Psycho-Babble Medication Thread 582087

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Re: Studies on long term use of SSRI's

Posted by Jakeman on November 25, 2005, at 20:39:51

In reply to Studies on long term use of SSRI's, posted by law663 on November 25, 2005, at 12:30:13

What has always been curious to me is the wild variations of efficacy that people report.
Recently I was perusing the website
askapatient.com

http://www.askapatient.com/classreport.asp?class=ANTIDEPRESSANTS

Prozac for example.. 224 people rated their experience. Several commented that it had saved their lives and had used it for years. Others said that the drug was worthless and/or dangerous. About as many people rated it 5 as rated it 1. The reviews are similarly mixed on other AD's.

Maybe SSRI's are efficacious, but only for about a third of us.

warm regards ~Jake

 

Re: Studies on long term use of SSRI's » Jakeman

Posted by Phillipa on November 25, 2005, at 21:45:11

In reply to Re: Studies on long term use of SSRI's, posted by Jakeman on November 25, 2005, at 20:39:51

Jake, sounds about right with the largest response indicating around a 70-80% satisfaction for lowering depression not eliminating it. Fondly, Phillipa BTW even the inserts say they do not work for everyone even shortterm.

 

Re: Studies on long term use of SSRI's

Posted by law663 on November 25, 2005, at 22:30:52

In reply to Re: Studies on long term use of SSRI's, posted by Jakeman on November 25, 2005, at 20:39:51

Yes, but for most psychiatric drugs that is the case. I think we must remember that before the SSRI's came out we only had the typicals which were "effective" but only with HUGE side-effects which prevented most from having any semblence of a routine life. So, Prozac et al was a "life saver" but not perfect. What troubles me is that we have no idea if long term use of SSRI's is associated with alterations in brain morphology. Epidem people will say that there is no assocaition with SSRI's and cancer, heart disease, etc -- but that speaks nothing to things like pituitary disease, diabetes, or subtle disease.

> What has always been curious to me is the wild variations of efficacy that people report.
> Recently I was perusing the website
> askapatient.com
>
> http://www.askapatient.com/classreport.asp?class=ANTIDEPRESSANTS
>
> Prozac for example.. 224 people rated their experience. Several commented that it had saved their lives and had used it for years. Others said that the drug was worthless and/or dangerous. About as many people rated it 5 as rated it 1. The reviews are similarly mixed on other AD's.
>
> Maybe SSRI's are efficacious, but only for about a third of us.
>
> warm regards ~Jake

 

Re: Studies on long term use of SSRI's » linkadge

Posted by fuchsia on November 26, 2005, at 1:55:43

In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 25, 2005, at 19:05:59

> The best that antidepressant could do was to make me numb to my problems. They never made me any happier.

They made me so happy I was dancing and singing. And I've been bipolar ever since.

Maybe that's a long term effect.

 

Re: Studies on long term use of SSRI's

Posted by flmm on November 26, 2005, at 9:38:44

In reply to Re: Studies on long term use of SSRI's » linkadge, posted by fuchsia on November 26, 2005, at 1:55:43

They are not supposed to make you "happy"! They are intended to reduce depression, and for many people, me included, they do just that! They make people with severe panic and depression, "functional". Once you acheive that you must find happiness the same way everyone alse does! They are not "happy pills". does not work that way people. Once you realize that, you can start doing the positive things in your life needed to bring contentement and satisfaction into your life.

 

Re: Studies on long term use of SSRI's

Posted by linkadge on November 26, 2005, at 10:47:51

In reply to Re: Studies on long term use of SSRI's, posted by law663 on November 25, 2005, at 19:56:45

Some doctors consider them "placebo's with a buzz", since the placebo margin can be increasingly reduced when active placebos are used. I don't admit they do something, but as far as saying they effectively treat the condition of depression is hard for some to accept.


Like I said in previous posts, I think they initially help because they cause a profound reduction in rem sleep. This improves depression in its own right. But the brain fights back, desparately wanting rem sleep. The result? You become what so many psychiatric patients complain about being "a zombie". Rem sleep is critical for the brain to create the most insighful ideas into its current state of being. So yes I think they have initial "effects", but I don't think they actually are very effective long term at all.


Neuroimiaging is another thing. It was shown that the people who respond to SSRI's have frontal cortex activation. But that doesn't say anything, because the patients who didn't respond didn't have that activation. Therapy was also shown to activate the frontal cortex. So I don't think it is necesarily the drug, as much as recovery, or placebo effect.


THe BDNF issue too has not been too conclusive. I was reading a nice little page on how prozac increased BDNF in mice. But then the article went on to say that BDNF was increased to a similar extent in any mouse that had been "handled".
Some of the BDNF increases are phasic, showing elevations for a number of hours and then going back to baseline.

Not all studies show that SSRI's reliably increase BDNF.

Another thing to consider is this. Scientists have been trying to find a bad serotonin gene. One of the latest studies has found a significant predisposition to depression if you cary a Short-Short varient of the serotonin transporter gene. Ie. The people with this varient showed significantly more lifetime depressive episodes, than people with the long-long or other varients.
But the problem is this. The short-short varient codes for a slower reuptake of serotonin than do other varients.

So essentially, researchers have found that the people who are the most depressed already have a slower serotonin uptake than people without the gene. These findings are the exact opposite to what researchers were expecting to find.

This is a case for Tianeptine, a clincally effective antidepressant that is a serotonin reuptake acellerator.

There is a lot of reasearch being done to discover their hazards too. I know that there is research being done into the propensity of antidepressants to induce rapid cycling and manic, and suicidal behaviors. This kind of research does not become accepted overnight. Just like how valium was not declared overnight to be addicting.

Then their is poop out and withdrawl. I talked to a lady who said she had taken prozac for 5 years and it took her five years to fully get over withdrawl. I said to myself, "thats about right".

Untreated depression rarely lasts longer than a year, but we have people on these drugs for many many years.

Meds are like Shawshank prison. At first you can't stand them, then you grow to tollerate them. Soon enough you can't live without them.


Linkadge


 

Re: Studies on long term use of SSRI's

Posted by linkadge on November 26, 2005, at 10:52:26

In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 9:38:44

In the angle that depression is accompanied by a severe deficit in happiness, they never made me happy. In the sence that they never tackled severe deificits in happiness, they never treated the depression.

Linkadge

 

Re: Studies on long term use of SSRI's

Posted by linkadge on November 26, 2005, at 10:54:30

In reply to Re: Studies on long term use of SSRI's, posted by law663 on November 25, 2005, at 22:30:52

Yes, I would think that if you avereraged every clinical trial, you might get an effect in about a third of people.


Linkadge

 

Re: Studies on long term use of SSRI's

Posted by flmm on November 26, 2005, at 11:24:03

In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 10:54:30

I think overanylisis is part of everyones problem. Depression is self obsession. Get off the couch, stop worrying about what drug is doing what, go help someone else and you might just stop obssessing about yourself so much!You will never find the perfect drug,deal with it!

 

Re: Studies on long term use of SSRI's (linkadge)

Posted by law663 on November 26, 2005, at 11:26:19

In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 10:52:26

Well put linkage. Do you happen to have the cite for the short-short paper? I'm aware of the tiapine paradoxical effect. I still say that AD's are effective. The BNDF is more than just transient I believe, but I think the jury is still out for the final verdict.

 

Re: Studies on long term use of SSRI's (linkadge)

Posted by linkadge on November 26, 2005, at 12:34:50

In reply to Re: Studies on long term use of SSRI's (linkadge), posted by law663 on November 26, 2005, at 11:26:19

Here is one.

It starts by talking about the effect of the transporter on drinking, and then goes on to discuss its relationship to depression.

http://www.futurepundit.com/archives/001611.html


But the story goes much deeper. One can do engine searches with key words short-short, SERT, depression, etc. There is lots of work being done, but most of the data seems to show that the short-short varient confers susceptability to depression and alcoholism.


Linkadge

 

Re: Studies on long term use of SSRI's

Posted by Tomatheus on November 26, 2005, at 13:04:32

In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 11:24:03

> Depression is self obsession.

What makes you say this? Do you speak from experience? Or is this part of a theory that's been written about in the scientific literature? If this theory is scientific, I am not familiar with it. Could you please cite an article from the literature discussing this theory of self obsession? I'd be interested in learning more about it.

> go help someone else and you might just stop obssessing about yourself so much!

It seems to me that helping others is what this meds board is all about. It's been helpful to me, and I'd like to hope that some of my posts have been helpful to others.

> You will never find the perfect drug,deal with it!

I don't think that any of us seeking drug therapy for depression are looking for perfection. I can't speak for others, but when my depression is at its most severe, all I'm looking for is the ability to lead some semblance of a normal life - to be able to feel alive and to be able to enjoy all of the things that I know I should be enjoying but cannot due to my condition.

Tomatheus

 

Re: Studies on long term use of SSRI's » Tomatheus

Posted by ed_uk on November 26, 2005, at 14:24:11

In reply to Re: Studies on long term use of SSRI's, posted by Tomatheus on November 26, 2005, at 13:04:32

Hi

>I'd like to hope that some of my posts have been helpful to others.

They have. You have many excellent posts to your name :-)

Ed

 

Re: Studies on long term use of SSRI's » ed_uk

Posted by Tomatheus on November 26, 2005, at 14:44:40

In reply to Re: Studies on long term use of SSRI's » Tomatheus, posted by ed_uk on November 26, 2005, at 14:24:11

Thanks, Ed. I'm glad to hear that you've enjoyed my posts, even though I really haven't written very *many* of them yet. I've certainly learned a lot from the many (and I do mean many) insightful posts you've made (since I've joined and from before, when I was in lurking).

Tomatheus

> Hi
>
> >I'd like to hope that some of my posts have been helpful to others.
>
> They have. You have many excellent posts to your name :-)
>
> Ed

 

Re: Studies on long term use of SSRI's

Posted by flmm on November 26, 2005, at 14:44:42

In reply to Re: Studies on long term use of SSRI's » Tomatheus, posted by ed_uk on November 26, 2005, at 14:24:11

All I am saying is dealing with depression will always be more than taking a pill. They help, but only about 50% of the way. The rest is up to you. Spending time looking on this board for the perfect drug is counterproductive and helps to increase the thought process of your own illness. Spend a couple weeks away from the board, if you can,and see if you do not feel a little better not looking for that "perfect" drug. There is a lot more to it than just drugs!In the end they all pretty much do the same thing!

 

Re: Studies on long term use of SSRI's » flmm

Posted by Tomatheus on November 26, 2005, at 15:05:34

In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 14:44:42

flmm,

I agree that there is more to dealing with depression than taking a pill, but I must question your statement that all drugs "pretty much do the same thing" in the end. Do antipsychotics, for example, do the same thing as stimulants? Of course not; the primary effects of antipsychotics and stimulants are basically the opposite of one another. All antidepressants are not alike, either, as it is not uncommon for patients to respond to one type of medication (say, an MAOI, for example), but not another (such as an SSRI). And even though some medications tend to lose their effectiveness in the long run for certain patients, this is not the case for all medications and all patients. There are plenty of case reports in the scientific literature - and even more on this board - of patients achieving long-term success on various meds. But having said this, I do think that there is a need for more studies (other than case reports) on the long-term effectiveness of psychiaric medications (especially the newer ones).

Tomatheus

> All I am saying is dealing with depression will always be more than taking a pill. They help, but only about 50% of the way. The rest is up to you. Spending time looking on this board for the perfect drug is counterproductive and helps to increase the thought process of your own illness. Spend a couple weeks away from the board, if you can,and see if you do not feel a little better not looking for that "perfect" drug. There is a lot more to it than just drugs!In the end they all pretty much do the same thing!

 

Re: Studies on long term use of SSRI's

Posted by linkadge on November 26, 2005, at 15:24:43

In reply to Re: Studies on long term use of SSRI's » flmm, posted by Tomatheus on November 26, 2005, at 15:05:34

I personally have not had much sucess with psychiatric medications.

For a while I was able to fool myself into thinking that my problems were reated to a chemical imballance. But at the end of 5 years on them I realized that they really weren't helping my problems more than they were just changing my problems into some other form.


Linkadge

 

Re: Studies on long term use of SSRI's

Posted by flmm on November 26, 2005, at 15:38:17

In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 15:24:43

I think you are getting a little too technical!

 

Re: Studies on long term use of SSRI's » linkadge

Posted by Tomatheus on November 26, 2005, at 15:48:07

In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 15:24:43

Linkadge,

I'm sorry to hear that your trials with psychiatric medications have not been successful. As I said, there are some patients who do achieve long-term success on psychiatric medications. On the flip side, I do think that meds are either less than effective or unnecessary in far too many patients, and I think it's important for patients to understand that antidepressants are not as universally effective as the drug companies would like to have us believe. Even though there is evidence in the scientific literature that genetically determined biochemical imbalances are part of what causes depression in some patients, there is no way to say for sure in any given case whether or not a patient actually does have a "chemical imbalance." There is far too much guesswork in psychiatry, and even though treatment is very successful in some cases, I think it's important to realize that treatment is often unsuccessful, and that there is a lot of room for improvement in psychiatry.

Thanks for your post.

Tomatheus

> I personally have not had much sucess with psychiatric medications.
>
> For a while I was able to fool myself into thinking that my problems were reated to a chemical imballance. But at the end of 5 years on them I realized that they really weren't helping my problems more than they were just changing my problems into some other form.
>
>
>
>
> Linkadge
>
>

 

Re: Studies on long term use of SSRI's » Tomatheus

Posted by ed_uk on November 26, 2005, at 15:52:04

In reply to Re: Studies on long term use of SSRI's » ed_uk, posted by Tomatheus on November 26, 2005, at 14:44:40

Thank you :-)

Ed

 

Re: Studies on long term use of SSRI's » flmm

Posted by Tomatheus on November 26, 2005, at 15:52:34

In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 15:38:17

flmm,

I'm sorry for going into so much detail. Perhaps it would have been sufficient to say that all psych meds clearly aren't the same. :)

Tomatheus

 

Re: Studies on long term use of SSRI's

Posted by zeugma on November 26, 2005, at 15:57:33

In reply to Re: Studies on long term use of SSRI's » linkadge, posted by Tomatheus on November 26, 2005, at 15:48:07

The point has been made that if active placebos were used, they would equal existing AD's in effectiveness.

The problem is that many 'nocebos' that have been used were anticholinergic agents, which probably have antidepressant effects in their own right.

Another problem is that depression itself is a clinical term, and implies nothing about the etiology of the syndrome.

Helay's name was mentioned somewhere up the thread. He is not a skeptic about whether or not AD's are better than placebo. But he does observe that SSRI's are more effective for treating premature ejaculation than depression.

-z

 

Re: Studies on long term use of SSRI's

Posted by linkadge on November 26, 2005, at 16:32:16

In reply to Re: Studies on long term use of SSRI's, posted by zeugma on November 26, 2005, at 15:57:33

I'm not really trying to dismiss people's experiences with meds, but sometimes depression gets better on its own. If somebody is on a medication when they get better then there is a tendancy to want to attribute it to the medication because that gives the patent a sence of controll over their situation, as opposed to thinking that things just got better on their own.

Linakdge

 

Re: Studies on long term use of SSRI's » linkadge

Posted by zeugma on November 26, 2005, at 17:28:53

In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 16:32:16

> I'm not really trying to dismiss people's experiences with meds, but sometimes depression gets better on its own. If somebody is on a medication when they get better then there is a tendancy to want to attribute it to the medication because that gives the patent a sence of controll over their situation, as opposed to thinking that things just got better on their own.>

That is very true. However, the situation also works for the converse: if someone experiences an adverse reaction at some point there is a tendency to blame the drug.

healy claims that TCA's do not cause switches to mania for bipolars, they merely do not prevent them. He says that rates of switching did not change after the introduction of AD's in the 50's, but that since they occurred in patients 'naturally', the drug was blamed. It seems to me that it is just dogma that SSRI's are better AD's for bipolar patients than TCA's.

All we can go on are our own subjective experiences with meds and with depression itself, since we can't get tested with depression as we can for TB. So it makes no sense to say that spontaneously remitting depression is any less depression than depression that improves with an AD, although statistics do seem to point in the direction of severity of depression being correlated with a response to an active drug and a falling off of placebo (and presumably of spontaneous remission).

-z
>
> Linakdge
>

 

Re: Studies on long term use of SSRI's

Posted by flmm on November 26, 2005, at 17:49:15

In reply to Re: Studies on long term use of SSRI's » linkadge, posted by zeugma on November 26, 2005, at 17:28:53

I know the difference between a true medication and a placebo. I will take the medication any day thank you!


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