Psycho-Babble Medication Thread 330066

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Re: Do antidepressants really work?

Posted by Althea8869 on April 4, 2004, at 22:34:08

In reply to Re: Do antidepressants really work? Althea8869, posted by SLS on April 4, 2004, at 13:33:38

Scott - please excuse my acronym ignorance, but what is DST?

Never the less, your point is well taken. I also wonder about the inclusion/exclusion criteria. I see two significant problems. First, it doesnt appear that the trials process is representative of our current body of knowledge on neurological disorders. We are way past the 'one size fits all' mentality which I suspect governed much of the process as recently as five years ago. Clinical testing must become far more targeted and precise - we have enough knowledge now to be well along this path and yet we are not. Second, the pharmaceuticals are still far too involved in the process. After submission for clinical testing, they should be completely divorced from the process, having no input or control over any part of either the trials or the corresponding reports of results.

Solve these problems and two things will happen: we will have far more accurate data about efficacy and response rates across the whole spectrum of neurological disorders, and, we will introduce a measure of integrity into a system which few patients currently trust.

Just my thoughts.
Hope you had a nice Sunday.
Take it easy.

 

Re: Do antidepressants really work? Althea8869

Posted by SLS on April 5, 2004, at 8:11:17

In reply to Re: Do antidepressants really work?, posted by Althea8869 on April 4, 2004, at 22:34:08

> Scott - please excuse my acronym ignorance, but what is DST?

DST = dexamethasone suppression test

Dexamethasone is a synthetic cortisol. In a negative feedback loop arrangement, ACTH secreted by the pituatary gland stimulates the adrenal glands to secrete cortisol. In healthy people, an increase in the blood level of cortisol signals the pituitary gland to reduce its output of ACTH. So too does the introduction of dexamethasone. However, in a sizable percentage of people diagnosed with major depression, dexamethasone fails to suppress the secretion of ACTH. The negative feedback loop fails to limit cortisol production. The DST was investigated intensively during the 1980s, and was used to aid in the diagnosis of endogenous depression.

Some studies suggest that people who are non-suppressors (abnormal) are statistically more severely depressed and, perhaps more importantly, more likely to respond to ECT or medication than suppressors.


- Scott

 

Re: Do antidepressants really work? SLS

Posted by Althea8869 on April 5, 2004, at 9:28:11

In reply to Re: Do antidepressants really work? Althea8869, posted by SLS on April 5, 2004, at 8:11:17

Fascinating! Apparently I have not been keeping up with my homework here. Why is this test not more widely utilized as a marker? Is it a cost issue(no insurance coverage) or is it a safety issue for the patient or possibly a question of validity of findings and causal relationships.

Need to do some research. I'll check back later.
Thanks Scott.
Take care.

 

Re: Do antidepressants really work? SLS

Posted by simus on April 5, 2004, at 11:16:38

In reply to Re: Do antidepressants really work? Althea8869, posted by SLS on April 5, 2004, at 8:11:17

Scott,

I am trying to digest this info. The reason being, I have always wondered if what I really needed to go to was an endricrinologist years ago instead of a psychiatrist for the sudden onset of anxiety/panic attacks. It just felt more like an adrenaline flood than a "mental" illness, which made me wonder about the proper function of the adrenal glands. I have also wondered if my hypothalamus was working properly (strong intolerance to heat).

I don't know how familiar you are on the topic, but I will run this past you. I have never had total success on a SSRI. The best success I have up to 3 months ago had was on a SNRI. Now on Wellbutrin alone, I feel great emotionally. But I have some symptoms that I think appear to be adrenal related. For instance, extreme edema, and a sudden onset of pain/achyness/stiffness. I am grasping at straws here, but I thought I would throw this all at you to see what you knew.

Thanks in advance. God bless.

 

Re: OCD or BP?

Posted by jdgjdg on April 5, 2004, at 21:56:44

In reply to OCD or BP? snapper, posted by katia on April 4, 2004, at 16:09:43

I have both OCD and BP I. It took a long time for my pdoc to diagnose the bp because I withheld a lot of information from her because I was afraid. OCD can and often does come and go. It seems to have triggers(and often doesn't have any triggers) just as any other disorder. OCD is primarily characterized by disruptive thoughts that cause you to repeat rituals such as hand washing, checking the door, locks, oven,etc. There are also many other compulsions that someone can have. Someone with OCD can also have what they call avoidance compulsions. That is simply avoiding a situation that causes the thoughs to race out of control. I can describe it best like this: When I am obsessing, it's like having a song stuck in my head. It just won't go away. The more I try to get the scary thought out of my head, the more I keep thinking of it. To make the thought go away, I will check and re check the windows, doors, and locks to insure my safety. My obsessions are usually about my safety. The more I check, the worse the obsessive thoughts get. Does this make sense? There is a website you can visit. www.ocfoundation.org I think you will find it useful. Jenn

 

Re: Do antidepressants really work?

Posted by snapper on April 5, 2004, at 23:04:08

In reply to Re: Do antidepressants really work? Althea8869, posted by SLS on April 5, 2004, at 8:11:17

> > Scott - please excuse my acronym ignorance, but what is DST?
>
> DST = dexamethasone suppression test
>
> Dexamethasone is a synthetic cortisol. In a negative feedback loop arrangement, ACTH secreted by the pituatary gland stimulates the adrenal glands to secrete cortisol. In healthy people, an increase in the blood level of cortisol signals the pituitary gland to reduce its output of ACTH. So too does the introduction of dexamethasone. However, in a sizable percentage of people diagnosed with major depression, dexamethasone fails to suppress the secretion of ACTH. The negative feedback loop fails to limit cortisol production. The DST was investigated intensively during the 1980s, and was used to aid in the diagnosis of endogenous depression.
>
> Some studies suggest that people who are non-suppressors (abnormal) are statistically more severely depressed and, perhaps more importantly, more likely to respond to ECT or medication than suppressors.
>
>
> - Scott

> Hi Scott, you are correct on the DST thing. At least in my experience. When I had the DST done in 1992' and was almost disappointed that it came back as normal, so to speak. I thought, how come that test came back neg. for me. I wanted a real reason for why I felt so awful. I thought it was a definitive type thing but we obviously know it is not!! Would'nt it be nice if it were that simple?
snapper

 

Re: OCD or BP? jdgjdg

Posted by katia on April 5, 2004, at 23:38:37

In reply to Re: OCD or BP?, posted by jdgjdg on April 5, 2004, at 21:56:44

Yes, you make perfect sense. I don't really experience that though. I can see how one could get stuck in that spiral tho'. To me, it's the anxiety that would make the thoughts go round and round, feeling like I was not in control, but being controlled and caged by this tormenting thought/song...The more I could let go and not let it torment me, the less it would become. We're prisoners to the fear of something controlling/caging us. I think that's a big part of it. And so then you do something to alleviate it - enter in the compulsion side.

For me it's more about noise. I feel caged and induces anxiety when I'm stuck listening to unpleasant sounds. or a wierd one is when people jitter or shake their legs. it's been murder being a student. I'm surrounded by people shaking their legs during class. I can't explain it, but it drives me insane. I remember the first time it bothered me when I was 11 in a classroom and a big boy next to me shook his leg sooo fast all the time it drove me mad. And since then I can't take it (I'm 33!). It induces anger, intolerance, a feeling of being caged and subjected to torture. perhaps it's too stimulating for me? I dunno. it's very odd indeed. Who knows. it could be some unconscious association w/ a trauma that happened for me at that time - although I don't remember what the trauma is?!
I just figured I had a touch of OCD to have such a wierd making crazy thing like shaking legs!
Katia

 

Re: OCD or BP? katia

Posted by simus on April 6, 2004, at 0:25:06

In reply to Re: OCD or BP? jdgjdg, posted by katia on April 5, 2004, at 23:38:37

> For me it's more about noise. I feel caged and induces anxiety when I'm stuck listening to unpleasant sounds. or a wierd one is when people jitter or shake their legs. it's been murder being a student. I'm surrounded by people shaking their legs during class. I can't explain it, but it drives me insane. I remember the first time it bothered me when I was 11 in a classroom and a big boy next to me shook his leg sooo fast all the time it drove me mad. And since then I can't take it (I'm 33!). It induces anger, intolerance, a feeling of being caged and subjected to torture.

I understand exactly. There are things that trigger me too, like soup slurping. I literally have to leave the room if someone is slurping their soup. Or there are those who can't seem to take a drink of something without following it EVERY TIME with an "Ahhhh". Or the people who can't sneeze without some sort of a shreiking noise - that they insist they can't control it. Even the "kissing noises" on TV during a romantic scene ruin the show for me. And then there are the "gum snappers" in church, of all places. Sometimes it irritates me to the point of being afraid that I won't be able to contain myself. I know it is really MY problem, but just telling yourself to ignore it DOES NOT WORK!!!

 

Re: Do antidepressants really work? SLS

Posted by simus on April 6, 2004, at 0:35:48

In reply to Re: Do antidepressants really work? Althea8869, posted by SLS on April 5, 2004, at 8:11:17

Scott,

You have some very intriguing information. What is your source?

 

Re: OCD or BP? simus

Posted by katia on April 6, 2004, at 2:59:55

In reply to Re: OCD or BP? katia, posted by simus on April 6, 2004, at 0:25:06

Have you been dxed w/ OCD? B/c what you described sounds like me. What is it about this intolerance of people's annoying habits that drive us around the bend? I don't get it. But it is a form of torture.
Katia

 

Re: Do antidepressants really work? snapper

Posted by SLS on April 6, 2004, at 8:02:10

In reply to Re: Do antidepressants really work?, posted by snapper on April 5, 2004, at 23:04:08


> > Hi Scott, you are correct on the DST thing. At least in my experience. When I had the DST done in 1992' and was almost disappointed that it came back as normal, so to speak. I thought, how come that test came back neg. for me. I wanted a real reason for why I felt so awful. I thought it was a definitive type thing but we obviously know it is not!! Would'nt it be nice if it were that simple?
> snapper


I know.

The DST is by no means specific and sensitive enough to be a global test for biological depression. Many people with biological depression do show normal suppression. I guess this is yet another indication that "depression" is a multifactorial presentation, the exact etiology of which is complex and varies from individual to individual.

I can only guess how you must have felt when your DST came back normal. The results did not "vindicate" you of having any control or responsibility for your mood states, which you in fact have very little. It must have been confusing and unsettling.


- Scott

 

Re: Do antidepressants really work? simus

Posted by SLS on April 6, 2004, at 8:11:07

In reply to Re: Do antidepressants really work? SLS, posted by simus on April 6, 2004, at 0:35:48

> Scott,
>
> You have some very intriguing information. What is your source?

Hi Simus.

DST has been around for a long time. It is used not only for depression, but for other cortisol abnormalities as well. Your best bet is to do a search on google:

http://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=dst+depression


Here is a review that helps verify the validity of the DST for identifying endogenous depressions, both unipolar and bipolar:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8909334

Have fun.


- Scott

 

Re: OCD or BP? katia

Posted by simus on April 6, 2004, at 12:16:58

In reply to Re: OCD or BP? simus, posted by katia on April 6, 2004, at 2:59:55

> Have you been dxed w/ OCD? B/c what you described sounds like me. What is it about this intolerance of people's annoying habits that drive us around the bend? I don't get it. But it is a form of torture.
> Katia

Yes, and I have been like this as far back as I can remember. I wish I wasn't this way. I am not judgemental and these are really nice people. I just can't stand their "noises". Maybe instead of drugs, the doc should give me earplugs. lol Actually, it does work. =) When my first daughter was born, she had colic and a very, very high pitched scream. I thought I was going to lose my mind for about a month, until I bought some earplugs.

 

SLS - thanks (nm)

Posted by simus on April 6, 2004, at 12:22:10

In reply to Re: Do antidepressants really work? simus, posted by SLS on April 6, 2004, at 8:11:07

 

Re: OCD or BP? simus

Posted by katia on April 6, 2004, at 14:54:31

In reply to Re: OCD or BP? katia, posted by simus on April 6, 2004, at 12:16:58

>>
> Yes, and I have been like this as far back as I can remember. I wish I wasn't this way. I am not judgemental and these are really nice people. I just can't stand their "noises". Maybe instead of drugs, the doc should give me earplugs. lol Actually, it does work. =) When my first daughter was born, she had colic and a very, very high pitched scream. I thought I was going to lose my mind for about a month, until I bought some earplugs.
>

So, having these things that drive us crazy means OCD? I don't really have the compulsion side though. Do you? I own mannnny ear plugs! I can't even imagine having to endure a baby screaming and HAVING to be there and play mother and be patient w/o losing my mind and killing us both!
Good job in maintaining!
Katia

 

Re: OCD or BP?

Posted by snapper on April 6, 2004, at 17:54:56

In reply to Re: OCD or BP? simus, posted by katia on April 6, 2004, at 14:54:31

> >>
> > Yes, and I have been like this as far back as I can remember. I wish I wasn't this way. I am not judgemental and these are really nice people. I just can't stand their "noises". Maybe instead of drugs, the doc should give me earplugs. lol Actually, it does work. =) When my first daughter was born, she had colic and a very, very high pitched scream. I thought I was going to lose my mind for about a month, until I bought some earplugs.
> >
>
> So, having these things that drive us crazy means OCD? I don't really have the compulsion side though. Do you? I own mannnny ear plugs! I can't even imagine having to endure a baby screaming and HAVING to be there and play mother and be patient w/o losing my mind and killing us both!
> Good job in maintaining!
> Katia

Hey Katia, the mere fact that things get on our nerves more so than others might be too simplistic I do know for sure that it is possible for ocd to potentially evolve into "primarally obsessional ocd" ie: obsessions but no apparent compulsions-however if you look deeper into the actual symptoms many times you will find that the obsessions are not the only thing present-but compulsions as well!! If you want, post me back and I'll try to explain what I mean.All I know is this:Since being off of FXR since last May or June 2003 I have been painfully aware of my obsessions and minor compulsions-its' Helllllll- I hate the idea that I might have to go back on effexor to control these problems, but it might be a neccessity
snapper

 

Re: OCD or BP? snapper

Posted by katia on April 6, 2004, at 21:01:36

In reply to Re: OCD or BP?, posted by snapper on April 6, 2004, at 17:54:56

Hi,
Yes I would like to hear more about that.
The other interesting thing is, when I was on Effexor, I had less obsessions like this. things didn't bother as much. However, I couldn't tolerate it for 1. I'm BP (come to find out afterwards) and 2. I got those electrical shock w/drawals happening EVEN while ON it. much less, the w/drawal was a NIGHTMARE. Is there anything else that does it?
I guess I have forgotten to mention these things to my pdoc. I guess i should. I was so caught up in my mood swings scenario that I forgot this aspect over the past year seeing him.
Katia

 

Re: OCD or BP?

Posted by snapper on April 6, 2004, at 22:20:18

In reply to Re: OCD or BP? snapper, posted by katia on April 6, 2004, at 21:01:36

> Hi,
> Yes I would like to hear more about that.
> The other interesting thing is, when I was on Effexor, I had less obsessions like this. things didn't bother as much. However, I couldn't tolerate it for 1. I'm BP (come to find out afterwards) and 2. I got those electrical shock w/drawals happening EVEN while ON it. much less, the w/drawal was a NIGHTMARE. Is there anything else that does it?
> I guess I have forgotten to mention these things to my pdoc. I guess i should. I was so caught up in my mood swings scenario that I forgot this aspect over the past year seeing him.
> Katia

Katia had this great post in reply to yours and after 10-15 min of composing it -- I lost it damn!!
Anyhow check out this link http://psycheducation.org; The Dr. who owns it is very knowledgable and goes into detail on how Bipolararity-OCD-and Social phobia all inter-relate to ea other!! Check it out and let me know what you think!!
If you have any other specific ?'s re OCD just post me and i'll try to answer you to the best of my ability!! I def do not claim to have all the answers.I am not an expert but have done quite abit of research and am starting to get a feel for what is going on!! So I guess that you could say that I am *obsessed* with trying to figure things out! oh yah the other link is http://www.ocdla.com
snapper

 

Re: OCD or BP? snapper

Posted by katia on April 7, 2004, at 2:46:03

In reply to Re: OCD or BP?, posted by snapper on April 6, 2004, at 22:20:18

Hey,
I clicked on most of the links for OCD and I can say that at one time in my life, I've experienced a few of them; i.e. body dysmorphic, panic attacks, hypochroniac, and phobias (spiders and ticks). But I tell you, everything under this OCD heading I feel I've gotten control over. Like I have outgrown a lot of it. I hate to say it that way, as though I had a hand in it (as tho' it's something I can control). But I really read thru' those categories and about 1/3 applied to me. And mostly in my teens/late teens and twenties. I have definitely developed a coping capacity. I have done a lot of meditation and so forth and wonder if this has to do w/ it. I've done so much work on mind over matter type of stuff that I think it's paying off, which feels good.

Again, I could say at one time in my life, I can answer yes to about a 1/3 of those questions and subcategories of OCD. But now, I feel more developed in a sense. Like I don't let it get to me. And I feel blessed for that. Who knows what's around the bend though!

This is my question then about OCD. Does it come and go? I know my mood swings (BP) are also correlated w/ how "neurotic" I am w/ sound and noises. (that's my obesession - noises). I'm way more tolerant when I'm feeling stable mood wise. I guess mine is more of an offshoot from the mood disorder?
Katia

 

Re: OCD or BP? katia

Posted by simus on April 7, 2004, at 7:23:39

In reply to Re: OCD or BP? snapper, posted by katia on April 7, 2004, at 2:46:03

> This is my question then about OCD. Does it come and go? I know my mood swings (BP) are also correlated w/ how "neurotic" I am w/ sound and noises. (that's my obesession - noises). I'm way more tolerant when I'm feeling stable mood wise. I guess mine is more of an offshoot from the mood disorder?
> Katia

I get worse during times of stress, lack of sleep and not eating properly, and it varies depending on med. I have found that once the OCD med kicks in, I still have to make a conscious effort to overcome the habits that the OCD started (for instance, I can refuse to recheck to see if the doors are locked, iron is unplugged, etc.)

 

Re: OCD or BP?katia

Posted by snapper on April 7, 2004, at 12:42:18

In reply to Re: OCD or BP? snapper, posted by katia on April 7, 2004, at 2:46:03

Hey Katia, I'm glad you checked those links out and it made some sense to you. In regards to the noise thing, I can only therorize that any time we are having a hard time with mood swings and 'hyper-excitability' in out brain cells---it is going to make all our senses *hyper-alert* almost an on guard type of thing. I believe that is what makes us so miserable. Also I am glad that you seemed to have overcome or outgrown a lot of your problems. I am having a hell of a time right now with noise etc-I almost constantly have to have my cd/headphones on everyday to drown out the noise or lack of the correct type of noise! It sucks!! The telephone ringing kills me
and I specifically don't have one in my bedroom for that reason and I also do not use an alarm clock cause I have so much trouble staying in a good sleep, that I know I am going to wake up w/o one. Being overly sensetive to noises is called hyperacusis-anyhow I do know that when my moods get better and level out my noise thing tends to diminish to a large degree.I just seem to startle so easily -do you have the startle problem?
snapper
snapper

 

Re: OCD or BP?katia

Posted by snapper on April 7, 2004, at 14:02:19

In reply to Re: OCD or BP?katia, posted by snapper on April 7, 2004, at 12:42:18

For Katia: p.s what meds are you currently on?
also if I failed to address your real question re :obsessing about sounds----I think that they are intricately connected -mood swings and obsessions!
snapper

 

Re: OCD or BP?katia snapper

Posted by katia on April 7, 2004, at 14:29:41

In reply to Re: OCD or BP?katia, posted by snapper on April 7, 2004, at 12:42:18

Hi Snapper,
Cool name. Where'd you come up w/ it?
I do startle easily sometimes. What is sounds like is being in the flight or fight/sympathetic nervous system always activated. We're on edge in fear and noises are the target/scapegoat?
who knows. I just so thankful mine's getting better. I'm taking Lamictal and Trileptal and Seroquel for sleep. Maybe that has something to do w/ it.
Maybe the fact that I just bought a house on my own is so wonderful, I can tolerate (more than before) the barking dog next door because I feel safe in my OWN! home.
and you're right, when I am out of balance mood wise and i"m tired - it's hell. Esp. snoring noises! that's probably why I don't have a boyfriend! I can't put up w/ the sleeping together!
Katia

 

Re: OCD or BP?katia snapper

Posted by simus on April 7, 2004, at 17:59:47

In reply to Re: OCD or BP?katia, posted by snapper on April 7, 2004, at 12:42:18

> I just seem to startle so easily -do you have the startle problem?

I wish you could ask my husband that and watch him roll his eyes. Every time he comes in a room now he will shuffle his feet or rattle a doorknob or something - just so I know he is there. If I am deep in thought and suddenly see someone standing there when I don't expect to, it isn't pretty. After my ear-piercing scream comes the heart racing and the dizzyness, and even sometimes tears. One time someone at work thought it would be "cute" to come up behind me and poke me in the ribs. After the scream, a couple of hundred sets of eyes were on us. I was just sitting there, shaking and embarrassed. His face got very red and he just disappeared. Not a banner day.

 

Re: OCD or BP?katia

Posted by snapper on April 7, 2004, at 19:18:18

In reply to Re: OCD or BP?katia snapper, posted by katia on April 7, 2004, at 14:29:41

> Hi Snapper,
> Cool name. Where'd you come up w/ it?
> I do startle easily sometimes. What is sounds like is being in the flight or fight/sympathetic nervous system always activated. We're on edge in fear and noises are the target/scapegoat?
> who knows. I just so thankful mine's getting better. I'm taking Lamictal and Trileptal and Seroquel for sleep. Maybe that has something to do w/ it.
> Maybe the fact that I just bought a house on my own is so wonderful, I can tolerate (more than before) the barking dog next door because I feel safe in my OWN! home.
> and you're right, when I am out of balance mood wise and i"m tired - it's hell. Esp. snoring noises! that's probably why I don't have a boyfriend! I can't put up w/ the sleeping together!
> Katia

Hey Katia, man I did it again ..I had a really good post going to reply to you and I hit something on my computer and lost it!!!!!!!!! Anyhow >snapper, name< long story, but the basic is that I used to have this really cool and cute little dog, named snapper,she was very small and very hyper! (yorkie-poo mix) Kind of like what I used to be :) I don't have her any more, and I miss her but had to give her away because my mom could'nt keep up with her when my Illness got really bad!! I used to joke that she was like me! Only I think she was tri-polar! lol You are def right about the nervous system being on alert all the time! I wish mine would get better! Most of the meds I have been on over the last several years have done little to dampen that horrible startle response and it sucks. I live w/my sister and my folks right now , but sometimes just someone calling my name to ask me a simple question will make me jump. It makes me feel like I have PTSD, which I don't-at least not that I know of!! Lamictal, Seroquel, and Tri-leptal huh? Thats a tasty and simple little med cocktail! Is it working for you? I wish I was that simple. I see my pdoc next thur. and My little head is very busy trying to figure out what new things to try to make my head feel better. He is NOT big into poly-pharmacy , which is cool to a degree but at the same time I am miserable as hell. Congrats on your new home , I bet that really does give you some peace of mind and anything that gives us peace of mind is good for the ol' brain - I am hoping to get back to that point! I don't work right now! It sounds like you do, to own a home unless someone just blessed you !! lol--- I also don't have a girlfriend right now like you don't have a boyfriend... Not that I wouldnt' want one -its just that with my moods and anxieties and having to have my own space in bed and what not , I probably would drive her nuts. Snoring drives me nuts too, even though I do it, because I have sleep apnea! Speaking of which- sleeping disorders and mood dis-orders are very commonly co-morbid! Its a very frustrating health situation
-the very thing I need to feel better (proper sleep) is exacerbating my mood disorder and the freakin' drugs you need to help control your mood disorder tend to make you put on the lbs, which does nothing to help my sleep apnea, which in turn makes getting a proper nights rest very hard. I am seriously thinking of proposing the idea to my -pdoc that I need to be on a stim like adderall so I have the motivation to excercize, to lose some weight so I sleep better to in turn create a better mood state. Probably going to be a hard sell -But I need to do something! Hey I am bablin away again, so i'll let ya go! But keep in touch you're fun to talk to!! Sounds like we both have some of the same idiosyncrasies(sp)!
snapper


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