Psycho-Babble Medication Thread 86151

Shown: posts 1 to 25 of 27. This is the beginning of the thread.

 

If you had to suggest three textbooks on meds for

Posted by svevo1922 on December 6, 2001, at 12:00:55

depression, anxiety and OCD (not bipolar disorder), what would they be? I've asked my doc a few times for recommendations for such books at the med-school level, or just below, but he always forgets.

Thanks in advance.

 

Re: If you had to suggest three textbooks on meds for

Posted by Cam W. on December 7, 2001, at 0:26:43

In reply to If you had to suggest three textbooks on meds for , posted by svevo1922 on December 6, 2001, at 12:00:55

Svevo - I like journals, rather than textbooks. It seems that textbooks are outdated before they hit the shelves. For pyschopharmacology, I would recommend the books by Dr. Stephen M. Stahl, an editor of The Journal of Clinical Psychiatry. I believe that he has at least 4 books out.

To find him (and to help out Dr.Bob), go to the top of the main page and type "Stephen M. Stahl" into the search of the Amazon ad. It should list his books, their prices, and their ratings. Dr. Stahl has access to the top researchers in the world through his editting of J.Clin.Psychiatry, so he is fairly up-to-date. He is also not afraid to go out on a limb when making statements.

As for 3 journals that I would have airdropped if I was stuck on a desert island, they would be:

The Journal of Clinical Psychiatry.

Neuropsychopharmacology

The European Journal of Pharmacology

- Cam

 

Re: Journal of Clinical Psychiatry » Cam W.

Posted by jazzdog on December 7, 2001, at 12:29:52

In reply to Re: If you had to suggest three textbooks on meds for , posted by Cam W. on December 7, 2001, at 0:26:43

Hi Cam

I wonder if you could do me a big favour. In the October 2001 issue of the Journal of Clinical Psychiatry is an article about using lamictal to treat depersonalization, by the team at Maudsley. I don't subscribe, and $60 US is a lot to pay for one article. If you've read the article, and if it's easy to summarize, would you mind posting a brief summary of the findings? Thanks a lot -

- Jane

 

Re: If you had to suggest three textbooks on meds for » svevo1922

Posted by paxvox on December 7, 2001, at 20:33:16

In reply to If you had to suggest three textbooks on meds for , posted by svevo1922 on December 6, 2001, at 12:00:55

I'm sure CAM had some good suggestions (but I didn't read the other posts) however, you can find just about ANY information you want about those things just by using search engines such as GOOGLE. I have found enormous amounts of data, much "intended" or generated by the medical community, that I have found very usefull. Give it a whirl, just type in the key words and start surfing!

PAX

 

Re: Journal of Clinical Psychiatry » jazzdog

Posted by Cam W. on December 13, 2001, at 17:27:43

In reply to Re: Journal of Clinical Psychiatry » Cam W., posted by jazzdog on December 7, 2001, at 12:29:52

Jane - Sorry, I almost forgot about this post.

"Lamotrigine in the Treatment of Depersonalization Disorder" is a letter to the editor by a group from King's College in London, England (M Sierra, ML Phillips, MV Lambert, C Senior, AS David) and JH Crystal from Yale in New Haven, USA. •Paid for by Glaxo Wellcome•. In J Clin Psychiatry, Oct. 2001; pp 826-827.

Lamictal has been reported to inhibit glutamate release and depersonalization symptoms may be due to excess excitatory amino acids.

Eleven treatment-resistant patients with chronic depersonalization disorder (for 2 to 15yrs) given lamotrigine as an add-on therapy to SSRIs (1 patient was taking no meds) Six of eleven responded (2 parox; 1 fluox; 1 sert; 1 cita + lith; monotherapy in 1) with a 40% to 80% improvement on a "subjective" improvement scale. Only the results of the responders is shown. The lamotrigine dose raised gradually over 3 weeks to 200mg or 250mg/day (in responders).

Study limitations (as per Cam): 1) open label; 2) short term (3 weeks); 3) no placebo; 4) small size; 5) rating scale only out of 4 and is subjectively, not objectively, measured - never heard of scale, so not sure if it has been validated; 6) glutamate is only one excitatory amino acid; 7) most important - drug company sponsored.

Therefore, and the researchers even mention this, "caution is needed at this early stage before ascribing the improvement seen in our patients to a specific antidepersonalization effect".

- Cam

 

Re: Journal of Clinical Psychiatry » Cam W.

Posted by jazzdog on December 13, 2001, at 17:54:27

In reply to Re: Journal of Clinical Psychiatry » jazzdog, posted by Cam W. on December 13, 2001, at 17:27:43

Cam -

Thank you so much for this. You really are an extraordinarily generous and helpful man. I agree with your list of limitations, particularly vis a vis the limited size and scope of the study and the sponsorship of Glaxco. But, as someone who has suffered from chronic derealization for most of my life, I'm willing to try anything. I'm hoping that the integrity of the Maudsley Hospital, the U. of London, and Yale trumps the drug company's participation. I know that the dp unit, staffed by these researchers, has treated over a hundred cases with lamictal, with what they claim is 60% success. Also, anecdotally, some dp sufferers on dpselfhelp.com report success with lamictal. I'm still at 75 mg, titrating slowly up to 250 mg., and alas, I so far haven't experienced any diminishing of dp symptoms. But I am less irritable, and I seem to be sleeping better. I'm hoping it at least potentiates the zoloft I'm on - there have been inklings of this. I'll still be living in a dream, but at least it will be a happy one.

If glutamate is only one excitatory amino acid, what are the others? Are there drugs to counteract them? Please don't go to any trouble to answer those questions, but if you know the answers off the top of your head, I'd be very interested.

Thanks again -
Jane

 

Re: Excitatory Amino Acids

Posted by Cam W. on December 13, 2001, at 18:17:40

In reply to Re: Journal of Clinical Psychiatry » Cam W., posted by jazzdog on December 13, 2001, at 17:54:27

Jane - Here's more reading than you need, but I think that you'll enjoy (well, maybe not enjoy) this:

http://www.acnp.org/g4/GN401000007/Default.htm

Have fun - Cam

P.S. If you have any questions about the article, just ask. - C.

 

Re: Excitatory Amino Acids » Cam W.

Posted by jazzdog on December 14, 2001, at 11:07:21

In reply to Re: Excitatory Amino Acids, posted by Cam W. on December 13, 2001, at 18:17:40

Hi Cam -

Thanks (I think) for the link. I dutifully read through it all, and barely understood a word. The article says something about the excitatory protein loops being complex systems - boy, they ain't kidding.

I don't think I understand this stuff well enough to pose any intelligent questions. Maybe if I keep taking the lamictal, my cognitive functions will improve.

Thanks again -
Jane

 

Re: Excitatory Amino Acids

Posted by dave40252 on December 14, 2001, at 12:37:31

In reply to Re: Excitatory Amino Acids, posted by Cam W. on December 13, 2001, at 18:17:40

Hi - I'm not Jane, but i did read the info you linked to. Would appreciate it if you could give a brief "dumbed down" explanation of what this says and why it is significant!

Thanks

> Jane - Here's more reading than you need, but I think that you'll enjoy (well, maybe not enjoy) this:
>
> http://www.acnp.org/g4/GN401000007/Default.htm
>
> Have fun - Cam
>
> P.S. If you have any questions about the article, just ask. - C.

 

Dumbed Down EAA explanation

Posted by IsoM on December 14, 2001, at 14:35:24

In reply to Re: Excitatory Amino Acids, posted by Cam W. on December 13, 2001, at 18:17:40

I can't understand everything being said in the link Cam gave (I think you'd need a 4th year level to understand it all) but basically it's discussing how the different EAAs work.

Scientists can understand the different shapes a particular EAA (like L-glutamate) take in the different pathways of neural transmission by making specific analogues of each shape & seeing where & what in the pathway is blocked using in vitro & in vivo studies. By doing so, they have the opportunity to develop new medications that fit these shapes.

An EAA (excitatory amino acid) can fold & bend into different shapes. Most proteins if folded into a different shape, no longer work or work incorrectly (prions & mad cow disease). Scientists first learned about L-glutamate & then learned just how many roles it plays by altering its shape as needed. What they hope is to develop an inhibitor medication that will fit each shape needed to control steps along the pathway.

Basically, the article talks about the steps, molecules, & shapes of these EAA molecules in understanding brain processes better which will enable them to develop (chemical engineering) the needed drugs to control problems. They're also finding what genes regulate these processes & perhaps in the future repairs to these genes will normalise us better.

I hope I've got most of this correctly & haven't dumbed it down too much. Cam will correct me if I have. :)

 

Re: Journal of Clinical Psychiatry » jazzdog

Posted by Cam W. on December 14, 2001, at 16:00:21

In reply to Re: Journal of Clinical Psychiatry » Cam W., posted by jazzdog on December 13, 2001, at 17:54:27

Jane - Sorry, I forget people don't always follow this stuff. Hell, the EAA stuff is my type of bathroom reading material (god!...I am a geek!).

Essentially, what the articles says is that, because of their relative toxicity (ie narrow therapeutic window), and their involvement in many, many bodily processes (intracellular energy regulation, calcium homeostasis, cognitive functioning, etc.), it is difficult to use EAAs directly, to treat specific disorders (they use glutamate as the example, but others excitatory amino acids can also stimulate the myriad of excitatory receptors. Some of these other EAAs are: S-sulfo-L-cysteine, L-homocysteate, L-aspartate,
homoquinolinate, L-homo-cysteinesulfinate, L-cysteinesulfinate, L-serine-O-sulfate,
L-cysteate, and quinolinate. This is in order - greatest to least - of their potencies, with glutamate being the most potent.

Therefore, to treat disorders caused by a malfuncrion of EAAs, researchers have been forced to look at other steps in the specific pathways where the breaks have occurred. Some of these therapeutic targets could be EAA-related G-proteins, the phosphoinositol (PI) pathway (where lithium may act), or at one of the various sub-receptors of EAAs. The do stress that the several receptor subtypes that of EAAs have very diverse actions and are controlled in a myriad of ways.

Before any medication can be made to work on defiencies or breakdowns of these excitatory systems, most selective agonists and antagonists are needed to tease out the subtle, but complex functioning, and neural correlates of excitatory neuronal functioning.

The article then goes on to show what is being tried by researchers, to modify single connections, in this highly interconnected system. The medications are still a few years away. - Cam

 

Re: Journal of Clinical Psychiatry » Cam W.

Posted by jazzdog on December 14, 2001, at 18:34:55

In reply to Re: Journal of Clinical Psychiatry » jazzdog, posted by Cam W. on December 14, 2001, at 16:00:21

Cam -

Thanks for another comprehensive reply. If derealization turns out to be due to excitatory proteins, then I guess hope is only a few years away. It makes sense - several sufferers complain of hyperstimulation pushing them into a kind of psychic numbness. People with dp/dr experience a worsening of symptoms with bright lights, fluorescent lights, chaotic noise, and crowds. From various polls on the dpselfhelp website, it seems that everyone has a parent who is bipolar, schizophrenic, or borderline, and everybody has a tendency toward obsessional thought patterns. Most have suffered from depression - I've had lifelong dysthymia, half a dozen major depressions, and two full-blown psychotic manic episodes. But it's the derealization that I find hardest to take - it's like living life in a waking dream. It feels physical, not emotional - like something in the temporal lobe has short-circuited.

Bathroom reading? Really? Pretty scary, Cam.

- Jane

 

Re: If you had to suggest three textbooks on meds » paxvox

Posted by svevo1922 on December 15, 2001, at 1:41:33

In reply to Re: If you had to suggest three textbooks on meds for » svevo1922, posted by paxvox on December 7, 2001, at 20:33:16

Thanks for the tip, but I'm quite astute at surfing, and I use google, ilor, copernic pro, dogpile, etc. I was really looking for some more focused advice from people who are already well read in this area. CAM's comment that one must read journals to stay up to date was helpful. I have two additional questions:

1. Will reading a good recent textbook help to provide the orientation necessary to u'stand the journal articles better?

2. Are these journals available at any general, university, or medical libraries open to the public in the northeast?

Thanks again to all for responses.
___________________________________-


> I'm sure CAM had some good suggestions (but I didn't read the other posts) however, you can find just about ANY information you want about those things just by using search engines such as GOOGLE. I have found enormous amounts of data, much "intended" or generated by the medical community, that I have found very usefull. Give it a whirl, just type in the key words and start surfing!
>
> PAX

 

Be careful with journal material

Posted by spike4848 on December 15, 2001, at 15:37:39

In reply to Re: If you had to suggest three textbooks on meds for , posted by spike4848 on December 15, 2001, at 15:23:54

> I agree, journals have the most up to date ...... well I would say "stuff." Medicine today is very different then even 5 years ago. The heart and soul of medicine is in the pockets of pharmaceutical companies. If it takes 2 to 3 million dollars to get a drug approved, you bet any company may cut some corners to make a profit back. I am leary sometimes of the articles in The Journal of Clinical Psychiatry. Many of the studies are sponsered by drug companies. When they compare drugs in studies, you never see TCA used at correct doses. They will compare Wonder Drug X to imipramine at doses of 150 mg. It is well known many people need up to 300 mg of imipramine per day to get a response. And if you look at the patient population, these people seem to depression lite-with half the calories. They're Hamilton-D scores just barely meet criteria for major depression.
>
> Textbook information is usually tried and true, has stood the test of time. But the best source is probably a seasoned clincian- who see patients day in and day out- sees that wonder drug X works great but wonder drug Y does not. Or even people on the web site like elizabeth. But I am leary of a few people here too ... it is so easy for someone to say drug X cured all my symptoms .. you should try it too.
>
> Spike

 

Re: textbooks on meds » svevo1922

Posted by Elizabeth on December 15, 2001, at 19:43:19

In reply to Re: If you had to suggest three textbooks on meds » paxvox, posted by svevo1922 on December 15, 2001, at 1:41:33

Umm. That's a difficult question. I'd recommend The American Psychiatric Press Textbook of Psychopharmacology, but with the caveats that it is itself pretty dense in some places and that it's bloody expensive (see if your library or medical library has it). There are these books that are written with laypeople as the intended audience, but they almost invariably seem to be too shallow (I think that a lot of doctors, including the ones writing the books, still don't realize what we are capable of). I'd be interestsed to know what good "in-between" resources people have found.

-elizabeth

 

Re: textbooks/Nwsltrs a source? But not Harvard's

Posted by svevo1922 on December 15, 2001, at 21:02:35

In reply to Re: textbooks on meds » svevo1922, posted by Elizabeth on December 15, 2001, at 19:43:19

I appreciate all the suggestions. I, too, would be interested in sources written at an intermediate level. I went to the site of one of the articles suggested by Cam, I think to Jane, and I would have a very hard time of making sense of it.

I hope that my earlier message about "I know how to surf the Web" didn't come off as impolite. It's just that I have already spent so much time sorting out the different available sources of information. I always read the official company drug monograph and it's gotten to the point that if certain side effects are reported as low, I immediately suspect them.

What about newsletters as intermediate-level sources of info? But I can't recommend the Harvard Mental Health Newsletter. I have been disappointed by its contents, which are somewhat scattershot and superficial.

Are there others that can be recommended?


I'd be interestsed to know what good "in-between" resources people have found.
>
> -elizabeth

 

Re: textbooks/Nwsltrs a source? But not Harvard's

Posted by svevo1922 on December 15, 2001, at 21:59:28

In reply to Re: textbooks/Nwsltrs a source? But not Harvard's, posted by svevo1922 on December 15, 2001, at 21:02:35

I forgot to add this. Someone said why not ask a good clinician? I discuss different drug therapies I've read about with my pdoc all the time and he answers my questions. He's a lot more receptive than my therapist, to whom I was referred by my pdoc, who keeps telling me I'm trying to tell him how to do his job! (The irony of course is that I think I'm in a much better position to comment on what's likely to work in therapy than in psychopharmacology. I have had a longish acquaintanceship with myself, as it happens.)

My pdoc doesn't have infinite amounts of time to field my questions. But I should remind him again that he was supposed to suggest some books for me.

 

Re: textbooks/Nwsltrs a source? But not Harvard's

Posted by spike4848 on December 15, 2001, at 23:24:23

In reply to Re: textbooks/Nwsltrs a source? But not Harvard's, posted by svevo1922 on December 15, 2001, at 21:59:28

The bible of Psychiatry is pretty much, Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. It is extremely comprehensive, touches on most aspects of psychiatry.

Personally, on my shelf at home is ...

(1) Panic Disorder: The Medical Point of View by Kernodle
(2) The Psychopharmacology Sourcebook by Zetin and Tate
(3) Psychiatry (House Officer Series) by Tomb

I find the British journals to be very sound and unbias. The British Journal of Psychiatry is quality journal with solid articles. The Journal of Clinical Psychiatry is also good, although somewhat bias.

Spike

 

J Clin Psychiatry » spike4848

Posted by Elizabeth on December 16, 2001, at 11:51:58

In reply to Re: textbooks/Nwsltrs a source? But not Harvard's, posted by spike4848 on December 15, 2001, at 23:24:23

> The Journal of Clinical Psychiatry is also good, although somewhat bias.

Biased in what sense?

(My SO is a research snob and thinks that the Journal of Clinical Anything is automatically crap! :-) )

-elizabeth

 

Re: Bias-Financial

Posted by spike4848 on December 16, 2001, at 15:35:43

In reply to J Clin Psychiatry » spike4848, posted by Elizabeth on December 16, 2001, at 11:51:58

> > The Journal of Clinical Psychiatry is also good, although somewhat bias.
>
> Biased in what sense?

Don't get me wrong, I think the Journal of C.P. has very innovative and ground breaking studies. People just have to be careful, and properly interprete what the study results mean.

I'm sure everyone notices that the studies are sponsered by the drug companies themselves or the author of the article is employed/receives grant money from a drug company. So many of the investigators have a vested interest in results of studies ... the results of the study may affect how much money goes into the college fund of their children or into house payments or simply putting food on the table.

This is why you never see an article in a journal titled, "New wonder drug X is completely ineffective for depression." The drug companies have been known to suppress research studies with negative results. And if drug X is ineffective ... that is important to know! So people with depression or whatever do not have to suffer though a 6,8 or 10 week trial of an ineffective medication.

I sure you know about the whole Synthroid/levoxyl lawsuit ..... where a drug company tried to force the researchers of a study they sponsered to supress the results. The study demonstrated their drug was inferior to a generic drug ... that is so wrong.
>
> (My SO is a research snob and thinks that the Journal of Clinical Anything is automatically crap! :-) )

>
> -elizabeth

 

Re: Bias-Financial » spike4848

Posted by Elizabeth on December 16, 2001, at 22:37:07

In reply to Re: Bias-Financial, posted by spike4848 on December 16, 2001, at 15:35:43

> The drug companies have been known to suppress research studies with negative results.

Yes, of course. But is this particularly a problem in JCP? I didn't know that.

-elizabeth

 

Elizabeth

Posted by spike4848 on December 17, 2001, at 7:03:07

In reply to Re: Bias-Financial » spike4848, posted by Elizabeth on December 16, 2001, at 22:37:07

> > The drug companies have been known to suppress research studies with negative results.
>
> Yes, of course. But is this particularly a problem in JCP? I didn't know that.

Yes, all journals suffer to a degree .... But some of JCP supplements and CME sections are geared simply to introduct a new drug by a pharmaceutial company. And yes, I find quality of their studies are not as high as in other journals.

Spike

>
> -elizabeth

 

Re: Elizabeth » spike4848

Posted by Cam W. on December 20, 2001, at 7:04:13

In reply to Elizabeth, posted by spike4848 on December 17, 2001, at 7:03:07

Spike - I subscribe to both JCP and The Archives of General Psychiatry (I had access to The American Journal of Psychiatry at the clinic, and now I borrow my pdoc's - it is outrageously priced; especially at the Canadian dollar - > $400 CDN/yr; where the other 2 are about $200 CDN/yr; besides Nancy Andreasen pissed me off at a conference a couple of years back :^)

I find JCP to be more clincally relevant than AGP or AJP. Also, a lot of the tables and charts in JCP studies are very good; especially Stahl's "Pearls of Wisdom" summaries and many of his editorial synopses of current thought. I keep enlargements in a binder for quick reference.

It is true that a lot of the drug company-funded studies in JCP are slanted, but as long as you look for the funding, it is easy to read between the lines to see what the study is really saying. The reviewers are fairly good at making them expose information, even though some of it may not be as overt as it could be.

My not some humble opinion - Cam


 

Cam: about subscribing to JCP

Posted by IsoM on December 20, 2001, at 11:30:24

In reply to Re: Elizabeth » spike4848, posted by Cam W. on December 20, 2001, at 7:04:13

Cam, I went to the JCP site & browsed through the Table of Contents. Then I checked out the subscription rates. Am I confused when it says that a person can be a Platinum subscriber for $60.00/year? That's not a bad bargain.

Or does it mean if I already subscribe to the paper journal, I can access it all on-line from their site for an additional $60.00? I'm definitely interested in it.

 

Re: Cam: about subscribing to JCP » IsoM

Posted by Cam W. on December 20, 2001, at 12:56:52

In reply to Cam: about subscribing to JCP, posted by IsoM on December 20, 2001, at 11:30:24

IsoM - The $60 is just for access to the JCP site. I like having the journal. I mean I'd print all the articles anyway, so I'd probably spend more than a couple hundred dollars on paper an toner. With the print journal you get full access to the site, as well.

Until this summer, you were able to download the whole journal, but now you can only download one article at a time. I have all the journals on my harddrive, but I still like having the print journal beside my bed. I think JCP is worth getting.

I think that the price is worth it, even at the lousy exchange rate on the Canadian dollar. I wanted to subscribe to Neuropsychopharmacology, but the owners, Elsevier, want an outrageous price (something like $500 CDN). Until I can write off journals on my income tax, I really can't justify another expensive journal to my wife ;^)

- Cam



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