of mental illness. However, I believe that there is still a lack of understanding and appreciation for how biological these illnesses are once they are triggered. It might take environment to precipitate MDD, but it can be necessary to intervene biologically in order to "trigger" remission. Of course, many people will have psychological / emotional issues to process afterwards, but this is not true of everyone with MDD or BD.
- Scott
Posted by morgan miller on September 30, 2011, at 9:34:33
In reply to Re: What a biased title » morgan miller, posted by SLS on September 30, 2011, at 6:07:22
> > Oh geeze, may have made a bit of an inflammatory post. Scott, I was just making a point. I hope no offense was taking. I sure did not meant to piss you off at all. I just get a bit fiesty sometimes and impulsively spit out whatever comes to mind. Peace..
> >
> > Morgan
>
>
> No problem. As always, I agree with your thoughts on the critical importance of environment on the development of many cases of mental illness. However, I believe that there is still a lack of understanding and appreciation for how biological these illnesses are once they are triggered. It might take environment to precipitate MDD, but it can be necessary to intervene biologically in order to "trigger" remission. Of course, many people will have psychological / emotional issues to process afterwards, but this is not true of everyone with MDD or BD.
>
>
> - ScottI also want there to be the right amount of focus on the biological components and medical treatment advances. Though, I have become concerned in recent years over the focus on genetic causes. It seems every time you read an article or see something on tv, the movement is towards finding a genetic cause and a pill to fix it. This accommodates many people, the pharmaceutical industry and parents included. If this movement continues the way it is, without a good balanced focus, we will get away from the other crucial half of the fight against mental illness. People just want a simple easy explanation and cure, most do not really want to face reality and take responsibility.
I am one that believes we all have psychological wounds that need to be dealt with. I have a hard time believing there is a single person suffering from any mental illness that had a consistently loving and nurturing environment. That said, some may not find relief from their depressive symptoms even after working very hard in therapy. I do believe though, that all can-if they stick it out and do all the work-benefit from therapy. If you find the right therapist, and do all the work(this may take some time), you will be able to know yourself better than before, love yourself more than before, rid yourself of inner anger(that's inner anger, not the misguided crap that's driven by inner anger), and be able to communicate better with people in a way that will improve your ability to maintain healthy relationships. All of these things will eventually increase someone's chance of having a better life, and should increase chances of remission and recovery. Like the saying goes, "the mind is a powerful thing". I'm not saying we can just will ourselves to get better, just that we can influence the outcome of things at least a little if we stay the course and do the work.
M-
Posted by Phillipa on September 30, 2011, at 19:04:28
In reply to Re: What a biased title, posted by morgan miller on September 30, 2011, at 9:34:33
Morgan maybe now we need a thread taking a poll as how many with Mental Illness feel that had a good childhood. My Mother and Father didn't hit me physically but the blame for the death of my Mother will always haunt me. Phillipa
Posted by zonked on October 1, 2011, at 10:31:51
In reply to Re: What a biased title, posted by morgan miller on September 30, 2011, at 1:00:05
> But Dinah, these drugs are overprescribed and should only be used as a last resort. A regular at the organic store I work at now has diabetes after being on Abilify. She can't take it anymore and realizes she should have been offered other treatements before Abilify.
Especially when there are excellent treatments we've had around for decades - for GAD, depression, bipolar disorder...
>Docs are f*ck*ng AAP coo coo for cocoa puffs dude. It's f*ck*ng out of control.
No kidding. Like Thorazine decades before it, these drugs will probably (technically) retain their indications for nonpsychotic disorders but almost never be prescribed, and the AAP era will be regarded as a dark one in this field of medicine as more and more lawsuits and analyses such as these come out. Wait for them all to come off patent.
Then we'll see a rush to prescribe whatever new is coming out of Pharmaland. I hope not more AAPs, I hope more novel things (like Viibryd).
-z
Posted by Dinah on October 1, 2011, at 11:59:16
In reply to Re: What a biased title » morgan miller, posted by zonked on October 1, 2011, at 10:31:51
What would you say works for anxiety the way AAP's do?
I haven't found anything.
Posted by zonked on October 1, 2011, at 12:59:11
In reply to Re: What a biased title » zonked, posted by Dinah on October 1, 2011, at 11:59:16
> What would you say works for anxiety the way AAP's do?
>
> I haven't found anything.Alprazolam (Xanax); and I would also say on the flipside, oddly enough, Dexedrine (but not Adderall or any Ritalin derivative).
Nardil helps now, testosterone does (my Xanax consumption has dipped significantly since adding it), and Zoloft has in the past.
If these medicines were appropriate for GAD, believe me, they would have pursued indications.
Perhaps they already did studies, they turned out with not so good results and never published them.
Having said that, it may work for some people but should not be tried as first-line treatment.
Posted by Phillipa on October 1, 2011, at 19:43:27
In reply to Re: What a biased title » Dinah, posted by zonked on October 1, 2011, at 12:59:11
In females progesterone of the bioidentical form is very calming. When started taking the estriol,progesterone, testosterone compounded creams from a MD doc that is when I started sleeping almost too well hence weaning off the benzos as just not necessary any longer. Phillipa
Posted by zonked on October 1, 2011, at 19:53:18
In reply to Re: What a biased title » zonked, posted by Phillipa on October 1, 2011, at 19:43:27
> In females progesterone of the bioidentical form is very calming. When started taking the estriol,progesterone, testosterone compounded creams from a MD doc that is when I started sleeping almost too well hence weaning off the benzos as just not necessary any longer. Phillipa
Hmm. From what I understand, the bio-identical thing is controversial but seems only to apply to some (if not all) female hormones. Testosterone is testosterone is testosterone.
I don't know if it's synthesized in the lab or made from natural sources but it is the same molecule.... Expensive stuff. Costs my insurance carrier $500 a fill. Just picked up my fill today. :)
-z
Posted by Phillipa on October 1, 2011, at 21:08:01
In reply to Re: 'bio-identical' hormones » Phillipa, posted by zonked on October 1, 2011, at 19:53:18
A good read is Stanley's Apothecary Charlotte NC. My script out of pocket is $55 a month the other compounding Rx I used was $44/mth but I didn't like them as well. Phillipa
Posted by Dinah on October 2, 2011, at 1:42:03
In reply to Re: What a biased title » Dinah, posted by zonked on October 1, 2011, at 12:59:11
My thought is that there ought to be more ways to categorize mental illness so that there aren't so many blanket first-line treatments.
I haven't found Xanax or Klonopin to be anything at all like Risperdal in action. Risperdal addresses anxiety in a different way. For me, it's a very helpful medication that I take with caution, on an as needed basis, at a low dose.
But I rather wish my first pdoc (as an adult) had not put me on an SSRI as a first-line treatment. It wasn't at all good for me and I think the effects linger. I suspect that a bit of discernment would have put me in a different group from those that would respond well to SSRI's. Or at least put me on a mood stabilizer in addition to the SSRI.
Incidentally, it was Depakote that packed the weight on me. AAP's aren't the only drug with negative health consequences. Not by a long shot. They shouldn't be singled out and vilified.
What should happen is more careful sorting of types of depression and anxiety. Not all depression and anxiety is the same.
This is the end of the thread.
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