![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 119 to 143 of 143. Go back in thread:
Posted by Squiggles on May 21, 2006, at 6:45:11
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 20, 2006, at 23:27:39
> >Why would any chemist make an antidepressant
> >that interferes with the release of dopamine?
> >Isn't dopamine supposed to alleviate depression >and other negative emotions?
>
> This is it. Fast acting antidepressants generally work via affecting dopamine release.
>
> When you take an SSRI, you are stimulating a number of serotonin receptors that will indirecectly supress dopamine release (for a while at least untill some sort of compensatory adapation takes place)
>
> 5-ht1a, 5-ht2a/c, 5-ht1b, (and others) act as indibitory pathways on dopamine function.
>
> Sure SSRI's are selective to serotonin, but not to specific serotonin receptors, as a result the final product is often a wild free for all.
>
> In contrast however, consider some endogenious neuromodulators such as anandamide. Anandamide agonizes 5-ht1a but antagonizes 5-ht2, 5-ht3, and other. Very rarely in nature, will you find compounds that affect the system as bluntly as the SSRI's do. The result, like I said, is a free for all. Doctors often try to augment with atypicals, since they block some of the undesirable serotonin receptors.
>
>
>
> Linkadge
>
>There seems to be a vogue for "agonizing" (i guess that is stimulating) serotonin receptors, which a friend of mine tells me are all over the the brain and body and the most numerous. I guess they are a bit like endocrine glands on a neurological level. BTW, I see here that anandamine is what cannabis stimulates:
http://www.steve.gb.com/science/nervous_system.html
But as you probably know, that really gets you stoned.
Are there any drugs that stimulate the dopamine receptors; Or even drugs that stimulate or are a clone of dopamine for depression? L-dopa is used in Parkinson's disease, and one of its side effects is the same as the effect of an anti-depressant.
p.s. It's amazing how simple and different the action of lithium is in comparison to man-made ADs.
Squiggles
Posted by Squiggles on May 21, 2006, at 7:27:25
In reply to Re: Statistical question on SSRIs - ADDENDUM » linkadge, posted by Squiggles on May 21, 2006, at 6:45:11
p.s. It's amazing how simple and different the action of lithium is in comparison to man-made ADs.
>
>
> Squigglesoops, not so fast, and not so simple;
but lithium does feel simple and natural
in comparison to man-made drugs for some reason;
i suppose the same can be said for many others, e.g. cannabis, heroin, quinine, caffeine.http://bipolar.about.com/od/lithium/
Squiggles
Posted by linkadge on May 21, 2006, at 15:46:42
In reply to Re: Statistical question on SSRIs - ADDENDUM » linkadge, posted by Squiggles on May 21, 2006, at 6:45:11
Yeah, there are serotonin receptors in the stomach, and hence the initial nausia and GI problems that SSRI's can cause.
Anandamide is like the brains version of THC. Ie both bind to the cannabanoid CB1 receptors.
Linkadge
Posted by Larry Hoover on May 22, 2006, at 17:32:04
In reply to Re: I rescind the DNP, posted by Squiggles on May 19, 2006, at 15:54:49
> I just dropped by ASDM and saw your post
> to me. It was very clever of you to
> post it there and not here, as it would
> not have met the civility bounds here.Dr. Bob does not allow certain forms of communication. I clearly said that, in the opening sentence. Not clever. Attentive. I saved you from being blocked, Squig. You're welcome.
Lar
Posted by Larry Hoover on May 22, 2006, at 17:58:03
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 20, 2006, at 2:13:31
> >Anecdote. What is anecdote? It is an >uncontrolled experiment with one subject. What >have you got when you collect one thousand >anecdotes? One thousand different uncontrolled >experiments with one thousand different subject >populations. Anecdote is a point in space. How >do you extrapolate from one point?
>
> Hopefully anecdotal instances might persuade the initiation of a host of more systematic experimentation.Unfortunately, I'm not arguing against that.
> You compare the incidences of such events between both groups, and you discover what many such trials are indicating, that SSRI's statistically seem to increase the likelyhood of such feelings.
When a recent study was published, and posted here, you dismissed the evidence made available by it. Pre-treatment suicidality was substantially higher than post-treatment measures, in the study population.
http://ajp.psychiatryonline.org/cgi/content/full/163/1/41
If you only look at the immediate post-treatment period, then your a priori assumptions force the effect of treatment itself to be your new baseline for the observation period. However, if you compare pre-treatment to post-treatment, the suicidality is substantially reduced. You are blinded by your experimental protocol, link.
In other words, under the paradigm you envision, you are doing a within-groups comparison, but you don't realize it. They're all treated subjects, but you're thinking as if the placebo is not treated. That is not the case. Placebo is a treatment.
> Perhaps nobody actually kills themselves in such trials, but the information will lend merrit to many of the anecdotal reports.
If anybody did kill themselves, and it was part of your experimental hypothesis, then you would be forced to terminate the study. That's what I'm saying, link. You can't do the research you envision, on ethical grounds. You'd never get it past an ethics committee. And even if you did, the moment you collected any evidence, you'd have to shut it down.....before you had any statistically meaningful evidence.
> I think that part of the mannagment, is in coming to terms with the extent of the problem.We know the extent of the problem. It seems, though, as if you wish to extrapolate your experience to all people. The study I linked to, above, is clearly inconsistent with your thesis.
> There is still such a devide. Either they cause people to kill themselves, or they do no such thing.
I only wish *any* science was that clear cut. With people as subjects...??? Forget about it.
> Lets suppose that there is something really quite unique about the individuals who have such negitive reactions to SSRI's. Its like we've skipped back 40 some odd years, when MAOI's were not known to interact with tyramine. Sure, only some people were dying, and nobody knew exactly why. We still have yet to discover why people are reacting this way. It is still a drug problem, just like MAOI dietary interactions were a drug problem. It is my belief that we simply don't know the mechanism yet.
>
> LinkadgeDid we stop using MAOIs? No. Did we modify the drugs? No. Did we manage patients better, based on what we learned? Yes.
The MAOIs haven't changed one lick. We did. We manage them better. We have a medical management issue here, not a drug issue. The drugs are what they are. We either manage them in such a way that nobody gets hurt, or we don't. So far, we weren't doing very well. So far, we believed the marketing hype. Even wise doctors got hoodwinked. By our own human nature. We wish it was as easy as taking a happy pill. Oh, we wish.
Lar
Posted by Larry Hoover on May 22, 2006, at 18:03:15
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 20, 2006, at 2:21:35
> I have actually seen a few clinical trials in which *healthy vaulenteers* were given placebo, or active SSRI. It seemed that the SSRI's were actually producing things like acute apathy, acute akathesia, insomnia, agitation, and suicidal feelings, whereas placebo group experienced no such events.
I can give insulin to healthy volunteers and kill them with it, whereas the target population finds the "drug" to be a wondrous benefit. Perhaps what you are describing is the inappropriate use of the drugs, all the while. Perhaps, if these things happen, you're proving the person didn't need the drug.
Unfortunately, there is no way to know. Not that I can think of, and I've spent a lot of time trying to figure a way. I'd love to prove your hypothesis, one way or the other. I really would. SSRIs nearly killed me. Serzone was perhaps one day from taking out my liver. I really am on your side, link. I only wish we could answer the question. If the evidence was available, I would be thrilled to post it here.
> This is an important type of trial, since in studies such as this we cannot lean back to the old "well this population was depressed anyway".
>
> I have seen reports of psychiatrists self testing SSRI's and having similar findings.
>
> LinkadgeSo long as there is an alternative plausible explanation, then you have not proven your case. I believe I gave a very plausible alternative theory.
Lar
Posted by Larry Hoover on May 22, 2006, at 18:12:05
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 20, 2006, at 3:03:59
> "It is a class effect of pharmacological treatment of mood disorders. If you're going to treat depression with drugs, you get this effect."
I now realize I was actually thinking of antidepressant treatment. My apologies. Please allow for the rephrasing, to read "treatment of depression" rather than of mood disorders. My first sentence and second one were not well matched.
> Thats not true at all. Its called SSRI induced akathesia. Some drugs induce more akathesia. Some drugs have a higher likelihood of inducing such events. To try and package it all as one deal is foolish, and reeks of carelessness.
Suicidality is higher with tricyclics and MAOIs than with SSRIs, according to the BMJ data published earlier this year. Current, real-time data gives SSRIs a lesser, but similar effect. I did not mean to suggest identical.
> The shear body of evidence, for instance, indicates that lithium prevents suicides better than depakote does. That is statistically significant. It is not a "bipolars are going to blow off their heads anyway so it doesn't really matter much what we give them".
Fair enough.
> There are better treatments, and there are worse treatments.
>
> Some antidepressants made me suicidal, others did not. No, I don't know the exact mechanism, but I sure don't think that it was just coincidence. Just like citalopram gave me anorgasmia and remeron did not. Drug induced suicidality is not a general consequence of drug treatment of depression, and if it is currently, then it needent be. A drug should make you better, not worse.In fact it *is* a general consequence of antidepressant treatment, and it always has been the case. The data are consistent, through our historical experiences with the drugs.
I wish you were correct, but I believe that you are not.
> Opium never made a depressed suicidal insomniac want to jump off a bridge. If somebody is about to jump of a bridge, shoot them in the leg with a dart of MDMA. I'm shure they'd first step off the ledge, then they'd come give you a warm hug for saving their life.
Getting someone high is hardly a long-term solution to anything.
> It's called SSRI's are lousy. We simply need better antidepressants.
>
> Good antidepressants work.
>
> LinkadgeI feel your pain. I really think I know it well. I just can't find any evidence for true antidepressant efficacy or safety, anywhere. But they're better than the alternative, when averaged over the population. Some individuals will suffer excessively. I'm sorry that's the case for you.
I'm stopping now.
Lar
Posted by linkadge on May 23, 2006, at 17:14:17
In reply to Re: Statistical question on SSRIs - ADDENDUM » linkadge, posted by Larry Hoover on May 22, 2006, at 17:58:03
>When a recent study was published, and posted >here, you dismissed the evidence made available >by it. Pre-treatment suicidality was >substantially higher than post-treatment >measures, in the study population.
I dismissed nothing. Different studies say different things. You believe what you want to.
>If you only look at the immediate post->treatment period, then your a priori >assumptions force the effect of treatment >itself to be your new baseline for the >observation period. However, if you compare pre->treatment to post-treatment, the suicidality is >substantially reduced. You are blinded by your >experimental protocol, link.
Often in such studies, if a researcher has reason to believe that a treatment is indeed increasing suicidiality, then the treatment is withdrawn.
Many studies are simply ended if researchers believe that the active treatment is causing suicidialtiy. So, is that information taken into consideration? Probably not. In addition, I don't trust studies in general.
>In other words, under the paradigm you >envision, you are doing a within-groups >comparison, but you don't realize it. They're >all treated subjects, but you're thinking as if >the placebo is not treated. That is not the >case. Placebo is a treatment.Of course placebo is treatment. It is treatment without the burdon of side effects. This is why the placebo often produces a more robust clinical effect.
>If anybody did kill themselves, and it was part >of your experimental hypothesis, then you would >be forced to terminate the study. That's what >I'm saying, link.
No, thats what I am saying. Think of all the clinical trials that we don't know about. The trials which might support my hypothesis, but were ended because of the conclusions which were reached.
>You can't do the research you >envision, on >ethical grounds. You'd never get >it past an >ethics committee. And even if you >did, the >moment you collected any evidence, you'd have >to shut it down.....before you had any >statistically meaningful evidence.You seem to think that my opinion is going to be swayed in any way by my lack of conclusive "scientific" evidence. I never set out to try and convince anybody but myself.
There are plenty of bits and pieces of information which I piece together to come to my conclusions. Studies are just studies. They need to be taken with a grain of salt.
For instance. I saw a study intitled: "Wellbutrin has strong Antianxiety Properties", published in the journal of clinical psychiatry. Do I believe such a study? No, I think it is GSK trying to attack the one reason that their medication is not prescribed more, which is that it is precieved to increase anxiety. Straight from the boardroom: "Design us a study that shows Wellbutrin does not increase anxiety"
>We know the extent of the problem. It seems, >though, as if you wish to extrapolate your >experience to all people. The study I linked >to, above, is clearly inconsistent with your >thesis.
We do not know what the extent of the problem is. That is why we are asking ourselves (and currently creating the studies to test the hypothesis) whether or not the increased indicidence of SSRI induced suicidiality actually extends to adults.
>I only wish *any* science was that clear cut. >With people as subjects...??? Forget about it.I am not saying that the science is that clear cut. All I am saying is that it is a binary situation. Either the person was going to kill themselves anyway and the med had no effect. Or, the person was not going to kill themselves and the med pushed them over the edge. No, I realize nobody can know for sure, unless we had a time machiene. But it can still be considered a binary situation nonetheless.
>Did we stop using MAOIs? No. Did we modify the >drugs? No. Did we manage patients better, based >on what we learned? Yes.
Well, the rate of prescription of MAOI's is significantly less than what it would have been had the meds not had this problem. So in a sence, yes, we did stop using the drugs (though not entirely) based on our findings. Many doctors believe they are superior antidepressants, but they are shunned because of this side effect. Perhaps when newer antidepressants come out, doctors will say, "oh we don't like to use the SSRI's anymore cause they can make some people suicidal".
>The MAOIs haven't changed one lick. We did. We >manage them better. We have a medical >management issue here, not a drug issue. The >drugs are what they are. We either manage them >in such a way that nobody gets hurt, or we >don't.I wish it was that easy. If doctors believed that the potentially lethal side effects of the MAOI's could be completely mannaged, then the drugs would likely hold a larger portion of the market. But the fact remains, that even the best management cannot completely eliminate their risks. Its the same with SSRI's. There is absolutely no way that doctors can contain SSRI induced suicidialty. Perhaps it can be limited, or reduced. All the management in the world is not going to change the nature of the drug, or the nature of how people respond to it. We can't lock people up till they get over that "hump".
Linkadge
Posted by linkadge on May 23, 2006, at 17:30:33
In reply to Re: Statistical question on SSRIs - ADDENDUM » linkadge, posted by Larry Hoover on May 22, 2006, at 18:03:15
>I can give insulin to healthy volunteers and >kill them with it, whereas the target >population finds the "drug" to be a wondrous >benefit. Perhaps what you are describing is the >inappropriate use of the drugs, all the while. >Perhaps, if these things happen, you're proving >the person didn't need the drug.
Anyone, for whom the drugs are not fixing a genuine chemical imbalence, does not need the drugs. Thats a lot of people who are probably responding similarly to the "healthy vaulenteers".
In a fantasy world, it all fits together. You start with the assumption that the drugs are actually fixing something that is wrong with the depressed brain. Under those pretenses a whole host of false conclusions can be reached. Ie. the conclusion that the depressed brain is going to mystically respond completely differently to the drugs than healthy vaulenteers, which may or may not be true. You can predict almost every other side effect of SSRI's with healthy vaulenteers, from insomnia, to sexual side effects. Why does the line stop at suicidial ideation ?
We are wrong in thinking that one size fits all depressed people. Depression is a manifestation of perhaps dozens of different biochemical peterbations.>Unfortunately, there is no way to know. Not >that I can think of, and I've spent a lot of >time trying to figure a way. I'd love to prove >your hypothesis, one way or the other. I really >would. SSRIs nearly killed me. Serzone was >perhaps one day from taking out my liver. I >really am on your side, link. I only wish we >could answer the question. If the evidence was >available, I would be thrilled to post it here.
I agree its very up in the air. Heck, you might even find some doctor who would convince you that luvox is safe for you to try again, and that your reaction was a freak outburst of your clinical condition. But you know what you know. I'm certainly not asking you to explain to me why you decide not to take luvox again. You know whats best for you, and you don't really need the science to support you.
>So long as there is an alternative plausible >explanation, then you have not proven your >case. I believe I gave a very plausible >alternative theory.
But thats what I don't understand. I am not trying to proove anything. An evolutionist, for instance, can argue his points, but he cannot proove anything. If you are looking to be convinced, your talking to the wrong person.
Linkadge
Posted by Squiggles on May 23, 2006, at 18:05:14
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 23, 2006, at 17:30:33
I'm sorry i have been out of this conversation
for a while. I *do* have a life outside the
net, believe it or not;The last post I contributed to the discussion
was lengthy and in context, but for some reason
it got eaten up and never reappeared - maybe the
timing of my posting or the way I configured the
options.Anyway, to make it short.... I think I was
suggesting in that post that what would be
informative and of a valuable medical contribution would be to study the causes of suicide in that small minority sample, in comparison to the huge (4,000 people) who took Prozac and did not have tragic side effects. And I suggest this because it is possible to take a drug and have a range of side effects including the desired one -- a strong anti-depressant effect. But if you are not clinically depressed you may have another significant side-effect such as feeling energized or needing less sleep, etc.I think it has been said in the FDA study that the larger the sample for a drug tested, the more likely it is to get erroneous results missing the mark.
Squiggles
Posted by Larry Hoover on May 23, 2006, at 18:05:30
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 23, 2006, at 17:14:17
> >When a recent study was published, and posted >here, you dismissed the evidence made available >by it. Pre-treatment suicidality was >substantially higher than post-treatment >measures, in the study population.
>
> I dismissed nothing.http://www.dr-bob.org/babble/20060108/msgs/596581.html
It is the only study there is, so far, that looks at pre-treatment and post-treatment (by modern antidepressants) suicidality in the general population. Period. Full stop. All the rest of the data is from clinical trials, or anecdote/case reports.
From the referenced study:
"Before the current controversy, two meta-analyses of data from adult clinical trials found no difference between antidepressant drugs and placebo in risk of suicide during short-term treatment (11, 12). Ironically, those meta-analyses were motivated by ethical concerns about suicide risk in study subjects who were randomly assigned to receive placebo. Because clinical trials typically exclude those at high risk for suicide, some writers have questioned whether suicide risk in clinical trial populations underestimates true risk in those treated for depression."
This is the first, and so far, only study to attempt to answer the question of what happens to real people (not clinical trial subjects, who represent about 7% of the depressed population), in a scientific way. That is all I have ever been saying.
I disagree with your scientific arguments, not your hypothesis.
It is unethical to conduct the studies that you believe would prove your point.
Lar
Posted by Larry Hoover on May 23, 2006, at 18:42:45
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 23, 2006, at 17:14:17
> There are plenty of bits and pieces of information which I piece together to come to my conclusions. Studies are just studies. They need to be taken with a grain of salt.
Methinks its anecdote that needs the salt. SSRIs have lower suicidality than do tricyclics. Why aren't you looking there, too?
http://bmj.bmjjournals.com/cgi/content/full/330/7488/389
Healy, after really studying the situation, now lumps all antidepressants together (I concluded that before he did).
Int Rev Psychiatry. 2005 Jun;17(3):163-72.
Antidepressant drug use & the risk of suicide.Healy D, Aldred G.
North Wales Department of Psychological Medicine, Cardiff University, Hergest Unit, Bangor, Wales LL57 2PW, UK. healy_hergest@compuserve.com
There have been longstanding concerns about the propensity of antidepressants to precipitate suicidality in vulnerable individuals. To investigate this further, first we have analyzed all clinical trials, and in particular trials submitted to regulators for evidence on the relative risk of antidepressants versus placebo for this hazard. Second, we have compiled current epidemiological evidence germane to the issue. Third, we have constructed a model (Investigative Medication Routine; IMR) to shed light on the interactions between drug uptake, patient numbers on treatment and suicidal events. The clinical trial data gives rise to a relative risk of suicide on antidepressants over placebo of the order of a 2.0-2.5 times greater risk with treatment. These figures are supported by epidemiological findings. Investigative Medication Routine translates such findings into estimates of likely adverse outcomes, and explains why apparently increasing consumption of antidepressants would not be expected to lead to increased national suicide rates. From this data, we conclude that there is a clear signal that suicides and suicidal acts may be linked to antidepressant usage. It would seem likely that explicit warnings and monitoring in the early stages of treatment could greatly minimize these hazards.
If you can't be rigorous, at least describe your conclusions as being unscientific, or I shall. SSRIs are, if anything, a lesser risk than the older drugs they replaced.
It sucks majorly being the one upon whom the weight of exception falls. You and I are both such individuals. Blaming somebody or something for that is not going to fix anything. Warning others certainly might.
Healy:
"It would seem likely that explicit warnings and monitoring in the early stages of treatment could greatly minimize these hazards."Hear! Hear!
Lar
Posted by Larry Hoover on May 23, 2006, at 19:04:10
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by Larry Hoover on May 23, 2006, at 18:42:45
> If you can't be rigorous, at least describe your conclusions as being unscientific, or I shall.
The title of the thread. It's not personal. It's a scientific question.
Lar
Posted by linkadge on May 24, 2006, at 19:03:42
In reply to Re: Statistical question on SSRIs - ADDENDUM » linkadge, posted by Larry Hoover on May 23, 2006, at 18:05:30
I didn't dismis the study because I never said it was completely inacurate. I was simply implying that the study needs to evalutated under the correct pretenses.
>It is the only study there is, so far, that >looks at pre-treatment and post-treatment (by >modern antidepressants) suicidality in the >general population. Period. Full stop. All the >rest of the data is from clinical trials, or >anecdote/case reports.
I don't know what you are trying to say. Do you honestly think that this study is the one and only embodiment containing evidence on the subject of antidepressants and suicide? Like I said before, there are many ways to interprate the data.
>This is the first, and so far, only study to >attempt to answer the question of what happens >to real people (not clinical trial subjects, >who represent about 7% of the depressed >population), in a scientific way. That is all I >have ever been saying.
You can discover truths, and truths can exist outside the confines of a specific clinical trial. I never said we had the data (or that it was at all possible) to rigorously proove my conclusions. The highlights of the last decade of studies paints a perfectly clear picture to me, I am not suggesting that you must reach the same conclusion.
>I disagree with your scientific arguments, not >your hypothesis.
Thats the problem. You are not accepting my argument because it is not detailed according to your paramters. I on the other hand, have no desire, or need to proove my point in such a manner. I only intent to satisfy my self.
>It is unethical to conduct the studies that you >believe would prove your point.
Yet such studies are occuring as we speak.
Linkadge
Posted by linkadge on May 24, 2006, at 19:20:19
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by Larry Hoover on May 23, 2006, at 18:42:45
>SSRIs have lower suicidality than do >tricyclics. Why aren't you looking there, too?
What is your point? This is a very poor scientific region to even be using words such as "have". We are no longer at the peak of TCA sales, and I don't think that conclusive methodology can be used retrospectively.
Our focus becomes very tight, when under the spotlight. I don't think such a spotlight was ever cast on the TCA's at a time when more significiant evidence could have been gathered.>Healy, after really studying the situation, now >lumps all antidepressants together (I concluded >that before he did).
That would be a safe thing to do. Although, this again makes no sense. The only way such comparisons could be made is if various antidepressants were prescribed with equal frequency, which is not the case.
>If you can't be rigorous, at least describe >your conclusions as being unscientific, or I >shall. SSRIs are, if anything, a lesser risk >than the older drugs they replaced.
I will admit that my conlcusions have been reached without sufficiant conventional evidence. I will also contend that many other conclusions are base upon insufficiant conventional evidence.
>It sucks majorly being the one upon whom the >weight of exception falls. You and I are both >such individuals. Blaming somebody or something >for that is not going to fix anything. Warning >others certainly might.
Contrary to popular belief, I have reached my conclusion based on evidence slightly outside of the boundary of my own experience with these drugs.
>Healy:
>"It would seem likely that explicit warnings >and monitoring in the early stages of treatment >could greatly minimize these hazards."Likely hmm. Well thats one opinion. I suppose even Healy has reason to try and pick up the pieces and reconstruct some foundation. I suppose the drugs would be of higher salvaging value had they demonstrated more efficacy.
Linkadge
Posted by linkadge on May 24, 2006, at 19:21:32
In reply to Link, here's why I'm so focussed on the science, posted by Larry Hoover on May 23, 2006, at 19:04:10
If only the content of a thread was to be strictly confined by the heading.
Linkadge
Posted by Larry Hoover on May 24, 2006, at 19:50:58
In reply to Re: Link, here's why I'm so focussed on the science » Larry Hoover, posted by linkadge on May 24, 2006, at 19:21:32
> If only the content of a thread was to be strictly confined by the heading.
>
> LinkadgeShe asked about statistical data. That's why I focussed the way *I* did. This wasn't contributed to, in a similar way, by both of us.
I reiterate, though. All antidepressants induce suicide. Always have. That's my point. (You asked what was my point.)
Lar
Posted by SLS on May 25, 2006, at 6:59:48
In reply to Re: Link, here's why I'm so focussed on the science » linkadge, posted by Larry Hoover on May 24, 2006, at 19:50:58
Perhaps some inpatient studies can be performed prospectively that include daily ratings. Two ratings would be employed; a clinical rating by the observer and a self-rating by the patient. I think a global impression by a trained observer would include ratings of vegetative symptoms that can be associated with the severity of depression. It would be possible that a clinical observer could note a global improvement in a patient's depression at the same time a patient reports an increase in suicidal ideation. This would demonstrate the scenario in which one becomes suicidal as the result of a drug-induced improvement. Likewise, a drug-induced exacerbation would be evident if both observer and patient ratings demonstrate a worsening of depression and an increase in suicidal ideation.
Just an idea.
- Scott
Posted by Larry Hoover on May 25, 2006, at 7:22:00
In reply to Re: Link, here's why I'm so focussed on the scienc, posted by SLS on May 25, 2006, at 6:59:48
> Perhaps some inpatient studies can be performed prospectively that include daily ratings.... Likewise, a drug-induced exacerbation would be evident if both observer and patient ratings demonstrate a worsening of depression and an increase in suicidal ideation.
>
> Just an idea.
>
>
> - ScottI'm uncertain as to the point of doing that sort of research, the more I think about it. I don't think any sensible person would question the existence of that early-treatment risk. That it hasn't been proven to a statistical certainty (the initial question in this thread was phrased that way) is of no ultimate utility. Unless you're trying to build a lawsuit or something.
I have only the sincerest sympathy for any family affected by suicide, no matter how it came to be that way. When my use of the word "care" came into question earlier, I meant it to mean every possible element of medical intervention. Not just drugs. Talking. Informing. Monitoring. Questioning. Answering. Referring. Empathy. Insight. And so on.
Lar
Posted by SLS on May 25, 2006, at 8:57:43
In reply to Re: Link, here's why I'm so focussed on the scienc » SLS, posted by Larry Hoover on May 25, 2006, at 7:22:00
> > Perhaps some inpatient studies can be performed prospectively that include daily ratings.... Likewise, a drug-induced exacerbation would be evident if both observer and patient ratings demonstrate a worsening of depression and an increase in suicidal ideation.
> I'm uncertain as to the point of doing that sort of research, the more I think about it.
Actually, I was thinking that this might be a good way to conduct studies in general.
- Scott
Posted by linkadge on May 25, 2006, at 17:50:24
In reply to Re: Link, here's why I'm so focussed on the science » linkadge, posted by Larry Hoover on May 24, 2006, at 19:50:58
I was under the impression that I was allowed to offer my coments, even if they didn't strictly fall in the category of the subject title.
>I reiterate, though. All antidepressants induce >suicide. Always have. That's my point. (You >asked what was my point.)Perhaps, but not to equal degrees.
Placebo's are often better antidepressants than the active drugs, and a lot of current research is showing that they do not induce suicidiality at the same rate as the active drugs. So, if you are trying to suggest that suicidiality is an effect of "treatment", I think that is incorrect.
Linkadge
Posted by linkadge on May 25, 2006, at 18:05:30
In reply to Re: Link, here's why I'm so focussed on the science, posted by linkadge on May 25, 2006, at 17:50:24
>Actually, I was thinking that this might be a >good way to conduct studies in general.
This is it. You needn't design studies to specifically test for suicidiality. It could be something that is simply tacked on to the current design of clinical trials like I think SLS was referring to.
When people's lives are at stake, I don't see how that kind of avenue would be considered at all irrelivant. After all, the more you can learn about why it is happening, the more that can be done to prevent it.
I don't think that suicidialty is inherent with the treatment of depression in general. I don't think that you need to be suicidal in order to get better. That doesn't make any sense to me. Especially, since some of the people who experience suicidiality on SSRI's were never suicidal before treatment.
Thats like saying, the only way to treat high blood pressure, is with pills that will make your BP skyrocket for the first few months.
I think we need better medications.
I also think that we need better research into the mechanisms. Maybe its just one receptor. Maybe the drugs are hitting the "I need to kill myself" receptor. We need to know what flicks the switch.
Linkadge
Posted by Larry Hoover on May 26, 2006, at 7:58:57
In reply to Re: Link, here's why I'm so focussed on the science, posted by linkadge on May 25, 2006, at 17:50:24
> I was under the impression that I was allowed to offer my coments, even if they didn't strictly fall in the category of the subject title.
Of course. I wanted you to understand that my impersonal approach was not about you. I was taking the question literally.
I find that the exercise of that sort of argument, stripping bare all opinion, can be amazingly revealing. How little we know. About anything. And how much of what we believe is opinion. The more I know, the less I know. Ya know?
So far, in all of science, there is only one study that even tries to answer your question (as I understand your question to be), the one I linked to. All the rest is opinion (anything arising from anecdote is opinion).
Real people, using antidepressant drugs, self-selected their need for care. And the results for that population were graphed. Significance testing was done.
I only know of that one study. All else is opinion. Healy was a champion, for a while. Not so much, anymore. His opinion is more informed, now. That's how I see it.
I truly regret bringing you discomfort, in this dialogue.
Lar
Posted by linkadge on May 26, 2006, at 16:50:09
In reply to Re: Link, here's why I'm so focussed on the science » linkadge, posted by Larry Hoover on May 26, 2006, at 7:58:57
Ok, so that study was the first to try and "directly" answer the question.
Linkadge
Posted by Larry Hoover on May 27, 2006, at 7:24:48
In reply to Re: Link, here's why I'm so focussed on the science, posted by linkadge on May 26, 2006, at 16:50:09
> Ok, so that study was the first to try and "directly" answer the question.
>
> LinkadgeAs far as I know, yes. I'm sure there will be more. But, unfortunately, there is this thing called publishing bias. I hope the editors loosen the reins a bit, and get more studies into print, even if they don't necessarily cover truly novel territory.
Lar
This is the end of the thread.
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