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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on July 18, 2008, at 5:25:26
In reply to Re: Want to stop meds ... should I? » SLS, posted by linkadge on July 17, 2008, at 21:46:44
She is feeling well. Given her history, I wonder why? Oh, I see, the meds chosen didn't work in the past, so the different meds she is now taking probably aren't really working now. The hell with statistics and anecdotes demonstrating a high probability of relapse when the patient treats for less than a year. Actually a physician at Mount Sinai, NY told me that they prefer to treat for 14 months as a minimum. This was in 1986. In Maxime's case, I believe most doctors would have her remain on drugs indefinitely. Indefinitely might mean that she might have to wait for something like gene therapy to come along.
As for seizures, for how long does a single ECT seizure bring about remission? How long does a single seizure of any sort improve depression. I don't see how you could possibly make a case for such things. Relapse. You gotta keep performing the treatments on a regular basis. Why should now be any different? I know, miracle cures. After all, they do happen. I guess we should all discontinue our medication to see which of us have the miracle thing going on.
Go ahead. Recommend to Maxime to stop taking her meds. I would like to see that. And while you are at it, you might as well go med-free indefinitely yourself and allow us to witness your algorithms at work. Maybe exercise for a robust and continuing remission for MDD or BD?
Don't you fret about SLS's way of thinking. He's ok with it.
- Scott
Posted by SLS on July 18, 2008, at 5:27:57
In reply to Re: Thank you, everyone, posted by linkadge on July 17, 2008, at 21:48:56
> Was maxime on meds when she attempted suicide? Well?
Why don't you ask her?
Well?
- Scott
Posted by SLS on July 18, 2008, at 5:30:40
In reply to Re: Thank you, everyone, posted by SLS on July 18, 2008, at 5:27:57
Sorry for exceeding the posting limit. My mistake.
- Scott
Posted by Midnightblue on July 18, 2008, at 10:58:32
In reply to Re: Thank you, everyone, posted by linkadge on July 17, 2008, at 21:48:56
I think she is on a very different combination of meds now. And I think that has made the difference.
MB
Posted by blueboy on July 18, 2008, at 10:59:59
In reply to Re: Want to stop meds ... should I?-flzcnclu?? » blueboy, posted by Lou PIlder on July 17, 2008, at 12:58:04
[...]
> > > I changed my meds a bit in February, but something else happened in Feb as well. I attempted suicide and ended up in a coma. My psychiatrist doesn't know if my remission is the results of the meds I am on ... or the coma.
[...]
> > But when AD's work, their effect is sometimes characterized by an initial suicide attempt. That makes me tend to think that the AD is at least partly responsible for your relief from depression.
>
> blueboy,
> You wrote,[...sometimes characterized by an innitial suicide attempt...].
> I am unsure as to if there is or is not a correlation with the aspect of an AD working with an attempted suicde.Could you post here any facts to support the statement in question? If you could, then I could have the opportunity to respond accordingly.1) A psychiatrist who had been practicing for over 30 years told me this. In fact, he said that in his experience "the most dangerous time for suicide is the weeks after a good drug treatment is started". His theory to explain it was that the patient would be activated enough to carry out a pre-existing tendency, but that was just a hypothesis.
2) A lot of AD's now carry a black box warning about suicide attempts, especially for teenagers. There is a definite "official" perception of a significant increase in suicide risk early in AD treatment.
3) Her pdoc thought that the meds might be the cause of her recovery.
4) She is taking the meds and is feeling enormous relief from depressive symptoms.
There isn't a lot of research on the hypothesis, largely due to the doctors' reactions of immediately discontinuing AD treatment after a suicide attempt. Even more, there is a disinclination to run a trial where patients who have started an AD treatment and then attempt suicide are continued on the AD, to see if they attempt suicide again. The possibility of lawsuits and ethical sanctions are too high.
5) Researchers have seen clues, however, that the phenomenon occurs. E.g., in Science Daily, "New UCLA Study Disputes Antidepressant/Suicide Link" (University Of California - Los Angeles (2005, February 7). There, Dr. Julio Licinio, a professor of psychiatry and endocrinology at the David Geffen School of Medicine and a researcher at the UCLA Neuropsychiatric Institute, who has been studying the problem for decades, stated:
"When people start antidepressant therapy, the first symptom to be alleviated is low energy, but the feeling that life isn't worth living is the last to go. Prior to taking SSRIs, depressed people may not have committed suicide due to their extreme lethargy. As they begin drug therapy, they experience more energy, but still feel that life isn't worth living. That's when a depressed person is most in danger of committing suicide."
6) If her suicide attempt was in fact tied to the onset of AD treatment, it means that the drug was doing *something* directly affecting her depression. Since she first attempted suicide and has since experienced a major remission of symptoms, the facts strongly suggest that the suicide and recovery are steps in a series of events.
Posted by blueboy on July 18, 2008, at 11:02:52
In reply to Re: Want to stop meds ... should I? » SLS, posted by linkadge on July 17, 2008, at 21:46:44
> But, if you recall, she said she was not feeling well on meds at all and thats why she attempted suicide and ended up in the coma. She said she felt better since then. Because of the timing of the remission, it can't be attributed to medications.
>It most certainly can.
http://www.sciencedaily.com/releases/2005/02/050205102643.htm
Posted by SLS on July 18, 2008, at 12:07:42
In reply to Re: Want to stop meds ... should I? » Lou PIlder, posted by blueboy on July 18, 2008, at 10:59:59
Nice post.
- Scott
Posted by linkadge on July 18, 2008, at 15:11:49
In reply to Re: Want to stop meds ... should I? » linkadge, posted by SLS on July 18, 2008, at 5:25:26
>As for seizures, for how long does a single ECT >seizure bring about remission? How long does a >single seizure of any sort improve depression. I >don't see how you could possibly make a case for >such things.
Some people who are treated with ECT remit from symptoms, Ie the ECT aborts the depressive episode.
I think it is also important to look at family history for the natural course of the disorder.
For instance, unmedicated, my grandfather had 4 depressive episodes (severe) in his lifetime. There were no meds back then. He was well inbetween episodes. That was the same general course of illness for my greatgrandmother (his mother).
Anyhow, depression can get better between episodes and it may not be necessary to treat for that entire time. Some even suggest that you are preventing full recovery with continuous treatment.
Linkadge
Posted by linkadge on July 18, 2008, at 15:12:55
In reply to Re: Thank you, everyone » linkadge, posted by Midnightblue on July 18, 2008, at 10:58:32
My mother's only suicide attempt was while on meds. The same meds she is on now.
Linakdge
Posted by linkadge on July 18, 2008, at 15:37:54
In reply to Re: Want to stop meds ... should I?, posted by blueboy on July 18, 2008, at 11:02:52
I don't think AD medication has made any significant drop in suicide rates. According to the following U.S. data, suicide rates have been steadily increasing since 1979 (and earlier). The increase peaked in the late 80's early 90's and has remained fairly constant since. If there has been a small drop in recent years, it is indeed a *very small* reduction, and certainly not a reduction to the levels of before 1979. I.e. if you look at the whole picture, there is nothing to suggest that antidepressant medication is at all responsable for the relatively miniscule drop in overal U.S. suicide rates.
Take a look for yourself. Let me know if you have any data for a larger study period.
http://fathersforlife.org/suicides/US_suicide_deaths.htm
Linkadge
Posted by linkadge on July 18, 2008, at 15:38:56
In reply to Re: Want to stop meds ... should I? » blueboy, posted by SLS on July 18, 2008, at 12:07:42
>Nice post.
>- ScottAny post that agrees with your point of view is a "nice post".
Linkadge
Posted by SLS on July 18, 2008, at 19:14:29
In reply to Re: Want to stop meds ... should I?, posted by linkadge on July 18, 2008, at 15:38:56
> >Nice post.
>
>
> >- Scott
>
> Any post that agrees with your point of view is a "nice post".So how is it that I still find your posts relevant enough to defer to you when something is beyond my knowledge?
It was a nice post. It was well thought-out and organized. The observations were accurate and the conclusions logical. It was a respectable effort.
- Scott
Posted by SLS on July 18, 2008, at 19:27:35
In reply to Re: Want to stop meds ... should I? » blueboy, posted by linkadge on July 18, 2008, at 15:37:54
So what?
http://www.suicide.org/suicide-statistics.html#death-rates
- Scott
Posted by maxime on July 18, 2008, at 21:25:58
In reply to Re: Thank you, everyone, posted by linkadge on July 17, 2008, at 21:48:56
> Was maxime on meds when she attempted suicide? Well?
>
> LinkadgeI had only just started the Cymbalta at 30 mg. After my attempt it was raised to 60 mg.
Maxime
Posted by linkadge on July 18, 2008, at 22:39:07
In reply to Re: Thank you, everyone » linkadge, posted by maxime on July 18, 2008, at 21:25:58
Well, of course it is up to you.
It just seems to me that if your meds were really making you feel well, then you wouldn't aways be starting posts about how much you hate them and how much you want to discontinue them.
Linkadge
Posted by BGB on July 18, 2008, at 22:39:48
In reply to Re: Want to stop meds ... should I? » blueboy, posted by linkadge on July 18, 2008, at 15:37:54
>
> http://fathersforlife.org/suicides/US_suicide_deaths.htm
>
> Linkadge
Am I totally insane or is that article basically saying that the reason why more men kill themselves than women is because of the "feminization of America" and the "War of the Sexes"?I had absolutely no idea we guys were at war women! And since I'm gay, does that mean that I am a "victim" of the "feminization of America"????? Did women somehow convert me as a small child??? My dad said he knew I was queer by the time I was four years old. I'll betcha the feminine gestapo got me while I was being circumcised as a baby (as if getting circumcised wasn't terrible enough in and of itself)!!!
By the way, I'm totally joking here, before anyone goes off. I just thought that the article had a very....uh.....unique point of view. I can say with all certainty that I have never heard that theory before.
Link, I realize that you were referring to the article for the statistics, and I'm not making fun of you or your views (or trying to imply that those are necessarily *your* views), I promise! Sometimes I just need to be silly to keep my spirits up, and that article was great fodder. :-)
Posted by linkadge on July 18, 2008, at 23:25:47
In reply to Re: Want to stop meds ... should I? » linkadge, posted by SLS on July 18, 2008, at 19:27:35
I really don't see how this shows anything.
In the 15-44 range, most of the suicide rates are higher in 2003 than what they were in the 50's 60's and 70's. Infact, most in this range continue to rise and peak around 1995. This is well into the introduction of the MAOI's, TCA's, ECT, and even the SSRI's. You see a small decline from 1995 to 2003, but still, the rate is higher than what is was in the pre-antidepressant period.
In the 25-34 and 35-44 ranges its still higher now than what it was in the 60's. Again, this rate peaks at about 1995 (when AD's are widely available and used). In this category, it drops a little from 95-2000, but then increases again (not this is still in the pre-black box SSRI warning era). I.e. in this category you're still higher than what you were in the pre-AD periods, and you continue to increase dispite the introduction and use of various AD's.The *only* group that has shown a consistent decrease in suicide rates since 1950/1960 is in the 45+ category. This category has a strong pull on the overal statistic as it is unusually high in the 1950's and 60's. **But**, if you notice, in this category, the rate starts to substantially drop well before the use of antidepressants. In fact, this category drops from 20ish down to 15ish just into the 80's *before* the more widespread use of AD's.
The elevated level of suicide in this category could be a post war effect as you only see the elevated suicide rate in adults in this period.
I.e. if you just focus on the 45-64 rates for the 50's, 50's and 70's, you notice that the significanly high rate here is what is really whats shaping the overall *all ages* stat. And, if you realize that this significantly elevated rate drops *before* the widespread use of AD's you realize that this category has already dropped to approxaimatly the suicide rate it is now before the use of AD's. I.e. the 45-64 category has not changed much 1980-2003.
That is why it is misleading to look at the "all ages".
Overall however, I see is that in every age category you have a rate that is either higher now than what it was before AD's (1950-60's), or it has dropped *before* the widespread use of AD's.
Also, that many of the rates peak in the mid 90's when AD's were widely used. There is a small, nonsignificant drop in *some* categories from 1995-03, but still not to the level it was before antidepressants *and* some categories it increases again from 2000-2003 (still before the black box warning was issued).I certainly don't see any drops in suicide as a result of the antidepressant era, instead an increase from pre-AD era, and a steady increase throughout the AD era. The small decrease from 95 till present is just a microtrend and will only have meaning in another few decades.
Remember, the overall data doesn't mean anything as it is combining the effect of the elevated rate in group mentioned (44-65 1960-1970) which drops on its own before the widespread use of AD's.
Linkadge
Posted by linkadge on July 18, 2008, at 23:28:31
In reply to Re: Want to stop meds ... should I? » linkadge, posted by BGB on July 18, 2008, at 22:39:48
Yes, I was only refering to the article for the one graph. SLS however, provided a more detailed set of data which I discussed above. The page you mentioned was actually a link from a WHO article.
Anyhow, I didn't read the article and certainly don't know what it was suggesting.
Linkadge
Posted by linkadge on July 18, 2008, at 23:35:30
In reply to Re: Want to stop meds ... should I? » linkadge, posted by BGB on July 18, 2008, at 22:39:48
And since I'm gay.......
Welcome to the club. I am in it, but not certainly not the founder.
Linkadge
Posted by BGB on July 19, 2008, at 0:20:45
In reply to Re: Want to stop meds ... should I? » BGB, posted by linkadge on July 18, 2008, at 23:35:30
> And since I'm gay.......
>
> Welcome to the club. I am in it, but not certainly not the founder.
>
>
> LinkadgeOh my god, they got you, too??????????????
LOL! =)
Posted by SLS on July 19, 2008, at 5:16:47
In reply to Re: Thank you, everyone » maxime, posted by linkadge on July 18, 2008, at 22:39:07
> Well, of course it is up to you.
>
> It just seems to me that if your meds were really making you feel well, then you wouldn't aways be starting posts about how much you hate them and how much you want to discontinue them.That does not follow from logic, especially when you are dealing with an emotional being such as ourselves.
- Scott
Posted by SLS on July 19, 2008, at 5:32:21
In reply to Re: Want to stop meds ... should I?, posted by linkadge on July 18, 2008, at 23:25:47
The rise in the suicide rates from 1950-1970 are, of course, not because of treatment. I believe it is the result of an increase in psychosocial stress and socioeconomic factors during this time period.
Start looking at the suicide rates starting for the decade 1980-1990. Prozac made its appearance in late 1987. The public hype surrounding Prozac fostered an increase in the numbers of people treated for depression, but still mostly for women. The rate comes down further still as men become brave enough to seek treatment.
The chart makes perfect sense in describing the reduction in suicide rates since the advent of the SSRIs and the social acceptance of seeking treatment for depression.
- Scott
Posted by SLS on July 19, 2008, at 5:50:37
In reply to Re: Thank you, everyone » linkadge, posted by maxime on July 18, 2008, at 21:25:58
> > Was maxime on meds when she attempted suicide? Well?
> >
> > Linkadge
>
> I had only just started the Cymbalta at 30 mg. After my attempt it was raised to 60 mg.
>
> MaximeIt is possible, Maxime, that you followed a very common path towards improvement in depression. During weeks 2-3, one often begins to see an increase in energy and gains enough inertia to act on pre-existing suicidal thoughts and feelings, which had not changed very much by then.
- Scott
Posted by SLS on July 19, 2008, at 5:55:26
In reply to Re: Thank you, everyone » maxime, posted by SLS on July 19, 2008, at 5:50:37
Maxime,
After reading this thread, how have your feelings surrounding the discontinuation of treatment changed, if at all?
- Scott
Posted by blueboy on July 19, 2008, at 8:25:48
In reply to Re: Want to stop meds ... should I? » blueboy, posted by linkadge on July 18, 2008, at 15:37:54
> I don't think AD medication has made any significant drop in suicide rates. According to the following U.S. data, suicide rates have been steadily increasing since 1979 (and earlier). The increase peaked in the late 80's early 90's and has remained fairly constant since. If there has been a small drop in recent years, it is indeed a *very small* reduction, and certainly not a reduction to the levels of before 1979. I.e. if you look at the whole picture, there is nothing to suggest that antidepressant medication is at all responsable for the relatively miniscule drop in overal U.S. suicide rates.
>
> Take a look for yourself. Let me know if you have any data for a larger study period.
>I'll just go with a quote from my previous link, since it's from a major research facility.
<<"Suicide rates rose steadily from 1960 to 1988 when Prozac, the first SSRI drug, was introduced," said Licinio. "Since then, suicide rates have dropped precipitously, sliding from the 8th to the 11th leading cause of death in the United States."
Several large-scale studies in the United States and Europe also screened blood samples from suicide victims and found no association between antidepressant use and suicide.
"Researchers found blood antidepressant levels in less than 20 percent of suicide cases," said Licinio. "This implies that the vast majority of suicide victims never received treatment for their depression.">>
I'm not in a position to do the research to join a long debate about whether or not SSRI's have lowered the suicide rate. Even if they have dropped or risen "precipitously", so many health researchers have such a blind eye to regression analyses that I doubt anyone has proven a causal relationship. Or the lack of one.
I have really been shocked, since I've started looking at "medical research" in two fields: nutrition/general health and psychiatric treatment.
At the bottom of the barrel you have publications such as "Prevention", who immediately consider a causal relationship proven when any research claims to have found a coincidental relationship.
Sharing the "F-" status is the entire psychiatric profession, which continues to give ECT -- a profoundly dangerous and invasive procedure -- to 50,000 people per year just in the US. This has been going on for over 50 years, and yet, nobody has done even the most rudimentary study of effectiveness and side effects, despite anecdotal evidence of profound mental damage to patients.
The answer to the question, "Have SSRI's resulted in a statistically significant decrease (or increase) in suicide rates" is the same as many questions in psychiatry, which could be answered by adequate research: "I don't know and nobody has bothered to find out".
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