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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on November 10, 2009, at 6:25:45
In reply to Re: Peter Breggin » uncouth, posted by Phidippus on November 9, 2009, at 22:56:47
> > How much should I be worried about the Lithium, antidepressants, antipsychotics, etc. that I take causing brain damage etc.?
> Lithium is a neuroprotective agent and can guard against nerve cell degeneration.> SSRIs act much in the same regard, protecting the hippocampus and other brain regions from the atrophying effects of depression.
I think the key word is "atrophy". I believe that the shrinking of brain tissue seen in depression is a true atrophy from disuse rather than a disease process. I could be wrong. I read that in order for an antidepressant to produce neurotrophic or neurogenic effects, it must effectively treat the depression / stress first.
If this is true, then:
AD > remission > neurogenesis.
This is in opposition to the majority view that:
AD > neurogenesis > remission.
> Antipsychotics, on the other hand, can stunt brain growth and cause dopamanergic pathways to atrophy.I never heard that.
- Scott
Posted by ColoradoSnowflake on November 10, 2009, at 11:27:43
In reply to Re: Peter Breggin, posted by SLS on November 10, 2009, at 6:25:45
What do you think Parnate does to the brain and cognition? I think it has "dumbed" be down some. I have a harder time remembering things, names especially.
What do you, who have Parnate experience, think?Thanks,
Gayle
Posted by uncouth on November 10, 2009, at 14:20:48
In reply to Re: Peter Breggin, posted by SLS on November 10, 2009, at 6:25:45
Scott,
That sequence you put forth is interesting. My primary concern right now is the potential toxicity of lithium. I have been at 600mg for 6 weeks and I can definitely tell some cognitive and memory problems. I am talking to my dr. about reducing the dose. I feel the lithium helped me get out of my suicidal pit, but now could be one of the causes of this chronic apathy and indifference I feel. I think SSRIs also contribute to that, and I'm hoping wellbutrin and agomelatine do not share that property....I for one won't ever take SSRIs again.Zyprexa WAS a significant help but the weight gain and intense hunger was too hard to manage, and it too helped me get out of "the pit". I talked to my dr. about potentially switching to asenapine (saphris) and he advised a 7 day washout from zyprexa first. Im mid way through that and now wondering if I should even be on an antipsychotic at all. Breggin is pretty convinced they are universally disabling.
But then again there is also research I believe showing increases in prefrontal activity and neurogenesis, and certianly many people ahve repsonded well to AP. So I don't know what to do.
The one thing I do believe Breggin is correct about is the "spellbinding" effect of many of these medications. They affect your ability to discern their effects. Even if you "respond" it's hard to tell what other subtle brain disfunction may be occuring.
I'm starting to wonder whether the safest bet might be a precursor strategy (L-Tryptophan, DL-Phenylalanine, Deplin, SAM-e, B12, etc.).
I don't know if Breggin has teased out differences between MAOIs/ TCAs/ and SSRIs, but he seems to think that all antidepressants are disabling, and that is effectively their mechanism of action.
Anyway, reading some of his stuff (his books are available in partial form to read on Google Books) got me thinking and a bit scared. Do I have to choose between intense emotional pain or complete numbness and affectlessness?
-uncouth
Posted by SLS on November 10, 2009, at 15:12:24
In reply to Re: Peter Breggin, posted by uncouth on November 10, 2009, at 14:20:48
Hi Uncouth.
I have no desire to produce an intelligent treatise on the whole of Peter Breggin's writings, but I do not take him seriously, despite his ability to weave a few facts into conclusions that seem logical. For instance, it is true that the volume of hippocampal tissue increases with the application of antidepressants. However, I would want to see the laboratory data that he uses to show that this is evidence of the destruction of neurons by these drugs. How does he account for the shrinking of this brain structure as is seen in depressive illness prior to any drug exposure? Holes.
> My primary concern right now is the potential toxicity of lithium.
Wise. Be sure to get regular blood tests for kidney and thyroid function. The lower the dosage of lithium, the lower is the risk of developing problems in these areas.
> I have been at 600mg for 6 weeks and I can definitely tell some cognitive and memory problems.
Lithium is known to produce impairments in these areas, although not all the time.
> I am talking to my dr. about reducing the dose. I feel the lithium helped me get out of my suicidal pit, but now could be one of the causes of this chronic apathy and indifference I feel.
Again, lithium is known to produce the side effects that you are reporting, although not everyone experiences them. I am very surprised that I don't seem to be having the flat affect and passivity that I thought lithium had produced in me in the past. I am currently at 900mg. I had a blood test for lithium level last week, but I don't know the results yet.
> I think SSRIs also contribute to that,
SSRIs can cause everything you describe.
> and I'm hoping wellbutrin and agomelatine do not share that property....I for one won't ever take SSRIs again.
If they are wrong for you, it makes sense to look elsewhere. I hope your next treatment cocktail does the trick. I would like to know if agomelatine can be combined with Parnate. Do you know anything about this?
> and now wondering if I should even be on an antipsychotic at all. Breggin is pretty convinced they are universally disabling.
In what way?
> Anyway, reading some of his stuff (his books are available in partial form to read on Google Books) got me thinking and a bit scared.
Don't be scared just yet. You might want to go Googling for material that addresses directly the validity of Breggin's claims and conclusions.
> Do I have to choose between intense emotional pain or complete numbness and affectlessness?
Probably not.
- Scott
Posted by SLS on November 10, 2009, at 16:19:20
In reply to Re: Peter Breggin, posted by ColoradoSnowflake on November 10, 2009, at 11:27:43
> What do you think Parnate does to the brain and cognition?
When it works, it makes me sharp as a tack.
> I think it has "dumbed" be down some. I have a harder time remembering things, names especially.
Just remember that you are not taking Parnate alone.
Depressive illness itself produces cognitive and memory impairments. Sometimes, people become more aware of them when they consider the possibility that they are side effects of a drug or residual effects of ECT. It happens. However, it also happens that the impairments are directly attributable to the drugs. I do recall experiencing a bit of a "brain fog" the first time I combined Parnate with desipramine. It improved with time. Also, I think that memory is one of the last things to improve as one emerges from depression. Lamictal causes me significant cognitive slowing and memory impairments. When the time is right, I am going to try to reduce the dosage.
- Scott
Posted by bleauberry on November 10, 2009, at 16:31:11
In reply to Peter Breggin, posted by uncouth on November 9, 2009, at 18:33:12
I think it will be 50 to 100 years before the theories...both pro and con...can be debated with any sense of scientific body. I think right now we are only in the pioneering stage of discovery what these meds do to the brain on a molecular level.
I think it deserves mention...and this is significantly contrary to the beliefs of most everyone here...that depression is not a disease. It is a set of symptoms caused by a disease. The disease could be a genetic flaw, toxic burden, infectious organisms (inflammation and general systemic disregulation), immune dysfunction (inflammation and general systemic), disregulation), hormone disregulation, and others. The set of symptoms resulting often fit the description of what we call depression. The impact on the brain is severe enough that we can see shrinking, damage, and lesions.
It is purely hit and miss, but in the support of ADs, the right one can actually reverse the disease...it is possible for an AD to regulate the immune system in such a way as to make Lyme go dormant...even though the patient is still infected, they are asymptomatic. On the other side of the coin, hit or miss, the AD can worsen the situation. I believe this scenario is probably true of all diseases. The ADs have the potential to either help the situation or worsen it.
Obviously the best strategy would be to identify what the cause of the set of depressive symptoms is for each patient. Much research is needed in that area. The best we can do today is probe and challenge with various substances to rule something in or rule something out.
I don't know if ADs cause brain damage. I know I experienced the so-called post-ssri syndrome, as have others here...but is that actually a post ssri thing or is a manifestation of the unknown disease that was there the whole time? Don't know.
Lithium in moderate doses probably is protective. As is magnesium, Resveratrol, Japanese Knotwood, Stephania Root, Chlorella, and at least a dozen others. Avoiding dairy, gluten, inorganic meats, inorganic veggies, inorganic fruits, various food additives and colors...all these are also protective.
Actually any substance that reduces brain inflammation and toxicity is neuroprotective. The substance to accomplish that will vary depending on the disease.
Whether Breggin is correct or not, I have no clue. I do think it is good to consider and respect all sides of a debate in psychiatry, because at this point in history, no one really knows. Someone we attack today as being a ridiculous scare-mongerer may in 50 years turn out to be completely accurate. Or not. We don't know right now.
We are all participants in a global pharmaceutical experiment that has been underway for only a few decades. It will take much more time to make any solid judgements, I believe.
Posted by SLS on November 10, 2009, at 16:57:34
In reply to Re: Peter Breggin, posted by bleauberry on November 10, 2009, at 16:31:11
Hi Bleauberry.
How do you define the word "depression" as you apply it? Semantics are critically important.
> I think it will be 50 to 100 years before the theories...both pro and con...can be debated with any sense of scientific body.
What theories? What do you mean by "pro and con"?
> I think it deserves mention...and this is significantly contrary to the beliefs of most everyone here...that depression is not a disease.
What about bipolar disorder (BD)?
> but in the support of ADs, the right one can actually reverse the disease...
What is the disease? Does major depressive disorder (MDD) count?
> it is possible for an AD to regulate the immune system
I should think it more likely that an AD helps reregulate the brain, which, in turn, regulates the immune system through the secretion of neuropeptides.
- Scott
Posted by SLS on November 10, 2009, at 17:30:50
In reply to Re: Peter Breggin » bleauberry, posted by SLS on November 10, 2009, at 16:57:34
> > it is possible for an AD to regulate the immune system
> I should think it more likely that an AD helps reregulate the brain, which, in turn, regulates the immune system through the secretion of neuropeptides.I forgot about brain-derived cytokines as being modulators of immune system function.
- Scott
Posted by uncouth on November 10, 2009, at 17:34:47
In reply to Re: Peter Breggin, posted by SLS on November 10, 2009, at 15:12:24
re: parnate + ago. i see no reason why they couldn't be used together
thanks for your response. i don't want to be seeing side effects where none actually exist, but at the same time, i feel as though i've lost something significant over the years, and despite times of "response", i haven't gotten that something back. maybe that's just the depression never fully remitting, or my life situation not improving. i don't know.
Posted by floatingbridge on November 10, 2009, at 17:46:09
In reply to Re: Peter Breggin, posted by uncouth on November 10, 2009, at 14:20:48
"Anyway, reading some of his stuff (his books are available in partial form to read on Google Books) got me thinking and a bit scared. Do I have to choose between intense emotional pain or complete numbness and affectlessness?
-uncouth"Uncouth, my understanding, (and maybe someone has said this already--I leapt ahead in the thread to write this), is that intense emotional pain has deleterious effects on the brain as well. Hopefully we can find some middle road. Is mild benzo use more damaging than non-stop stress? I'll go for benzos. As for AP's, I don't know. I've heard mixed information. But to suffer is not a good choice either.
my two uninformed cents,
fb
Posted by floatingbridge on November 10, 2009, at 17:50:10
In reply to Re: Peter Breggin, posted by bleauberry on November 10, 2009, at 16:31:11
Well, I think the discussion between BB and SLS just about nails it.
My question is does anyone suspect MAOI (such as emsam, segiline) to be more nueroprotective than an ineffective ssri or snri?
Posted by emmanuel98 on November 10, 2009, at 18:28:10
In reply to Re: Peter Breggin » bleauberry, posted by floatingbridge on November 10, 2009, at 17:50:10
I don't know what neuroprotective means. I don't know what it means to say depression isn't a disease. All I know is that I would be dead if it weren't for parnate. I had barely moved in over two months except to try and hang myself. So, for me, parnate has been neuroprotective and I don't much care what it does to my brain as long as it stops the depression. Because the depression wasn't doing me much good at all.
>
> My question is does anyone suspect MAOI (such as emsam, segiline) to be more nueroprotective than an ineffective ssri or snri?
Posted by Phidippus on November 10, 2009, at 20:10:02
In reply to Re: Peter Breggin » Phidippus, posted by metafunj on November 10, 2009, at 5:55:05
> Do you have any idea if that is true?
Sounds like a tall tale to me. It just doesn't work that way.
P
Posted by floatingbridge on November 10, 2009, at 21:14:21
In reply to Re: Peter Breggin, posted by emmanuel98 on November 10, 2009, at 18:28:10
Emmanuel, I'm very glad that parnate is working for you! Thank you for posting.
I still wonder about the potential neuroprotective properties of MAOIs--I mean, relief from emotional suffering and potential brain healing? I'd love it to be true.
Does anyone know?
fb
Posted by TriedEveryDrug on November 10, 2009, at 22:13:43
In reply to Re: Peter Breggin » uncouth, posted by Phidippus on November 9, 2009, at 22:56:47
http://en.wikipedia.org/wiki/Lithium_pharmacology#Harmful_effects_of_lithium"The average developmental score[clarification needed] for the lithium-exposed group of children was 78 points lower than the control group (siblings), but well within the normal range of 100±15.[19]"
>
> Lithium is a neuroprotective agent and can guard against nerve cell degeneration.
>
>
Posted by SLS on November 10, 2009, at 22:39:55
In reply to Litium is neuroprotective? You sure?, posted by TriedEveryDrug on November 10, 2009, at 22:13:43
>
> http://en.wikipedia.org/wiki/Lithium_pharmacology#Harmful_effects_of_lithium
>
> "The average developmental score[clarification needed] for the lithium-exposed group of children was 78 points lower than the control group (siblings), but well within the normal range of 100±15.[19]"
Unfortunately, the link for the relevant bibliography entry in this Wikipedia submission does not work. It wouldn't surprise me if lithium were to produce measurable deficits in cognitive function. The question is to what degree is it noticeable and irreversible. After all, depression produces deficits that are debilitating and, according to some, irreversible if left untreated. I guess it is a matter of degree.
- Scott
Posted by linkadge on November 11, 2009, at 6:59:54
In reply to Re: Litium is neuroprotective? You sure?, posted by SLS on November 10, 2009, at 22:39:55
Lithium can produce cognative deficits. By keeping glutamatergic neurotransmission in a very narrow range it may reduce stimulus evoked long term potentiation (learning).
This is not necessarily evidence of neurotoxicity.
The other thing is that GKS-3b inhibition produces differential effects on neuroplacticity depending on the phase of development.
Linkadge
Posted by SLS on November 11, 2009, at 7:30:25
In reply to Re: Litium is neuroprotective? You sure?, posted by linkadge on November 11, 2009, at 6:59:54
> The other thing is that GKS-3b inhibition produces differential effects on neuroplacticity depending on the phase of development.
What are some of the differences?
For those whom are unfamiliar with GSK-3b inhibition, this is one of the many biological effects of lithium. High levels of GSK-3b are associated with neuronal cell death (apoptosis). This might not always a bad thing, though. In a juvenile developing brain, a process known as pruning must take place to allow the brain to better focus its activity. Pruning allows for the degeneration of unneeded brain tissue. I'm sure Linkadge can describe any association there might be between GSK-3b and pruning.
To remain on topic: Does anyone know what Peter Breggin's views are on the use of lithium?
- Scott
Posted by manic666 on November 11, 2009, at 12:41:44
In reply to Re: Litium is neuroprotective? You sure? Breggin?, posted by SLS on November 11, 2009, at 7:30:25
i love it , i havnt got a clue what your on about, i just stick things in my mouth an hope for the best.
Posted by SLS on November 11, 2009, at 12:54:22
In reply to Re: Litium is neuroprotective? You sure? Breggin?, posted by manic666 on November 11, 2009, at 12:41:44
> i love it , i havnt got a clue what your on about, i just stick things in my mouth an hope for the best.
Perfect.
:-)
Thanks for the smile.
When I first started with doctors, I did exactly as you do. I was blindly and trustingly compliant, and never questioned a doctor's decisions. I only wanted to know the minimum necessary to get by. Eventually I reached the point where my doctors declared that I was probably untreatable. That is when I decided to take my first step into a medical school library. Actually, things are not so differenct now than they were at the beginning. What I really want to know is the minimum necessary that will help me get well.
In the meantime, I just stick things in my mouth and hope for the best.
LOL
- Scott
Posted by 49er on November 11, 2009, at 14:13:23
In reply to Peter Breggin, posted by uncouth on November 9, 2009, at 18:33:12
> Just was reading some of Peter Breggin's anti psychopharmacology writings and I'm curious if anyone has any intelligent things to say about him. Seems to be well-informed and not making baseless claims. How much should I be worried about the Lithium, antidepressants, antipsychotics, etc. that I take causing brain damage etc.?
Uncouth,
You might want to read this article about long term use of antipsychotics causing brain damage:
http://www.nytimes.com/2008/09/16/health/research/16conv.html?_r=1 or
Nancy Andreson, a mainstream psychiatrist did the research on this.
I have personally suffered cognitive damage from long term use of antidepressants and know people in similar situations.
I assure you SLS, it is not due to depression. I know the difference and I am frankly getting tired of everything being blamed on depression. Not a rant at you but one in general.I knew I had but didn't realize how much until I started taking phosphatidyl serine which supposedly helps with dementia. While it isn't the total answer, it definitely has helped. Unfortunately, it is causing insomnia which is another post.
By the way, I used to think that Breggin was a crazy wacko anti psychiatry nut until I saw the light on what these psych meds were doing to me. Now I think he is mostly correct with the exception of his position on autism which seems to be in the dark ages.
If you decided to taper uncouth, feel free to babble mail me. I have nothing to sell. I have tapered from 4 meds down to 1 which I am going to have taper with micro cuts since it is a sleep med.
49er
PS - I am hoping that once I am completely off of med that the cognitive damage will improve. Only time will tell.
Posted by 49er on November 11, 2009, at 14:16:53
In reply to Litium is neuroprotective? You sure?, posted by TriedEveryDrug on November 10, 2009, at 22:13:43
> > Lithium is a neuroprotective agent and can guard against nerve cell degeneration.It seems the only way to measure whether something truly is neuroprotective is to conduct neuropsychological testing over several years since it takes several years for drug damage to show up in many cases. Of course, the changes of that happening are zilch.
49er
Posted by uncouth on November 11, 2009, at 14:57:40
In reply to Re: Peter Breggin » uncouth, posted by 49er on November 11, 2009, at 14:13:23
49er i would love to hear what you have done, what meds you have tapered, how you have felt during the process, and the 'before/after' of you with respect to antipsychotics. which one(s) were you on and for how long? what's your diagnosis?
i'm in the middle of deciding whether to try saphris (asenapine), the newest AP. on the one hand, i underwent a severe, suicidal, ruminative depression for months this summer. refractory to antidepressants, eventually lithium and zyprexa got me out of it. unfortunately i can't tolerate zyprexa.
at my baseline, i am someone with a pretty messed up dopamine system. my normal state is one of anhedonia, amotivation, impulsiveness. i tend to get addicted to the internet, cigarettes, anything that can provide me with a fix.
bupropion has helped bring back some control. i'm on 600mg, a very high dose. and am thinking about going higher, because it's incomplete.
i am hoping an antipsychotic will help normalize my dopamine system. i had high hopes for abilify as it is a 'stabilizer' but it just made things worse. maybe i was on too high of a dose?
my life is a mess because i can't focus on normal, long term rewards (work, career, women, etc.) and instead I revert to impulsive, short term thinking (lets stay on the internet instead of planning something, let's not do my work, etc.). antidepressants by themselves haven't made a dent over the last few years, and probably have made them worse (at least the SSRIs). my diagnosis is bipolar 2, and though i spend most of my time depressed, i am hoping a mood stabilizer / antipsychotic will help normalize my reward system over time and give me some semblance of a life again. right now i'm just irresponsible, feel lazy, like i'm wasting my life, and not able to control myself.
the one drug that helped self-will was emsam. unfortunately it also caused a psychotic depression and made me feel like a genius. definite hypomanic reaction.
zyprexa did work well for me but couldn't handle weight gain.
anyway sorry for sprawling post. i took 30mg of adderall i had laying around this morning + 200mg of modafinil because i have a deadline i need to make for some applications due today. thats probalby why this post is stream of consciousness (see told you my dopamine system is screwy).
but i certainly don't want brain damage from neuroleptics. the problem i have is just continuing down the path of antidepressants + stimulants. it hasn't worked for years so i need to try something new. i know APs are powerfull...it scares me that they will change my thinking dramatically, or slow down my thoughts, or kill creativity, but at the same time, I NEED and WANT something that will shake me to a new equilibrium point in my brain.
thanks for the link.
bye for now,
uncouth (crazy verison)
Posted by SLS on November 11, 2009, at 15:10:13
In reply to Re: Peter Breggin » uncouth, posted by 49er on November 11, 2009, at 14:13:23
> You might want to read this article about long term use of antipsychotics causing brain damage:
> http://www.nytimes.com/2008/09/16/health/research/16conv.html?_r=1
What exactly would you like to focus on? Can you post an exerpt of the article that you found salient?
> I have personally suffered cognitive damage from long term use of antidepressants and know people in similar situations.
How did you measure this damage?
I guess you'll know for sure if you have been damaged only once you have discontinued the drugs that you currently identify as the offenders. Otherwise, you might be experiencing an ongoing side effect. Hopefully, it is a side effect that will disappear once your protracted taper period comes to an end.
By the way, how long do you have left until you are medication-free?
How long ago did you begin your tapers? You've been tapering the same drug(s) for many months, right?
> I assure you SLS, it is not due to depression.
Had I addressed you personally? I don't remember challenging you or minimizing your experiences.
> I know the difference and I am frankly getting tired of everything being blamed on depression.
Then perhaps you should study some other subject.
I don't know anyone here who blames all of their ills on depression. However, medicine is just coming to grips with how depression can affect the brain, mind and body, and that there are indeed many physiological processes that are controlled by the brain, autonomic, and neuroendocrine systems that are deranged as a result of the brain dysregulation associated with depression. Depression can even cause blurred vision, dizziness, dry mouth, and constipation as the result of dysautonomia.
- Scott
Posted by linkadge on November 11, 2009, at 15:30:47
In reply to Re: Litium is neuroprotective? You sure? Breggin?, posted by SLS on November 11, 2009, at 7:30:25
I'm not exactly sure of the association. If GSK-3b gets too high then (as SLS mentioned) there can be cell death. If GSK-3b gets too low there is also a reduction in some forms of placticity. GSK-3b is important for triggering axonal growth in the early stages of developement. GSK-3b inhibition is supposedly partially responsible for the tetarogenic effects of lithium and divalproex.
I also know that mild gsk-3b inhibition improves neurotransmission but if gsk-3b inhibition gets too low there are significant derangements in normal brain function (ie sensorimotory gating deficicts, latent inhibition issues). I think some studies have found that gsk-3b is dramatically reduced in schizophrenia.
Linkadge
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