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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by linkadge on October 27, 2022, at 16:00:21
I would say that most modern antidepressants are rubbish. They can produce some emotional anesthesia and a mild mood boost but do little else. Most patients probably recover spontaneously.
Linkadge
Posted by SLS on October 27, 2022, at 19:56:26
In reply to Most antidepressants are rubbish, posted by linkadge on October 27, 2022, at 16:00:21
> I would say that most modern antidepressants are rubbish. They can produce some emotional anesthesia and a mild mood boost but do little else. Most patients probably recover spontaneously.
>
> Linkadge
B u l l s h i tHere we go again...
My current experience contradicts your characterizations. No emotional anesthesia. Emotional anesthesia isn't the mechanism by which antidepressants work. I think you are confusing unwanted apathy, emotional numbness, sedation, and flat affect that are side effects rather than being necessary for a drug to work. You might find emotional numbing to be a relief from tortured thinking and chronic anxiety.
Perhaps you should talk to more people for whom antidepressants have worked steadily and turned their lives around. Perhaps you don't have an illness that antidepressants can improve. I saw someone who was diagnosed with MDD treated unsuccessfully with a long list of traditional antidepressants. Nothing worked. His doctor then took a shot that he might have ADD / ADHD. Atomoxetine turned his life around.
- Scott
Posted by Phillipa on October 28, 2022, at 11:42:40
In reply to Most antidepressants are rubbish, posted by linkadge on October 27, 2022, at 16:00:21
Never worked for me. I have over 10 facebook friends that used to post here. Could see them falling into the take another med trap and got them off of here. Today they are on no medications at all. What worked for me was going into RN school and studying and achieving Dean's List and graduating Magna C*m Laude it was a natural high. The having my own Aerobic Dance business at the same time. Add running when younger and a natural high! Phillipa
Posted by linkadge on October 28, 2022, at 15:39:00
In reply to Re: Most antidepressants are rubbish » linkadge, posted by SLS on October 27, 2022, at 19:56:26
Sure, there are some people that may benefit from a serotonin boost, but (in general) modern antidepressants are not that effective for depression. I agree with Gillman in this regard. In a recent study, for example, sertraline improved anxiety, but not depression.
Linkadge
Posted by SLS on October 28, 2022, at 20:56:15
In reply to Re: Most antidepressants are rubbish » SLS, posted by linkadge on October 28, 2022, at 15:39:00
Antidepressants seemed to work a whole lot better in the 1980s.
I think the inclusion and exclusion criteria for accepting subjects into current clinical trials is so "flexible" as to make their results less relevant to me as a patient.
1970s and 1980s = 67% response rate
1990s to 2020s = 35% response rateJust a thought. The drugs that I take today with success were all available in 1996. That's when lamotrigine was approved. I was 36 at the time. I'm 62 now. It took all of that time to find tghe right combination at the right dosages. That's a hell of a thing to contemplate. 36. Young. An alternate timeline to be sure. I thank God that I can now die knowing that I was allowed time to know how to live.
How do you know who to trust?
- Scott
Posted by Lamdage22 on October 30, 2022, at 13:11:06
In reply to Re: Most antidepressants are rubbish » linkadge, posted by SLS on October 28, 2022, at 20:56:15
I wouldnt say rubbish, but if you think a pill or a few pills will take you all the way to remission, youll likely get disappointed.
I havent added new drugs since 2016 for precisely that reason.
Posted by jay2112 on October 30, 2022, at 17:47:06
In reply to Re: Most antidepressants are rubbish » linkadge, posted by SLS on October 28, 2022, at 20:56:15
Scott,
So true, that a.d.'s worked better in the 80's. Again, reason being, I think, is most used were tricyclics, Maoi's, and stims. There were also a lot wider variety of t.c.a's used, and sadly, many have been pulled from the market. As well, I think there are many t.c.a's not used in N.America and Europe, that could be useful. Most disgusting part was the gp's and even conservative psych's who insist on SRI/SNRI/NRI's, saying they are the only effective antidepressants. What RUBBISH!! Even esketamine is having pretty lame response rates. And the SRI+Antipsychotic route is looking lame, without consequences too. Ugghhhh...
Jay
Posted by jay2112 on October 30, 2022, at 17:54:00
In reply to Most antidepressants are rubbish, posted by linkadge on October 27, 2022, at 16:00:21
> I would say that most modern antidepressants are rubbish. They can produce some emotional anesthesia and a mild mood boost but do little else. Most patients probably recover spontaneously.
>
> LinkadgeHave you tried amphetamine? (Either Dexedrine, or Vyvanse?) VERY, very different response than Ritalin. (For many, EVEN better..smoother. Doesn't have Reuptake Inhibition like Ritalin.) Worth a shot, anyways??
Jay
Posted by linkadge on October 31, 2022, at 15:01:52
In reply to Re: Most antidepressants are rubbish, posted by jay2112 on October 30, 2022, at 17:54:00
I agree that the MAOIs and TCAs were more effective. Think of it, both classes of those medications were discovered by ACCIDENT. Doctors recognized that they were making patients feel better.
Because of their success, researchers proposed the monoamine hypothesis which caused them (IMHO) to get tunnel vision on monoamine based drugs. But, the monoamine hypothesis is very incomplete (at best) and completely incorrect (at worst).
Medicine in the past was more based on getting patients better. Now it's just about money. Useless arrays of me-too drugs are not helping patients.
Linkadge
Posted by SLS on November 5, 2022, at 23:19:42
In reply to Re: Most antidepressants are rubbish, posted by linkadge on October 31, 2022, at 15:01:52
I failed to make my point clear enough, I guess.
In the 1960s, 1970s, and 1980s, scientists / doctors were just learning that they were looking at a biological phenomenon in the genesis of certain depressive symptomatologies. The syndrome they recognized first was the subtype of Major Depressive Disorder they named endogenous (generated from within). Later, the term melancholic was applied to differentiate this first description from a newly described subtype of depressive disorder to be labelled atypical depression (Which was later found to actually be the more common presentation).
Investigations into this new discovery of the biological underpinnings of mental illness were performed by university psychiatric departments. The studies were funded by universities or the government in the form of grants from the National Institute of Mental Health. These investigators were scientists with very little bias. They were motivated by seeking the answers to medical questions using the scientific method. The ultimate goal was to provide knowledge and understandings that would lead to cures and palliative treatments
By the 1990s, this schema was no longer the model used for scientific investigation. New compounds were investigated using funds provided by the pharmaceutical companies. Their only goal was to bring new compounds to market and make money. The more subjects recruited for the study, the more weight the results were given and the quicker the drug comes to market in order to optimize its patent life. In order to do this, investigator manipulated the inclusion and exclusion criteria. They would take just about anyone who described themselves as being depressed. This effectively diluted the population of subjects by including people who did not have the illness that the drugs were meant to treat. That makes for some pretty bad numbers. The statistical rate of efficacy was necessarily lower. The placebo rate was bound to be higher when people with mild or minor depression or situational depression are accepted into clinical trials. People with minor depression have a higher rate of spontaneous remissions, which is interpreted as a placebo response. In addition, a little recognized variable enters the clinical trial not accounted for when interpreting the numbers measuring the placebo effect. That variable is hope and emotional support. Thus, placebo treatment does not equal no treatment. People with more mild depressions are likely to display a more robust psychological boost. The reported improvement occurs very early in the trial, often by week two. THIS is the placebo effect. It over represents subjects with mild depression more likely to report feeling better.
As we now know, the more severe the depression, the greater the response rate and the lower the placebo rate. The reason for this is simple. In a subject population comprised exclusively of severe presentations, the likelihood of having a high percentage of people with the genuine Major Depressive Disorder is very high. Subjects with low depression scores dont meet the inclusion criteria, thus lowering the rate of placebo response.
Do tricyclics no longer have a 67 percent response rate in 2022 as they did in 1982? How did these drugs become less effective in 30 years? Are people getting better at responding to placebo?
The old days: TCA and SSRI response rates 60-70%
The old days: Placebo response = 25%Think about it.
- Scott
Posted by undopaminergic on November 6, 2022, at 4:28:51
In reply to Re: Most antidepressants are rubbish, posted by SLS on November 5, 2022, at 23:19:42
I'm inclined to agree with the essence of what you're saying. Placebo response rates are so high because subjects included into trials are not
genuinely depressed, and therefore benefit less, if at all, from drug treatment. However, I don't understand why these subjects are included when they make the drug under investigation appear less effective.-undopaminergic
Posted by SLS on November 7, 2022, at 12:29:43
In reply to Re: Most antidepressants are rubbish » SLS, posted by undopaminergic on November 6, 2022, at 4:28:51
> I'm inclined to agree with the essence of what you're saying. Placebo response rates are so high because subjects included into trials are not
> genuinely depressed, and therefore benefit less, if at all, from drug treatment.You are surely right.
> However, I don't understand why these subjects are included when they make the drug under investigation appear less effective.
Possibly because the businessmen who conduct clinical trials are paid by drug companies for each subject recruited. In this situation, money interferes with science. Everyone in the R & D process looks for big study populations, possibly in order to get the drug approved quicker and thus get as much patent time in the market.
How many times do these "scientists" have to make the same mistake over and over and sabotage their clinical trial results? Einstein's definition of insanity...
- Scott
Posted by SLS on November 7, 2022, at 13:21:27
In reply to Re: Most antidepressants are rubbish, posted by Lamdage22 on October 30, 2022, at 13:11:06
> I wouldnt say rubbish, but if you think a pill or a few pills will take you all the way to remission, youll likely get disappointed.
I am disappointed that you are disappointed in pharmacology as an avenue of successful treatment with extremely robust improvements. SLS is an example of reaching a dramatic and persistent remission using drugs and without psycotherapy. Sorry. It exists. If you are coming to your conclusions based upon what you see in the Psycho-Babble population, you are making a monumental mistake. It is far to skewed towards treatment-resistence, or even refractoriness.
Are you aware that many people who have bipolar disorder are *ultra* rapid cyclers? Their mood switches dramatically from depression to mania and back to depression again - on a very regular cycle that can be predicted months in advance - before they take their very first pill? You should read "Mood Swing" by Ronald R. Feive. You will become a believer. He describes patients switching every 48 hours. What's that remarkably precise and persistent cycle all about? They become different people every two days. Is that likely to be a psychological cycle? Of course not.
I watched someone close to me have a starkly regular and dramatic mood switch having a period of exactly 11 days. Not 10. Not 12. 11. This was his presentation when he entered the research program at Columbia-Presbyterian in Manhattan. His 11-day cycle had been in place for over two years before being given his very first pill to swallow.
His 11-day bipolar mood cycle comprised 8 days of a severely vegetative depression followed by 3 days of remission, etc. Without fail, this cycle continued for two years uninterrupted. The time it took to switch from one extreme to the other was no longer than 30 - 45 minutes. The change was dramatic. in magnitude and paroxysmal in its and That was then followed by 8 days that left him mute and without the ability to read the written word. At least he knew what it was like to feel normal for 3 consecutive days. Were it not for this carrot, I think he would have committed suicide decades ago. Anyway, the first drug they tried on him was imipramine, a tricyclic. He responded to it with a dramatic improvement that lasted almost 2 weeks. The degree of improvement was greater than that he saw during his cyclic 3 days of of improvement.
Then came a costly mistake. He was placed on high dosages of lithium added to imipramine. Besides making him feel moderately worse, it abolished his cycle permanently. No more 3 days of relief.
After 40 years of swallowing all sorts of pills and having ECT, nothing worked - until 2 years ago.
That person was me.
My illness is a biogenic brain disorder. Period. You don't need an accurate biological explanation in order to validate clinical observation. The brain has been very much like a black box. We know what goes in. We know what comes out. However, there is very little consensus as to what happens inside the box. All that really matters is that people get better.
Depression leaves in its wake great psychological damage to one's psyche. If they were well-adjusted and psychologically strong (emotional intelligence), the spontaneous emergence of a depressive disorder wreaks havoc with the mind. The mind is altered by the changes in brain function. Psychotherapy is often necessary to heal the mind after the brain has been stabilized.
Don't lose hope. What else is there?
- Scott
Posted by jay2112 on November 7, 2022, at 17:31:16
In reply to Re: Most antidepressants are rubbish » Lamdage22, posted by SLS on November 7, 2022, at 13:21:27
Hey Scott,
Yeah, I rapid cycle quite a bit. BUT, I have made HUGE strides in going with a small bit of a dopamine agonist, and adding a pro-gaba powerful drug with Lyrica. The dopamine agonist lifts me greatly when my anxiety and depression sink in.
So, I think I have tamed the wild mood swings...and my god, do I feel like *myself* again! Oh...and for emergencies, like getting TOO much stimulation, I have a bit of risperidone. I NEVER thought I would get back to this point of feeling good, but not TOO good.Plus, I have a personal community worker who helps me with both existential angst, and practical problems in my life. But, grabbing hold of the biological chemistry with the new dopamine/gaba axis angle, is a step in the right direction, I think. I know Nardil has powerful pro-gaba qualities, so I am trying to simulate something similar to what you have with Nardil.
Best,
Jay
Posted by SLS on November 8, 2022, at 10:07:52
In reply to Re: Most antidepressants are rubbish » SLS, posted by jay2112 on November 7, 2022, at 17:31:16
Hi, Jay.
> Hey Scott,
>
> Yeah, I rapid cycle quite a bit. BUT, I have made HUGE strides in going with a small bit of a dopamine agonist, and adding a pro-gaba powerful drug with Lyrica. The dopamine agonist lifts me greatly when my anxiety and depression sink in.> So, I think I have tamed the wild mood swings...and my god, do I feel like *myself* again!
> Plus, I have a personal community worker who helps me with both existential angst, and practical problems in my life.
As I mentioned earlier, biogenic depression leaves psychological damage in its wake, regardless of how well adjusted you were prior to its onset. Conversely, often times the first depression is the result of a psychological insult to the brain. Too much chronic trauma or psychosocial stress are the enemies of a healthy, although vulnerable brain. Your "angst" and existential crises could easily have generated the brain dysfunctions responsible for your mood instability. However, once triggered, it is the dysfunctional biology that perpetuates the depression, even though the original psychosocial stressors are removed. Your community worker may be helping you immensely by quieting your mind and reducing stress in order to allow biological somatic therapies to produce improvements that persist.
> But, grabbing hold of the biological chemistry with the new dopamine/gaba axis angle, is a step in the right direction, I think. I know Nardil has powerful pro-gaba qualities, so I am trying to simulate something similar to what you have with Nardil.
Wow, Jay. That's phenomenal. Congratulations. Combining dopamine receptor agonists with pro-GABA drugs is a new one on me. Very impressive. Do you know anyone else who has had similar results using your strategy?Don't rock the boat. Don't fix what hasn't broken.
Continued health...
- Scott
Posted by jay2112 on November 15, 2022, at 12:26:00
In reply to Re: Most antidepressants are rubbish » jay2112, posted by SLS on November 8, 2022, at 10:07:52
Hi Scott:
> Hi, Jay.
>
> > Hey Scott,
> >
> > Yeah, I rapid cycle quite a bit. BUT, I have made HUGE strides in going with a small bit of a dopamine agonist, and adding a pro-gaba powerful drug with Lyrica. The dopamine agonist lifts me greatly when my anxiety and depression sink in.
>
> > So, I think I have tamed the wild mood swings...and my god, do I feel like *myself* again!
>
> > Plus, I have a personal community worker who helps me with both existential angst, and practical problems in my life.
>
>
> As I mentioned earlier, biogenic depression leaves psychological damage in its wake, regardless of how well adjusted you were prior to its onset. Conversely, often times the first depression is the result of a psychological insult to the brain. Too much chronic trauma or psychosocial stress are the enemies of a healthy, although vulnerable brain. Your "angst" and existential crises could easily have generated the brain dysfunctions responsible for your mood instability. However, once triggered, it is the dysfunctional biology that perpetuates the depression, even though the original psychosocial stressors are removed. Your community worker may be helping you immensely by quieting your mind and reducing stress in order to allow biological somatic therapies to produce improvements that persist.
>Yes, if I didn't have the meds to help me sleep, and help me wake in a decent mood, it would suck. But, to solve many of my practical, day to day problems, a counsellor was/is needed. This is the 'art' part of psychiatry. We have combined the medical model, and the recovery model, to supercharge our healing. Just google 'recovery model mental health'. With my mind feeling better from meds, I am much more receptive to creative ways to adapt and thrive in this world. We don't learn to walk, talk, think, without parents and teachers. We still need this guidance no matter how old we get. Therapy is vital.
> > But, grabbing hold of the biological chemistry with the new dopamine/gaba axis angle, is a step in the right direction, I think. I know Nardil has powerful pro-gaba qualities, so I am trying to simulate something similar to what you have with Nardil.
>
>
> Wow, Jay. That's phenomenal. Congratulations. Combining dopamine receptor agonists with pro-GABA drugs is a new one on me. Very impressive. Do you know anyone else who has had similar results using your strategy?Not really. Oddly, I still take a small amount of antipsychotic. But I think they act more as 'dopamine stabilizers'.
> Don't rock the boat. Don't fix what hasn't broken.
>
> Continued health...
>Thanks...I wish the best to you too :)
> - Scott
>Jay
Posted by ed_uk on December 4, 2022, at 13:40:39
In reply to Most antidepressants are rubbish, posted by linkadge on October 27, 2022, at 16:00:21
The thing is Link, SSRIs aren't modern anymore. Most antidepressants are old!
There has been very little development lately. The only new antidepressant we have got in the UK more recently is vortioxetine.
This is the end of the thread.
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