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Dr. Bob is Robert Hsiung, MD,
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Posted by doxogenic boy on October 18, 2013, at 9:55:39
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by SLS on October 18, 2013, at 9:01:22
> Been there, done that.
>
> I am disinclined to waste any more of my time reading or debating the various theses of Irving Kirsch.
>
> If you would like to fortify your concerns about psychiatry and psychiatric drugs, here are the names of a few other charlatans:
>
> Robert Whitaker
> Irving Kirsch
> Joseph Glenmullen
> David Healy
> Peter BregginActually, Robert Whitaker was here in Norway in August; two organizations for psychiatric patients had invited him to deliver a lecture on psychiatric drugs. (I was not there.)
Are the organizations for psychiatric patients in the United States attracted to these names too?
- doxogenic
Posted by doxogenic boy on October 18, 2013, at 11:03:52
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by Phillipa on October 18, 2013, at 9:43:30
> Same thing my pdoc said that even in his opinion that ad's are more of a placebo effect. That life circumstances play more a role. Also the hope of the patient that "well now I have a med I am better".
Could you ask your pdoc what he thinks about Irving Kirsch's claims about antidepressants and placebo, as mentioned is this thread? Do the mental health professionals in the United States discuss this topic a lot? I am very curious about what psychiatrists say about this.
The placebo effect is part of the effect of every treatment for any disease. (I have never heard of a treatment that does not have a placebo effect in addition to the pharmacological effect.)
I have read earlier in Scientific American Mind that the reason for the high placebo responses in drug studies for antidepressants in the United States, is that some of/lots of patients in the studies weren't depressed in the first place. (I think they got money for participating in the studies.) Therefore the placebo response looks higher than it is. What do you think about this?
- doxogenic
Posted by LouisianaSportsman on October 18, 2013, at 13:35:22
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 18, 2013, at 11:03:52
I think he does have one point. I really do placebo effect plays a large part in a patient's response to SSRIs, but to say it's solely placebo is just not correct. I've never gotten anything out of a SSRI beyond placebo, but I feel like I'm at least getting a placebo effect from my Pristiq (desvenlafaxine). As a patient with some of the best access to psychiatric healthcare in the world via my PDOC and insurance that pays for any med, I know that not all psychotropic psychiatric medications are placebo. Abilify is not placebo and is the most "non-placebo" medicine I have ever taken in terms of its effect on symptoms rather than side effects. I think some patients that go to GPs and get Prozac may rely on the placebo effect more than patients that go to licensed PDOCs and try a large array of psychiatric medicines.
Posted by SLS on October 18, 2013, at 14:54:37
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 18, 2013, at 11:03:52
> lots of patients in the studies weren't depressed in the first place.
Exactly.
> (I think they got money for participating in the studies.)
Exactly.
> Therefore the placebo response looks higher than it is.
Exactly.
What do you think about this?
Perfect!
https://www.google.com/search?q=sls+placebo+severe+mild&sitesearch=dr-bob.org
- Scott
Posted by linkadge on October 18, 2013, at 18:09:17
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by SLS on October 18, 2013, at 14:54:37
For the most part, I agree. I do believe that the placebo effect plays a large role in antidepressant response.
Linkadge
Posted by doxogenic boy on October 18, 2013, at 18:22:39
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by SLS on October 18, 2013, at 14:54:37
> > lots of patients in the studies weren't depressed in the first place.
>
> Exactly.
>
> > (I think they got money for participating in the studies.)
>
> Exactly.
>
> > Therefore the placebo response looks higher than it is.
>
> Exactly.
>
> What do you think about this?
>
> Perfect!
>
> https://www.google.com/search?q=sls+placebo+severe+mild&sitesearch=dr-bob.orgI didn't know you had discussed Kirsch's articles before. I have now read some of it, such as this post:
http://www.dr-bob.org/babble/20050728/msgs/536653.html(See this article: http://web.archive.org/web/20050212082903/http://www.journals.apa.org/prevention/volume5/pre0050024c.html )
I will read more of the earlier placebo debate tomorrow. Here is a critical comment to Kirsch's article in PLOS Medicine:
http://ebmh.bmj.com/content/11/3/66.full
Excerpt from the link above:
Evid Based Mental Health 2008;11:66-68 doi:10.1136/ebmh.11.3.66
EBMH Notebook
Do antidepressants work? A commentary on Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration by Kirsch et al
R H McAllister-Williams
+ Author Affiliations
Institute of Neuroscience, Newcastle University
Dr H McAllister-Williams, Reader in Clinical Psychopharmacology and Honorary Consultant Psychiatrist, Psychiatry, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK; r.h.mcallister-williams@ncl.ac.uk
The publication of this meta-analysis1 received a vast amount of coverage in the UK. This is despite the bottom line that the review does not report any novel findingsantidepressants work and their effectiveness increases with baseline severity of depression. This was not the picture painted in the media. Rather the conclusions drawn by the authors took an extreme viewpoint and the reviews publication was sensationalised both by the journal editor and the media.
[...]
COMMENTS ON THE AUTHORS CONCLUSIONS
Undoubtedly the findings in this analysis are robust, as far as the studies included in the analysis are concerned. The choice of the data set was based on logical reasoning in trying to avoid publication bias. However it does not include all possible data from studies completed subsequent to FDA submissions. Nevertheless, in line with many previous analyses (including NICEs own), the meta-analysis demonstrates that antidepressants are significantly better than placebo. Further, in line with previous evidence, the drug-placebo difference increases with increasing severity of baseline illness.5 The conclusion that this is due to a decrease in response to placebo rather than an increase in effectiveness of the drug is entirely fallacious because the magnitude of the therapeutic effect is the difference between active drug and placebo, not the absolute response to active drug.
End quote.
------------- doxogenic
Posted by doxogenic boy on October 18, 2013, at 18:36:29
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 18, 2013, at 18:09:17
> For the most part, I agree. I do believe that the placebo effect plays a large role in antidepressant response.
There also is some research that long-term use of antidepressants can worsen the course of depression/cause tardive dysphoria.
See this article from The Journal of Clinical Psychiatry:
And this from Medical Hypotheses:
http://www.madnessradio.net/files/tardivedysphoriadarticle.pdf- doxogenic
Posted by doxogenic boy on October 18, 2013, at 19:16:47
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by LouisianaSportsman on October 18, 2013, at 13:35:22
> I think he does have one point. I really do placebo effect plays a large part in a patient's response to SSRIs, but to say it's solely placebo is just not correct.
I have experienced that paroxetine has induced manic psychosis, and then (1994) I was commited to a psychiatric hospital. Is there any research indicating that placebos can cause mania?
- doxogenic
Posted by Phillipa on October 18, 2013, at 20:58:35
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 18, 2013, at 11:03:52
I agree as ad's handed out like candy here. If you are sad, recent death in family, loss of job, the list goes one "here take this pill". Phillipa
Posted by doxogenic boy on October 19, 2013, at 7:02:52
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by Phillipa on October 18, 2013, at 20:58:35
> I agree as ad's handed out like candy here. If you are sad, recent death in family, loss of job, the list goes one "here take this pill".
I found this diagnosis in DSM-5:
"Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions"Do they prescribe antidepressants for this in America?
- doxogenic
Posted by linkadge on October 19, 2013, at 11:49:46
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 18, 2013, at 18:36:29
>There also is some research that long-term use >of antidepressants can worsen the course of >depression/cause tardive dysphoria.
This is also a premise that I agree with. I have no doubt that antidepressants can induce some significant short term improvements. However, I think that it is difficult to fully recover while on the medications.
For example, much is being researched about the healing properties of REM sleep (i.e. stem cell activity, processing of emotional memories, fear extinction, connection pruning etc.). REM sleep dysfunction also increases the risk of certain neurodegenerative disorders. REM sleep disorders, for example are apparent years before the onset of clinical parkinsonian syptoms.
By supressing REM sleep, antidepressants but the brain in limbo.
Linkadge
Posted by linkadge on October 19, 2013, at 12:11:46
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 19, 2013, at 7:02:52
Not to target any groups here, but I think there is a huge overlapping problem between disability, antidepressant prescription, and the growing problem with long term unemployment and social security overuse.
To put it simply. One loses their job, they get shoved on paxil and zyprexa to help with a natural depressive response. They become apathetic and insulin resistant. They become less motivated to get off the system and find a job. Then they qualify for disability as their depression worsens and they have developed diabetes and it all spirals downward.
In many cases the drugs are the problem. They are making people complacent about the cycle of poverty.
Heres a better idea. Lower the minimum wage to create more jobs and force employers to offer and unlimited supply of cocaine leaves for chewing on the job. Your employees will stay fit and sharp, develop fewer metabolic symptoms and are guaranteed to keep coming to work.
You don't deal with long term unemployment by handing out free money and sopoforiants. Look how Japan got itself back on its feet after WWII - amphetamines!
The irony is that people will work hard for the illegal drugs. Illegal drugs create job! OTOH SSRIs are job killers.
Cocaine - "I'll do anything for more cocaine"!
Paxil - "Naa, I'm too good to haul sewage".
Linkadge
Posted by doxogenic boy on October 19, 2013, at 16:06:20
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 11:49:46
> This is also a premise that I agree with. I have no doubt that antidepressants can induce some significant short term improvements. However, I think that it is difficult to fully recover while on the medications.
Yes, it seems like there are lots of antidepressant users who never find meds that work in the long run. Maybe they work at best a month or a year, and then it is trial and error again. It is well known that benzodiazepines can worsen anxiety and insomnia, so it shouldn't be a surprise if long-term use of antidepressants could worsen depression.
I wonder why there isn't more research into long-term effects and long-term side effects of antidepressants. Could it be so simple that it isn't profitable? Why should a pharmaceutical company use money to find bad things with their drugs?
> By supressing REM sleep, antidepressants but the brain in limbo.
SSRIs can cause frequent nightmares - could this harm the brain if it continues for years?
- doxogenic
Posted by doxogenic boy on October 19, 2013, at 16:27:34
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 12:11:46
> Not to target any groups here, but I think there is a huge overlapping problem between disability, antidepressant prescription, and the growing problem with long term unemployment and social security overuse.
Here in Norway are 9,4 % of the people from 18 - 67 years old on disability benefit. 11,1 % of women and 7,8 % of men.
This is the official statistics:
https://www.nav.no/Om+NAV/Tall+og+analyse/Jobb+og+helse/Uf%C3%B8repensjon/Uf%C3%B8repensjon/Mottakere+av+uf%C3%B8repensjon+som+andel+av+befolkningen+*%29%2C+etter+kj%C3%B8nn+og+alder.+Pr.+30.06.2004-2013+**.356503.cmsAnd then there are other kinds of social security.
> To put it simply. One loses their job, they get shoved on paxil and zyprexa to help with a natural depressive response. They become apathetic and insulin resistant. They become less motivated to get off the system and find a job. Then they qualify for disability as their depression worsens and they have developed diabetes and it all spirals downward.
---
Inactivity is very bad for mental disorders. Being without a job for a long time will
undoubtedly worsen depression, so if the antidepressants pacify it could end up being a trap.- doxogenic
Posted by doxogenic boy on October 19, 2013, at 17:01:15
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:27:34
> Inactivity is very bad for mental disorders. Being without a job for a long time will
> undoubtedly worsen depression, so if the antidepressants pacify it could end up being a trap.Correction " ... so if the antidepressants make people passive and apathetic, it could end up being a trap."
- doxogenic
Posted by linkadge on October 19, 2013, at 17:02:29
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:06:20
I'm not a sleep expert, but I think nightmares are due to some sort of cholinergic / monoaminergic imbalance. The brain is trying to process emotional content without being in a paralyzed state(?). It is certainly not rejuvenating to be having constant nightmares. Its probably as unhealthy as apnea.
Linkadge
Posted by doxogenic boy on October 19, 2013, at 17:14:00
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:02:29
> I'm not a sleep expert, but I think nightmares are due to some sort of cholinergic / monoaminergic imbalance. The brain is trying to process emotional content without being in a paralyzed state(?). It is certainly not rejuvenating to be having constant nightmares. Its probably as unhealthy as apnea.
Thanks for your reply. I did a simple search for SSRIs and nightmares, and it gave lots of relevant results:
https://www.google.no/search?num=100&safe=off&site=&source=hp&q=ssri+nightmares- doxogenic
Posted by linkadge on October 19, 2013, at 17:16:23
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:27:34
Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things. Correspondingly SSRIs can decrease feelings of guilt associated with being inactive or unproductive.
Deep sleep is needed to help reorient an individual to long term goals and aspirations. One could easily loose a decade or more on SSRIs. One would be perfectly content watching Seinfeld and making peanut butter sandwiches for a decade (been there done that).
Throw in some money for being disabled and away we go.This is not to trivialize some people's situations as I know some people really are sick. However, I feel like there is a growing segment of the population that just need a steady job and some strong coffee.
Linkadge
Posted by baseball55 on October 19, 2013, at 19:05:00
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:16:23
Who says ADs suppress REM sleep? Where is the evidence? I never experienced that.
And who says that ADs make people passive and lazy? That was not my experience at all. Depression made me unproductive, unmotivated and unable to function normally. Successful treatment with ADs put me back to work again.
Also, where's the evidence for tardive dysphoria? Besides a few anecdotes?
Posted by sigismund on October 19, 2013, at 19:26:34
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 12:11:46
>Heres a better idea. Lower the minimum wage to create more jobs and force employers to offer and unlimited supply of cocaine leaves for chewing on the job. Your employees will stay fit and sharp, develop fewer metabolic symptoms and are guaranteed to keep coming to work.
Just the coca leaves. They really work.
How about some old fashioned protection for US jobs? Those Bangladeshi children are overworked.
Posted by linkadge on October 19, 2013, at 20:20:35
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by baseball55 on October 19, 2013, at 19:05:00
Do a google search for REM sleep + SSRI, you should get may hits. SSRIs make tons of people apathetic and lazy.
Linkadge
Posted by linkadge on October 19, 2013, at 20:35:30
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by sigismund on October 19, 2013, at 19:26:34
I agree with you about American protectionism. Unfortunately, I believe, we are witnessing the beginning of the fall of the US empire. Our living standards will continue to fall, as those of individuals in third world countries rise. We consume more than we produce. We borrow money from China to buy things from China that we neither need nor can afford.
We are witnessing other countries copy the 1900's US style of economic growth. Jobs will continue to leave the country and the US will continue to print money. Eventually China will catch on that is never going to get its money back. At this stage, the US will be unable to finance its debt. Interest rates will skyrocket and the typical western debt driven consumption model will implode.
Buy gold and get the hell out of the US dollar!
Linkadge
Posted by Phillipa on October 19, 2013, at 20:56:09
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 20:35:30
I agree and also going to renew my passport so I can get out of Dodge for real. Phillipa
Posted by sigismund on October 19, 2013, at 21:39:24
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 20:35:30
I'm in favour of eliminating structural rigidities from the drug market, and improving labour productivity there too.
My coca has to come here from Peru via the US.
Sliced white, I love it.
Posted by doxogenic boy on October 20, 2013, at 11:43:20
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by baseball55 on October 19, 2013, at 19:05:00
> And who says that ADs make people passive and lazy?
There is some information here:
http://www.dr-bob.org/tips/split/SSRIs-and-apathy.htmlMessages about SSRI-induced apathy on dr-bob.org:
https://www.google.no/search?hl=en&as_q=ssri+apathy&as_epq=&as_oq=&as_eq=&as_nlo=&as_nhi=&lr=&cr=&as_qdr=all&as_sitesearch=dr-bob.org&as_occt=any&safe=images&tbs=&as_filetype=&as_rights=- doxogenic
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