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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 49. Go back in thread:
Posted by rgb on November 6, 2007, at 12:25:44
In reply to SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 6, 2007, at 2:42:33
Sorry to hear that you had difficult experiences with them.
But what makes you think that your experience is a "inevitability" (unless you were only talking about how they affect /you/ there)?
I've been on sertraline for half a year and it's still working fine. Though I agree that the beginning was the best (I had some really nice feelings starting on day 3, but as you say, not the stimulant-kind euphoria, actually it slightly reminded me of 5-HT2A agonists :) A major advantage over dopamine euphoria is that there is zero desire to redose.).
Maybe the apathy will slowly creep up on me, but for now I will stick with the sertraline and see how it affects me /personally/.
I do have /some/ dampened emotions (mostly negative ones are dampened, I was pretty anhedonic at base-line anyway). I don't think this is necessarily bad. It doesn't mean that one is a zombie, it's not so black and white. It might merely make the negative emotions manageable. There is more to life than emotionality; I for one like the fact that it seems to enable me to think beyond my negative feelings, look at outside things.
Motivation still seems to be somewhat increased.
I do try to counteract the dampening with caffeine (I don't have to watch the dose for anxiety reasons anymore :)) and nicotine gum though. Not sure whether it's doing anything in the long-run when you are tolerant though.
Regards,
rgb
Posted by rgb on November 6, 2007, at 12:29:55
In reply to you have a point, but I think it's not so bad. » Questionmark, posted by rgb on November 6, 2007, at 12:25:44
p.s.: I do find MAOIs interesting, but since sertraline works for me so far, I don't want to bother with MAOI interactions. Also, noone seems to want to prescribe the "irreversible" and nonselective ones, which look most promising to me.
Posted by linkadge on November 6, 2007, at 12:53:39
In reply to p.s. about MAOIs, posted by rgb on November 6, 2007, at 12:29:55
Thats what bothers me about the arguments used int the "war" against marijuanna.
Opponents incessantly harp on about how it can cause amotivational syndrome, and how this is particularly damaging to youth.
You hear it on Dr. Phil. They pay off some youth to talk about how he had no motivation on marijuanna.
They then proceed to prescribe youth drugs like paxil for anxiety and depression.
Anyhone who I have talked to about the differences in apathy between the two substances indicate that SSRI apathy is like MJ amotivation syndrome times 10.
Anyhow, I'm done ranting.
Linkadge
Posted by War-Face on November 6, 2007, at 15:56:38
In reply to Re: p.s. about MAOIs, posted by linkadge on November 6, 2007, at 12:53:39
Interesting comparison with marijuana and ssri's. I found Lexapro to have a kind of similar amotivational action to marijuana.
I found Prozac, on the other hand, to be extremely motivating (probably from NE boosting properties), although after prolonged use, it did leave me feeling dumb and forgetful and tired, in a way similar to the well-articulated cycle of SSRI use above.
Posted by mike lynch on November 7, 2007, at 15:37:39
In reply to SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 6, 2007, at 2:42:33
I go through this cycle too. I am off all drugs now but I just feel flat.
Posted by bleauberry on November 7, 2007, at 18:35:25
In reply to SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 6, 2007, at 2:42:33
Yeah, well said. I think maybe that is why certain drugs go well with SSRIs (the drugs vary from person to person of course), such as zyprexa, remeron, wellbutrin, provigil, ritalin...they tweek the norepinephrine or dopamine circuits in a way to partnership with the tweeked serotonin circuits and cut back on that apathy numbness stuff. I experienced that ssri partnership good feeling with zyprexa added to prozac, or adrafinil/provigil added to prozac.
Posted by rskontos on November 8, 2007, at 11:56:04
In reply to SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 6, 2007, at 2:42:33
I am glad you wrote this thread because I started Lex a little over a month ago and I never felt that bright happy sociable energized feeling. I feel slightly not so anxious but I will still have a panic attack and I am still depressed so I guess it isnt' working. I have no desire to do anything I push myself and I have had more thoughts of suicide than ever so I am guessing this one is bad. I believe with my issues ssri's aren't right. I think it is time to taper off. I am not sure what to go to next but thanks for this thread to alert me all is definitely not right with this med. Sometimes it takes a large rock to fall on me to wake me up in my present state. Thanks for being that cyber rock ! rk
Posted by bart on November 9, 2007, at 10:26:30
In reply to SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 6, 2007, at 2:42:33
wow!!!! the words in your post took the words right out of my mouth. I'm glad others are noticing this stuff so I don't feel so isolated
Posted by Questionmark on November 11, 2007, at 21:26:46
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Questionmark, posted by Dinah on November 6, 2007, at 12:12:44
I appreciate the comments.
I do want to say, just to be clear, that i think SSRIs can be very useful in many situations. I just think that patients and doctors need to be more aware of their (SSRI's) limitations, and understand that the general SSRI effect is to a large extent what is both good and bad about them.
Ah shoot i'll just reply to each post individually.
Posted by Questionmark on November 11, 2007, at 21:30:27
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » War-Face, posted by Phillipa on November 6, 2007, at 11:48:57
These are also common side effects of SSRIs, but not as common in my opinion as the flattening of affect. But if i remember correctly i thought you had Bipolar, which could (and does) change the dynamic of SSRI effects quite significantly.
> Why am I the only person they seem to do the opposite to reve me up and then horrible side effects. So I stay at a low dose and suffer and try and work through it with diversion and the reamains of my nightly valium. Phillipa
Posted by Questionmark on November 11, 2007, at 21:45:48
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Questionmark, posted by Bob on November 6, 2007, at 11:53:24
"Currently, drug studies only seem to provide information on what occurs in the first few months at most." Yes this is so often completely true is it not? This is one of the aspects of psychiatric research that i think is most ridiculous. I mean come ON, many people need to be on these drugs for many months if not years, especially after they become somewhat more or less dependent on them (and subsequently oftentimes severely dependent on them). And similarly we have so -- ***so little*** knowledge about the long-term consequences (i.e., potential adverse even irreversible? long-term effects) of taking various psychiatric drugs.
It is ridiculous. It is shameful. It is absurd.
And only time (if that) will tell what the long-term consequences of drugging a generation of children with stimulants are. [Again stimulants also *may* be quite beneficial overall for many children as well as adults, but certainly not to the extent that we have taken it, i strongly believe].> I too have experienced this unfortunate cycle. Sadly, long term effects of drugs are not payed attention to much in the medical and pharma communties. STAR*D is the only study I've seen which has even touched on the dismaying effects of long term AD use, and that has hardly even scratched the surface. Currently, drug studies only seem to provide information on what occurs in the first few months at most.
>
> Honestly, I don't know how this will ever change.
Posted by Questionmark on November 11, 2007, at 22:08:13
In reply to you have a point, but I think it's not so bad. » Questionmark, posted by rgb on November 6, 2007, at 12:25:44
I'm basically of the opinion that, given enough time, eventually an SSRI will begin to exert the zombie effect, so to speak. Maybe that's pessimistic; maybe it's wrong. It could very well be for some people. But it's how i feel about it. I hope your positive response to sertraline continues.
And i don't mean one becomes completely like a zombie, like it is black and white. Of course there are variations on the scale. Also, if it is only "making the negative emotions more manageable," that is not what I'm talking about. I'm specifically referring to a condition in which both positive and negative emotions are dampened.
P.S. That was a great if simple point about the difference between strictly serotonergically derived happiness or well-being and "dopamine euphoria"-- that there "is zero desire to redose" with the former. I never really thought about it in those terms (that i remember), but it's completely true and a good way to describe the difference. Strange actually, too.P.P.S. In your second post you stated the following:
"I do find MAOIs interesting, but since sertraline works for me so far, I don't want to bother with MAOI interactions. Also, noone seems to want to prescribe the "irreversible" and nonselective ones, which look most promising to me."
First, if an SSRI is working for you, then ***by ALL MEANS*** stay on it before trying to get onto an MAOI. I would actually try to talk you out of getting on an MAOI. Absolutely. But for people in whom they're not working, especially if severely depressed or "debilitated" (or if having certain comorbid anxiety disorders), my stance is stop freaking struggling with that same class of drugs and try an MAOI.
And yes, you also will find that trying to find someone to prescribe you an MAOI can be a freaking chore in itself-- which is ridiculous, unfortunate, and unnecessary, in my opinion.> Sorry to hear that you had difficult experiences with them.
>
> But what makes you think that your experience is a "inevitability" (unless you were only talking about how they affect /you/ there)?
>
> I've been on sertraline for half a year and it's still working fine. Though I agree that the beginning was the best (I had some really nice feelings starting on day 3, but as you say, not the stimulant-kind euphoria, actually it slightly reminded me of 5-HT2A agonists :) A major advantage over dopamine euphoria is that there is zero desire to redose.).
>
> Maybe the apathy will slowly creep up on me, but for now I will stick with the sertraline and see how it affects me /personally/.
>
> I do have /some/ dampened emotions (mostly negative ones are dampened, I was pretty anhedonic at base-line anyway). I don't think this is necessarily bad. It doesn't mean that one is a zombie, it's not so black and white. It might merely make the negative emotions manageable. There is more to life than emotionality; I for one like the fact that it seems to enable me to think beyond my negative feelings, look at outside things.
>
> Motivation still seems to be somewhat increased.
>
> I do try to counteract the dampening with caffeine (I don't have to watch the dose for anxiety reasons anymore :)) and nicotine gum though. Not sure whether it's doing anything in the long-run when you are tolerant though.
>
> Regards,
> rgb
Posted by Questionmark on November 11, 2007, at 22:21:01
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Questionmark, posted by Dinah on November 6, 2007, at 12:12:44
Post Preface: So sorry if i'm posting too many consecutive posts at once! I now feel stupid. But i just wanted to respond to each reply post individually cuz -- well because i did.
_____________________________________________That *is* a great link, and I'm glad you posted it so I can read it again and bookmark it. It's brilliant.... Or maybe not that brilliant but so refreshingly logical and common-sensical in an industry of such a frustratingly appalling lack of logic and common sense. (Oh, many highly intelligent people, but grossly lacking in logic for some reason, and with an overabundance of hubris-- and probably a great deal of corruption, ultimately, involved as well.)
I was actually just going to read a bit of that and then ended up reading the whole article/page(?).
I totally agree with so much in that article (or whatever it should be called). Many great and important points.
> This is my favorite link on the topic:
>
> http://www.geocities.com/ss06470/index.htm
>
> I haven't read it for a while, so I should temper my endorsement to only the portion that points out that the way it works in very dissimilar conditions is similar.
Posted by Questionmark on November 11, 2007, at 22:44:17
In reply to Re: p.s. about MAOIs, posted by linkadge on November 6, 2007, at 12:53:39
Oh i could go on about marijuana and the hypocrisy of our government and legal system and the medical profession, and psychiatry in particular, in regards to it, for hours.
And this is coming from someone who does not use marijuana anymore and who more or less HATES the high from it.
But i'll restrain my comments to .
I will say that I think I am *personally* more demotivated and lazy from marijuana than SSRIs. Yeah almost definitely. And i also think the latter are better antidepressants than cannabis, for me. That said, I do believe there are many who are the opposite in both respects. And cannabis also has many other beneficial as well as medicinal properties (and actually increases sex drive in the short term, and is not nearly as detrimental to it as SSRIs in the long term). But of course SSRIs are treated as the diamonds of psychiatric drugs while marijuana is treated as ... well, feces... at best.
And don't even get me started on comparisons and differences of alcohol vs. marijuana. I'll just get incredibly angry.
And again I do not use marijuana but i do drink.
> Thats what bothers me about the arguments used int the "war" against marijuanna.
>
> Opponents incessantly harp on about how it can cause amotivational syndrome, and how this is particularly damaging to youth.
>
> You hear it on Dr. Phil. They pay off some youth to talk about how he had no motivation on marijuanna.
>
> They then proceed to prescribe youth drugs like paxil for anxiety and depression.
>
> Anyhone who I have talked to about the differences in apathy between the two substances indicate that SSRI apathy is like MJ amotivation syndrome times 10.
>
> Anyhow, I'm done ranting.
>
> Linkadge
Posted by Questionmark on November 11, 2007, at 23:00:11
In reply to Re: SSRI Apathy- This is the *True* SSRI Questionm, posted by rskontos on November 8, 2007, at 11:56:04
I'm so glad to be helpful, if it hopefully turns out to be the case that i was.
It's possible that you're not on a high enough (or low enough?) dose of Lexapro, but that's doubtful seeing as how most psychiatrists tend to over-prescribe (dosage wise) than under-, in my opinion. It's also possible that you just need something else along with it (also doubtful from sounds of things)-- but i really do not know, of course. And, as you said, it's quite possible you just need to get off it and on to something else altogether. Regardless there are many options, so don't lose hope.
And remember there will never be a perfect drug, but there almost definitely is SOMEthing that will be good enough to give you the ability to live your life and to be happy that you are living it.
> I am glad you wrote this thread because I started Lex a little over a month ago and I never felt that bright happy sociable energized feeling. I feel slightly not so anxious but I will still have a panic attack and I am still depressed so I guess it isnt' working. I have no desire to do anything I push myself and I have had more thoughts of suicide than ever so I am guessing this one is bad. I believe with my issues ssri's aren't right. I think it is time to taper off. I am not sure what to go to next but thanks for this thread to alert me all is definitely not right with this med. Sometimes it takes a large rock to fall on me to wake me up in my present state. Thanks for being that cyber rock ! rk
Posted by rskontos on November 12, 2007, at 10:23:56
In reply to Re: SSRI Apathy- This is the *True* SSRI Questionm » rskontos, posted by Questionmark on November 11, 2007, at 23:00:11
Again, thanks Questionmark, I am going back to the doctor this week. I went ahead and lowered the dosage to begin a taper. My T said for my dx Ad's aren't always very effective. I rarely tell her about the suicide issues. I know I should but I don't. I feel a little better on less. No side effects from less, not so tired. Maybe I will stay a while and see what happens. Again thanks, rk
Posted by Phillipa on November 12, 2007, at 18:19:19
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 11, 2007, at 21:30:27
No not bipolar MDD with anxiety. That's my official diagnosis thanks for the response. Phillipa
Posted by circusboy on November 13, 2007, at 15:15:02
In reply to Re: p.s. about MAOIs » linkadge, posted by War-Face on November 6, 2007, at 15:56:38
> I found Prozac, on the other hand, to be extremely motivating (probably from NE boosting properties), although after prolonged use, it did leave me feeling dumb and forgetful and tired, in a way similar to the well-articulated cycle of SSRI use above.
>Wanted to chime in and say I've had very similar experiences with Prozac. Pretty good in the short term, then the not-insignificant cognitive deficits start to move in. Also, the Prozac-induced anxiety (5-HT2C agonism? I can't remember which receptor subtype) starts to overwhelm the positive effects as well, and I become a nervous idiot in social situations.
I was prescribed methylphenidate to help with the concentration issues, but it took a very high dose (40 - 60 mg/day) which left me in irritable withdrawal every night. Once the Prozac was out of my system, I could have a very productive day on only 10 mg methylphenidate.
As a sort of aside... I know most of us believe this here, but it's worth repeating: the secondary affinities of "selective" drugs like the SSRIs are highly significant. Prozac at the NE transporter, Zoloft at the DA transporter, (Strattera at the kappa opiate receptor...not a SSRI, but still), Lexapro doing...something sleepy... all of these things are /supposed/ to be clinically insignificant, but those of us who have tried these drugs know they're not.
Posted by circusboy on November 13, 2007, at 15:34:42
In reply to you have a point, but I think it's not so bad. » Questionmark, posted by rgb on November 6, 2007, at 12:25:44
> I've been on sertraline for half a year and it's still working fine. Though I agree that the beginning was the best (I had some really nice feelings starting on day 3, but as you say, not the stimulant-kind euphoria, actually it slightly reminded me of 5-HT2A agonists :) A major advantage over dopamine euphoria is that there is zero desire to redose.).
>
> Maybe the apathy will slowly creep up on me, but for now I will stick with the sertraline and see how it affects me /personally/.
>After swearing off SSRIs forever for the reasons above, I've started another trial of Zoloft. It was the very first antidepressant I tried (10 years ago now), and, nostalgia aside, I think it was the most effective.
Two concerns: I was very depressed then, and didn't respond until we'd gone up to 200 mg and added Li. My depression is closer to dysthimia now (with the fun recent addition of obsessive thoughts), so hopefully this time I can stay at a low dose and avoid the lithium. Also, the sexual side effects were terrible. Again, I'm hoping I can cope with them at a low dose (25 - 50 mg).
Way back then when my pdoc switched me from Zoloft to Prozac (after a brief and ill-advised stop in Serzone land), my mood was dimmer and flatter. Prozac was better than Serzone and the sexual side effects were minimal, so I kept coming back to it when depression would descend on me again and the other drugs proved unsatisfactory. I still thought of Zoloft as the best... but those sexual side effects!
I -- like you -- am hoping that Zoloft's affinity for the DA transporter will at least partially counter the DA dampening effect of long-term SSRI use. If I have to take Ritalin too, so be it.
But I think -- and again, hope -- that sertraline may be the only drug in the class that can prevent or stave off SSRI apathy. We'll see.
-cb
Posted by Bob on November 13, 2007, at 15:45:34
In reply to Re: Prozac in particular » War-Face, posted by circusboy on November 13, 2007, at 15:15:02
"...all of these things are /supposed/ to be clinically insignificant, but those of us who have tried these drugs know they're not."
God knows, if I made a list of all the things that are supposed to be insignificant but often turn out to be show-stoppers for people on these drugs, I may never finish.
Posted by Questionmark on November 15, 2007, at 3:13:39
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Questionmark, posted by Phillipa on November 12, 2007, at 18:19:19
Oh, sorry. Then in that case the answer to your question "Why am I the only person they seem to do the opposite to rev me up and then horrible side effects?" is, in my thinking (and in the simplest of terms, of course), because your "serotonin system" (so to speak) is probably not very under-active, or at least maybe that certain of your serotonin receptors (specifically 5-HT2A[?]) are getting activated on a relatively normal to excessive level. Then with the SSRI it just resulted in too much 5-HT (esp.ly 5-HT2A?, for ex.) receptor activation and, hence, anxiety.
Or your dr. just put you on too high a dose of the SSRI than was necessary.
> No not bipolar MDD with anxiety. That's my official diagnosis thanks for the response. Phillipa
Posted by Questionmark on November 15, 2007, at 3:26:36
In reply to Re: Prozac in particular » War-Face, posted by circusboy on November 13, 2007, at 15:15:02
Yeah, Prozac acts on the 5-HT2C receptor (as well), i'm pretty sure. But remember part of what could contribute to its anxiogenic and more or less stimulating type of effects is that its metabolite... duloxetine, i believe (as opposed to Prozac/fluoxetine)... is a NRI-- and one with a significantly long half-life, if i'm not mistaken.
Also, do you know, does it pretty much sound like overall consensus here that Zoloft does have qualities different enough than other SSRIs in a way that feels like a dopamine reuptake inhibiting effect? That would be interesting because, yeah, the experts seem to think that its effect on the DA transporter would be negligible in terms of subjective effects.
Also, does Strattera really act on the kappa opioid receptor? I never heard that. That's really interesting if so.
> > I found Prozac, on the other hand, to be extremely motivating (probably from NE boosting properties), although after prolonged use, it did leave me feeling dumb and forgetful and tired, in a way similar to the well-articulated cycle of SSRI use above.
> >
>
> Wanted to chime in and say I've had very similar experiences with Prozac. Pretty good in the short term, then the not-insignificant cognitive deficits start to move in. Also, the Prozac-induced anxiety (5-HT2C agonism? I can't remember which receptor subtype) starts to overwhelm the positive effects as well, and I become a nervous idiot in social situations.
>
> I was prescribed methylphenidate to help with the concentration issues, but it took a very high dose (40 - 60 mg/day) which left me in irritable withdrawal every night. Once the Prozac was out of my system, I could have a very productive day on only 10 mg methylphenidate.
>
> As a sort of aside... I know most of us believe this here, but it's worth repeating: the secondary affinities of "selective" drugs like the SSRIs are highly significant. Prozac at the NE transporter, Zoloft at the DA transporter, (Strattera at the kappa opiate receptor...not a SSRI, but still), Lexapro doing...something sleepy... all of these things are /supposed/ to be clinically insignificant, but those of us who have tried these drugs know they're not.
Posted by circusboy on November 15, 2007, at 11:18:06
In reply to Re: Prozac in particular » circusboy, posted by Questionmark on November 15, 2007, at 3:26:36
> Yeah, Prozac acts on the 5-HT2C receptor (as well), i'm pretty sure. But remember part of what could contribute to its anxiogenic and more or less stimulating type of effects is that its metabolite... duloxetine, i believe (as opposed to Prozac/fluoxetine)... is a NRI-- and one with a significantly long half-life, if i'm not mistaken.
>Duloxetine is Cybalta, right? The only major fluoxetine metabolite I know about is norfluoxetine... I hadn't heard that it was extra-sticky at the NE transporter. That's interesting.
> Also, do you know, does it pretty much sound like overall consensus here that Zoloft does have qualities different enough than other SSRIs in a way that feels like a dopamine reuptake inhibiting effect? That would be interesting because, yeah, the experts seem to think that its effect on the DA transporter would be negligible in terms of subjective effects.
>
I don't know if it's the consensus here, really. My comments along those lines are as much hope as fact. :) I remember sertraline feeling subjectively (in retrospect) dopaminergic when I took it 10 years ago... we'll see what it does for me this time. So far (less than 1 week at 25mg) it's MUCH better in the motivation/concentration/energy department than Lexapro (the last SSRI I took, 6 months ago) was. Either that or I'm getting a healthy placebo effect.> Also, does Strattera really act on the kappa opioid receptor? I never heard that. That's really interesting if so.
>
Yep. Search pubmed for "atomoxetine kappa opioid" and it'll pop right up. (I recalled incorrectly -- it's actually an atomoxetine metabolite that has this action). Seems at least a possible mechanism for the crushing dysphoria Strattera caused in me and others. It also makes sense that it would be a metabolite, since the bad feelings didn't kick in for several days.
Posted by Phillipa on November 15, 2007, at 18:57:14
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Phillipa, posted by Questionmark on November 15, 2007, at 3:13:39
Questionmark explains why the starting dose of luvox 50mg is all I need. Anxiety leads to depression in me as then not able to do what I want to do. Thanks for the easily understood explaination. An example is when prozac first came out a pdoc gave me only avaiable dose 20mg. Day l wallpapered the foyer felt great, second day anxiety, day three panic attack all day flushed them away and took three days of xanax to come down. The pdoc thought it was an incredible fast response and begged me to take it every three day. I refused and continued on low dose xanax. Oh thyroid was still okay too. Phillipa
Posted by Robert Hoffman on November 17, 2007, at 8:23:19
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Dinah, posted by Questionmark on November 11, 2007, at 22:21:01
> Post Preface: So sorry if i'm posting too many consecutive posts at once! I now feel stupid. But i just wanted to respond to each reply post individually cuz -- well because i did.
> _____________________________________________
>
> That *is* a great link, and I'm glad you posted it so I can read it again and bookmark it. It's brilliant.... Or maybe not that brilliant but so refreshingly logical and common-sensical in an industry of such a frustratingly appalling lack of logic and common sense. (Oh, many highly intelligent people, but grossly lacking in logic for some reason, and with an overabundance of hubris-- and probably a great deal of corruption, ultimately, involved as well.)
> I was actually just going to read a bit of that and then ended up reading the whole article/page(?).
> I totally agree with so much in that article (or whatever it should be called). Many great and important points.
>
>
> > This is my favorite link on the topic:
> >
> > http://www.geocities.com/ss06470/index.htm
> >
> > I haven't read it for a while, so I should temper my endorsement to only the portion that points out that the way it works in very dissimilar conditions is similar.The reason this article is so relevant and many psychiatrists are not clearheaded is they are operating within a so called evidence based mode of thinking which categorizes patients by disease rather than as individuals with psychological issues. DSM IV has some usefulness, but it is based on operational definitions not true descriptions of illnesses in the sense that a strept throat will be cured by penicillin. In that case the cause of the illness is truly understood. As Dr. Sobo is saying, psychiatry is simply not at that point in its development. Yet "evidence based medicine" makes it appear there is more science to decision making than truly exists. It is ironic that some of the posters are trying to think their way through their symptoms on the basis of subtle neurotransmitters distinctions when this kind of science just doesn't exist. Speculations yes but not clear data.
The article is trying to say that the meds have an effect that is not specific for diagnosis, but rather works by having a psychological effect. You might want to check out Dr. Sobo's interesting description of the effect of dopaminergic drugs (such as Wellbutrin, Adderal (pure amphetamines) Ritaline etc in his article "ADHD and other Sins of Our Children" (also available on the internet) Or go to Bipolarworld.net (go to "news") which has most of his articles linked.
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