![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 38. Go back in thread:
Posted by herpills on June 1, 2010, at 11:44:21
In reply to Don't know what to believe, posted by linkadge on May 31, 2010, at 17:36:22
> I know there have been a lot of discussions about the the truthfulness about data regarding psychiatric medications.
>
> I know this is a rather simple point, but I don't know what to believe.
>
> There is just so much conflicting evidence out there and I am tired of being a guinny pig. I have to make important decissions and what good data is there out there?
>
> LinkadgeYou are right, it is difficult when we are making these choices and decisions about our care. I try to look at as many different sources as I can. I actually start with the full prescribing information for anything I have chosen to take. I might not understand all the science, but I do feel more informed, which helps guide my decisions. I also go to places like this to hear other experiences. I try and talk to as many professionals as possible- pdocs, family docs, pharmacists, nurses, etc...
You are right, how do we make decisions if we don't know if the data is true/false?
Taking these meds is a choice, a difficult choice to make.
herpills
Posted by manic666 on June 1, 2010, at 13:50:25
In reply to Re: Don't know what to believe, posted by herpills on June 1, 2010, at 11:44:21
i hard to feel your in safe hands with meds//an what info is right//listen at this, this is a p doc talking to me about ssri,s// pick anyone , there near as all the same anyway???????????? i swear he atually said that
Posted by Dr. Bob on June 1, 2010, at 15:43:51
In reply to Re: Don't know what to believe, posted by Huxley on June 1, 2010, at 0:52:40
> Have you read 'anatomy of an epidemic' by Robert Whitiker?
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, a movie, or music without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though.
Thanks!
Bob
Posted by bleauberry on June 1, 2010, at 20:03:07
In reply to Don't know what to believe, posted by linkadge on May 31, 2010, at 17:36:22
> I know there have been a lot of discussions about the the truthfulness about data regarding psychiatric medications.
>
> I know this is a rather simple point, but I don't know what to believe.
>
> There is just so much conflicting evidence out there and I am tired of being a guinny pig. I have to make important decissions and what good data is there out there?
>
> LinkadgeYou really can't believe the data on psych meds. It is tainted from start to finish, either directly, indirectly, purposefully, or incidentally. As just a 1% example of an entire discussion, consider the cherry-picked participants. They aren't representative of you and me. Consider the cherry-picked data submitted for review, and the cherry-picked data hidden away because it did not support the case at hand. And then the fine art of statistics in being able to twist things one way or the other and still able to call it valid despite the artful twisting. Or the simple abscence of available data not presented to you, which would have changed the entire outlook on the data you were presented.
The human body is complicated beyond the comprehension of man. We make our best efforts at any given time, but in the big picture our wisdom is but a speck of sand on a beach.
I have some excellent data from a genetic test. It shows exactly which genes...MAO-a, COMT, various methylation genes, and a bunch of others...that are either normal or have "snippets". That is, wrong instructions inserted into them sometime after birth due to an outside interference such as metals or infection, and they are permanent. These snippets, or roadblocks, can be overcome. For example, 3 different forms of B12, 2 different forms of folate, and a handful of specific supplements would over-ride some of those genetic snippets.
But, a psychiatric drug could get the same result. Not by fixing the genetic coding, but by going straight to the finish line for the desired product. Maybe those B12s and folates and stuff would fix the genetic roadblocks making the functioning of dopamine and serotonin the way they are supposed to be. But the right psych drugs can do that too.
The problem is we just don't know from one person to the next exactly what the discrepancy is that is causing the mood disorder, what exactly is the end result of that disprepency, how to over-ride it, or exactly what drugs do. Practically every drug label says something like, "the mechanism in treating XYZ disorder is unknown but is assumed to be...".
Ya know?
To compound the problem, data is gathered by testing groups of people as if they were one and the same. They aren't.
Personally I think the best data comes from the anecdotal observations of open minded experienced PCP. They see what works the most, what doesn't, and the more effective optional strategies when they don't.
Case in point. My hometown doctor prescribes prozac at a rate of about 100-to-1 compared to the other ssris. Why? Because he sees it works. His second choice is zoloft. You will not find any data or studies anywhere that would lead someone to the conclusion that prozac is the reliable heavy hitter. But in a town of about 10,000 people, it is.
Another case in point. Most scientific data on moclobemide makes it appear to be a worthy drug. But in the real world, I can't recall a single instance where it actually was.
So there ya go. I think data is helpful, but the important thing is to keep it "in perspective". To not rely on it as a primary deciding factor. No amount of data can replace what actual clinicians witness in the field with real people like you and me.
No amount of data can replace what a drug actually does to us when we swallow it. It doesn't matter what it did to 60% of some group of cherry picked people. What matters is what does it do to you. Or me.
Just my opinions on that. That said, I have based many decisions on what I read in studies. Some turned out fairly ok, some not, but I could have gotten the same results by just blindly flipping a coin or drawing straws.
My best most reliable data, ideas, and results came from the anecdotal observations of my fellow friends at psychobabble. Or from a couple wise observant doctors who have been around the block a few times and have a passion in helping people feel better (not in it for the money). Like the one I saw today that charges me 45 minutes for a solid 3 hour visit and covered everything from A to Z.
But when I do seek scientific data, pubmed seems to put the world at one's fingertips. Type whatever you want in the searchbox and there are literally hundreds of studies on it. Whether it is helpful or not, or accurate or not, well, that's another story.
Posted by Bob on June 1, 2010, at 22:12:59
In reply to Don't know what to believe, posted by linkadge on May 31, 2010, at 17:36:22
> I know there have been a lot of discussions about the the truthfulness about data regarding psychiatric medications.
>
> I know this is a rather simple point, but I don't know what to believe.
>
> There is just so much conflicting evidence out there and I am tired of being a guinny pig. I have to make important decissions and what good data is there out there?
>
> Linkadge
The more familiar I become with medical studies, the more demoralized I become. Even studies that seem sound and appear to come to a very logical conclusion are sometimes overturned later. It just seems to show how difficult it is to understand the things these studies strive to elucidate.Bob
Posted by hyperfocus on June 2, 2010, at 6:34:20
In reply to Don't know what to believe, posted by linkadge on May 31, 2010, at 17:36:22
I agree with bleauberry that the most important sources of info are communities like PB and having good PCPs who actually care about their patients. These are some of the things I believe wrt depression:
There are three major classes of depressive illness: First you have typical' depression which can develop following a traumatic experience or chronic stress or simply for no reason at all.
The 2nd class contains so-called TRD, major depression, bipolar depression, double depression, psychotic depression et.al.
In the third class you have depression co-morbid with anxiety, social anxiety, OCD, Body Dysmorphic Disorder, Dissociation, etc.
Of course these things can occur without depression but in the majority of cases they do appear together.Practically all empirical results are screwed up because they group the first set of patients together with the 2nd and 3rd like there's no difference between them. This is why studies on meds give false results on med response and seem to contradict each other.
In the first case the best result you can get from the data is that meds work, but they are only as effective as other methods - counselling, psychotherapy, exercise, diet changes, and plain old-fashioned time to heal.
The other two groups show a marked decrease in response rate to meds and practically zero response to alternative therapies. These people need new and innovative treatment that goes beyond traditional med strategies. Again the only place to discover what works are communities like PB.
SSRIs are very effective for the first group. And yes you could say that they're all the same when dealing with this type of depression, as there doesn't seem to be any marked difference in response among the SSRIs. Prozac is just as likely to work as Lexapro or any of the SSRIs
People in the 2nd and third class typically don't respond to SSRIs or SNRIs. The treatments that have been shown to work for some of these people are:
TCAs
MAOIs (except Marplan)
atypicals like Stablon or Valdoxan
Augmentation of a AD with an AP like Abilify or Risperdal
Augmenation of an AD with a mood-stabiliser like Lamictal
Augmentation of an AD with a stimulant like ritalinTCAs have heavy-to-moderate sideeffects but generally work better than SSRIs MAOIs can have the most dramatic response but a lot of people can't tolerate the SEs
Benzos are controversial but they can help a lot of people.
The truth is nobody knows how these drugs work. Nor does anybody know how mental illness develops. You can talk about neurotransmitters all you want but as BB keeps telling us people can take a course of antibiotics and find their mental illness improving drastically. The only solution is to collect as much empirical data and observations as you can and try to formulate a strategy. You need a good PCP who understands the vagaries and contradictions of psych meds and is willing to go beyond what is in the PDR.
Posted by Bob on June 2, 2010, at 11:43:00
In reply to Re: Don't know what to believe, posted by hyperfocus on June 2, 2010, at 6:34:20
Some excellent insights/commentary are provided by bleauberry and and infocus regarding the nature of drug studies, and man's comprehension of mental illness among other things.
With respect to finding a PCP who has a deep and nuanced understanding of psych meds, that for me would present a monumental challenge. Most PCPs I've come across are only vaguely familiar with such things. I don't doubt that there are some out there with unusual insight, but I haven't found it.
Posted by manic666 on June 2, 2010, at 12:53:39
In reply to Re: Don't know what to believe, posted by hyperfocus on June 2, 2010, at 6:34:20
3 different class,s of depression//no way you may have well say 100///the first you put that responds to ssri,s //i would say %90 of the population have at some time in there life// an go on to make full recoveries//now i must be a lot stronger than you as i have had every thing you mentioned in the 3 depression an am still on ssri,s//well mabye not bipolar ,but i have had the symtoms ,its just english p docs dont see there hand infront of them,, my ocd was curred by prozac an ssri////snris like effexor are the kiss of death for me //makeing my syptoms 10times worse//jesus i was near on bald in 5 weeks //an most rip you guts to pieces///as for maoi,s dont donate you major organ to science// you wont have any left for them anyway???????????.if your illness is life long benzo addiction like me is just about inevetable with major anxierty //so people will never fall into 3 depressive groups an med types//some come good on a good old fashion leaveing well alone//now lets get on to theropy//that is cool if you have one major prob to solve//you may come good if they make you understand //but people with major derpression have a weath of probs //you carnt solve them all one after the other// cos thats what happens//it happend to me my theropist said i can have a go at one //but your brain invents another to take its place//so its up to yourself to sort ///cbt theropy is so of base its laughable.they say every thing you fear is not real//it sure seems like it when you bolt for the nearest hideing place to loose your bowel movments// the therory is fight or flight //it should be flight or SHHHHHHHHHITE
Posted by manic666 on June 3, 2010, at 3:14:45
In reply to Re: Don't know what to believe, posted by manic666 on June 2, 2010, at 12:53:39
well im suprised i wasnt hit with my post// are well another debate lost
Posted by MrTook on June 6, 2010, at 14:41:06
In reply to Re: Don't know what to believe, posted by Huxley on June 1, 2010, at 0:52:40
> > I know there have been a lot of discussions about the the truthfulness about data regarding psychiatric medications.
> >
> > I know this is a rather simple point, but I don't know what to believe.
> >
> > There is just so much conflicting evidence out there and I am tired of being a guinny pig. I have to make important decissions and what good data is there out there?
> >
> > Linkadge
>
> Have you read 'anatomy of an epidemic' by Robert Whitiker?
>
> Must read for anyone on serious psych meds.
>I took a look at the article and I wasn't too impressed. Sure he has a scary premise, I was certainly thrown into an anxious tizzy at first, but a scary premise doesn't make something a fact.
My first problem with the article is that it equates hospitilization with social security disability without really going into detail as to why this is a valid comparison. I mean just think about it, might there possibly be some motivation for the 1950's patient to stay out of the hospital, and possibly some motivation for today's mentally ill to receive "free" money. Would it be possible that getting SSI has gotten a little easier as the world has gotten a better understanding and acceptance of mental illness?
Another problem, what is a patient care episode? It is impossible to understand why the rate might be increasing without understanding what is really being reported.
Let's say that his assumption on comparing hospitilzation and SSI is valid. He uses Table 2 to drive his point home by saying that from 1955 to 2003 the rate of disability increased by a factor of 6x, but is not interested at all in why it increased by a factor of 9x in roughly the same amount of time from 1850 to 1903? What might have caused the jump then, and is it possible that it continued to have an influence from 1955 till now? I can think of a couple.... maybe increasing population density? Maybe increased urbanization? Maybe changes in diet? Maybe increased exposure to pollution?
There is certainly an epidemic of mental health problems, and I would like nothing better for a cure and long term solutions. Might Whitaker be right? What is the cause? What is the problem? who knows? Whitaker certainly doesn't have anything more than guess.
Posted by Huxley on June 7, 2010, at 0:25:56
In reply to Re: Don't know what to believe, posted by MrTook on June 6, 2010, at 14:41:06
> > > I know there have been a lot of discussions about the the truthfulness about data regarding psychiatric medications.
> > >
> > > I know this is a rather simple point, but I don't know what to believe.
> > >
> > > There is just so much conflicting evidence out there and I am tired of being a guinny pig. I have to make important decissions and what good data is there out there?
> > >
> > > Linkadge
> >
> > Have you read 'anatomy of an epidemic' by Robert Whitiker?
> >
> > Must read for anyone on serious psych meds.
> >
>
> I took a look at the article and I wasn't too impressed. Sure he has a scary premise, I was certainly thrown into an anxious tizzy at first, but a scary premise doesn't make something a fact.
>
> My first problem with the article is that it equates hospitilization with social security disability without really going into detail as to why this is a valid comparison. I mean just think about it, might there possibly be some motivation for the 1950's patient to stay out of the hospital, and possibly some motivation for today's mentally ill to receive "free" money. Would it be possible that getting SSI has gotten a little easier as the world has gotten a better understanding and acceptance of mental illness?
>
> Another problem, what is a patient care episode? It is impossible to understand why the rate might be increasing without understanding what is really being reported.
>
> Let's say that his assumption on comparing hospitilzation and SSI is valid. He uses Table 2 to drive his point home by saying that from 1955 to 2003 the rate of disability increased by a factor of 6x, but is not interested at all in why it increased by a factor of 9x in roughly the same amount of time from 1850 to 1903? What might have caused the jump then, and is it possible that it continued to have an influence from 1955 till now? I can think of a couple.... maybe increasing population density? Maybe increased urbanization? Maybe changes in diet? Maybe increased exposure to pollution?
>
> There is certainly an epidemic of mental health problems, and I would like nothing better for a cure and long term solutions. Might Whitaker be right? What is the cause? What is the problem? who knows? Whitaker certainly doesn't have anything more than guess.Hi Mr Took.
I have to disagree with you. I think Whitaker has put forward a solid scientific case that these medications that we take are causing the very illnesses that they claim to cure.
There are many debatable points in the book,I asked myself the same questions you have just raised.. by the end of the book Whitaker has covered most of them.
Whitiker is a renowned scientific author and thinker and not the sort of person to use a 'scary premise' to sell books. All his conclusions are drawn on research and evidence.
I am not here to convince anyone of anything, but I do think that each and everyone of you should read anatomy of an epidemic. Arm yourself with the facts and make up your own mind.
Everything I believed in regarding psych meds was turned on it's head.
Posted by manic 666 on June 7, 2010, at 3:06:27
In reply to Re: Don't know what to believe, posted by Huxley on June 7, 2010, at 0:25:56
that still leaves a major floor//take you meds or take your life????????? what would you choose
Posted by SLS on June 7, 2010, at 5:42:23
In reply to Re: Don't know what to believe, posted by Huxley on June 7, 2010, at 0:25:56
I agree with Mr. Took. Whitaker seems to compare apples and oranges and presents them as being equivalent. For example, he equates the number of hospitalizations in 1955 to SSD cases in 2003 as indexes of illness rates. There is no science presented here to establish the validity of using such a comparison.
"Source: The disability rates for 1850 through 1955 are based on
the number of hospitalized mentally ill, as cited by E . Fuller
Torrey in The Invisible Plague (2001) . The disability rates for
1987 and 2003 are based on the number of mentally ill receiving
SSI or SSDI payments, as was reported in 2004 by the Social
Security Administration."Whitaker misuses statistics quite dramatically to promote his thesis. How does he account for the lack of an equally dramatic rise in suicides over this same time period? Actually, the rate of suicide in the US had been increasing prior to the introduction of antidepressants. This must be accounted for when looking for a cause and effect. Is this increase due to sociological factors or simply a difference in reporting practices? Perhaps both? And what of the decline in suicides seen since the introduction of Prozac in 1987?
http://www.suicide.org/suicide-statistics.html#death-rates
- Scott
Posted by manic 666 on June 7, 2010, at 8:49:20
In reply to Re: Don't know what to believe, posted by MrTook on June 6, 2010, at 14:41:06
all i no is i reached a stage in my life //where i couldnt hide it any more//i was ill from drinking at times to cover myself//people thought i didnt arrange to meet them as i was my own man//i could not make arangments as i didnt no how i woluld feel on the he day// if i could cover the slurring of my words ,or control my shakeing or thought pattern//i had reached a crossroads ,an i could not carry on //i needed help an bad//i became a recluse ,could not work an suicide on my mind//i found help????????well pretty sh*tty actually but it was a start//tried loads of meds //what else is there ,this was not a new thing to me it was a life time sh*t//it was only going to get worse//then i had a break through with prozac//the world was a place i had never been in before beautiful an full of coulor//it lasted 2 years but it had sown the seed in my brain there/was help//i would have killed myself without that little spark of life//i have been in a lot worse conditions since ,even suicide attept//brought on through bad p doc pratice//but what stuck in my mind is that one time i saw the world different//i have never got to be that good again bbbbbbbut it never leaves my head//so i would have been dead ///end off without meds// the post is a little old talk really //people killed themself in the hundreds before meds//it was just put down to save face //heart attack or simular//the pressures are far greater today//no more jobs for life//millions more people//asylums were bursting with patients ,,drugs an new meds have closed most down//how would a schizophrenic hold down a job without meds/or a bipolor patient//i think without meds the world would have nuked itself 10 years ago
Posted by SLS on June 7, 2010, at 9:08:33
In reply to Re: Don't know what to believe, posted by manic 666 on June 7, 2010, at 8:49:20
Your experience with remission is much the same as mine. The world seemed totally different to me during the nine months I was well in 1987. It was a completely different place to live in. I didn't feel different - the world felt different. I hold tightly to my memories of that time. It is all I have to convince me that it is worth the pain and suffering to continue working towards finding another effective treatment. I know that life can be worth living when free of depression.
- Scott
Posted by Mrtook on June 7, 2010, at 9:43:35
In reply to Re: Don't know what to believe, posted by Huxley on June 7, 2010, at 0:25:56
Well I haven't read the book and I am not sure I will as the pdf linked,to me was a scare piece masquerading as a scholarly article and such bait and switch tactics turn me off.
Huxely you are entitled to your opinion and you and Whitaker my very well be right. I have no doubt you and Whitaker believe it to be true, but to me it is just another hypothesis right up there with not taking medication leads to a worsening of conditions.
Posted by manic 666 on June 7, 2010, at 12:25:30
In reply to Re: Don't know what to believe, posted by Mrtook on June 7, 2010, at 9:43:35
buddy ,how cool is that//i hope my post gave you a boost// so much alike but are lives have been so different //stay safe my brother
Posted by Huxley on June 7, 2010, at 18:04:50
In reply to scott, posted by manic 666 on June 7, 2010, at 12:25:30
Hi All,
This book profoundly changed the way I look at psychiatric medications and the industry.
If nothing else it is an intriguing look into it's history.
You walk your own path in life and I am not trying to tell you which direction to walk.
I have found that over the course of my treatment with psychiatric medications, I have lacked information.
I have relied upon doctors who seem to have less knowledge about the subject than me and ancedotal evidence and advice from people on the internet.
I think it is a very valuable information for anyone who is using psychiatric medicine.
Posted by manic 666 on June 8, 2010, at 4:22:45
In reply to Re: scott, posted by Huxley on June 7, 2010, at 18:04:50
this may be true for you///but for people who tried to go through life without meds like me//an found myself finally on the floor//nowhere else to go,only meds or death// then getting relief from them ,,something you never had///why would i want to read a book that would trigger an rubbish to only think i have left//have you got something i could look to after i crash an burn//people who are ill dont want to read book that rubbish the only thing the have//every thing in the book may be true //bbbbbbbut i dont want to no
Posted by mrtook on June 8, 2010, at 7:47:59
In reply to Re: scott, posted by Huxley on June 7, 2010, at 18:04:50
> Hi All,
>
> This book profoundly changed the way I look at psychiatric medications and the industry.
>
> If nothing else it is an intriguing look into it's history.
>
> You walk your own path in life and I am not trying to tell you which direction to walk.
>
> I have found that over the course of my treatment with psychiatric medications, I have lacked information.
>
> I have relied upon doctors who seem to have less knowledge about the subject than me and ancedotal evidence and advice from people on the internet.
>
> I think it is a very valuable information for anyone who is using psychiatric medicine.
>
>
Huxley, would you mind sharing your story? What have you suffered from? What meds have you taken? What works for you now,Regards, mr took
Posted by manic666 on June 8, 2010, at 12:47:19
In reply to Re: scott, posted by Huxley on June 7, 2010, at 18:04:50
yes huxley ,tell us your history
Posted by Huxley on June 9, 2010, at 5:33:55
In reply to Re: scott, posted by manic666 on June 8, 2010, at 12:47:19
I was put on Zoloft for Social anxiety when I was about 20 years old.
It helped alot at the time but of course it stopped working.I was shopped around all the SSRI's and SSNI's. Nothing really did much to help me.
I have always been mildly depressed or dysthymic. I have always had trouble relating to people
and 'fitting in'.I had a depressive episode when I was about 24 after the break up of a relationship.
I recovered from that and a couple of years ago I had another one, again at the end of a relationship.
I was a mess. I couldn't sleep and I was in a deep dark hole.My doctor put me first on Zyprexa and then seroquel as well. I stopped the Seroquel but stayed on the Zyprexa.
Things have progressivly gotten worse and so my doctor put me on lactimal and provigil.And that is where I am now. I am still dysthymic. I still have alot of anxiety, probably more than ever. And on top of
that I have the side effects that come with all these meds.I have never been the same as the day I was before I started taking zyprexa.
So thats why I ask the question. What are these medications doing for me? I still have all my original symptoms which
are probably worse anyway. I have trouble with the simpelest of tasks. My short term memory is gone, I can't remember a thing even if I try.
I forget words and muddle up sentances. I am pretty much emotionless, although I still seem to feel the bad ones.So i'm just as lost and messed up as most.
I want to see what life is like without meds and If I crash and burn in the process so be it.
I am encouraged my thousands of others who have done it and are living peaceful lives. And I am scarred of the thousands of others who have just lost
the plot attempting it. I am scared of the withdrawals. Maybe I will go through a year of hell and end back up here at square one but to me the risk of that is less than the risk of living the rest of my life like I am now.
Posted by SLS on June 9, 2010, at 7:26:57
In reply to Re: scott, posted by Huxley on June 9, 2010, at 5:33:55
> My doctor put me first on Zyprexa and then seroquel as well. I stopped the Seroquel but stayed on the Zyprexa.
> Things have progressivly gotten worse and so my doctor put me on lactimal and provigil.What a mess. No wonder you have lost faith in biological psychiatry. I don't understand why these drugs have been chosen to treat depression, dysthymia, or social anxiety.
I completely understand your desire to discontinue drug treatment. If you find it necessary to restart pharmacotherapy in the future, you might want to explore the use of MAO inhibitors.
- Scott
Posted by manic666 on June 9, 2010, at 8:58:37
In reply to Re: scott, posted by Huxley on June 9, 2010, at 5:33:55
huxley //thats what i mean //a bad d tox can an will kill you simple as//i am a strong man an i was bought to my knees with d dox//// slow d tox may be ok //but some talk of full stop detox//i carnt stress enough how bad that would be//mine was forced //but to do it voluntary on a high dose of meds//perpair to crash an even die//thats no b*llsh*t
Posted by MrTook on June 9, 2010, at 10:46:42
In reply to Re: scott, posted by Huxley on June 9, 2010, at 5:33:55
It certainly seems that you are not in a good place. I am not trying to change your mind on your course of action, but have you considered getting a 2nd opinion from another pdoc?
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