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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on February 27, 2006, at 21:39:38
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by yxibow on February 27, 2006, at 19:08:31
"A placebo will work as well as medication 1/3 of the time."
I'd like to believe that 2/3's of SSRI trials show that they're superior to placebo. I remember reading something that prozac fared better than placebo in closer to 1 in 10 clinical trials. But the truth, we will never know, because isn't it law that drug companies can keep this information private ?
Linkadge
Posted by linkadge on February 27, 2006, at 21:45:30
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Jakeman on February 27, 2006, at 20:39:33
Thats another issue. I could get max maybe 4 months of "effect" on an SSRI. Then nothing. Then withdawl, which I define as an expanse of time during which you feel equally as much worse from baseline as you did better on the drug.
Hey, but at least I'm not bitter... :)
Linkadge
Posted by 10derHeart on February 27, 2006, at 21:51:57
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
Prozac worked really well for me for MDD for two years.
I have also been on Strattera for over two years with minimal to no side effects, and it does control many of my ADD symptoms better than anything else I tried (or that my CV system could tolerate)
I may well be an exception, unfortunately. I feel blessed that these meds worked quickly and well. I disagree with the resident saying they are 'all hype.' Actual changes in the brain have been observed and measured, that's not made up. And some people have been helped.
Hang in there, Phillipa
Posted by linkadge on February 27, 2006, at 21:57:39
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by 10derHeart on February 27, 2006, at 21:51:57
But thats the thing. Placebo's can and do produce strong and real changes in brain activity too. Cognitive behavioral therapy also can change brain chemistry.
Some authors speculate that the side effects of a medication cue the user to know the drug has set in, and then their imagination and hope does the rest.
I don't know if I'd go that far, but I would say that for many people, they're not all they're cracked up to be.
Linkadge
Posted by erik98225 on February 27, 2006, at 23:04:54
In reply to The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Phillipa on February 27, 2006, at 13:12:49
They certainly do work. I can't live without Lexapro.
Posted by TylerJ on February 28, 2006, at 0:28:10
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » TylerJ, posted by Phillipa on February 27, 2006, at 20:01:44
> Tyler so far just tired. No I don't feel good yet. Hoping to though. Love Jan
You will, just stick with it..Luvox is a very safe drug and it is a very effective antidepressant! There's always going to be idiots that are gunna say this or that.I think that was really irresponsible for that guy to tell you they don't work-he's full of you know what. we have to be careful of who we listen too.. i trust my pdoc,he'll actually tell me if he thinks a drug doesn't work very well. And guess what, he really likes Luvox! :)
Love, Ty
Posted by linkadge on February 28, 2006, at 8:53:20
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 28, 2006, at 0:28:10
To say that they don't work at all may be closed minded on my part. But I wouldn't call somebody an idiot just based on the fact that they dissagree with the efficacy suggested by the drug companies.
A drug would need to keep me away from major depression for at least 6 months before I'd say it had any effect.
Some of the initial effects of a drug may be due to its actions on sleep. We know, for instance that interupting REM sleep in depressed patients has a very acute antidepressant effect. Most antidepressants initally significantly reduce REM sleep. Some of the "most effective" enatidepressants reduce REM sleep the most, ie the MAOI's.
But the body fights back hard. After a few months the body regains its REM sleep. You see drugs poop out a lot around the same time REM rebound occurs.
So I guess what I am saying is that, wait 6 months, and if you are still as enthused about a particular drug, then maybe it is doing something.
And who knows what it is your REM sleep is trying to do. Sure REM sleep is depressing, but maybe it is working on a much more solid an concrete solutions to your problems.
Linkadge
Posted by vainamoinen on February 28, 2006, at 12:41:19
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Phillipa, posted by TylerJ on February 28, 2006, at 0:28:10
Alone they don't do sheeeit for me. They work great for a week or two then poop out. I've tried many alone or in combination.
Let me see here...imipramine, desipramine, doxepin, prozac, zoloft, paxil, effexor, remeron, wellbutrin, nefazadone, reboxetine, selegiline. All to no avail.
But when taken with Seroquel like I do now, straight up rocket fuel. Prozac+Seroquel = :)
Posted by FredPotter on February 28, 2006, at 13:50:15
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by vainamoinen on February 28, 2006, at 12:41:19
Hegelian logic was cited by a previous poster to explain the prescribing of benzos. In their case the stages were (in the States):
(i) THE answer – prescribe for everyone with the mildest worry right through to patients with panic disorder (ironically Xanax seems to work best on extreme symptoms);
(ii) Demonize and try to ban them;
(iii)Use benzos carefully for some clearly defined disordersThe position with SSRIs and SNRIs is at an earlier stage of this process. (i) was and is taking place with a hint that (ii) is beginning to happen. Some drug trials have used a positive placebo (one with side-effects so the patient suspects if s/he's getting the real drug). I gather the SSRIs at least have an even poorer success rate under these conditions.
On the other hand, some further things need to be said. If there is such an illness as clinical depression (and some dispute that there is), a patient's prognosis might be muddied by people presenting with common-or-garden misery or grief, for which SSRIs were not designed and probably not very effective.
A final point is: most depressed people have "atypical" depression, for which SSRIs are not a good choice, MAOIs possibly being a better solution.
Despite the positive placebo remark above, it's possible there would be a more robust AD response tom SSRIs and SNRIs if they were prescribed for the right patients, hence setting stage (iii) in motion.
Any comments?
Fred
Posted by linkadge on February 28, 2006, at 14:47:32
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by FredPotter on February 28, 2006, at 13:50:15
I agree with you. The big thing with the SSRI's was that they were/are thought to be safe, or at least safer than the TCA's. Because of their presumed safety they've been dispersed like dandilion spores.
Many authors site the fact that TCA's were as effective if not more effective than the SSRI's. SSRI's were also popular because they fit hand in glove with the theory that depression was a disease related to low serotonin.
Theres no doubt in my mind that SSRI's did some weird and wonderfull things. But to call that an "antidepressant effect", I don't know.
Linkadge
Posted by TylerJ on February 28, 2006, at 15:04:58
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by linkadge on February 28, 2006, at 8:53:20
> To say that they don't work at all may be closed minded on my part. But I wouldn't call somebody an idiot just based on the fact that they dissagree with the efficacy suggested by the drug companies.
>
> A drug would need to keep me away from major depression for at least 6 months before I'd say it had any effect.
>
> Some of the initial effects of a drug may be due to its actions on sleep. We know, for instance that interupting REM sleep in depressed patients has a very acute antidepressant effect. Most antidepressants initally significantly reduce REM sleep. Some of the "most effective" enatidepressants reduce REM sleep the most, ie the MAOI's.
>
> But the body fights back hard. After a few months the body regains its REM sleep. You see drugs poop out a lot around the same time REM rebound occurs.
>
> So I guess what I am saying is that, wait 6 months, and if you are still as enthused about a particular drug, then maybe it is doing something.
>
> And who knows what it is your REM sleep is trying to do. Sure REM sleep is depressing, but maybe it is working on a much more solid an concrete solutions to your problems.
>
>
> Linkadge
>
>
>
>
Your entitled to your opinion just as I am. What I am trying to do is encourage Phillipa-she's vulnerable right now, and she certainly doesn't need someone to tell her the med she is on doesn't work. That's that persons opinion, but being a resident i personally think he shouldn't be telling someone who is suffering terribly as she is that the med she's on doesn't work...she doesnt need to hear that from anyone. On top of that Luvox DOES help SOME people-it helped me for about a year. You're right i shouldn't have called the guy an idiot...but again, when i come here my goal is to try to encourage and give people hope, we all need that, living w/ such a terrible ruthless desease!TylerJ
P.S. I am currently experiencing REM sleep and I still feel great. And you know what, if ANY drug helps me for even one freakin' week it's worth it to me cause I have been living in a pit for too damn long. (My opinion and how I feel...you know what they say about opinions :)
Posted by TylerJ on February 28, 2006, at 15:20:56
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 14:47:32
> I agree with you. The big thing with the SSRI's was that they were/are thought to be safe, or at least safer than the TCA's. Because of their presumed safety they've been dispersed like dandilion spores.
>
> Many authors site the fact that TCA's were as effective if not more effective than the SSRI's. SSRI's were also popular because they fit hand in glove with the theory that depression was a disease related to low serotonin.
>
> Theres no doubt in my mind that SSRI's did some weird and wonderfull things. But to call that an "antidepressant effect", I don't know.
>
>
> Linkadge
>
>
> TCA's are considered by most pdocs to be superior to ssri's and snri's your absolutely right. But as you know they are "dirty drugs" lot's of side-effects and of course can be deadly when taking an over-dose. I think this is the main reason (the over dose issue) that most docs shy away from them-plus ssri's and snri's are much cleaner drugs..i guess. I also agree that too many docs hand them out like candy. Tofranil saved my life 25 yrs ago-my first severe episode of depression, i was really bad off, only got out of bed for nearly 3 mos. to use the bathroom and shower and was hospitalized for a week for extensive tests-Diagnosis: Major depression w/ panic attacks, GAD, and OCD- disturbing thoughts no rituals. I also took ativan which helped me greatly. I was on Tof. for 5 yrs. and it worked pretty darn good. Nothing however has made me feel as well as Parnate. Take care.Tyler
>
Posted by linkadge on February 28, 2006, at 16:25:35
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » linkadge, posted by TylerJ on February 28, 2006, at 15:04:58
Thats where I disagree. I think that if a class of drugs has a particularly low sucess rate then the patient should know about it.
I would not tell somebody that the drug they're on is miraculous if I didn't think it were true. That can set somebody up for disaster.
P.S. How do you know you are experiencing REM sleep ?Linkadge
Posted by linkadge on February 28, 2006, at 16:35:29
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by TylerJ on February 28, 2006, at 15:20:56
I wish you the best success in your recovery.
I just see a pattern on this board and that is a tendancy to give the drugs merit that is not due to them, which can sometimes have negative consequences down the road.
I think it is wrong for a doctor to tell you that this drug will cure you, if it may do nothing at all. Because if doctors were honest about the drugs they dealt, then people would be forced to start to develop more diverse coping stradegies instead of putting their hopes in one single cure.So if somebody doesn't think a drug is doing anything, I'd say trust your intuition, ditch the drug, and try something else.
Linkadge
Posted by linkadge on February 28, 2006, at 16:38:48
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:35:29
When I took Remeron it made me very angry. I know now that is a possable side effect. At the time, my doctor told me that could not be true so I took the drug much longer than needed, and I lost a lot of friends because of my temper.
So, I think it is necessary to tell people the bare truth about a drug nomatter if you think that lying is what is best for them, becuse the truth is the only thing that can help long term.
Linkadge
Posted by Glydin on February 28, 2006, at 16:44:32
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:35:29
> I just see a pattern on this board and that is a tendancy to give the drugs merit that is not due to them, which can sometimes have negative consequences down the road.Really?
I tend to see the opposite.
Posted by TylerJ on February 28, 2006, at 17:18:09
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by linkadge on February 28, 2006, at 16:25:35
> Thats where I disagree. I think that if a class of drugs has a particularly low sucess rate then the patient should know about it.
>
> I would not tell somebody that the drug they're on is miraculous if I didn't think it were true. That can set somebody up for disaster.
>
>
> P.S. How do you know you are experiencing REM sleep ?
>
> Linkadge
>
> Well, It does work very well for some people, and it's very effective against OCD as well. And it did help me for a year so I believe in it from my own personal experience. It's also effective against panic disorder, and depression. Luvox
is in fact, is pretty much the same as
other ssri's Prozac, Zoloft,and Paxil-all excellent ssri's. For a partial responder adding Lithium or thyroid may help. Takes 4-6 wks for a a full response.As far as the REM sleep goes-my wife watches me when i sleep and can see my eyes moving back and forth very rapidly-just kidding:) Seriously, it is during REM sleep that dreaming occurs, and I am definitely dreaming. Adults spend about 25% of the night in REM phase. I have also had some nightmares and and they always occur during REM phase. I know you'll probably disagree, but I know I'm experiencing REM-and have done some study on sleep..and well i know what i believe to be true.
Tyler
Posted by TylerJ on February 28, 2006, at 17:26:56
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:35:29
> I wish you the best success in your recovery.
>
> I just see a pattern on this board and that is a tendancy to give the drugs merit that is not due to them, which can sometimes have negative consequences down the road.
>
>
> I think it is wrong for a doctor to tell you that this drug will cure you, if it may do nothing at all. Because if doctors were honest about the drugs they dealt, then people would be forced to start to develop more diverse coping stradegies instead of putting their hopes in one single cure.
>
> So if somebody doesn't think a drug is doing anything, I'd say trust your intuition, ditch the drug, and try something else.
>
> Linkadge
>
>
> Definitely, after a good trial usually 6 wks. I'm with you, stop wasting time w/ a drug that's not going to work for you, and try something else.Tyler
Posted by TylerJ on February 28, 2006, at 17:35:42
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:38:48
> When I took Remeron it made me very angry. I know now that is a possable side effect. At the time, my doctor told me that could not be true so I took the drug much longer than needed, and I lost a lot of friends because of my temper.
>
> So, I think it is necessary to tell people the bare truth about a drug nomatter if you think that lying is what is best for them, becuse the truth is the only thing that can help long term.
>
> Linkadge
>Yea, but just because a drug doesn't work well for YOU doesn't mean it won't work very well for someone else. i.e., Remeron was the best AD I had ever taken besides Parnate. It was very effective for 5 years. But just because it worked for me does not mean it will work for everyone...and just because it didn't work for you, etc, etc.
Tyler
Posted by tizza on February 28, 2006, at 18:45:53
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » Jakeman, posted by linkadge on February 27, 2006, at 21:45:30
> Thats another issue. I could get max maybe 4 months of "effect" on an SSRI. Then nothing. Then withdawl, which I define as an expanse of time during which you feel equally as much worse from baseline as you did better on the drug.
>
> Hey, but at least I'm not bitter... :)
>
>
> LinkadgeHey link maybe you and I should get together and go bowling. That is exactly how I reacted to SSRI and effexor but I must concede that Luvox helped me the best and the longest, maybe around 10 to 12 months. None of the others helped any longer than 4 months at the most. Paul
Posted by jflange on February 28, 2006, at 21:00:08
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone?, posted by Jakeman on February 27, 2006, at 20:39:33
Three years on Zoloft and three years without the dreaded panic disorder. I think that's a success.
It's not a magic bullet, though. Like many, I have to do combo therapy with other meds.
It's still an imperfect science, alas!
jflange
Posted by cecilia on February 28, 2006, at 21:14:29
In reply to Yes, posted by jflange on February 28, 2006, at 21:00:08
They obviously work for some people, though none has ever worked for me. There's definitely a huge placebo effect, though it probably doesn't last beyond the 6 weeks of the trial for most people. (Of course in real life the placebo effect is even stronger because the person knows they're getting the real thing.) I definitely think only the person taking them , not a doctor or a friend can judge whether they're working. Plenty of people are miserable on the inside while appearing functional on the outside. Cecilia
Posted by FredPotter on February 28, 2006, at 21:26:31
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 28, 2006, at 16:38:48
When I first took Prozac years ago I complained to my Dr that I couldn't achieve orgasm. He said, "Sexual side-effects? That's a new one!"
Has anyone had this experience when they tell a Dr or psych what AD they're on? They give an avuncular chuckle and say, "You'll do just fine on Dothiepin" - or whatever the drug is. A psych on the opposite side of the world also said it to me regarding Nortryptilene. Perhaps it's only tricyclics which elicit this response
Posted by FredPotter on February 28, 2006, at 21:31:59
In reply to Re: Yes, posted by cecilia on February 28, 2006, at 21:14:29
> They obviously work for some people, though none has ever worked for me. There's definitely a huge placebo effect, though it probably doesn't last beyond the 6 weeks of the trial for most people. (Of course in real life the placebo effect is even stronger because the person knows they're getting the real thing.) I definitely think only the person taking them , not a doctor or a friend can judge whether they're working. Plenty of people are miserable on the inside while appearing functional on the outside. Cecilia
Thanks Cecilia this is a very good post. Good point about the placebo effect in real life. Also it is fairly well established that placebo effects fade with time. Is this what poop-out is?
Posted by Phillipa on February 28, 2006, at 21:43:37
In reply to Re: Yes, posted by cecilia on February 28, 2006, at 21:14:29
Cecelia how true. Thanks Phillipa
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