![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 106. Go back in thread:
Posted by Christ_empowered on September 17, 2015, at 16:31:40
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by europerep on September 17, 2015, at 15:48:53
I think all ADs in the US have the black box. Even the atypicals sometimes used for depression have to have the warning.
Posted by Tomatheus on September 17, 2015, at 16:50:02
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by europerep on September 17, 2015, at 15:48:53
> Again, my point is that we need to look at the facts. As far as I know, in the US, only SSRIs have the black box warning about possible suicidality in teenagers as a side-effect. That other drugs (for me, tranylcypromine) can worsen depression is a different phenomenon. And by the by, I actually think there is something encouraging in this fact: if it worsens my depression, it does at least seem to hit the spot in my brain where depression is "happening", it just does the wrong thing there. Shows that we're not completely off the mark with today's treatments for depression.
Europerep,
As far as I can tell, the black box warning regarding suicidal thinking and behavior applies to all antidepressant medications.
Here is a page on the U.S. Food and Drug Administration's Web site listing the antidepressant medications that the warning applied to as of May 2007:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273
Also, as far as I can tell, it seems that the black box warning is even included in the information that comes with medications that are used in the add-on treatment of depression, given that the Abilify that I get from my pharmacy each month comes with the warning.
I haven't looked at all of the studies that have been conducted on the association between antidepressant use and suicidality. It may very well be the case that only SSRIs, or perhaps only the newer antidepressant medications in general, have been found to increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Nevertheless, it seems that the FDA's warning applies to all antidepressant medications, at least if the information I'm looking at is correct.
Tomatheus
Posted by europerep on September 17, 2015, at 17:32:12
In reply to Re: Young people on SSRI's commit more crimes? » europerep, posted by Tomatheus on September 17, 2015, at 16:50:02
Ok, I stand corrected on that point, thanks to Tomatheus and C_E for pointing it out.
Still, this hardly justifies Hello's general statement that "antidepressants have already been shown to decrease the concern for ones own wellbeing". For very few patients in certain age brackets antidepressants can (temporarily?) increase suicidality. Plus, the fact that the FDA mandates those warnings actually is a sign of openness and transparency.
So I think my larger point still stands.
Posted by baseball55 on September 17, 2015, at 18:42:46
In reply to Re: Young people on SSRI's commit more crimes?, posted by europerep on September 17, 2015, at 17:32:12
A child psychiatrist I know believes some AD's increase suicide attempts in early treatment with teens because the AD's reduce vegetative symptoms before boosting mood, leading to a situation where people have the energy to carry out suicidal plans.
This is not at all the same as "reduced concern for one's well-being." Probably lots of people lie around thinking of suicide, but lack the energy and motivation to carry it through. It's possible that AD's allow people to get up and carry it through.
Posted by Hello321 on September 17, 2015, at 20:00:50
In reply to Re: Young people on SSRI's commit more crimes?, posted by baseball55 on September 17, 2015, at 18:42:46
The depression each human being experiences is as unique as this persons brain. Im sure suicidal thoughts, or a worsening of ones current suicidal thoughts are caused by different experiences each person has when taking the medication. In some cases a suicide might very well be completed simply because the patient has enough energy induced by the med to follow through with it. Other cases it might be the worsening of depression a patient experiences as a result of the med not being right for them. I can see Sexual Dysfunction caused by the treatment resulting in suicide. Not being able to perform for a partner can have very negative effects in ones wellbeing. A healthy libido is a major part of a happy life for many in their "mating years". And in the rare cases sexual dysfunction persists long after an antidepressant is stopped, im sure this can
Be a terrible thing to experience.But to sum up, im thinking there are many reasons why one is pushed to take their life as a result of taking an antidepressant.
This is from Drugs.com:Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.
Adult and pediatric patients receiving antidepressants for MDD, as well as for psychiatric and nonpsychiatric indications, have reported symptoms that may be precursors to emerging suicidality, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Causality has not been established
Posted by SLS on September 17, 2015, at 20:15:24
In reply to Re: Young people on SSRI's commit more crimes?, posted by baseball55 on September 17, 2015, at 18:42:46
> A child psychiatrist I know believes some AD's increase suicide attempts in early treatment with teens because the AD's reduce vegetative symptoms before boosting mood, leading to a situation where people have the energy to carry out suicidal plans.
>
> This is not at all the same as "reduced concern for one's well-being." Probably lots of people lie around thinking of suicide, but lack the energy and motivation to carry it through. It's possible that AD's allow people to get up and carry it through.EXACTLY!
- Scott
Posted by Hello321 on September 17, 2015, at 20:26:34
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 17, 2015, at 20:00:50
But really, hot damn this has gotten way past the point of being mundane. I just dont know why some are so unacceptable of any suggestion that a chemical designed to alter the fundamental functions of the brain that lead to a change in their outlook, thoughts and actions can indeed lead to the worst of scenarios, at least in a certain fraction of those who take it.
Everything these meds/chemicals do to tbe brain is unnatural. It is as artificial as it gets. Sometimes
they function as an amazing artificial crutch that greatly improves the life of the person taking it. But sometimes they work like an artificial "bat" that worsens the life of the person taking it and beats them down when theyre in need of help. Then there are times they are just mildly helpful or mildly harmful. They in no way function like an essential nutrient that is needed when a sick person is low on that nutrient. Maybe one day we will have medications that work tbat effeciciently, but unfortunately at this time we do not. So dont give ourselves more credit than we deserve. We have to recognize any problem before we can fix it.
Posted by europerep on September 18, 2015, at 4:55:40
In reply to Re: Young people on SSRI's commit more crimes?, posted by baseball55 on September 17, 2015, at 18:42:46
> A child psychiatrist I know believes some AD's increase suicide attempts in early treatment with teens because the AD's reduce vegetative symptoms before boosting mood, leading to a situation where people have the energy to carry out suicidal plans.
>
> This is not at all the same as "reduced concern for one's well-being." Probably lots of people lie around thinking of suicide, but lack the energy and motivation to carry it through. It's possible that AD's allow people to get up and carry it through.Yes, that is indeed exactly what I had in mind when I wrote this:
"Or are you referring to the fact that in rare cases, when mood brightening takes longer to kick in than an increase in motivation in patients already harboring suicidal thoughts, these patients may experience increased suicidality and then possibly commit suicide? This can indeed happen, but it requires a lot of very specific circumstances (plus possibly errors on behalf of the prescriber), so making a statement as general and clear-cut as you made in your initial post is most certainly problematic."
Posted by europerep on September 18, 2015, at 5:07:00
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 17, 2015, at 20:26:34
> I just dont know why some are so unacceptable of any suggestion that a chemical designed to alter the fundamental functions of the brain that lead to a change in their outlook, thoughts and actions can indeed lead to the worst of scenarios, at least in a certain fraction of those who take it.
Do you actually read the replies to the things you post? In one of the first replies from Scott he linked to an earlier post of his where he described his own experience with reboxetine and made exactly that point, backed up with scientific references for various drugs. I, too, explicitly acknowledged the phenomenon of worsening depression and suicidality as a rare but possible effect of antidepressants, not the least because I have experienced it myself. And noone here calls into question the black box warnings on antidepressants.
So, if you actually read the posts here you will find that we are by no means "unacceptable" to this. I just object to your dramatizations, misrepresentations and exaggerations.
I also strongly disagree with your qualification of a working antidepressant as an "amazing artificial crutch", but that's for a different thread I guess.
Posted by SLS on September 18, 2015, at 5:59:47
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 17, 2015, at 20:26:34
I understand your argument that antidepressants can have clinical effects that are negative instead of positive. I agree with this. However, one cannot make the argument that an antidepressant can cause someone to begin practicing limbo dancing obsessively without scientific evidence. I don't think that the issue here is whether or not antidepressants can have negative effects on mood and cognition. However, I think you have been challenged to produce sources of information to validate your claim:
"Antidepressants have already been shown to decrease the concern for ones own wellbeing."
Perhaps you could be more specific as to what are the components to "wellbeing" that you are referring to.
- Scott
Posted by SLS on September 18, 2015, at 6:05:51
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by europerep on September 18, 2015, at 5:07:00
> I also strongly disagree with your qualification of a working antidepressant as an "amazing artificial crutch", but that's for a different thread I guess.
Don't get me started!
:-)
- Scott
Posted by Hello321 on September 18, 2015, at 15:42:11
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by SLS on September 18, 2015, at 5:59:47
http://www.drugs.com/sfx/lexapro-side-effects.html
Scott, i honestly thought negative effects on ones mood and cognition were already well recognized possibilities of taking antidepressants. In the link from Drugs.com i posted above, there are many possible side effects listed that affect mood and cognition. And many of them seem like they can be pretty severe.
From the artocle:
"Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.Adult and pediatric patients receiving antidepressants for MDD, as well as for psychiatric and nonpsychiatric indications, have reported symptoms that may be precursors to emerging suicidality, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Causality has not been established.[Ref]
"Very common (10% or more): Insomnia
Common (1% to 10%): Abnormal dreams, agitation, anxiety, nervousness, restlessness
Uncommon (0.1% to 1%): Abnormal thinking, aggravated depression, aggressive reaction, aggravated restlessness, alcohol problem, apathy, bruxism, confusion, confusional state, depersonalization, depression, emotional lability, excitability, feeling unreal, forgetfulness, hallucination, hypomania, irritability, jitteriness, obsessive-compulsive disorder, panic reaction, paroniria, sleep disorder, suicide attempt, tics
Frequency not reported: Mania, suicidal ideation
Postmarketing reports: Acute psychosis, anger, delirium, delusion, disorientation, non-accidental overdose, mood swings, nightmare, psychotic disorder, withdrawal syndrome"These side effects dont just affect the life of the person taking the med. They dont just end at the front door. They can very well have effects on the wellbeing of the patient. I am not understanding what more info people are insisting they need? Are they simply waiting for the FDA or who ever to tell them what the deal is before they make up their mind? I have my own anecdotal experience with such severe effects from various psychiatric meds, and ive mentioned it on this forum before. And im sure that has helped me to understand these severe reactions more easily. But i think theyre listed right there in front of us. And i feel some want to make it as techhnical as Bill Clinton when discussing what the meaning of the word "is" is.
Posted by SLS on September 18, 2015, at 16:26:14
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 18, 2015, at 15:42:11
I read the list of adverse events and reactions that you have provided, and I find them to be accurate.
I think that your use of the word "wellbeing" is what some people might be confused by. I interpreted your post as stating that one's desire to take care of themselves decreases as a result of antidepressant use. I have never had an antidepressant reduce my desire to take care of myself, despite occasional episodes of suicidal ideations.
The statistics are critical when interpreting the material that you quoted. Suicide attempt is considered to be uncommon, and may not be related to the treatment. Depressed people attempt suicide in the absence of drug treatment. Several different study methods have demonstrated that the rate of suicide attempts is lower in populations where antidepressant drug treatment increased. However, the media is now focused only on the "antidepressants cause suicide" phenomenon without ever discussing the rate at which this happens compared to the therapeutic effects that reduce suicide rates.
http://www.psychiatrictimes.com/articles/antidepressant-prescribing-associated-suicide-rates
- Scott
Posted by SLS on September 18, 2015, at 16:38:57
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 18, 2015, at 15:42:11
> I have never had an antidepressant reduce my desire to take care of myself, despite occasional episodes of suicidal ideations.
I would add that when an antidepressant makes me feel worse, I am less functional and therefore have difficulties taking care of myself, even though I still want to. When an antidepressant makes me feel better, my sense of wellbeing and desire to take care of myself increase tremendously.
I guess the point is: it is difficult to make sweeping generalizations about mental illness and its treatment.
I admire your courage and persistence in helping to explore an important issue. I hope you don't feel attacked personally.
- Scott
Posted by Hello321 on September 18, 2015, at 17:20:19
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by SLS on September 18, 2015, at 16:38:57
I like the discussion
Abnormal thinking, aggravated depression, aggressive reaction, aggravated restlessness, alcohol problem, apathy,onfusion, confusional state, depersonalization, depression, emotional lability, cute psychosis, anger, delirium, delusion, disorientation,mood swings, nightmare, psychotic disorder, withdrawal syndrome.
These are certain effects the treatments can have that stand out that surely can decrease a patoents wellbeing. And i think im referring to wellbeing in any sense of the word. Ive had experience with the effects of the treatment making me feel so bad, because of varying effects from different mefs, that i just think "F*** YOU!!" When it comes to anything and anyone. Just the general worsening of my mood caused by the med would make me almost completely intolerant of anyone that i feel at the time is getting in my way in life. And it is like my emotions and thpughts are capable of new lows that just didnt exist when not taking the med. So i think much darker, sometimes plain evil thoughts that never occured without the medication. Yeah, it was terrible. Then i have a friend who, upon trying an antidepressant (prozac) for the first time actually jumped off the bridge in my town. This kind of emotional instability is nothing like him. The bridge is i guess about 100 feet off the water below it, and he was fine because he landed in water. But he says prozac made him unable to control himself. This does seem off the wall to me, but im guessing this was an extreme case of mania? Hes on lithium noe and says it helps his mood a lot.
Then if a treatment just leads to a general worsening of depression, this is a decreased semse of wellbeing all by itself. But then there are the effects of worsened depression that can make it even worse. Being less emotionally capable to take care of yourself and your priorities, worsened sleep. Less energy. Irritability, etc... if these are new or made worse by an antixepressant, then wellbeing decreases further. And of course all these effects compounded together can have disasterous results.
Posted by SLS on September 18, 2015, at 17:50:15
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 18, 2015, at 17:20:19
> I like the discussion
What shall we do with cortisone?
"Psychiatric Adverse Effects of Corticosteroids"
"The most commonly reported corticosteroid-induced psychiatric disturbances are affective, including mania, depression, or mixed states. Most often, patients receiving short-term corticosteroid therapy present with euphoria or hypomania, whereas long- term therapy tends to engender depressive symptoms. 9 Although mood disorders occur in the vast majority of cases, either delirium or frank psychosis, typified by hallucinations, delusions, and disorganized thought, is the presenting syndrome in a sixth of patients. 10-12 Severe episodes of depression, mania, or psychosis frequently include suicidal ideation."
- Scott
Posted by SLS on September 18, 2015, at 17:52:55
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 18, 2015, at 17:20:19
Would you like to see antidepressants removed from the market or to be made illegal?
If not, why not?
- Scott
Posted by Hello321 on September 19, 2015, at 14:03:10
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by SLS on September 18, 2015, at 17:52:55
Its a difficult decision when it comes to deciding how any medical treatnent with the possibility of inducing and such severe effects. I was thinking as long as the patient/caregiver is fully informed about the risks of treatment, then let them be the final decision maker on if they should take the med or not. But if others having nothing to do with this persons treatment are harmed in certain cases because of further negative effects on the patients mental health, then thats a problem.
But i will likely post more on this later. I had my whole post written wben i clicked out of the page on accident. Lol sucks. But i had this part copied so i'll just post thos right now.
Posted by SLS on September 19, 2015, at 16:20:11
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 19, 2015, at 14:03:10
I'm sorry that you lost your post composition. That's a lot of time and effort to disappear. I sometimes use a word processor when writing long posts. Sometimes not. :-(
If you come to decide that antidepressants should be withdrawn from the market, what about angiotensin receptor blockers (ARBs)? ARBs can cause kidney failure. What about acetaminophen (Tylenol)? It can cause liver failure. Again, I think statisics are important when assessing the worth of a drug. So many people commit suicide when they are depressed and untreated, that I think any discussion without acknowledging this fact is of limited value.
This is an interesting outcome of the STAR*D study:
http://www.ncbi.nlm.nih.gov/pubmed/19217668
How do you feel about medicinal marijuana?
- Scott
Posted by Hello321 on September 19, 2015, at 20:58:20
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by SLS on September 19, 2015, at 16:20:11
Youre jumping ahead of me on this. Ive posted on topics similar to this many times on this site and dont think ive ever mentioned these medications should be banned. I just think patients need to be fully informed on all possible outcomes theses treatments can have. And they should be done so in the such a way as one would describe what sunlight feels like to someone who has never felt the sun. The positive and negative effects need to be fully understood. If a patient doesnt have time for this, then their mood problems likely arent bad enough to require prescription treatment.
Respectfully, i believe it is naive for anyone to think the public benefits from full transparency by the Drug Companies or regulatory agencies. Or any Association that is tied to psychiatric treatments. Im about to be doing ECT again and saw the ECT doc monday to vet the treatment set up. I had a friend with me and at one point he asked if ECT can cause brain damage. The ECT doc said a big "no". But thats untrue and one would know this if they simply read a paper titled
"Electroconvulsive therapy reduces frontal cortical
connectivity in severe depressive disorder"Or talked to those who have experienced seemingly permant negative effects from tbe treatment on certain aspects of their life that the brain has control over. If a patient just experiences some memories being permanently wiped away after doing ECT, then just what is that? Something being permanently altered in the brain by the ECT, right? And if this effect is negative in any way at all, then isnt that permanent brain damage from the ECT? We just need full transparency. We cant be giving medical "professionals" a pass when they are wrong for what ever reason with their info their job requires them to be informed on. They make too much $ off poor, sick, helpless people for this to be acceptable. Even with something as simple as when my psychiatrist at my last appointment said 20mgs of Viibryd isnt a therapeutic dose, when that dose was approved as a therapeutic dose for the treatment of depression some months ago. Their job is too important for them to be getting by without knowledge on how to do it properly.
Anyway, the Tylenol and tbe other med you mentioned (cant recall it at the moment) have warnings on them for the possibility of such negative effects being caused by them. There is no warning for the most controversial negative effects antidepressants can cause. Any speak of homicidal thoughts being induced by a psychiatric often results in anyone bringing it up being lookdd at like a crazed conspiracist theorist. Then there are permanent effects some have experienced from them, like sexual dysfunction. Even a permant change in brain/neurotransmitter function that van result in a permant worsening of ones mental health looooong after the treatment has been stopped.
I guess i shouldnt refer to these things as permanent. Longterm is a better word i guess, since if these effects go away at any point after experiencing them over a long period of time, theyre not technically permenant. I know these possible effects i mentioned are controversial. But lets stop doing things to discredit those suffering from them.
SoOOoooOo i guess i believe if its possible a chemical out there could benefit someones mental illness, then they should have access to it after being fully informed on all known effects it can have by a fully knowledgeable doctor who is "on their game" everytime a patient is in front of them (which currently isnt the case). And more precautions should be taken to minimize the worst effects happening, maybe seeing their doc more often could minimize this. Tho i myself in the past decided to opt out of letting my psychiatrist know about any of the darkest thoughts/emotions ive felt from treatment. Basically, i dont want to be locked in a mental hospital. Im sure others are like this too. Or if they think these thoughts could have the law step in and some of their rights taken away, then they may just keep these thoughts to themselves. And if these thoughts start to just feel so right, then bad things can happen to themselves or others. And i guess continuing to pfescribe these meds can just result in "collateral damage" at times. We need to get past debating on if this is possible and get to how to minimize this outcome as much as possible.
Posted by Hello321 on September 19, 2015, at 21:14:40
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 19, 2015, at 20:58:20
I drove to walmart earlier and made it back home to reply to you because i understand the possible risks of driving my car with other people also driving on the same roads. If i werent aware that sometimes, in rare occasions, that i could go around a curve with a car taking up my lane speeding right at me, then id be likely to not know what i should do in such a situation. then i wouldnt be discussing with you the possibilities of terrible things happening while taking chemicals to alter your brain function. Tbe public needs to understand any severe dangers.
This might be simplistic, but i think ot still relates to thr discussion very well.
Posted by SLS on September 19, 2015, at 22:43:35
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 19, 2015, at 20:58:20
Sorry, Hello.
I haven't followed your posts closely enough, I guess.
Anyway, I still think the study you posted is an important one to look at.
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001875
Have you had bad experiences with antidepressants? What were they?
Have you ever responded to an antidepressant? Which ones?
> Youre jumping ahead of me on this. Ive posted on topics similar to this many times on this site and dont think ive ever mentioned these medications should be banned.
That's why I asked the question.
What would you do to remedy the problems you have identified?
> I just think patients need to be fully informed on all possible outcomes theses treatments can have.
Okay. What about penicillin?
http://www.rxlist.com/pfizerpen-drug/side-effects-interactions.htm
When was the last time you were informed of all possible outcomes this treatment can have?
> And they should be done so in the such a way as one would describe what sunlight feels like to someone who has never felt the sun.
Beyond telling a depressed patient that they might feel worse, what would you like to see a doctor say to them?
> The positive and negative effects need to be fully understood.
Do you think a doctor should discuss the statistics involved for all possible sequalae? Wouldn't that be the only way to properly present them?
http://www.rxlist.com/prozac-drug/side-effects-interactions.htm
> If a patient doesnt have time for this, then their mood problems likely arent bad enough to require prescription treatment.
How very condescending. Who are you to determine the extent of the suffering of others? Not cool.
By the way, each manufacturer's container for a medication includes a package label that lists the treatment-emergent adverse events, even if there are no causal relationships. All you have to do is ask your pharmacist for it. I don't think the pharmacist will have enough of these labels to place on each vial he fills, though.Why would you subject yourself to ECT believing that it will produce brain damage?
Next time you go to ANY doctor, before you leave the office, ask him to verbally list ALL of the possible side effects of the drugs he prescribes. That should be interesting.
One idea is to have all doctors hand out to each patient a list of the possible side effects of the drugs being prescribed. That might be a problem for people with OCD, phobias, non-compliance, hypochondriosis, psychosis, etc. Somewhere, there should be a balance. I don't think sitting down with each patient and describing all of the possible side effects is consistent with finding such a balance.
You have identified very real problems. However, I don't think they apply universally to all doctors, drugs, or drug companies.
- Scott
Posted by Hello321 on September 19, 2015, at 23:51:28
In reply to Re: Young people on SSRI's commit more crimes? » Hello321, posted by SLS on September 19, 2015, at 22:43:35
Ive never taken penicillin? Havent said anything hinting i might have taken it either. Why are you asking that question?
I read the lists of all recognized effects on certain medications. But all possible effects arent listed.
I was trying to describe a goal we should aim for with mental health treatment. A goal of insuring patients are able to make fully informed decisions on their treatment.
But maybe youre right, that we dont need to be helping depressed patients make informed decisions by insuring theyre fully aware of what they could be getting themselves into by altering their brain function with these treatments. We need to have those in positions of authority protect them. These people care. Why else would they be be in that position?. By elling them they could become homicidal from the treatment might make them less willing to take it. And those who are depressed, or OCD ridden patients to be making decisions on their healthcare when the doctor always knows best. He/She also cares. Yeah, the scariest info needs to be clearly presented to those in positions of authority. And are much too harsh for us little people. Lets do business as usual. And if we have collateral damage consisting of uninformed patients who just had no idea, at least the authority figures protected those who they felt they should basically make decisions for by not making certain important info ckear. Its nice to play the role of the ultimate protector. Like a mother figure.
I try to find a middle ground of keeping meds that could be helpful to some patients on the market, even if they do harm others, as long as every patient is informed. But maybe thats not the way to go. Maybe i should take a stand for not allowing sick people to not make partially informed decisions on their treatment. And vote and write letters to my reps in government explaining my thoughts on the matter. Maybe participate in protests too. So that laws that give the ultimate protective mother figures with my point of views the authority to protect the public completely by banning antidepressants.
But really, i just want sick people to be allowed to make the final decision based on a complete picture. And yes, every situation should be treated uniquely.
Posted by Hello321 on September 20, 2015, at 0:43:47
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 19, 2015, at 23:51:28
Should the suicide warning be removed from antidepressants to lower any possible anxiety a depressed/anxious person might experience about deciding to start an antidepressant?
Posted by SLS on September 20, 2015, at 5:40:49
In reply to Re: Young people on SSRI's commit more crimes?, posted by Hello321 on September 19, 2015, at 23:51:28
The penicillin example: You either did not understand the concept of analogy or you have never been prescribed a drug without being shown the PDR by your doctor. Can you think of any instances when you have taken a drug without opening the PDR or its facsimile on the Internet? Antibiotic? Laxative? Aspirin? Hypoglycemic? Antihypertensive? Diuretics. Anticonvulsants? Antinociceptives? Choose a drug that you have taken other than one used for psychiatric purposes. We can then use RxList as a reproduction of the package label and see how you feel about the drug afterwards.
Would you agree that sufferers of mental illness are often plagued by cognitive impairments, poor judgement, psychoses, and an inability to comprehend information and make decisions?
As much information should be presented to the patient as makes sense in the clinical setting. It does not make sense to loan them a copy of the Physician's Desk Reference.
If you were a doctor, how would you present Prozac to your patient?
You know, if you can learn and process new information such that you can understand all of the side effects listed in the PDR, then you are not ill enough to be treated. I would argue that the patient who remains mute or dissociated or too severely psychomotor retarded in the doctor's office, and wants to leave as soon as possible, is precisely the one who needs the most aggressive treatment. There is irony there somewhere. Do I really believe that you don't need to be treated? Well, I imagine you are affected severely enough to want to turn to ECT, which you believe will damage your brain. Sometimes, one's verbal gifts can leak through enough to mask even the worst of depressions. If you add a little passion, someone's writing can seem perfectly fine and unaffected. Perhaps you fit into this category. Certainly, you are a good debater.
I am not a doctor, of course, and I wouldn't know where to strike a balance for each person needing treatment. I believe I would learn such balance after years of clinical experience and in communicating with colleagues and attending conferences, symposia, and CME. I would probably treat each person differently depending upon my clinical impressions of their illness, current mental state, and capacity to understand perspective. I would not tell them everything appearing in a PDR simply because they would not know how to interpret the information, and this may have a deleterious effect on compliance.
So... My answer is that I would not teach each patient everything there is to know about a drug. Neither would I stand mute writing on my prescription pad and having them leave with nothing more than a little blue piece of paper. Doctors learn more than just anatomy and physiology. They learn how to interact with patients of many different types of illness and illness severities. Optimized bedside manner should treat and inform. How and what to inform is the professional choice of the prescriber.
Regarding your writing letters, I think that's a good idea. I think it would help insure that doctors understand that there is an obligation to provide some information regarding the drugs they prescribe. Even though I don't agree with the extremes with which you would mandate such obligations, I think it would offer some new perspectives.
> But really, i just want sick people to be allowed to make the final decision based on a complete picture. And yes, every situation should be treated uniquely.
You can't have it both ways.
You either inform people about ALL adverse effects or you don't. In the latter case, a good doctor will draw from his clinical experience exactly what to teach each patient.
The black box warning on drug labels is justified in my opinion. We now see it for drugs that are not categorized as being psychotropics. The precipitation of suicidality is not limited to the realm of antidepressants. Until medical science can do better, these are the drugs we have to work with, and I thank God everyday for them. 100 years ago, I'm pretty sure I would have committed suicide before age 24. I also convey to God my anger for not being born 100 years from now, when medical science will have found a way to cure or produce life-long remission from bipolar depression. In the meantime, my immediate goal is to function well enough to return to employment. I still have a little ways to go. I will live a life of more mental energy, but be denied the recovery or improvements in interest, motivation, anhedonia, sex-drive, clarity of thought, sharp memory, animated affect, etc. That is no way to experience a life of limited years.
I have already tried ECT, but failed to respond to it. However, that was in 1991. The procedure has changed. Perhaps you will get lucky.
- Scott
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