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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by West on July 22, 2008, at 18:38:23
This is the website of retired Australian Psychiatrist and Pharmacologist Dr Ken Gilman. He has experience in the research and publishing of clinical data and has some GROUNDBREAKING conclusions regarding the efficacy of currently marketed antidepressants. The website includes figures stating exact reuptake affinities for various drugs (like those for venlafaxine: 5HT:NE inhibition 200:1). From a personal perspective for example, I found it very helpful to discover that both SNRIs effexor and cymbalta have insubstantial effects on 5HT and NE to warrant a theraputic response, whilst a combination of sertraline + reboxetine/nortryptaline does - the catch being the lack of interest in marketing the combination of either of these drugs. Take a look:
http://www.psychotropical.com/dual_action_ads.shtml
main website:
Posted by bleauberry on July 22, 2008, at 19:45:36
In reply to Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 22, 2008, at 18:38:23
Cool reading. So according to his experience in 1000 patients, a 1:1 balance of 5ht and NE works best, and a bit better with 5ht antagonism. I wonder though why after he commented and critisized all the drugs on his chart, he did not say a word about Milnacipran, which looked to be almost the ideal of what he was looking for, according to his own charts, minus the 5ht antagonism. Milnacipran is a very close match to his favorite TCA, but no mention? Maybe it isn't available in his country and he never used it? That's all I could figure.
Posted by Phillipa on July 22, 2008, at 23:37:48
In reply to Re: Psychobabblers KNOWLEDGE IS POWER!, posted by bleauberry on July 22, 2008, at 19:45:36
Guess it's okay to post another countries website as how would we gain access to it? Sent to to an Australian buddy of mine to see if he's heard of him. Phillipa
Posted by Chris O on July 23, 2008, at 14:50:51
In reply to Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 22, 2008, at 18:38:23
God, that information is depressing. But whenever I bring those types of concerns up to psychiatrists, they just tell me "it's my disorder talking." Damned if I do, damned if I don't. I hate my life! Grrrrrr.
Posted by West on July 23, 2008, at 17:01:38
In reply to Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 22, 2008, at 18:38:23
'Most of the new antidepressant drugs introduced in the last twenty years do not work effectively. The evidence about them presented to doctors, even in the most respected leading medical journals, is closer to advertising copy than it is to science. There is clear and incontrovertible evidence that scientific data and publications are controlled, manipulated and subverted by international pharmaceutical companies to an extent that would astonish most ordinary people, including doctors.'
Much of his damning of modern antidepressants is to do with smudging/shelving of data and ghostwriting of data, none of which is particularly new.
In fact the Lancet's studies disproving the effectiveness of the SSRIs and claiming them to be no more effective than placebo are thought to be false*. Views of this nature have gained popularity in medical journals and mainstream medical literature of late in the UK so that many practitioners (dangerously, in my view) presently subscribe to the peculiar and fashionable view that drugs for psychiatric conditions should be avoided wherever possible in favour of talking therapies and lifestyle changes (somehow the suggestion of fresh air and exercise doesn't give the impression of being taken seriously).
Doctors I have had experience with have put little faith in getting better on medication alone, and perhaps this is true of some people. Another still has said 'you know there's little evidence that any of these work at all'. Perhaps they are right, although there is a cruel irony in the production and marketing of drugs with negligible benefits on depression...only for patients to take them, not get better, and subsequently get the 'i told you so' treatment.
Suggestions have been made to me that not succeeding on antidepressants serves to reinforce the notion that I am not depressed, such is the pervading logic and sloppy complacency of doctors on the NHS. Their livelihood does not rely on creativity or resourcefulness; only that they prescribe the right drug in the right order out of a little book we call the BNF (british national formulatory) and try not to get their wires crossed in prescribing contraindicated substances: many successfully manage to balls even this up.
Anyway enough of the lecture. The point is that where some of these new drugs lack efficacy (i.e the SNRIs) others exist which do work, especially when combined and put to work on the uptake or selective agonism/antagonism of specific neurotransmitters: this is called psychopharmacology and not an art practiced with any conviction by any psychiatrist you're likely to come across.
For example, a pdoc adding wellbutrin to lexapro in the US is not an example of considered psychopharmacolgy, but merely bad science the type of which a six year old child could reasonably be taught to grasp.
We are downtrodden and misery-ridden enough as it is, so i won't include this:
Pharmaceutical companies justify their record profits by emphasising the cost of developing new drugs, yet the figures indicate that they only spend 10% on Research and Development (R&D), but they spend 30% of their budget on advertising. Furthermore, a sizeable chunk of that meagre 10% includes expenses to doctors who do very little actual research, but attend briefings, conferences and the like that are thinly disguised junkets (I have colleagues who participate in such activities). So the proportion of the 10% that is true research is much smaller even than it seems. In reality most companies are almost certainly doing far more development, of publicly (taxpayer) funded original research, than original research of their own. My analysis and summation of the situation is that pharmaceutical companies have been persistently and systematically deceiving us all and misrepresenting what they do, and how they do it, to their great financial benefit and everyone elses detriment. I expect some would argue that constitutes powerful evidence against the benefits of unregulated capitalist free enterprise: I find it hard to counter that argument. The main source of financial information concerning Big Pharma, i.e. pharmaceutical companies that I know of is Public Citizen Congress Watch (3) www.citizen.org/documents/Pharma_Report.pdf.
However sometimes feeling as though you fighting for something good, for virtue and truth, is useful when struggling with depression. Many of us are here precisely because we haven't found sufficient relief in these medicines, if that is what they are, or found fleeting benefit only to lose it again, or didn't really find it at all, but thought they did. It's not our fault, there is mass-ignorance at work surrounding the popular treatment of depression, starting at the root of these drugs in their inception which have largely been the result of coincidence or accident- the indications for which an agent is nearly always a secondary consideration.
In years from now people will look back with great sympathy for those who had to endure such dreadfully crude medicine, in the meantime it is up to us to remain extra vigilant and educate ourselves in all aspects of our respective conditions as patients and in many cases consumers.
Working with available tools, Dr. Gillman would suggest a combination of a tricyclic/reboxetine + sertraline:
'Furthermore, we also know that there is a congruent difference in the ability of amitriptyline / imipramine / clomipramine to precipitate serotonin toxicity. The above receptor affinity data clearly indicates that (at least for TCAs) potencies of less than one (i.e. Ki < 1 nM) are required for clinical effectiveness. It is therefore reasonable to suggest that in designing a dual action strategy it would be ideal to aim for those kinds of potencies in both pathways. Neither venlafaxine nor duloxetine come anywhere near that. Clomipramine definitely does, combinations like sertraline + nortriptyline, or sertraline + reboxetine very probably do...In my firm opinion none of the new drugs, and that includes the supposed dual action drugs venlafaxine (Efexor) and duloxetine (Cymbalta), actually work as well clomipramine.'
One other drug he seems to champion is Tranylcypromine with which he has treated over a thousand patients successfully (although he concedes insomnia is a problem in many). He even says it would be his first choice in friends or loved ones who fell ill.
* i have only somebody's word on this (although he is something of an authority)- would be interested if anyone could find anything to support it.
Posted by Marty on July 23, 2008, at 22:03:09
In reply to Re: Psychobabblers KNOWLEDGE IS POWER!, posted by bleauberry on July 22, 2008, at 19:45:36
Hi Bleau,
> he did not say a word about Milnacipran, which looked to be almost the ideal of what he was looking for
---
If you're interested in having his opinion on Milnacipran there's a web form to send your question. There a place on his site where he even say that he is willing to give free consultation by Skype (internet voice chat / VOIP). But simple question is answered by mail.I wonder if he would be willing go give us 2, 3 hours a week 'pro-bono' on this forum. That would be great.. but I sense he has better things to do with now that he's retired.
/\/\arty
PS: If you ask about Milnacipran, I'd like to know his opinion.
Posted by Marty on July 23, 2008, at 22:13:50
In reply to Re: Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 23, 2008, at 17:01:38
He offers to answer emailed question, so I posted him this one:"Mr Gillman,
I'd like to know if Serotonin Syndrome has been treated with Tianeptine in the past. If not do you think it could be an interesting agent in some case ?
Also I wonder what is your appreciation of Tianeptine as an antidepressant/anxiolytic.
Cordially, Marty"
If he answers me I'll post his response on this thread.
/\/\arty
Posted by West on July 23, 2008, at 23:37:42
In reply to Re: Psychobabblers KNOWLEDGE IS POWER! » West, posted by Marty on July 23, 2008, at 22:13:50
Good work Marty; Do you mean you want to ask him if tianeptine can treat serotonin syndrome or cause it. I would anticipate tianeptine causing it in overdose or if used with an MAOI. At the risk of accuations of conservatism might I also suggest you address him as Dr. (even though he is retired (?)
Posted by Phillipa on July 24, 2008, at 0:27:36
In reply to Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 22, 2008, at 18:38:23
I mailed my Australian friend and he said this guy is good and what he says was on TV. Love Phillipa
Posted by Marty on July 24, 2008, at 0:29:35
In reply to Re: Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 23, 2008, at 23:37:42
> Good work Marty; Do you mean you want to ask him if tianeptine can treat serotonin syndrome or cause it. I would anticipate tianeptine causing it in overdose or if used with an MAOI. At the risk of accuations of conservatism might I also suggest you address him as Dr. (even though he is retired (?)
---
Hi West and thanks for having shared the URL of the site.Dr. .. CONSERVATIST !! seriously you're right but I can't change it since when I posted a copy of my email it was already post. But I'll think about it if I correspond with him in the future.
About Tianeptine and Serotonin Syndrome: My question was if it could be of any help to TREAT Serotonin syndrome as is it a Reuptake Accelerator/Enhancer and so there's LESS Serotonin in the synapse. Sounds like it could be a good thing for the receptors in theory but it may be more complex than that (it surely is) .. ie.: maybe somehow it could be bad for the 5-HT vesicles.
Anyway if I'm lucky enough to have this ->DR<- replying me it's gonna surely be very interesting.
Again thanks for the URL West.
/\/\arty
Posted by yxibow on July 29, 2008, at 1:22:08
In reply to Psychobabblers KNOWLEDGE IS POWER!, posted by West on July 22, 2008, at 18:38:23
> This is the website of retired Australian Psychiatrist and Pharmacologist Dr Ken Gilman. He has experience in the research and publishing of clinical data and has some GROUNDBREAKING conclusions regarding the efficacy of currently marketed antidepressants. The website includes figures stating exact reuptake affinities for various drugs (like those for venlafaxine: 5HT:NE inhibition 200:1). From a personal perspective for example, I found it very helpful to discover that both SNRIs effexor and cymbalta have insubstantial effects on 5HT and NE to warrant a theraputic response, whilst a combination of sertraline + reboxetine/nortryptaline does - the catch being the lack of interest in marketing the combination of either of these drugs. Take a look:
>
> http://www.psychotropical.com/dual_action_ads.shtml
>
> main website:
>
> http://www.psychotropical.com
I dunno. Effexor is still hideous stuff compared to Cymbalta, in my opinion, regardless of the argued in vivo statistics. Its like 50 cups of coffee. But then of course, we all are different. Some people can't stand even a tiny dose of Cymbalta.
Posted by Marty on July 29, 2008, at 16:03:39
In reply to Re: Psychobabblers KNOWLEDGE IS POWER! » West, posted by yxibow on July 29, 2008, at 1:22:08
> I dunno. Effexor is still hideous stuff compared to Cymbalta, in my opinion, regardless of the argued in vivo statistics. Its like 50 cups of coffee. But then of course, we all are different. Some people can't stand even a tiny dose of Cymbalta.
---
Hi,In your own experience you felt Cymbalta was very different than Effexor XR in his effect ? Could you describe how it was different for you ... and if you can compare it to something else. How was sex on Cymbalta ? I heard it's horrible.
/\/\arty
Posted by yxibow on July 30, 2008, at 0:49:20
In reply to Re: Psychobabblers KNOWLEDGE IS POWER! » yxibow, posted by Marty on July 29, 2008, at 16:03:39
> > I dunno. Effexor is still hideous stuff compared to Cymbalta, in my opinion, regardless of the argued in vivo statistics. Its like 50 cups of coffee. But then of course, we all are different. Some people can't stand even a tiny dose of Cymbalta.
> ---
> Hi,
>
> In your own experience you felt Cymbalta was very different than Effexor XR in his effect ? Could you describe how it was different for you ... and if you can compare it to something else. How was sex on Cymbalta ? I heard it's horrible.
>
> /\/\arty
>I wasn't particularly thinking in the sexual direction when I was on Cymbalta -- this had been more recent and my mood has been more downcast (because of my disorder).
As for Effexor, that was considerably in the past -- I don't think it effected things but my anxiety. I don't know how Cymbalta varies on people -- as a SNRI with a 6:1 ratio of SS to SN I can imagine there could be some SSRI like sexual side effects but thats purely comparing apples and oranges.
I am affected to some extents but -some- SSRIs in the sexual direction. It just.... takes longer, and longer. But that's a dosal reason as it is also a psychological part of depression and self-consciousness in the first place, at least in my view. Some doctors say you can drop things with low half lives (like Paxil, e.g.) shall we say for some festivities -- but to be careful on that of course because of the fire and brimstone of return of symptoms and withdrawal.
There are ways around these things chemically if needed. Cyproheptadine in low doses is one, yohimbine used to be advocated but I don't know if it is viewed as more toxic these days or not. Very low doses of Wellbutrin too.
-- Jay
This is the end of the thread.
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