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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 51. Go back in thread:
Posted by linkadge on November 26, 2005, at 10:54:30
In reply to Re: Studies on long term use of SSRI's, posted by law663 on November 25, 2005, at 22:30:52
Yes, I would think that if you avereraged every clinical trial, you might get an effect in about a third of people.
Linkadge
Posted by flmm on November 26, 2005, at 11:24:03
In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 10:54:30
I think overanylisis is part of everyones problem. Depression is self obsession. Get off the couch, stop worrying about what drug is doing what, go help someone else and you might just stop obssessing about yourself so much!You will never find the perfect drug,deal with it!
Posted by law663 on November 26, 2005, at 11:26:19
In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 10:52:26
Well put linkage. Do you happen to have the cite for the short-short paper? I'm aware of the tiapine paradoxical effect. I still say that AD's are effective. The BNDF is more than just transient I believe, but I think the jury is still out for the final verdict.
Posted by linkadge on November 26, 2005, at 12:34:50
In reply to Re: Studies on long term use of SSRI's (linkadge), posted by law663 on November 26, 2005, at 11:26:19
Here is one.
It starts by talking about the effect of the transporter on drinking, and then goes on to discuss its relationship to depression.
http://www.futurepundit.com/archives/001611.html
But the story goes much deeper. One can do engine searches with key words short-short, SERT, depression, etc. There is lots of work being done, but most of the data seems to show that the short-short varient confers susceptability to depression and alcoholism.
Linkadge
Posted by Tomatheus on November 26, 2005, at 13:04:32
In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 11:24:03
> Depression is self obsession.
What makes you say this? Do you speak from experience? Or is this part of a theory that's been written about in the scientific literature? If this theory is scientific, I am not familiar with it. Could you please cite an article from the literature discussing this theory of self obsession? I'd be interested in learning more about it.
> go help someone else and you might just stop obssessing about yourself so much!
It seems to me that helping others is what this meds board is all about. It's been helpful to me, and I'd like to hope that some of my posts have been helpful to others.
> You will never find the perfect drug,deal with it!
I don't think that any of us seeking drug therapy for depression are looking for perfection. I can't speak for others, but when my depression is at its most severe, all I'm looking for is the ability to lead some semblance of a normal life - to be able to feel alive and to be able to enjoy all of the things that I know I should be enjoying but cannot due to my condition.
Tomatheus
Posted by ed_uk on November 26, 2005, at 14:24:11
In reply to Re: Studies on long term use of SSRI's, posted by Tomatheus on November 26, 2005, at 13:04:32
Hi
>I'd like to hope that some of my posts have been helpful to others.
They have. You have many excellent posts to your name :-)
Ed
Posted by Tomatheus on November 26, 2005, at 14:44:40
In reply to Re: Studies on long term use of SSRI's » Tomatheus, posted by ed_uk on November 26, 2005, at 14:24:11
Thanks, Ed. I'm glad to hear that you've enjoyed my posts, even though I really haven't written very *many* of them yet. I've certainly learned a lot from the many (and I do mean many) insightful posts you've made (since I've joined and from before, when I was in lurking).
Tomatheus
> Hi
>
> >I'd like to hope that some of my posts have been helpful to others.
>
> They have. You have many excellent posts to your name :-)
>
> Ed
Posted by flmm on November 26, 2005, at 14:44:42
In reply to Re: Studies on long term use of SSRI's » Tomatheus, posted by ed_uk on November 26, 2005, at 14:24:11
All I am saying is dealing with depression will always be more than taking a pill. They help, but only about 50% of the way. The rest is up to you. Spending time looking on this board for the perfect drug is counterproductive and helps to increase the thought process of your own illness. Spend a couple weeks away from the board, if you can,and see if you do not feel a little better not looking for that "perfect" drug. There is a lot more to it than just drugs!In the end they all pretty much do the same thing!
Posted by Tomatheus on November 26, 2005, at 15:05:34
In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 14:44:42
flmm,
I agree that there is more to dealing with depression than taking a pill, but I must question your statement that all drugs "pretty much do the same thing" in the end. Do antipsychotics, for example, do the same thing as stimulants? Of course not; the primary effects of antipsychotics and stimulants are basically the opposite of one another. All antidepressants are not alike, either, as it is not uncommon for patients to respond to one type of medication (say, an MAOI, for example), but not another (such as an SSRI). And even though some medications tend to lose their effectiveness in the long run for certain patients, this is not the case for all medications and all patients. There are plenty of case reports in the scientific literature - and even more on this board - of patients achieving long-term success on various meds. But having said this, I do think that there is a need for more studies (other than case reports) on the long-term effectiveness of psychiaric medications (especially the newer ones).
Tomatheus
> All I am saying is dealing with depression will always be more than taking a pill. They help, but only about 50% of the way. The rest is up to you. Spending time looking on this board for the perfect drug is counterproductive and helps to increase the thought process of your own illness. Spend a couple weeks away from the board, if you can,and see if you do not feel a little better not looking for that "perfect" drug. There is a lot more to it than just drugs!In the end they all pretty much do the same thing!
Posted by linkadge on November 26, 2005, at 15:24:43
In reply to Re: Studies on long term use of SSRI's » flmm, posted by Tomatheus on November 26, 2005, at 15:05:34
I personally have not had much sucess with psychiatric medications.
For a while I was able to fool myself into thinking that my problems were reated to a chemical imballance. But at the end of 5 years on them I realized that they really weren't helping my problems more than they were just changing my problems into some other form.
Linkadge
Posted by flmm on November 26, 2005, at 15:38:17
In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 15:24:43
I think you are getting a little too technical!
Posted by Tomatheus on November 26, 2005, at 15:48:07
In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 15:24:43
Linkadge,
I'm sorry to hear that your trials with psychiatric medications have not been successful. As I said, there are some patients who do achieve long-term success on psychiatric medications. On the flip side, I do think that meds are either less than effective or unnecessary in far too many patients, and I think it's important for patients to understand that antidepressants are not as universally effective as the drug companies would like to have us believe. Even though there is evidence in the scientific literature that genetically determined biochemical imbalances are part of what causes depression in some patients, there is no way to say for sure in any given case whether or not a patient actually does have a "chemical imbalance." There is far too much guesswork in psychiatry, and even though treatment is very successful in some cases, I think it's important to realize that treatment is often unsuccessful, and that there is a lot of room for improvement in psychiatry.
Thanks for your post.
Tomatheus
> I personally have not had much sucess with psychiatric medications.
>
> For a while I was able to fool myself into thinking that my problems were reated to a chemical imballance. But at the end of 5 years on them I realized that they really weren't helping my problems more than they were just changing my problems into some other form.
>
>
>
>
> Linkadge
>
>
Posted by ed_uk on November 26, 2005, at 15:52:04
In reply to Re: Studies on long term use of SSRI's » ed_uk, posted by Tomatheus on November 26, 2005, at 14:44:40
Thank you :-)
Ed
Posted by Tomatheus on November 26, 2005, at 15:52:34
In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 15:38:17
flmm,
I'm sorry for going into so much detail. Perhaps it would have been sufficient to say that all psych meds clearly aren't the same. :)
Tomatheus
Posted by zeugma on November 26, 2005, at 15:57:33
In reply to Re: Studies on long term use of SSRI's » linkadge, posted by Tomatheus on November 26, 2005, at 15:48:07
The point has been made that if active placebos were used, they would equal existing AD's in effectiveness.
The problem is that many 'nocebos' that have been used were anticholinergic agents, which probably have antidepressant effects in their own right.
Another problem is that depression itself is a clinical term, and implies nothing about the etiology of the syndrome.
Helay's name was mentioned somewhere up the thread. He is not a skeptic about whether or not AD's are better than placebo. But he does observe that SSRI's are more effective for treating premature ejaculation than depression.
-z
Posted by linkadge on November 26, 2005, at 16:32:16
In reply to Re: Studies on long term use of SSRI's, posted by zeugma on November 26, 2005, at 15:57:33
I'm not really trying to dismiss people's experiences with meds, but sometimes depression gets better on its own. If somebody is on a medication when they get better then there is a tendancy to want to attribute it to the medication because that gives the patent a sence of controll over their situation, as opposed to thinking that things just got better on their own.
Linakdge
Posted by zeugma on November 26, 2005, at 17:28:53
In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 16:32:16
> I'm not really trying to dismiss people's experiences with meds, but sometimes depression gets better on its own. If somebody is on a medication when they get better then there is a tendancy to want to attribute it to the medication because that gives the patent a sence of controll over their situation, as opposed to thinking that things just got better on their own.>
That is very true. However, the situation also works for the converse: if someone experiences an adverse reaction at some point there is a tendency to blame the drug.
healy claims that TCA's do not cause switches to mania for bipolars, they merely do not prevent them. He says that rates of switching did not change after the introduction of AD's in the 50's, but that since they occurred in patients 'naturally', the drug was blamed. It seems to me that it is just dogma that SSRI's are better AD's for bipolar patients than TCA's.
All we can go on are our own subjective experiences with meds and with depression itself, since we can't get tested with depression as we can for TB. So it makes no sense to say that spontaneously remitting depression is any less depression than depression that improves with an AD, although statistics do seem to point in the direction of severity of depression being correlated with a response to an active drug and a falling off of placebo (and presumably of spontaneous remission).
-z
>
> Linakdge
>
Posted by flmm on November 26, 2005, at 17:49:15
In reply to Re: Studies on long term use of SSRI's » linkadge, posted by zeugma on November 26, 2005, at 17:28:53
I know the difference between a true medication and a placebo. I will take the medication any day thank you!
Posted by linkadge on November 26, 2005, at 18:14:59
In reply to Re: Studies on long term use of SSRI's » linkadge, posted by zeugma on November 26, 2005, at 17:28:53
I wouldn't go so far as to say that the TCA's are incapable of causing manic reacitons.
Lack of sleep has been known to precipitate mania medication or no medication. So if a drug happens to cause insomnia, mania may be a response to this in a bipolar patient.
Funny enough, mania has also been a side effect of zyprexa, a drug which is often used to curb mania.
Linkadge
Posted by willyee on November 27, 2005, at 0:11:44
In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 11:24:03
Your posts are hoerrendously wrong.You say you are on a medication which helps you,Okay well how would you take to someone telling you that you are wrong for being on a medication period,that NO DRUG is needed and instead of a popping a pill instead drink more water,eat a better diet.
You would not agree with that would you,and why,well because you know how you feel,and obviously the other person doesent,the other person is just being influenced by there own mood to judge you.
Well in that same manner how can you say it is counter productive for anyone to be on here,so it is not possable that unlike yourself there are people out there who achieve zero benifit from the current drugs,in fact from ssris like myself feel worse,should they not expect the same results as you do,maybe instead of feeling that way towards people who are searching for the "perfect med" you should instead feel LUCKY you are a responder so early on.I am in no way looking for the perfect med,and your comment is very general,i wanna to make sure in that case that you understand just because i search this group or go through trials with different drugs does not mean im looking for the "perfect pill" i am far from a perfect pill.
Being on medication and knowing how REAL the agony of not having control of your own thoughts and being victim to clinical depression im SHOCKED you can say such a comment concerning others who are searching for reliaf.
If i found an effective pill tommorrow,i would not feel like everyone should switch to the one im taking,or that everyone else still searching to no avail are just looking for a cure all people.
No id think wow i should feel very lucky,and i hope those poor people can find some relieaf and find some effective med or combination.
I am willing to bet the fram that the over whelming majority of people here would be joyous to find a drug that even allowed that some reliaf with consistency.
Finaly i dont know where opted you to say the drugs are all the same,yess the ssri class of drugs do primarly work the same,HOWEVER the tca,maoi,and off label drugs which are used in high degree DO NOT work in any way simliar ,AT ALL.
I also dont think knowing the method of action,the chemistry and everything u can about a different drug or class of them is not being too technical,in fact its to cut back on the long process of switching meds......you learn and understand how a single drug works,and you can can a good idea of how one in a similiar class would more likly act.I for example did TERRABLE on ssris,but being younger i listeneded and obeyed my doc when i was switched from one ssri to another,when now its sensable to me after two the most i should have simply gave up on ssris.
I responded to parnate an maoi,and then at another point i repsonded to deprenyl an maoi,see where im going?
Posted by willyee on November 27, 2005, at 0:19:09
In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 26, 2005, at 15:38:17
Thats absurd,the post wasnt technical at all,i think knowing how something is believed to work since you are choosing to ingest it is very smart and responsable,we are already totaly limited to the degree of the role we play in our treatment by the industry.
People look up ingredients in foods all the time,how much more so with something that will enter our brain and seriously alter it,maybe its too technical for YOU,but make that clear please,i can never know too much on a drug im currently taking,if someone knows something more about what it can do to me,my ears our open.This statment contradicts your whole point,if someone were just looking for easy fixes and perfect pills then mor elikly they would just "pill pop" until they felt good,knowung ur drug shows to me a huge level of responsability.
Sometimes more than your docter themselves are willing to invest.
Posted by willyee on November 27, 2005, at 0:31:21
In reply to Re: Studies on long term use of SSRI's, posted by linkadge on November 26, 2005, at 16:32:16
> I'm not really trying to dismiss people's experiences with meds, but sometimes depression gets better on its own. If somebody is on a medication when they get better then there is a tendancy to want to attribute it to the medication because that gives the patent a sence of controll over their situation, as opposed to thinking that things just got better on their own.
>
> Linakdge
>Thats open to strong debate mainly because to this day we dont know enough,we dont know if it is a solid fact that emotional disorders are TRULY chemical imbalances,and who could blame us,first were told they are and sent to a Docter which seems sensable,but at the same time were told that talk therapy is needed or should be used .
I cant think of one single pyshical condition,not one that permits or recomends the use of talking with a professional as treatment,not parkinsons,not seizures,not migraines,not cancer,id still prefer some tums for a sick tummy over a chat anyday.
Dont get me wrong i dont question anyone who finds success with talk therapy,but it just shows how totaly off we are in understanding the true rold of cause .
Personaly i believe that IF emotional disorders are in fact some sort of pyhsical disorder,and this was pure fact,and i dont mean the absurd zoloft commercial explanation to it with cartoons,but real understanding and scienace showing some forms of depression are chemical,well in that case i would say i dont see how one could expect to get better without some medical intervention be it medication surgery etc. i wouldent understand in that case how it could just go away.
But reality is we are clueless,your head can spin if you read all the theorys out there,one side of the brain is more dominant,over active nueron firing,too much serotionion,not enough serotion,too much dopamine,not enough,gaba problems i mean its a giant circle.
With this being the case i would never argue someone who found a effective treatment,who am i to do so.Instead id be quite happy for them and a little envious,but i will not try to dictate facts on them that dont exisit,its just theory,all theory,based on studies that prob coud show different outcomes every time.
I say you find a way out,live it ,love it!
Posted by linkadge on November 27, 2005, at 11:10:04
In reply to Re: Studies on long term use of SSRI's, posted by willyee on November 27, 2005, at 0:31:21
Ok, I should't generalize. I guess in my case I don't think the meds did all that much. My depression only really started to improve when the problems in my life started to resolve.
Linkadge
Posted by flmm on November 27, 2005, at 11:57:32
In reply to Re: Studies on long term use of SSRI's, posted by willyee on November 27, 2005, at 0:31:21
You made my point for me wylee, we are clueless, so I think obsessing about what med does what is counterproductive. The way to eliminate depression goes above and beyond drugs.Unfortunately, that's all this sight is about, drugs!
Posted by med_empowered on November 27, 2005, at 14:49:00
In reply to Re: Studies on long term use of SSRI's, posted by flmm on November 27, 2005, at 11:57:32
I think truly treating depression does involve more than drugs. However, b/c of the push towards drugs in depression, its harder now to get psychotherapy...lots of insurance plans will pay for antidepressants, but not for extended therapy (or any therapy, really). Plus, for the past 10 years the message has been "depression is a physical problem with a physical cause, and requires physical/medical treatment" Its really only now that shrinks are back-tracking and recognizing the value of psychotherapy and a psychosocial understanding of depression. Finally...although I dont currently take meds for depression, when I did the idea wasn't "feel 100% better"; the idea was "feel better *enough* to do everything else (therapy, self-help, etc.)". THe problem is that the pills often couldn't even do that much for me.
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