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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by dave_fox on July 29, 2001, at 6:56:42
Excuse me for what may sound like a bit of a dumb question.
I understand that there is a group of antipsychotic meds called "Atypical Antipsychotics" and I wanted to ask if this is anything at all to do with treating what is called "Atypical Depression".
I am trying to understand the so far unsuccessful treatment of my own atypical depression (I also have dysthymia and a noticeably obsessional personality type too).
There have been one or two references here to the atypical antipsychotics, Amisulpride and Risperdal. Are these atypical antipsychotics linked to atypical depression? Or is the name "atypical" just a co-incidence?
Thanks for any info.
dave
Posted by MM on July 29, 2001, at 8:23:39
In reply to ATYPICAL antipsychotics for ATYPICAL depression?, posted by dave_fox on July 29, 2001, at 6:56:42
Atypical anti-psychotics can be helpful for depression, but their name comes from the fact that they are chemically different than the "typical" anti-psychotics, which means they work by a different, or "atypical" mechanism. The atypicals are sort of "new and improved" and are not meant SPECIFICALLY for atypical depression, but they do help some depressives. Hope this answers your question.
Posted by JohnL on July 31, 2001, at 4:39:30
In reply to ATYPICAL antipsychotics for ATYPICAL depression?, posted by dave_fox on July 29, 2001, at 6:56:42
Just my opinion, but all these names such as atypical, depression, etc, are fairly useless. If they were truly helpful, this board wouldn't have any reason to exist. Instead, I prefer to look at it as chemical imbalance. Chemical imbalance could apply to serotonin, NE, or dopamine. And it also could mean one of them is too much, rather than too little. After all, it is chemical imbalance, not chemical deficiency. Too much or too little are equally bad. There is a proper balance. Drugs can restore the correct balance. I have yet to see anything more successful in doing that than the atypical antipsychotics. Just my opinion, but thousands or millions of depression sufferrers would be far better off with an AP in their mix, with less emphasis on the ADs.
Atypical antipsychotics are wonderful drugs for treating all kinds of psychiatric problems, whatever name someone wants to put on them.
John> Excuse me for what may sound like a bit of a dumb question.
>
> I understand that there is a group of antipsychotic meds called "Atypical Antipsychotics" and I wanted to ask if this is anything at all to do with treating what is called "Atypical Depression".
>
> I am trying to understand the so far unsuccessful treatment of my own atypical depression (I also have dysthymia and a noticeably obsessional personality type too).
>
> There have been one or two references here to the atypical antipsychotics, Amisulpride and Risperdal. Are these atypical antipsychotics linked to atypical depression? Or is the name "atypical" just a co-incidence?
>
> Thanks for any info.
>
> dave
Posted by MM on July 31, 2001, at 5:58:49
In reply to Re: ATYPICAL antipsychotics for ATYPICAL depression?, posted by JohnL on July 31, 2001, at 4:39:30
John, do you know much about chemical imbalances? If serzone (snri) helped me with anxiety, and looking through prescriptions I guess effexor (snri?) was ok too, but the SSRI's weren't good for me. Do you know if this suggests a certain chemical being out of balance? (like norepinephrine?) and if there's a med that specifically targets that? (I think I have too much serotonin). Sal said norepinephrine CAUSES anxiety, which confuses me. Do you know of any good LAYMAN sites on brain chemicals? I have no idea what affinity for receptor dL57 means etc.
Posted by Else on July 31, 2001, at 7:14:58
In reply to Re: ATYPICAL antipsychotics for ATYPICAL depression?, posted by JohnL on July 31, 2001, at 4:39:30
>Atypical antipsychotics are wonderful drugs for >treating all kinds of psychiatric problems, >whatever name someone wants to put on them.
>JohnExcuse me but I must object to that. Antipsychotics, even atypical, still have many unpleasant neurological side-effects and are still potentially dangerous in the long run (the risk of TD may be decreased but it is not eliminated, look at the PDR). They are not first line treatment for anxiety disorders, which can benefit from less toxic drugs that have been used for longer and/or have a lower incidence of side effects and/or cause less sedation. They are certainly not first line treatment for depression either. The (Canadian) Compendium of Pharmaceutical Substances repeatedly states that these drugs should be reserved for psychosis on non-psychotic conditions that have failed to respond to classical treatment. I am really against the idea of antipsychotics becoming first-line treatment for every mental illness under the sun. My brother was put on Risperdal because he was a bit hysterical, but not psychotic. He said he felt absolutely horrible on it. These drugs don't work for everyone. Obviously, he was misdiagnosed, stoppped taking it and is back to self-medicating his anxiety and depression with pot.
In addition to this, these drugs, because they cloud thinking and are so sedating, they make an accurate diagnosis and evaluation of the illness difficult. And let us not forget the sexual problems they cause, which are at least as bad, but probably worse than those caused by SSRIs (because they cause more indifference). In any case, I don't belive these drugs should be first-line treatment for non-psychotic disorders. I am not saying they might not have value as augmentation therapy. However Zyprexa is not Aspirin, it does alter personnality in a major way and should not become the Prozac of the 21rst century.
> Just my opinion, but all these names such as atypical, depression, etc, are fairly useless. If they were truly helpful, this board wouldn't have any reason to exist. Instead, I prefer to look at it as chemical imbalance. Chemical imbalance could apply to serotonin, NE, or dopamine. And it also could mean one of them is too much, rather than too little. After all, it is chemical imbalance, not chemical deficiency. Too much or too little are equally bad. There is a proper balance. Drugs can restore the correct balance. I have yet to see anything more successful in doing that than the atypical antipsychotics. Just my opinion, but thousands or millions of depression sufferrers would be far better off with an AP in their mix, with less emphasis on the ADs.
>
> Atypical antipsychotics are wonderful drugs for treating all kinds of psychiatric problems, whatever name someone wants to put on them.
> John
>
> > Excuse me for what may sound like a bit of a dumb question.
> >
> > I understand that there is a group of antipsychotic meds called "Atypical Antipsychotics" and I wanted to ask if this is anything at all to do with treating what is called "Atypical Depression".
> >
> > I am trying to understand the so far unsuccessful treatment of my own atypical depression (I also have dysthymia and a noticeably obsessional personality type too).
> >
> > There have been one or two references here to the atypical antipsychotics, Amisulpride and Risperdal. Are these atypical antipsychotics linked to atypical depression? Or is the name "atypical" just a co-incidence?
> >
> > Thanks for any info.
> >
> > dave
Posted by dave_fox on July 31, 2001, at 8:12:36
In reply to Re: ATYPICAL antipsychotics for ATYPICAL depression?, posted by JohnL on July 31, 2001, at 4:39:30
JohnL wrote:
>
> Just my opinion, but all these names such as atypical,
> depression, etc, are fairly useless. If they were truly helpful,
> this board wouldn't have any reason to exist. Instead, I prefer
> to look at it as chemical imbalance. Chemical imbalance
> could apply to serotonin, NE, or dopamine. And it also could
> mean one of them is too much, rather than too little. After all
> it is chemical imbalance, not chemical deficiency. Too much
> or too little are equally bad. There is a proper balance. Drugs
> can restore the correct balance. I have yet to see anything
> more successful in doing that than the atypical antipsychotics.JohnL, I have unsuccessfully used so many classic anti-depressant meds (and also my dysthymia seems linked to a personality type) that I suspect that something like on of the antipsychotics may be suitable for me. I do respect the caution Elsie urges in her posting but I would take these under supervision.
I now very little about antiopsychotics although I do know quite a bit about anti-depressants. Can I ask you or someone else kind enough to reply about my question to do with these antipsychotics (atypical or otherwise) ...
Do the antipsychotics work in much the same way as antidepressants in that they modulate parts of the body's amine system (NE and serotonin mainly and less often dopamine)? Or is their mode of action really quite different?
Thanks for any pointers! This is going to be quite a learning xperience for me, I can see!
Dave
Posted by JohnL on July 31, 2001, at 18:13:26
In reply to This is going too far, posted by Else on July 31, 2001, at 7:14:58
As you pointed out in a previous post Else, I do repeat myself a lot. One thing I repeat constantly is "Just my opinion". That's all it is. Doctors have to make the decisions. They are in charge, not me. So when my posts upset you, please just remember it is only an opinion. You are free and welcome to have your own opinion and voice it any way you like. I happen to appreciate your opinion.
John
Posted by medlib on August 1, 2001, at 3:47:27
In reply to Re: This is going too far...Else, posted by JohnL on July 31, 2001, at 18:13:26
John--
I really admire your post's equanimity; many thanks for the excellent exemplar of civility!
An appreciative medlib
Posted by Else on August 1, 2001, at 6:50:08
In reply to Re: This is going too far...Else, posted by JohnL on July 31, 2001, at 18:13:26
> As you pointed out in a previous post Else, I do repeat myself a lot. One thing I repeat constantly is "Just my opinion". That's all it is. Doctors have to make the decisions. They are in charge, not me. So when my posts upset you, please just remember it is only an opinion. You are free and welcome to have your own opinion and voice it any way you like. I happen to appreciate your opinion.
> John
You're right John, but I think all I did was express my *opposing* view or opinion and nothing more. My doctor once suggested I take Seroquel for anxiety and I objected. I would rather feel anxious then feel like a Zombie. There is a trend going on and I, personnally believe it is a mistake to use these drugs when the more well-known and less toxic benzodiazepines are more indicated. You could argue that I push benzos as much as you push your own set of miracle drugs. I suppose I do sometimes but I do believe they are useful drugs with few side-effects and that they are under-used because the supposed risk of addiction has been blown out of all proportion by the hysterical media, and some docs don't use them simply because they have a bad rep. Yes, these drugs can be addictive. But not to the extent that some doctors would have us believe. And as far as long term use is concerned this is a non-issue because even *safe* alternatives like Paxil and Effexor produce withdrawal symptoms. But then, this is just *my* opinion.
Posted by jojo on August 2, 2001, at 22:55:05
In reply to Re: This is going too far...Else, posted by JohnL on July 31, 2001, at 18:13:26
Just my opinion, John ; >) but I think "Doctors have to make the
decisions. They are in charge, not me.' Is a dangerous position for you to take. You, not they, will suffer the consequences of the decisions that are made, and when 5 different doctors, all equally well trained and certified, come up with 5 different treatments (choices of drugs, doses, which drugs are used first, etc., etc., someone has to choose which one to follow, and , rather than it being just the current physician, perhaps the patient, if he is able, and using due diligence, should cast the deciding vote.jojo
Posted by JohnL on August 3, 2001, at 3:53:23
In reply to Re: This is going too far...Else » JohnL, posted by jojo on August 2, 2001, at 22:55:05
> Just my opinion, John ; >) but I think "Doctors have to make the
> decisions. They are in charge, not me.' Is a dangerous position for you to take. You, not they, will suffer the consequences of the decisions that are made, and when 5 different doctors, all equally well trained and certified, come up with 5 different treatments (choices of drugs, doses, which drugs are used first, etc., etc., someone has to choose which one to follow, and , rather than it being just the current physician, perhaps the patient, if he is able, and using due diligence, should cast the deciding vote.
>
> jojo
Hi jojo,
I really hate to admit it, but the whole psychiatric game is a pure hit and miss venture anyway. You could probably write down the names of 30 different drugs on seperate pieces of paper, put them in a hat, and randomly draw one at a time, and do as well (or as bad) as the best layed plans.I see no danger in offering my opinions, since they are based on solid facts. Opinions that really suck are those that include junk like buspar, pindolol, mood stabilizers, and such for dysthymia or depression. Find one person in the archives that has done extremely well with one of these and I'll eat that hat. On the other hand, you can find dozens of people who have loved Zyprexa, Adrafinil, and Prozac, the three opinionated drugs I suggest most often. Not only is clinical research very supportive of my opinionated suggestions, but real world results are very good as well. Obviously mileage varies, and even my favorite drugs are failures for some people. But in this hit and miss game, they offer some of the highest odds for success compared to anything else. I see no danger in that.
John
Posted by jojo on August 3, 2001, at 10:37:26
In reply to Re: This is going too far...jojo, posted by JohnL on August 3, 2001, at 3:53:23
> > Just my opinion, John ; >) but I think "Doctors have to make the
> > decisions. They are in charge, not me.' Is a dangerous position for you to take. You, not they, will suffer the consequences of the decisions that are made, and when 5 different doctors, all equally well trained and certified, come up with 5 different treatments (choices of drugs, doses, which drugs are used first, etc., etc., someone has to choose which one to follow, and , rather than it being just the current physician, perhaps the patient, if he is able, and using due diligence, should cast the deciding vote.
> >
> > jojo
>
>
> Hi jojo,
> I really hate to admit it, but the whole psychiatric game is a pure hit and miss venture anyway. You could probably write down the names of 30 different drugs on seperate pieces of paper, put them in a hat, and randomly draw one at a time, and do as well (or as bad) as the best layed plans.
>
> I see no danger in offering my opinions, since they are based on solid facts. Opinions that really suck are those that include junk like buspar, pindolol, mood stabilizers, and such for dysthymia or depression. Find one person in the archives that has done extremely well with one of these and I'll eat that hat. On the other hand, you can find dozens of people who have loved Zyprexa, Adrafinil, and Prozac, the three opinionated drugs I suggest most often. Not only is clinical research very supportive of my opinionated suggestions, but real world results are very good as well. Obviously mileage varies, and even my favorite drugs are failures for some people. But in this hit and miss game, they offer some of the highest odds for success compared to anything else. I see no danger in that.
> JohnJohn-
I wasn't suggesting that there was any danger in offering your opinions, in fact they are most welcome.
The danger, I was suggesting, was in accepting that "Doctors have to make the decisions. They are in charge, not me." You are in charge, and can disagree with their treatment, suggest other treatments, or tell them that they are no longer suitable to be your physician. You are employing them, and if you are not satisfied with their work …. you know how the system works with unsatisfactory help.jojo
Posted by JohnL on August 3, 2001, at 17:53:17
In reply to Re: This is going too far...jojo, posted by jojo on August 3, 2001, at 10:37:26
Ahhh, I see what you meant now. My apologies. I totally misunderstood what you were saying. I in fact feel exactly the way you do. I mean, sure, in one sense doctors are in control because we can't do anything without their pen and prescription pad. But you are absolutely correct that the patient is the boss. After all, who pays who? I totally agree with you.
John> > > Just my opinion, John ; >) but I think "Doctors have to make the
> > > decisions. They are in charge, not me.' Is a dangerous position for you to take. You, not they, will suffer the consequences of the decisions that are made, and when 5 different doctors, all equally well trained and certified, come up with 5 different treatments (choices of drugs, doses, which drugs are used first, etc., etc., someone has to choose which one to follow, and , rather than it being just the current physician, perhaps the patient, if he is able, and using due diligence, should cast the deciding vote.
> > >
> > > jojo
> >
> >
> > Hi jojo,
> > I really hate to admit it, but the whole psychiatric game is a pure hit and miss venture anyway. You could probably write down the names of 30 different drugs on seperate pieces of paper, put them in a hat, and randomly draw one at a time, and do as well (or as bad) as the best layed plans.
> >
> > I see no danger in offering my opinions, since they are based on solid facts. Opinions that really suck are those that include junk like buspar, pindolol, mood stabilizers, and such for dysthymia or depression. Find one person in the archives that has done extremely well with one of these and I'll eat that hat. On the other hand, you can find dozens of people who have loved Zyprexa, Adrafinil, and Prozac, the three opinionated drugs I suggest most often. Not only is clinical research very supportive of my opinionated suggestions, but real world results are very good as well. Obviously mileage varies, and even my favorite drugs are failures for some people. But in this hit and miss game, they offer some of the highest odds for success compared to anything else. I see no danger in that.
> > John
>
> John-
> I wasn't suggesting that there was any danger in offering your opinions, in fact they are most welcome.
> The danger, I was suggesting, was in accepting that "Doctors have to make the decisions. They are in charge, not me." You are in charge, and can disagree with their treatment, suggest other treatments, or tell them that they are no longer suitable to be your physician. You are employing them, and if you are not satisfied with their work …. you know how the system works with unsatisfactory help.
>
> jojo
Posted by Elizabeth on August 3, 2001, at 18:49:20
In reply to This is going too far, posted by Else on July 31, 2001, at 7:14:58
> Excuse me but I must object to that. Antipsychotics, even atypical, still have many unpleasant neurological side-effects and are still potentially dangerous in the long run (the risk of TD may be decreased but it is not eliminated, look at the PDR). They are not first line treatment for anxiety disorders, which can benefit from less toxic drugs that have been used for longer and/or have a lower incidence of side effects and/or cause less sedation.
I'd add that antipsychotics generally do not work for panic disorder. And dopamine antagonists make a lot of depressed people feel *worse*, not better.
> I am really against the idea of antipsychotics becoming first-line treatment for every mental illness under the sun.
Me too. I'm aware that they do work (mainly in low doses and in combination with antidepressants) for some people with certain types of depressive symptoms, but they're far from being a reasonable first- (or even third-) line treatment.
> My brother was put on Risperdal because he was a bit hysterical, but not psychotic. He said he felt absolutely horrible on it.
His experience is not unique. A lot of people who aren't actually psychotic feel very crappy on these drugs.
My feeling is that medication treatment should be tailored to the individual -- I doubt that there is really a "short list" of drugs that are the most effective for all types of depression.
And medication treatment doesn't have to be luck of the draw. I decided to try desipramine because I know that TCAs are the treatment of choice for my type of depression. The only reason I'd never gotten through an adequate trial of a tricyclic was that I hadn't tolerated them; now I've found out that this might be the result of inadequate metabolism (resulting in very high serum levels). There are some types of depression that tend to be nonresponsive to TCAs; for some people, TCAs can even make their depression worse. These people are more likely to benefit from SSRIs, MAOIs, and perhaps stimulants, mood stabilisers, or atypical antipsychotics as augmentors.
-elizabeth
Posted by gretchenjm on September 15, 2007, at 21:35:02
In reply to ATYPICAL antipsychotics for ATYPICAL depression?, posted by dave_fox on July 29, 2001, at 6:56:42
Has anyone tried:
Abilify
Seroquel
Symbyax or (Zyprexa plus Prozac)
Risperdal
Geodon
Clozaril
Or the other anticonvulsant Tegretol?99% of my bipolar illiness is DEPRESSION.
Today my dosage of 5 mgs. of zyprexa twice a day seems to have completely lifted my DEPRESSION.
Have atypical antipsychotics helped others fight Depression as well as zyprexa has helped me. Lamictal was a disaster for me?
This is the end of the thread.
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