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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by radish on February 24, 2019, at 18:11:22
A "real" drug works in virtually everyone. Morphine, caffeine, alcohol, for example,
will all produce their intended effects on everyone, assuming one does not have a tolerance and is not
a medical anomaly with a physiological inability to process it.For many (most?) antidepressants, only some people respond. This makes it seem like the drug is "fake."
I don't mean to imply conspiracy, just that it boggles my mind how drugs so statistically
weak got market approval. Indeed the SSRI class has a track record of performing no better, or only
very very slightly better, than placebos, which means in my definition that it is placebo. The
knowledge of various mechanisms exist for making perhaps universally effective anti-depressants, e.g.
mu-opiod pathways and novel dopamine pathways. But we continue to dispense placebo-like drugs?Everyone has and can expect to to experience physical pain. Hence the development of universally
effective pain-killers. If drug developers had first-hand experience with severe mental
suffering, would there be a sense of urgency towards research and development
of more effective drugs for attacking the various expressions of extreme psychological suffering?
The pharmaceutical industry has profit incentive to produce better drugs, so why don't they?
Is it more difficult to research and create effective psychoactive drugs than other types? I suppose
science has barely begun to scratch the surface on learning how the brain works. Maybe psych
treatments need time to catch up because mental illnesses are "invisible" and the medical
community only relatively recently acknowledged their existence?
Posted by beckett2 on February 24, 2019, at 18:53:59
In reply to 'Real' drugs work on virtually everyone, posted by radish on February 24, 2019, at 18:11:22
SSRI's leave me apathetic. (Also anti epileptics.) I don't want to kill myself or wring my hands all day, but I don't want to do much of anything else, either.
For me, they're not a placebo, but they are very very incomplete. If it wasn't for caffeine <3 I'd likely do nothing at all.
I'm sorry understand you have severe social phobia. I do too and it's incredibly impairing. For that, I haven't found a treatment. Certainly not SSRI's!
Posted by sigismund on February 24, 2019, at 21:37:37
In reply to 'Real' drugs work on virtually everyone, posted by radish on February 24, 2019, at 18:11:22
Exactly. Though problems arise. One of which is the distinct ambivalence of the general public (or someone) relating to any mental relief which might be construed as euphoric.
Here I would be thinking of the treatment of witches. At least SSRIs cannot be said to be euphoric, which should help someone or other rest easier at night.
Posted by sigismund on February 24, 2019, at 21:58:06
In reply to Re: 'Real' drugs work on virtually everyone, posted by sigismund on February 24, 2019, at 21:37:37
That's what I think. Though problems arise, from which some are avid to save us. And have been all my life.
When I was much younger (with real deprivation) I thought there had to be a solution.
Then I wondered if that was part of the problem. Be that as it may, many people less privileged than us had looked after their children much better. By leaving them alone, and being with them when they needed it, by not having ridiculous ideas of superiority. But those were the times.
Most of my reading these days doesn't make me want to have a lot to do with others. It doesn't matter; I don't have the energy.
The world outside is not such a happy place, and has no interest in yours.
All things are connected. If it was OK to lock up many millions of people for nothing, psych patients will not count more.
Posted by sigismund on February 24, 2019, at 22:16:32
In reply to Re: 'Real' drugs work on virtually everyone, posted by sigismund on February 24, 2019, at 21:37:37
I liked this, the son of psychiatrists in Boston or somewhere.
"The Last Shaman"
It is on Netflix, set in equatorial Peru. He was really helped by the experience and by how he did it, or so it seemed
Amazon had something set in the Congo by that name. I thought 'It's all the same to them', which was perhaps not fair.
Posted by SLS on February 25, 2019, at 9:00:54
In reply to 'Real' drugs work on virtually everyone, posted by radish on February 24, 2019, at 18:11:22
Don't be fooled.
Take a look at the clinical trials of antidepressants performed in the late 1960s, 1970s and early 1980s. You will see that the results were closer to 70% drug and 30% placebo. The criteria for selecting subjects were strict and well-defined. The goal was to promote accuracy and objectivity in order to investigate how a treatment influences the course of a true mood disorder. The symptoms of the people chosen for these studies were more severe. Now, the goal of many clinical investigators is to recruit as many people as possible in order to make more money and be chosen for future studies. It is getting harder and harder to find severely ill people who are not treatment-resistant. Why run to a placebo-controlled clinical trial first when there are already a plethora of approved treatments available? People with mild and moderate depression are now being included in the pool of subjects in order to compensate for this reduction in particpation. My guess is that a large percentage of these people have a depression that is more psychogenic than biogenic. I believe that those people with a psychogenic depression are less likely to respond to a biological treatment. In addition, they are more likely to report feeling better because they are being provided emotional support and anticipate feeling better. This explains the increase in placebo effect and the decrease in drug response reported.
- Scott
Posted by radish on February 25, 2019, at 17:02:30
In reply to Re: 'Real' drugs work on virtually everyone, posted by SLS on February 25, 2019, at 9:00:54
Sigismund - I think it is a vestige of the culture's (specifically America's) puritanical roots that we believe suffering is good, e.g. that it leads to resilience and "toughness" and holiness. But those in the know know endless suffering without a circumstantial cause leads to demoralization. That view leads to the idea that no one should get to experience euphoria unless they "deserve it" or toil for it in the right ways.
SLS - I'm losing hope in science-based medicine in the medical-industrial complex.
Posted by baseball55 on February 25, 2019, at 18:57:11
In reply to Re: 'Real' drugs work on virtually everyone, posted by radish on February 25, 2019, at 17:02:30
While it is probably true that research is limited as drug companies try to milk profits from the drugs they have, I'm sure that if someone could figure out how to make an opioid that killed pain and created enough (but not too much) euphoria WITHOUT being dangerously addictive, pharma would jump on it.
But opioids are dangerously addictive, not to mention sure-thing vehicles for suicide (not an insignificant concern with a depressed population). I have heard a lot of people with severe depression wonder - why not oxycodone? Why not suboxone?
As a former opioid addict I can tell you a few things. (1) resistance builds very quickly; (2) opioids kills the endorphin system so that the brain loses the natural ability to feel pleasure, sometimes permanently or for a long time. A psych-doc who specialized in opioid addiction told me that 40% of addicts relapse in the first week because they can't handle the dope-sickness and another 40% in the second week because they can't handle the depression; (3) if you think SSRI withdrawal is bad, try opioid withdrawal, You feel like you'd rather be dead than feel this way; (4) even if you can get enough to keep ahead of the resistance, depression has a way of breaking through. And you probably can't get enough. Eventually you need to shoot it up and eventually, shooting in the arm isn't enough, I've known addicts who end up shooting in their necks to get a better rush.
Also, yes, morphine and caffeine work the same way on everyone, but many other drugs don't at all. Anti-cancer drugs often have very low response rates, as do many neurological drugs (for MS, epilepsy, Parkinson's).
I think Scott is correct also. Clinical trials often won't take people who have used other anti-depressants, which is to say, anyone with severe depression. Most people who use anti-depressants are mildly depressed or barely depressed at all, just unhappy about issues in their lives. GPs give this stuff out like candy. Almost everyone I know is on prozac or wellbutrin. They swear it works, but the line between placebo and actual effect is quite low for those whose depression is mostly situational.
Posted by radish on February 26, 2019, at 16:33:39
In reply to Re: 'Real' drugs work on virtually everyone » radish, posted by baseball55 on February 25, 2019, at 18:57:11
that's really interesting, thank you baseball.
Posted by SLS on February 26, 2019, at 17:36:58
In reply to Re: 'Real' drugs work on virtually everyone, posted by radish on February 25, 2019, at 17:02:30
> SLS - I'm losing hope in science-based medicine in the medical-industrial complex.
What are your reasons for feeling this way?
I am not challenging you. Perhaps someone can help to give you back some hope.
- Scott
Posted by Radish on February 27, 2019, at 12:46:22
In reply to Re: 'Real' drugs work on virtually everyone » radish, posted by SLS on February 26, 2019, at 17:36:58
SLS
I'm not sure. My brain isn't working well today. I just wish it were easier to get good treatment for mental disease. Seems there are many barriers before patients achieve that. At least there has been in my situation.
This is the end of the thread.
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