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Dr. Bob is Robert Hsiung, MD,
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Posted by bleauberry on June 2, 2011, at 10:06:30
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
> When Tofranil first came onto the market, it was generaly accepted that it was very effective in endrogenous depression, modestly effective in reactive or neurotic depression, and useless in depression due to inadequate personality.
>
> Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
>
> Are we expecting too much?Yes. They are not even reliable for endogenous simply because there are a variety of unrelated biological causes that the med may or may not have any impact on. For example if someone is feeling depressed, foggy, and fatigued due to gluten intolerance but they have no clue they are gluten intolerant, there is no amount of tweeking serotonin, NE, or DA that is going to impact that situation robustly. Just one of several similar examples.
Posted by Phillipa on June 2, 2011, at 11:20:28
In reply to Re: Do we expect too much of antidepressants today?, posted by bleauberry on June 2, 2011, at 10:06:30
Hence the Happy Pill. My Sister years ago went on paxil don't know why and all her friends and they called they their happy pills those and their benzos. I always wondered why they didn't make me happy? Phillipa
Posted by floatingbridge on June 2, 2011, at 12:32:33
In reply to Re: Lou's request-correction, posted by jono_in_adelaide on June 2, 2011, at 7:20:53
Joni, I agree with what's been said about marketing conditioning consumers, about psychiatry educating itself and the lay population by it's (often very underwritten by pharma) research, and one more thing: people always hope for a cure. Many people want to be sold a solution one can swallow.
Let me use an I statement: I certainly
did. Can't say I still don't. Just been knocked about too much to keep skepticism from setting in.
Posted by sigismund on June 2, 2011, at 13:14:44
In reply to Re: Lou's request-correction, posted by jono_in_adelaide on June 2, 2011, at 7:20:53
Now they are going to boot people off the disability pension because depression these days is treatable.
I was never impressed by the new hype. Any drug that made you feel half way good was out.
Posted by hyperfocus on June 2, 2011, at 17:48:20
In reply to Do we expect too much of antidepressants today?, posted by jono_in_adelaide on June 2, 2011, at 0:22:15
I'd have to say no. I think at some point people who have gone through a long period of crushing sadness or grief or hopelessness, or have experienced severe anxiety for a long time, come to realize that what they are feeling is not normal and has gone beyond the normal human response to trauma or loss or stress, and needs to be treated medically. Antidepressants do not make you happy AFAIK. They just normalize your emotional response. That's all that people with MI want, generally. If you think taking an AD will make your life wonderful then you may not need to be on an AD. I don't take meds for social phobia to make me be the life of the party and have 5 girlfriends - I take them so I can go to the supermarket and not feel like I've got three heads and five eyes. I don't expect ADs to make me feel wonderful and glorious - I'd just like to wake up in the morning and not feel this huge weight of sadness and bad memories of inconsequential events ten years in the past crushing me all the time.
>Now, we seem to expect antidepressants to cure not only endrgenous depression, but every unhappiness life can bring, dissatisfaction, disafection, misery and sadness.
A lot of the time dissatisfaction, disaffection, misery and sadness is caused by the illness we have. So it's logical to believe that if the illness is gone we can at least try to do the things that bring us satisfaction and happiness. There's no guarantees in this life but at least when I roll the dice I'd like them to be fair and not loaded. That's not expecting too much.
What I would say is that doctors need to go deeper and test for things like dissociation and bipolar and psychosis etc., together with disorders like PTSD which can be co-morbid with or simply the cause of clinical depression and anxiety. People classified with TRD might need a deeper exploration of their illness and different kinds of medication besides ADs. Also recovering from any long debilitating illness requires a lot of psychological, behavioral, emotional, spiritual/philosophical work.
Posted by SLS on June 2, 2011, at 18:12:48
In reply to Re: Do we expect too much of antidepressants today?, posted by hyperfocus on June 2, 2011, at 17:48:20
> I don't take meds for social phobia to make me be the life of the party and have 5 girlfriends...
Damn! But my doctor promised! Now, I'm really depressed.
:-/
- Scott
Posted by floatingbridge on June 2, 2011, at 18:56:55
In reply to Re: Do we expect too much of antidepressants today? » hyperfocus, posted by SLS on June 2, 2011, at 18:12:48
:+)
Posted by hyperfocus on June 2, 2011, at 20:32:41
In reply to Re: Do we expect too much of antidepressants today? » hyperfocus, posted by SLS on June 2, 2011, at 18:12:48
Clinical studies show a mean of only 1.7 new girlfriends acquired unfortunately. Either your doctor is overly optimistic or they haven't read the latest data.
Posted by emmanuel98 on June 3, 2011, at 0:04:54
In reply to Re: Do we expect too much of antidepressants today? » SLS, posted by hyperfocus on June 2, 2011, at 20:32:41
There are people in AA who object to psych meds as "happy pills" that keep people from the real, painful work of growth and change through the 12 steps. These people have obviously never themselves suffered from MDD. Anti-depressants are not happy pills. I expected them to be when I first started seeing a psychiatrist. I expected that they would substitute for my opiate and alcohol addiction. But they didn't make me happy. They just made me a little less angry and irritable.
My own p-doc has given up on anti-depressants for me. He is not into trying drug after drug. If an SSRI doesn't work, he doesn't then try every SSRI on the market. He goes to a new class of drugs. So far I have failed on SSRI's, SNRIs, TCAs and most mood stabilizers. I do well on AAPs, but get dangerously fat. MAOIs pulled me out of a near catatonic depression, but haven't made me feel happy at all. I still get severely depressed, but haven't spent days in bed since I started the MAOI.
My p-doc is now convinced that my only hope to stay alive is DBT. DBT is hard work. I called 40 people before I found a DBT practicioner willing to take on a patient with severe SI.
Now, my main fear is that I don't have the fight in me to commit to DBT.I get annoyed at these ads that suggest MDD is easily treatable with happy pills like lexapro. That hasn't been my experience.
Posted by SLS on June 3, 2011, at 4:18:28
In reply to Re: Do we expect too much of antidepressants today?, posted by emmanuel98 on June 3, 2011, at 0:04:54
Hi E.
> There are people in AA who object to psych meds as "happy pills" that keep people from the real, painful work of growth and change through the 12 steps. These people have obviously never themselves suffered from MDD. Anti-depressants are not happy pills. I expected them to be when I first started seeing a psychiatrist. I expected that they would substitute for my opiate and alcohol addiction. But they didn't make me happy. They just made me a little less angry and irritable.
Have you tried combining Zoloft with Trileptal and possibly adding lithium? If you go with an MAOI, you could still add these other drugs.
I think most of us on PB recognize that a healthy brain does not guarantee a healthy mind. Neither does a healthy mind guarantee happiness. People on PB almost never describe antidepressants as being "happy pills". This is a mischaracterization of clinical effects of these drugs.
- Scott
Posted by SLS on June 3, 2011, at 8:08:23
In reply to Re: Do we expect too much of antidepressants today?, posted by emmanuel98 on June 3, 2011, at 0:04:54
Have you tried combining Zoloft with Trileptal and possibly adding lithium? If you go with a switch from Zoloft to an MAOI, you could still add the Trileptal and lithium.
- Scott
Posted by Christ_empowered on June 3, 2011, at 12:20:19
In reply to yes, but..., posted by Christ_empowered on June 2, 2011, at 3:17:25
...why we keep getting more and more over-priced, ineffective pills on the market.
I mean, personally, I'm reasonably lucky, as crazy goes. I take Abilify, I'm not psychotic. I take Celexa, my social phobia and psychotic depression get better. But I can't Celexa forever, because it makes me too apathetic to function. I doubt I'm the only one in this situation.
I find the whole "antidepressant" concept misleading. Really? Anti-sad pills? Sign me up, please.
My current shrink refers to Celexa as a "tranquilizer." That's the sort of thinking that needs to come back into psychiatry--pills that calm people down, pills that perk people up, basic stuff. "Antidepressant" ? Please. If antibiotics failed as much as "antidepressants" do, they would have been abandoned long ago. If anti-epileptic drugs worked as miserably as "antidepressants," epilepsy would either be crippling or science would have moved on to other forms of treatment.
Not only is that term "antidepressant" misleading, I think it gives the false sense that this pill acts specifically on depression and is effective, when that's simply not the case.
Posted by linkadge on June 4, 2011, at 7:09:24
In reply to what I don't understand is..., posted by Christ_empowered on June 3, 2011, at 12:20:19
I would argue that many people are depressed because of a bad marrage, job, finiancial situation, etc. They want the drug to make all that go away, but its not going to happen.
For many, theres a lot deeper work that needs to be done. IMHO
Linkadge
Posted by linkadge on June 4, 2011, at 7:11:03
In reply to Re: Do we expect too much of antidepressants today? » jono_in_adelaide, posted by SLS on June 2, 2011, at 6:27:48
>It is thought by some that this illness in >particular has a rate of response of 85% when >any and all existing psychotropics are to be >considered as potential therapies in the >practice of polypharmacy.
Oh, of course. You could select some group in which they worked 100% of the time!
Linkadge
Posted by linkadge on June 4, 2011, at 7:14:21
In reply to Re: Do we expect too much of antidepressants today?, posted by hyperfocus on June 2, 2011, at 17:48:20
>Antidepressants do not make you happy AFAIK. >They just normalize your emotional response.
I didn't know numb was normal. But, I guess if you're emotions have gone haywire, numb feels more normal.
Linkadge
Posted by linkadge on June 4, 2011, at 7:16:54
In reply to Re: Do we expect too much of antidepressants today? » SLS, posted by hyperfocus on June 2, 2011, at 20:32:41
>Clinical studies show a mean of only 1.7 new >girlfriends acquired unfortunately.
Well, thats great if you're a heterosexual or lesbian.
Linkadge
Posted by SLS on June 4, 2011, at 7:43:02
In reply to Re: don't change your life - change your drug, posted by linkadge on June 4, 2011, at 7:09:24
> I would argue that many people are depressed because of a bad marrage, job, finiancial situation, etc. They want the drug to make all that go away, but its not going to happen.
>
> For many, theres a lot deeper work that needs to be done. IMHO
>
> Linkadge
This is why MDD must be differentiated from the scenarios you describe. An accurate diagnosis is the goal. I wonder if DMS V will be any better than the anemic DMS IV regarding distinguishing depressive disorders from depression that is predominately psychogenic. A question that has occurred to me lately is whether or not antidepressants can help with situational or psychogenic depression. Maybe they can. I have never seen a study addressing this issue. Make the presence of MDD or BD an exclusion rather than an inclusion.
- Scott
Posted by SLS on June 4, 2011, at 7:47:07
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 7:11:03
> >It is thought by some that this illness in >particular has a rate of response of 85% when >any and all existing psychotropics are to be >considered as potential therapies in the >practice of polypharmacy.
>
> Oh, of course. You could select some group in which they worked 100% of the time!
>
> Linkadge
>
How would you be able to select such a population? If someone comes up with a way to predict treatment response for subtypes of depression, that would be a monumental step forward. I believe that it will happen sooner than later.From time to time, let us assume that the investigators know what they are doing when executing a RCT.
- Scott
Posted by SLS on June 4, 2011, at 7:50:08
In reply to Re: Do we expect too much of antidepressants today? » hyperfocus, posted by linkadge on June 4, 2011, at 7:14:21
> >Antidepressants do not make you happy AFAIK. >They just normalize your emotional response.
>
> I didn't know numb was normal. But, I guess if you're emotions have gone haywire, numb feels more normal.
>
> Linkadge
I think Hyperfocus is right. This has been my own observation when I compare the operation of my psyche when depressed versus non-depressed.- Scott
Posted by SLS on June 4, 2011, at 7:53:32
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 7:16:54
> >Clinical studies show a mean of only 1.7 new >girlfriends acquired unfortunately.
>
> Well, thats great if you're a heterosexual or lesbian.
>
> Linkadge
Touché
- Scott
Posted by linkadge on June 4, 2011, at 9:40:26
In reply to Re: don't change your life - change your drug » linkadge, posted by SLS on June 4, 2011, at 7:43:02
I think is very difficult to tell whether something is MDD or simply a natural reaction to major life stressors. Some doctors would argue that there is no difference, and both warrant the same treatment.
I think some people subconsiously avoid adrressing the things in their life that they feel that they can't change, are too difficult to change, or that they don't want to change.
Linkadge
Posted by linkadge on June 4, 2011, at 9:41:56
In reply to Re: Do we expect too much of antidepressants today? » linkadge, posted by SLS on June 4, 2011, at 7:47:07
>From time to time, let us assume that the >investigators know what they are doing when >executing a RCT.
Oh, I think they know what they're doing. They're trying to establish the efficacy of biological psychiatry.
Linkadge
Posted by SLS on June 4, 2011, at 10:34:08
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 9:41:56
> >From time to time, let us assume that the >investigators know what they are doing when >executing a RCT.
>
> Oh, I think they know what they're doing. They're trying to establish the efficacy of biological psychiatry.
>
> Linkadge
>
>Hi.
Do you doubt that there are cases of depressive illness that are biological, or is it that you don't feel that current treatment is efficacious, or both?
- Scott
Posted by SLS on June 4, 2011, at 10:36:37
In reply to Re: Do we expect too much of antidepressants today?, posted by linkadge on June 4, 2011, at 9:41:56
> >From time to time, let us assume that the >investigators know what they are doing when >executing a RCT.
>
> Oh, I think they know what they're doing. They're trying to establish the efficacy of biological psychiatry.
Have they been successful?
- Scott
Posted by floatingbridge on June 4, 2011, at 11:18:12
In reply to Re: don't change your life - change your drug » SLS, posted by linkadge on June 4, 2011, at 9:40:26
> I think is very difficult to tell whether something is MDD or simply a natural reaction to major life stressors. Some doctors would argue that there is no difference, and both warrant the same treatment.
> I think some people subconsiously avoid adrressing the things in their life that they feel that they can't change, are too difficult to change, or that they don't
want to change.
>
>
>
> LinkadgeHi Link,
I agree people in general are somewhat at the very least subconciously avoidant, yet do majority really break down? Self-collusion serves a protective function. Avoidance is not the right word here--sounds willfully rational and most people are an aggregate of more than their rational self.
I know we're talking theory here, since PB represents a heterogeneous dx population, and I understand your main meaning. When the great societal urge to have someone else do one's recovery for them started, at least in the states, I don't know. There was the excitement in science that relief was within reach for a spectrum of ailments. When does that coincide with the rise of corporate interests in creating a market greater than the need? But at PB the need is pretty real in all it's variables.
Many at AA walk that fine line given in
the Serenity Prayer. The only widely available medicine when Bill W began AA was alcohol. People would risk drink wood alcohol during prohibition. The rise of gout in Europe during the 14th(?) Century coincided with the importation of sugar, a rich persons' substance that
was documented to cause exotic physical
changes in the consumer.Drug addicts, alcoholics. What are they
doing? There's some genetics to be
explored as a society from which science springs reexamines it's moral assumptions.However, the 12 steppers, religious and community groups help quite a bit in aiding people in coping with lives they might not have chosen or somehow cannot otherwise change.
Some people work awfully hard, you know, the lives of quiet desperation line. Someone shows them something pretty, a little bottle of sky blue pills and says here take one. You'll feel so much better, and there's no unsightly mess to deal with. Until one is kicked around by such seductions once or twice, it looks like a great deal.
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