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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by linkadge on July 19, 2011, at 14:22:59
Wow. **THIS** is the kind of research we need done. Study confirms what a few here have hypothesized.
http://www.sciencedaily.com/releases/2011/07/110719121354.htm
Posted by Phillipa on July 19, 2011, at 18:44:46
In reply to Study: AD use linked to **MORE** relapses, posted by linkadge on July 19, 2011, at 14:22:59
I do believe it as twice when younger and on no ad's sat in a chair or lay on couch for two weeks after stressful periods. I did have benzos but not ad's. After two weeks I just got up and started over. Phillipa
Posted by jono_in_adelaide on July 19, 2011, at 20:00:51
In reply to Re: Study: AD use linked to **MORE** relapses » linkadge, posted by Phillipa on July 19, 2011, at 18:44:46
"Most depressive episodes are triggered by traumatic events such as the death of a loved one, the end of a relationship or the loss of a job. Andrews says the brain may blunt other functions such as appetite, sex drive, sleep and social connectivity, to focus its effort on coping with the traumatic event."
I'm quite happy to accept that depression under these conditions is self limiting and part of the healing process - but what does he suggest for people like me, who suffer deep suicidal depression for no apparent reason? Just kill our self early in the course of the illness and get it over with?
Posted by SLS on July 19, 2011, at 21:06:13
In reply to Study: AD use linked to **MORE** relapses, posted by linkadge on July 19, 2011, at 14:22:59
> Wow. **THIS** is the kind of research we need done. Study confirms what a few here have hypothesized.
>
> http://www.sciencedaily.com/releases/2011/07/110719121354.htmWhat is it about this article that separates it from all the others scientifically? Do you just like the conclusion, or, rather, the science that produced it?
Were those chosen to take medication more ill to begin with, and thus more likely to relapse? Are a great many of the "relapses" cited actually temporary drug discontinuation withdrawal rebound depressions?
This guy is way off. Of course, this is but one possible conclusion.
- Scott
Posted by Christ_empowered on July 19, 2011, at 23:50:15
In reply to Re: Study: AD use linked to **MORE** relapses » linkadge, posted by SLS on July 19, 2011, at 21:06:13
I believe it. I think doctors need to be more careful about selecting patients for whom antidepressants, possibly used indefinitely, would be appropriate. Many people could probably benefit from other forms of treatment--exercise, anticonvulsants, stimulants, benzos, etc.--that might not induce these brain changes.
Posted by JONO_IN_ADELAIDE on July 20, 2011, at 1:08:06
In reply to Re: Study: AD use linked to **MORE** relapses, posted by Christ_empowered on July 19, 2011, at 23:50:15
"stimulants, benzos"
Yeah, because they dont produce any dependency do they?
Posted by jane d on July 20, 2011, at 3:11:58
In reply to Study: AD use linked to **MORE** relapses, posted by linkadge on July 19, 2011, at 14:22:59
http://www.frontiersin.org/evolutionary_psychology/10.3389/fpsyg.2011.00159/full
The article is in something called the frontiers in evolutionary psychology. Note that it is not peer reviewed. http://www.frontiersin.org/about/evaluationsystem
I'll reserve any other comments until I've had time to read it.
Posted by SLS on July 20, 2011, at 5:59:28
In reply to About the actual article - and link, posted by jane d on July 20, 2011, at 3:11:58
> http://www.frontiersin.org/evolutionary_psychology/10.3389/fpsyg.2011.00159/full
>
> The article is in something called the frontiers in evolutionary psychology. Note that it is not peer reviewed. http://www.frontiersin.org/about/evaluationsystem
>
> I'll reserve any other comments until I've had time to read it.
>
>
>
>
Thanks.
- Scott
Posted by SLS on July 20, 2011, at 6:24:44
In reply to Re: Study: AD use linked to **MORE** relapses, posted by Christ_empowered on July 19, 2011, at 23:50:15
> I believe it.
What do you believe, exactly. What evidence do you have to believe it?
> I think doctors need to be more careful about selecting patients for whom antidepressants, possibly used indefinitely, would be appropriate.
Yes. but would you know this in advance? Unfortunately, the selection criteria that would be used in such a protocol doesn't exist, and is poorly represented by the DSM IV. Soon, clinical treatment will be chosen by a combination of behavioral presentations and biological markers. In fact, I don't doubt that a biological phenotype will predict treatment outcomes. In the meantime, without these tools, I don't know how one would differentiate clinical presentations as a guide to treatment choices.
> Many people could probably benefit from other forms of treatment--exercise, anticonvulsants, stimulants, benzos, etc.--that might not induce these brain changes.
It seems to me that the treatments you suggest are ineffective in MDD, especially the endogenous type, and most presentations of BD depression. How do you justify your suggestions?
Are you still utilizing safe pharmacological modalities yourself? Have you ever? I know through personal experience that, of the available psychotropics, I respond to a treatment regime that must include a combination of two antidepressants - MAOI and TCA.
Personally, I have little doubt that antidepressants can produce profound and perhaps permanent untoward effects in CNS function. However, this is not something that this article addresses with supportive scientific evidence. It is, like my opinion, a personal theory on the part of the author that is made without objectively acquired information. I have yet to read the full text being referred to as has been provided by Jane D., though.
- Scott
Posted by SLS on July 20, 2011, at 6:37:25
In reply to Study: AD use linked to **MORE** relapses, posted by linkadge on July 19, 2011, at 14:22:59
Me: "Do you just like the conclusion, or, rather, the science that produced it?"
I apologize Linkadge. This sentence was written in haste and a product of emotional arousal. It was a personal attack of sorts. Sorry.
I read as much of the article as I had the stomach for. The guy is way off. Fancy graphs representing retrospective meta-analysis reviews of medical literature searches using their proprietary selection exclusions sure looks persuasive.
- Scott
Posted by Bob on July 21, 2011, at 0:40:01
In reply to Re: Study: AD use linked to **MORE** relapses » Christ_empowered, posted by SLS on July 20, 2011, at 6:24:44
I know through personal experience that, of the available psychotropics, I respond to a treatment regime that must include a combination of two antidepressants - MAOI and TCA.
>
> - Scott
Scott,What is your experience with SSRIs? I've noticed that they're never considered in your current or recent cocktails. Don't the MAOIs cause significant side effects for you, or did you find that the longer you were on them the less pronounced they became?
Bob
Posted by huxley on July 21, 2011, at 3:46:18
In reply to Re: Study: AD use linked to **MORE** relapses » SLS, posted by Bob on July 21, 2011, at 0:40:01
I agree with this guy.
Posted by SLS on July 21, 2011, at 5:30:58
In reply to Re: Study: AD use linked to **MORE** relapses » SLS, posted by Bob on July 21, 2011, at 0:40:01
> I know through personal experience that, of the available psychotropics, I respond to a treatment regime that must include a combination of two antidepressants - MAOI and TCA.
> >
> > - Scott
>
>
> Scott,
>
> What is your experience with SSRIs? I've noticed that they're never considered in your current or recent cocktails. Don't the MAOIs cause significant side effects for you, or did you find that the longer you were on them the less pronounced they became?
>
> Bob
Hi Bob.I was first exposed to a SSRI in 1983. It was a French drug called Indalpine. I don't know that it is still around, but it also had positive effects on anxiety; though at the cost of moderate amotivation.
The only SSRI drugs that I have not tried are Celexa and Luvox. My history with SSRIs is that I experience a brief 3-day improvement of depression in the first or second weeks. The side effects of SSRIs I experience are fairly typical. but tolerable. Nardil and Parnate both have produced side effects for me that eventually mitigated with time. I *almost* don't know that I am taking them after 4-6 months. I have found this also to be true of some TCAs, even when combined with other antidepressants. Of course, I can only guarantee how these drugs affect me but not everyone else.
Here are the majority of dugs that I have tried over the years to treat bipolar depression. It does not list drug combinations, however. The list would be very long were they included. Not all of the items are antidepressants.
- Scott
-----------------------------------------------adinazolam
agomelatine
alprazolam
amitriptyline
amoxapine
amphetamine
aripiprazole
asenapine
bromocriptine
bupropion
carbamazepine
chloral hydrate
chlorpromazine
clomipramine
clonazepam
clorgyline
desipramine
doxycycline
duloxetine
escitalopram
fluoxetine
fluphenazine
gabapentin
idazoxan
iloperidone
imipramine
indalpine
isocarboxezid
lamotrigine
levitiracetam
lithium
lorazepam
lurasidone
methylphenadate
mifepristone
milnacipran
mirtazapine
moclobemide
modafinil
nomifensine
nortriptyline
olanzapine
oxcarbazepine
paroxetine
pemoline
perphanazine
phenelzine
PKU-8059
pregabalin
protriptyline
quetiapine
reboxetine
risperidone
selegiline
sulpiride
temazepam
thioridazine
thyroxine T4
topiramate
tranylcypromine
trazodone
triazolam
triiodothyronine T3
trimipramine
valproate
venlafaxine
viqualine
ziprasidone
zaleplon
zolpidem
zonisamide
----------------------------------------- Scott
Posted by SLS on July 21, 2011, at 5:35:18
In reply to Re: Study: AD use linked to **MORE** relapses, posted by huxley on July 21, 2011, at 3:46:18
> I agree with this guy.
What, specifically, do you agree with?
Why do you agree with it?
The author wrote about more than one issue.
- Scott
Posted by Zana on July 21, 2011, at 17:02:33
In reply to Re: Study: AD use linked to **MORE** relapses » huxley, posted by SLS on July 21, 2011, at 5:35:18
The image used in the article of the brain being like a spring loaded with weight- or ADs- springing back after being unloaded makes perfectly good sense to me. It helps explain why it is so hard to get off Meds.
Posted by Kizzie on July 25, 2011, at 4:49:31
In reply to Re: Study: AD use linked to **MORE** relapses, posted by Zana on July 21, 2011, at 17:02:33
What is everyones view on whether you can actually reverse these effects.
So *IF* they are true and there is some long term negative impact on the brains capability of dealing with trauma/depression - can it then recover over time if say ADs are discontinued.
Thanks
Posted by Bob on July 25, 2011, at 15:14:26
In reply to Re: Study: AD use linked to **MORE** relapses, posted by Kizzie on July 25, 2011, at 4:49:31
> What is everyones view on whether you can actually reverse these effects.
>
> So *IF* they are true and there is some long term negative impact on the brains capability of dealing with trauma/depression - can it then recover over time if say ADs are discontinued.
>
> Thanks
>
>
What's so depressing about these studies for me is that I think they may be true in many cases. Problem is, we might just be beginning to discover that this is the case. Nobody knows how to help treatment resistand depression now, and if tardive dysphoria does exist no one seems to know the first thing about how to help it.Bob
Posted by kizzie2 on July 26, 2011, at 5:59:20
In reply to Re: Study: AD use linked to **MORE** relapses » Kizzie, posted by Bob on July 25, 2011, at 15:14:26
Thats what I feared someone would say :-(
Posted by Lou Pilder on July 26, 2011, at 7:50:59
In reply to Re: Study: AD use linked to **MORE** relapses » Kizzie, posted by Bob on July 25, 2011, at 15:14:26
> > What is everyones view on whether you can actually reverse these effects.
> >
> > So *IF* they are true and there is some long term negative impact on the brains capability of dealing with trauma/depression - can it then recover over time if say ADs are discontinued.
> >
> > Thanks
> >
> >
>
>
> What's so depressing about these studies for me is that I think they may be true in many cases. Problem is, we might just be beginning to discover that this is the case. Nobody knows how to help treatment resistand depression now, and if tardive dysphoria does exist no one seems to know the first thing about how to help it.
>
> Bob
>
Bob,
You wrote,[...xxx knows how to help treatment resistant depression...yyy seems to know...].
I am unsure *ss to what you are wanting too mean here. If you could post answers to the following, then I could have the opportunity to respond accordingly.
A. Could there be someone that does know that could be unbeknownst to you?
B. If not, why not?
C. redacted by respondent
Lou
Posted by Bob on July 26, 2011, at 13:00:45
In reply to Lou's request-phozdrihndok » Bob, posted by Lou Pilder on July 26, 2011, at 7:50:59
> > > What is everyones view on whether you can actually reverse these effects.
> > >
> > > So *IF* they are true and there is some long term negative impact on the brains capability of dealing with trauma/depression - can it then recover over time if say ADs are discontinued.
> > >
> > > Thanks
> > >
> > >
> >
> >
> > What's so depressing about these studies for me is that I think they may be true in many cases. Problem is, we might just be beginning to discover that this is the case. Nobody knows how to help treatment resistand depression now, and if tardive dysphoria does exist no one seems to know the first thing about how to help it.
> >
> > Bob
> >
> Bob,
> You wrote,[...xxx knows how to help treatment resistant depression...yyy seems to know...].
> I am unsure *ss to what you are wanting too mean here. If you could post answers to the following, then I could have the opportunity to respond accordingly.
> A. Could there be someone that does know that could be unbeknownst to you?
> B. If not, why not?
> C. redacted by respondent
> Lou
I suppose there's a little exaggeration there but there seems to be increasing literature out there suggesting that many treated for depression are not achieving remission - especially in the treatment resistant set. Not all of course, but many.
Posted by Bob on July 26, 2011, at 23:13:39
In reply to Re: Study: AD use linked to **MORE** relapses » Bob, posted by SLS on July 21, 2011, at 5:30:58
> > I know through personal experience that, of the available psychotropics, I respond to a treatment regime that must include a combination of two antidepressants - MAOI and TCA.
> > >
> > > - Scott
> >
> >
> > Scott,
> >
> > What is your experience with SSRIs? I've noticed that they're never considered in your current or recent cocktails. Don't the MAOIs cause significant side effects for you, or did you find that the longer you were on them the less pronounced they became?
> >
> > Bob
>
>
> Hi Bob.
>
> I was first exposed to a SSRI in 1983. It was a French drug called Indalpine. I don't know that it is still around, but it also had positive effects on anxiety; though at the cost of moderate amotivation.
>
> The only SSRI drugs that I have not tried are Celexa and Luvox. My history with SSRIs is that I experience a brief 3-day improvement of depression in the first or second weeks. The side effects of SSRIs I experience are fairly typical. but tolerable. Nardil and Parnate both have produced side effects for me that eventually mitigated with time. I *almost* don't know that I am taking them after 4-6 months. I have found this also to be true of some TCAs, even when combined with other antidepressants. Of course, I can only guarantee how these drugs affect me but not everyone else.
>
> Here are the majority of dugs that I have tried over the years to treat bipolar depression. It does not list drug combinations, however. The list would be very long were they included. Not all of the items are antidepressants.
>
>
> - Scott
>
>
> -----------------------------------------------
>
> adinazolam
> agomelatine
> alprazolam
> amitriptyline
> amoxapine
> amphetamine
> aripiprazole
> asenapine
> bromocriptine
> bupropion
> carbamazepine
> chloral hydrate
> chlorpromazine
> clomipramine
> clonazepam
> clorgyline
> desipramine
> doxycycline
> duloxetine
> escitalopram
> fluoxetine
> fluphenazine
> gabapentin
> idazoxan
> iloperidone
> imipramine
> indalpine
> isocarboxezid
> lamotrigine
> levitiracetam
> lithium
> lorazepam
> lurasidone
> methylphenadate
> mifepristone
> milnacipran
> mirtazapine
> moclobemide
> modafinil
> nomifensine
> nortriptyline
> olanzapine
> oxcarbazepine
> paroxetine
> pemoline
> perphanazine
> phenelzine
> PKU-8059
> pregabalin
> protriptyline
> quetiapine
> reboxetine
> risperidone
> selegiline
> sulpiride
> temazepam
> thioridazine
> thyroxine T4
> topiramate
> tranylcypromine
> trazodone
> triazolam
> triiodothyronine T3
> trimipramine
> valproate
> venlafaxine
> viqualine
> ziprasidone
> zaleplon
> zolpidem
> zonisamide
>
>
> ----------------------------------------
>
>
>
> - Scott
I had a plan to try an MAOI that's been on the back burner for a while now. I had mentioned it previously to my pdoc and brought it up again at my most recent appointment. This time though, he seemed to change his tune. I suggested that I hold steady on the nortriptyline I'm on at 80mg, taper down the sertraline from 125mg to zero, wait for 2 weeks and then ramp up on the MAOI. Last time he agreed to consider that, but now he said that it is not feasible because of contraindications between the MAOI and a norepinephrine drug. I had given him an article in support of this a long time ago but now I can't find it. I simply don't think I can survive an excruciating taper, a washout period, a possible failed trial of an MAOI, and then another taper and washout before getting on a drug that may help me. That's a BIG risk for me as I've had 20 years of experience with how I react to withdrawals and washouts... it's not pretty.The other thing that really got me worried about trying an MAOI was that, special diet not withstanding, he said I would not be permitted to take any cold medicines or decongestants while on MAOIs. What happens when someone gets a terrible cold or flu?
What might be the final straw for excluding MAOIs from a trial possibility is the contraindication for taking any triptans while on them. I don't know what I'd do if I got an extreme migraine and couldn't take something like almotriptan. Once I got a headache so serious I had to be hospitalized and receive an injection of high dose Imitrex.
Then there's the serious issue of anasthesia if you need an operation.
I cannot afford to taper on and off of one of these meds for special situations and then spend days or weeks with no meds. It would be life threatening to say the least.
Bob
This is the end of the thread.
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