![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 46. This is the beginning of the thread.
Posted by rainbowbrite on May 29, 2005, at 12:06:29
This is a medication question so I think it is appropriate here??
Do you guys think it is possible that most of us dont need our drugs?
Sometimes I believe very strongly in the nurture side of mental health issues, but then other times I think but I cant handle a few days off my AD so whats up with that??
I feel so repetitive on this topic so Im sorry, but it is a serious issue for me
So do alot of you think that we could very well be addicted to our meds (excluding benzos)as opposed to needing them?
It just seems so strange to me to have to take a pill to make me less all over the place, more able to concentrate, less emotional and less able to focus 100% on what Im talking about ugh!
The meds help me stay focused and less emotional BUT they take away a portion of my concentration and I feel dulled on them....
Ok, I got off on a tangent but my question really was what do you think about the addiction theory as opposed to the meds are necessary theory??
Obviously many illnesses dont fall into this category but just curious.
Thanks for actually reading to the end of this :-)
Posted by fires on May 29, 2005, at 14:00:41
In reply to Meds need vs addiction?? what do you think?, posted by rainbowbrite on May 29, 2005, at 12:06:29
> Do you guys think it is possible that most of us dont need our drugs?Absolutely not, unless I'm the exception.
> So do alot of you think that we could very well be addicted to our meds (excluding benzos)as opposed to needing them?
Absolutely not. I'm afraid I told you what you didn't want to hear.
Posted by rainbowbrite on May 29, 2005, at 14:52:02
In reply to Re: Meds need vs addiction?? what do you think? » rainbowbrite, posted by fires on May 29, 2005, at 14:00:41
>>I'm afraid I told you what you didn't want to hear
You did, but thats ok. I am interested in views from both sides. I appretiate your response. :-)
Posted by SLS on May 29, 2005, at 15:06:22
In reply to Meds need vs addiction?? what do you think?, posted by rainbowbrite on May 29, 2005, at 12:06:29
Hi RB.
It is always dangerous to generalize to such a degree as to use the word "we". "We" represents a mosaic of interactions between psychological and physiological needs for which no one answer to your question can apply.
I can only guess that the majority of people posting on Psycho-Babble whom suffer from a properly diagnosed mood disorder needs a biological intervention of some sort to help treat a long-term or short-term dysregulation of important physiologic processes. Often, these processes are deranged by psychosocial stress, in which case the stress is best treated with psychotherapy alongside the biological therapy. Unfortunately, once these abnormal processes are triggered, they can perpetuate themselves and become free-running, even in the absence of psychosocial stress. In these cases, it is absolutely necessary to intervene with a biological treatment.
In my opinion, with a few possible exceptions, there is no antidepressant that is truly addictive. Many, however, induce an accomodation by the body as the body compensates for its presence. To discontinue one of these drugs too quickly disallows the body to accomodate to a drug-free state as the changing biology cannot keep pace with the changing drug exposure. Some call this physiologic accomodation "dependence". Regardless of what we choose to call it, it is not a true addiction. With addiction exist powerful physiological cravings and psychological habituation.
- Scott
Posted by linkadge on May 29, 2005, at 15:12:27
In reply to Meds need vs addiction?? what do you think?, posted by rainbowbrite on May 29, 2005, at 12:06:29
I agree with you. I have found the simplest things impossable since stopping these medications.
The longest I was off serotogenics was about 6 months. My mood was fine, but the brain zaps, and a whole host of other problems continued then spontainiously remmitted after starting the meds again.
I think that the medications permanantly change the way that the brain processes reailty.
Linadge
Posted by linkadge on May 29, 2005, at 15:16:34
In reply to Re: Meds need vs addiction?? what do you think? » fires, posted by rainbowbrite on May 29, 2005, at 14:52:02
I think there is a tremendous tendancy to sweep this issue under the carpet, becuase of the whole nature of depression/anxiety.
The last thing that doctors want to do is create panic about panic meds, anxiety about antianxiety meds, depression about antidepressants, and obsessions about anti-obsessives.
Did you know that the primary action of cocaine is a serotonin uptake inhibitor????!!
Linkadge
Posted by rainbowbrite on May 29, 2005, at 15:24:25
In reply to Re: Meds need vs addiction?? what do you think? » rainbowbrite, posted by SLS on May 29, 2005, at 15:06:22
>>It is always dangerous to generalize to such a degree as to use the word "we". "We" represents a mosaic of interactions between psychological and physiological needs for which no one answer to your question can apply.
Your right, but what I meant was 'me' I guess, sorry. Or people who suffer from depression type things. I know there are a host of medical conditions that NEED drugs.Im just conflicted within myself and trying to understand why I cant get off, why I even need drugs (oddly, Im quite a happy person)?? Thats all. I seem to be having difficulties being articulate here with my concerns.
I do agree with you that stress related problems may be better treated with drugs. Oh Im just totally confused as to what they are doing to me :-(
Thank you
Rain
Posted by rainbowbrite on May 29, 2005, at 15:31:41
In reply to Re: Meds need vs addiction?? what do you think?, posted by linkadge on May 29, 2005, at 15:16:34
Hi Linkadge
Ive read alot of your med posts and I totally understand what you are talking about...it is so frustrating.
How long were you on drugs for? How old when you started?It frustrates me the way drugs are handed out (to me), when as you have said in another thread, they used to use all sorts of illicit drugs in the past to treat mental illnesses. Are we any more educated now?? And I have heard so many times that doctors actually are doing this prescribing thing via trial and error. I definately dont feel 100% comfy with pdocs and prescritions. It makes me so uneasy thats all, especially when I dont feel right.
PS- This is just my opinion, Im now getting paranoid Im going to say the wrong thing.
Posted by linkadge on May 29, 2005, at 15:33:32
In reply to Re: Meds need vs addiction?? what do you think?, posted by linkadge on May 29, 2005, at 15:16:34
But I would also disagree with that.
My own experience with these drugs say that yes they do entirely fit the category of "addictive"
1. Initially they produced a false sence of well
being out of proportion to reality.
"I was giggleing at my grandmothers funeral
because of the way her pretty coffin looked
so psycadellic"2. Tollerance is built to the mood elevating
effect of the drug.
"Anyone I have talked to who has taken an
antidepressant for more than 1 year (even
off this board) say that tollerance to the
AD effect has almost completely developed.
I will try to locate the article I recently
read that gives (catch this) "an animal model
of antidepressant poop out", whereby if the
foot shocks continue, even a near leathal dose
of antidepressant will not reverse the
behavior....scarry !!!!3. Significant withdrawl symptoms occur,
that force the user to reinstate the drug
even if the initial reasons for starting the
drug no longer exist.I would totally say that the fit the criteria for addicting, but I suppose the definition of addicting becomes more and more obscure when we try to defend our precious drugs.
Linkadge
Posted by linkadge on May 29, 2005, at 15:42:27
In reply to Re: Meds need vs addiction?? what do you think? » linkadge, posted by rainbowbrite on May 29, 2005, at 15:31:41
I've been on them for 5 years. I started them when I was 17, and now I'm 22.
Think of it this way. We *first* discovered that these drugs had antidepressant properties, and then *secondly* came up with the proposed mechanisms why they might work.So why is it that when the drugs start to fail, we trust the *propsed mechanisms* and ignore the reality.
Do you know what I am saying?? We accepted these drugs, not based on science, but based on their "clinical actions", but yet we refuse to reject them based on their "clinical actions" instead defending them with science !!!!
Linkadge
Posted by rainbowbrite on May 29, 2005, at 15:48:00
In reply to Re: Meds need vs addiction?? what do you think?, posted by linkadge on May 29, 2005, at 15:42:27
I absolutely understand!
And Im so afraid of what I may hear one day about any of the drugs I take or have taken.
Im so conflicted about this ugh!
Posted by linkadge on May 29, 2005, at 16:00:14
In reply to Re: Meds need vs addiction?? what do you think?, posted by rainbowbrite on May 29, 2005, at 15:48:00
And they're the only drugs for which there seems to be such a *giant* devide.
Like, If I talk to my doctor about the safety of the next anti-inflamitory, he responds with something like: "we can never be sure that these drugs are completely without long term consequence"
However, when I bring up antidepressants, its like, "no thse drugs can be safely taken indefinately"
I understant "why" the doctors are trying to underplay the side effects, but that doesn't make it right.
Linkadge
Posted by SLS on May 29, 2005, at 16:07:13
In reply to Re: Meds need vs addiction?? what do you think?, posted by linkadge on May 29, 2005, at 15:33:32
> But I would also disagree with that.
>
> My own experience with these drugs say that yes they do entirely fit the category of "addictive"
>
> 1. Initially they produced a false sence of wellInitially, they do little or nothing at all to elevate mood or produce a sense of well-being. That takes 2-4 weeks to happen.
> being out of proportion to reality.
> "I was giggleing at my grandmothers funeral
> because of the way her pretty coffin looked
> so psycadellic"I never experienced this when I responded well to antidepressants. Everything actually seemed rather matter-of-fact. It was I who decided how to proceed with life, not the medication. There was nothing "false" about my sense of wellbeing.
> 2. Tollerance is built to the mood elevating
> effect of the drug.Perhaps this is true for you. More often than not, it has been true for me as well. However, this is not true of many, many others whom do not fit into a treatment-resistent category. That's why we don't see them here.
> "Anyone I have talked to who has taken an
> antidepressant for more than 1 year (even
> off this board) say that tollerance to the
> AD effect has almost completely developed.You need to meet more depressed people!
NOT.
:-)
> I will try to locate the article I recently
> read that gives (catch this) "an animal model
> of antidepressant poop out", whereby if the
> foot shocks continue, even a near leathal dose
> of antidepressant will not reverse the
> behavior....scarry !!!!
PSYCHOSOCIAL STRESS MUST BE MINIMIZED IN ORDER FOR THESE DRUGS TO WORK LONG-TERM, OTHERWISE, BREAKTHROUGH DEPRESSION IS INEVITABLE!
The animal models represent an extreme form of chronic psychosocial stress. How the intensity of the experimental paradigm equates to the human condition can only be guessed at. However, the lesson is there to be learned: Reduce psychosocial stress. For many people, this will include psychotherapy.
> 3. Significant withdrawl symptoms occur,
> that force the user to reinstate the drug
> even if the initial reasons for starting the
> drug no longer exist.Accomodation by the body to pharmacological substances is common. That the body must therefore accomodate to the absence of these substances is not surprising but predictable. To reduce the exposure to a drug faster than the body can accomodate to its loss yields withdrawal symptoms. Physiological dependence to a substance is not sufficient to deem it addictive.
You haven't mentioned cravings anywhere, nor psychological habituation.
- Scott
Posted by SLS on May 29, 2005, at 16:13:45
In reply to Re: Meds need vs addiction?? what do you think?, posted by linkadge on May 29, 2005, at 15:16:34
> Did you know that the primary action of cocaine is a serotonin uptake inhibitor????!!
I don't know if I would agree that it is "the" primary action. However, which of its actions would you say is most responsible for its recreational use? Does this action appear as a property of any antidepressant you can think of?Hint: Wellbutrin is not so good at doing it.
- Scott
Posted by Phillipa on May 29, 2005, at 18:08:27
In reply to Re: Meds need vs addiction?? what do you think? » linkadge, posted by SLS on May 29, 2005, at 16:13:45
All these posts are what keeps me from trying a higher dose of AD's. Fondly,Phillipa
Posted by fires on May 29, 2005, at 18:41:02
In reply to Re: Meds need vs addiction?? what do you think?, posted by linkadge on May 29, 2005, at 15:33:32
>
> 2. Tollerance is built to the mood elevating
> effect of the drug.
> "Anyone I have talked to who has taken an
> antidepressant for more than 1 year (even
> off this board) say that tollerance to the
> AD effect has almost completely developed.
>Parnate kept me depression free for 14 years -- no increase in the dose.
I had no discontinuation symptoms from stopping Parnate -- went "low and slow".
Posted by fires on May 29, 2005, at 18:49:03
In reply to Re: Meds need vs addiction?? what do you think?, posted by Phillipa on May 29, 2005, at 18:08:27
> All these posts are what keeps me from trying a higher dose of AD's. Fondly,Phillipa
Is it these posts, or these posts plus what the whacky cult member Tom Cruise recently said?
Posted by SLS on May 29, 2005, at 19:20:59
In reply to Re: Meds need vs addiction?? what do you think?, posted by Phillipa on May 29, 2005, at 18:08:27
> All these posts are what keeps me from trying a higher dose of AD's.
I don't believe that.
Perhaps you are just afraid to try, even without reading such posts?
Not too many people here find remission in lower dosages.
Don't let the negative experiences of the few overshadow the successes of the many. You have too much to lose.
Actually, I really don't know how much it is you have to lose. I have never come across any posts of yours where you describe very much about yourself. (I don't read very much these days, so maybe I could have missed these types of posts from you).
For example:
What mental illness do you suffer from?
1. How are you doing?
2. Are you happy with the way you are currently feeling?
3. What drugs are you taking currently, and at what dosages?
4. If you are not feeling the way you would like to be, what do you think is getting in your way?
Be well.
- Scott
Posted by Mr.Scott on May 29, 2005, at 19:27:52
In reply to Meds need vs addiction?? what do you think?, posted by rainbowbrite on May 29, 2005, at 12:06:29
I think actually quite few people have 'chronic' or 'nearly chronic' affective disorders. I am one. When you take a medicine for a chronic mood/anxiety disturbance as opposed to a more episodic disturbance the bodies 'normal' adaptation mechanisms may be more problematic so that a bit of tolerance might not bother someone so much who gets depressed twice a year so much as someone who is chronically depressed. The brain is likely more adaptive to the presence of artificial chemicals than other organs and is often refered to as plasticity. What our brain thinks is normal, what is its natural state and what it tries to get back to in the presence of artificial chemicals may be a pathological mood state. I have never seen any antidepressant that was approved for chronic depression, and few 'long-term' studies on antidepressants for dysthymia either (more than a year). Despite the unfortunate neuroadaptive mechanisms of our brains which I'm sure serve great purpose for some reasons (just not chronic mood disorder response to meds!) I would have a hard time calling antidepressants addictive. I would agree and have experienced firsthand damage caused to the brain from long-term exposure to ssri antidepressants. At least that would be the most obvious explanation given the symptoms and their relief (not taking the SSRI!) This after years of efficacy.
Benzos and stimulants are surely addictive however generally speaking anyways, and a great many people continue to take them despite not really needing them anymore either out of compulsion (stims) or to avoid painful withdrawal that mimicks psychiatric disorder (benzos).
Is it possible that something like exists for antidepressants? Maybe in soft bipolars who may get more than just simple relief from taking them, or in drug addicts who are so far into addiction as to compulsively take anything even if all they have is an incorrect assumption it is altering their mood.
I think there are way more questions than answers about all of these things, and while we can all agree to disagree about this that and the other, nobody really knows...
Posted by Mr.Scott on May 29, 2005, at 19:29:53
In reply to Re: Meds need vs addiction?? what do you think? » rainbowbrite, posted by SLS on May 29, 2005, at 15:06:22
Hello Scott,I saw some very dated posts indicating you either were taking or contemplating taking stimulants for help with your depression. I'm curious to know what ever came of your trial if you indeed had one?
Scott
Posted by Phillipa on May 29, 2005, at 19:43:26
In reply to Question for SLS » SLS, posted by Mr.Scott on May 29, 2005, at 19:29:53
Scott, That's interesting as I remember pdocs referring to my depression as dysthemia. That would explain a lot. I wonder if you replaced them with a placebo what would happen. Fondly, Phillipa
Posted by SLS on May 29, 2005, at 19:50:23
In reply to Re: Question for SLS » Mr.Scott, posted by Phillipa on May 29, 2005, at 19:43:26
> Scott, That's interesting as I remember pdocs referring to my depression as dysthemia. That would explain a lot. I wonder if you replaced them with a placebo what would happen. Fondly, Phillipa
I am still looking for the perfect placebo - one that you only have to pretend to take.:-)
- Scott
Posted by SLS on May 29, 2005, at 20:01:25
In reply to Question for SLS » SLS, posted by Mr.Scott on May 29, 2005, at 19:29:53
Hi Buddy.
> I saw some very dated posts indicating you either were taking or contemplating taking stimulants for help with your depression. I'm curious to know what ever came of your trial if you indeed had one?
>
> ScottI don't recall what my most recent plans were regarding the use of stimulants. I would like to try Adderall simply because I never have. However, I have added stimulants (Dexedrine and Ritalin) in combination with Parnate + desipramine. I find that Dexedrine is good for about 3 days of relief before I lose the effect altogether. As best as I can remember, Ritalin was without effect.
- Scott
Posted by linkadge on May 29, 2005, at 20:02:24
In reply to Re: Meds need vs addiction?? what do you think?, posted by Phillipa on May 29, 2005, at 18:08:27
"Initially, they do little or nothing at all to elevate mood or produce a sense of well-being. That takes 2-4 weeks to happen."
I don't think a substance needs to have an immediate effect to be classified as addictive, perhaps to be classified as an abusable substance.
"I never experienced this when I responded well to antidepressants. Everything actually seemed rather matter-of-fact. It was I who decided how to proceed with life, not the medication. There was nothing "false" about my sense of wellbeing."
Perhaps I respond differently. But all of the antidepressants have made me simply made me apathetic to my problems. Just tamed down the initial blow of the event. The lack of that appropriate reaction was what made me so unable to respond to the situation correctly. The fact that it was litterally impossable to cry, should have been warning sign enough for myself.
"Perhaps this is true for you [tollerance]. More often than not, it has been true for me as well. However, this is not true of many, many others whom do not fit into a treatment-resistent category. That's why we don't see them here."I think this is kind of wishfull thinking. Again feeding into the idea that the drugs are not at fault but that you are at fault. I'll be the first to admit that my life has been lived "in VAIN" if these drugs come up short of what imagination has made them out to be. I think its clear enought by simply looking at the statistics of the situation. The statistics of skyrocketing antidepressant sales, the statistics that the majority of people being treated are now taking muliple drugs. I think the drugs are extremely overrated in their effectivness, and that we try to boost their effectiveness in our minds because we have restricted ourselves to think that they are the only way to treat depression. My little old neighbour was once on just celexa 10mg, now hes on maximum doses of celexa 60mg, wellbutrin 450mg, and zyprexa 15mg. No, he's not on psychobabble, but his likes are much more common than you might think! When somebody reffered to these drugs as "placebo's with a buzz", at first I became extremely defensive (which is usually a sign that my subcontious knows that this statement hit home) That "buzz" is enought to feed the imagination into believing a lot of things about the drugs. Did you know that the only two drugs that have been "proven" to reduce suicide are lithium, ECT, and Clozapine? But lithium is no fun at all!! Why are antidepressants not cutting it statistically ?
"PSYCHOSOCIAL STRESS MUST BE MINIMIZED IN ORDER FOR THESE DRUGS TO WORK LONG-TERM, OTHERWISE, BREAKTHROUGH DEPRESSION IS INEVITABLE!"
I can't argue with you there, but sometimes minimizing psychosocial stress is the biggest hurdle in overcoming depression, not finding the "right drug"
"The animal models represent an extreme form of chronic psychosocial stress. How the intensity of the experimental paradigm equates to the human condition can only be guessed at. However, the lesson is there to be learned: Reduce psychosocial stress. For many people, this will include psychotherapy."
I know for a fact that my depression was caused by too much stress. The courses I was taking were too hard. Oftentimes giving someone a drug and sending them on their way, SIGNIFICANTLY reinforces their bad habbits. Because I was lead to believe that my depression had nothing to do with life, but was all in my head, I began to make even dumber choices about the future.
Have you seen those images of arachnids on prozac?? Oh sure they might be a bit more resisant to "psychosocial stress", but now they can't even spin a proper web, which would create more psycosocial stress in itself."You haven't mentioned cravings anywhere"
To me the fundemental definition of addicting, is the inability to stop a drug when it is appropriate. That is the biggest problem we have at hand. The average depression does not last more than a year or so, especialy in young people like me. But yet, for some reason discontinuing these drugs makes me feel so utterly, inexplicaby, and excrutiatingly terrable worthless, and suicidal (the likes of which I have *never* experiecned even in my deepest prior depressions) that I must continue taking them. As for craving it:... when I am off of it, I think about it day and night.
"I don't know if I would agree that it is "the" primary action (cocaine). However, which of its actions would you say is most responsible for its recreational use? Does this action appear as a property of any antidepressant you can think of?"
I am sure you have read the studies which show that blocking the 5-ht1a receptor seems to block the rewarding effects of the drug. Blocking the 5-ht1a/b receptors also "completely" changes the pattern of self administration in rats, even more so than the blockade of dopamine receptors. Rats will still administer cocaine even if dopamine receptors are blocked, but not if the 5-ht1a/b receptors are blocked. The reason that rats don't inject themselves with antidepressants is because the enhanced serogotonic function doesn't happen immediately. But thats not to say that the enhanced serotogenic function (when it occurs) does not produce rewarding effects. Dopamine is not the magic pleasure chemical. My "nondepressed", drugee friend stole (without my knowledge) my effexor, and then proceeded to later tell me that if he had had effexor, he woudn't have done all of that cocaine. He then asked me what illness he would need to "fake" to get a prescription for effexor. (Yes I suppose he again could be the exception to the rule)
Linkadge
Posted by Phillipa on May 29, 2005, at 20:10:15
In reply to Re: Meds need vs addiction?? what do you think? » Phillipa, posted by SLS on May 29, 2005, at 19:20:59
SLS, Scott, Well you've got me. I've seen many different pdocs over the years. That's because I lived in Ct, VA, and now NC. They always in the beginning said Panic disorder, then anxiety/dysthemia, then PTSD, then anxiety/depression. I know I have OCD. The kind where I have to do the same things in the same order every day. And I count.
l. I'm not doing well
2.I feel helpless, and hopeless when I used to be able to travel by myself and live on my own. And I was always the best RN.
3. Taking 5mg of valium in am with 25mg of zoloft,and l0mg of valium at HS.
4. Getting in the way? I feel trapped and powerless. And afraid of my shadow. Negative. Afraid to speak up when in the past I would confront people. I even worked in a jail as an RN parttime once. And yes, afraid of the meds.
Afraid of the meds is because I was at first given only l0mg of paxil with 50mg of lopressor, and xanax and drank beer at night which the pdoc said was okay. In three months I felt good again. My hypothroidism had just occurred that year. And I found out I had chronic lymes disease. My chemistry must have changed because I tolerated 250mg of luvox. Then the pdoc switched me to paxil again, then back to luvox at 50mg. I asked why and he said the high dose was because I had been in the hospital. Then he wanted me to take part in a celexa trial. I said no so he said that I was catatonic on the luvox and dc'd it and put me on celexa. I'd never felt worse in my life. So after a month he took me off of it and put me on 5mg of ativan divided. Now comes menopause. New pdoc and anxiety off the scales. Couldn't tolerate even one day of AD;s she put me on. Goes on and on. Now nothing seems to even bother me. When you went on cymbalta last year I found Pbabble and routed you on daily. Will Scott feel better? I was crushed when it didn't work. I took up to 60mg for around 3 months and then quit as I saw no results. So that's enough for now. I went to your website in the beginning but it's closed. You are the reason I got involved in Pbabble. I didn't even know how to use a computer at the time. I would come home and say to my husband let's see how Scott is doing. He'd find the site. Fondly, Phillipa
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