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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by waterlily on July 14, 2002, at 17:33:39
Go over to MSN.com, click on the left where it says "Antidepressants - better than dummy pills?". The story basically says that there is a new study out that shows that placebo pills are 80% as effective as antidepressant medications. Also Roger P. Greenberg, PhD is quoted as saying "Biochemical imbalance is a handy catch phrase, but there is not alot of evidence there is such a thing.". I am not well versed in the biochemical processes involved in depression, so I can't dispute the findings myself. I know some of you guys are very knowledgeable about these things, so shoot away! What I do know is that regular exercise did absolutely nothing for my depression and that even with careful tapering of medication, I still get depressed below a certain dose. Therapy has done some good for me, but has not been near as effective as antidepressants.
Posted by JonW on July 14, 2002, at 19:16:44
In reply to Someone please shoot some holes in this story..., posted by waterlily on July 14, 2002, at 17:33:39
I know the Newsweek article quotes a doctor who makes a good point. He says that the patients with mild depression who typically participate in clinical trials can exaggerate their response to placebo while in his experience severely depressed patients don't do nearly as well on placebo. He believes that drugs are more effective in the real world where they are used to treat a variety of depressions over a long period of time.
Jon
Posted by katekite on July 14, 2002, at 21:28:22
In reply to Someone please shoot some holes in this story..., posted by waterlily on July 14, 2002, at 17:33:39
Well, from experience, I'd have to say the majority of antidepressants I've taken were no better than placebo, LOL. I'm just unlucky that way.
But the one encouraging thing I have to say is that most drug vs placebo studies are short. People are always having their depression come and go in severity, leading to a high placebo rate in depression drug studies. I would guess that placebo response is not long lasting... ie if the studies went for more than a few months the effect of the active antidepressant could be sustained and the placebo response rate would drop markedly.
Posted by Ritch on July 15, 2002, at 10:03:14
In reply to Someone please shoot some holes in this story..., posted by waterlily on July 14, 2002, at 17:33:39
> Go over to MSN.com, click on the left where it says "Antidepressants - better than dummy pills?". The story basically says that there is a new study out that shows that placebo pills are 80% as effective as antidepressant medications. Also Roger P. Greenberg, PhD is quoted as saying "Biochemical imbalance is a handy catch phrase, but there is not alot of evidence there is such a thing.". I am not well versed in the biochemical processes involved in depression, so I can't dispute the findings myself. I know some of you guys are very knowledgeable about these things, so shoot away! What I do know is that regular exercise did absolutely nothing for my depression and that even with careful tapering of medication, I still get depressed below a certain dose. Therapy has done some good for me, but has not been near as effective as antidepressants.
Hi WaterLily,
I read that the other day. Towards the end of the article the PhD psychologist who set up the trial "admits that the design of the experiment could have skewed the results". Well, that pretty much says it all. The really bad thing is that story will get passed around 2nd, 3rd hand, and it will become "fact" to antimed folks. There is something else I have noticed-most of the "antimed" folks don't have the power to prescribe meds. They seem to be politicians, ministers, or psychologist/therapists. Medications may generally be overused(due to TV advertising?), and people may be over-discounting the benefits of therapy/faith, etc., but just because we lack a truly decent bio-chemical model to explain depression, doesn't mean it doesn't exist. The really scary thing I think is the ability to manipulate a clinical trial to support your own assertions. That goes both ways. I don't want to take more medications than I really need.
Mitch
Posted by cybercafe on July 16, 2002, at 3:29:54
In reply to Re: Someone please shoot some holes in this story... » waterlily, posted by Ritch on July 15, 2002, at 10:03:14
yes i am a cynical bastard now :)do you ever walk up to someone who claims they had heart surgery and say
"No you didn't! You look fine to me. I can't see anything wrong with you. I don't have a heart condition so why should YOU? I think some people just worry about nothing"if this sounds bad, think about how bad it is when it's done to someone who is suffering emotionally and needs support
disclaimer: always pull out the half-joking smile, or you're just not being a nice fellow ;)
Posted by Ritch on July 16, 2002, at 10:08:50
In reply to Re: Someone please shoot some holes in this story..., posted by cybercafe on July 16, 2002, at 3:29:54
>
> yes i am a cynical bastard now :)
>
> do you ever walk up to someone who claims they had heart surgery and say
> "No you didn't! You look fine to me. I can't see anything wrong with you. I don't have a heart condition so why should YOU? I think some people just worry about nothing"
>
> if this sounds bad, think about how bad it is when it's done to someone who is suffering emotionally and needs support
>
> disclaimer: always pull out the half-joking smile, or you're just not being a nice fellow ;)Cyber,
I think medications *are* working at least half-ass for *most* people that need them for affective disorders. If it wasn't for Prozac and lithium 10 years ago I might not be paying taxes and using Medicaid instead ..or perhaps not alive at all. A lot of "antimed" people see folks on several expensive drugs and complaining about side-effects (like I and others do here), and it seems like we don't even need them at all----that is the paradox. If you improve enough on them you don't seem that ill at all! You don't seem ill---so you probably didn't need meds. Many people just don't quite get the banana: The meds are allowing me to function well enough to contribute to the economy and to pay taxes that can be used to help others who can't.
Mitch
Posted by Squiggles on July 16, 2002, at 16:44:58
In reply to Re: Someone please shoot some holes in this story... » cybercafe, posted by Ritch on July 16, 2002, at 10:08:50
Just passing through and saw this;
I think the problem is "prophylaxis" -
that concept allows docs to give drugs
idefinitely for a presumed indefinite
psychiatric disorder. The consequence
of that, is that there is no empirical
test by which to determine whether you
initially had the disorder or not.Furthermore, discontinuation after many yrs
of drug taking can be lethal.I think we have a mess.
Squiggles
Posted by Ritch on July 16, 2002, at 22:54:06
In reply to Re: Someone please shoot some holes in this story..., posted by Squiggles on July 16, 2002, at 16:44:58
> Just passing through and saw this;
> I think the problem is "prophylaxis" -
> that concept allows docs to give drugs
> idefinitely for a presumed indefinite
> psychiatric disorder. The consequence
> of that, is that there is no empirical
> test by which to determine whether you
> initially had the disorder or not.
>
> Furthermore, discontinuation after many yrs
> of drug taking can be lethal.
>
> I think we have a mess.
>
> Squiggles
Yes, I agree wholeheartedly-if the diagnosis is in any state of *dispute*. It would be a tragedy to be misdiagnosed from the get-go and have that anchor around your neck for many years needlessly. I would agree however.. that if you are *correctly* diagnosed (bipolar, i.e.), from the get-go, that you ARE dealing with an "indefinite psychiatric disorder". I am bipolar and have went off antimanic agents (and all meds) in the past and gotten all sorts of horrid results. The scary thing is obviously-what if you get misdiagnosed as bipolar (i.e.) frm the getgo and are given antimanic agents that you don't really need. However, they *do* calm you down and seem to address other symptoms (partially or indirectly), and so that tends to *confirm* the diagnosis. You truly would have a MESS, because that person would need to get off meds and be re-evaluated by a 2nd or 3rd pdoc to accurately determine the correct diagnosis. WHAT IF that person gets terminated at their place of employment based on psychiatric drug usage, which is BASED ON a misdiagnosis.. The plot thickens further.Mitch
Posted by Xevious on July 16, 2002, at 23:47:05
In reply to Re: Someone please shoot some holes in this story... » Squiggles, posted by Ritch on July 16, 2002, at 22:54:06
A while back, I read an article (I'm still searching for it; I'll post details if I find it) that reported research findings from SPECT scans showing the before/after serotonin systems of the brains of depressed patients. (SPECT imagery provides the most precise snapshot of a brain's neurochemical condition of any scanning technology available at the moment, and can in fact empirically determine to a large extent many psychiatric disorders, including depression.)
The results were surprising; patients given an antidepressant (can't remember which one) showed a marked change in brain chemistry after three weeks. Those given a placebo ALSO showed marked changes in brain chemistry, but appeared to have compensated not by inhibiting reuptake but by manufacturing more serotonin. The third group (control) was given an informational brochure on depression and showed little change in brain chemistry.
A similar study was conducted on the effectiveness of psychotherapy vs. antidepressant, and found that psychotherapy also has an effect on a patient's neurochemistry. The brain is a strange beast, indeed.
Posted by Squiggles on July 17, 2002, at 8:49:03
In reply to Re: Someone please shoot some holes in this story... » Squiggles, posted by Ritch on July 16, 2002, at 22:54:06
Hi Mitch,
Two interesting points:
1. Misdiagnosing and therefore mistreating
a mental illness on a chronic basis, can present
problems.2. Treating a chronic mental illness with
the wrong drugs can also present problems;Granted to both;
My point is different: that prophylaxis assumes
that the illness is chronic. You say that getting
off presented with bad symptoms; I am not sure
if that is a result of the withdrawal or the illness
coming back.I recall reading in Kraeplin that mania aNd
depression can have cycles that span from 7 to 11
years. I can understand that from an economic
and risk-benefit medical view prophylaxix may
be more efficacious - but I can't say that it
is correct.Squiggles
Posted by Ritch on July 17, 2002, at 10:35:20
In reply to Re: Someone please shoot some holes in this story..., posted by Squiggles on July 17, 2002, at 8:49:03
> Hi Mitch,
>
> Two interesting points:
>
> 1. Misdiagnosing and therefore mistreating
> a mental illness on a chronic basis, can present
> problems.
>
> 2. Treating a chronic mental illness with
> the wrong drugs can also present problems;
>
> Granted to both;
>
> My point is different: that prophylaxis assumes
> that the illness is chronic. You say that getting
> off presented with bad symptoms; I am not sure
> if that is a result of the withdrawal or the illness
> coming back.
>
> I recall reading in Kraeplin that mania aNd
> depression can have cycles that span from 7 to 11
> years. I can understand that from an economic
> and risk-benefit medical view prophylaxix may
> be more efficacious - but I can't say that it
> is correct.
>
> Squiggles
Squiggles,Thanks for clarifying that. I was off meds for about three years. But, I have two (and at times three) sets of cycles going at the same time. I have got a seasonal pattern that causes 4 major mood flips during any given year. Then there is a three week cycle (a few days mild hypo-a few days depressed, a few days OK). And during the most intense part of the seasonal bipolar depressions I develop a daytime cycle where I am alert and feel ok in the morning and then in the evening I get simultaneously agitated and very fatigued (kind of a mixed thing). So, in conclusion (in my own personal case), I might as well be taking meds all of the time (and they help).
But, to address the prophylaxis issue... I also agree that if you aren't experiencing any mania for a reasonable duration of time-what's the point in taking antimanic agents for prophylaxis? I assume you are disputing the "kindling" theory? I don't firmly disbelieve it, but I wouldn't be surprised if that changes or is significantly modified in the coming years. I knew someone who went for quite some time without developing mania and he *did* stop his lithium for months at a time, and then would resume it when he started showing signs of mania, and it controlled them OK. They would just push the dose up aggressively when they kicked in. He didn't take any antidepressants.
Mitch
Posted by Squiggles on July 17, 2002, at 13:10:02
In reply to Re: Someone please shoot some holes in this story... » Squiggles, posted by Ritch on July 17, 2002, at 10:35:20
Hi Mitch,
I appreciate your description of the cycles;
in your case definitely you would need ongoing
treatment - perhpas one never knows exactly
how fast the cycles will be, how frequent, and
to what extreme - I would have thought they
would study this kind of thing;When I first got symptoms (if they were not
withdrawal symptoms from valium as some critics
have tried to suggest), i got very rapid swings
in depression and euphoria - it was very strange -
it was like your waltenschuung changed every
minute with associated affect - very strange;Anyway, of course you should take it in
your case and not stop, though this is all
in forecast not restrospect, if you know what I
mean.About prophylaxis, well it's safer i guess.
The point you make which I find fascinating
is the "kindling theory" of Papolos - i have
read about it and it would seem to suggest
that the brain actually progresses to a worse
and worse state if you have bipolar... that is,
the longer you leave the bipolar brain untreated
the higher the dose of the drug to treat it is
necessary.Is that correct?
Squiggles
Posted by Ritch on July 17, 2002, at 13:51:38
In reply to Re: Someone please shoot some holes in this story..., posted by Squiggles on July 17, 2002, at 13:10:02
> About prophylaxis, well it's safer i guess.
> The point you make which I find fascinating
> is the "kindling theory" of Papolos - i have
> read about it and it would seem to suggest
> that the brain actually progresses to a worse
> and worse state if you have bipolar... that is,
> the longer you leave the bipolar brain untreated
> the higher the dose of the drug to treat it is
> necessary.
>
> Is that correct?
>
> Squiggles
I don't think it is so much the dosage of antimanic agent required for future episodes that pdocs are worried about. The kindling theory postulates that untreated bipolar leads to more frequent and more intense episodes which by definition would require more medication to treat due to the increased severity of the subsequent episodes. There is also a concern about subsequent effectiveness of any given antimanic agent used in the future which has been stopped and started. There is evidence that stopping and starting lithium seems to reduce its future effectiveness. That may be true, but it also could just be one study's (which may not have been designed properly enough) conclusions that get passed around and around until it becomes "conventional wisdom" (and isn't rethought out, just taken for granted as true). In my own personal experience I rapid cycle, but my cycle lengths haven't changed much in 25 years despite being on and then off different medications. But then my "flavor" of bipolar may be one that doesn't involve kindling OR since I seem to need medication all of the time anyways, I am actually preventing the worsened cycling, etc., that the kindling model predicts.Mitch
Posted by Squiggles on July 17, 2002, at 14:21:38
In reply to Re: Someone please shoot some holes in this story... » Squiggles, posted by Ritch on July 17, 2002, at 13:51:38
Mitch,
Before I comment on other points of
your message, here is the 60 million
dollar question:What does "kindling" feel like? Have
they observed/reported it?Squiggles
tx
Posted by Ritch on July 18, 2002, at 0:00:30
In reply to Re: Someone please shoot some holes in this story..., posted by Squiggles on July 17, 2002, at 14:21:38
> Mitch,
>
> Before I comment on other points of
> your message, here is the 60 million
> dollar question:
>
> What does "kindling" feel like? Have
> they observed/reported it?
>
> Squiggles
>
> tx
Hi,Shopping is a feeling, not kindling. (Talking Heads) :)
The word "kindling" suggests the idea of "future fire". If you don't have anything left to start a fire with.. the future fire will not happen. That really is the core of the whole concept. In other words, if you get manic and don't continue prophylaxis antimanic treatment after the initial episode subsides, you will leave "coals" behind that are ready to start the next future fire, OR you will fail to "put out" the coals leftover from the initial manic episode which will linger about to "reignite" a future episode sooner and more furiously than it otherwise would happen. That's what it is in a nutshell.
The question of what "kindling" *feels* like would be nonsensical because it is a theory that is spread out over a long time frame. Short term subjective aspects of "feeling" wouldn't span the timeframe involved and would be irrelevant to the question, unfortunately.
Mitch
Posted by missliz on July 18, 2002, at 0:35:16
In reply to Re: Someone please shoot some holes in this story... » Squiggles, posted by Ritch on July 17, 2002, at 13:51:38
The world is full of mean , small minded people with axes to grind, and psych patients are convenient targets. I didn't look at the article, but what was this guys PhD in? Psychologists are notoriously anti med, because the success of drug treatments threatens their livelihoods and status. ( No, not all psychologists, but I've come across some mean petty ones).
Also, you all may not remember this, but the Church of Scientology periodicly goes on an anti psychiatry campaign by using shills who put out crap like this. The press will publish almost anything, remember the big stink over Prozac supposedly made people murderously violent back around 1990? Scientology PR campaign. Don't beleive everything you read in the news. It may just be a press release from god knows who with a crackpot agenda.
I know I need my meds to function, you know you need your meds, so beleive in your own reality. We're no different than diabetics, just maybe more interesting ;) and If you substitute the word insulin for anti-depressent you'll see how ridiculous the article is.
Posted by Squiggles on July 18, 2002, at 7:44:15
In reply to Waterlilly, there are crackpots loose all over..., posted by missliz on July 18, 2002, at 0:35:16
Sorry, what article are you referring to?
I, myself am a great proponent of lithium;
to tell you the truth this pharm. shill versus
Scientology, versus legitimate critics of
treatment has my head spinning.I think i need therapy just for that - it is
very confusing, and i can never tell anymore
who is up front and who is not.Squiggles
Posted by Squiggles on July 18, 2002, at 9:03:10
In reply to Re: Someone please shoot some holes in this story... » Squiggles, posted by Ritch on July 18, 2002, at 0:00:30
Right,
so it's a metaphor -- for "if you don't
take your drugs and leave your brain to
go simmering in an undercurrent of smolder,
it will be worse the next time;- the same thing can happen with withdrawal
conditions, worsening of a disease, and
an introduction of a new disease, or just
the disease returning with stronger force,
though not necessarily so;- thanks for the explanation - i mistook it
for actually having detectable symptoms -
but it is a theory not an observation as far
as i know.Squiggles
Posted by Squiggles on July 18, 2002, at 10:51:46
In reply to Someone please shoot some holes in this story..., posted by waterlily on July 14, 2002, at 17:33:39
OK - yes, i have seen that claim - there
is something to be said about placebos -
but not much - first of all they do not last
1/1000th the amount of time as ADs do and
the kind of brainwashing required to make
them work could only be found in Korean torture
camps during WWII;- it is a desperate claim and one wonders
why it is made -Squiggles
Posted by oracle on July 19, 2002, at 0:47:57
In reply to Re: Someone please shoot some holes in this story..., posted by Xevious on July 16, 2002, at 23:47:05
(SPECT imagery provides the most precise snapshot of a brain's neurochemical condition of any scanning technology available at the moment,
and can in fact empirically determine to a large extent many psychiatric disorders, including depression.)
Sorry, but SPECT is from the 60's and measures blood flow with radiotracers.
There are some radiotracers that can be used to
study receptors, but these radiotracers, have not yet reached the stage of
routine clinical practice, as a consensus on measuring receptor binding using
single-photon tracers has not yet been reached nor have diagnostic clinical
strategies been identified.We are years away from looking at scans and using this to decide what meds to
use as a primary means of Dx and treatment.
We also need a proven biochemical model for
a mental illness before scans become
major tools.
This is the end of the thread.
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