![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 118. Go back in thread:
Posted by Jazzed on July 19, 2005, at 22:54:13
In reply to About my post..and Suicide..., posted by med_empowered on July 19, 2005, at 17:45:30
>>For thousands of years, people have searched for answers about life and happiness/unhappiness. As a result, humanity has art, religion, philosophy, music...things that make life meaningful, full, rich...and worth living.Yeah, but if you're depressed it's very difficult to find the energy or desire to enjoy those pursuits. I would rather know that there is medication which might be beneficial to me, that I can take if I'm depressed. If I have to take medication to overcome depression, in order to be able to enjoy life, then so be it. I'd rather do that than try in vain to overcome a depression that is possibly biochemical in nature, that no art, religion, philosophy, or music will help. That said, I know that there are people out there who are having a very difficult time overcoming their depression even with medication, BUT at least there is some hope that they will find the right medication, at the right dose in order to feel better. At the time I was seriously depressed, the answers to those questions had little meaning to me, I just wanted to feel better, to get my life back. Those questions were for people with more energy.
>>How can psychiatry, which emerged from the madhouse with claims of "curing the insane" even TRY to compare itself to these endeavors?
I don't recall ever hearing that psychiatry has ever tried to compare itself with those endeavors.
>>How can psychiatrists dare to assert that their expensive little pills are some how of equal value as, say, the teachings of Jesus, Buddha, or Gandhi in explaining and healing life's pain?
IMHO I don't think very many psychiatrists would exert that medications were of equal value. Hopefully the good psychiatrists just want to make people who are suffering feel better and function more effectively.
Jazzy
Posted by Jazzed on July 19, 2005, at 23:00:43
In reply to Re: About my post..and Suicide..., posted by linkadge on July 19, 2005, at 20:47:16
> I don't think one can infer from this table that mental illness is universal. The highest regions have like 75/100,000 and the lowest are like 0.
>
> If mental illness was univeral I would expect to see much less diversity in the rates.
>
>
> LinkadgeIs it possible that in some of these areas it's a problem with reporting suicide, rather than the data being correct? I don't know, just asking.
Jazzy
Posted by Jazzed on July 19, 2005, at 23:10:35
In reply to Not sure what to believe anymore, posted by TamaraJ on July 19, 2005, at 17:18:34
> I, personally, am about to give up. I can't live like this anymore - trying one drug after another. I have tried to maintain some faith that I will be fortunate enough to have a similar response to another med, or combination of meds, as I did to Paxil 9 years ago. But, I am demoralized and tired, and, as pitiful as this sounds, I have lately just been hoping for a heart attack in my sleep to put me out of my misery. Can't believe I just said that, but it actually feels good to get it off my chest.Hi Tamara,
My gosh, not a rant at all! I am so sorry that you're feeling so incredibly bad. I can really hear in your post how painful this is for you, and it's certainly understandable that you want to get help somewhere, anywhere. I hope that the Zoloft starts to work for you soon. Did you start at a lower dose? Do you trust your p-doc?
I really honestly don't know anything technical about the antidepressants, and the secondary effect that people talk about, I hope it's not true for everybody, and that you will find something that helps, and soon.
(((hugs))))
Jazzy
Posted by CAROLINA on July 20, 2005, at 1:05:58
In reply to Re: Not sure what to believe anymore, posted by Jazzed on July 19, 2005, at 23:10:35
ok i tried to keep up w/ who said what but there were so many posts! im gonna keep it simple. from the psy. that i have studied i believe that this comes back to nature vs nurture. i agree 100% that there are people that need medications b/c of biological related reasons but i have also seen people that grew up in negative environments or had a life altering event that they had a hard time coping w/ and needed meds. to be honest, i was on effexor and after reading all the different reactions and side effects,etc., i did some research of my own and believe that my taking the meds. wasn't the answer. i think that PERSONALLY i allowed my docs to convince me that "this drug will help" and ur diag. is....when i realized that until 2001 i was ok. a life altering event changed me but now over 4 years later i am no better so i quit the meds. and have decided to get into intensive counseling to deal w/ the issue that sent me into this awful darkness. i feel better so far and i know that time will tell but i believe that IN MY CASE, i need to dig deep and the meds. were only masking the real issue- each person is different so unless each person is individually tested, who can truly say if they do or do not need meds.??? take care..Carolina
Posted by SLS on July 20, 2005, at 1:53:18
In reply to Re: Bad (but expected) news about ADs » SLS, posted by linkadge on July 19, 2005, at 17:26:56
> I don't know what you are saying.
>
>
> Linadge
What I am saying is that the rates of reporting of suicides have changed, not the occurence of suicide. Suicides are reported much more often now because it is no longer a taboo to admit that it happens at all. It is a cultural thing. It is also a data collection thing. How does one go about finding out who commits suicide and who doesn't? Compare the technology between then and now. Even the telephone has made a huge difference in reporting practices. If anything, the rates of *reported* suicides should have increased given an equal rate of actual suicides, yet, reported rates have remained the same according to *your* citation. This means that the rate of actual suicides must actually have decreased.Along another line of observation is the *fact* that rates of suicide have dropped precipitously since the introduction of Prozac and the media coverage that it brought to depression and its biological nature. It has become far less stigmatized, and more people came out of the closet to be treated.
American suicide rates have dropped steadily since the introduction of serotonin reuptake inhibitor (SSRI) drugs
http://www.news-medical.net/?id=7622
Suicide rates have decreased steadily since the introduction of antidepressants. These drugs work. For many, they work like magic.
- Scott
Posted by SLS on July 20, 2005, at 2:01:05
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 19, 2005, at 17:25:01
> Combinations of drugs can also do more harm, and cause more unknown and potentially permanant side effects.
This why I allow my doctor to treat me rather than me treat myself. I bring in my ideas for combinations, but he is the one educated in pharmacology and other areas of medicine that render him capable of determining the risks of adverse drug interactions. Of course, sometimes we enter unknown territory. This is why he is slow in his titrations in such circumstances.
> We don't do enough studies on how single drugs affect the brain, let alone taking combinations of drugs.
This is true. We just aren't there yet, I guess. However, why should the elucidation of drug-brain biology prevent one from taking a combination of imipramine + lithium, one that is known to be safe and actually work? Do you think people found it necessary to understand the mechanisms behind the antibiotic activity of penicillin before commiting to using it?
> I just think they're overrated thats all.
To someone who is treatment-resistant *or* misdiagnosed, this feeling is perfectly understandable.
- Scott
Posted by SLS on July 20, 2005, at 2:07:40
In reply to About my post..and Suicide..., posted by med_empowered on July 19, 2005, at 17:45:30
The apparent "weakness" of placebo controlled studies arises from the incredibly high rate of placebo response seen in these trials - 30-35%. If you drop the placebo responders, you get a success rate of antidepressants that is truly impressive - 65-75%.
Some investigators have studied the nature of the placebo response, its course longitudinally, and how it affects the statistical power of results.
Here's a quicky that uses the same citations as one that would have us believe that antidepressants are barely more effective than placebo. I wrote about this in another thread today, but I don't remember where it is.
Counterpoint:Clinical trials of antidepressant medications are producing meaningless results
http://bjp.rcpsych.org/cgi/content/full/183/2/102
- Scott
Posted by SLS on July 20, 2005, at 2:18:11
In reply to Re: Here we go again... » SLS, posted by Jazzed on July 19, 2005, at 18:03:36
Hi Jazzy.
> Once again, I think you are brilliant!
My intellectual powers are greatly overrated, but I will accept the self-esteem booster. Thanks.
> My opinion, for what it's worth....> I don't think any one drug, or class of drugs, works for all people who are depressed,
This is unfortunate. Things would be so much easier if one drug cured everone. Unfortunately, depression (and other mental illnesses) are just like any other medical illness. No one drug works optimally for 100% of cases of any one illness, whether it be lymphoma, Parkinsons, throat infections, dandruff, headache, AIDS, arthritis, hypertension, etc.
> or that any one drug works for anyone 100% of the time, or that the "recommended dose" works the same (or as it should) for all people who are depressed.
I think we have unreasonable expectations of our antidepressants. We demand of them more than we demand of other types of medication.
> I think the number of choices available today are a lot better than the number of choices that were available years ago. I also have hope that the drugs to treat mental illnesses will get better and better with more research and development. While I'm sure the "bottom line" will always be a factor, and managed health care (or lack of health care, or NHS) will continue to interfere with the ability to get proper care for mental illness, there has to be some hope that things will get better, and more choices will be out there for people suffering from mental illnesses. I do worry about how managed healthcare will be, with regard to mental health, for our kids when they reach adulthood.
>
> Aren't there a lot more people "functioning" at a much higher level today than there were years ago? I really don't know, this is a question.
>
> As far as my personal situation is concerned with regard to medication, I trust my p-doc to help me find what will work best for me.I agree with you on all points. I guess you must be brilliant too.
;-)
- Scott
Posted by SLS on July 20, 2005, at 2:24:09
In reply to Re: Bad (but expected) news about ADs, posted by Nickengland on July 19, 2005, at 16:23:12
> One thing to remember is (and this is my experience) with anti-depressants - they are not "pro happiness" pills.
Perfect!
This is great. I never thought to put it that way, but you are absolutely right.
I think this is where a great deal of miscommunication take place amongst people when they enter a discussion regarding antidepressants and mental illness in general.
Thanks!
- Scott
Posted by SLS on July 20, 2005, at 2:33:40
In reply to Re: Here we go again..., posted by linkadge on July 19, 2005, at 16:30:42
> > "When I responded well to antidepressants, it certainly did "bust" the underlying illness, not just selected symptoms."
> No offence, but that is impossable for you to know.I am somewhat offended, only because you are asserting something that *you* couldn't possibly know.
> Didn't these majic pills make you manic ?
After 6 months of uninterrupted euthymia, yes.
I am bipolar, remember? How does becoming manic nullify the global effect of remission that the antidepressants produced for me?
> Even though sinequan made my mother manic, and sent her into a downward spiral of psychwards, dirty antipsychotics, and experimentational mood stabalizing agents, she still contends that it was a gift from god, and that it cured her.
> Why does she say this?
Have you ever asked her?
> Because if she says otherwise, the last 20 years of her life have been lived in vain.
Was this her answer?
- Scott
Posted by SLS on July 20, 2005, at 2:55:39
In reply to Re: About my post..and Suicide... » med_empowered, posted by Jen Star on July 19, 2005, at 17:54:37
> I think it's dangerous to get too "into" any one method to cure something as fragile and mysterious (even to the best neurologists and researchers!) as the human mind.
It is the brain that seems to be working improperly in most cases of properly diagnosed MDD, and certainly in BD. The mind just naturally follows. Actually, this can work the other way around as well. Actually, both can work simultaneously. However, affective disorders, the brain gets stuck somehow and proceeds to deteriorate further on its own. If you interrupt the cycle of dysregulated brain -> dysfunctional mind by tickling the brain, you sometimes see an almost instantaneous resolution of the dysfunction in mind dynamics.
> If we focus on drugs to the exclusion of religion, meditation, etc, we are losing out.
Any healthy person can benefit from these things. They may not be at all necessary in most cases of MDD, but they can certainly help. I think psychotherapy can sometimes accelerate recovery from depression, and certainly help prevent relapses in many people.
> But I think in general we as a society are starting to overmedicate in general
I think I would agree with you on this. It is a very popular theme at the moment.
> I believe that mental illness is real.It definitely is.
However, I think some people get hung-up in pondering the abstractions of what are normal and abnormal behaviors for a particular culture at a particular time such that they would nullify the existence of mental illness.
> I'm just not sure that our drugs really work to "fix" it.
I think that most of our current treatments probably work by producing compensatative changes in the brain rather than producing a true cure. However, this should not dissuade someone from believing that these therapeutic mechanisms, whatever they may me, actually can produce a full remission, and not simply manage sets of symptoms.
> I hope that as tech. advances, our drugs become more refined and can really help the majority of people.
I'm sure we all do. Damned drugs.
- Scott
Posted by SLS on July 20, 2005, at 3:02:17
In reply to Re: About my post..and Suicide..., posted by Jakeman on July 19, 2005, at 21:03:54
> I do think sociology plays into this,
In a big way. This is unfortunate, but true.
> not just biology.
It is hard to separate the two. If we look at stress in general, we know that it can affect adversely if not generate things like hypertension, heart disease, cancer, immunosupression, diabetes, etc. These are all biological disorders. So is MDD (more or less).
- Scott
Posted by SLS on July 20, 2005, at 3:05:20
In reply to Re: About my post..and Suicide... » Phillipa, posted by Jakeman on July 19, 2005, at 21:17:27
> Then we have to worry about the fact that long-term effects (>6 monthes) have not been tested.
I'm sorry, I'm a little confused here. The long-term effects of what have not been tested?
- Scott
Posted by SLS on July 20, 2005, at 3:09:14
In reply to Re: Here we go again... » Jazzed, posted by SLS on July 20, 2005, at 2:18:11
Posted by Jazzed on July 20, 2005, at 7:35:37
In reply to Re: Here we go again... » Jazzed, posted by SLS on July 20, 2005, at 2:18:11
> I agree with you on all points. I guess you must be brilliant too.
>
> ;-)
>
>
> - Scott
>LOL, you are too funny Scott!
Posted by Jazzed on July 20, 2005, at 7:41:35
In reply to Re: About my post..and Suicide... » Jakeman, posted by SLS on July 20, 2005, at 3:02:17
>>If we look at stress in general, we know that it can affect adversely if not generate things like hypertension, heart disease, cancer, immunosupression, diabetes, etc. These are all biological disorders. So is MDD (more or less).
>
>
This is an excellent point, Scott.
Jazzy
Posted by linkadge on July 20, 2005, at 16:38:46
In reply to Re: Bad (but expected) news about ADs » linkadge, posted by SLS on July 20, 2005, at 1:53:18
I don't think that study shows anything.
Suicide rates go up and down like a yo-yo.
Plus, if what you are saying is true, then this study has no merrit as well (since as you are proposing that we did not record suicides too well in the past)
The link between antidepressants and suicidal behavior was so strong, that England basically banned their use in children. Are you saying that they based their decision on nonsence ?
Canadian suicide rates increased
http://fathersforlife.org/health/cansuic.htm
US suicide rates decreased (although very insignificantly)Linkadge
Posted by linkadge on July 20, 2005, at 16:49:44
In reply to Re: Here we go again... » linkadge, posted by SLS on July 20, 2005, at 2:33:40
What I am saying is this. Heroin masks pain. Say someone had broken their leg. They take heroin, and suddenly there is absolutely nothing concivably wrong with them.
It is not that I am undermining your ability to determine your state of wellness, it is just that I am underminning the ability of humans to determine their state of illness.
Suppose you had a shrunken prefrontal cortex, and this was the true reason for your melancholy. If the drug makes you feel better, do you think it has restored the prefrontal volume ? Not necessarily. The prefrontal cortex turns on reward areas in the presence of reward, but the reward areas can be turned on artificially, creating a seemless, and compltetely natural sence of well being. Are you cured, of course not.
AD's rarely change brain anatomy (and when they do, it is extremely slowly). My mother said that sinequan worked over night. And while subjective relief was attained overnight, there was nothing to proove that she was indeed cured. No offence to you, I am just saying that we as humans are dumb.Linkadge
Posted by linkadge on July 20, 2005, at 16:54:13
In reply to Re: About my post..and Suicide... » Jen Star, posted by SLS on July 20, 2005, at 2:55:39
In your own words.......
"I think that most of our current treatments probably work by producing compensatative changes in the brain rather than producing a true cure."
now how can this co-exist with
"When I responded well to antidepressants, it certainly did "bust" the underlying illness, not just selected symptoms. It cured everything."
Posted by linkadge on July 20, 2005, at 17:02:31
In reply to Re: About my post..and Suicide... » SLS, posted by linkadge on July 20, 2005, at 16:54:13
Ok, so we know that AD's might produce some changes on a PET scan. This does not really justify their use and safety. I am sure that other drugs, like say a speedball would do something remarkably similar.
Linkadge
Posted by Phillipa on July 20, 2005, at 17:32:03
In reply to Re: About my post..and Suicide..., posted by linkadge on July 20, 2005, at 17:02:31
Okay, so my ignorance is showing again but what does MDD stand for? Fondly, Phillipa
Posted by mworkman on July 20, 2005, at 17:32:55
In reply to Bad (but expected) news about ADs, posted by med_empowered on July 19, 2005, at 13:53:07
>hey. I was just checking out yahoo news, and it >turns out theres a growing feeling that ADs >aren't that great. A British study was cited >which found: 1) anti-depressants, by and large, >dont' do so well in placebo-controlled trials. >There are positive studies, but factoring in >all good, available data points to a very weak >anti-depressant effect at best....2) the entire >concept of an anti-depressant is flawed. The >researchers theorize that anti->depressants "work" by controlling some symptoms >of depression--by stimulating or sedating, >controlling anxiety, inducing sleep, that kind >of thing--rather than through some >magical "depression busting" mechanism. Their >conclusion?
Is this growing feeling based on just one study? Is this talking about all AD's, or just SSRI's? And yes there is no "magical "depression busting" mechanism". Most people know that taking an AD doesn't just magically make them less depressed.
>Maybe more people should do drug-free >depression treatment involving social support >and community integration rather than drugs. >The American Psychiatric Association calls it >a "radical sociological theory of depression".
Just like you and many sociologists consider the psychiatric medical profession radical in thier ways.
> As a budding sociologist, I can tell you >that "mental illness" is itself largely a >concept, one dependant upon the social context >in question; given this, it makes sense to >approach the disorder at an individual and >social level rather than a medical one. Its >also worth noting that the APA receives >millions of dollars in funding each year from >Big Pharma and individual psychiatrists are >often very well compensated by drug companies.
Yes, this would make sense to a " budding sociologist" or maybe you just have a case of tunnel vision and can't see the whole picture, just the side your sociology studies have shown you.
Posted by linkadge on July 20, 2005, at 17:49:39
In reply to Re: Bad (but expected) news about ADs, posted by mworkman on July 20, 2005, at 17:32:55
What is the whole picture ?
According to:
http://www.biopsychiatry.com/antidepskep.htm
"Two of the largest and most reputable trials found only negligible differences between tricyclic antidepressants and placebo."
Posted by SLS on July 20, 2005, at 18:36:44
In reply to Re: Bad (but expected) news about ADs, posted by linkadge on July 20, 2005, at 16:38:46
Hi Linkadge.
> I don't think that study shows anything.
>
> Suicide rates go up and down like a yo-yo.As was previous mentioned, I think sociological variables play a significant role in the rates of mental illness (not necessarily suicide) in a population. As the stress in a population increases, as seems to have happened in western society in general, I think the rate of depression increases.
> Plus, if what you are saying is true, then this study has no merrit as well (since as you are proposing that we did not record suicides too well in the past)No. What I am proposing is that mental illness and suicides are more apt to be reported now than they were 100 years ago. Thus, if rates have suicide have decreased, or even stabilized within the milieu of increased reporting, then the true rate of suicidal has actually decreased with the advent of antidepressants.
> The link between antidepressants and suicidal behavior was so strong, that England basically banned their use in children.
This is unfortunate. Antidepressants have also decreased the rate of suicide in adolescents. I do feel that psychotherapy should be the first line therapy in pediatric depression unless severe psychomotor retardation is present. Pediatric bipolar disorder presents a particularly difficult quandry. If not treated biologically, it will only get worse.
Adolescent antidepressant-induced suicides could be prevented by educating the patient that they could possibly feel worse, and that this should be reported promptly. They should also be monitored particularly closely with weekly visits to the doctor. I don't like the idea of serving the developing brain a meal of Prozac any more than you do. We don't yet know what the consequences are.
> Are you saying that they based their decision on nonsence ?
I think they based their decision as much on political pressure and panic as they did by a naturalistic study of the phenomenon.
> Canadian suicide rates increased
> http://fathersforlife.org/health/cansuic.htmPerhaps the socialized medical system of Canada doesn't lend itself to prompt and robust intervention in cases of depression. This has been the impression I get from the posters here, particularly you.
> US suicide rates decreased (although very insignificantly)
According to the literature I encounter on the Net, I invariably come across statements to the contrary; that the rates of suicide has decreased, particularly since the advent of the SSRIs and the increase in the percentage of people seeking treatment. It is illogical to conclude otherwise. Even if we just consider the impact of lithium, we both agree that it prevents suicide at a significant rate. How could the rate not be reduced significantly?
It is my guess that the rates of depression has increased over the last few decades as the stresses of societal day to day living has increased. However, it is also my guess that the percentage of these people committing suicide while taking antidepressants has decreased considerably. In other words, these drugs work. Prospective studies designed to observe probands longitudinally is a much better way to assess this hypothesis than using gross population statistics.
-----------------------------------------------------
1: Arch Suicide Res. 2005;9(3):279-300. Related Articles, Links
Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years' follow-up.Angst J, Angst F, Gerber-Werder R, Gamma A.
There is no data on the variation in the suicide risk over lifetime and on the suicide-preventive effect of the long-term treatment of mood-disorder patients with antidepressants and neuroleptics. Our research focused on 186 unipolar (D), 60 bipolar II (Dm), 130 nuclear bipolar I (MD), and 30 preponderantly manic patients (M/Md); that were followed-up from 1963 to 2003. By 2003, 45 (11.1%) of the 406 patients had committed suicide. Suicide rates were highest among D patients (Standardized Mortality Ratio, SMR = 26.4), MD (SMR = 13.6), Dm (SMR = 10.6) and lowest among M/Md patients (SMR = 4.7). Prospectively, the suicide rate decreased over the 44 years' follow-up; Lithium, neuroleptics and antidepressants reduced suicides significantly. Long-term treatment also reduced overall mortality, and combined treatments proved more effective than mono-therapy.
PMID: 16020171 [PubMed - in process]
---------------------------------------------------------
- Scott
Posted by SLS on July 20, 2005, at 18:40:08
In reply to Re: Here we go again... » SLS, posted by linkadge on July 20, 2005, at 16:49:44
> It is not that I am undermining your ability to determine your state of wellness, it is just that I am underminning the ability of humans to determine their state of illness.
I guess you'll just have to trust me on this one, Linkadge. I can tell the difference, even with my eyes closed.
:-)
- Scott
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.