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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by rradarr on March 29, 2009, at 1:18:24
Are ADs the wonder drugs we always read about? I know they work, but I mean did they really "empty out the mental hospitals" back in the day as I've read about so many times? Anybody know? Thanks.
Posted by Garnet71 on March 29, 2009, at 1:41:54
In reply to Are ADs As Advertised?, posted by rradarr on March 29, 2009, at 1:18:24
Prisons emptied out the mental hospitals, not ADs.
Posted by bleauberry on March 29, 2009, at 8:31:05
In reply to Are ADs As Advertised?, posted by rradarr on March 29, 2009, at 1:18:24
As far as I can tell in the real world, the only three antidepressants that are true antidepressants worth being advertised are Parnate, Nardil, and Clomipramine. No one is going to do that with these 50 year old meds. Other ones worth advertising would be combinations of serotonin/norepinephrine meds such as Zoloft+Nortriptyline. No one is going to do that.
Clinicians can be puzzled why they do not get the same results in their practice that the clinical studies did. Clinical study patients are cherry-picked. Previous suicide attempts? Forget it, you're out. You've been depressed before? Forget it, you're out. Other medical problems? Forget it, you're out. Stuff like that, varying from study to study. In other words, the patients in the studies are often not a representative sample of the patients in a doctor's office.
Drug companies do not have to report their failed studies to the FDA when trying to get a drug approved. They only need to show the ones that succeeded. A drug can do worse than a placebo in 3 studies, better than a placebo in 2 studies, and be approved by the FDA as a blockbuster drug.
Most ADs are judged by a 50% improvement as being the threshold for "success". Well, a 50% improvement means you are still 50% sick. A more accurate way to look at it is that roughly maybe 15% to 25% of a sample of patients will reach remission.
If mental hospitals were emptied, it wasn't because of great antidepressants. None have been invented that are better than the real ones invented 50 years ago. They only appear to be better because of flaws in the clinical studies, flaws in the FDA process, and...key word from your original question...advertising. Companies spend millions of dollars to promote their products. Even more than they spend on the actual research and production. Ya know, if I go out and spend millions of dollars saying how great the pine tree is to this world, and you see the ads all over TV and on the radio and in magazines, well, the next time you see a pine tree you can't help but think what a great tree that is.
For taking some of the burden off of mental hospitals, I would give some credit to Zyprexa, Seroquel, Abilify, and Lamictal, as well as the use of polypharmacy. But not any of the antidepressants, with the exception of the 50 years olds which are still the best and totally unadvertised. Outside of the drugs, society has changed in a way that allows many of those people previously locked up to find alternative places in the world.
Posted by yxibow on March 29, 2009, at 9:49:37
In reply to Re: Are ADs As Advertised? » rradarr, posted by Garnet71 on March 29, 2009, at 1:41:54
> Prisons emptied out the mental hospitals, not ADs.
Not true here if you count state (non prison) facilities. Now instead of veterans and the like being treated with APs, the homeless population is large since the 1960s and 1970s when they closed.
Posted by garnet71 on March 29, 2009, at 10:53:32
In reply to Re: Are ADs As Advertised? » Garnet71, posted by yxibow on March 29, 2009, at 9:49:37
I don't know, Yxibow. I'm no statician, but there's a gizillion studies about this subject. Correlated with the Reagan Administration's systematic closure of mental hospitals and state institutions were skyrocketing prison rates (in terms of percentage of the adult population). The juvinille incarceration of mentally ill youth is a huge problem and the rates are much higher than the adult prison population if i remember correctly--it's actually pathetic and sad. There's a detailed report to Congress on the subject of attempted suicide rates and mental health issues among our incarcerated youth that you should read, if your interested. It is shocking. I'll have to find it. At the same time, since the 80s, access to health care has had a steep decline. You do realize that the U.S. prison population is huge in comparison with other countries--double that of some--and consider that every developed nation besides the U.S. provides health care to its citizens.
I'm not pulling up all the stats I've seen, instead, I think I'm going to take my ADD meds now and divert my attention to tasks I really should be doing.
:))
"Increasing reliance on the justice system to care for individuals with mental illness. This trend has been clearly documented for the adult population. A report to Congress (Center for
Mental Health Services, 1995:iii) found: As jail and prison populations increased, and the number of persons with mental illness living at the fringe of their communities rose, the absolute number of persons with mental illness in jails and prisons also increased. The survey-based study Criminalizing the Seriously Mentally Ill (Torrey et al., 1992:iv) also concluded:
Our jails have once again become surrogate mental hospitals. Various other studies have confirmed that large proportions of individuals in the Nations jails and prisons are seriously mentally ill. For example, Teplin (1990) reported prevalence rates of 6.4 percent for male jail
inmates and 15 percent for female jail inmates. The most recent study released by the U.S. Department of Justice reported that 16 percent of State prisoners were identified as mentally ill
(Ditton, 1999). Such findings buttress the view that [j]ails and prisons have become the nations new mental hospitals
Posted by Phillipa on March 29, 2009, at 12:22:28
In reply to Re: Are ADs As Advertised? » yxibow, posted by garnet71 on March 29, 2009, at 10:53:32
Don't know your age Garnet but I do remember when they closed prisons and the homeless was living up North then. NYC was just full of homeless that were released from mental hospitals. Poor things living in boxes and stuff pushing their shopping carts. Seems a good topic for politics? Phillipa
Posted by Relapse on March 30, 2009, at 10:15:11
In reply to Re: Are ADs As Advertised?, posted by bleauberry on March 29, 2009, at 8:31:05
bleauberry, I'm not sure about your short list for everyone, but I'm sure those drugs work for many people. Aside from that, I would think lithium would make any short list?
Dave
Posted by bleauberry on March 30, 2009, at 17:07:45
In reply to Re: Are ADs As Advertised?, posted by Relapse on March 30, 2009, at 10:15:11
> bleauberry, I'm not sure about your short list for everyone, but I'm sure those drugs work for many people. Aside from that, I would think lithium would make any short list?
> DaveHi Dave. Well, let my clarify. The short list was pretty much based on the meds I have seen here the last 10 years that have a high probability of success and a low probability of failure. Nothing scientific. Most other common meds do not seem to fit that profile as consistently.
From what I've seen with Lithium, it seems to often be good as monotherapy for pure mania, though its side effects and dangers have led to other meds instead. For depression, as far as I have seen, it is basically useless except in cases where it is added a primarily noreadrenergic medication. Lithium seems somehow serotonergic, which could possibly balance out other meds, but not much another serotonin med. ??? Just some observations. Nothing scientific.
Posted by Relapse on March 30, 2009, at 18:32:45
In reply to Re: Are ADs As Advertised? » Relapse, posted by bleauberry on March 30, 2009, at 17:07:45
Thanks bleauberry. I will keep the short list in my pocket, when I inevitably well.. relapse.
Dave
Posted by desolationrower on March 31, 2009, at 1:28:28
In reply to Re: Are ADs As Advertised?, posted by Relapse on March 30, 2009, at 18:32:45
amoung other things, Li affects 5ht2b autoreceptors, and affects camp/pkc formation from adrenoceptors.
-d/r
Posted by metric on April 2, 2009, at 18:27:48
In reply to Re: Are ADs As Advertised? » rradarr, posted by Garnet71 on March 29, 2009, at 1:41:54
> Prisons emptied out the mental hospitals, not ADs.
But mental hospitals *are* prisons... It is telling that convicted criminals prefer incarceration in the latter.
Are you familiar with Thomas Szasz?
This is the end of the thread.
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