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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
Posted by SLS on November 29, 2010, at 9:43:00
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
Hi Violet.
What was it about this article that appealed to you so much that you chose to post it?
Anything specific?
- Scott
Posted by Conundrum on November 29, 2010, at 10:34:20
In reply to Re: JAMA-.will never be a drug that 'cures' depression » Conundrum, posted by merpmerp on November 28, 2010, at 21:27:35
You might want to look at this thread, specifically the part about low dose prozac. It is pretty technical, but basically a lower dose of prozac seems to increase norepinephrine and dopamine more than a higher dose which seems to increase more serotonin. You will still get serotonin in this low dose, but there is more of a kick.
The way I take 2.5mg is approximate. An acute dose of prozac has a half life of about 2-3 days, chronic dosing even longer. So I just take a 10mg pill, break it in half, and then take it every other day. So thats approximately 2.5 mg a day. For me, the motivating effects stop and get worse than before it seems, if I start to take it every day. It would be interesting to see if other people respond to this low dose of prozac. It really helps with motivation and interest and keep your mind focused on one thing.
http://www.dr-bob.org/babble/neuro/20090701/msgs/904542.html
Posted by merpmerp on November 29, 2010, at 10:46:45
In reply to Re: JAMA-.will never be a drug that 'cures' depression » merpmerp, posted by Conundrum on November 29, 2010, at 10:34:20
Thank you very much for your response, and the link, which I will read through when not at work.
I have heard that about Prozac (lower doses have a relatively stronger effect on dopamine and norepinephrine than higher doses). I have come to wonder if maybe this approach would work for me. The first time I was on Prozac, as I've said, it was a miracle. But I have some reason to believe that the generic formulation I was on was a weaker one than brand name or other formulations. So maybe I was getting the Dop + Norep effect.
Posted by Conundrum on November 29, 2010, at 14:34:38
In reply to Re: JAMA-.will never be a drug that 'cures' depression » Conundrum, posted by merpmerp on November 29, 2010, at 10:46:45
Yeh I take a generic too, but I don't think it is weaker, since I have to take such a low dose. Maybe weaker is better.
> Thank you very much for your response, and the link, which I will read through when not at work.
>
> I have heard that about Prozac (lower doses have a relatively stronger effect on dopamine and norepinephrine than higher doses). I have come to wonder if maybe this approach would work for me. The first time I was on Prozac, as I've said, it was a miracle. But I have some reason to believe that the generic formulation I was on was a weaker one than brand name or other formulations. So maybe I was getting the Dop + Norep effect.
Posted by linkadge on November 29, 2010, at 14:35:19
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by Tomatheus on November 28, 2010, at 22:44:07
Keep in mind, this is one man's interpretation of the current evidence. The pendulum swings back and forth.
Just because one specific gene has not yet been identified, does not mean that there isn't a genetic basis for depression. It can be the interaction of several genes and the environment.
And at this point, there's really no way of knowing to what extent any one individual's depression is related to genes or environment.
So, this guy saying that depression is a "social disorder" is based on a series of assumptions. For some people, yes, but for others no.
Until we understand the full extent of interaction between genes and the environment, there's really no way for anyone to say.
Linkadge
Posted by ed_uk2010 on November 29, 2010, at 15:06:32
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by linkadge on November 29, 2010, at 14:35:19
Depression isn't a single disease entity, it's not a specific illness like Parkinson's disease. Depression is a clinical syndrome - a collection of symptoms. There are many different types of depression, there are many different causes.... and there are many different treatments which are effective in different patient groups. There will never be a drug that 'cures' depression. There may be a drug which cures a specific subgroup of patients, but that's different.
Posted by jane d on November 29, 2010, at 17:20:55
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
It's here and it's free. Not sure how a blog entry about this got confused with the real thing.
http://jama.ama-assn.org/cgi/content/full/301/23/2462#relation_type_129
Posted by emme on November 29, 2010, at 17:32:03
In reply to The real JAMA article says no such thing, posted by jane d on November 29, 2010, at 17:20:55
Thanks for posting that. I was wishing for the article itself, but didn't have time to hunt for it and didn't expect it to be freely accessible. I don't think anyone is confusing the blog with the original article. I think we're all reacting to what the blog-writer did with the article.
emme
Posted by Phillipa on November 29, 2010, at 19:34:02
In reply to Re: The real JAMA article says no such thing, posted by emme on November 29, 2010, at 17:32:03
The blood typing I know I'm type A through giving blood and the cross and typing? So does this mean no depression only anxiety? Just curious as had read the same article. Phillipa
Posted by FluffMama on November 29, 2010, at 21:53:48
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
This is clearly a community of depressed people seeking healing and in particular, this specific board is labeled, "MEDICATION" board. By posting something like this, which is controversial at best, and dangerous at worst for suffering human beings hoping desperately for assistance, I am curious as to what your purpose was in posting it? It could be seen as motivating, I suppose, for those who need therapy but are depending only on medication, but it seems pretty extreme.
Were you just wanting different opinions on the article or is this also your opinion, that no medication will ever be found to relieve depression because there is no ONE gene found that is linked to it? (although there are clearly multiple genes linked to depression - see my post on Blood Type differences). If this is your opinion, perhaps it is best not posted on a board labeled MEDICATION, or else it seems rather "in your face" to people trying to manage their depression with MEDICATION.
I welcome your clarification.
Posted by Willful on November 29, 2010, at 22:39:52
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
From what I read here, the actual study says that there is no depression "gene." Or, more precisely, no single depression gene, or series of such genes, has yet been found `~except~ one, which is relatively weak.
Everything else in the piece quoted above is the blogger's personal opinion. which he has been advocating for a long time-- ie since before this study was done.
Now, first of all, there are many studies, often with contradictory claims and results. So there is no certainty that others studies do not or will not exist that "prove" just the contrary.
Second, and more importantly, no one of any real scientific credibility has really claimed that there's one depression gene.
There may be many genes which singly or in combination could either cause or greatly predispose someone to depression--
and, it's entirely possible that these genes have not yet been discovered, and that this weakly predisposing gene will be but one among many.
Furthermore, just because something is not caused by a gene, or is caused by a gene interacting with social or interpersonal forces, does not mean that a biological (ie drug) cure would not be possible. I really see no reason why a drug couldn't greatly affect feelings that were originally caused by interactions or social conditions.
So all in all, I'd say that we just have one individual's personal opinion that depression is caused by environmental factors and that drugs aren't the answer.
It's not a study, and it's not even a logical argument. It's just an opinion in any area where there are many opinions but no clear evidence.. I don't think it changes the debate or gives any closure.
Willful
Posted by jane d on November 30, 2010, at 5:12:39
In reply to Re: The real JAMA article says no such thing, posted by emme on November 29, 2010, at 17:32:03
> Thanks for posting that. I was wishing for the article itself, but didn't have time to hunt for it and didn't expect it to be freely accessible. I don't think anyone is confusing the blog with the original article. I think we're all reacting to what the blog-writer did with the article.
>
> emmeI didn't think that you had. And I'm grateful to Tomatheus for posting the source of the blog since the original poster did not.
JAMA now lets you read the research articles for free after six months. I believe some of the other journals do the same.
Posted by europerep on November 30, 2010, at 18:15:17
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
>As I have said in previous blogs, depression is much more of a social condition than a biological one,
Hm, ok, so we know so little about depression, but we do already know that it's more of a social tha of a biological condition? How? How can that be measured or determined? People say the brain is the most complex "thing"/organism/whatever in the whole universe, so how could one suppose that there are not lots of things that could malfunction in there?
There are people who profit, in a personal way, from making such claims, I believe. it makes you feel *soo* good about yourself when you see that you lead a healthy, successful life, and it would be very inconvenient to learn that part of that is just 'luck'..
Posted by bleauberry on November 30, 2010, at 19:53:50
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
Depression is in the damage that mercury molecules do.
Depression is in the damage that lead molecules do.
Depression is in the damage that aluminum molecules do.
Just for starters. Not to mention all that crap in food ingredient labels you can't even pronounce and don't know what it is.
Believe it, for sensitive individuals, FDA red food color causes depression, but FDA yellow is even worse.
Lyme, borrelia, bartonella, babesia, candida....all notorious for going undetected and wreaking havoc on depression.
Gluten can cause depression. People have seen their long standing depression and fatigue magically disappear in days after stopping all wheat products. Dairy is the next one. Sometimes corn, soy, tree nuts.
I'm just sayin. It happens.
I mean, I could sit here all night and list things that cause biological depression, but other more knowledgable folks do it much better than I. The point is, no, there will never be a single med directed at genes, serotonin, or whatever, that will cure depression, because there are too many variable causes of depression for any single agent to cover them all.
If we would only spend half the time trying to make an accurate diagnosis of where the depression is coming from (not really hard to do) compared to the time we spend titrating on and off medicines year after year, we would we way way way advanced in the game. Cure depression? First identify the culprit. Is it a metal? Is it an infection? Is it a gene? These really aren't hard to figure out. It aint rocket science. It's just that nobody does it because it is so much easier to pull out a prescription pad and say see you in a month.
I'm not sure how it happens, but somewhere along the journey in science men try to compartmentalize everything into a neat little picture, with no idea actually of what they are talking about and no ability to even prove it or duplicate it. Nothing is like that.
IMO
Posted by FluffMama on December 1, 2010, at 1:46:35
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by bleauberry on November 30, 2010, at 19:53:50
AMEN to that, Blueberry. The neat little diagnosis we all have are scary when you think that probably 90% of us haven't been tested for substances in our blood or bodies that can cause depression and we are just handed meds based on statements that are totally subjective by patients who can't think clearly because they are depressed anyway! Hormones, opioids attaching themselves to wheat and dairy molecules because they don't belong in our bodies which lead to addiction, low blood sugar problems, and genuine grief over life events and tragedies - depression is so complicated.
I agree they wont' find a single gene, but the article seems to then conclude falsely that this means depression is "all in our heads" and we need to get off our butts and do something about it in therapy. I'm all for therapy - I tried to drown my childhood abuse for years with medications and only now at age 42 am I facing things and getting help. But for me at least, I am staying on the medications to keep me stable while I deal with the root causes of my depression. I dunno. The article left me feeling badly, and usually that is because there is an inherent judgment of right and wrong or black and white going on.
Posted by SLS on December 1, 2010, at 5:46:19
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by bleauberry on November 30, 2010, at 19:53:50
Gene therapy.
It will happen.
- Scott
Posted by violette on December 2, 2010, at 18:46:20
In reply to To Violette: Reason behind this post?, posted by FluffMama on November 29, 2010, at 21:53:48
I don't come hear that often, but dropped by and saw 100 posts about administration and just a few anywhere else. Thought it would encourage discussion/debate and wanted to hear the opinions of the "scientific people" who write here.
Sometimes i think theres an imbalance in discussion content here and on other sites of course. There are plenty of discussions about every and any cause of depression, but very little about emotional and social causes. I also think the scientific community is experiencing a shift in focusing on more envioronmental factors effecting all areas of health in general. I posted some links to McLean Center here in the past about childhood development and mental health which outlines its findings of biological consequences of environmental factors experienced in childhood.
Did you all know about the large scale government childhood development study going on now in the US?
"Planning for the Study began in 1999 as an activity of the Presidents Task Force on Environmental Health Risks and Safety Risks to Children. Title X of the Childrens Health Act of 2000 subsequently authorized the National Institute of Child Health and Human Development, in collaboration with the Centers for Disease Control and Prevention, the U.S. Environmental Protection Agency, and other appropriate federal agencies, to plan, develop, and implement a prospective cohort study, from birth to adulthood, to incorporate behavioral, emotional, educational, and contextual consequences to enable a complete assessment of the physical, chemical, biological and psychosocial environmental influences on childrens well-being
http://www.nationalchildrensstudy.gov/research/hypotheses/Pages/default.aspx
If you read that page, you'll see they are also looking at genetic influences, so there will hopefully be comparisons and answers. Im really looking forward to the results of this study.
btw, i know this is a medication blog but i think it might be doing more harm than good to talk about every reason for depression out there - sleep issues, thyroid, lymes, etc, on this forum while leaving out important emotional influences. I do think there are various cures to some types of depression out there - exercise, psychotherapy, improved sleep, diet etc. People get depression from heart problems, liver problems, and many medical factors. But people also get depression from emotional problems and might benefit from facing emotions if that is the case. Sorry if posting this offended anyone. I tend to think the more information, the better, but can understand other views about this. Stilll, in my humble opinion, I really do not think a psychiatric drug will actually cure depression, but only cure symptoms. i also agree with the focus on environment, there is so much that can be done with that knowledge and prevention. If there are genetic therapies discovered and created, whose going to actually be able to afford them? depression is a huge world problem. I just don't see how genetic research will provide relief to so many. If the genes are identified, then what? How will knowing that that change the emotional aspect of depression? how can genes be altered to actually change you personality? Not expecting anyone to know the answers to those questions....thats what comes to mind though.
Thanks to whoever posted the link to the JAMA article. I follow several psychiatry and psychology opionio blogs and its a rarity to get the actual article discussed. Havent had time to read it yet but glad to have the link for when i feel inclined.
I mostly lurk here but thought I should post to answer your question Fluff Mama, worried i offended some. I think sometimes since i'm not as sensitive to others words and actions as i used to be, i forget that others might be moreso, so it was somewhat selfish of me to not think of that.
Posted by Phillipa on December 2, 2010, at 20:04:46
In reply to eason behind this post?, posted by violette on December 2, 2010, at 18:46:20
I'm not offended. I welcome all information. Phillipa
Posted by SLS on December 3, 2010, at 0:42:09
In reply to eason behind this post?, posted by violette on December 2, 2010, at 18:46:20
Hi Violette.
> Thought it would encourage discussion/debate and wanted to hear the opinions of the "scientific people" who write here.
Why did you choose to use quotation marks here?
It is certainly important to survey different sources of information and opinions in a field of medicine for which there is so much yet to be understood.
> Sometimes i think theres an imbalance in discussion content here and on other sites of coursePerhaps the reason you feel
Perhaps this imbalance in discussion content is a manifestation of an imbalance in the validity of one explanation over the others that have been proposed. The current consensus provided by decades of scientific investigation into the phenomenology of major depressive disorder (MDD) and bipolar disorder (BD) indicates that a deviation in the function of the brain is present during depressive episodes of these illnesses. With bipolar disorder, some of these anomalies in brain function persist even during periods of remission.
> There are plenty of discussions about every and any cause of depression,...
Can you suggest at least one cause of depression that you believe is representative of the dynamics extant in the evolution of MDD or BD?
> ...but very little about emotional and social causes.
That depends on what you use as sources of information. Psychosocial stress is considered by most researchers to be an important component to the evolution of affective disorders. For those individuals who possess biological vulnerabilities that will allow for the precipitation of depressive episodes, there is often a chronic psychological pathology or an acute trauma that triggers a cascade of events in the brain that results in observable and measurable abnormal brain activity.
It is *very* old news that no single gene is fully responsible for expressing MDD.
> Stilll, in my humble opinion, I really do not think a psychiatric drug will actually cure depression.
If by cure, you mean that a finite period of treatment will indefinitely prevent subsequent recurrences, I believe that you are correct in stating that such a treatment does not currently exist. In my humble opinion, a cure will eventually be developed. It may involve drugs. It may involve gene therapy. It may involve tissue ablation. It may involve the induction or inhibition of neural activity using magnets. Regarding drugs, there is no scientific reason to believe that a cure cannot be achieved through pharmacotherapy. Perhaps you know of one.
> but only cure symptoms
I don't understand. What do mean by this? I hear this said over and over again.
If you accomplish resolving all of the symptoms in a case of depression, how do you know that you haven't effected a persistent normalization of brain activity? There are several loci in the brain that have been identified as being important in the regulation of circuits known to influence mood and cognition. It is my guess that manipulating neural activity at these key sites induces the reestablishment normal gene activity. Note that I am commenting on the mental illnesses known as major depressive disorder and bipolar disorder. Contrast this with the ubiquitious use of the generic term "depression", which is commonly used to describe a great many human conditions involving mood. If we don't standardize our nomenclature regarding depression, it will be extremely difficult to establish the insights that will provide treatment algorithms tailored for the different types of depression once they are identified and characterized.
- Scott
Posted by FluffMama on December 3, 2010, at 1:55:20
In reply to eason behind this post?, posted by violette on December 2, 2010, at 18:46:20
I mostly lurk here but thought I should post to answer your question Fluff Mama, worried i offended some. I think sometimes since i'm not as sensitive to others words and actions as i used to be, i forget that others might be moreso, so it was somewhat selfish of me to not think of that.
****Thank you, Violetta. I for one had a crappy childhood and I know darn well that it is the reason I am struggling with emotional pain and depression. It sucks. There will never be a medication that heals a broken heart or helps us to forgive or learn to trust again. I guess for me my meds just keep me out of the hospital until I can learn better ways of handling my emotional pain and even get rid of some.
Posted by EastC on December 6, 2010, at 21:12:30
In reply to To Violetta, posted by FluffMama on December 3, 2010, at 1:55:20
As someone who has experienced a progressive form of depression and insomnia from birth until the present (age 30) I can say with a great degree of certainty that for me it is primarily biological in nature. I have had struggles (work and personal), insecurities, disappointments and falling-outs with people in life just like anyone else. During my time on medication (ages 21 through 30) I have tried going meds-free more times than I can count - always relapsing into the original depression that I had prior - even with many life issues being resolved.
Many people only experience a more transient/lighter form of depression that comes and goes with the seasons or according to temporary life circumstances - seemingly being cured by making different choices moving forward (which fuels articles like the one you posted). Others have a chronic form that only remits with medication management. If you took me off all of my medications and then gave me several million dollars, gave me the relationship of my dreams and guaranteed me good physical (not mental) health for the next 100 years, I would still be in a deep depression where I couldn't enjoy any of it.
I can understand your desire and intent to include the social-psychological aspect of depression Violetta, but something tells me you haven't experienced it at a level of severity and persistence that would give you enough of an understanding of where many of us are coming from - especially those who have had good lives with no history of abuse, neglect or trauma of any kind. I find offense to the idea that I could be causing a biological handicap just like someone who is born without a limb would be offended.
Science will back this up eventually, but for now we will have to deal with articles like the one you posted.
Posted by Lou Pilder on December 6, 2010, at 21:50:24
In reply to Re: To Violetta, posted by EastC on December 6, 2010, at 21:12:30
> As someone who has experienced a progressive form of depression and insomnia from birth until the present (age 30) I can say with a great degree of certainty that for me it is primarily biological in nature. I have had struggles (work and personal), insecurities, disappointments and falling-outs with people in life just like anyone else. During my time on medication (ages 21 through 30) I have tried going meds-free more times than I can count - always relapsing into the original depression that I had prior - even with many life issues being resolved.
>
> Many people only experience a more transient/lighter form of depression that comes and goes with the seasons or according to temporary life circumstances - seemingly being cured by making different choices moving forward (which fuels articles like the one you posted). Others have a chronic form that only remits with medication management. If you took me off all of my medications and then gave me several million dollars, gave me the relationship of my dreams and guaranteed me good physical (not mental) health for the next 100 years, I would still be in a deep depression where I couldn't enjoy any of it.
>
> I can understand your desire and intent to include the social-psychological aspect of depression Violetta, but something tells me you haven't experienced it at a level of severity and persistence that would give you enough of an understanding of where many of us are coming from - especially those who have had good lives with no history of abuse, neglect or trauma of any kind. I find offense to the idea that I could be causing a biological handicap just like someone who is born without a limb would be offended.
>
> Science will back this up eventually, but for now we will have to deal with articles like the one you posted.
>EastC,
You wrote,[...something tells me you havn't experianced it...that would give you enough of an understanding...]
I am unsure as to what you are wanting to mean here. If you could post answers to the following, then I could have the opportunity to respond accirdingly.
A. What is the something telling you?
B. How can you be sure, if you are, that Violetta has not experianced it?
C. what is lacking, if you know, for violetta to have {enough} of an understanding, and how do you know if violetta does or does not have what you think, if you do, this aspect that could give violette {enough}?
Lou
Posted by SLS on December 7, 2010, at 5:39:43
In reply to Re: To Violetta, posted by EastC on December 6, 2010, at 21:12:30
> I can understand your desire and intent to include the social-psychological aspect of depression Violetta, but something tells me you haven't experienced it at a level of severity and persistence that would give you enough of an understanding of where many of us are coming from - especially those who have had good lives with no history of abuse, neglect or trauma of any kind.
This is not a commentary on Violette or you, but I think there is a tendency to formulate a perspective of what depression is, how it feels, and the therapies that best treat it, based upon one's ovn experiences with it.
> Science will back this up eventually, but for now we will have to deal with articles like the one you posted.Science has already substantiated the biological underpinnings of major depressive disorder (MDD) and bipolar disorder (BD). This is old news. Science is a lot further along than many of us would believe. Unfortunately, it is not far enough along to provide us all with the resolution of our depressions.
- Scott
Posted by emmanuel98 on December 7, 2010, at 19:48:00
In reply to Re: To Violetta » EastC, posted by SLS on December 7, 2010, at 5:39:43
I have had depression that was both situational and biological. Both were severe. But I knew when it was biological. There was nothing wrong with my life. I had worked through most of my issues with two therapists and a DBT group. I just crashed and could not get out of bed. I cried and felt suicidal all the time. I didn't wash my hair or shower for 10 days, when my daughter came home to try and get me out of bed. I spent five weeks in the hospital and during that time, I barely spoke to anyone, slept constantly, ate nothing and had no will to live. I felt like I had a terminal disease. I spent two months in bed. Nothing could snap me out of it, even temporarily. I started on parnate after a washout of all other meds and was fine in 48 hours. I'm convinced depression can be biologically driven. But I know from other experience that it can also be driven by repressed emotions, traumatic childhoods.
Posted by Phillipa on December 7, 2010, at 21:13:23
In reply to Re: To Violetta, posted by emmanuel98 on December 7, 2010, at 19:48:00
Best discription of biological depression I've read. When a med works like that you "know it's not in your head" so to speak. Thanks for posting this. Phillipa
This is the end of the thread.
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