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Dr. Bob is Robert Hsiung, MD,
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Posted by doxogenic boy on October 19, 2013, at 7:02:52
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by Phillipa on October 18, 2013, at 20:58:35
> I agree as ad's handed out like candy here. If you are sad, recent death in family, loss of job, the list goes one "here take this pill".
I found this diagnosis in DSM-5:
"Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions"Do they prescribe antidepressants for this in America?
- doxogenic
Posted by linkadge on October 19, 2013, at 11:49:46
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 18, 2013, at 18:36:29
>There also is some research that long-term use >of antidepressants can worsen the course of >depression/cause tardive dysphoria.
This is also a premise that I agree with. I have no doubt that antidepressants can induce some significant short term improvements. However, I think that it is difficult to fully recover while on the medications.
For example, much is being researched about the healing properties of REM sleep (i.e. stem cell activity, processing of emotional memories, fear extinction, connection pruning etc.). REM sleep dysfunction also increases the risk of certain neurodegenerative disorders. REM sleep disorders, for example are apparent years before the onset of clinical parkinsonian syptoms.
By supressing REM sleep, antidepressants but the brain in limbo.
Linkadge
Posted by linkadge on October 19, 2013, at 12:11:46
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 19, 2013, at 7:02:52
Not to target any groups here, but I think there is a huge overlapping problem between disability, antidepressant prescription, and the growing problem with long term unemployment and social security overuse.
To put it simply. One loses their job, they get shoved on paxil and zyprexa to help with a natural depressive response. They become apathetic and insulin resistant. They become less motivated to get off the system and find a job. Then they qualify for disability as their depression worsens and they have developed diabetes and it all spirals downward.
In many cases the drugs are the problem. They are making people complacent about the cycle of poverty.
Heres a better idea. Lower the minimum wage to create more jobs and force employers to offer and unlimited supply of cocaine leaves for chewing on the job. Your employees will stay fit and sharp, develop fewer metabolic symptoms and are guaranteed to keep coming to work.
You don't deal with long term unemployment by handing out free money and sopoforiants. Look how Japan got itself back on its feet after WWII - amphetamines!
The irony is that people will work hard for the illegal drugs. Illegal drugs create job! OTOH SSRIs are job killers.
Cocaine - "I'll do anything for more cocaine"!
Paxil - "Naa, I'm too good to haul sewage".
Linkadge
Posted by doxogenic boy on October 19, 2013, at 16:06:20
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 11:49:46
> This is also a premise that I agree with. I have no doubt that antidepressants can induce some significant short term improvements. However, I think that it is difficult to fully recover while on the medications.
Yes, it seems like there are lots of antidepressant users who never find meds that work in the long run. Maybe they work at best a month or a year, and then it is trial and error again. It is well known that benzodiazepines can worsen anxiety and insomnia, so it shouldn't be a surprise if long-term use of antidepressants could worsen depression.
I wonder why there isn't more research into long-term effects and long-term side effects of antidepressants. Could it be so simple that it isn't profitable? Why should a pharmaceutical company use money to find bad things with their drugs?
> By supressing REM sleep, antidepressants but the brain in limbo.
SSRIs can cause frequent nightmares - could this harm the brain if it continues for years?
- doxogenic
Posted by doxogenic boy on October 19, 2013, at 16:27:34
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 12:11:46
> Not to target any groups here, but I think there is a huge overlapping problem between disability, antidepressant prescription, and the growing problem with long term unemployment and social security overuse.
Here in Norway are 9,4 % of the people from 18 - 67 years old on disability benefit. 11,1 % of women and 7,8 % of men.
This is the official statistics:
https://www.nav.no/Om+NAV/Tall+og+analyse/Jobb+og+helse/Uf%C3%B8repensjon/Uf%C3%B8repensjon/Mottakere+av+uf%C3%B8repensjon+som+andel+av+befolkningen+*%29%2C+etter+kj%C3%B8nn+og+alder.+Pr.+30.06.2004-2013+**.356503.cmsAnd then there are other kinds of social security.
> To put it simply. One loses their job, they get shoved on paxil and zyprexa to help with a natural depressive response. They become apathetic and insulin resistant. They become less motivated to get off the system and find a job. Then they qualify for disability as their depression worsens and they have developed diabetes and it all spirals downward.
---
Inactivity is very bad for mental disorders. Being without a job for a long time will
undoubtedly worsen depression, so if the antidepressants pacify it could end up being a trap.- doxogenic
Posted by doxogenic boy on October 19, 2013, at 17:01:15
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:27:34
> Inactivity is very bad for mental disorders. Being without a job for a long time will
> undoubtedly worsen depression, so if the antidepressants pacify it could end up being a trap.Correction " ... so if the antidepressants make people passive and apathetic, it could end up being a trap."
- doxogenic
Posted by linkadge on October 19, 2013, at 17:02:29
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:06:20
I'm not a sleep expert, but I think nightmares are due to some sort of cholinergic / monoaminergic imbalance. The brain is trying to process emotional content without being in a paralyzed state(?). It is certainly not rejuvenating to be having constant nightmares. Its probably as unhealthy as apnea.
Linkadge
Posted by doxogenic boy on October 19, 2013, at 17:14:00
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:02:29
> I'm not a sleep expert, but I think nightmares are due to some sort of cholinergic / monoaminergic imbalance. The brain is trying to process emotional content without being in a paralyzed state(?). It is certainly not rejuvenating to be having constant nightmares. Its probably as unhealthy as apnea.
Thanks for your reply. I did a simple search for SSRIs and nightmares, and it gave lots of relevant results:
https://www.google.no/search?num=100&safe=off&site=&source=hp&q=ssri+nightmares- doxogenic
Posted by linkadge on October 19, 2013, at 17:16:23
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:27:34
Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things. Correspondingly SSRIs can decrease feelings of guilt associated with being inactive or unproductive.
Deep sleep is needed to help reorient an individual to long term goals and aspirations. One could easily loose a decade or more on SSRIs. One would be perfectly content watching Seinfeld and making peanut butter sandwiches for a decade (been there done that).
Throw in some money for being disabled and away we go.This is not to trivialize some people's situations as I know some people really are sick. However, I feel like there is a growing segment of the population that just need a steady job and some strong coffee.
Linkadge
Posted by baseball55 on October 19, 2013, at 19:05:00
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:16:23
Who says ADs suppress REM sleep? Where is the evidence? I never experienced that.
And who says that ADs make people passive and lazy? That was not my experience at all. Depression made me unproductive, unmotivated and unable to function normally. Successful treatment with ADs put me back to work again.
Also, where's the evidence for tardive dysphoria? Besides a few anecdotes?
Posted by sigismund on October 19, 2013, at 19:26:34
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 12:11:46
>Heres a better idea. Lower the minimum wage to create more jobs and force employers to offer and unlimited supply of cocaine leaves for chewing on the job. Your employees will stay fit and sharp, develop fewer metabolic symptoms and are guaranteed to keep coming to work.
Just the coca leaves. They really work.
How about some old fashioned protection for US jobs? Those Bangladeshi children are overworked.
Posted by linkadge on October 19, 2013, at 20:20:35
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by baseball55 on October 19, 2013, at 19:05:00
Do a google search for REM sleep + SSRI, you should get may hits. SSRIs make tons of people apathetic and lazy.
Linkadge
Posted by linkadge on October 19, 2013, at 20:35:30
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by sigismund on October 19, 2013, at 19:26:34
I agree with you about American protectionism. Unfortunately, I believe, we are witnessing the beginning of the fall of the US empire. Our living standards will continue to fall, as those of individuals in third world countries rise. We consume more than we produce. We borrow money from China to buy things from China that we neither need nor can afford.
We are witnessing other countries copy the 1900's US style of economic growth. Jobs will continue to leave the country and the US will continue to print money. Eventually China will catch on that is never going to get its money back. At this stage, the US will be unable to finance its debt. Interest rates will skyrocket and the typical western debt driven consumption model will implode.
Buy gold and get the hell out of the US dollar!
Linkadge
Posted by Phillipa on October 19, 2013, at 20:56:09
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 20:35:30
I agree and also going to renew my passport so I can get out of Dodge for real. Phillipa
Posted by sigismund on October 19, 2013, at 21:39:24
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 20:35:30
I'm in favour of eliminating structural rigidities from the drug market, and improving labour productivity there too.
My coca has to come here from Peru via the US.
Sliced white, I love it.
Posted by doxogenic boy on October 20, 2013, at 11:43:20
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by baseball55 on October 19, 2013, at 19:05:00
> And who says that ADs make people passive and lazy?
There is some information here:
http://www.dr-bob.org/tips/split/SSRIs-and-apathy.htmlMessages about SSRI-induced apathy on dr-bob.org:
https://www.google.no/search?hl=en&as_q=ssri+apathy&as_epq=&as_oq=&as_eq=&as_nlo=&as_nhi=&lr=&cr=&as_qdr=all&as_sitesearch=dr-bob.org&as_occt=any&safe=images&tbs=&as_filetype=&as_rights=- doxogenic
Posted by SLS on October 22, 2013, at 6:34:23
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:16:23
> Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things.
Is this true of SSRIs even when they produce a robust antidepressant response, or is this associated only with non-response? I don't doubt that SSRI-induced apathy and amotivation are acute effects, but what happens after receptor desensitization occurs? Wouldn't these unwanted effects dissipate?
I don't know, of course.
- Scott
Posted by SLS on October 22, 2013, at 6:38:25
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 19, 2013, at 7:02:52
> I found this diagnosis in DSM-5:
> "Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions"
>
> Do they prescribe antidepressants for this in America?I believe so. Columbia / New York State Psychiatric Institute has been studying this for at least a year.
- Scott
Posted by doxogenic boy on October 22, 2013, at 8:36:39
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by SLS on October 22, 2013, at 6:38:25
> > I found this diagnosis in DSM-5:
> > "Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions"
> >
> > Do they prescribe antidepressants for this in America?
>
> I believe so. Columbia / New York State Psychiatric Institute has been studying this for at least a year.Have they found evidence that antidepressants work for this diagnosis? Are the patients satisfied?
- doxogenic
Posted by doxogenic boy on October 22, 2013, at 8:45:25
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by SLS on October 22, 2013, at 6:34:23
> > Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things.
>
> Is this true of SSRIs even when they produce a robust antidepressant response, or is this associated only with non-response? I don't doubt that SSRI-induced apathy and amotivation are acute effects, but what happens after receptor desensitization occurs? Wouldn't these unwanted effects dissipate?
--Isn't SSRI-induced apathy a long-term side effect of SSRIs?
See this study:
http://www.ncbi.nlm.nih.gov/pubmed/12019662
Excerpt from the abstract above:
J Clin Psychiatry. 2002 May;63(5):391-5.
Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM.
SourceMood Disorders Center, Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA. laurenm@bcm.tmc.edu
Abstract
BACKGROUND:We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression.
[...]
CONCLUSION:These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.
End quote.Do you know of patients with SSRI-induced apathy that have been helped with atypical antipsychotics?
- doxogenic
Posted by SLS on October 22, 2013, at 11:30:29
In reply to Re: Irving Kirsch, placebos and antidepressants » SLS, posted by doxogenic boy on October 22, 2013, at 8:45:25
This is good. Thanks.
Lauren Marangell is a respectable academician.
- Scott> > > Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things.
> >
> > Is this true of SSRIs even when they produce a robust antidepressant response, or is this associated only with non-response? I don't doubt that SSRI-induced apathy and amotivation are acute effects, but what happens after receptor desensitization occurs? Wouldn't these unwanted effects dissipate?
> --
>
> Isn't SSRI-induced apathy a long-term side effect of SSRIs?
>
> See this study:
> http://www.ncbi.nlm.nih.gov/pubmed/12019662
> Excerpt from the abstract above:
> J Clin Psychiatry. 2002 May;63(5):391-5.
> Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
> Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM.
> Source
>
> Mood Disorders Center, Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA. laurenm@bcm.tmc.edu
> Abstract
> BACKGROUND:
>
> We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression.
> [...]
> CONCLUSION:
>
> These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.
> End quote.
>
> Do you know of patients with SSRI-induced apathy that have been helped with atypical antipsychotics?
>
> - doxogenic
Posted by doxogenic boy on October 22, 2013, at 11:46:43
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by SLS on October 22, 2013, at 11:30:29
Thanks for your reply.
Here is a case report which indicates that dose reduction can help for SSRI-induced apathy.
http://www.ncbi.nlm.nih.gov/pubmed/21240154
Psychopharmacol Bull. 2010;43(4):76-9.
Antidepressant induced apathy responsive to dose reduction.
Kodela S, Venkata PD.
SourceCarilion Clinic-Virginia Tech Psychiatry Residency Program, Roanoke, VA, USA. sreekant.kodela@googlemail.com
AbstractApathy has a significant negative impact on the quality of life. It can be a part of other axis I and axis III disorders such as depression. It has also been reported as a treatment emergent side effect of SSRI drugs. A 48 year old male with diagnosis of personality change due to medical condition and depressive symptoms was started on Sertraline. Although his depressive symptoms, impulse control and his irritability improved significantly he became quite apathetic. This responded positively to a reduction in the dose of sertraline. Since apathy can be a residual symptom of depression it may be a valid consideration to increase the dose of the SSRI. However if apathy was not a significant part of depressive syndrome prior to SSRI treatment then antidepressant treatment emergent apathy needs to be considered and one option is to reduce the dose of the SSRI. Other options appear to be addition of other pharmacological agents such as stimulants, dopamine agonists, acetylcholinesterase inhibitors and NMDA antagonists.
- doxogenic
Posted by babbler20 on October 30, 2013, at 21:57:56
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 18, 2013, at 11:03:52
> > Same thing my pdoc said that even in his opinion that ad's are more of a placebo effect. That life circumstances play more a role. Also the hope of the patient that "well now I have a med I am better".
>
> Could you ask your pdoc what he thinks about Irving Kirsch's claims about antidepressants and placebo, as mentioned is this thread? Do the mental health professionals in the United States discuss this topic a lot? I am very curious about what psychiatrists say about this.
>
> The placebo effect is part of the effect of every treatment for any disease. (I have never heard of a treatment that does not have a placebo effect in addition to the pharmacological effect.)
>
> I have read earlier in Scientific American Mind that the reason for the high placebo responses in drug studies for antidepressants in the United States, is that some of/lots of patients in the studies weren't depressed in the first place. (I think they got money for participating in the studies.) Therefore the placebo response looks higher than it is. What do you think about this?
>
> - doxogenicDoxogenic,
I actually hadn't considered the fact that many of the patients that were given the placebo weren't depressed. This is an excellent point !
Posted by doxogenic boy on November 2, 2013, at 9:14:04
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by babbler20 on October 30, 2013, at 21:57:56
> > I have read earlier in Scientific American Mind that the reason for the high placebo responses in drug studies for antidepressants in the United States, is that some of/lots of patients in the studies weren't depressed in the first place. (I think they got money for participating in the studies.) Therefore the placebo response looks higher than it is. What do you think about this?
> Doxogenic,
>
> I actually hadn't considered the fact that many of the patients that were given the placebo weren't depressed. This is an excellent point !Yes, I think the pharmaceutical companies will take this into consideration in future trials/research, because they obviously lose money when they get too high placebo responses. So maybe the Kirsch/placebo debate took place on false premises?
Here is an overview of that debate:
http://web.archive.org/web/19990128083252/http://journals.apa.org/prevention/
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045
http://ebmh.bmj.com/content/11/3/66.full
- doxogenic
Posted by larryhoover on November 2, 2013, at 22:23:38
In reply to Irving Kirsch, placebos and antidepressants, posted by doxogenic boy on October 18, 2013, at 8:23:17
Kirsch is a man who selects his data to match his hypothesis, manipulating the data until the stats say what he wishes them to say, IMHO.
It was a while ago, when I wrote this, but I haven't changed my mind.
http://www.dr-bob.org/babble/20080221/msgs/815551.html
Lar
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