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Dr. Bob is Robert Hsiung, MD,
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Posted by yxibow on March 4, 2006, at 0:38:25
In reply to Re: To Linkadge » deniseuk, posted by linkadge on March 1, 2006, at 16:00:02
> But define "antidepressants work". If by work you mean taking a drug produces some very favorable short term effects, then perhaps they do.
>
> But if by work, you mean that the drug gets to the root of the problem, and produces a sustainable, consistant, and dependable relief from the depressive illness, then I'd disagree.You have hit on at least partially a point which I will continue -- the brain... if you are going to believe the biochemical model of neuropsychiatric illness (I prefer to call them than then "mental illness" which tends to have a perjorative sense) then I will continue.
The brain is an ever changing device. I have OCD, which I will have for the rest of my lifetime, due to no fault of anybody but genetics. I have anxiety, and depression due to the same. There will always be ups and downs. So essentially, you're aiming at a moving target.
It is no suprise that a particular drug will work for a particular period of time, because of this moving target. Also over the course of taking the drug, neurons and the like are in a constant, but slow change and flux.
There is no drug that, for the majority of people will "produce.. a sustainable, consistant, and dependable relief", short of possibly those with mild dysthmia or just random good luck.
Short of brain surgery, there is no "getting to the root of the problem" because of this moving target. You can get a good... sometimes even great approximation, but nothing is going to be 100%. Nothing is ever guaranteed in life. Life is for living, and sometimes things suck. Things suck for me horribly now. Things probably suck for a number of people on here horribly. Then discouragement sets in, and trials of drugs are not given long enough time periods. And again, the brain is still a moving target, just like any other part of the body.
So do SSRIs work ? They work for what they are intended for -- relief from depression and anxiety with the informed consent and predisposed knowledge that they, just like any other antidepressant or anxiolytic, could eventually not work at some point.
I think that, if anything, is the root of the matter.
Posted by yxibow on March 4, 2006, at 0:54:25
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » yxibow, posted by tizza on March 1, 2006, at 17:09:32
> Jay that was the worst combo for me by far, atypical's (zyprexa and seroquel) taken at different periods, with AD's was horrendous. I know eveyone is different and i suppose it depends what you are being treated for but that just put me into to a stupor and i cant believe i held my job down, plus a load of other crazy sh*t that happened at the time, it's just so freaky how differently we all react. PaulIts no question -- we all on here react differently to things. Thats why this argument, while fascinating is chasing a moving target. Unless someone on this thread is an identical twin, I doubt the same drug regiment will work for that individual for any length of time. Not to mention, that everyone here has different DSM diagnoses. So, I'm sorry to hear your combination did not work.
Its worth noting, I dont know how much of a dose of Zyprexa or Seroquel you had, but they can definately put people in a stupor, and that varies by the individual. Seroquel puts me into a stupor, but I have to take it (no, I don't have a schizophreniform disorder), regardless. Its hard pushing myself through the morning. High doses, especially Seroquel have a very drowsy component of their compound -- its just the way it is.
You will probably eventually benefit from some other treatment. If we all wait around long enough, and this country doesn't go to * in a handbasket, some genetic and stem cell research will eventually produce the future drugs of tomorrow. But its also about therapy other than drugs too, psychotherapy, reintegration into the workforce and the world around you (at least for me).
So, do SSRIs work -- for some people yes, for some no. But I will reiterate that I think it does a disservice to say they do not work at all for those who are teetering on the brink of things and reading these discussions and thinking that their SSRI will suddenly stop at exactly 12 midnight. There is always hope. And hope comes from within. And maybe I say this as do as I say but not as I do -- I know I don't always have hope. But I have to. Life is for living, since there really is no explanation for it, other than what each individual wants to believe.
Good tidings
Jay
Posted by tizza on March 4, 2006, at 1:10:49
In reply to Re: 150mg » wildcard11, posted by linkadge on March 3, 2006, at 9:31:44
> I just find that hard to believe. How long before you went onto another antidepressant ? Don't mean to be a dweeb, but I'd just have to see it to believe it.
>
>
> Effexor is so addicting for some people that they have to start counting the pelets in the 37.5mg capsules.
>
That's what I did link to no avail, it was beyond description what I went through but I'm sure everyone knows what I mean except for wildcard11, he is just so bloody lucky, I wish it was that easy for me. Paul
> Linkadge
Posted by yxibow on March 4, 2006, at 1:14:34
In reply to Re:Is advertising Meds allowed in the US? » wildcard11, posted by Chairman_MAO on March 3, 2006, at 9:25:09
> The only AD they won't advertise right off the bat are MAOIs. Those you have to jump through flaming hoops while juggling baby seals to get permission to take. It is easier to get an Rx for d-amphetamine.
That's preposterous. It's not easier to get an Rx for a triplicate medication and that varies from state to state. Nobody is going to give you Concerta unless you're properly evaluated.
MAOIs are not advertised because while most of them are still patented medication, they have ceased to be the most recent advertised drug. And one should jump through slightly crispy hoops before taking them. They may work for you, I dont know, but they're positively dangerous. EMSAM may have some positive effects on that front. A class of medications that, unless you live in Europe and can take a RIMA, bars you from taking most OTC medications, without ending up in a hospital or comatose. They're medications of last resort. And like some individuals on this board with very serious depression, they have worked. But you have to play the game with your diet. Very carefully. Its about one step removed from ECT.
> Yes, there are potentially life-threatening effects. What does that matter if you feel like killing yourself when you aren't on the medication?
>
> The commercials are basically saying in so many words "this drug works just like the first time you took [illlict drug of choice]".I think that's a bit of an exxageration but advertising of medications has gotten to a new low in this country, I will admit -- that doesn't mean I have any conspiracy theories about them.
Posted by tizza on March 4, 2006, at 1:34:51
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » tizza, posted by yxibow on March 4, 2006, at 0:54:25
Thanks for the post Jay, I really appreciated it, I'm just pissed off that I was rx'ed zyprexa and seroquel for depression, GAD, etc when it was totally unnescessary. I just don't understand so much about me and I'm so sick and tired of being prescribed numbing medication to just shut me up. Thanks again Paul. I hope you are doing well. I'm a bit freaky at the moment again which is disturbing me but I've go a bit of sh*t going down at the moment and I'm sure it will resolve itself soon.
Posted by cecilia on March 4, 2006, at 2:36:56
In reply to Re:Is advertising Meds allowed in the US? » wildcard11, posted by Chairman_MAO on March 3, 2006, at 9:25:09
You'll never see an ad for a traditional MAOI because they're old and off patent. Once the patent expires, so do the ads, unless the drug companies can figure out a way to tweak it a little to make it seem like a new drug. I bet we'll see plenty of ads for the Emsam patch! Cecilia
Posted by cecilia on March 4, 2006, at 3:01:21
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
Someday hopefully we'll have genetic research that will tell us what will work for whom. But I'm suspicious that even so a lot of people will still not get properly treated because drug companies aren't going to waste their money on a drug that works on only a tiny fraction of the population with a certain genetic makeup,( even if they can get it approved.) I read a book many years ago about a young woman with schizophrenia who failed trials of all the AP drugs available at the time. She went into a clinical trial on kidney dialysis for schizophenia. Overall, it worked no better than placebo,so the trial was discontinued. But for her it worked dramatically, she went on to become a pdoc, and at least at the time the book was written had had no more symptoms. There are probably lots of drugs potentially out there that would work the same way-dramatic results for a tiny percentage of the population but never approvable because overall they're no better than placebo. There may be hundreds of different types of depression, but researchers see them as all the same. It' ridiculous-nobody thinks all cancers should be treated exactly the same way. Cecilia
Posted by linkadge on March 4, 2006, at 9:27:34
In reply to Re: oh » linkadge, posted by Chairman_MAO on March 3, 2006, at 22:01:43
Mice know the difference between real drug and saline. They will lever administer crack without sleep or food till they die. I don't think they'd do the same with saline.
Linkadge
Posted by linkadge on March 4, 2006, at 9:33:33
In reply to SSRIs et alia, Brain Chemistry and a moving target » linkadge, posted by yxibow on March 4, 2006, at 0:38:25
"They work for what they are intended for -- relief from depression and anxiety with the informed consent and predisposed knowledge that they, just like any other antidepressant or anxiolytic, could eventually not work at some point."
Well for some people they do this. Do opiates work for scurvey ? I suppose they might "work" under a loose definition. Although, I'd really like to do better than opiates. Vitamin C would be nice. But I suppose we havn't discovered that.
Linkadge
Posted by linkadge on March 4, 2006, at 9:37:25
In reply to Re: 150mg » linkadge, posted by tizza on March 4, 2006, at 1:10:49
I'm not saying that I don't believe wildcard, I would just need to be there in the room in the insuing days to monitor behavior for myself untill I was able to believe that dropping the drug cold turkey did nothing at all. Thats just skeptical me.
Linkadge
Posted by ed_uk on March 4, 2006, at 13:06:52
In reply to Re: Yes » ed_uk, posted by zeugma on March 3, 2006, at 18:07:08
Hi Z :)
>When people wothdraw from an SSRI the serotonin system is depleted, and they enter REM prematurely, experiencing those 'zap' sensations from cholinergic hypersensitivity, which results from the sudden aminergic weakness.
Some people take diphenhydramine (Benadryl), an antihistamine and anticholinergic, to reduce the symptoms of SSRI withdrawal. I imagine the anticholinergic effect reduces the withdrawal symptoms and the antihistamine effect reduces any insomnia which may be present.
Warm regards
Ed
Posted by ed_uk on March 4, 2006, at 13:09:38
In reply to Re: 150mg » ed_uk, posted by linkadge on March 3, 2006, at 21:17:04
Hi Link,
>How long was it though, until you went on a new medication ??
I think it was about 2 weeks. The withdrawal symptoms were pretty much over by then though. The next AD I took was moclobemide. I didn't have any withdrawal symptoms when I stopped moclobemide, I don't think it was really doing anything!
Ed
Posted by linkadge on March 4, 2006, at 14:41:24
In reply to Re: 150mg » linkadge, posted by ed_uk on March 4, 2006, at 13:09:38
Never knew you took moclobemide.
Linkadge
Posted by Phillipa on March 4, 2006, at 16:50:52
In reply to NASA's , SSRI, SNRI, etc., posted by musky on March 3, 2006, at 23:59:34
Serotonin can't be messured by a blood test. At least the serotonin in your brain. You can test for some TCA's but no blocd test of SSRI ,SNRI. If there were they would know how much and which drug to give you. Correct me if I'm wrong. Fondly, Phillipa
Posted by Phillipa on March 4, 2006, at 17:04:49
In reply to Re: 150mg » tizza, posted by linkadge on March 4, 2006, at 9:37:25
I personally know wildcard and it is true she stopped the med without withdrawal. Her life circumstances changed dramitically hence her depression disappeared. Hence no more need for the effexor. Right now there is a picture of her on the social board in her pregnant state and I've never seen her look so happy. Fondly, Phillipa
Posted by yxibow on March 4, 2006, at 17:23:02
In reply to Re: NASA's , SSRI, SNRI, etc. » musky, posted by Phillipa on March 4, 2006, at 16:50:52
> Serotonin can't be messured by a blood test. At least the serotonin in your brain. You can test for some TCA's but no blocd test of SSRI ,SNRI. If there were they would know how much and which drug to give you. Correct me if I'm wrong. Fondly, Phillipa
There is a test for serotonin serum levels. You may be right that it doesn't allow for blood-brain level testing, although of course more than 90% of the serotonin receptors are -not- in your brain, they are in your gut.http://www.nlm.nih.gov/medlineplus/ency/article/003562.htm
Posted by yxibow on March 4, 2006, at 17:28:40
In reply to Re: SSRIs et alia, Brain Chemistry and a moving target, posted by linkadge on March 4, 2006, at 9:33:33
> "They work for what they are intended for -- relief from depression and anxiety with the informed consent and predisposed knowledge that they, just like any other antidepressant or anxiolytic, could eventually not work at some point."
>
> Well for some people they do this. Do opiates work for scurvey ? I suppose they might "work" under a loose definition. Although, I'd really like to do better than opiates. Vitamin C would be nice. But I suppose we havn't discovered that.You're correct -- I think with due respect you may have missed the issue or I may have not described the above sentence in the right language -- it is for some people. Not everyone.
Opiates for scurvey? I dont know whether to laugh or stare at the ceiling.
There seems to be a spectrum of arguments about opiates -- one also has to remember for a section of the population, opiates, or certain forms of morphine related drugs, do not work at all. Genetically. In fact, they may make an individual sick. So again, there's no one step tailored drug. And I think most people would or should recognize that on here, with this lively debate.
Cheers
Jay
Posted by ed_uk on March 4, 2006, at 17:54:43
In reply to Re: 150mg, posted by linkadge on March 4, 2006, at 14:41:24
Hi Link
I took moclobemide for a couple of months about 3 years ago. It didn't really do anything.
Ed
Posted by Phillipa on March 4, 2006, at 18:46:13
In reply to Re: NASA's , SSRI, SNRI, etc. » Phillipa, posted by yxibow on March 4, 2006, at 17:23:02
Stupid question from stupid me but if they are in your gut how do they affect you brain and depression remember I can be an imbacile. Love Phillipa
Posted by Larry Hoover on March 4, 2006, at 19:20:21
In reply to Re: NASA's , SSRI, SNRI, etc. » Phillipa, posted by yxibow on March 4, 2006, at 17:23:02
> > Serotonin can't be messured by a blood test. At least the serotonin in your brain. You can test for some TCA's but no blocd test of SSRI ,SNRI. If there were they would know how much and which drug to give you. Correct me if I'm wrong. Fondly, Phillipa
>
>
> There is a test for serotonin serum levels. You may be right that it doesn't allow for blood-brain level testing, although of course more than 90% of the serotonin receptors are -not- in your brain, they are in your gut.
>
> http://www.nlm.nih.gov/medlineplus/ency/article/003562.htmThere has never been any evidence that correlates serum serotonin levels, or urine serotonin metabolite levels for that matter, with affective states or mood disorders. The blood test you linked to is part of the screening panel for carcinoid syndrome, the results of a fairly rare cancer which secretes hormones. In effect, that person would develop the various symptoms of serotonin syndrome, plus some others occurring because of regulatory changes over time.
You can test for anything in blood or urine. But there is no meaning you can attribute between blood/serum neurotransmitter levels, and any psychiatric condition (excluding rare bizarre stuff). If there was any utility to such testing, it would be routine. Doctors love simple blood work, and determining treatment from a graph or chart. _If only_ psych treatment was so simple and robustly founded.
Lar
Posted by tizza on March 4, 2006, at 21:17:19
In reply to Re: 150mg » linkadge, posted by ed_uk on March 4, 2006, at 13:09:38
> Hi Link,
>
> >How long was it though, until you went on a new medication ??
>
> I think it was about 2 weeks. The withdrawal symptoms were pretty much over by then though. The next AD I took was moclobemide. I didn't have any withdrawal symptoms when I stopped moclobemide, I don't think it was really doing anything!
>
> Edmoclobemide was the first AD I ever took about 12 years ago and it did sweet f*ck all so they gave me xanax to agument it and next thing I knew I had a serious xanax addiction. Short acting benzo's are terrilbe for me so now it's Valium
Posted by yxibow on March 5, 2006, at 4:14:33
In reply to Re: NASA's , SSRI, SNRI, etc. » yxibow, posted by Larry Hoover on March 4, 2006, at 19:20:21
> > > Serotonin can't be messured by a blood test. At least the serotonin in your brain. You can test for some TCA's but no blocd test of SSRI ,SNRI. If there were they would know how much and which drug to give you. Correct me if I'm wrong. Fondly, Phillipa
> >
> >
> > There is a test for serotonin serum levels. You may be right that it doesn't allow for blood-brain level testing, although of course more than 90% of the serotonin receptors are -not- in your brain, they are in your gut.
> >
> > http://www.nlm.nih.gov/medlineplus/ency/article/003562.htm
>
> There has never been any evidence that correlates serum serotonin levels, or urine serotonin metabolite levels for that matter, with affective states or mood disorders. The blood test you linked to is part of the screening panel for carcinoid syndrome, the results of a fairly rare cancer which secretes hormones. In effect, that person would develop the various symptoms of serotonin syndrome, plus some others occurring because of regulatory changes over time.
>
> You can test for anything in blood or urine. But there is no meaning you can attribute between blood/serum neurotransmitter levels, and any psychiatric condition (excluding rare bizarre stuff). If there was any utility to such testing, it would be routine. Doctors love simple blood work, and determining treatment from a graph or chart. _If only_ psych treatment was so simple and robustly founded.
>
> Lar
Oh -- I thought I made it clear that the test was not for corellation with neurotransmitter levels -- at least not those in the brain. Its used for testing carcinoid syndrome. You're right -- if only we could. But the 21st century holds promise if we avoid the reality distortion field of this current presidential administration, of genetic tailoring of a lot of things. We could go so far by 2050 considering the progress we have made just in the past 2 decades. But it may be countries like China and India, and possibly Great Britain that will overtake us unless we allow stem cell research and other such things. But that's just my political spin.
Posted by yxibow on March 5, 2006, at 4:25:01
In reply to Re: NASA's , SSRI, SNRI, etc. » yxibow, posted by Phillipa on March 4, 2006, at 18:46:13
> Stupid question from stupid me but if they are in your gut how do they affect you brain and depression remember I can be an imbacile. Love Phillipa
Remember the old phrase "gut instinct" ? For whatever reason, and I can only place this if one believes in evolution, genetics somehow could not fit much of the serotonin receptors in an average sized brain. So they ended up in the gut, a great percentage of them. Especially 5HT3, responsible for nausea and vomiting and the like. Ginger is a weak 5HT3 inhibitor, the older Tigan and the new 5HT3 blockers ondansetron and granisetron (and tropisetron outside of the US) are heavy 5HT3 blockers. Its the reason why earlier "unclean" SSRIs initially affect people in the stomach largely until they become accustomed to the nausea. Perhaps it was an early defense system -- your gut is a pretty powerful feeling. Serotonin itself cannot pass the blood brain barrier and largely circulates in your blood stream. Its precursor components such as 5HTP can though.
Posted by SLS on March 5, 2006, at 6:44:59
In reply to Re: NASA's , SSRI, SNRI, etc. » Larry Hoover, posted by yxibow on March 5, 2006, at 4:14:33
> > > > Serotonin can't be messured by a blood test. At least the serotonin in your brain.
> > There has never been any evidence that correlates serum serotonin levels, or urine serotonin metabolite levels for that matter, with affective states or mood disorders.
CSF might be a better source of chemical markers.
If it is found that the etiologies of some mental illnesses are to be found in abnormal gene expression, perhaps microarrays will be helpful in diagnosing and determining treatment. We really aren't all that far from that now. (I guess it's all relative. It is still too far away to suit me).
- Scott
Posted by Larry Hoover on March 5, 2006, at 9:42:50
In reply to Re: NASA's , SSRI, SNRI, etc. » Larry Hoover, posted by yxibow on March 5, 2006, at 4:14:33
> > You can test for anything in blood or urine. But there is no meaning you can attribute between blood/serum neurotransmitter levels, and any psychiatric condition (excluding rare bizarre stuff).
> Oh -- I thought I made it clear that the test was not for corellation with neurotransmitter levels -- at least not those in the brain.
Actually, I'm the one who should apologize. I'm sorry, I didn't mean to centre you out. I just really wanted to emphasize that the only benefit from blood serotonin testing accrues to the laboratory doing the test (and maybe the doctor who ordered it). The patient simply wastes money.
Lar
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