Posted by ace on June 5, 2008, at 1:45:38
In reply to Re: Clonidine Contributing to Depression?, posted by undopaminergic on June 3, 2008, at 3:43:30
> > >
> > > > > What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?
> > >
> > > > Very much so- the vast majority were diagnosed with ADHD or ADHD type symptoms. Although I have seen anecdotes on 'normal' depression (without co-morbidity) responding to it favourably. I believe I have some on trials on it too- for OCD, ADHD- always with depression as a co-morbid problem.
> > >
> > > The ADHD I knew about. Not the OCD. Interesting. I guess that makes sense if NE pathways to the frontal cortex are overactive.
> Eur J Pharmacol. 1991 Feb 14;193(3):309-13. PMID 1675994
> Clonidine causes antidepressant-like effects in rats by activating alpha 2-adrenoceptors outside the locus coeruleus.
> "Clonidine, 0.05, 0.1 and 0.5 mg/kg administered i.p. as a three-injection course but not as single doses, significantly reduced the immobility of rats in the forced swimming test."
> Eur J Pharmacol. 1990 Jan 17;175(3):301-7. PMID 1969801
> Alpha 2-adrenoceptor blockade prevents the effect of desipramine in the forced swimming test.
> - - - -
> Personally, I like to maintain a suitable degree of alpha2-agonism through the use of guanfacine. I haven't noticed an antidepressant action, but it improves some facets of working memory and executive function. Bonus effects include a reduction of heart rate and blood pressure. The only drawback is an increased tendency to dry mouth. It should perhaps be noted that guanfacine is not equivalent to clonidine for all intents and purposes - it's better tolerated, and more suitable for cognitive enhancement, but may be less efficacious for some other uses.
> > I understand, and I checked out the link- thanks for that. You must of heard that statement Jung made about a physician 'washing his hands first' (before treating others)
> A physician should of course wash himself, and be free from contagious diseases, so as not to transfer these to his patients.
* I don't believe any mental illness to be contagious at all. However, I feel that certain behaviours, which I deem as unethical, which have their genesis in mental illness can be very deleterious to a psychiatrists 'patients' Also, the inherent 'power' structure within the clinician/patient relationship can be abused.
> > Would you say, per se, it would be unethical for a psychiatrist to be on the very medications he prescribes?
> Absolutely not. In the good old days, doctors often tested treatments and medications on themselves - for instance, the stethoscope, the hypodermic needle, opium preparations, and hypnotic agents. Freud familiarised himself with the effects and propertiess of cocaine by administering it to himself before venturing to use it on his patients.
I see what your saying, but I don't feel the physician used these treatments in a therapuetic way, i.e. as to relieve certain symptoms they themselves suffered.
In this day and age, psychiatrists generally lack first hand experience with most of the treatments that they prescribe, often prolifically, to others.
I'm not too sure here. I personally feel many psychiatrists are on psychiatric medications themselves. Obviously this is from what I have read, seen, and the psychiatrists I have met through my study, through friends, and a personal relative.
In my opinion, this is somewhat irresponsible.
I can see what you mean. Can we go far to say as, in a certain sense, an (obviously informal!) pre-requisite to specialising as a psychiatrist should be a mental illness or illness's, which have subsequently been treated and 'resolved' to a great degree? I think this enhances the doctors ability to effectively 'help, 'treat' his/her patients to a great degree.
The main issue, I feel, however, is whether such an illness has been 'resolved'. At least to unhinder the clinicians behaviour, perception, and treatment of the patient....
> It would, however, be unethical - and more importantly, unsuitable and inefficient - for a physician to be so enthusiastic and passionate about a particular medicine or other treatment that he presses it onto patients for whom it is not appropriate, or for whom alternative treatments would be more effective or suitable.
I agree 100%.
Such enthusiasm may come from personal use of the treatment and a resulting amazement with its efficacy for treating a health condition, or any other agreeable effect of it.
I am preety sure you are alluding to me and Nardil. My opinion of Nardil is NOT due soley on the great level of thereapeutic efficacy I recieved from it. I can see why would would think this however.
Before starting the drug, I investigated it extremely thoroughly- it's pharmacological properties, it's history, it's rate of use in different countries, and most importantly clinical and anectodal reports on the drug.
I literally printed out anything about Nardil from any resource possible (on-line journals, psych web-site akin to this and this site, etc etc) Also, I obtained many psychiatric journals from 1950+ (I am OCD!)
I had never seen ANY response as positive to a drug EVER before. And previous to taking Nardil I was no stranger to psychiatric meds and had already researched them (as a hobby at that time)
Obviously my response to the drug, inveterated what I already felt about the drug.
After kicking in, I was certainly in a state of (healthy) euphoria ( I still do recieve a euphoria at times from Nardil, in addition to it's wonderful primary therapeutic effect). This is evident in my posts on this sites all those many years ago now. I am naturally an eccentric person, but Nardil accentuated that to a great degree, and I WAS a little over the top in some things I did. I do tell people this can happen.
> As an example, if a physician used morphine on himself to treat chronic back aches, and found it not only to be remarkably effective for the pain, but also to induce a state of comfort and joy, it would not be appropriate to let such experience cloud his judgement so that he proceeds to prescribe morphine therapy for a patient presenting with migraine (except perhaps after trying other, more suitable treatments first and finding them ineffective).
Once again I agree totally, however I do feel this is not congruent with my situation with Nardil. (Although i can fully understand why you would think so)
> As a particularly pertinent example, it would be inappropriate for you to let your personal success and satisfaction with Nardil lead you to prescribe it for patients for whom EMSAM or Parnate would have equal probability of success but less likelihood of adverse effects regarded by the patient as particularly undesirable.
I preety much answered this above, but you are correct. Nardil's s/effects can be preety rough for a lot of people- I have always stated this (in addition to stating their are treatments for the s/effects). Parnate can be a phenomenal boon to others too, and also the TCA's. I do not find the newer drugs in any way better than the older drugs, except that, on the whole, we do see fewer s/effects.
But I WOULD indeed use Nardil as a first line for what I deemed a severe depression or severe anxiety disorder (or combinations of the both). Once again, this is certainly NOT based, in any way, soley on my response to the drug.
> > I do know many psychiatrists (on a personal level) (Also, my uncle is a psychiatrist) who certainly suffer mental illness, and a myriad of "Axis II" disorders. And I have noted (what I feel) is improper behaviour, due, to what I feel is their own psychiatric problems.
> It is important to remember that psychiatrists are only human, and it is not reasonable to demand them to be perfect.
Sure- I think all of them have positives and negatives like us all! Medical school does NOT bestow a person with wisdom, compassion, empathy, love, etc etc And certainly not sanity, ha ha!!
Besides, the definitions of mental health and illness are subject to change - for example, homosexuality is a mental condition that is no longer regarded as an illness.
Psychiatry is still more of an art than a science. But I do see great things on the horizon for it as a speciality.....maybe it will always be that 'asymptope' which never reaches the curve (i.e. the point where we can say "here is your disease!!")
Physics, Maths, chemistry, other branches of medicine etc, are bona-fide science or very close too- It is my hope that psychiatry does reach this level. It is a great challenge.
Additionally, ideals are also subject to change - for instance, what may have been considered ideals for everyone to strive towards in ancient Greece may be regarded with ridicule or contempt in some other place and time.
I know. I believe homosexuality, in time long past, was a 'manly' thing. I am no historian but!
We are now looking at the more 'social construct' side of psychiatry here- your ideas are absolutely valid.
> > Maybe my whole anxiety about this is a manifestation of my own mental illness, I'm not sure?
> It's quite possible that it's a manifestation of some underlying mental condition, such as a lack of confidence or self-esteem, or alternatively, exaggerated perfectionism or idealism.
I think it's my OCD now, after long reflection. That being said, it could be any/all off the above....!!!!