![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by bulldog2 on May 15, 2008, at 8:39:46
P-doc had given me clonidine years ago to help with anxiety and to keep my klonopin use down which was never more than 2 milligrams a day. Usually take it at night before sleep. Took one in the middle of the day instead of .5 milligram klonipin for anxiety the other day. Within an hour my mood crashed and I felt really depressed.I looked up the drug and saw it works by suppressing NE. That's not good for a person prone to depression as NE is one of the feel good neurotransmitters. Call in to p-doc to drop this med!
Posted by Phillipa on May 15, 2008, at 12:10:27
In reply to Clonidine Contributing to Depression?, posted by bulldog2 on May 15, 2008, at 8:39:46
Let us know what he says. Love Phillipa
Posted by SLS on May 15, 2008, at 15:28:22
In reply to Clonidine Contributing to Depression?, posted by bulldog2 on May 15, 2008, at 8:39:46
> P-doc had given me clonidine years ago to help with anxiety and to keep my klonopin use down which was never more than 2 milligrams a day. Usually take it at night before sleep. Took one in the middle of the day instead of .5 milligram klonipin for anxiety the other day. Within an hour my mood crashed and I felt really depressed.I looked up the drug and saw it works by suppressing NE. That's not good for a person prone to depression as NE is one of the feel good neurotransmitters. Call in to p-doc to drop this med!
Clonidine is well known to cause depression.
- Scott
Posted by undopaminergic on May 15, 2008, at 21:22:45
In reply to Re: Clonidine Contributing to Depression?, posted by SLS on May 15, 2008, at 15:28:22
> > P-doc had given me clonidine years ago to help with anxiety and to keep my klonopin use down which was never more than 2 milligrams a day. Usually take it at night before sleep. Took one in the middle of the day instead of .5 milligram klonipin for anxiety the other day. Within an hour my mood crashed and I felt really depressed.I looked up the drug and saw it works by suppressing NE. That's not good for a person prone to depression as NE is one of the feel good neurotransmitters. Call in to p-doc to drop this med!
>
>
> Clonidine is well known to cause depression.Clonidine is a centrally acting antihypertensive agent that is usually quite sedating, but depression is not the best term to describe it. Clonidine's sedative effects are probably a result of its agonism at alpha2C-adrenergic and imidazoline I1 receptors, since guanfacine - a preferential alpha2A-adrenergic agonist - is much less sedative, and selegiline - an agonist at alpha2B-adrenoceptors - is not sedative at all.
In my experience, guanfacine is insignificantly sedative, and not depressive at all. Some animal data suggests that it may have anxiolytic properties, and although I haven't noticed any, you may wish to ask your doctor to substitute guanfacine for clonidine so that you may see for yourself.
Posted by SLS on May 16, 2008, at 4:35:08
In reply to Re: Clonidine Contributing to Depression?, posted by undopaminergic on May 15, 2008, at 21:22:45
> > Clonidine is well known to cause depression.
> Clonidine is a centrally acting antihypertensive agent that is usually quite sedating, but depression is not the best term to describe it.I respectfully disagree. I have seen this happen a few times, and it is definitely depression.
- Scott
Posted by undopaminergic on May 16, 2008, at 9:28:13
In reply to Re: Clonidine Contributing to Depression?, posted by SLS on May 16, 2008, at 4:35:08
> > > Clonidine is well known to cause depression.
>
> > Clonidine is a centrally acting antihypertensive agent that is usually quite sedating, but depression is not the best term to describe it.
>
> I respectfully disagree. I have seen this happen a few times, and it is definitely depression.
>What kind of depression? Major depression that meets the DSM-IV diagnostic criteria? Or just dysphoria? Suicidality? Anhedonia? Impaired concentration? Lasting for a few minutes? Days? Weeks?
Posted by SLS on May 16, 2008, at 9:33:32
In reply to Re: Clonidine Contributing to Depression?, posted by undopaminergic on May 16, 2008, at 9:28:13
> What kind of depression? Major depression that meets the DSM-IV diagnostic criteria? Or just dysphoria? Suicidality? Anhedonia? Impaired concentration? Lasting for a few minutes? Days? Weeks?
Please.
- Scott
Posted by undopaminergic on May 16, 2008, at 10:38:27
In reply to Re: Clonidine Contributing to Depression?, posted by SLS on May 16, 2008, at 9:33:32
> > What kind of depression? Major depression that meets the DSM-IV diagnostic criteria? Or just dysphoria? Suicidality? Anhedonia? Impaired concentration? Lasting for a few minutes? Days? Weeks?
>
> Please.
>Seriously, it's a very vague term and requires clarification to be meaningful. Hence, it's not the best term to describe the adverse effects of a drug, as there are more specific terms that avoid much of the ambiguity.
Posted by MidnightBlue on May 16, 2008, at 13:09:07
In reply to Re: Clonidine Contributing to Depression?, posted by SLS on May 15, 2008, at 15:28:22
Scott,
Thank you for affirming that! I was given one dose of clonidine to rapidly reduce serioiusly high blood pressure. 24 hours later I had a complete emotional meltdown. It only lasted a day, but it was way out of character for me. I do have a long history of severe depression that is in remission.
MB
Posted by bulldog2 on May 16, 2008, at 15:28:38
In reply to Re: Clonidine Contributing to Depression? » SLS, posted by MidnightBlue on May 16, 2008, at 13:09:07
I would think the depression would abate within a couple days of stopping the med. But I took it every day for several years. I generally took it at bedtime so was not that aware of what it might have been doing to my mood. I decided to take it in the middle of the day instead of .5 milligrams of klonopin. Boy what a difference. The klonopin usually dissolves the anxiety without a noticeable change in mood. I'm not sophisticated enought to give a text description as to what type of depression it was. But there was a quick plummeting of mood. No desire to communicate with people, lost interest in a book I was reading and just sat there with almost no ability to feel any emotion. Talked to my p-doc and we're stopping the clonidine. The klonopin is a better option for anxiety. Also the end result of whatever receptors clonidine works on norepenephrine production is reduced.
Posted by undopaminergic on May 21, 2008, at 6:16:08
In reply to Re: Clonidine Contributing to Depression?, posted by bulldog2 on May 16, 2008, at 15:28:38
> But there was a quick plummeting of mood. No desire to communicate with people, lost interest in a book I was reading and just sat there with almost no ability to feel any emotion.
>What about drowsiness?
> Talked to my p-doc and we're stopping the clonidine. The klonopin is a better option for anxiety.
>I find opiates and stimulants more effective.
> Also the end result of whatever receptors clonidine works on norepenephrine production is reduced.
>Yes, alpha2-adrenergic agonists reduce noradrenaline (-epinephrine) production. This is good when you have an excess of it. Maybe you don't.
Posted by bulldog2 on May 22, 2008, at 9:51:22
In reply to Re: Clonidine Contributing to Depression?, posted by undopaminergic on May 21, 2008, at 6:16:08
> > But there was a quick plummeting of mood. No desire to communicate with people, lost interest in a book I was reading and just sat there with almost no ability to feel any emotion.
> >
>
> What about drowsiness?
>
> > Talked to my p-doc and we're stopping the clonidine. The klonopin is a better option for anxiety.
> >
>
> I find opiates and stimulants more effective.
>
> > Also the end result of whatever receptors clonidine works on norepenephrine production is reduced.
> >
>
> Yes, alpha2-adrenergic agonists reduce noradrenaline (-epinephrine) production. This is good when you have an excess of it. Maybe you don't.yes I was drowsy. Yes I find stimulants and opiates more effective. Opiates address both depression and anxiety. I believe too much of a benzo can exacerbate one's depression.
Posted by Phillipa on May 22, 2008, at 20:07:02
In reply to Re: Clonidine Contributing to Depression?, posted by bulldog2 on May 22, 2008, at 9:51:22
And I felt great on one percocet a day????Love Phillipa
Posted by ace on May 23, 2008, at 0:01:10
In reply to Clonidine Contributing to Depression?, posted by bulldog2 on May 15, 2008, at 8:39:46
> P-doc had given me clonidine years ago to help with anxiety and to keep my klonopin use down which was never more than 2 milligrams a day. Usually take it at night before sleep. Took one in the middle of the day instead of .5 milligram klonipin for anxiety the other day. Within an hour my mood crashed and I felt really depressed.I looked up the drug and saw it works by suppressing NE. That's not good for a person prone to depression as NE is one of the feel good neurotransmitters. Call in to p-doc to drop this med!
the issue with NE is extremely variable from person to person. Lowered levels can create anti-depressive effects in some.
It sounds Clonidine could have caused the depressive feelings, although, obviously, this may not be the case.I thing, on the whole, Clonidine is very good for anxiety, ADHD symptoms, a smoking cessation agent. Also, in some patients a great anti-OCD agent and AD
We are all so different!~
Posted by SLS on May 23, 2008, at 5:36:25
In reply to Re: Clonidine Contributing to Depression? » bulldog2, posted by ace on May 23, 2008, at 0:01:10
It's not too tough to do a Google search. Clonidine is depressogenic.
- Scott
Posted by ace on May 25, 2008, at 23:52:37
In reply to Re: Clonidine Contributing to Depression?, posted by SLS on May 23, 2008, at 5:36:25
> It's not too tough to do a Google search. Clonidine is depressogenic.
>
> http://www.google.com/search?hl=en&q=clonidine+AND+%28depressogenic+OR+depressive+OR+depression%29&btnG=Search
>
>
> - ScottI don't think we can say that as a 'blanket' claim. I have seen in some that Clonide has indeed reduced depression.
You know as well as me the inprecision inherent in pyschopharmalogical treatment of the clinical psychiatric syndromes....
Ace:)
Posted by SLS on May 26, 2008, at 5:58:08
In reply to Re: Clonidine Contributing to Depression? » SLS, posted by ace on May 25, 2008, at 23:52:37
> > It's not too tough to do a Google search. Clonidine is depressogenic.
> >
> > http://www.google.com/search?hl=en&q=clonidine+AND+%28depressogenic+OR+depressive+OR+depression%29&btnG=Search
> >
> >
> > - Scott
>
> I don't think we can say that as a 'blanket' claim.If by that, you mean that my claim is that clonidine produces depression 100% of the time, this is certainly not the case. However, the rate is high enough to consider it as a possibility any time this drug is used.
> I have seen in some that Clonide has indeed reduced depression.
What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?
> You know as well as me the inprecision inherent in pyschopharmalogical treatment of the clinical psychiatric syndromes....
Of course. However, I do not believe that inprecision is a de facto property of psychopharmacological treatment. We are close to producing tests for genotypes that will offer information that will help choose drugs for each individual.
How is school?
- Scott
Posted by ace on May 28, 2008, at 0:33:03
In reply to Re: Clonidine Contributing to Depression? » ace, posted by SLS on May 26, 2008, at 5:58:08
> > > It's not too tough to do a Google search. Clonidine is depressogenic.
> > >
> > > http://www.google.com/search?hl=en&q=clonidine+AND+%28depressogenic+OR+depressive+OR+depression%29&btnG=Search
> > >
> > >
> > > - Scott
> >
> > I don't think we can say that as a 'blanket' claim.
>
> If by that, you mean that my claim is that clonidine produces depression 100% of the time, this is certainly not the case. However, the rate is high enough to consider it as a possibility any time this drug is used.
I did interpret your claim in such a way- I would agree with your statement here- that the rate is high enough to consider it a possibility- I personally just don't like to discount any drug as a possible treatment, especially when dealing with refractory illness> > I have seen in some that Clonide has indeed reduced depression.
>
> What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?Very much so- the vast majority were diagnosed with ADHD or ADHD type symptoms. Although I have seen anecdotes on 'normal' depression (without co-morbidity) responding to it favourably. I believe I have some on trials on it too- for OCD, ADHD- always with depression as a co-morbid problem.
>
> > You know as well as me the inprecision inherent in pyschopharmalogical treatment of the clinical psychiatric syndromes....
>
> Of course. However, I do not believe that inprecision is a de facto property of psychopharmacological treatment.At this point in time I would think it so. What would suggest otherwise to you at the present?
But it's not easy for psychiatry- how can such treatment be precise when we have no external evidence of any mental illness- there is only speculation and clinical opinion. I certainly not am suggesting that mental illness does not exist- I feel it does. However, I feel it is not analogous to most other biological diseases in that the aetiology in mental illness can not fit into a simple medical model. The same illness (i.e OCD) amongst a population of patients can have a totally different aetiologies in each patient- with perhaps, a common factor.We are close to producing tests for genotypes that will offer information that will help choose drugs for each individual.
>I have read somewhat about this- in particular with psychotic disorders. However, most studies end with the usual "more research needs to be done" With regards to OCD- have a look at this (if time permits)
http://www.medicalnewstoday.com/articles/40652.phpI certainly don't think the future is bleak. I think the time will come where psychiatry will be able to (in some form) conduct external validating test of pychopathology...
> How is school?
It's really good but demanding...I got through the GAMSAT here in NSW, so all is looking very good. However, I am a bit concerned about my own problems, and the fact that I take psychiatric drugs as possibly being of detriment to all...this issue is really making me anxious at the moment....
>
> - ScottCheers Scott- stay positive mate,
Andrew:)
>
Posted by SLS on May 28, 2008, at 5:28:48
In reply to Re: Clonidine Contributing to Depression? » SLS, posted by ace on May 28, 2008, at 0:33:03
> I personally just don't like to discount any drug as a possible treatment, especially when dealing with refractory illness.
Yes, sir. Definitely.
> > What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?
> Very much so- the vast majority were diagnosed with ADHD or ADHD type symptoms. Although I have seen anecdotes on 'normal' depression (without co-morbidity) responding to it favourably. I believe I have some on trials on it too- for OCD, ADHD- always with depression as a co-morbid problem.
The ADHD I knew about. Not the OCD. Interesting. I guess that makes sense if NE pathways to the frontal cortex are overactive.
> > Of course. However, I do not believe that inprecision is a de facto property of psychopharmacological treatment.
> At this point in time I would think it so. What would suggest otherwise to you at the present?
I don't think we are that far away from using microarray techniques to assess gene activity. Pinpointing which genes are over- or under- expressed might allow for the selection of specific drugs to an individual.
About choosing medicine as a profession, you would not be the only physician to have a mental illness. I guess if Kay Redfield Jamison can do it, so can you.
http://en.wikipedia.org/wiki/Kay_Redfield_Jamison
Good luck.
- Scott
Posted by ace on May 29, 2008, at 1:43:35
In reply to Re: Clonidine Contributing to Depression? » ace, posted by SLS on May 28, 2008, at 5:28:48
> > I personally just don't like to discount any drug as a possible treatment, especially when dealing with refractory illness.
>
> Yes, sir. Definitely.
>
> > > What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?
>
> > Very much so- the vast majority were diagnosed with ADHD or ADHD type symptoms. Although I have seen anecdotes on 'normal' depression (without co-morbidity) responding to it favourably. I believe I have some on trials on it too- for OCD, ADHD- always with depression as a co-morbid problem.
>
> The ADHD I knew about. Not the OCD. Interesting. I guess that makes sense if NE pathways to the frontal cortex are overactive.I know there are definitely some articles on it's use for OCD at PubMed (It's often been used as an augmentative agent) Basically, as to be expected, the results were not unequivocal by any means. I believe in some a defect in noradrenaline function was posted to be a viable explanation of their OCD sx. I(n others a different mechanism was posed.....One study, which I really want to find, documents a case where 20+ patients recieved great benefit when IV Clonidine was administered....
I think, for OCD, it is worth a shot- but certainly not a first-liner. With depression I would certainly leave it until a plethora of other treatments have been tried.
> > > Of course. However, I do not believe that inprecision is a de facto property of psychopharmacological treatment.
>
> > At this point in time I would think it so. What would suggest otherwise to you at the present?
>
> I don't think we are that far away from using microarray techniques to assess gene activity. Pinpointing which genes are over- or under- expressed might allow for the selection of specific drugs to an individual.
I have seen data on this- and am looking at some now as I type this, and it does look promising...I guess the most fundamental, and trenchant question is how far away is 'not too far away'?
Have you seen this article?
http://www.biomedcentral.com/1471-244X/8/29
> About choosing medicine as a profession, you would not be the only physician to have a mental illness. I guess if Kay Redfield Jamison can do it, so can you.
>
> http://en.wikipedia.org/wiki/Kay_Redfield_Jamison
>
> Good luck.
>
>
> - Scott
I understand, and I checked out the link- thanks for that. You must of heard that statement Jung made about a physician 'washing his hands first' (before treating others)Would you say, per se, it would be unethical for a psychiatrist to be on the very medications he prescribes? I do feel a certain unethic inherent in this, although, negating this feeling is the fact that experiencing mental illness (and subsequently being pharcologically treated for it) would enhance ones capacity to empathise with 'patients'.
I do know many psychiatrists (on a personal level) (Also, my uncle is a psychiatrist) who certainly suffer mental illness, and a myriad of "Axis II" disorders. And I have noted (what I feel) is improper behaviour, due, to what I feel is their own psychiatric problems.
Maybe my whole anxiety about this is a manifestation of my own mental illness, I'm not sure?
Give me your thoughts!
Stay positive,
Andrew
Posted by SLS on May 29, 2008, at 4:59:09
In reply to Re: Clonidine Contributing to Depression? » SLS, posted by ace on May 29, 2008, at 1:43:35
Dear Ace,
Thanks a bunch for providing the microarray article. Exciting stuff.
Would an orthopedist who takes ibuprofen for his own arthritis represent an ethical dilemma?
Would an endocrinologist needing thyroxine be violating his Hippocratic Oath?
At the moment your passions lie in neuroscience - psychiatry in particular. You would be a much better doctor to choose a speciality that you have a passion for and for which study comes more easily than a field for which your interest lies in different motivations.
I don't know what is the source of your ethical dilemma. I don't see that there is one. However, whereas depression can certainly warp one's perceptions and decision making processes, it seems to me that your difficulties lie in your history rather than your cephaloneurofunction.
Oh, by the way, thanks for expanding my vocabulary. You are becoming a hell of a writer.
- Scott
Posted by undopaminergic on June 3, 2008, at 3:43:30
In reply to Re: Clonidine Contributing to Depression? » SLS, posted by ace on May 29, 2008, at 1:43:35
> >
> > > > What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?
> >
> > > Very much so- the vast majority were diagnosed with ADHD or ADHD type symptoms. Although I have seen anecdotes on 'normal' depression (without co-morbidity) responding to it favourably. I believe I have some on trials on it too- for OCD, ADHD- always with depression as a co-morbid problem.
> >
> > The ADHD I knew about. Not the OCD. Interesting. I guess that makes sense if NE pathways to the frontal cortex are overactive.
>Eur J Pharmacol. 1991 Feb 14;193(3):309-13. PMID 1675994
Clonidine causes antidepressant-like effects in rats by activating alpha 2-adrenoceptors outside the locus coeruleus.
"Clonidine, 0.05, 0.1 and 0.5 mg/kg administered i.p. as a three-injection course but not as single doses, significantly reduced the immobility of rats in the forced swimming test."Eur J Pharmacol. 1990 Jan 17;175(3):301-7. PMID 1969801
Alpha 2-adrenoceptor blockade prevents the effect of desipramine in the forced swimming test.
- - - -Personally, I like to maintain a suitable degree of alpha2-agonism through the use of guanfacine. I haven't noticed an antidepressant action, but it improves some facets of working memory and executive function. Bonus effects include a reduction of heart rate and blood pressure. The only drawback is an increased tendency to dry mouth. It should perhaps be noted that guanfacine is not equivalent to clonidine for all intents and purposes - it's better tolerated, and more suitable for cognitive enhancement, but may be less efficacious for some other uses.
> I understand, and I checked out the link- thanks for that. You must of heard that statement Jung made about a physician 'washing his hands first' (before treating others)
>A physician should of course wash himself, and be free from contagious diseases, so as not to transfer these to his patients.
> Would you say, per se, it would be unethical for a psychiatrist to be on the very medications he prescribes?
>Absolutely not. In the good old days, doctors often tested treatments and medications on themselves - for instance, the stethoscope, the hypodermic needle, opium preparations, and hypnotic agents. Freud familiarised himself with the effects and propertiess of cocaine by administering it to himself before venturing to use it on his patients. In this day and age, psychiatrists generally lack first hand experience with most of the treatments that they prescribe, often prolifically, to others. In my opinion, this is somewhat irresponsible.
It would, however, be unethical - and more importantly, unsuitable and inefficient - for a physician to be so enthusiastic and passionate about a particular medicine or other treatment that he presses it onto patients for whom it is not appropriate, or for whom alternative treatments would be more effective or suitable. Such enthusiasm may come from personal use of the treatment and a resulting amazement with its efficacy for treating a health condition, or any other agreeable effect of it.
As an example, if a physician used morphine on himself to treat chronic back aches, and found it not only to be remarkably effective for the pain, but also to induce a state of comfort and joy, it would not be appropriate to let such experience cloud his judgement so that he proceeds to prescribe morphine therapy for a patient presenting with migraine (except perhaps after trying other, more suitable treatments first and finding them ineffective).
As a particularly pertinent example, it would be inappropriate for you to let your personal success and satisfaction with Nardil lead you to prescribe it for patients for whom EMSAM or Parnate would have equal probability of success but less likelihood of adverse effects regarded by the patient as particularly undesirable.
>
> I do know many psychiatrists (on a personal level) (Also, my uncle is a psychiatrist) who certainly suffer mental illness, and a myriad of "Axis II" disorders. And I have noted (what I feel) is improper behaviour, due, to what I feel is their own psychiatric problems.
>It is important to remember that psychiatrists are only human, and it is not reasonable to demand them to be perfect. Besides, the definitions of mental health and illness are subject to change - for example, homosexuality is a mental condition that is no longer regarded as an illness. Additionally, ideals are also subject to change - for instance, what may have been considered ideals for everyone to strive towards in ancient Greece may be regarded with ridicule or contempt in some other place and time.
> Maybe my whole anxiety about this is a manifestation of my own mental illness, I'm not sure?
>It's quite possible that it's a manifestation of some underlying mental condition, such as a lack of confidence or self-esteem, or alternatively, exaggerated perfectionism or idealism.
Posted by ace on June 5, 2008, at 1:45:38
In reply to Re: Clonidine Contributing to Depression?, posted by undopaminergic on June 3, 2008, at 3:43:30
> > >
> > > > > What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?
> > >
> > > > Very much so- the vast majority were diagnosed with ADHD or ADHD type symptoms. Although I have seen anecdotes on 'normal' depression (without co-morbidity) responding to it favourably. I believe I have some on trials on it too- for OCD, ADHD- always with depression as a co-morbid problem.
> > >
> > > The ADHD I knew about. Not the OCD. Interesting. I guess that makes sense if NE pathways to the frontal cortex are overactive.
> >
>
> Eur J Pharmacol. 1991 Feb 14;193(3):309-13. PMID 1675994
> Clonidine causes antidepressant-like effects in rats by activating alpha 2-adrenoceptors outside the locus coeruleus.
> "Clonidine, 0.05, 0.1 and 0.5 mg/kg administered i.p. as a three-injection course but not as single doses, significantly reduced the immobility of rats in the forced swimming test."
>
> Eur J Pharmacol. 1990 Jan 17;175(3):301-7. PMID 1969801
> Alpha 2-adrenoceptor blockade prevents the effect of desipramine in the forced swimming test.
> - - - -
>
> Personally, I like to maintain a suitable degree of alpha2-agonism through the use of guanfacine. I haven't noticed an antidepressant action, but it improves some facets of working memory and executive function. Bonus effects include a reduction of heart rate and blood pressure. The only drawback is an increased tendency to dry mouth. It should perhaps be noted that guanfacine is not equivalent to clonidine for all intents and purposes - it's better tolerated, and more suitable for cognitive enhancement, but may be less efficacious for some other uses.
>
> > I understand, and I checked out the link- thanks for that. You must of heard that statement Jung made about a physician 'washing his hands first' (before treating others)
> >
>
> A physician should of course wash himself, and be free from contagious diseases, so as not to transfer these to his patients.* I don't believe any mental illness to be contagious at all. However, I feel that certain behaviours, which I deem as unethical, which have their genesis in mental illness can be very deleterious to a psychiatrists 'patients' Also, the inherent 'power' structure within the clinician/patient relationship can be abused.
>
> > Would you say, per se, it would be unethical for a psychiatrist to be on the very medications he prescribes?
> >
>
> Absolutely not. In the good old days, doctors often tested treatments and medications on themselves - for instance, the stethoscope, the hypodermic needle, opium preparations, and hypnotic agents. Freud familiarised himself with the effects and propertiess of cocaine by administering it to himself before venturing to use it on his patients.I see what your saying, but I don't feel the physician used these treatments in a therapuetic way, i.e. as to relieve certain symptoms they themselves suffered.
In this day and age, psychiatrists generally lack first hand experience with most of the treatments that they prescribe, often prolifically, to others.I'm not too sure here. I personally feel many psychiatrists are on psychiatric medications themselves. Obviously this is from what I have read, seen, and the psychiatrists I have met through my study, through friends, and a personal relative.
In my opinion, this is somewhat irresponsible.I can see what you mean. Can we go far to say as, in a certain sense, an (obviously informal!) pre-requisite to specialising as a psychiatrist should be a mental illness or illness's, which have subsequently been treated and 'resolved' to a great degree? I think this enhances the doctors ability to effectively 'help, 'treat' his/her patients to a great degree.
The main issue, I feel, however, is whether such an illness has been 'resolved'. At least to unhinder the clinicians behaviour, perception, and treatment of the patient....
>
> It would, however, be unethical - and more importantly, unsuitable and inefficient - for a physician to be so enthusiastic and passionate about a particular medicine or other treatment that he presses it onto patients for whom it is not appropriate, or for whom alternative treatments would be more effective or suitable.I agree 100%.
Such enthusiasm may come from personal use of the treatment and a resulting amazement with its efficacy for treating a health condition, or any other agreeable effect of it.
I am preety sure you are alluding to me and Nardil. My opinion of Nardil is NOT due soley on the great level of thereapeutic efficacy I recieved from it. I can see why would would think this however.
Before starting the drug, I investigated it extremely thoroughly- it's pharmacological properties, it's history, it's rate of use in different countries, and most importantly clinical and anectodal reports on the drug.
I literally printed out anything about Nardil from any resource possible (on-line journals, psych web-site akin to this and this site, etc etc) Also, I obtained many psychiatric journals from 1950+ (I am OCD!)
I had never seen ANY response as positive to a drug EVER before. And previous to taking Nardil I was no stranger to psychiatric meds and had already researched them (as a hobby at that time)
Obviously my response to the drug, inveterated what I already felt about the drug.
After kicking in, I was certainly in a state of (healthy) euphoria ( I still do recieve a euphoria at times from Nardil, in addition to it's wonderful primary therapeutic effect). This is evident in my posts on this sites all those many years ago now. I am naturally an eccentric person, but Nardil accentuated that to a great degree, and I WAS a little over the top in some things I did. I do tell people this can happen.
> As an example, if a physician used morphine on himself to treat chronic back aches, and found it not only to be remarkably effective for the pain, but also to induce a state of comfort and joy, it would not be appropriate to let such experience cloud his judgement so that he proceeds to prescribe morphine therapy for a patient presenting with migraine (except perhaps after trying other, more suitable treatments first and finding them ineffective).
Once again I agree totally, however I do feel this is not congruent with my situation with Nardil. (Although i can fully understand why you would think so)
>
> As a particularly pertinent example, it would be inappropriate for you to let your personal success and satisfaction with Nardil lead you to prescribe it for patients for whom EMSAM or Parnate would have equal probability of success but less likelihood of adverse effects regarded by the patient as particularly undesirable.I preety much answered this above, but you are correct. Nardil's s/effects can be preety rough for a lot of people- I have always stated this (in addition to stating their are treatments for the s/effects). Parnate can be a phenomenal boon to others too, and also the TCA's. I do not find the newer drugs in any way better than the older drugs, except that, on the whole, we do see fewer s/effects.
But I WOULD indeed use Nardil as a first line for what I deemed a severe depression or severe anxiety disorder (or combinations of the both). Once again, this is certainly NOT based, in any way, soley on my response to the drug.
>
> >
> > I do know many psychiatrists (on a personal level) (Also, my uncle is a psychiatrist) who certainly suffer mental illness, and a myriad of "Axis II" disorders. And I have noted (what I feel) is improper behaviour, due, to what I feel is their own psychiatric problems.
> >
>
> It is important to remember that psychiatrists are only human, and it is not reasonable to demand them to be perfect.Sure- I think all of them have positives and negatives like us all! Medical school does NOT bestow a person with wisdom, compassion, empathy, love, etc etc And certainly not sanity, ha ha!!
Besides, the definitions of mental health and illness are subject to change - for example, homosexuality is a mental condition that is no longer regarded as an illness.Psychiatry is still more of an art than a science. But I do see great things on the horizon for it as a speciality.....maybe it will always be that 'asymptope' which never reaches the curve (i.e. the point where we can say "here is your disease!!")
Physics, Maths, chemistry, other branches of medicine etc, are bona-fide science or very close too- It is my hope that psychiatry does reach this level. It is a great challenge.
Additionally, ideals are also subject to change - for instance, what may have been considered ideals for everyone to strive towards in ancient Greece may be regarded with ridicule or contempt in some other place and time.I know. I believe homosexuality, in time long past, was a 'manly' thing. I am no historian but!
We are now looking at the more 'social construct' side of psychiatry here- your ideas are absolutely valid.
>
> > Maybe my whole anxiety about this is a manifestation of my own mental illness, I'm not sure?
> >
>
> It's quite possible that it's a manifestation of some underlying mental condition, such as a lack of confidence or self-esteem, or alternatively, exaggerated perfectionism or idealism.I think it's my OCD now, after long reflection. That being said, it could be any/all off the above....!!!!
Cheers:)
Ace:)
Posted by ace on June 6, 2008, at 0:51:50
In reply to Re: Clonidine Contributing to Depression? » ace, posted by SLS on May 29, 2008, at 4:59:09
> Dear Ace,
>
> Thanks a bunch for providing the microarray article. Exciting stuff.
No probs Scott- I actually have found a few additional ones since then which are very interesting- let me know if you want the links!
>
> Would an orthopedist who takes ibuprofen for his own arthritis represent an ethical dilemma?
>
> Would an endocrinologist needing thyroxine be violating his Hippocratic Oath?I do see what your saying, and definately
see legitimacy in your sentiments. I am preety sure this whole anxiety is just another manifestation of OCD- The thoughts which accompany this anxiety belie a fundamental sense of 'normality' I do possess...they are ego-dystonic...> At the moment your passions lie in neuroscience - psychiatry in particular. You would be a much better doctor to choose a speciality that you have a passion for and for which study comes more easily than a field for which your interest lies in different motivations.
I agree too. In a certain way I feel I have to accept the fact that I will indeed suffer, to a greater or lesser extent, from mental illness until I die. My main focus is how to live as peacefully with it. I also hope to be able to use this illness to my advantage. I feel it can become a boon, if it facilitates greater empathy for a person going through a similiar experience(s)
What's your take on all this? Do you think such a 'self-prognosis' is rather bleak......
And your right- I could read about psychomaracology, psychopathalogy etc etc for hours on end!
Have you ever thought about pursuing a similiar career?- I feel it is obvious you have a passion for these things too.
> I don't know what is the source of your ethical dilemma. I don't see that there is one. However, whereas depression can certainly warp one's perceptions and decision making processes, it seems to me that your difficulties lie in your history rather than your cephaloneurofunction.
>
> Oh, by the way, thanks for expanding my vocabulary. You are becoming a hell of a writer.Hey?! Where did I? You have always struck me as an eloquent writer yourself Scott!
Many thanks for your post mate,
Andrew:)
>
> - Scott
This is the end of the thread.
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