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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 50 to 74 of 74. Go back in thread:
Posted by FredPotter on February 19, 2007, at 22:23:50
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by Squiggles on February 19, 2007, at 6:26:19
It says in New Scientist that antidepressant treatment is "only about 80% effective". As if...
Posted by Squiggles on February 20, 2007, at 7:18:59
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by FredPotter on February 19, 2007, at 22:23:50
I was having a discussion with a friend
yesterday. He does not take antidepressants
but does take medication for cardiovascular
disease. Like psychiatric patients though,
he is constantly complaining about the side
effects and the many things he used to be
able to do and cannot anymore.And it occurred to me, that many people
who have been stabilized on anti-depressants
and hate the side effects, as much or more than
their families, their employers, and friends do,
*actually* expect to be better than well.But when you look at the hospital situations
50, 60, 100 and more years ago, you realize
that such people rarely lived a life outside
the confines of an asylum or cloister or some
sort, and had very seriously debilitating treatments.So, i asked myself, if possibly we are not
expecting too much. If possibly, our culture
has excluded the possibility of toleration for the sick and the effects of their medication. For example, if you gain weight, or get sleepy, or develop diabetes, or whatever from drugs that you MUST take, you and your doctor will be hounded into the 7th circle of medical hell.So, I say, chill, until something better comes up. If the drugs made you feel perfect, it is unlikely that there would be so much activism, and wars against the drugs. (That doesn't mean that corruption and stupidity are not with us in the drug corps. and medical field)-- those diseases are with us forever.
Squiggles
Posted by linkadge on February 20, 2007, at 7:36:51
In reply to Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:18:59
We are a very comercial society. We expect to get our money's worth so to speak.
The drug companies have only fed the underlying misconception that happiness can be bought in pill form.
As human beings we also tend to become acoustomed to whatever we have and to want more.
If you look apart from mild and moderate depression however, I think there is still a trend for higher response in severe depression with the TCA's and MAOI's.
The SSRI's were sucessfull in that they were the first antidepressant that could be dispersed like dandilion spores to the general public.
Kind of like the Ford-T model of antidepressnats.
Linkadge
Posted by Squiggles on February 20, 2007, at 7:56:12
In reply to Re: Are we culturally primed to expect too much? » Squiggles, posted by linkadge on February 20, 2007, at 7:36:51
> The SSRI's were sucessfull in that they were the first antidepressant that could be dispersed like dandilion spores to the general public.
>
> Kind of like the Ford-T model of antidepressnats.
>
>
> Linkadge
>Are you suggesting that the SSRIs are weaker
ADs- with less side effects?Squiggles
>
Posted by Larry Hoover on February 20, 2007, at 8:01:53
In reply to Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:18:59
Simple answer. Yes.
People want to go on doing the same things they've always done, and thinking the same thoughts they've always thought, and expecting novel outcomes. Pills aren't going to have the effects some people expect of them.
That doesn't mean there is a behaviour or a thought or a collection of behaviours and thoughts that will make a difference, but you still have to look.
Lar
Posted by Quintal on February 20, 2007, at 8:49:34
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:56:12
>Are you suggesting that the SSRIs are weaker
>ADs- with less side effects?Many people (myself included) find the SSRIs are weaker antidepressants with *more* side effects.
Q
Posted by linkadge on February 20, 2007, at 9:34:37
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 7:56:12
>Are you suggesting that the SSRIs are weaker
>ADs- with less side effects?Thats exactly what I am suggesting :)
Linkadge
Posted by bulldog2 on February 20, 2007, at 9:37:47
In reply to Re: Are we culturally primed to expect too much?, posted by Quintal on February 20, 2007, at 8:49:34
There are a couple reasons that the ssris appeal to doctors. They don't have to worry about lethal overdose as with tcas. They don't have to worry about hypertensive crisis as they do with maois. Also there's the convenient once a day dosing with ssris. So the ssris are much easier to manage and less to worry in the near term for the physician. The reality is we don't know the long term effects of chronic elevation of just serotonin. The sexual sides which we know are very prevalent were never brought out in early studies of ssris.
Posted by linkadge on February 20, 2007, at 9:43:39
In reply to Re: Are we culturally primed to expect too much?, posted by linkadge on February 20, 2007, at 9:34:37
The TCA's I tried were definately more effective. The side effects were tollerable it was just that I couldn't get my mind past the possable consequences of their toxicity, ie cardiac and otherwise.
Linkadge
Posted by laima on February 20, 2007, at 9:48:46
In reply to Re: Are we culturally primed to expect too much?, posted by bulldog2 on February 20, 2007, at 9:37:47
Tricky question, do we expect to much from medications. Perhaps, sometimes? Not always. Depends what one asks. Feeling like a euphoric million bucks every single day isn't realistic or normal, but depression isn't normal either. A normal life will have ups and downs. I really like my own doctor's philosophy, because it seems balanced and realistic: "medications are a powerful and valuable tool- when they work, don't squander the opportunity, or expect them to make up for terrible lifestyle choices. Examine your sleeping, eating, and other habits. Look at stress. Watch the alcohol, get exercise, be sure to have some fun". etc.
Posted by Quintal on February 20, 2007, at 9:49:24
In reply to Re: Are we culturally primed to expect too much?, posted by bulldog2 on February 20, 2007, at 9:37:47
>The sexual sides which we know are very prevalent were never brought out in early studies of ssris.
That's what I mean about SSRIs actually having more disruptive side effects. It's not only the sexual numbing that causes problems in relationships (as well as being frustrating and annoying), it's the emotional numbing too. All of these side effects lead to me discontinuing SSRIs, while Parnate not only lacked them, it seemed to enhance my enjoyment of life.
I worry that the idea that MAOIs have more severe side effects would lead some people to think they necessarily wouldn't be able to tolerate MAOIs because they can't tolerate the 'weaker' SSRIs. Not true.
Q
Posted by laima on February 20, 2007, at 10:18:58
In reply to Re: Are we culturally primed to expect too much?, posted by Quintal on February 20, 2007, at 9:49:24
Yes- you know I read an article several years ago about how long-term users of ssris were having difficulty with emotional aspects of relationships/forging bonds. It was so long ago though, that I have no clue where I read this. Does anyone remember any such article?> That's what I mean about SSRIs actually having more disruptive side effects. It's not only the sexual numbing that causes problems in relationships (as well as being frustrating and annoying), it's the emotional numbing too.
Posted by bulldog2 on February 20, 2007, at 12:03:28
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by FredPotter on February 19, 2007, at 22:23:50
Here's another link about the theory of serotonin and depression.
http://medicine.plosjournals.org/archive/1549-1676/2/12/pdf/10.1371_journal.pmed.0020392-S.pdf
Posted by Brutus1 on February 20, 2007, at 14:24:17
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by bulldog2 on February 20, 2007, at 12:03:28
So where does an atypical SSRI fit in this discussion?
"In a study comparing the effects of fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine on extracellular concentrations of serotonin, dopamine, and norepinepherine in the prefrontal cortex, only fluoxetine showed robust and sustained increases in extracellular concentrations of norepinephrine and dopamine after acute systemic administration,[13] suggesting that fluoxetine is an atypical SSRI"
Personally I have never tried it, but I'll bet most posters on this board have. (And please, I'm not advocating SSRI's TCA's, MAOI's etc. We are all wired differently with numerous root causes and numerous levels of comorbidity.)
It's been around 20 plus years. There has to some meta data to support it's efficiency one way or another (or most likely both :))
B
Posted by Chairman_MAO on February 20, 2007, at 15:02:10
In reply to Why Most New Antidepressants Are Ineffective, posted by bulldog2 on February 17, 2007, at 13:07:07
Thanks for posting such a great article. It's nice to know that a professional has written something along the lines of what I've been thinking for years. Everyone should note what he says about MAOIs and tranylcypromine.
Posted by Squiggles on February 20, 2007, at 15:27:55
In reply to Re: Are we culturally primed to expect too much?, posted by Quintal on February 20, 2007, at 9:49:24
I think the problem with the MAOIs is not
that people would not prefer them to SSRIs
if they are indeed "cleaner", but that the
dietary restrictions really pose a threat.It may not be a big threat -- it may have been
overblown or overbroadcaster or exaggerated;
i know that has happened with the "narrow
therapeutic index" of lithium (really exaggerated and not compared to other drugs with a toxic or
narrow therapeutic index). But, put the idea into people's heads with enough medical articles and everyone will be less likely to use them.In such cases, the drug companies should do something to enhance the marketability of a good drug. For example, with lithium I asked some drug companies if the could use a portable detector for home use for lithium blood levels to get feedback. Who knows maybe it will happen someday.
Squiggles
Posted by halcyondaze on February 20, 2007, at 15:45:34
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 15:27:55
It's funny, because I couldn't tolerate SSRIs and TCAs at all and I tolerate Parnate remarkably well.
When one SSRI caused bedwetting, every doctor I saw would be like, "How about THIS SSRI? How about THIS SSRI?" until I had been on Prozac, Zoloft, Celexa, Effexor, Cymbalta - all with the same effect! And the only drug I had an antidepressant response to was Zoloft.
Finally I found a doctor who said, "Well, TCAs are used for bladder problems. Let's try those." However, they made me very irritable, and so it was down the road of trying mood stabilizers to curb the irritablity. Then it was heart palpitations, which involved switching TCAs. When I found out I have mitral valve prolapse, I said: enough.
Thankfully, I have a doctor who was willing to experiment with MAOIs and didn't just suggest going back to Zoloft and "dealing with" the bedwetting (which, at 24 years old, I shouldn't be expected to do and am unwilling to do) and I tried Parnate. Nine years after taking my first antidepressant, nine years after seeing too many psychiatrists to count, this drug was finally offered as an option to me.
Was I nervous? Sure. I was afraid it would have an effect on my Interstitial Cystitis and bladder issues (it hasn't - it's essentially cured them), afraid of hypertensive crisis, afraid it would be too hard to follow the diet ... but the diet is a small price to pay for being able to live my life again. I carry Nifedipine, which I've had to use several times in the past year [after strictly adhering to the diet, I started experimenting - some foods it turns out I can eat, and some I can't.] Nifedipine resolved it and I was fine. I carry an at-home BP kit with me as well, just in case.
I don't feel like I have lost anything significant by not being able to eat cheddar cheese or soy products. But when I went off Parnate and stayed off of it for six months last year? The loss was so profound it was tangible.
Posted by Squiggles on February 20, 2007, at 16:08:51
In reply to Re: Are we culturally primed to expect too much?, posted by halcyondaze on February 20, 2007, at 15:45:34
It takes a very dedicated and persistent
doctor to go from drug to drug and class to
class, for the patient's sake. And a patient patient. But I think
that given the ambiguity and personal idiosyncracy of the patient's mental state/illness, it may yield results in the end. Right now, drug therapy is a crapshoot and the DSM is a rough road map, still being chartered.I was extremely lucky, and again serendipity helped as the first AD gave me hives. The second one (li) followed a presentation of a completely different state (bipolar symptoms). Even then, the drs. were not sure *that* would work. It did, within a week.
Squiggles
Posted by elanor roosevelt on February 21, 2007, at 0:56:26
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 20, 2007, at 16:08:51
no
retrieving an essential part of your spirit is not asking too much
expecting pdocs to be informed and compassionate beings is not asking too much
coping with side effects that lower the quality of your life is not an acceptable option
Posted by stargazer on February 22, 2007, at 9:16:55
In reply to Re: Are we culturally primed to expect too much?, posted by elanor roosevelt on February 21, 2007, at 0:56:26
I know for myself, I expect to feel as good as humanly possible, but agree sometimes the expectations we may have for ourselves are above and beyond what our biology, aka, genetic profile has given us. We have to remember from where we came.
My expectations are first and foremost to not be in a depressed, non-functional state that prevents me from working and being a productive and balanced person in the world, able to enjoy things to a certain depree, but enjoy them nonetheless.
I believe I have realistic expectations for myself, but do agree that perhaps many seeking answers for their conditons may have expectations that can never achieved, but they still have the right to continue to try and reach a certain level of functioning on their own.
I do try and find the best treatment for my depression, knowing there is most often room for improvement, either through med tweaking or certainly through changes in my lifestyle, especially exercise, which is usually the first thing that goes when I'm depressed. There does seem to be a point where I can live and be satisfied with my life, although I know I have my own shortcomings and I can't become the person I hoped I would be at a younger age.
For many of us, dealing with lifelong depression, has set us back in many ways; personally, financially, eductionally, and causes me to feel more depressed about not having achieved what I might have, had I not had the condition that I do.
That realization that I will never have the life I dreamed of will always contribute to my depression but I believe if I set realistic goals for the present, it helps me see that I can still contribute and be a valuable person, despite everything I have lost. Obviously, seeing this when depressed is almost impossible.
I don't think I expect anymore than I believe is possible given my understanding of treatment options and being realistic about feeling good on a continuum, not every day, but hopefully more days than not, and maybe on rare occasions, feeling great! I don't think that is expecting too much for myself.
But I do feel many who search and search for perfection will only be disappointed because that doesn't exist, even for those without depression. And there is a point where depression treatment becomes a lifestyle rather than a means to an end. That can be dangerous when the time you spend on depression takes you away from living your life, separate from your identity as a depressed person. A therapist pointed that out to me once and it stuck, that from time to time you must question if you are avoiding living by using depression as an excuse.
I don't think I have done this too often, but I do find myself from time to time, spending too much time on depression, giving it more of a life than I want it to have. It is up to us to keep the search for feeling better balanced with living a life apart from the condition. Depression is powerful enough on its own without keeping the fire stoked continuously.
Stargazer
Posted by Squiggles on February 22, 2007, at 9:24:47
In reply to Re: Are we culturally primed to expect too much?, posted by stargazer on February 22, 2007, at 9:16:55
That's a very thoughtful post Stargazer.
You have to learn to ignore that
nagging pebble under your sole, in your
shoe and walk on.:-)Squiggles
Posted by bulldog2 on February 22, 2007, at 12:13:47
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 22, 2007, at 9:24:47
I think the answer depends on the person. Yes we live in a society where many people have been brought up with a sense of entitlement. If you were given everything when you were young than that could lead to problems down the road. You look at Hollywood stars who have all the money in the world and yet seem so unhappy. I think we need goals to strive for to remain happy. Once you have everything than you essentially lose your purpose in life.
On the other hand there have always been endogenously depressed people in all eras and cultures. I believe mentally healthy people find enjoyment in hobbies, social interaction and possibly work. Once nothing brings us any joy or there is nothing to look forward to that is depression. I once read that Lincoln suffered from dark depressions. Some of us are just genetically hardwired for depression and hopefully some day we will have more answers and better modes of treatment.
Posted by Squiggles on February 22, 2007, at 12:31:18
In reply to Re: Are we culturally primed to expect too much?, posted by bulldog2 on February 22, 2007, at 12:13:47
bulldog2,
one thing i've noticed is that depressed people fall into a cumulative spiral for social reasons;
the Western ideal at least helps and admires certain traits and not others; you don't have to read too many news on-line today, to see for example that the homeless have become a sport for a Clockwork Orange-like ethic. Despite the hard efforts of NAMI, DBSA, NIHM, etc., i think that dominance is ingrained in our culture.Squiggles
Posted by bulldog2 on February 22, 2007, at 14:27:52
In reply to Re: Are we culturally primed to expect too much?, posted by Squiggles on February 22, 2007, at 12:31:18
I guess that type of depression would fall under culturally primed. For sure our self esteem is often created from a comparison of our personal lives against the cultural standard.
So maybe somes episodes of depession are caused by someone who has a genetic predisposition to depression and low self esteem. In my case depression seems to run in my family. As a child with add I was teased by my peers for being short and fat. For me this was an early recipe for depression. You can make some headway with talk therapy and try to dismiss those early rejections and see you really have choices but unfortunately your also dealing with early hardwiring which subconsciouly competes with your new conscious thoughts that therapy may create.
Posted by Squiggles on February 22, 2007, at 14:45:27
In reply to Re: Are we culturally primed to expect too much?, posted by bulldog2 on February 22, 2007, at 14:27:52
"short and fat" ha, you think you had
problems; i was raised by wolverines--
how feral is that;Squiggles
This is the end of the thread.
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