![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 64 to 88 of 89. Go back in thread:
Posted by Greg on May 15, 2000, at 14:43:21
In reply to Re: Evidence For Forced ECT?, posted by SLS on May 15, 2000, at 14:00:24
Scott,
Educate me, what is the "criteria" (for lack of a better word), as you understand it, for subjecting a person to involuntary ECT? I've been doing some reading since this thread came up, but there is much I still don't understand.Tx,
Greg> Most states allow for the involuntary application of ECT.
>
>
> - Scott
Posted by gg on May 15, 2000, at 15:13:22
In reply to Re: I'm outa here (middle finger raised), posted by Adam on May 15, 2000, at 14:00:33
> Not too long ago, some idiot decided to post a "humorous" message filled with
> anti-Semitic language and references to Nazism. I practically begged to have
> it removed, and then aagonized afterward over the conflict I have with my
> feelings about public discourse being polluted with such filth and their
> juxtoposition with some equally strong feelings of opposition to censorship.I think there is a difference between fred's overreaction to someone's apparent misunderstanding and dismissal of an important issue and posts supporting Naziism. Of course if I'd felt attacked I might have seen it differently. I hope if it were me being attacked I would have the grace to retreat in the face of someone else's overwhelming pain. Of course it is dr bob's board and he has the legal right to enforce his own criteria.
boBB, I have to admire you for taking a stand. I certainly think your arguments deserve to be heard and I'm sure you'll find another forum for them. Psychobabble won't be the same without you though ;-)
>
> I think I may have found some peace with the issue, though I admit it's an
> uneasy peace.
>
> Nothing is perfect. No stable balance will ever be found between the need for
> free speech and the damage such freedoms can lead to when abused. Perhaps in
> some situations a certain amount of censorship is appropriate. For instance,
> this forum, contrary to your suggestion, is not in fact a "public" one. Dr.
> Bob states quite clearly in his disclaimer that this space is his, what goes
> into it is his, and he can do what he wants with it. He also lays down some
> simple rules, the most appropros to this discussion being the demand for
> civility.
>
> So, it is a place that all are invited (not entitled) to participate in, and
> that invitation is extended so long as we respect the host and each other. It's
> not our inalienable right to be here, it's our privilege. If we want to keep
> it, we shouldn't abuse it. It is a place to find support and gather information,
> not microcosm or meta-world where unrestricted speech should flourish. That is
> beyond its scope. Few restrictions are placed on us, though, so we have little
> cause to complain.
>
> Well, I feel better, anyway.
>
> little cause to complain.
>
> > Well, if that is the way you feel, I guess I will stop posting here.
> >
> > It seems the mutual education and support wanted by users of this board is one where the pro-university, pro-medical industry, pro-collegiate-speach camp is supported, and where those who engage in conversation styles more common to poor neighborhoods are excluded. It seems people here generally want their medical model of themselves as sick, helpless victims reinforced and any other kind of education excluded.
> >
> > It is perfectly okay for you to sit in a comedy club or tune in the comedy channel and listen to a person engage in political speach that includes insults, curses and name calling but when a person uses this style of speech outside a capitalist, paid venue relationship, it seems unacceptable.
> >
> > Why is it that so many people here claim to have problems with rage and call it a medical problem, but when someone expresses legitimate rage, it they are treated with utter contempt? It sounds to me like those who like to call themselves sick and whine about being stigmatized are afraid their paper-thin analysis of themselves will fall apart if exposed to any other point of view.
> >
> > You educate me only as to your narromindedness and you support me or my ally Fred none whatsoever. If I have anything to say here, you can expect it to be said with audacious rage, and using another alias and alternate ISP's and with all cookie's blocked so as to end-run any attempts to censor my speach in this PUBLIC RESOURCE
> >
> > Fred's speach was nowhere near equivilant with yelling fire in a theater. It was annoying because in impinged on your world view. Get a clue. This kind of speach is all over the internet. Frankly, all of this medical model BS and diagnosis of supposed illness, in cases where people to numb to hear the voice of their conscience are called depressed, is a personal insult to me and to all living beings. Your insistence on the medical model, coupled with a legal system where I can be committed with no benifit of a jury hearing is a real physical threat to me.
Posted by gg on May 15, 2000, at 15:39:42
In reply to Re: I'm outa here (middle finger raised), posted by gg on May 15, 2000, at 15:13:22
thanks for your courage in sharing a painful part of your life. It is important to bear witness to these horrors no matter how long ago. god bless you,fred. gg
Posted by Jamie on May 15, 2000, at 17:37:32
In reply to Re: Don't stop - Being civil, posted by Greg on May 15, 2000, at 9:37:50
I received an interesting e-mail this morning from someone named Fred Stone, directing me to this thread. I am not sure if it is the same Fred who got booted from this thread, but Mr. Stone offered some intersting links.
One link was to a state of California study that indicated most ECT therapy is given to people age 65 and older. Another mentioned a Texas newspaper's study that revealed ECT is most often paid for by medicaid.
The e-mail started off with suggestions about the role of anti-depressants in school shootings. It ended with links to information about the drug war, and especially the role of former New York Governor David Rockefeller.
In the middle of the e-mail was information about John D. Rockefeller, founder of the University of Chicago. The link talks about J. Rockefeller's Standard Oil monopoly and the vast amount of wealth he accumulated for his estate and the organizations he endowed, which include the University of Chicago. There was also some information in there about the University's role in the production of the first atomic bomb.
I am not sure how Mr. Stone got my e-mail address, or how he knew of my interest in these topics. Electronic dialogue breeds some strange bedfellows. Nor do I know who else received this information, but in the interest of better understanding, I decided to post it here.
Received from Fred Stone, May 15, 2000:
___________________________________________Here is something to thing about:
Kip Kinkel, who in Springfield, Oregon in May of 1998 opened fire in a high school and also killed his parents, was taking Prozac.
Eric Harris was rejected by Marine Corps recruiters just five days before the April 20, 1999 Columbine massacre because he was on an anti-depressant medication known as Luvox.
What the people of Colorado say:
http://www.denverpost.com/news/leg/leg1110.htm
http://www.ktb.net/~psycrime/pc-287.htm
http://www.ktb.net/~psycrime/pc-230.htm
http://www.ktb.net/~psycrime/ed-05.htm
http://madnation.org/parity.htm
http://madnation.org/news/kendra/strategiesthatwork.htm
http://www.madnation.org/news/kendra/nyaprsspeaks.htm
The University of Chicago was founded by John D. Rockefeller:
http://www.micheloud.com/FXM/SO/rock.htm
http://www.fm.co.za/99/0423/trends/ctrend.htm
http://www.homestead.com/AmHistory/Industrialism.html
http://www.indian-express.com/fe/daily/19980520/14055524.html
In January 1942, Enrico Fermi's on-going work with graphite and uranium was transferred to a new secret project, code named the Metallurgical Laboratory (Met Lab) at the University of Chicago. In April, Fermi begins design of CP-1, the world's first (human built) nuclear reactor.
Frederick Rudolph, professor of history at Williams College, wrote in his 1962 study, The American College and University: A History,
"No episode was more important in shaping the outlook and expectations of American higher education during those years than the founding
of the University of Chicago, one of those events in American history that brought into focus the spirit of an age." (U of Chi web site)
ALL IN THE FAMILY:http://www.walrus.com/~resist/resist_this/120798nyprisons.html
http://ndsn.org/FEB95/NEWYORK.html
http://www.november.org/
http://www.cjcj.org/jpi/nysom.html
http://macc.4mg.com/
http://www.igc.org/hrw/campaigns/drugs/index.htm
http://www.csdp.org/factbook/crime.htm
http://www.mapinc.org/
Posted by Mark H. on May 15, 2000, at 19:54:56
In reply to Information, posted by Jamie on May 15, 2000, at 17:37:32
Hi Jamie,
I received the information from "Fred Stone" as well. I believe it is important to open dialogs with those who experience things differently than most people, because there is no compelling evidence that any one point of view or understanding of relative reality is correct.
In other words, as I've been reminded, a label such as "psychotic," while useful within the "majority reality" for quickly and efficiently dealing with a too-large caseload or prescribing medications based on the experience of other physicians, breaks down as a definitive explanation for a person under closer examination -- as does any label. It's not that "psychosis" doesn't exist -- it's just a cluster of enough-similar symptoms to justify a diagnosis -- but that everyone seems to be somewhere on a continuum that includes psychosis. As such, our only argument for "correctness" is that more people see the world the way "we" do than the way "they" (i. e., schizophrenics) do. That's not much of a basis for an argument!
I have some intuitive ability. I really don't care if someone who doesn't believe in intuition says I'm picking up on visual cues, small subconscious signals in body language or tone of voice, or making generalizations that apply to everybody. That's fine. I don't need an explanation to know what I know, and the basis for my knowing is unimportant to me. But if I presented it in the "wrong" way, I could be considered insane. Instead, people used to seek my advice on a regular basis. There's an interestingly small difference there. (I quit doing readings when I couldn't reliably set my depression aside.)
When someone sees vast, interconnected conspiracies controlling the world right down to a particular individual (usually the person perceiving the conspiracy), my internal "oh, this person is a paranoid" alarm usually goes off.
But increasingly, I'm interested in knowing what exactly they perceive. Why? Because most spiritual paths state that heaven and hell are right here on earth, that they are not "somewhere else," that all realities are in fact co-existing in the same place and time. "Healthier" or at least "happier" people generally exhibit more denial and assumption of goodness than "less healthy" or at least "less happy" people. "Correct" or "incorrect" becomes a bit of a blur. I sometimes wonder if we were all instantly aware of all the suffering and wrongdoing in the world, we might despair and want to kill ourselves -- yet my teacher says just the opposite is true. On the other hand, if we are able to perceive the emptiness of even the most seemingly debased and sadistic phenomena, then we're free, aren't we?
Buddhism suggests that the outer world doesn't need to change to be understood as perfect and empty of any inherent reality. Yet my lama claims that no one ever got to enlightenment from negativity, so I smile that once again Buddhism proves practical as well as epistemological.
So if I choose the relative delusion of happiness and trust and innate goodness over the relative delusion of unhappiness and distrust and evil, it is for a reason, and not just because I think it is more "correct." I am interested in the personal experiences of the damned, as it were, because in understanding my differences and similarities with them I might glimpse an enlightened person's differences and similarities with me, and in doing so, choose to move more towards the light, towards positiveness, greater healing, and ultimately, benefit for others as well as for myself. I'm just a selfish beginner who is longing to be a little less so.
Best wishes,
Mark H.
Posted by Cam W. on May 15, 2000, at 22:22:50
In reply to Re: Information and Relative Realities, posted by Mark H. on May 15, 2000, at 19:54:56
I got that Fred Stone e-mail as well. So, it's from here. Since many of us post our e-mail addresses I guess we have to put up with it. Actually I got the e-mail twice (twice blessed).
The sites he has posted are not, to my knowledge, peer reviewed statements, but news items. To be honest, I did not go to all sites, but I did see enough to tell me that we are dealing with someone with an agenda.
Perhaps it was perpetrated by an organization who seemingly has an agenda to discredit medicine and to be more specific, psychiatry. Hmmm, I wonder who they could be?
Musing over the possibilities - Cam
Posted by bob on May 15, 2000, at 23:00:18
In reply to Fred Stone, posted by Cam W. on May 15, 2000, at 22:22:50
I guess I'm yet another "friend of Fred Stone."
Personally, I cannot see the connection between Enrico Fermi, Luvox, and Columbine ... but I guess I should visit the web sites to find out.
[time to poke tongue firmly in cheek...]
My guess? What's the car commercial with the guy driving the Volvo or something like that, whiteish hair, flattop buzz cut, pocket protector and pens, listening to the conspiracy theory talk radio program, driving through the desert ... pulls off the road after the advertised car won't get off his tail even after he thinks they're eating his dust. I think THAT guy is Fred Stone.
"Takes all kinds ...."
knowhutimean?
bob
Posted by boBB on May 16, 2000, at 0:11:39
In reply to Re: Fred Stone, posted by bob on May 15, 2000, at 23:00:18
No agenda, no salary, not even my own personal computerYou forgot to watch the end of the commercial, which is never broadcast for commercial reasons. The couple in the advertised car died in a fiery crash moments later, a result of their own excessive speed. They left three children to grow up as orphans.
Try to involuntarily commit me, Motherfucker, and I will rip your head off and stuff it up your ass PROFESSOR!!!
Know where I learned to talk like that? The United States Army.
Vote Democrat. I do.
Posted by SLS on May 16, 2000, at 7:07:36
In reply to Re: Information and Relative Realities, posted by Mark H. on May 15, 2000, at 19:54:56
A few personal thoughts...
I don't know what lies beyond.Life for us is on earth.
You only go around once in the flesh as You.
I'm afraid to bet on anything else.
- Scott
Posted by Elizabeth on May 22, 2000, at 4:25:11
In reply to Information, posted by Jamie on May 15, 2000, at 17:37:32
> One link was to a state of California study that indicated most ECT therapy is given to people age 65 and older. Another mentioned a Texas newspaper's study that revealed ECT is most often paid for by medicaid.
The elderly often find it difficult to tolerate the side effects of antidepressant drugs, especially because they're more likely than younger people to be taking lots of other drugs as well.
> The e-mail started off with suggestions about the role of anti-depressants in school shootings.
Hmm -- like, for example, Eric Harris, who stopped taking his Luvox shortly before gunning down a bunch of his classmates?
These days, troubled people are liable to be taking antidepressants. Do the antidepressants always work? No, obviously not. But do the antidepressants make them more troubled? I doubt it.
> In the middle of the e-mail was information about John D. Rockefeller, founder of the University of Chicago. The link talks about J. Rockefeller's Standard Oil monopoly and the vast amount of wealth he accumulated for his estate and the organizations he endowed, which include the University of Chicago. There was also some information in there about the University's role in the production of the first atomic bomb.
Loose associations????
The more I read, the more I wonder whether this fellow you heard from is (or was) suffering from acute mania. If he (or she) is reading, I urge him (or her) to look into or at least consider the possibility.
Posted by grannybabble on May 22, 2000, at 14:43:13
In reply to Re: Information, posted by Elizabeth on May 22, 2000, at 4:25:11
> Loose associations????
>
> The more I read, the more I wonder whether this fellow you heard from is (or was) suffering from acute mania. If he (or she) is reading, I urge him (or her) to look into or at least consider the possibility.
I know you must feel strongly about these issues to have brought this thread forward and I think that is good,but I think it would be most useful if we focused on the ideas and issues rather than personalities.
There seems to be an increasing tendency on this board (and I'm not totally innocent) towards labeling others behaviours and beliefs as evidence of pathology. I think this is wrong. I apologize for doing it if I have.
I think acute mania is not something that can be diagnosed by a stranger in cyberspace. I think someone in acute mania probably would not be receptive to your suggestions anyway no matter of how well meant they may or may not have been.
I think we would all do well to argue with people's ideas and not offer diagnosis. When a diagnosis is appended to a disagreement it seems to perpetuate stigma and I'm sure you don't want to do that.
After all loose associations are also associated with creativity.
Posted by Adam on May 22, 2000, at 20:47:41
In reply to Re: Diagnosing/labeling others, posted by grannybabble on May 22, 2000, at 14:43:13
It seems it was just a suggestion. I saw someone when I was in the hospital suffering from "acute mania". She
was given Celexa, and it precipitated a manic episode. She was still in enough command of her faculties to voluntarily
isolate herself after repeated suggestions that her behavior was becoming inappropriate, and that if she did not
make some effort to keep from accosting people, that effort would have to be made for her. She had a lot on her mind,
and felt whoever was nearby needed to hear it. It was very sad, because once it was over, she returned to har usual
self, which was very sweet and actually quite introverted, though admittedly, depressed. I hope she found some relief.If "Fred" was/is in a manic state, he may not realise it. To be so informed might save him some serious trouble, if
not his life. If he is not so afflicted, no harm done. I imagine "Fred", who clearly displayed some odd and
inappropriate behavior, might benefit from an evaluation. Whatever impells him to get that is a positive thing.
> > Loose associations????
> >
> > The more I read, the more I wonder whether this fellow you heard from is (or was) suffering from acute mania. If he (or she) is reading, I urge him (or her) to look into or at least consider the possibility.
>
>
> I know you must feel strongly about these issues to have brought this thread forward and I think that is good,but I think it would be most useful if we focused on the ideas and issues rather than personalities.
> There seems to be an increasing tendency on this board (and I'm not totally innocent) towards labeling others behaviours and beliefs as evidence of pathology. I think this is wrong. I apologize for doing it if I have.
> I think acute mania is not something that can be diagnosed by a stranger in cyberspace. I think someone in acute mania probably would not be receptive to your suggestions anyway no matter of how well meant they may or may not have been.
> I think we would all do well to argue with people's ideas and not offer diagnosis. When a diagnosis is appended to a disagreement it seems to perpetuate stigma and I'm sure you don't want to do that.
> After all loose associations are also associated with creativity.
Posted by SLS on May 26, 2000, at 8:06:25
In reply to Re: Information, posted by Elizabeth on May 22, 2000, at 4:25:11
Hi Elizabeth.
I wanted to ask you three questions and make one comment.
> The elderly often find it difficult to tolerate the side effects of antidepressant drugs, especially because they're more likely than younger people to be taking lots of other drugs as well.
Is there a greater occurrence of melancholic or psychotic depression in the elderly?I am pretty sure that tricyclics tend to be more effective in the elderly. Is this true?
Do you think pseudodementia is being more properly diagnosed as depression now as compared to ten years ago?
> > The e-mail started off with suggestions about the role of anti-depressants in school shootings.> Hmm -- like, for example, Eric Harris, who stopped taking his Luvox shortly before gunning down a bunch of his classmates?
> These days, troubled people are liable to be taking antidepressants. Do the antidepressants always work? No, obviously not. But do the antidepressants make them more troubled?
> I doubt it.
Don't.
- Scott
Posted by Cam W. on May 27, 2000, at 1:06:17
In reply to Re: Information - Elizabeth, posted by SLS on May 26, 2000, at 8:06:25
Scott - I have been bonig up on my geriatric psychopharmacology lately. Here is some of what I remember from what I have read.
> Is there a greater occurrence of melancholic or psychotic depression in the elderly?
Not really. Many depressions in the elderly are drug-induced (eg corticosteroids, NSAIDs, phenothiazines) or disorder-induced major depressive disorders (Parkinsonism, Alzheimer's, chronic bronchitis). Many depressions in geriatric patients are missed because many of the symptoms of depression are also thought to be results of aging. Ten percent of late-onset depressions (depression in the elderly) have comorbid severe cognitive impairment, though. Seventy percent of elderly depressed patients have measureable cognitive deficits, which can affect their quality of life. Cognitive impairment increases normally with age, further with depression and still further with the exacerbating effects of many centrally active drugs, including antidepressants.
>
> I am pretty sure that tricyclics tend to be more effective in the elderly. Is this true?No. Several studies have demonstrated that TCAs produce impairment in cognitive and psychomotor function that is not just due to sedation. The TCAs have very potent antihistaminic effects (histamine release facilitates cerebral arousal through it's interaction with postsynaptic H1 receptors which is block by antihistaminergic action). TCAs also have very potent anticholinergic effects (the cholinergic system is also involved in the maintenance of arousal and more specifically, in the encoding, immediate active processing and storage of information - ie working memory, it's transferral to long term memory and memory retrieval ; anticholinergic effects block this).
Both of these effects can cause psychomotor impairment by retarding the flow of sensoimotor information (esp. during activities requiring continuous manual control - eg driving a car). Tolerance does develop to the sedation and psychomotor impairment caused by TCAs, but not to memory disturbances. Therefore, TCAs should not be used in the elderly, if at all possible.
Paxil, while used extensively in the geriatric population, may also not be a good choice. It has anticholinergic effects and may decrease dopamine neurotransmission (via sertonergic mechanisms) in the prefrontal cortex, leading to cognitive related deficits. Zoloft or Celexa may be a better choice in the elderly (although, because Celexa is a purer SRI, it may also cause some hypodopaminergic related cognitive deficits). Zoloft enhance PFC dopaminergic function to a certain extent.
>
> Do you think pseudodementia is being more properly diagnosed as depression now as compared to ten years ago?Sorry, don't know. I'm a terrible diagnostician.
Posted by Kellie on May 28, 2000, at 10:30:04
In reply to Re: Diagnosing/labeling others, posted by Adam on May 22, 2000, at 20:47:41
> I'm a new reader here, found this site just today. I need help with my depression and when I read all these threads I began to wonder just what was so wrong with me.Let me state firmly that I can understand all the positions taken. It's a curse I seem to have, to be able to see all the sides of the coin at once. Fred is not manic. His experience with ECT wasn't just with the ECT. It was with the total loss of control of his life to people who appeared not to care about him, only about the results of their treatments. This would cause anyone to erupt in rage if they perceived someone else making light of it. My own mother often accused me of just trying to get attention when my emotions got out of control. Even after diagnosis and honest to god medical treatment, I still can't get my family to stop blaming me for a chemical imbalance I didn't ask for. I can also understand the bewilderment on others' part in not understanding Fred's anger. If you've never been thru such an experience you can't possibly know how it feels. Also, for people who have never suffered from depression, knowing what it does to your life is impossible to understand. If you live with a depressive, you have an inkling, if you've never encountered one, you can't have any clue. Anyone can resort to insults when they run out of intelligent things to say, but keep aware that depressives have little or no emotional control. It's a symptom of the illness. Don't judge Fred or boBB too harshly. If this board if for educational purposes let it also be for enlightenment. A mental illness takes control away from you. I would like to learn how to get control back. I've learned a lot from reading these messages, but it worries me that so many people would rather argue over semantics that get to the core of the issue. I'm 35 and I've had major depression for 30 of those years. I've been on medication for 5 years. It's helped and not helped. I have learned not to waste precious time over the little things. Fred's anger was not little. The reaction all of you had to him was not little. But the continuing discourse is. Be done with it and help me to learn other ways of treating my illness. I want to know exactly what ECT is and what an MAO is and whether there's more out there for me than Paxil and Effexor. Please don't let me down, my family doesn't really understand what's going on with me and my doctor never has enough time. I need information. Thanks for listening, Kellie.
> It seems it was just a suggestion. I saw someone when I was in the hospital suffering from "acute mania". She
> was given Celexa, and it precipitated a manic episode. She was still in enough command of her faculties to voluntarily
> isolate herself after repeated suggestions that her behavior was becoming inappropriate, and that if she did not
> make some effort to keep from accosting people, that effort would have to be made for her. She had a lot on her mind,
> and felt whoever was nearby needed to hear it. It was very sad, because once it was over, she returned to har usual
> self, which was very sweet and actually quite introverted, though admittedly, depressed. I hope she found some relief.
>
> If "Fred" was/is in a manic state, he may not realise it. To be so informed might save him some serious trouble, if
> not his life. If he is not so afflicted, no harm done. I imagine "Fred", who clearly displayed some odd and
> inappropriate behavior, might benefit from an evaluation. Whatever impells him to get that is a positive thing.
>
>
> > > Loose associations????
> > >
> > > The more I read, the more I wonder whether this fellow you heard from is (or was) suffering from acute mania. If he (or she) is reading, I urge him (or her) to look into or at least consider the possibility.
> >
> >
> > I know you must feel strongly about these issues to have brought this thread forward and I think that is good,but I think it would be most useful if we focused on the ideas and issues rather than personalities.
> > There seems to be an increasing tendency on this board (and I'm not totally innocent) towards labeling others behaviours and beliefs as evidence of pathology. I think this is wrong. I apologize for doing it if I have.
> > I think acute mania is not something that can be diagnosed by a stranger in cyberspace. I think someone in acute mania probably would not be receptive to your suggestions anyway no matter of how well meant they may or may not have been.
> > I think we would all do well to argue with people's ideas and not offer diagnosis. When a diagnosis is appended to a disagreement it seems to perpetuate stigma and I'm sure you don't want to do that.
> > After all loose associations are also associated with creativity.
Posted by SLS on May 28, 2000, at 13:32:56
In reply to Re: Diagnosing/labeling others, posted by Kellie on May 28, 2000, at 10:30:04
Hi Kellie.
I just thought I'd say hello and tell you that I think you'll find quite a bit of constructive and helpful discourse on this board. I can see that you've been quite busy today, so I guess you've already discovered that. I guarantee that "we" won't let you down, especially now that you are part of the "we".
Yes, being able to see all of the untold sides of the same coin can sometimes seem like a curse. It often plagues me. You know, of course, that this is a wonderful attribute. However, it takes quite a bit of work to manage it and synthesize your own ideas and conclusions. I look forward to hearing some of your curse words. :-)
> > I'm a new reader here, found this site just today. I need help with my depression and when I read all these threads I began to wonder just what was so wrong with me.Let me state firmly that I can understand all the positions taken. It's a curse I seem to have, to be able to see all the sides of the coin at once.
> > Fred is not manic.
This may be true. I have no reason to believe otherwise. I haven't read the entirety of this thread because I have no desire to. I felt it was more destructive than constructive. I only submitted a few posts that I thought were relevant.
I have seen people who were manic. It is the nature of that particular mental state that the sufferer usually does not recognize it. They fight like hell to prove otherwise. One of the symptoms of mania that sometimes develops is a thought process that creates "loose associations". The person makes associations between things for which there is little connection. They find it difficult to stay on the same topic, and present a flight of ideas.
Example:
dog -> fire hydrant -> fire -> water -> water-buffalo -> Buffalo Bill -> Wild West -> Call of the Wild -> dog
Uh oh. That was too easy.
> My own mother often accused me of just trying to get attention when my emotions got out of control. Even after diagnosis and honest to god medical treatment, I still can't get my family to stop blaming me for a chemical imbalance I didn't ask for.Coming from you, they probably give your explanation little credence. Hearing it from a doctor helps, but not always. Seeing it in black-and-white can be quite persuasive. At this point, you may not have enough reason to pursue educating them, but there are often classes devoted to family-education about mental illness offered by local advocacy groups and mental health facilities.
> I can also understand the bewilderment on others' part in not understanding Fred's anger.
> If you've never been thru such an experience you can't possibly know how it feels.
> Also, for people who have never suffered from depression, knowing what it does to your life is impossible to understand.
> If you live with a depressive, you have an inkling, if you've never encountered one, you can't have any clue.Yes. Yes. Yes. Yes.
> Anyone can resort to insults when they run out of intelligent things to say, but keep aware that depressives have little or no emotional control.
People don't need to suffer a mental illness to behave this way. This sort of thing happens here from time to time. There all sorts of people, all sorts of posts, all sorts of ways to be lured into participating in these sorts of threads, and all sorts of ways not to. I encourage you to exercise your choice not to.
> I'm 35 and I've had major depression for 30 of those years. I've been on medication for 5 years. It's helped and not helped.
This is the reason why many people end up here, and, hopefully start here.
> I want to know exactly what ECT is and what an MAO is and whether there's more out there for me than Paxil and Effexor. Please don't let me down, my family doesn't really understand what's going on with me and my doctor never has enough time. I need information. Thanks for listening, Kellie.
LOUD AND CLEAR!
:-)
See ya'
Sincerely,
Scott
Posted by andrew on May 29, 2000, at 1:32:30
In reply to Hi Kellie, posted by SLS on May 28, 2000, at 13:32:56
The information about serotonin syndrom elsewhere on Dr. Bob's site should provide some clues as to how mass murder might be related to the use of pdrugs. Many people talk here about the agitation and mania they experience taking SSRI's and other AD's. Few people smart enough to be interested in this site are so viscious as to be interested in mass murder, so it might be hard to understand how a pdrug-augmented manic episode could escalate severe angst to the point that a person executes a murderous plan conceived while they were depressed. Put yourself in someone elses shoes and think again.
School counselers might want to take notice. The social conflicts associated with depression don't neccessarily evaporate just because someone starts taking a prescribed drug.
Harris was planning the school shooting long before he did it - he posted his plans on a web site months in advance apparently during the same period he was taking Luvox. I am not aware of evidence of when he took his last dose. He was rejected by a military recruiter because of his Luvox treatment a few days before the shooting. Harris is only one of several recent mass-shooting suspects who had been taking ADs.
Power to Harm is an interesting text that explores the correlation of mass murder with SSRI's. It details a shooting at a newspaper press room in Louisville, Ky. and the subsequent civil trial in which Lillie was the defendant.
The shooter was prescribed Prozak but his doctor noticed the guy was so agitated he told him to quit taking it. The shooter liked it, though, and continued taking it. The author says that was the trial that set the precedent for later civil litigation concerning drug maker's liability for criminal acts committed by people on SSRIs. Several other civil suits were pending at the time, but were dropped after Lillie won the Standard Gravieur case. The author contends that Lille paid an undisclosed sum of money to the plaintiffs in exchange for their agreement to not introduce evidence of incomplete clinical testing of Prozak (during the FDA approval process) and to not introduce evidence of Lillie's previous CRIMINAL convictions (misdemeanor) for falsefying drug testing data.
The argument that mentally ill people are more likely to commit person crimes and that there actions are not related to pdrugs has been around for a while. It is the first line of argument of pdrug companies, but we need to remember they are motivated in part by profit interests. Corporate leaders have a long well-documented history of spin-doctoring information to protect their profits. The legal legacy surrounding these medicines is at least as informative as the drug-makers arguments.
Posted by Cam W. on May 29, 2000, at 6:55:11
In reply to Re: Hi , posted by andrew on May 29, 2000, at 1:32:30
Andrew - I have extensively researched the relationships between stgma, violence and mental illness. I have one article published and have given numerous presentations on the subject. The NHS (hardly paid by the drug companies) in the U.K. has paid for many studies into these topics and are involved in an ongoing mental illness anti-stigma campaign.The Lancet a year or two ago published a collection of articles on the stigma of mental including a couple on violence and the mentally ill. They concluded that the amount of violence perpetrated in society is miniscule compared to the amount of violence that occurs (especially when excluding substance abuse-related violence). The only risk of increased violence in the mentally ill occurs in the "untreated", severely mentally ill person.
Drug companies have backed up their drugs in court, most notably Eli Lilly in the early 1990s. The Church of Scientology released press reports that were alarmist and unscientific (made to look scientific). The Church overstated the numbers of Prozac-related deaths in their statistics by a factor of more than ten. The reason for these suicides while taking Prozac was that the Prozac was relieving the depressive symptoms in these people who committed suicide. These people already had suicidal ideation and the Prozac had given them more energy to act upon their impulses. So, yes, I guess you could say that it was the Prozac that caused their death by relieving their depression. I guess if these people were never treated, and were depressed for the rest of their lives, they wouldn't have committed suicide.
Any disease requires disease-management. There are no cures in pharmacy. All of the medication are only bandages. Psychotherapy is necessary (be it talking to a therapist, your pastor, a family member, or a friend) to recover from depression. It has been well established that drugs alone will not "cure" a depression. It is people with mental illness, who have violent or suicidal thoughts, that neede to be followed closely during treatment. Other people who know a potentially violent or suicidal person (and especially the doctor) can notice signs of changes in the ill person (usually before that person does) and can head off any potentially violent of suicidal tendencies as someone recovers from depression. Recovery does not occur in a vaccuum.
Sincerely - Cam
Posted by Cam W. on May 29, 2000, at 6:57:39
In reply to Hi Kellie, posted by SLS on May 28, 2000, at 13:32:56
Kellie - Any specific questions you have about psychotropic medication will most likely be answered on this board (usually by several people in slightly different ways). So, ask away!
Welcome! - Cam
Posted by SLS on May 29, 2000, at 11:31:40
In reply to Re: Drug-related Violence , posted by Cam W. on May 29, 2000, at 6:55:11
> The Church of Scientology released press reports that were alarmist and unscientific (made to look scientific).
They have made a science of this.
> The reason for these suicides while taking Prozac was that the Prozac was relieving the depressive symptoms in these people who committed suicide. These people already had suicidal ideation and the Prozac had given them more energy to act upon their impulses.
This is, of course, true in many cases. I guess this applies with any antidepressant. A good psychiatrist understands that there is an increased risk of suicide within the first three or four weeks of treatment (assuming they begin to respond after two weeks), exactly for the reasons you describe. This makes a good argument for close doctor supervision using weekly visits.
> So, yes, I guess you could say that it was the Prozac that caused their death by relieving their depression. I guess if these people were never treated, and were depressed for the rest of their lives, they wouldn't have committed suicide.
A definite possibility.
> Any disease requires disease-management. There are no cures in pharmacy. All of the medication are only bandages.
Gosh, the term "bandage" really rubs me the wrong way. Sorry, Cam. I do know what your point is, though. A bandage sounds like a temporary superficial patch to be used until the REAL problem is solved. Yes, a bandage stops the bleeding, but it does nothing to prevent the wielded knife from opening up the wound again, or cutting open new ones. I would rather think of an antidepressant as being more of a corrective agent, changing the operation of the brain to bring about a restoration and normalization of function. That this correction must be maintained by the drug that produces it indefinitely indicates that the illness has not been cured. But it is in remission. It has gone away.
> Psychotherapy is necessary (be it talking to a therapist, your pastor, a family member, or a friend) to recover from depression.
No. (Sorry again)
> It has been well established that drugs alone will not "cure" a depression.
See above.
I find this to be a misleading application of semantics. It is well established that insulin injections alone will not "cure" diabetes. Neither will psychotherapy, although it might help preserve glucose dynamics by reducing stress. (wild guess)
> It is people with mental illness, who have violent or suicidal thoughts, that neede to be followed closely during treatment. Other people who know a potentially violent or suicidal person (and especially the doctor) can notice signs of changes in the ill person (usually before that person does) and can head off any potentially violent of suicidal tendencies as someone recovers from depression. Recovery does not occur in a vaccuum.
Getting back to antidepressant-induced suicide and violence...
That this occurs is so manifestly true.
I don't think it makes sense to begin a discourse as to the phenomenology of the psychobiological substrate for spontaneous suicidal states (as opposed to a cerebral decision making process) and for that of violence. There is a plethora of personal descriptions on this board to demonstrate conclusively that this is indeed the case.
Check out the posts that are on the board right now!
Serzone-induced anger. What's this all about? Prozac-induced agitation. Wellbutrin-induced rage. How might the evolution of these mental states affect the behavior of a disgruntled postal worker with a gun? Browse the board, you'll find plenty more.
* I apologize for the postal worker thing. It just made for an easily described scenario based upon its popularity. I make no judgments as to its validity.
I experienced reboxetine-induced suicidality. Unfortunately, this was not a manifestation of an improvement of depression. It is significant that my suicidal state was dose-dependant. At 4mg., I experienced anxiety, dysphoria, and some catastrophic thinking. At 8mg., these things became quite severe, and suicidal ideation became prominent. I called my parents and told them that I wanted to begin getting my affairs in order. I wanted to hide my savings so that I could bequeath it to family and friends, leaving the state to pay for my burial. Suicidality vanished within 36 hours of my last dose of reboxetine.
What about violent rage produced by benzodiazepine-induced disinhibition? Alcohol?
Of course, psychotropics are not the only drugs capable of exerting a psychotropic effect resulting in depression, aggression, or psychosis. Prednisone, Dianabol, testosterone, Inderal, reserpine, digoxin, l-dopa - Cam, help me out here.
These are just things that can happen when only *one* drug is used. What about combinations of drugs?
Suicidal or violent psychological profile + drug-induced biological perturbation = Suicide and Murder.
This stuff is so obvious, regardless of the statistical rate of occurrence.
If we don't take our heads out of the sand with this one, more people will get hurt.
Drug-induced depression, aggression, rage, psychosis, and suicidality should all be regarded simply as being the adverse side effects and reactions that they are. Just like any other set of drug side effects, they must be screened for through appropriate monitoring. Patients should be educated to the potential of these reactions and be encouraged to report them.
As far as psychological versus biological causes and remedies for depression are concerned, I think it is best conceptualized as a spectrum of contribution and interaction. I may be bipolar, but I hope my posts don't give the impression that I am bound by polar thinking.
I wrote a little piece back aways that I think makes a good framework for this conceptualization (it may suck, but I like it just the same). "Biology or Psychology?" It's pretty short.
http://www.dr-bob.org/babble/20000401/msgs/29296.html
* Does Prozac cause suicide? Yes.
Balance.
- Scott
--------------------------------------------------------: Biol Psychiatry 2000 May 1;47(9):804-12 Related Articles, Books
Lactate-induced rage and panic in a select group of subjects who perpetrate acts of domestic violence.George DT, Hibbeln JR, Ragan PW, Umhau JC, Phillips MJ, Doty L, Hommer D, Rawlings RR
Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-1610, USA.
[Medline record in process]
BACKGROUND: Perpetrators of domestic violence frequently report symptoms of autonomic arousal and a sense of fear and/or loss of control at the time of the violence. Since many of these symptoms are also associated with panic attacks, we hypothesized that perpetrators of domestic violence and patients with panic attacks may share similar exaggerated fear-related behaviors. To test this hypothesis, we employed the panicogenic agent sodium lactate to examine the response of perpetrators to anxiety fear induced by a chemical agent. METHODS: Using a double-blind, placebo-controlled design, we infused 0.5 mol/L sodium lactate or placebo over 20 min on separate days to a select group of subjects who perpetrate acts of domestic violence and two nonviolent comparison groups. We compared their behavioral, neuroendocrine, and physiologic responses. RESULTS: Lactate administration elicited intense emotional responses in the perpetrators of domestic violence. Perpetrators evidenced more lactate-induced rage and panic and showed greater changes in speech, breathing, and motor activity than did nonviolent control subjects. There were no significant differences between the groups for any neuroendocrine or physiologic measure. CONCLUSIONS: These results are consistent with our hypothesis that some perpetrators of domestic violence have exaggerated fear-related behavioral responses.
PMID: 10812039, UI: 20277614
---------------------------------------------------------
1 : Harv Rev Psychiatry 1998 Jan-Feb;5(5):239-46 Related Articles, Books, LinkOut
Mood symptoms during corticosteroid therapy: a review.Brown ES, Suppes T
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75235-9070, USA.
Corticosteroids such as prednisone are commonly prescribed for a variety of illnesses mediated by the immune system. This paper reviews the available literature on mood symptoms during corticosteroid treatment. Few studies have used well-recognized measures of symptoms or clearly defined diagnostic criteria to characterize such mood changes. The limited data available suggest that symptoms of hypomania, mania, depression, and psychosis are common during therapy. Symptoms appear to be dose dependent and generally begin during the first few weeks of treatment. Risk factors for the development of mood instability or psychosis are not known. The similarities of the psychiatric symptoms resulting from corticosteroid treatment to the symptoms of bipolar disorder are discussed.
Publication Types:
Review
Review, tutorialPMID: 9493946, UI: 98152965
---------------------------------------------------------
: J Med Assoc Thai 1998 Jul;81(7):551-4 Related Articles, Books, LinkOut
Drug-induced akathisia and suicidal tendencies in psychotic patients.Kasantikul D
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Five patients, while being treated with high potency antipsychotic drugs developed akathisia and tended towards committing suicide as a consequence of the inner agitation and restlessness they were suffering. Upon discontinuation of the respective medication or switching to low potency drugs, as well as addition of anti-parkinson drugs or benzodiazepines, the akathisia and suicidal tendencies abated. Clinicians ought to be aware of suicidal impulses emerging in patients suffering from akathisia. By prompt recognition and treatment of akathisia such suicidal tendencies and attempts can be prevented.
PMID: 9676095, UI: 98340746
-----------------------------------------------------
17 : Int J Clin Pract 1997 Jul-Aug;51(5):330-1 Related Articles, Books, LinkOut
Suicide attempt due to metoclopramide-induced akathisia.Chow LY, Chung D, Leung V, Leung TF, Leung CM
Department of Psychiatry, Chinese University of Hong Kong.
Akathisia as a side-effect of metoclopramide has received increasing attention in consultation-liaison psychiatry in recent years. A case of metoclopramide-induced akathisia resulting in a suicide attempt is reported in order to highlight the suffering of such patients and the factors that lead to misdiagnosis.
PMID: 9489098, UI: 98150356
------------------------------------------------------------------
Drugs Aging 1997 May;10(5):367-83 Related Articles, Books
Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment.Young BK, Camicioli R, Ganzini L
Mental Health Division, Portland Veterans Affairs Medical Center, Oregon, USA.
Parkinson's disease (PD) is a progressive neurological condition that causes considerable disability in the elderly. Drugs used to treat PD, such as levodopa, offer symptomatic relief but often have neuropsychiatric adverse effects, most prominently psychosis and delirium. Aged patients and those with dementia are particularly vulnerable to these adverse effects. Evaluating PD patients with drug-induced neuropsychiatric adverse effects is made difficult by their complex clinical presentations. The treatment of drug-induced psychosis and delirium begins with manipulating the antiparkinsonian drug regimen, but this frequently worsens motor function. Atypical antipsychotics such as clozapine have been successfully employed to treat the psychosis without worsening the motor disability. Patient intolerance of clozapine therapy has prompted open-label studies with newer agents such as risperidone, remoxipride, zotepine, mianserin and ondansetron.
Publication Types:
Review
Review, tutorialPMID: 9143857, UI: 97288925
-----------------------------------------------------------
29 : J Emerg Med 1994 Sep-Oct;12(5):685-7 Related Articles, Books, LinkOut
Revisiting fluoxetine (Proxac) and suicidal preoccupations.Tueth MJ
Department of Psychiatry, University of Florida, Gainesville 32608.
Several reports were published in the psychiatric literature in 1990 and 1991 documenting fluoxetine (Prozac) causing patients to consider or attempt suicide. During the following 2 years, retrospective studies appeared in the medical literature that seemed to indicate that suicidal preoccupation was not related to the antidepressant fluoxetine (Prozac) but was probably a symptom of the depressive illness. Recent studies have suggested, however, that fluoxetine (Prozac) may in fact lead to suicidal behavior because the drug appears to adversely affect serotonergic neuronal discharge and induce an akathisia-like extrapyramidal reaction. While fluoxetine (Prozac) has a very favorable side effect profile compared to the tricyclic antidepressants, it may cause akathisia and induce a small subset of patients to consider or attempt suicide.
PMID: 7989697, UI: 95081530
------------------------------------------------------------
50 : J Clin Psychiatry 1991 Dec;52(12):491-3 Related Articles, Books, LinkOut
Reexposure to fluoxetine after serious suicide attempts by three patients: the role of akathisia.Rothschild AJ, Locke CA
McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA 02178.
Considerable controversy exists regarding the relationship between fluoxetine and the emergence of suicidal ideation. Three cases are presented of patients who were reexposed to fluoxetine after having previously made a serious suicide attempt during fluoxetine treatment. All three patients developed severe akathisia during retreatment with fluoxetine and stated that the development of the akathisia made them feel suicidal and that it had precipitated their prior suicide attempts. The akathisia and suicidal thinking abated upon the discontinuation of the fluoxetine or the addition of propranolol. The emergence of suicidal ideation during treatment with fluoxetine may be secondary to the development of akathisia. Gradual increments of fluoxetine dose and the prompt recognition and treatment of akathisia may reduce further the rare occurrence of suicidal ideation during fluoxetine treatment.
Comments:
Comment in: J Clin Psychiatry 1992 Jul;53(7):256-7
Comment in: J Clin Psychiatry 1993 Nov;54(11):439PMID: 1752848, UI: 92091324
---------------------------------------------------------
J Clin Psychopharmacol 1993 Aug;13(4):235-42 Related Articles, Books
Postmarketing surveillance by patient self-monitoring: trazodone versus fluoxetine.Fisher S, Bryant SG, Kent TA
Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston 77555.
This article presents incidence estimates and relative risks for a number of adverse clinical events reported by outpatients being treated with either trazodone or fluoxetine. Data were collected via an innovative method of patient self-monitoring. Many of the suggested differences between the two drugs are quite consistent with expected adverse drug reactions documented in both the package insert data for outpatients and with reports in the literature. Findings not so readily anticipated for trazodone, however, include higher relative frequencies for muscle weakness or soreness, skin swelling, and urinary complaints compared with fluoxetine; for fluoxetine, data are presented indicating a higher incidence of various psychologic/psychiatric adverse clinical events, including delusions and hallucinations, aggression, and suicidal ideation. Other possible interpretations of the results are discussed.
PMID: 8376610, UI: 93388901
----------------------------------------------------------
Posted by SLS on May 29, 2000, at 14:36:31
In reply to Re: Drug-related Violence and Suicide (and more), posted by SLS on May 29, 2000, at 11:31:40
> > Psychotherapy is necessary (be it talking to a therapist, your pastor, a family member, or a friend) to recover from depression.
> No.
I did a disservice to the people here by reacting in this fashion. I confused "recovery" with "remission".
Sorry, Cam. (Meant in a different way this time).
1. In some cases, there is an interplay between the psychological and the biological that produces a depression for which psychotherapy can actually contribute to its "remission". Chronic stress resulting from psychological and emotional entanglements causes changes in the body, including the brain. When enough "depressive pressure" is applied for long enough, systems in the brain break-down. It is important to relieve this depressive pressure by addressing the psychological dynamics that is producing the stress.
2. When depression remits due to biological intervention, there often remains psychological, emotional, and behavioral scars that must heal. Counseling and psychotherapy can address this. In addition, relationships between family and friends are often shattered. One's whole life can be shattered, and the pieces must be put back together. This is much easier when the tools to help do this are made available, and healing is encouraged and facilitated by the emotional support of others.
This is "recovery".
I apologize for having displayed such a knee-jerk reaction to Cam's statement. I tend to go ballistic whenever anyone hints that there may be any psychological component to my illness. When my depression remits, within hours I am frolicking among the trees and the squirrels, visiting friends I haven't seen in years, and beginning to plan the rest of my life. I don't need any help with this. I recover on my own very quickly.
Sincerely,
Scott
Posted by andrew on May 29, 2000, at 16:44:54
In reply to Re: Drug-related Violence , posted by Cam W. on May 29, 2000, at 6:55:11
>>>(Cam wrote:)The reason for these suicides while taking Prozac was that the Prozac was relieving the depressive symptoms in these people who committed suicide. These people already had suicidal ideation and the Prozac had given them more energy to act upon their impulses.
Cam, that is my point exactly. I was not talking about stigma, or really about the definition of mental illness as relates to propensity for violence, which is a neccessary consideration in reviewing these studies. For example, the chief justice of the Supreme Court of New York was arrested, tried and convicted for terrorizing his mistress. At trial, he was deemed competent. In the prison system, he was housed in a psych hospital and treated as a mentally ill person. His own assessment, if I correctly recall and interpret his autobiographical book, was that he had intellectually matured, sufficient to become a Chief Justice, but that he had failed to mature emotionally. Was he criminal, mentally ill, immature or all three?
Perhaps stigma should be considered as a factor in Harris' case - if he had not been stigmatized, if that is what happened when he was disqualified for military service because of the medications he took, he might have been among the small percentage of military personnel who are actually cabable of close-quarter killing in combat. (Read Lt. Col. (retired) David Grossman's On Killing). Are we talking about a choice between Mia Lai or Columbine?
At some point we need to consider both the pervasive aggression and social stratification at public schools, which seemed to be as prejudicial to Harris as are stairs to a person in a wheel chair, and the pervasive glorification of lethal ideation in the military that seemed to play a role in the actions of Calley in Vietnam and perhaps McVeigh in OKC. Therein lies the risk of painting all these things into the "chemical imbalance, brain disease" corner - we collectively absolve ourselves from considering how persistantly we might be knocking people off balance. Blaming the imbalance on "biology" and ignoring sociological, contextual influence seems to be yet another way of stigmatizing people.
I was talking about the role of SSRIs in mass shooting, more or less from a public safety standpoint. I must not understand your reply, I doubt if you meant it this way - perhaps you inadvertantly implied that some people are as well off dead as depressed, or that the possible risk of death while being treated for depression is worth the possible result of being happy. Maybe you were just saying it happens that way without offering a value judgment.
>>>>Cam wrote: So, yes, I guess you could say that it was the Prozac that caused their death by relieving their depression. I guess if these people were never treated, and were depressed for the rest of their lives, they wouldn't have committed suicide.
While I would say choose life, even if it is a dark life, we are talking about both suicide and homicide. The point you make is exactly the one I make - that the drugs facilitate mutation of the abnormality, or illness, or whatever word your social set agrees to use. The resulting hypermania, or the abundance of reinforcing neurochemicals (5HT) seems in some cases to lead to homicidal behavior, especially among people who previously had homicidal ideation.
My social set is definatly not Scientology and my concern over the effect of legal drugs is not informed by Scientology literature. Nor is my consideration limited to peer-reviewed academic studies.
>>>Cam wrote: Drug companies have backed up their drugs in court, most notably Eli Lilly in the early 1990s.
Again, that is my point. We tend to jump from considering medical processes to legal processes. If you want to assess the legal process that established the definition of safety for these drugs, consult someone familiar with the legal system. In the Standard Gravieur case, which set the precedent for other cases involving a drug-makers liability for the risks you recognize (above) Eli Lilly paid the plaintiff to not introduce evidence of their incomplete human testing, specifically the phase of testing that would have revealed the problems you cite (above) and also paid the plaintiff not to introduce evidence of Eli Lillies previous criminal convictions in cases involving falsified testing reports.
Power to Harm is not alarmist Scientology rhetoric. It is a studious review of legal processes whereby Eli Lilly "backed up their drugs in court". Killers are sometimes acquited in court. If Eli Lilly were as concerned about informing the public of the contraindications and risks of their medicines as they were about absolving themselves of liability, we might have a better handle on how usefull their drugs may or may not be.
Posted by SLS on May 30, 2000, at 8:04:05
In reply to Re: Drug-related Violence , posted by andrew on May 29, 2000, at 16:44:54
Hi Andrew.
You make some VERY important points that offer some balance of perspective that I think often gets lost on this board. I guess this trend is understandable, given that most of the people here DO suffer from a biologically-driven disorder. This is where their eyes are focused.Thanks mucho. I was very happy to read your post.
> >>>(Cam wrote:)The reason for these suicides while taking Prozac was that the Prozac was relieving the depressive symptoms in these people who committed suicide. These people already had suicidal ideation and the Prozac had given them more energy to act upon their impulses.
This is absolutely true. I think you misunderstood the way Cam W. tried to circumscribe and emphasize the dynamics of this phenomenon.
Cam wrote:> So, yes, I guess you could say that it was the Prozac that caused their death by relieving their depression. I guess if these people were never treated, and were depressed for the rest of their lives, they wouldn't have committed suicide.
> ... I was not talking about stigma, or really about the definition of mental illness as relates to propensity for violence, which is a neccessary consideration in reviewing these studies. For example, the chief justice of the Supreme Court of New York was arrested, tried and convicted for terrorizing his mistress. At trial, he was deemed competent. In the prison system, he was housed in a psych hospital and treated as a mentally ill person. His own assessment, if I correctly recall and interpret his autobiographical book, was that he had intellectually matured, sufficient to become a Chief Justice, but that he had failed to mature emotionally. Was he criminal, mentally ill, immature or all three?Simple. All three. The question is, how does one approach these apparant mental incongrueties when trying to assess a breech of social responsibilitly. He may be guilty of the crime, but can he be "blamed" for it? What makes this situation easy for me to deal with is that he was deemed responsible for his crime and penalized for it the same way as would be anyone else. He obviously had some psychological abnormalities that the state provided treatment for. That he was not sentenced to life in prison without the possibility of parole seems reasonable to me, so it must be anticipated that he would eventually be returned to society. I think the state's attempt to prevent this person from committing acts similar to the one he was convicted for was pretty smart. I see no incongruety here.
> Perhaps stigma should be considered as a factor in Harris' case - if he had not been stigmatized, if that is what happened when he was disqualified for military service because of the medications he took, he might have been among the small percentage of military personnel who are actually cabable of close-quarter killing in combat. (Read Lt. Col. (retired) David Grossman's On Killing). Are we talking about a choice between Mia Lai or Columbine?> At some point we need to consider both the pervasive aggression and social stratification at public schools, which seemed to be as prejudicial to Harris as are stairs to a person in a wheel chair, and the pervasive glorification of lethal ideation in the military that seemed to play a role in the actions of Calley in Vietnam and perhaps McVeigh in OKC. Therein lies the risk of painting all these things into the "chemical imbalance, brain disease" corner - we collectively absolve ourselves from considering how persistantly we might be knocking people off balance. Blaming the imbalance on "biology" and ignoring sociological, contextual influence seems to be yet another way of stigmatizing people.
This is nice. Thanks.
There are untold scenarios of unhealthy psychosocial development in which the social environment is, unfortunately, unhealthy. So, who is to "blame". No one. Everyone. This is the human condition. Hopefully, we can help to make the future human condition healthier. This might have more of an impact to lower the rate of school shootings than gun-control.
> I was talking about the role of SSRIs in mass shooting, more or less from a public safety standpoint. I must not understand your reply, I doubt if you meant it this way - perhaps you inadvertantly implied that some people are as well off dead as depressed, or that the possible risk of death while being treated for depression is worth the possible result of being happy. Maybe you were just saying it happens that way without offering a value judgment
I think this is where you misunderstood Cam and his proposition that an untreated individual who is so severely paralized by depression will not have the mental or physical energy to commit suicide until an antidepressant gives it to them. Perhaps I misunderstand your point.
> While I would say choose life, even if it is a dark life, we are talking about both suicide and homicide. The point you make is exactly the one I make - that the drugs facilitate mutation of the abnormality, or illness, or whatever word your social set agrees to use. The resulting hypermania, or the abundance of reinforcing neurochemicals (5HT) seems in some cases to lead to homicidal behavior, especially among people who previously had homicidal ideation.
I think this was my point. Again, I obviously agree.
By the way, what "social set" do you belong to?
> My social set is definatly not Scientology and my concern over the effect of legal drugs is not informed by Scientology literature. Nor is my consideration limited to peer-reviewed academic studies.
> >>>Cam wrote: Drug companies have backed up their drugs in court, most notably Eli Lilly in the early 1990s.
Perhaps they were lying. Perhaps they didn't know anything at that point in time.
> In the Standard Gravieur case, which set the precedent for other cases involving a drug-makers liability for the risks you recognize (above) Eli Lilly paid the plaintiff to not introduce evidence of their incomplete human testing, specifically the phase of testing that would have revealed the problems you cite (above) and also paid the plaintiff not to introduce evidence of Eli Lillies previous criminal convictions in cases involving falsified testing reports.
How do you know all of this? Is this stuff public record? Wow.
I don't know anything about the Gravieur case. However, I conducted some research in the mid-1980's focusing on a drug for which a drug company, perhaps with the collusion of a government regulator, covered-up a very serious side effect that emerged early in its development. The drug is currently marketed. The potential for this side effect probably goes unrecognized by 90 percent of the physicians prescribing it. I forget which one.
> Power to Harm is not alarmist Scientology rhetoric. It is a studious review of legal processes whereby Eli Lilly "backed up their drugs in court". Killers are sometimes acquited in court. If Eli Lilly were as concerned about informing the public of the contraindications and risks of their medicines as they were about absolving themselves of liability, we might have a better handle on how usefull their drugs may or may not be.
Thanks again.
Sincerely,
Scott
Posted by Cam W. on May 31, 2000, at 1:07:30
In reply to Re: Drug-related Violence - Andrew, posted by SLS on May 30, 2000, at 8:04:05
Scott - Thank you for pleading my case with andrew. I don't think I could have said it as eloquently as you. You basically said what I had meant. I agree with much of what andrew said (but I would like proof of the hush money claim) and I will still stand by all of what I said.In your previous post, you have no need to apologize for your beliefs. Yes, I agree that some people (about 10%) do get akasthesia-like or agression as a side effect of a number of medications. Aggression is probably due to the medications or aggressive disorders causing (or caused by) a neurotransmitter imbalance in areas of the brain regulating emotion (Is it the prefrontal cortex, hippocampus and amygdala? - I didn't have time to look this up and I can't remember, off-hand). Evidence for this (only a quick search done) is as follows:
"There are clear genetic contributions to impulsivity and aggression, although the exact details remain to be elucidated. Abnormalities in neurotransmitters, including decreased serotonergic function as well as increased noradrenergic function, have been related to aggressive behavior."[1]
"Cocarro and colleagues have demonstrated an inverse relationship between several measures of serotonin function and impulsive aggression in a group of individuals with personality disorder. Cerebral spinal fluid (CSF) vasopressin levels appear to be positively correlated with impulsive aggression, while there is an inverse correlation between serotonin function and vasopressin."[2]
Remember, vasopressin is needed in conjunction with CRH to efficiently stimulate the pituitary to release ACTH. Lack of vasopression can dysregulate the HPA axis, resulting in depressive symptoms [from a paper on CRH antagonists in anxiety that I have at work; I believe the author was F.Hoeboer(sp?) - reference available upon request]
"PET scan studies have demonstrated that individuals with intermittent explosive disorder have less serotonin activity in the orbital-frontal cortex than controls. A number of studies indicate that dysregulation of the serotonin system plays a role in impulsive aggression. For example, CSF 5-HIAA, the major metabolite of serotonin, is decreased in individuals with a history of impulsive aggression compared with those who suffer from nonimpulsive aggression and with normal controls...
... Depression and violent behavior are significantly correlated with moderate to severe outwardly directed irritability, as demonstrated by a study in which 37% of depressed patients reported having such irritability...
...Compared with controls, outpatients with major depressive disorder (MDD) have a significantly higher rate of anger attacks. As many as 38% to 44% of depressed outpatients report anger attacks, which are more common in individuals with unipolar depression than in those with bipolar disorder."[2]So, is the antidepressant causing the anger and aggression or is it the drug or is it a combination of the two? I believe that it is probably the latter.
"...amitriptyline has been shown to increase aggression in some individuals with borderline personality disorder."[2: see ref.3]
"Tricyclic antidepressants may increase irritability because they stimulate the norepinephrine system."[4]"In individuals with MDD, there are marked signs of autonomic arousal associated with anger attacks, including tachycardia, hot flashes, and sweating."[2]
More evidence of an imbalance in the body's chemistry causing anger responses?
"A number of studies have suggested that aggression is associated with reduced serotonin function. Dr.Fava reported that he and his colleagues found a blunting of the prolactin response to fenfluramine, a measure of serotonin function, in depressed individuals with anger attacks as compared to depressed individuals without anger attacks. This finding suggests a greater dysregulation of serotonergic neurotransmission in MDD with anger attacks than in MDD alone."[2]
More evidence of decreased serotonin function causing anger. Could this be used as a marker for determining if a depression is caused by a lack of serotonin or a lack of norepinephrine? It is increased norepinephrine that can cause aggressive behavior. [see 3rd paragraph of this post - Re: ref.1]
"A number of open-label studies have demonstrated that antidepressive agents, particularily the serotonin reuptake inhibitors, are effective in decreasing anger attacks. The depression response to these agents is equally robust in depressed individuals with or without anger attacks. In individuals with depression without anger attacks. treatment with either fluoxetine or sertraline is associated with less emergence of anger attacks than treatment with placebo."[2: see ref.5]
"These studies indicate that serotonin reuptake inhibitors can be safely used and show substantial promise in the treatment of anger attacks."[2]While having a slight propensity to cause anger attacks, SRIs seem to be the treatment of choice for depression-related anger management. Other medications can also be used for aggression control:
"A number of studies have demonstrated a decrease in the use of seclusion and improvement in measures of aggression and irritability in hospital-based settings since the introduction of clozapine."[2: see ref.6]
"Similar comparisons for riseridone have demonstrated a decrease in physical assault, seclusion, and restraint."[2]
"Olanzapine has been found to decrease aggression in the treatment of acute mania..."[2: see ref.7]
Yes Scott, I agree with you that drug-induced aggression and anger can be a problem in some instances, but with proper case management and an astute physician, the risks can be held to a minimum.
I also agree with your views on psychological versus biological causes and remedies of depression. The stress/diasthesis model of mental illnesses (esp. depression, bipolar disorder and schizophrenia) has been championed by some great minds (Charles Nemeroff of Emory, Ming Tsang of Harvard, and, I believe, Nancy Andreasen, editor of the American Journal of Psychiatry).
[1] Korn ML. Various perspectives on violence. American Psychiatric Association 153rd Annual Meeting, Day 3, May 16, 2000, Chicago, Illinois.
[2] Brady K. The treatment and prevention of violence. American Psychiatric Association 153rd Annual Meeting, Day 2, May 15, 2000, Chicago, Illinois.
[3] Soloff PH, George A, Nathan RS, Schulz PM, Perel JM. Paradoxical effects of amitriptyline on borderline patients. Am J Psychiatry. 1986; 143: 1603-1605.
[4] Korn ML. Treatment of aggression. American Psychiatric Association 153rd Annual Meeting, Day 5, May 18, 2000, Chicago, Illinois.
[5] Coccaro EF, Kavoussi RJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry. 1997; 54: 1081-1088.
[6] Chiles JA, Davidson P, McBride D. Effects of clozapine on use of seclusion and restraint at a state hospital. Hosp Community Psychiatry. 1994; 45: 269-271.
[7] Tohen M, Sanger TM, McElroy SL, et al. Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group. Am J Psychiatry. 1999; 156: 702-709.
For further reading; a good commentary (available online at www.archgenpsychiatry.com):
Hirschfield RMA, Suicide and antidepressant treatment. Arch Gen Psychiatry; Apr 2000; 57: 325-326.
Scott, your opinions on my postings are greatly appreciated (as are yours andrew). Do not feel sorry for believing in something. I am not always right and sometimes I state my opinions as fact. The original comments I made in the post that started all this fun, I truly believe (but my beliefs can be modified, I'm not that old, yet).Take care my friend - Sincerely - Cam
P.S. If I'd known I was going to get this kind of reaction, I would have gone back and corrected my spelling mistakes. There may be some in this post as well, but I'm tired and I don't care (bob - edit this for me, please) ;^ƒ
andrew, I hope you don't think that I have left you out. My comments were not made with any sort of value judgements at all. I do not wish anyone harm and I believe that life should be lived to it's fullest. Having MDD is not what I would consider a fulfilling life (I've been there, and lately I'm not sure if I am headed back). I, myself would risk the aggression/violence/suicidal side effects of medications; if only to enjoy a nice sunny day, sitting on the side of a grassy hill with nothing to do but watch billowy clouds float by in a calm breeze and listen to the rustle of the leaves in nearby trees. Thanks for taking time to respond to my post. I must go to bed now, as I am exhausted from another trying day at work and karate (BTW - I finished dead last in my division in both categories at the provincial karate tournament on Saturday, and you know what, I don't care - the job action by the nurses and support staff last week has left me absolutely drained). Sincerely - Cam
Posted by SLS on June 1, 2000, at 7:56:47
In reply to Re: Drug-related Violence - Scott, posted by Cam W. on May 31, 2000, at 1:07:30
Dear Cam,
> Scott - Thank you for pleading my case with andrew. I don't think I could have said it as eloquently as you. You basically said what I had meant. I agree with much of what andrew said (but I would like proof of the hush money claim) and I will still stand by all of what I said.
Cam - Thank you for pleading my case with you.
It is wonderful how the truth manages to demonstrate itself through the ardent attempts of people to prove it wrong. You have done an excellent job.
What you have done here is to not only prove that drugs can indeed produce violent and suicidal reactions, but have explained why.
Of course there are going to be differences between an individual for whom Prozac has an antidepressant effect and another for whom it has a suicidal effect. There are neurobiological differences between the individual who reactions to alcohol by becoming sleepy and falling into a slumber and the individual who beats his wife in a fit of unrelenting rage.
Even if the substrates for these differences are totally psychological, it *still* argues for the recognition of the phenomenon and the acceptance that it occurs often enough to do something about it. We can at least try to prevent injuries and deaths that result from these infrequent adverse drug-induced events by believing that it does happen.
The rest of your post does a fine job to promote the advancement of my admonishments.
On behalf of mankind, I thank you.
> In your previous post, you have no need to apologize for your beliefs. Yes, I agree that some people (about 10%) do get akasthesia-like or agression as a side effect of a number of medications.
10% percent is an outrageous number and is unacceptable. I hope it is not nearly so high. I don't believe it is, even among the neuroleptics.
> Aggression is probably due to the medications or aggressive disorders causing (or caused by) a neurotransmitter imbalance in areas of the brain regulating emotion (Is it the prefrontal cortex, hippocampus and amygdala? - I didn't have time to look this up and I can't remember, off-hand). Evidence for this (only a quick search done) is as follows:
I think the amygdala is often implicated - I'm not sure - but I doubt it is that well understood.
=> Go get em' Cam...
> "There are clear genetic contributions to impulsivity and aggression, although the exact details remain to be elucidated. Abnormalities in neurotransmitters, including decreased serotonergic function as well as increased noradrenergic function, have been related to aggressive behavior."[1]> "Cocarro and colleagues have demonstrated an inverse relationship between several measures of serotonin function and impulsive aggression in a group of individuals with personality disorder. Cerebral spinal fluid (CSF) vasopressin levels appear to be positively correlated with impulsive aggression, while there is an inverse correlation between serotonin function and vasopressin."[2]
> Remember, vasopressin is needed in conjunction with CRH to efficiently stimulate the pituitary to release ACTH. Lack of vasopression can dysregulate the HPA axis, resulting in depressive symptoms [from a paper on CRH antagonists in anxiety that I have at work; I believe the author was F.Hoeboer(sp?) - reference available upon request]
> "PET scan studies have demonstrated that individuals with intermittent explosive disorder have less serotonin activity in the orbital-frontal cortex than controls. A number of studies indicate that dysregulation of the serotonin system plays a role in impulsive aggression. For example, CSF 5-HIAA, the major metabolite of serotonin, is decreased in individuals with a history of impulsive aggression compared with those who suffer from nonimpulsive aggression and with normal controls...
> ... Depression and violent behavior are significantly correlated with moderate to severe outwardly directed irritability, as demonstrated by a study in which 37% of depressed patients reported having such irritability...
> ...Compared with controls, outpatients with major depressive disorder (MDD) have a significantly higher rate of anger attacks. As many as 38% to 44% of depressed outpatients report anger attacks, which are more common in individuals with unipolar depression than in those with bipolar disorder."[2]
> So, is the antidepressant causing the anger and aggression or is it the drug or is it a combination of the two? I believe that it is probably the latter.
> "...amitriptyline has been shown to increase aggression in some individuals with borderline personality disorder."[2: see ref.3]
> "Tricyclic antidepressants may increase irritability because they stimulate the norepinephrine system."[4]> "In individuals with MDD, there are marked signs of autonomic arousal associated with anger attacks, including tachycardia, hot flashes, and sweating."[2]
> More evidence of an imbalance in the body's chemistry causing anger responses?
> "A number of studies have suggested that aggression is associated with reduced serotonin function. Dr.Fava reported that he and his colleagues found a blunting of the prolactin response to fenfluramine, a measure of serotonin function, in depressed individuals with anger attacks as compared to depressed individuals without anger attacks. This finding suggests a greater dysregulation of serotonergic neurotransmission in MDD with anger attacks than in MDD alone."[2]
> More evidence of decreased serotonin function causing anger. Could this be used as a marker for determining if a depression is caused by a lack of serotonin or a lack of norepinephrine? It is increased norepinephrine that can cause aggressive behavior. [see 3rd paragraph of this post - Re: ref.1]
> "A number of open-label studies have demonstrated that antidepressive agents, particularily the serotonin reuptake inhibitors, are effective in decreasing anger attacks. The depression response to these agents is equally robust in depressed individuals with or without anger attacks. In individuals with depression without anger attacks. treatment with either fluoxetine or sertraline is associated with less emergence of anger attacks than treatment with placebo."[2: see ref.5]
CAM - Someone invented the term "paradoxical reaction" for a reason. I'm sure you use it often. Zoloft has been used with striking success in the treatment of pathological aggression. However, sometimes...
> "These studies indicate that serotonin reuptake inhibitors can be safely used and show substantial promise in the treatment of anger attacks."[2]
> While having a slight propensity to cause anger attacks, SRIs seem to be the treatment of choice for depression-related anger management. Other medications can also be used for aggression control:
> "A number of studies have demonstrated a decrease in the use of seclusion and improvement in measures of aggression and irritability in hospital-based settings since the introduction of clozapine."[2: see ref.6]
5-HT2 antagonism (maybe).
> "Similar comparisons for riseridone have demonstrated a decrease in physical assault, seclusion, and restraint."[2]
> "Olanzapine has been found to decrease aggression in the treatment of acute mania..."[2: see ref.7]
DA D2 (maybe).
> Yes Scott, I agree with you that drug-induced aggression and anger can be a problem in some instances, but with proper case management and an astute physician, the risks can be held to a minimum.
I love when people repeat my words using different words. It really makes me think that my posts are not read closely enough. I guess I can't complain, though, as this is also a problem for me. Depression does a great job of impairing my concentration and my ability to read a paragraph in its entirety. Fother Mucker.
> I also agree with your views on psychological versus biological causes and remedies of depression. The stress/diasthesis model of mental illnesses (esp. depression, bipolar disorder and schizophrenia) has been championed by some great minds (Charles Nemeroff of Emory, Ming Tsang of Harvard, and, I believe, Nancy Andreasen, editor of the American Journal of Psychiatry).
Although it must surely be used by others, I have conjured the term "depressive-pressure" to conceptionalize this interaction.
I have recently run across some stuff that really hints to the involvement of HPA stuff here. I'm glad you "stress" it so much.
I don't have the mental energy nor the resources to review the following material, but I definitely trust your objectivity in selecting it.
See ya' soon.
----------------------------------------------
> [1] Korn ML. Various perspectives on violence. American Psychiatric Association 153rd Annual Meeting, Day 3, May 16, 2000, Chicago, Illinois.
> [2] Brady K. The treatment and prevention of violence. American Psychiatric Association 153rd Annual Meeting, Day 2, May 15, 2000, Chicago, Illinois.
> [3] Soloff PH, George A, Nathan RS, Schulz PM, Perel JM. Paradoxical effects of amitriptyline on borderline patients. Am J Psychiatry. 1986; 143: 1603-1605.
> [4] Korn ML. Treatment of aggression. American Psychiatric Association 153rd Annual Meeting, Day 5, May 18, 2000, Chicago, Illinois.
> [5] Coccaro EF, Kavoussi RJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry. 1997; 54: 1081-1088.
> [6] Chiles JA, Davidson P, McBride D. Effects of clozapine on use of seclusion and restraint at a state hospital. Hosp Community Psychiatry. 1994; 45: 269-271.
> [7] Tohen M, Sanger TM, McElroy SL, et al. Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group. Am J Psychiatry. 1999; 156: 702-709.
> For further reading; a good commentary (available online at www.archgenpsychiatry.com):
> Hirschfield RMA, Suicide and antidepressant treatment. Arch Gen Psychiatry; Apr 2000; 57: 325-326.
> Scott, your opinions on my postings are greatly appreciated (as are yours andrew). Do not feel sorry for believing in something. I am not always right and sometimes I state my opinions as fact. The original comments I made in the post that started all this fun, I truly believe (but my beliefs can be modified, I'm not that old, yet).Cam, please do not feel sorry in believing in the same thing that I believe in, even if you don't believe that you do.
> Take care my friend - Sincerely - Cam
I feel priveledged that you should consider me a friend. The feeling is mutual.
Your admiring friend,
Scott
> BTW - I finished dead last in my division in both categories at the provincial karate tournament on Saturday, and you know what, I don't care - the job action by the nurses and support staff last week has left me absolutely drained). Sincerely - CamI guess this explains it. :-)
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