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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 56. Go back in thread:
Posted by linkadge on January 31, 2010, at 11:50:21
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 11:17:39
>I don't believe it should be an option for >mental illness.
Why not? Its your life. Some people say commiting suicide is selfish. I don't. What is selfish is when another individual demands that you stay alive, despite severe suffering, in order to keep the other individual happy.
I think its all about prognosis. If the disease is chronic and unremitting despite years or decades of continual and optimal treatment why stay alive?
Hope for future meds? What, wait a few decades for them to release another monoamine reuptake inhibitor?
P.S. I am safe, so don't panic.
Linkadge
Posted by linkadge on January 31, 2010, at 11:50:35
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 11:17:39
>I don't believe it should be an option for >mental illness.
Why not? Its your life. Some people say commiting suicide is selfish. I don't. What is selfish is when another individual demands that you stay alive, despite severe suffering, in order to keep the other individual happy.
I think its all about prognosis. If the disease is chronic and unremitting despite years or decades of continual and optimal treatment why stay alive?
Hope for future meds? What, wait a few decades for them to release another monoamine reuptake inhibitor?
P.S. I am safe, so don't panic.
Posted by bulldog2 on January 31, 2010, at 12:41:41
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on January 31, 2010, at 11:50:35
> >I don't believe it should be an option for >mental illness.
>
> Why not? Its your life. Some people say commiting suicide is selfish. I don't. What is selfish is when another individual demands that you stay alive, despite severe suffering, in order to keep the other individual happy.
>
> I think its all about prognosis. If the disease is chronic and unremitting despite years or decades of continual and optimal treatment why stay alive?
>
> Hope for future meds? What, wait a few decades for them to release another monoamine reuptake inhibitor?
>
> P.S. I am safe, so don't panic.
>
>There is always the hope that some treatment may be available in the near future.
Maybe it's a selfish decision on my part. I just could not deal with someone I loved killing themselves while I just stood by. Maybe tomorrow they might feel differently? Is there something we have not tried?
Posted by ralphrost2 on January 31, 2010, at 13:45:18
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 12:41:41
What leads us to think about suicide when we are severely depressed? It might be seen as a way to end the pain but also as an evolutionary tool. Your life went wrong, so you might be better off the evolutionary chain. Nature is kind of cruel, I think.
Ralph
Posted by Sigismund on January 31, 2010, at 14:51:16
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 11:17:39
>I don't believe it should be an option for mental illness.
Why not? Surely not because of the efficacy of psychiatric treatment.
Posted by Sigismund on January 31, 2010, at 14:52:26
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 12:41:41
>There is always the hope that some treatment may be available in the near future.
Not in me there isn't.
Posted by Meltingpot on January 31, 2010, at 14:53:03
In reply to Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 9:34:15
I do think it is. I know they say that suicide is irrational but if you have been feeling irrational for years because of depression and anxiety then maybe suicide is actually rational. I think though you still should have tried everything there is to try before you do so.
I think people who are chronically ill and have been for years should be HELPED to kill themself in the most peaceful a way as possible. Why should people be left to throw themselves off train tracks etc.
I also think if I thought anyone I loved was suffering in the way that I do when I'm not on medication then I would feel very much inclined to help them to escape. As Linkadge says it's more selfish to want somebody to continue to live when they are suffering (whether it be mental or physical). Mental suffering feels like physical suffering to me anyway.
Although, what Phillipa said about a Doctor actually condoning suicide is pretty scary, I would personally like to have a Doctor who gave me hope and kept encouraging me to carry on and to keep trying.
Denise
Posted by linkadge on January 31, 2010, at 15:05:13
In reply to Re: Is Suicide Ever A Viable Option?, posted by ralphrost2 on January 31, 2010, at 13:45:18
I'm not sure if I believe the 'evolutionary perspective'. It doesn't make a whole lot of sence.
The idea of evolution is not that the genes know (or care) whats best for the greater good, but more that the good genes naturally survive - or that the genes that are most adaptive survive.
The contrapositive of that is not logical however: that bad genes care about taking themselves out. Plus, if the bad genes effectively took themselves out, they would not be so prevailent.
I think depression is adaptive to a certain extent. Depression can be an outward sign of a complex but powerful adaptive change. Notice how when something dramatic and negative happens in life, depression often follows. Its like the brain shuts down happiness so that the organism will stop and make the most complex and hardest considerations for optimal adaption.
Linkadge
Posted by linkadge on January 31, 2010, at 15:35:17
In reply to Re: Is Suicide Ever A Viable Option?, posted by Sigismund on January 31, 2010, at 14:51:16
>Why not? Surely not because of the efficacy of >psychiatric treatment
Thats it. Sometimes I feel that the treatment of depression is just not a priority. The research shows that a good proportion of patients are not getting better, that patients are not achieving remission, that patients are relapsing etc. Bipolar depression is also very difficult to treat effectively - and is probably a higher risk of suicide than unipolar.
Many of the 'effective drugs' are not safe for long term administration IMHO. Atypical antipsychotics, TCA's and ECT, have various toxicities, many of which would be unacceptable in other brances of medicine. If I took my seroquel daily like a good patient, where would I be in 20 years from now. Probably an insulin resistant diabetic.
I am discouraged about the lack of progress. In the last 10 years I don't really see the kind of improvement one might expect.
There are so many leads they could take. There are dozens of phytochemicals which could be used as templates for synthetic drugs. For instance, resveratrol, quercetin, hyperforin and turmeric have various cellular, immunilogical and neurotransmitter targets that could be more intesivly investigated.
What happened with RU486? It was supposed to be 'fast tracked' for depression like 10 years ago. What have we got since 2000? Cymbalta, escitalopram and abilify? Is that it? My doctor doesn't even prescribe escitalopram since he says citalopram is as effective. And head to head trials suggest that cymbalta is consistently inferior to effexor or even fluoxetine. Plus, I've got a book here from 1983 "drugs and the brain" solomon h. snyder which lists citalopram as a promising new antidepressant. So our top antidepresants today were known about like 30 years ago.
Suicide is the 2nd leading cause of death in young people. It outkills cancer. Think of the mony poured in to cancer research. I would be suprised if depression research gets 1/50th of that. For ever person that kills themselves theres probably a dozen more that feel like doing it on a daily basis, which is worse than death itself.
In the 90's there was so much hope for biological psychiatry. The SSRI's and atypicals were the magic bullits. People were starting to believe that science was getting a grip on depression. In the past 10 years a lot of that has fizzled away. I think a lot of psychiatrists are discouraged too - when the best they can offer their patients is paxil and zyprexa combos. And they have to deal with all the backlash about whether these drugs even work. I feel that psychiatrists are just going through the motions these days. There isn't that spark of inthusiastic belief that this is a real illness that can be treated safely and effectively.
Even things like ECT have come under heavy fire in the last 10 years. Studies have been released casting serious doubt on the boasted 70% remission rate. Studies released suggesting that most patients relapse and that reports of memory loss were not properly assessed.
The FDA is just taking no risks when it comes to depression. All that gets approved are drugs with the same mechanisms of action namely monoamine reuptake inhibitors.
I'd rather see drugs get approved then recalled than not approved at all.
Linkadge
Posted by linkadge on January 31, 2010, at 15:48:16
In reply to Re: Is Suicide Ever A Viable Option?, posted by Meltingpot on January 31, 2010, at 14:53:03
I also don't think that people realize how economially useful a truely safe and effective antidepressant would be.
Imagine a drug that completely and rapidly relieves depression - in a way where the patient can still experience deep emotion and true joy. A drug that restores deep restful sleep and effective, nonsedating relief of innapropriate anxiety. A drug that restores interest in everday activities without clouding the intellect. A drug that restores proper immune and endocrine function and effectively combats many of the dozens of the depression comorbid health conditions (diabetes, heart disease etc).
Such a drug would likely save billions related health costs and money due to lost productivity.
Perhaps such a drug or treatment is a fanacy, but it is a goal. The laser eye surgery of psychiatry.
I honestly just feel that people still see depression as a ficticious disease.
Linkadge
Posted by bulldog2 on January 31, 2010, at 16:36:07
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on January 31, 2010, at 15:48:16
> I also don't think that people realize how economially useful a truely safe and effective antidepressant would be.
>
> Imagine a drug that completely and rapidly relieves depression - in a way where the patient can still experience deep emotion and true joy. A drug that restores deep restful sleep and effective, nonsedating relief of innapropriate anxiety. A drug that restores interest in everday activities without clouding the intellect. A drug that restores proper immune and endocrine function and effectively combats many of the dozens of the depression comorbid health conditions (diabetes, heart disease etc).
>
> Such a drug would likely save billions related health costs and money due to lost productivity.
>
> Perhaps such a drug or treatment is a fanacy, but it is a goal. The laser eye surgery of psychiatry.
>
> I honestly just feel that people still see depression as a ficticious disease.
>
> Linkadge
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>Man has been looking for such a drug for thousands of years. I don't think modern medicine doesn't care but they are tremendously frustrated by the complexity of this disease or diseases. Modern medicine for all the money they pour into looking for a cancer cure hasn't done that much better here. Most patients are still put through gruesome chemo treatments of dubious value.
I think western medicine thought they had the key to disease when they discovered bacteria. Find the bacteria that causes the disease and than find the approriate antibiotic. But cancer and mental illness have not been found to fall under the simple cause and effect model.
Right now medicines are produced for depression without knowing what the real causes are. So that's a real crap shoot. Science/medicine needs to know the root causes before we find really good meds that work in sync with the body. I don't think we've progressed beyong doctors who in the early 1900's used opiates and cocaine preperations for their patients. They work immediately for many however problems of tolerance and addiction have put them out of favor.
Posted by linkadge on January 31, 2010, at 16:52:12
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 16:36:07
I don't know. I think the industry is controlled by money and by drug companies. There is nothing ethical about the way the desease is treated.
For instance, the FDA removes drugs like nomifenasine and amineptine because they demonstrate some properties of abuse in some patients. I don't think the drugs are any more addicting than the amphetamines or ritalin yet these drugs are prescribed to children every day.
Why does an antidepressant need to be completely free of abuse potential? Why can't we just monitor abuse like we do with opiates or stimulants?
Instead, clinically superior antidepressants are taken from the market. It doesn't make sense.
Same goes with ketamine. Sure it can cause psychosis and or euphoria, but so can the stimulants. Why bar it from medical use because of possible side effects in some patients?
The whole process is f'd up. Good drugs are rejected for poor reasons.
Why have there been no clinical trials on synthetic hyperforin? Why doesn't the government sponsor and control drug comparisons between things like SJW, SAMe vs other antideprssants. If you leave it to the drug companies, the public will never have an acurate picture of the true effectiveness of such agents.
Linkadge
Posted by linkadge on January 31, 2010, at 17:13:39
In reply to Re: Is Suicide Ever A Viable Option? » bulldog2, posted by linkadge on January 31, 2010, at 16:52:12
For instance, turmeric was much more effective than fluoxetine in animal studies of antidepressant efficacy.
Why are there no large scale (government controlled) human trials of how this agent stacks up against synthetic antidepressants?
The only agents that get tested in humans are the agents which can serve to profit drug companies. Drug companies can't make money from turmeric, so it doesn't get fully tested. Is this ethical? No.
If people were truely interested in getting people well and not just $, researchers would take so many more avenues.
SSRI's are not proven to lower suicide rates. Lithium is, however. Why are there no studies of say (relatively safe) lithium augmentation on youth at high risk for suicide? Because there is no bug $ to be made from lithium so nobody really gives a rats behind (well, they give a rat's behind just not a human behind)
Psychotherapy is often superior to antidepressants in certain groups of patients with depression. Why is psychotherapy not covered for depression but antidepressants are? Because antidepressants are cheaper. Nobody really cares if psychotherapy might not help certain patients achieve a safer lasting remission. Its too expensive to pay for.
Why did it take 10 years before somebody did a large scale (CATIE) study to comapre typical and atypical antipsychotics. For that time patients were made to pay high prices for atypicals under the premise that the drugs were more effective and better tollerated. What it CATIE find, that atypicals are no more effective that older agents like perphenazine (even for negative symptoms) dispite being much more expensive. Newer agents also pose higher risk of metabolic side effects than do drugs like perphenazine. How many cases of diabeties might have been prevented if patients were just prescribed typical antipsychotics from the get go? (I.e. sombody actually bothered to question what the drug companys assert). Instead, the drug companies were allowed (for 10 years) to make all sorts of unsubstantiated claims about atypical antispychotic drug safety and efficacy.
The drug companies rule the buisness. There is no real concern about what actually works, about what is actually safe or about what will actually get patients well.
If people actually cared about what was best for patients, things would be done much, much differently.
Linkadge
Posted by linkadge on January 31, 2010, at 17:29:32
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on January 31, 2010, at 17:13:39
Also, a high number of patients with depression recieve augmentation with atypical antipsychotics.
There is good reason to believe that cleaner augmentation with selective 5-ht2a blockers like eplivanserin would reduce complications associated with long term atypical antipsychotic exposure.
Then all of a sudden, boom, eplivanserin is not approvable. Why? Even if it just tested effective as a substitute to atypical augmentation, this would be an ethical advantage.
But no, without good reason we need to continue consuming the diabetogenic drugs, potentially indefinately.
Linkadge
Posted by emmanuel98 on January 31, 2010, at 18:21:40
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on January 31, 2010, at 15:48:16
I think such a drug exists. It's called an opiate. Unfortunately, it's highly addictive and people build tolerance, requiring dangerously high dosages. It is also fatal in overdose, so would be risky for a suicidal patient. Ectasy makes people feel pretty good too. So do cocaine and speed. The problem with psychoactive drugs has always been finding drugs that work but can't be abused. A lot of people would love a drug that made them feel good and not just people with TRD.
>
> Imagine a drug that completely and rapidly relieves depression - in a way where the patient can still experience deep emotion and true joy. A drug that restores deep restful sleep and effective, nonsedating relief of innapropriate anxiety. A drug that restores interest in everday activities without clouding the intellect. A drug that restores proper immune and endocrine function and effectively combats many of the dozens of the depression comorbid health conditions (diabetes, heart disease etc).
>
> Such a drug would likely save billions related health costs and money due to lost productivity.
>
> Perhaps such a drug or treatment is a fanacy, but it is a goal. The laser eye surgery of psychiatry.
>
> I honestly just feel that people still see depression as a ficticious disease.
>
> Linkadge
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Posted by bulldog2 on January 31, 2010, at 18:32:21
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on January 31, 2010, at 17:29:32
> Also, a high number of patients with depression recieve augmentation with atypical antipsychotics.
>
> There is good reason to believe that cleaner augmentation with selective 5-ht2a blockers like eplivanserin would reduce complications associated with long term atypical antipsychotic exposure.
>
> Then all of a sudden, boom, eplivanserin is not approvable. Why? Even if it just tested effective as a substitute to atypical augmentation, this would be an ethical advantage.
>
> But no, without good reason we need to continue consuming the diabetogenic drugs, potentially indefinately.
>
> Linkadge
>I would like to see ads developed that work on se,ne and dopamine. I would like to see more maois developed. What is the ratio of neurotransmitters to each other in the brains of undepressed or normal people. If we're going to develope drugs based on the neurotransmitter theory than develope drugs that restore the proper balance of all the neurotransmitters. The current ssris drive down dopamine and lower sex hormones. That is not what an ad should be doing. Develope drugs to augment ssris so dopamine is restored and sex drive left intact.
As far as natural substances go they cannot be patented so Pharm companies have no interest in them. I guess they would have to extract the alkaloids and patent some drug that has a powerful extract.
These companies will suppress any drug that's better than their drug in the name of profits. That's why some of the dopamine enhancing ad drugs have been banned.
There are some good herbal places on the internet that have some really good herbs. You just have to look around.
Posted by Sigismund on January 31, 2010, at 19:44:28
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on January 31, 2010, at 15:35:17
Don't hold your breath waiting for that.
(Some people believe in progress. Good for them.)
>There are dozens of phytochemicals which could be used as templates for synthetic drugs. For instance, resveratrol, quercetin, hyperforin and turmeric have various cellular, immunilogical and neurotransmitter targets that could be more intesivly investigated.
Posted by Sigismund on January 31, 2010, at 19:48:56
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 16:36:07
Maybe it has something to do with this society which this society is ill-equipped to deal with.
Good meds? Oh yes. Maybe. I doubt it. So does my shrink. When I said I was going to Vietnam and that I could check out Taltierin he said "Or maybe buy something useful like opium". At least that worked. Indigenous people had much better drugs.
>Science/medicine needs to know the root causes before we find really good meds that work in sync with the body. I don't think we've progressed beyong doctors who in the early 1900's used opiates and cocaine preperations for their patients. They work immediately for many however problems of tolerance and addiction have put them out of favor.
Posted by Sigismund on January 31, 2010, at 19:53:32
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 18:32:21
OK, in fairness, agomelatine stands out among the dreadful crowd of psych drugs by being relatively humane (if a fraction ineffectual) and at least addressing sleep and drive by an interesting mechanism.
It's no accident that psych drugs are so dysphoric.
>If we're going to develope drugs based on the neurotransmitter theory than develope drugs that restore the proper balance of all the neurotransmitters. The current ssris drive down dopamine and lower sex hormones. That is not what an ad should be doing. Develope drugs to augment ssris so dopamine is restored and sex drive left intact.
Posted by Sigismund on January 31, 2010, at 19:55:50
In reply to Re: Is Suicide Ever A Viable Option?, posted by emmanuel98 on January 31, 2010, at 18:21:40
Anything can be and is abused these days. Stuff like petrol, for heavens sake. The modern world. Unlikely to get any better in this respect.
>The problem with psychoactive drugs has always been finding drugs that work but can't be abused.
Posted by Phillipa on January 31, 2010, at 20:02:16
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 16:36:07
Skipping over some posts will go back to they do know that thyroid disease does cause depression even when treated and also hormones out of wack. Phillipa
Posted by meltingpot on February 1, 2010, at 5:21:12
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on January 31, 2010, at 17:29:32
Linkadge,
I couldn't agree more with everything you have said. The only thing is the drug that did all those things you mentioned as below is the drug that I had at the age of 24 which was Prothiaden and then later on at the age of 27 (which was 20mg of Seroxat). Those drugs did for me then exactly as you describe below. For some reason they just don't work like that for me anymore. So the SSRIs and tricyclics do have the potential to completely eradicate depression they just don't seem to be as effective (for everyone) later on for some reason.
I'm still following the DBS trials closely, I've pretty much given up on drugs being the whole answer for me and I'm pinning my hopes on surgery such as this.
> Imagine a drug that completely and rapidly relieves depression - in a way where the patient can still experience deep emotion and true joy. A drug that restores deep restful sleep and effective, nonsedating relief of innapropriate anxiety. A drug that restores interest in everday activities without clouding the intellect. A drug that restores proper immune and endocrine function and effectively combats many of the dozens of the depression comorbid health conditions (diabetes, heart disease etc).
Denise
Posted by linkadge on February 1, 2010, at 6:56:26
In reply to Re: Is Suicide Ever A Viable Option?, posted by emmanuel98 on January 31, 2010, at 18:21:40
>The problem with psychoactive drugs has always >been finding drugs that work but can't be abused.
I disagree. I think anything 'can' be abused. There are reports of seroquel abuse, amitriptyline abuse, parnate abuse, venlafaxine or fluoxetine abuse, even general SSRI abuse.
The question is not whether it *can* be abused, but will this patient abuse this drug? If the patient abuses the drug, how out of control will it get? Is the theraptutic effect more beneficial than the detrimental effects?
For instance, if ECT is given for a "temporary" remission, why can't an opiate be given?
Linkadge
Posted by linkadge on February 1, 2010, at 6:59:11
In reply to Re: Is Suicide Ever A Viable Option?, posted by emmanuel98 on January 31, 2010, at 18:21:40
>A lot of people would love a drug that made them >feel good and not just people with TRD.
But my question is *why the double standard*? Why is it acceptable to use highly abusable drugs for *childhood* ADHD (which generally does not have a suicide risk) but not to use abusable drugs for adult depression *which does have a suicide risk*?
Its just f'd up.
Linkadge
Posted by Maxime on February 1, 2010, at 7:26:55
In reply to Is Suicide Ever A Viable Option?, posted by bulldog2 on January 31, 2010, at 9:34:15
It is always a viable option in my books, even for people with mental illness. A lot of suffering goes on with mental illness. You can't see it the way you can see something like terminal cancer, but it's there and it can kill.
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