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Dr. Bob is Robert Hsiung, MD,
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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).
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> Such a drug would likely save billions related health costs and money due to lost productivity.
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> Perhaps such a drug or treatment is a fanacy, but it is a goal. The laser eye surgery of psychiatry.
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> I honestly just feel that people still see depression as a ficticious disease.
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> 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.
Posted by Phillipa on February 1, 2010, at 18:41:54
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on February 1, 2010, at 6:56:26
Link opiods work. Neighbor graduated from fentnyl patch to I think Dilaudid one and has vicodin for break through pain and she feels good. They work. Phillipa
Posted by Sigismund on February 2, 2010, at 2:25:05
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on February 1, 2010, at 6:56:26
>There are reports of seroquel abuse, amitriptyline abuse, parnate abuse, venlafaxine or fluoxetine abuse, even general SSRI abuse.
Oh yeah, it is said, I suppose truthfully, that Zyprexa and Seroquel are sold on the streets.
When people started sniffing petrol they introduced a different kind of petrol called Opal without the high.
This kind of pattern can go on forever.
And before 1968 unit doses of heroin were sold OTC as were morphine based cough mixtures and Benzedrine inhalers.
Not that I'm recommending it or not. It's just interesting.
Posted by Sigismund on February 2, 2010, at 2:29:35
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on February 1, 2010, at 6:59:11
>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*?
Because children will not be able to use them recreationally?
The main issue here, the very worst thing, is the recreational use of drugs.
That's why the situation is hopeless. As soon as a psych drug is benign and helpful it will become a drug of abuse.
That is the problem. Why wasn't it a problem in 1950?
Posted by linkadge on February 2, 2010, at 10:36:58
In reply to Re: Is Suicide Ever A Viable Option?, posted by Sigismund on February 2, 2010, at 2:29:35
>Because children will not be able to use them >recreationally?
I assume you're kidding.
>The main issue here, the very worst thing, is >the recreational use of drugs.
Even abusable drugs can be made less abusable. For instance, amphetamine -> vyvanse. Why can't something similar be done with amineptine?
Linkadge
Posted by Sigismund on February 2, 2010, at 14:48:48
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on February 2, 2010, at 10:36:58
>I assume you're kidding.
I'm just trying to understand the group mind or whatever it is that determines policies about drugs.
Otherwise what's the answer to your very good question, which I shall have to look at again.
A bioethicist was on the radio saying that if Ritalin is safe enough to give to kids it is safe enough to be used routinely by anyone.
My guess is that it's given to kids because it is assumed that they are too young to have figured out how to use it recreationally.
Then there's the issue of school and upbringing generally which we don't want to have to interfere with.
>Why can't something similar be done with amineptine?
Yes, why not? Was it some kind of unwelcome challenge to the serotonin depression connection?
Posted by linkadge on February 2, 2010, at 15:54:47
In reply to Re: Is Suicide Ever A Viable Option?, posted by Sigismund on February 2, 2010, at 14:48:48
It really depends on the school and the individual. I've heard of 5th graders cheeking ritalin and storing them up, then taking many at once. By highschool, I'd say many students know that ritalin has abuse potential.
There have been many problems of students selling (younger to older) in schools.
Its also not uncommon for kids in highschool to have tried a friends stimulant prescription and then faking ADHD symptoms to get some.
Furthermore, the situation is more complicated in university/college.
Linkadge
Posted by Sigismund on February 2, 2010, at 16:56:02
In reply to Re: Is Suicide Ever A Viable Option?, posted by linkadge on February 2, 2010, at 15:54:47
>then faking ADHD symptoms to get some.
That's the only way to get it here.
And half the doctors who give the diagnosis have doubts about it and think that if the Ritalin/Dexedrine really helps they'll do the diagnostic thing.
Half the class of one school here had to carted off by ambulance, some frothing at the mouth. They took about 10 each.
Posted by inanimate peanut on February 2, 2010, at 22:51:19
In reply to Re: Is Suicide Ever A Viable Option?, posted by Sigismund on February 2, 2010, at 16:56:02
Does your answer on whether suicide is a viable option thus depend on whether new drugs will become available to treat it? Is there a time limit on suffering? After all, there's always the promise of new drugs (look at Pristiq and Saphris) even if they suck. I don't think we can expect people to hang on with the vague promise of "someday a drug might come along" I think if you're in pain NOW and you've been in extensive pain for a long time and have tried everything available NOW, you have the right to kill yourself (and indeed should be helped to do so in a humane way). Otherwise, it will never end.
Posted by bulldog2 on February 3, 2010, at 15:21:42
In reply to Re: Is Suicide Ever A Viable Option?, posted by inanimate peanut on February 2, 2010, at 22:51:19
> Does your answer on whether suicide is a viable option thus depend on whether new drugs will become available to treat it? Is there a time limit on suffering? After all, there's always the promise of new drugs (look at Pristiq and Saphris) even if they suck. I don't think we can expect people to hang on with the vague promise of "someday a drug might come along" I think if you're in pain NOW and you've been in extensive pain for a long time and have tried everything available NOW, you have the right to kill yourself (and indeed should be helped to do so in a humane way). Otherwise, it will never end.
The goal of the pharm companies is to create drugs that make you functional enough to keep the capitalistic machine running. You will achieve your happiness through your work and family. They don't want you to happy from your meds. You may just vegge out and listen to music and not be productive. It's the entire anti pleasure ethic. Basically we're still a puritan society that measures your success and therefore your right to happiness in the amount of goods you produce and consume. So forget good drugs. If you want happy drugs you will have to get them on the street.
The entire drug war is a failure. The prisons are filled with drug users and sellers. Before the great drug war when opiates were legal there were many drug addicts. Probably medicating depression with their opiates. But they went about their business and no one knew who they were. Yes they were addicted but they did not have to steal to pay inflated prices for illegal drugs. Much of what we call the ravages of drug addiction are due to the criminal life style. The drugs before drug prohibition were cheap and readily available. And the entire usa was not addicted. It was a certain subset of people of responded to them. The irony is the were probably much better than what is being offered today.
Posted by inanimate peanut on February 3, 2010, at 15:33:30
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on February 3, 2010, at 15:21:42
One interesting reason I think pharma companies are not trying hard to get new drugs in the USA is because they're focusing on the overseas market. There's a new book out called Crazy Like Us about how the US Drug Companies are just shipping the same old drugs to new markets and making tons of money. Why manufacture new drugs when you can just ship the old ones to Japan and even Argentina?
Posted by bulldog2 on February 3, 2010, at 15:35:05
In reply to Re: Is Suicide Ever A Viable Option?, posted by bulldog2 on February 3, 2010, at 15:21:42
My prior post really was a stand alone and not response to inanimate peanut. Just my opinion why we don't see better drugs.
Posted by Sigismund on February 3, 2010, at 15:41:04
In reply to Re: Is Suicide Ever A Viable Option?, posted by inanimate peanut on February 3, 2010, at 15:33:30
I wish they'd ship their WWII surplus to me.
They could even declare war on me if I refused to buy their opium.
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