Posted by JLM on August 16, 2004, at 11:35:17
In reply to Re: drug effect on healthy people » JLM, posted by Larry Hoover on August 16, 2004, at 9:22:20
> > The idea with a challenge/dechallenge/rechallenge
> > is fairly simple: if give someone a drug once and you see a particular side effect, you can't really
> > be sure of causation. But, if you give it to them AGAIN, and you see the same thing happen again, then you can be reasonably certain that it was indeed the drug. Especially if you give it to a healthy volunteer.
>
> True enough, but you cannot exclude alternate explanations for adverse effects in "healthy people" by just defining things a certain way.
>
> If you gave digoxin to "healthy people" it would adversely affect heart function. You can't extrapolate from that to people with low cardiac output. They are distinct populations.
>
> If ADs are associated with increased risk of suicide in non-depressed people, you cannot infer that there is a hidden effect in the depressed population. It's a reasonable thing to consider, but it cannot (yet) be demonstrated.
>
> That said, there is a critical window early on in pharmaceutical treatment of depression (and this is true for virtually all ADs, not just SSRIs), where suicidality is enhanced. It's tempting to blame the drugs for that, but the very reason many people are being treated with ADs is because of the morbid risk of suicidality in depressive disorders. There are many theories about why this increase in suicidal behaviour may occur, but once again, blaming the drugs alone is short-sighted.
>
> LarTrue, a healthy population is a healthy population.
But, that's exactly the problem. These drugs are vastly overprescribed, and that being the case, this phenomena is particularly relevent. There are all kinds of people out there, thanks to HMO's/Managed Care, that are walking around on SSRI's that aren't truly depressed. So, this potential phenomena is PARTICULARLY relevent to them.
And, since the proposed mechanism is akathisia, it
would/could be relevent to 'sick' people as well. Look at all the people who got akathisia from antipsychotics. They didn't get akathisia because the drug behaved a certain way in THEIR bodies, they got akathisia because the drugs can cause akathisia in ANYONE, even a healthy person.In the Teicher and Cole articles, the patients they were dealing with were obviously depressed (you wouldn't be seeing someone of the stature of Dr. Cole if you were not sick), and when put thru a challenge/dechallenge/rechallenge, they became suicidial BOTH times they drug was reinstituted. Coincidence? Johnathan O. Cole is one of the most prominent psychopharmacologists in the world. He was a founding member of the ACNP and on their editorial board.
poster:JLM
thread:208072
URL: http://www.dr-bob.org/babble/20040811/msgs/378250.html