![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 48 to 72 of 297. Go back in thread:
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
Posted by Phillipa on February 28, 2006, at 21:45:09
In reply to Re: Yes, posted by FredPotter on February 28, 2006, at 21:31:59
Fred now that's a really good question. Anyone to comment on that? Thanks Phillipa
Posted by Chairman_MAO on February 28, 2006, at 21:49:06
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
The only FDA-approved antidepressants that deserve that designation are the irreversible MAOIs.
There are other drugs that do this as well, but most people consider them "drugs of abuse".
In Goodman & Gilman's "Pharmacological Basis of Therapeutics", they state outright that the response rate of most antidepressants differs from placebo by the barest of margins. What this doctor said to you is reality.
Posted by Comet on February 28, 2006, at 21:52:07
In reply to Re: Yes, posted by cecilia on February 28, 2006, at 21:14:29
"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"
I respectfully disagree with this. It is often the close people who know a person intimately who first notice improvement, whether it is from therapy or drugs whatever has happened to cause the improvement. I noticed before my ex how much better she was able to cope with the world and how much more stable she had become. When I remarked on it, she was surprised herself, but had to agree.
Posted by Phillipa on February 28, 2006, at 21:57:58
In reply to Re: Yes, posted by Comet on February 28, 2006, at 21:52:07
boy this is getting interesting. Love Phillipa
Posted by stargazer on February 28, 2006, at 22:44:32
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
Most of the SSRI's I have taken made me apathetic and emotionally dull, but in some cases that was preferable to feeling too much, as depression can do.
Looking back over the years of treatment with many AD's, all classifications, few with the exception of the MAO's had any clear and sustained effects for me.
Right now, I'm back off of all of the latest combination I was on: Wellbutrin 150, Adderall 20, Celexa 20 and Lamictal 100. In preparation of trying Marplan again, I had to come off everything, except Lamictal. I stopped all of the meds, including Lamictal, since it didn't seem to be doing anything in combination with the others. I did have some withdrawl symptoms, i.e. feeling foggy, unfocused, irritable, so I started taking Lamictal 100 mg alone. It seems to be doing something positive, unclear of the benefit, yet willing to wait before trying Marplan again.
Back in a holding pattern...where so many of us live our lives...waiting for the right one.
Posted by yxibow on March 1, 2006, at 1:44:03
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Phillipa, posted by Chairman_MAO on February 28, 2006, at 21:49:06
> The only FDA-approved antidepressants that deserve that designation are the irreversible MAOIs.
>
> There are other drugs that do this as well, but most people consider them "drugs of abuse".
>
> In Goodman & Gilman's "Pharmacological Basis of Therapeutics", they state outright that the response rate of most antidepressants differs from placebo by the barest of margins. What this doctor said to you is reality.
>
Just because I am assuming you get benefit from MAOIs I gather -- the last resort of antidepressants, which have dangerous issues with diet, does not mean that the millions of people by now who have taken SSRIs have not gotten at least some relief from them.By drugs of abuse, It would assume you're referring to the 19th century idea of using opiates to cure depression, which would verge on the edge of a practitioner losing their DEA license (yes, I know about the Oxycodone experiment on this board and I wish the individual well).
Antidepressants are tested in Phase trials that compare them to other antidepressants and p values . If their p value doesn't come within a statistical range, the Phase trials are usually halted.
I dont mean to insult you, but the statement seems to come out of left field. Not every antidepressant is right for every person. But I know of many people who have been helped by SSRIs.
We can all go back and forth bantering on this issue, but it does a disservice I think to those who are currently being helped by SSRIs on this board. I'm sure this won't be the last posting.
And I do agree with one of the earlier posts -- some people benefit greatly with minor augmentation of SSRIs with mild atypical antipsychotics.
Tidings and no bad feelings meant
Jay
Posted by nicky847 on March 1, 2006, at 10:14:44
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Chairman_MAO, posted by yxibow on March 1, 2006, at 1:44:03
From my experience...they help..but they're not a magic pill...for the first 2 months they probably make you feel worse than you did before...but if you stick it out you do begin to feel much better..
SSRIs work best as part of a total wellness program in my opinion...that means not only taking the med..but changing the way you think and above all else taking care of your body as best you can...i am consistently surprised how neglect of the body (thru too much stress, not enough rest) leads to depression, while caring for the body (resting, good diet, exercise, simplifying your life) leads to recovery
Posted by Chairman_MAO on March 1, 2006, at 10:32:38
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » Chairman_MAO, posted by yxibow on March 1, 2006, at 1:44:03
Why not do a search on medline for opioids in depression, especially buprenorphine? There are plenty of studies documenting the efficacy of psychostimulants for depression, especially in the most debilitating cases (post-stroke, HIV, etc).
Why would it be malpractice to treat depression with an opioid? They are not teratologic in any way. Can you say that about all of these new drugs? I, for one, would rather be on morphine+d-amphetamine than Prozac+Zyprexa! There are many others here who would agree with me that SSRI withdrawal can be a more protracted misery than heroin withdrawal.
My statements only sound like they're coming out of left field if one is way too far to the [religious] right. Pharamcological Calvinism has no place in an enlightened society. What on earth does a doctor's DEA license have to do with which drug is the best therapy for a condition?
If you think that many--if not most--studies documenting SSRI efficacy (especially for anxiety disorders) are more sophistry than sophisticated, you need to read a little more. How can one do a study on an anxiolytic that takes 6+ weeks to work when most anxiety dissipates on its own within 6 weeks? SSRIs _INCREASE_ anxiety while attenuating the patient's concern about the anxiety.
Again, I can cite pages and pages of studies concerning the use of opioids, etc. in various mental illnesses. Did you know you can treat schizophrenia and acute psychosis with extremely high doses of clonazepam and the cholinergic galantamine...with virtually no untoward side effects (including sedation/cognitive impairment)?
Most opioids (meperidine and some others excluded) are antimanic, antipanic, antipsychotic, and antidepressant with no physical toxicity.The next time you're talking to the ghost of your dead best friend as it is threatening to possess you and use your body to kill your family unless you kill yourself, and you have a choice between relief from morphine or haloperidol (with the morphine working better), make sure to tell the physician to force the haloperidol on you. There's a bottle of benzotropine with your name on it, don't worry!
Posted by andromeda on March 1, 2006, at 10:37:16
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
> Was talking to a Medical Resident. He said the SSRI's and SNRI's are all hype. They may work for a few but not for the majority. Please some good experiences I'm fed up. Thanks Phillipa/ Jan
Hi Phillipa/Jan,
Interesting comments so far. My thoughts are that you just have to trust yourself at some point. I have been doing meds for 14 years with little or no success. I am only on 25 mg of Lamictal now. I have gone in many times to my pdoc and said I wanted to stop taking meds. Pdoc's always gave me hope to try something else or tweak the dose or add this. Something else never helped. I would have hope. Hope will only go so far and than reality sets in.
I will be going off the Lamictal completely because this time I am listening to "me".
Before when I would stop meds I would do so quickly. This time I am slowly decreasing meds. I do feel worse after each drop of 25 mg of Lamictal weekly ...for awhile anyway until I adjust. Addiction??? Pdoc's were never willing to help me go off meds. They seem to want to play it safe and I really can't blame them for doing that. I wanted to play it safe, too many scary stories of what might happen if went off meds.
I have to find out what is best for me and that is all I can do. Don't listen to everyone else listen to yourself. This is hard to do bc sometimes it is hard to figure out which is your inner knowing and experiences or someone else's experiences and inner knowing. Information can be good and helpful but it also cannot apply to your situation and confuse the situation even more.
MY family and friends know what I am doing and can help me judge my reactions to going off meds.
So far I am feeling a little better some days or about the same other days. Time will tell and I always have the option to choose which works best for me and rather or not to continue searching through the maze of med combos.
Not only do I question the drugs but I also question my diagnosis and my therapy experiences. When my dx has the word atypical in front of it that pretty much ia a clue for me that they don't know. I do think the mental health field can harm as well as help, as happens in any field.
You need to be the judge. From reading your posts you sound very capable to know what works and does not work for you and what you need to do, whatever that may be at this point in time.
Peace and blessings.
Andromeda
Posted by Chairman_MAO on March 1, 2006, at 10:40:01
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » yxibow, posted by Chairman_MAO on March 1, 2006, at 10:32:38
Aristotle held that physical and psychological pain are one and the same. The hard scientific evidence seems to corroborate this. So why are some drugs only OK to use for physical pain and others for emotional pain? Why does the supposed etiology matter if the end result is pain?
NOTE: I do agree that using drugs to kill pain can be destructive. What I'm uncertain about is how this justifies the prohibition of what is often the most effective medications. If SSRIs work for you, I say go ahead and use one if you like it. I haven't met too many people who like being sexually anesthetiszed, though.
Posted by Chairman_MAO on March 1, 2006, at 10:46:00
In reply to Phillipa, posted by andromeda on March 1, 2006, at 10:37:16
Family and friends--even if they have the best intentions--often resist any change in a dynamic, positive or negative. Just keep that in mind.
Designating you as "ill" serves many purposes, and many may not have to do with you at all. Read "The Politics of the Family" by R.D. Laing.
Posted by deniseuk on March 1, 2006, at 11:38:07
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
Hi Phillipa,
I've probably said this before but the first time I ever took an antidepressant was at 24 and I was very anti drugs at the time.
The next day I felt like I had literally stepped into another dimension, colours brighter, smells intensified, I felt relaxed and yet motivated instead of tense and tired. I could not believe it! I honestly felt like pinching myself and I prayed that I would die before the drug ever stopped working.
Five years later and the prothiaden seemed to stop working as well, switched to Seroxat 20mg and felt great after three days, I remember feeling so alive, energetic etc.
about 4 or 5 years later came off Seroxat, was drug free and fine for about 3 years and then the depression came back again, like an old friend and i've still not managed to completely beat it after trying numerous drugs. The only drug that really helps me now is Zyprexa (an antipsychotic.
I only ever knew I was depressed because an antidepressent took away all the symmptoms that were bothering me. Strangely if I'd never taken them and my recent experience of ADs was my only experience of ADs then I'd swear blind they didn't and can't work. So It would now be an antipsychotic that works but that doesn't mean I'm psychotic? I get very confused sometimes about this illness, it's definately an illness but the labels are all wrong because the names for them are based on the symptoms and not the cause, anti-depressive, anti-psychotic. You don't give somebody an anti-fatigue or an anti-neck pain.
I sincerely hope that one day they get to the root of these problems and then instead of my having "depression" I could say I have "a deficiency in such and such".
Sorry for rambling and giving a long winded answer to a basic question.
Kind Regards.....Denise
Posted by deniseuk on March 1, 2006, at 11:43:39
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon, posted by linkadge on February 27, 2006, at 15:21:16
Linkadge,
I really disagree with you here. I can't honestly believe you could have ever had a really robust response to an anti-depressant drug because if you had you would KNOW that they worked, there would be no two ways about it.
I think for some people who's depression is circumstance related then there is obviously a chance that a change of circumstance will help them but what about those people who's depression isn't related to situation.
Everytime I've ever got depressed there has never been an obvious reason for it. I know I am so lucky from an outsiders point of view, I have loads going for me, I'm financially fairly secure and I have people who love me and yet I still feel like sh*t, look forward to very little, enjoy very little and nothing apart from a drug has ever been able to change that.
I could be sitting on a paradise island surrrounded by Greek Gods or in a prison cell and I'd still feel the same way.
Denise
Posted by Meri-Tuuli on March 1, 2006, at 12:09:29
In reply to Re: To Linkadge, posted by deniseuk on March 1, 2006, at 11:43:39
But we're talking about SSRIs and SNRIs here and whether they work or not and from your previous post, you mention that you were taking prothiaden and APs.
Posted by tessellated on March 1, 2006, at 12:10:31
In reply to addendum to my post, posted by Chairman_MAO on March 1, 2006, at 10:40:01
I hate playing conspiracy theory guy all the time.
But most opiod patents have been expired for a long long time.
Ergo there is little profit to be had there, and therefore little motivation to trump up their benefits off lable..> Aristotle held that physical and psychological pain are one and the same. The hard scientific evidence seems to corroborate this. So why are some drugs only OK to use for physical pain and others for emotional pain? Why does the supposed etiology matter if the end result is pain?
>
> NOTE: I do agree that using drugs to kill pain can be destructive. What I'm uncertain about is how this justifies the prohibition of what is often the most effective medications. If SSRIs work for you, I say go ahead and use one if you like it. I haven't met too many people who like being sexually anesthetiszed, though.
Posted by Phillipa on March 1, 2006, at 15:00:12
In reply to Re: addendum to my post » Chairman_MAO, posted by tessellated on March 1, 2006, at 12:10:31
Everyone has their own opinion was just asking if people thought the SSRI's and SNRI's worked. Not looking for people to get argumentative. Maybe this thread should stop here. Afterall I started the Thread. Enough is Enough. Thanks Fondly, Phillipa
Posted by linkadge on March 1, 2006, at 15:13:55
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » linkadge, posted by Glydin on February 28, 2006, at 16:44:32
Well, there are many different types of post.
But there is certainly one type which involves the assigning of undue merrit to drugs.
Linkadge
Posted by linkadge on March 1, 2006, at 15:23:46
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » linkadge, posted by TylerJ on February 28, 2006, at 17:18:09
That doesn't necessarily mean that your REM sleep is not being supressed. A drug can still be supressing or reducing REM sleep significantly without eliminating it.
I am not saying that the drugs do not work for certain people. But, if I was to take a drug I would like to know the overall sucess rate. I guess I am just asking that patients be made aware of how effective a drug is.
Its just like how I disagree with common drug company practice that says it is allowed to conceil as many failed trials as it likes.
Linkadge
Posted by linkadge on March 1, 2006, at 15:26:22
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyone? » linkadge, posted by tizza on February 28, 2006, at 18:45:53
Hey, I'm up for some bowling.
Linkadge
Posted by linkadge on March 1, 2006, at 15:31:54
In reply to Re: Yes, posted by FredPotter on February 28, 2006, at 21:31:59
I think fading placebo effect is certainly a component of poop out.
I think the placebo effect is stronger with the first drug you take. When I first took an AD I was so naive. I figured that it was all an exact science and the pill was fixing this medical abnormality. The more I read, the more sceptical I become, and the less I seem to respond to drugs.
Knowledge too, about the dangers and hazzards of a drug, can work in the opposite way to the placebo effect. For it to work, you need to see the drug as a clearly good thing. There can't be any doubt in your mind. The more doubt, the less placebo effect.
Linkadge
Posted by linkadge on March 1, 2006, at 15:38:38
In reply to Re: Yes, posted by Comet on February 28, 2006, at 21:52:07
I think I would respectfully disagree with your respectfull disagreement.
I have fooled **everbody**. I have fooled doctors, parents, grandmothers, best friends, pets, pastors etc. If I feel the *need* to put on normal face, nobody knows my suffering.
While friends can sometimes be good, at least in my case, they are clueless.
Linkadge
Posted by linkadge on March 1, 2006, at 15:46:10
In reply to Re: The Truth Do SSRI's and SSNRI's Work For Anyon » yxibow, posted by Chairman_MAO on March 1, 2006, at 10:32:38
Hey I completely agree. Its like I said it before. People get better on their own, but people like their rabit's feet. They like to have that little symbol of what they believe empowers them. People like to feel in control of their recovery, that is part of the recovery process, the gaining of sence of controll. Some people attibute their recovery to religion, some people to SSRI's so take your pick.
Sure, you can say that people got better on SSRI's, but people get better naturally too. The only way that we have to distinguish the two, is the double blind placebo trial, and the results of that, are not so great.
BTW
put me down for some morphine+d-amphetamine.
Linkadge
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.