![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 61 to 85 of 118. Go back in thread:
Posted by SLS on July 20, 2005, at 18:57:08
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 17:02:31
> Ok, so we know that AD's might produce some changes on a PET scan. This does not really justify their use and safety. I am sure that other drugs, like say a speedball would do something remarkably similar.
How sure are you?
Let's keep things simple - empirical. Some compounds are antidepressants. Some are not. What we see through imaging is instructive, but not yet predictive.
- Scott
Posted by SLS on July 20, 2005, at 19:11:20
In reply to Re: Bad (but expected) news about ADs, posted by mworkman on July 20, 2005, at 17:32:55
> Most people know...
Most?
How did you arrive at this assertion?
> ...that taking an AD doesn't just magically make them less depressed
Of course it does.
Someone smarter than me said something to the effect of "Antidepressants might resolve the depression, but they are not 'get-happy' pills."
Antidepressants will not resolve the psychological issues that existed before the depression began. After the depression magically resolves with antidepressants, all of those issues are still there waiting for you to work on. These might include a depressive thought-style. The greater your success at working on your happiness, the less your chance of relapse into depression.
- Scott
Posted by SLS on July 20, 2005, at 19:19:06
In reply to Re: About my post..and Suicide... » linkadge, posted by Phillipa on July 20, 2005, at 17:32:03
Just a few:
MDD = major depressive disorder
BD = bipolar disorder
BPD = borderline personality disorder
OCD = obsessive compulsive disorder
OCPD = obsessive compulsive personality disorder
PTSD = post traumatic stress disorder
PMS = premenstrual stress syndrome
PMDD = premenstrual dysphoric disorder
GAD = generalized anxiety disorder
SAD = seasonal affective disorder
SP = social phobia
SA = social anxiety disorder
PD = panic disorder
Posted by linkadge on July 20, 2005, at 19:21:54
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 20, 2005, at 18:36:44
"Antidepressants have also decreased the rate of suicide in adolescents."
Any proof of this? Aren't you essentially saying the exact opposite to what the FDA has spend the last year concluding ??
Linkadge
Posted by SLS on July 20, 2005, at 19:23:34
In reply to Re: Bad (but expected) news about ADs » mworkman, posted by linkadge on July 20, 2005, at 17:49:39
> What is the whole picture ?
>
> According to:
>
> http://www.biopsychiatry.com/antidepskep.htm
>
>
> "Two of the largest and most reputable trials found only negligible differences between tricyclic antidepressants and placebo."Unfortunately, the abstract doesn't specify which two. I would love to scrutinize them.
- Scott
Posted by SLS on July 20, 2005, at 19:30:15
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 19:21:54
> "Antidepressants have also decreased the rate of suicide in adolescents."
>
> Any proof of this? Aren't you essentially saying the exact opposite to what the FDA has spend the last year concluding ??I wish Larry Hoover were here to provide a links to his treatises of this question. I don't have the intellectual resources and knowledge to address this issue as intelligably and pursuasively as he did.
Bottom line:
ADs have reduced the rate of adolescent suicide, despite the fact that they have produced suicide in a small percentage.
1000 suicidal youths
700 AD preventions
10 AD inductionsYield: Reduced rate of suicide when treated with antidepressants. Right?
- Scott
Posted by linkadge on July 20, 2005, at 19:38:34
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 20, 2005, at 18:53:08
That is assuming that receptor dysregulation is the cause of depression.
Even this has been disputed. For instance, some AD's decrease 5-ht2a receptor function, but ECT actually upregulates 5-ht2a receptors.
ECT is clinically more effective, so one might suggest that 5-ht2a upregulation is necessary for remission.
http://www.vakkur.com/psy/MOOD/TSLD121.HTM
I've seen similar findings reported elsewhere.
The fact that tianeptine, and SSRI's are both clinically effective is as crazy as saying that vitamin C prevents scurvy, and vitamin C deficiancy prevents scurvey.
Linkadge
Posted by Jakeman on July 20, 2005, at 20:08:46
In reply to Re: About my post..and Suicide... » Jakeman, posted by SLS on July 20, 2005, at 3:05:20
> > Then we have to worry about the fact that long-term effects (>6 monthes) have not been tested.
>
> I'm sorry, I'm a little confused here. The long-term effects of what have not been tested?
>I meant the long-term effects of antidepressants have had little study. It's my understanding that clinical trials are usually less than six months.
warm regards ~Jake
Posted by linkadge on July 20, 2005, at 20:11:24
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 20, 2005, at 18:57:08
"Let's keep things simple - empirical. Some compounds are antidepressants. Some are not. What we see through imaging is instructive, but not yet predictive"
Yes, exactly. Some compounds are antidepressants. The ones that make rats swim longer in a tank are antidepressants. That doesn't say much.
Linkadge
Posted by linkadge on July 20, 2005, at 20:17:04
In reply to Re: Bad (but expected) news about ADs » mworkman, posted by SLS on July 20, 2005, at 19:11:20
"Antidepressants will not resolve the psychological issues that existed before the depression began. After the depression magically resolves with antidepressants, all of those issues are still there waiting for you to work on. "
------------------------------------------------Thats the problem, most people abandon the notion that their depression was caused by their problems, and adopt the idea that it was something wrong with their preception. That, of course is more palatable. Most people who start AD's figure they don't need CBT.
The imballences caused by stress, are more universal than we would like to believe. I know that I like the chemical imballence theory cause it made me feel special. But I am like everyone else who gets depressed because of stress. Sometimes these imballences are purposefull. They tell us to let go. Masking burnout with prozac is deadly.
Linkadge
Posted by linkadge on July 20, 2005, at 20:19:09
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 20, 2005, at 19:30:15
ADs have reduced the rate of adolescent suicide, despite the fact that they have produced suicide in a small percentage.
---------------------------------------------Just because certain youths don't commuit suicide on the drugs doesn't mean that the drugs prevented suicide. Many times people just get better.
Linkadge
Posted by linkadge on July 20, 2005, at 20:25:39
In reply to Re: About my post..and Suicide..., posted by Jakeman on July 20, 2005, at 20:08:46
That is correct. These drugs have not been tested nearly as long as we take them for.
We have a panic attack at the notion that our drugs might stop working one day, and that we might not be able to take them indefinately, and yeild the same results. As a result we cling to the notion that these drugs are fixing some deficiancy, because that notion leads us to believe that their workings are more natural. Why do we buy into the chemical imballence theory? Mainly because it comforts us. Comfort us it may, but save us it will not. As if, knowing how the drug works will keep it working.
Linkadge
Posted by Jazzed on July 20, 2005, at 20:36:59
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 16:38:46
>
> Canadian suicide rates increased
> http://fathersforlife.org/health/cansuic.htm
>
>
> US suicide rates decreased (although very insignificantly)
>
>
> Linkadge
>I'm sorry, but IMO this study is seriously flawed. If you go by this study, which never mentions ADs, it is not ADs which are to blame for the suicide rates, but it's women who are to blame! Could it get any more obvious that this article is a little about suicide, and the whole site is a lot about how women are to blame for all of societies evils? The Canadian portion of this study doesn't take into account the rise in population during this time period, and it does mention the disproportionate number of suicides in the prison population. Below are just a few of the quotes that make my case that this article is not about suicide at all, so I would seriously have to question the data.
"The Canadian society is far too busy worrying about far more valuable victims of violent deaths, the total of half a hundred women that are being brought to their deaths each year as victims of so-called domestic violence. We can't spare the time worrying about a few hundred boys who kill themselves each year — as the 25 or so boys aged 10-14 who commit suicide each year are just the tip of the iceberg."
"Note that with the increase in the divorce rate that resulted from the 1968 Divorce Reform that there were slight concurrent increases in the male suicide rate. "
" Do we perhaps not worry about the increasing epidemic of boys' suicides because subconsciously the thought is in people's minds that every dead boy is a good boy? We can't even get statistics that cover the period from 1993 until now to determine whether the problem of boys' suicides has leveled off since 1992 or is getting worse. Would that be the case if the sexes were reversed? "
"It appears that Statistics Canada is actually involved in actively hiding the gruesome truth from the public: Canadian men kill themselves at rates far higher than at any time before in Canadian history and have been doing so since 1971, ever since the liberation of women got well under way. "
"An analysis of the data to determine the reasons for the regional differences will most likely provide clear indications of what drives people to suicide, but because the vast majority of the victims are men it isn't very likely that the analysis will be made. Men don't seem to be worth the effort. "
"After all, a man who can't see his children but must pay for their support, who lost his home but must still pay for its upkeep, who lost his means of transportation but must still provide the funds that make it possible for his ex-wife to pursue her interests..."
"All the above factors can be seen to be directly linked to the bias in family courts. Once the control of his life has been taken away from an individual he no longer has the ability to solve his problems. That leads to high hopelessness and low level of self-esteem. Yet, study after study ends with the remark that it is not fully understood what is the cause for the ever-expanding epidemic of suicides by men who are in their prime. "
"Divorce and separation not only increase suicide risk for men but also for children. "
"True, men are far more likely than women to commit suicide after divorce and separation."
"Joint custody awards ought to improve that sorry state of affairs "
USA:
"The number of male suicide victims rose in virtually every year during the eighteen-year 1979 - 1996 interval, whereas the number of female victims of suicide was generally on the decline in virtually every year. ""In other words, more American boys and men died during and on account of the War of the Sexes than died in all military conflicts in which the USA were involved during the 20th century."
"Where are the memorials for the war-dead of the War of the Sexes, the Rout of the American Males? A total of 800,000 boys and men gave their lives not in the service of their country but to cater to equal rights for women, and there's not a single memorial or cenotaph to mourn their passing. "
And on and on and on ad nauseum!
Jazzy
Posted by linkadge on July 20, 2005, at 21:20:45
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by Jazzed on July 20, 2005, at 20:36:59
I really was not interested in the study at all, I was merely trying to find a statistic for canadian suicide.
Do you have a more accurate statistic for the suicide rates in canada ?
Sorry could not read all your post, have to go to work now.
Linkadge
Posted by Jazzed on July 20, 2005, at 21:27:25
In reply to Re: Bad (but expected) news about ADs » mworkman, posted by linkadge on July 20, 2005, at 17:49:39
>
> According to:
>
> http://www.biopsychiatry.com/antidepskep.htm
>
>
> "Two of the largest and most reputable trials found only negligible differences between tricyclic antidepressants and placebo."
>This site appears to be pro pharmacological site, particularly the development of opiates and ecstatcy for "paradise engineering". Unfortunately, if this is true, then we will have to wait until the next century for this to occur. Also, if this is the case, then research and development of new pharmaceuticals for mental illness is vital.
From this site:
" This feeling of absolute well-being will surpass anything contemporary human neurochemistry can imagine, let alone sustain. The story gets better. Post-human states of magical joy will be biologically refined, multiplied and intensified indefinitely. Notions of what now passes for tolerably good mental health are likely to be superseded. They will be written off as mood-congruent pathologies of the primordial Darwinian psyche. Such ugly thoughts and feelings will be diagnosed as typical of the tragic lives of emotional primitives from the previous era. In time, the deliberate re-creation of today's state-spectrum of normal waking and dreaming consciousness may be outlawed as cruel and immoral. "
" Life-long happiness of an intensity now physiologically unimaginable can become the genetically-preprogrammed norm of mental health. "
Today's images of opiate-addled junkies, and the lever-pressing frenzies of intra-cranially self-stimulating rats, are deceptive. Such stereotypes stigmatise, and falsely discredit, the only remedy for the world's horrors and everyday discontents that is biologically realistic."
"States of "dopamine-overdrive" can actually enhance exploratory and goal-directed activity. Hyper-dopaminergic states can also increase the range and diversity of actions an organism finds rewarding. So our descendants may live in a civilisation of well-motivated "high-achievers", animated by gradients of bliss. Their productivity may far eclipse our own. "
"The Hedonistic Imperative outlines how genetic engineering and nanotechnology will abolish suffering in all sentient life."
"Yet the therapeutic implications of a recognition that dysfunctional endogenous opioid systems underlie a spectrum of anxiety-disorders and depression are too radical - at present - for the medical establishment to contemplate. In consequence, the use of opioid-based pharmacotherapies for "psychological" pain is officially taboo. The unique efficacy of opioids in banishing mental distress is neglected. Their unrivalled efficacy in treating "physical" nociceptive pain is grudgingly accepted. "" Within a few centuries, it will be technically if not ideologically feasible to abolish suffering of any kind. If we wish to do so, then genetic engineering and nanotechnology can be used to banish unpleasant modes of consciousness from the living world. "
"The ideological obstacles to a happy world, however, are more formidable still. For we've learned how to rationalise the need for mental pain - even though its nastier varieties blight innumerable lives, and even though its very existence will soon become optional. "
" Needless to say, subtleties and technical complexities abound here. The very meaning of being "nice" to anyone or anything, for instance, is changed if well-being becomes a generic property of mental life. Either way, once suffering becomes biologically optional, then only sustained and systematic malice towards others could allow us to perpetuate it for ever. "
"Next century and beyond, however, the development of highly selective, site-specific designer drugs and innovative gene-therapies may enhance our native opioid function and revolutionise mental health. Therapeutic intervention targeted on the opioid pathways will potentially enrich the quality of life of even the nominally "well", not least because - by the more enlightened health standards of posterity - we may all be reckoned mentally ill."
" Critically, such gradients of celestial bliss can also be lucid, serene, entactogenic and empathetic - i.e. MDMA-like and better, not manic or vulgarly hedonistic. The godlike powers of tomorrow's biotechnologists will allow the neurological substrates of empathy and self-insight to be permanently up-regulated. Aesthetically, the mundane ugliness of life in the present epoch can be replaced by gradations of (to us) unimaginable beauty. Potentially again, an E-like magic can imbue the texture of normal waking consciousness. If we so wish, our emotional palette can be genetically enriched, mixed and then pharmacologically refined in ways that transcend the crude primary colours of our Darwinian past. "
" Inevitably, talk of treating humans like organic robots, and then mooting a baseline of mental health many orders of magnitude richer than the Darwinian mind can contemplate, sounds fantastical today. In the context of our traditional conceptual framework, the idea of an analogue of Moore's law for successive generations of human mental health evokes cloud-cuckoo-land, not a global health-plan. Amid the messiness of our daily lives, the prospect of using biotechnology to abolish suffering, and a post-Darwinian transition to paradise-engineering, strikes most of us as fanciful, its liberatory potential just a mirage. At best, such heady words fall lifelessly off the page or screen. Yet a major discontinuity - a momentous evolutionary transition in the development of life on earth - is imminent as the biotechnology revolution unfolds. The advent of genomic medicine is set to challenge the old Darwinian regime of natural selection and the emotionally crippled minds it spawned. ""Today, of course, empathogens and entactogens are outlawed for any purpose. The states of consciousness they induce are criminalised. People who take such agents are stigmatised as "drug abusers". Yet some MDMA users feel, rightly or wrongly, they've been granted a tantalising glimpse of what true mental health may be like in centuries to come; and an insight into what the rest of us are missing."
" There is perhaps a single predictable time of life when taking crack-cocaine is sensible, harmless and both emotionally and intellectually satisfying. Indeed, for such an occasion it may be commended. Certain estimable English doctors were once in the habit of administering to terminally-ill cancer patients an elixir known as the "Brompton cocktail". This was a judiciously-blended mixture of cocaine, heroin and alcohol. The results were gratifying not just to the recipient. Relatives of the stricken patient were pleased, too, at the new-found look of spiritual peace and happiness suffusing the features of a loved one as (s)he prepared to meet his or her Maker."
Interesting reading if you have the time and if you are so inclined...
http://www.hedweb.com/hedethic/tabconhi.htm
Jazzy
Posted by Phillipa on July 20, 2005, at 21:35:53
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 21:20:45
Thanks Scott. It was the MDD one that had me. It's so obvious though. The other two that I hadn't seen were OCPD and PMDD. BTW how is OCPD different than OCD? See they don't teach nurses any of this and I'd like to again work. I've talked with the NC Board of Nursing. Since I have an active license I can go back to work without a refresher course except all the major hospitals in Charlotte [hope to move there] require a refresher course. That means 2months of med/surg and 2mths minimum of course work on computer. Then if they hired me I would have to work full time for at least a few months. I don't think I could handle the stress of all this after being out of work for 8yrs. But I feel since psych is my bag that if I could wow them with what I know I stand a change of being hired. The stress of the full day of back and forth between hospitals and Board let me know that I still have it in me to fight to win but it left me emotionally drained. So now I question my ability to work. So, thanks to Carolina who has provided me with a lot of hospital numbers and Community Health tele numbers I can continue to look for a job that doesn't require the schooling. I feel this site provides more knowledge than any nursing course could. I just hope I can get my meds straight. Fondly, Phillipa
Posted by Jazzed on July 20, 2005, at 21:40:08
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 20, 2005, at 19:30:15
>
> I wish Larry Hoover were here to provide a links to his treatises of this question. I don't have the intellectual resources and knowledge to address this issue as intelligably and pursuasively as he did.Does this help?
http://www.healthyplace.com/Communities/Depression/news/teen_suicide.asp
http://my.webmd.com/content/article/75/89677.htm
http://my.webmd.com/content/article/79/96376.htm
http://www.uchsc.edu/news/bridge/2004/December%202004/suicide.html
Of course, there are plenty of sites which state just the opposite. So it comes down to whether or not you're inclined to use medications for yourself or your children. IMHO, if you opt for medication, I think it's a case of the right medication, for the right person, in the right dose, no matter what the age.
Jazzy
Posted by Jazzed on July 20, 2005, at 22:00:31
In reply to Re: Bad (but expected) news about ADs » SLS, posted by Jazzed on July 20, 2005, at 21:40:08
My own experience with ADs has been that the theraputic window is small. Again, that is for me. Too little didn't work, too much made things worse.
Teens/kids, unfortunately, are not always the ones who determine, or help determine, the dosage that might be effective. I got significantly depressed on various medications, suicidally so, fortunately that abated after the drug was withdrawn. I would guess, from that experience alone, that parents don't always have the information that kids can have an adverse reaction to their medication, and what they perceive as "bad" or "fussy" behavior could be a serious adverse reaction.
When I was a teen-ager, and seriously depressed, I was not given the choice of whether or not to take medication, or asked my opinion as to how the medications were affecting me. I can say that most of the effects were detrimental because I was given too much or the wrong medication (I don't know), not to mention I had a terrible psychiatrist.
Now, as an adult, I can choose to take them or not, to take something else or not. I wish there were a one size fits all answer to all mental illness.
Jazzy
Posted by Jazzed on July 20, 2005, at 22:07:36
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 21:20:45
> I really was not interested in the study at all, I was merely trying to find a statistic for canadian suicide.
>
> Do you have a more accurate statistic for the suicide rates in canada ?
>
> Sorry could not read all your post, have to go to work now.
>
>
> Linkadge
Sorry, once I got to reading that information, I got really carried away.There's a lot of information if you google, unfortunately, the stats vary from site to site as to whether rates are affected by ADs. From what I can gather, it appears that most sites are saying there appears to be "no direct correlation" between the use of SSRIs and the teen suicide rate.
I still maintain that it depends on the person, and whether they are accurately dosed with the correct medication for what ails them. Of course, I'm no scientist, I'm just going by my own experience, which is basically of no value to anyone other than myself (and my own kids should they ever need anything other than their ADD meds).
Jazzy
Posted by linkadge on July 21, 2005, at 15:30:18
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by Jazzed on July 20, 2005, at 22:07:36
My main problem with AD's is that they cause so much dysregulation that it is hard to tell what they do, if anything.
Think of it this way. I am in school. If I can't sleep, think, concentrate, then I am going to do poorly. That alone will make me depressed.
If I don't take them, I might do better, which might help my confidence and my mood.
They don't fit well into my lifestyle at all. And I find their side effects so disruptive at times, it is hard to tease out any antidepressant effect.
Linkadge
Posted by SLS on July 21, 2005, at 19:53:12
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 19:38:34
> That is assuming that receptor dysregulation is the cause of depression.
What *exactly* the problem is doesn't make antidepressants work any less.
Actually, we don't even know enough to say that the primary site of abnormality *isn't* rectified by antidepressants. Again, though, this makes no less real the complete remission of an illness that antidepressants can produce.
- Scott
Posted by rod on July 21, 2005, at 20:00:40
In reply to Re: About my post..and Suicide... » linkadge, posted by SLS on July 21, 2005, at 19:53:12
> > That is assuming that receptor dysregulation is the cause of depression.
>
> What *exactly* the problem is doesn't make antidepressants work any less.
>
> Actually, we don't even know enough to say that the primary site of abnormality *isn't* rectified by antidepressants. Again, though, this makes no less real the complete remission of an illness that antidepressants can produce.
>
>
> - Scott
>*signed*
regardsroland
Posted by SLS on July 21, 2005, at 20:00:55
In reply to Re: About my post..and Suicide..., posted by Jakeman on July 20, 2005, at 20:08:46
Hi, Jake.
> > > Then we have to worry about the fact that long-term effects (>6 monthes) have not been tested.
> >
> > I'm sorry, I'm a little confused here. The long-term effects of what have not been tested?
> >
>
> I meant the long-term effects of antidepressants have had little study. It's my understanding that clinical trials are usually less than six months.This is true of most studies. Unfortunately, most of the clinical trials that involve antidepressants have rarely exceeded 10 weeks. However, there have been a few longitudinal studies that have followed people for five years and more. One of the most important findings of such studies is that the dosage of an antidepressant that successfully treats the depression acutely is the same dosage that should be used for long-term maintenance.
What sorts of things are you interested in discovering with long-term studies? Just curious.
- Scott
Posted by SLS on July 21, 2005, at 20:05:28
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 20:11:24
> "Let's keep things simple - empirical. Some compounds are antidepressants. Some are not. What we see through imaging is instructive, but not yet predictive"
>
> Yes, exactly. Some compounds are antidepressants. The ones that make rats swim longer in a tank are antidepressants. That doesn't say much.
>
> LinkadgeCome on, those are only paradigms that are used for screening compounds for *potential* antidepressants. They are not designated as being antidepressants at this stage of investigation. Their potential as antidepressants is tested further in human studies. They don't become antidepressants until they show efficacy in human beings.
- Scott
Posted by SLS on July 21, 2005, at 20:09:37
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 20:19:09
> ADs have reduced the rate of adolescent suicide, despite the fact that they have produced suicide in a small percentage.
> ---------------------------------------------
>
> Just because certain youths don't commuit suicide on the drugs doesn't mean that the drugs prevented suicide. Many times people just get better.At what rate? How does this rate of spontaneous remission compare with the observered rates of suicide prevention that these drugs demonstrate?
Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers
http://www.nimh.nih.gov/healthinformation/antidepressant_child.cfm
- Scott
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