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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 143. This is the beginning of the thread.
Posted by Squiggles on May 6, 2006, at 6:54:51
Would anyone here know the statistical
rates of AD-caused suicides, comparing
different classes of drugs; or where I
could find studies in such assertions?
I am searching for evidence regarding
the proposed unique ability of SSRIs to
cause suicide, in exclusion of other
causes and other classes of antidepressants.Thanks
Squiggles
Posted by pseudoname on May 6, 2006, at 10:57:50
In reply to Statistical question on SSRIs, posted by Squiggles on May 6, 2006, at 6:54:51
David Healy republished someone's table of “Incidence of suicides and suicide attempts in antidepressant trials”. It's available on the web on page 3 of this article: “Antidepressants and Suicide.” Journal of Psychiatry and Neuroscience, 2003; 28(5):331-7 http://lucire.com.au/documents/pdf/HealyWhitaker.pdf
There are other studies, but the full text isn't usually available on the web.
Posted by Squiggles on May 6, 2006, at 12:34:20
In reply to SSRI suicidality table » Squiggles, posted by pseudoname on May 6, 2006, at 10:57:50
Thank you very much. It's going to take
me some time to read and analyze this,
partly because I don't have the level
of education to recognize the clinical
concepts and phrases. But it's certainly
a relevant paper.Later,
Squiggles
Posted by bassman on May 6, 2006, at 20:12:30
In reply to SSRI suicidality table » Squiggles, posted by pseudoname on May 6, 2006, at 10:57:50
Thanks for the reference-interesting paper. By the data, it would seem Zoloft would be the AD to prescribe to mimimize the chance of suicide, not Prozac, as is recommended, at least for teens. I personally thing it just has to do with taking an anxious/depressed person who is feeling awful and making them feel worse with meds, and then wondering why they decide to kill themselves. I think everyone on psychoactive meds should be actively monitored, myself-even just e-mailing the doc/whomever every few days at first.
Posted by Squiggles on May 6, 2006, at 21:12:30
In reply to SSRI suicidality table » Squiggles, posted by pseudoname on May 6, 2006, at 10:57:50
I am reading the paper, weighing the
significant value of different data
collection (epidemiology, meta-analysis,
Challenge-Rechallenge-Dechallenge),
looking at the stats, etc.I am not ready to draw any conclusions
yet - though the Abstract already states
the validity of the study's proposition as not being "null". There is a lot in between.One more piece of information I would like
is the statistical suicide reports (in the UK Health Bank or other countries - 50 countries
are claimed to use Reboxetin).That's all for now.
Squiggles
Posted by yxibow on May 7, 2006, at 0:41:02
In reply to Statistical question on SSRIs » pseudoname, posted by Squiggles on May 6, 2006, at 21:12:30
Nonwithstanding the potential of any antidepressant to possess possible danger to cause suicidality, I would question things that come from David Healy. He was stripped of his position at the University of Toronto. If you quack like a duck... its hard to say. There are varying opinions on that issue.
There is also the issue that any seriously suicidal patient can commit suicide while on any medication regardless. They were destined, if that is a word, to do so in the first place. The medication didn't cover the disorder, and tragedies happen.
Nonetheless, in this litigious society, we now have black box warnings on SSRIs, especially re adolescents. That is an entirely different question -- not all medications in the past were tested for the under 18 population. So that fits a whole special consideration. Adolescents have rapidly changing bodies and rapidly changing brains as well.
I would say the jury is out on these sorts of manners, but analysis does no harm. Hysteria and my dear departed so and so committed suicide because he/she took X, Y, or Z, is not always so easy to tease out exactly the circumstances, and does do harm when improper information about antidepressants are handed out, i.e. Scientology, which rejects all antidepressants (yes, lets have people who really need help run in front of cars, that is a great solution -- but then this comes from people like Tom Cruise who would eat placentas on television.)
- tidings
Jay
Posted by linkadge on May 7, 2006, at 1:41:03
In reply to Re: Statistical question on SSRIs, posted by yxibow on May 7, 2006, at 0:41:02
I don't have any personal reason to assume the drugs are unsafe.
I do think that there is some intrinsic activity to the SSRI's which can be responsible for increased suicidal ideation in certain persons. Akathesia is a very powerful negitive feeling, and can definately add to the negative emotions present in depression.
Linkadge
Posted by Squiggles on May 7, 2006, at 6:12:34
In reply to Re: Statistical question on SSRIs, posted by linkadge on May 7, 2006, at 1:41:03
I wonder if akathisia occurs with
some SSRIs in particular, because of their
short half-life or their unique chemical
structure. Personally, i have experienced
akathisia close to suicide in lithium
depletion, and clonazepam withdrawal - both
stopped by resumption of the drug.I have been looking at Reboxetin, not
just because it is relevant in this case,
but to find an alternative (after 25? drugs
now) for my friend. It is an NSRI, and
supposedly lacks the agitating feature
of fluoexetine. However, I read that
Dr. Nemeroff points out that it is often
used as an adjunct to another SSRI (they
are compatible together). That would make
it inefficient and possibly agitating in
itself for Major Depression at least.Squiggles
Posted by Squiggles on May 7, 2006, at 6:22:17
In reply to Statistical question on SSRIs, posted by Squiggles on May 7, 2006, at 6:12:34
> I wonder if akathisia occurs with
> some SSRIs in particular, because of their
> short half-life .........(correction)I think that should be long half-life. The
longer the half-life of the drug, the longer
it takes to start effecting, upon first
taking it, right?Squiggles
Posted by Squiggles on May 8, 2006, at 6:01:41
In reply to Statistical question on SSRIs, posted by Squiggles on May 7, 2006, at 6:22:17
Here are some studies I found on PubMed on the
topic of comparing Reboxetine to Fluoxetine:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
It looks as good as, or even superiour to
both fluoxetine and imipramine. This is
a point for Healy, but it is also something
that interests me personally.If it is superiour, why isn't it available?
Why did the FDA nix it? I searched for
Pharmacia and Upjohn who have now been
bought or merged into Pfizer, but the
drug is still not available and without
a patent number.Any ideas, what's going on with a drug
that is superiour and unique for major
depression, and stashed on the shelves?
Maybe a typical bureaucratic problem,
or is this pharmapolitics?Thanks for any opinion. My friend is
willing to try it, if the present increase
in her imipramine dose does not work.Squiggles
Posted by bassman on May 8, 2006, at 6:23:11
In reply to Statistical question on SSRIs, posted by Squiggles on May 8, 2006, at 6:01:41
This is what I found:
"The conspiracy theory is that the FDA did
not approve reboxetine so that Eli Lilly (makers of Prozac),
who have the patent on tomoxetine, can have the FDA-approved
NARI. Whether or not this is true, tomoxetine has had excellent
results in the recent studies".Having worked in the pharmaceutical industry for 25 years, I find this hard to believe, however. If the company believed in reboxetine, I'm sure they would have put up a fight/re-applied, whatever. I'd be more willing to believe that they were "bought out" (you don't try to get your drug approved and we give you $$) or there was something nasty in terms of safety data that the Feds found. Whatever it was, looks like it was a well-kept secret, which is odd in the pharmaceutical industry.
Posted by SLS on May 8, 2006, at 7:45:41
In reply to Re: Statistical question on SSRIs, posted by bassman on May 8, 2006, at 6:23:11
Reboxetine was denied approval by the FDA several years ago because the clinical investigations performed in the US were failed studies. Neither reboxetine nor fluoxetine demonstrated superiority over placebo.
My impression over these last five years is that reboxetine is not as effective as desipramine as a NARI. A few people have responded favorably to it, but it seems that many more have not.
My personal experience with reboxetine was that it made my depression significantly worse and produced anxiety.
I did not like atomoxetine. It produced fatigue and did not help much with depression.
I am very treatment-resistant, so my reactions to these drugs may not be typical.
- Scott
Posted by Squiggles on May 8, 2006, at 8:21:32
In reply to Re: Statistical question on SSRIs, posted by SLS on May 8, 2006, at 7:45:41
Thank you for your reply.
> Reboxetine was denied approval by the FDA several years ago because the clinical investigations performed in the US were failed studies. Neither reboxetine nor fluoxetine demonstrated superiority over placebo.
But fluoxetine is a big seller, no? The
studies at PubMed compare fluoxetine to
Reboxetine, and find the majority of Reboxetine
more potent, less annoying in side effects,
and at least as effective as Prozac (which i
think is fluoxetine -- hope i didn't get that
wrong).
>
> My impression over these last five years is that reboxetine is not as effective as desipramine as a NARI.Desipramine - a tricyclic?. Reboxetine is said
to be unique as an NARI - not like the other
NARIs.A few people have responded favorably to it, but it seems that many more have not.
You probably have access to data on this.
>
> My personal experience with reboxetine was that it made my depression significantly worse and produced anxiety.Hmm, i appreciate the feedback.
>
> I did not like atomoxetine. It produced fatigue and did not help much with depression.
>
> I am very treatment-resistant, so my reactions to these drugs may not be typical.That's important to me - we are dealing with
a treatment-resistant case and a sledgehammer
seems necessary. I have had my doubt about
classes outside the tricyclics and anti-psychotics
for this case. Maybe just an opinion, but
the SSRIs and NARIs seem a class of perkier,
but not as sedating drugs.It's possible that what we have with the
HEALY case is a fight which could be terribly
immoral if it affected lives, but if the two
drugs are more or less equivalent in sucicidality
rates, and efficacy rates, the fight only affects
reputation and personal antagonism. I love
self-interest :-)
>
>
Squiggles> - Scott
Posted by Squiggles on May 8, 2006, at 10:54:37
In reply to Statistical question on SSRIs, posted by Squiggles on May 8, 2006, at 8:21:32
The verdict is not out yet, in my opinion.
I'm going to let it rest until Reboxetin
is actually on the market, and is tried
by my friend for treatment-resistant depression- clinical severity. That may take as long as it took lithium to be reintroduced into the market after some people suffered heart attacks from overdose. Imipramine is a hard drug to tolerate,
but the only thing efficient so far.S T A H L's assessment:
In the meantime here is something from
Dr. Stephen M. Stahl, in "Essential Psychopharmacology of Depression and Bipolar
Disorder", p. 100-101:
SNRIs"Although some tricyclic antidepressants (e.g.,
desipramine, maprotilene) block norepinephrine reuptake more potently than serotonin reuptake, even these tricyclics are not really selective,
since they still block alpha 1, histamine 1, and msucarine cholinergic receptors, as do all tricyclics. The first truly selective noradrenergic reuptake inhibitor (NRI) is [REBOXETINE], which lacks these undesirable binding properties....."Thus, [REBOXETINE] is the logical pharmacological complement to the SSRIs--since it provides selective *noradrenergic* reuptake inhibition greater than serotonin reuptake inhibition but without the undesirable binding properties of the tricyclic antidepressants. ....
p. 105
Early indications from the use of [REBOXETINE]
show that its efficacy is at least comparable to that of the tricyclic antidepressants and the SSRIs. In addition, [REBOXETINE] may specifically enhance social functioning, perhaps by converting apathetic responders into full remitters. Furthermore, [REBOXETINE] may be useful for severe depression, for depression unresponsive to other antidepressants, and as an adjunct to serotonergic antidepressants when dual neurotransmitter mechanisms are necessary to treat the most difficult cases."Squiggles
Posted by SLS on May 8, 2006, at 11:13:33
In reply to Statistical question on SSRIs, posted by Squiggles on May 8, 2006, at 8:21:32
Regarding reboxetine:
> > A few people have responded favorably to it, but it seems that many more have not.
> You probably have access to data on this.
I most certainly do not.
I doubt you will find any "data" other than that which is anecdotal. I believe you can get a better idea of the experiences of people who have posted here over the years by perusing the archives. That's about all I can offer you. Sorry.
I might suggest that not everything that looks good on paper as we feebly try to understand it translates into real world clinical outcomes. Reboxetine might be selective as we have come to define it, but that does not make it any more useful than desipramine. From what I have seen here on psychobabble, it seems to be less useful.
- Scott
Posted by Squiggles on May 8, 2006, at 12:41:32
In reply to Re: Statistical question on SSRIs, posted by SLS on May 8, 2006, at 11:13:33
> Regarding reboxetine:
>
> > > A few people have responded favorably to it, but it seems that many more have not.
>
> > You probably have access to data on this.
>
> I most certainly do not.
>
> I doubt you will find any "data" other than that which is anecdotal. I believe you can get a better idea of the experiences of people who have posted here over the years by perusing the archives. That's about all I can offer you. Sorry.
>
> I might suggest that not everything that looks good on paper as we feebly try to understand it translates into real world clinical outcomes. Reboxetine might be selective as we have come to define it, but that does not make it any more useful than desipramine. From what I have seen here on psychobabble, it seems to be less useful.
>
>
> - Scott
Yes, i am looking at the posts here - thank
you. I have always considered testimonials
to be a good source of feedback - given
that there are enough of them to get a
general picture. It is odd, that the
drug is no longer available though -- i wonder
where these people got it a few years ago,
and if it was pulled off the market for some
undisclosed reasons. Nobody here has any
horror stories about it.Squiggles
Posted by Squiggles on May 8, 2006, at 12:56:53
In reply to Statistical question on SSRIs » SLS, posted by Squiggles on May 8, 2006, at 12:41:32
I read the testimonials on Reboxetine,
going back to 2001; to me it does not
sound much better or different than the
woes that come with SSRIs - but everyone
starts at a different biological point.If I were to recommend it simply on the
testimonials here, I would say, don't
expect much more than the SSRIs.Thank you, and I am sorry I am posting so much.
Yikes.
Bye
Squiggles
Posted by SLS on May 9, 2006, at 8:55:04
In reply to Statistical question on SSRIs - Psychobabble says, posted by Squiggles on May 8, 2006, at 12:56:53
> Thank you, and I am sorry I am posting so much.
>
> Yikes.
I am sorry I am trying to help so much.I wouldn't recommend reboxetine to a family member based upon what I've read and what I've experienced. I guess that's a testimonial of sorts.
Having said that, I don't doubt that reboxetine acts like a miracle drug for a minority of people. I have nothing against its being made available to the whole world. It seems to be generally safe physiologically. As with other antidepressants, one would want to be aware of the possibility that reboxetine might make their depression worse.
If you are interested in trying reboxetine, you might try asking Ed_Uk what he thinks. Living in a country where reboxetine is available, perhaps he can describe what are his impressions of the drug. Also, you can call Pharmacia & Upjohn to see if they have abandoned reboxetine for sale in the US.
- Scott
Posted by Squiggles on May 9, 2006, at 9:01:56
In reply to Re: Statistical question on SSRIs - Reboxetine » Squiggles, posted by SLS on May 9, 2006, at 8:55:04
> > Thank you, and I am sorry I am posting so much.
> >
> > Yikes.
>
>
> I am sorry I am trying to help so much.
>
> I wouldn't recommend reboxetine to a family member based upon what I've read and what I've experienced. I guess that's a testimonial of sorts.
........
> If you are interested in trying reboxetine, you might try asking Ed_Uk what he thinks. Living in a country where reboxetine is available, perhaps he can describe what are his impressions of the drug. Also, you can call Pharmacia & Upjohn to see if they have abandoned reboxetine for sale in the US.
>
>
> - ScottThank you Scott. My search turned out a
merger or sell of Pharmacia & Upjohn to Pfizer -
which has an office in our city. I may call them.
The present drug (imipramine) i believe would
be the best choice, if only the added benzos were
reduced a tad and the imipramine increased a tad.
But, not being a doctor, it is my own personal
observations of the case against those of
the real doctor. I have confidence in my judgement, but others don't, obviously.Squiggles
Posted by bassman on May 9, 2006, at 9:02:49
In reply to Re: Statistical question on SSRIs - Reboxetine » Squiggles, posted by SLS on May 9, 2006, at 8:55:04
Upjohn became Upjohn/Pharmacia and is now Pfizer (who laid a whole bunch of people off). So call Pfizer.
Posted by SLS on May 9, 2006, at 9:17:00
In reply to Re: Statistical question on SSRIs - Reboxetine, posted by bassman on May 9, 2006, at 9:02:49
> Upjohn became Upjohn/Pharmacia and is now Pfizer (who laid a whole bunch of people off). So call Pfizer.
I apologize for the misinformation.
I can't believe how large this company has become. Where's Teddy Roosevelt when you really need him?
- Scott
Posted by Squiggles on May 9, 2006, at 9:21:37
In reply to Re: Statistical question on SSRIs - Reboxetine, posted by SLS on May 9, 2006, at 9:17:00
I think it's very promiscuous behaviour;
i don't understand the Teddy Roosevelt
reference.Squiggles
Posted by bassman on May 9, 2006, at 9:31:45
In reply to Re: Statistical question on SSRIs - Reboxetine, posted by SLS on May 9, 2006, at 9:17:00
My theory is that Pfizer, GSK, BMS, etc. will become just one huge pharmaceutical company, so no one will every have to say, "who makes drug A?" or "you work for a pharmaceutical company, which one?". Marx would have been soooo happy. :>}
Posted by SLS on May 9, 2006, at 9:41:21
In reply to Statistical question on SSRIs - Psychobabble says, posted by Squiggles on May 9, 2006, at 9:21:37
> I think it's very promiscuous behaviour;
> i don't understand the Teddy Roosevelt
> reference.
>
> SquigglesT.R. was a "trust-buster" and began to administer a policy of preventing and dismantling monopolies.
- Scott
Posted by Squiggles on May 9, 2006, at 9:50:25
In reply to Re: Statistical question on SSRIs - Reboxetine, posted by bassman on May 9, 2006, at 9:31:45
Politics and drugs are a lethal combination.
Infact, politics alone can be dangerous, when
taken on an empty brain.Squiggles
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