Posted by linkadge on February 14, 2007, at 18:55:44
In reply to Re: low dose risperdal -- linkadge, posted by munificentexegete on February 13, 2007, at 8:44:41
>Sure, however, there is nothing physically wrong >with them, anxiety in the absence of biological >markers is just a feeling nothing more is it >not? There should be biological markers in the >case of chronic pain: epinephrine, >norepinephrine, cortisol levels, and beta->endorphins, insulin production, glucagon, growth >hormone, prolactin, heart rate, blood pressure, >vagal tone, oxygen saturation, breathing, >intracranial pressure, and sweating can all be >used to measure the stress response and pain. I >am sure there are many more markers for pain.
Unfortunately these are not always practical diagnostic markers. It is possable for an individual to experience chronic pain in the absense of such indicators.
The same thing goes with depression. I believe there are probably dozens of biochemical imbalances which have not yet been fully discovered let alone have accuate diagonostic tests for.
I would not deny a person medicaton for chronic pain based on the fact that no test indicates they are in pain. That could be a grave mistake.
>Well the doctor isn't really there to deal with >anything other than medical issues are they?
Yes, they are there to deal with medical issues. Due to the unfortunate imperfections of modern science however, they must also work within the rhelm of presumed medical illnesses. Its like parkinsons disease. You can treat parkinsons without seeing anything but physical symptoms. There are no accurate "dopamine" tests or anything to indicate parkinsons. The same thing goes with alhzheimer's. You cannot truly diagnose alzheminer's untill after death. But doctors will still medicate for what they presume is alzhemiers. Is that wrong. Maybe some would say so, but I wouldn't.
>If you prescribe medications for a non disease >isn't that malpractice? If your doctor >prescribed you chemotherapy if you didn't have >cancer; would that be malpractice?
It would only be malpractice if there wasn't good reason to suspect it was cancer. If all the conventional diagonostic tests were utilized and pointed to cancer, then chemotherapy is indicated.
Unfortunately, in depression, there are no usefully diagonistic tests, because it is very unlikely that it is one singal disease. Not all depressed patients are hypersecretors of cortisol. Not all blood tests, or even post mortem tests indicate low levels of monoamines. But it would be unethical to assume that a person's suffering is artificial just because science lacks the tools to identify the problem.
You do realize, that even if a spinal fluid test indicates low serotonin, that SSRI's or MAOI's are not correcting the problem. So, even for those who can be identified by monoamine tests, all medications are still only working on a symptomatic level. As such, there is no such thing as anyones disease being more physical than another's.
>Trigger for what? Delusions (retreating into >fantasy worlds, overactive imaginations and >apparently even using metaphors in one's speech >is a sign of delusion), voices (doesn't everyone >have an internal dialog),How much do these people have to suffer for somebody to help them out? You can excuse their disease, but what does that do? When I was a child, I used to look at my grandfather with Parkinson's and ask my mother "why doesn't he just keep his hands still??"
If you are able to mentally write off the symptoms of schizophrenia, then clearly you do not have it, and should never need antipsychotic medication. But, why do that to people who do have the disorder? If they kill themselves because of their delusions, would you still blame that on an "overactive imagination". Clearly there are degrees of the illness, but trying to write off human suffering is not right IMHO.
Everybody knows that these people disever better than antipsychotics. But what?>paranoia (being scared >is a natural emotion >like anxiety or depression), disorganised speech >(not having perfect grammar is apparently a sign >of disease), talking too quickly, showing too >much emotion, showing too little emotion, >talking too slowly, blunted emotions, having a >messy haircut, wearing “odd” clothes, facial >hair, not doing the dishes, quirky personality, >not working for extended periods of time, not >agreeing with the government.
Let those who can get by without drugs do so.
>At the moment people incorrectly believe they >have a medical condition when they get anxious >or depressed, they see their doctor and he >incorrectly tells them it is due to a chemical >imbalance and then goes on to talk about >reuptake mechanisms.
Thousands of studies have failed to indicate any consistent changes in the levels of monoamine transporters in affective disorders. I agree. When and if the drugs work, they work for unknown reasons.
> I agree, but such tests are not commonplace. In>Some doctors won't prescribe even painkillers >unless they have evidence of disease, like a >lady I know who was involved in a car accident >and has a permanent migraine as a result of her >head injury which you could see on the MRI scan.
Whats the lesser of two evils? Prescribing painkillers to somebody who doesn't need them, or
not prescribing them to somebody who does?>With a migraine there is probably something to >measure I would have thought, I could be wrong >though, however, I would imagine there would be >some enzyme or some identity to be traced, even >the pain and stress markers that I listed above >would probably be enough to guide a doctor in >identifying a true migraine patient from a >morphine addict.
You don't treat migranes with morphine. They can be treated with other drugs which are generally not abusable. Patients generally don't fake migrane to get on triptans, beta blockers, or anticonvulsants. Just as most people don't fake depression to get on SSRI's. SSRI's are not that good. I found SSRI' therapy very disagreeble, even when I was very depressed.
Sure, there could be some yet unidentified biological cause of all migrane. Unfortunately, we *do not( have any test which identifies migrane with a high degree of accuracy.
>Otherwise couldn't we all just see the doctor >for our weekly barbituate script?I would not want to live life on barbiturates. I do not find sedatives enjoyable at all, they make me depressed, and use them as infrequently as possable. I am fortunate that they are there when I need them, and am glad that a doctor trusts me to prescribe them, since I know we could go through 1000s of tests and come up with no idenifyable cause of anxiety.
Why should the few people who abuse these drugs ruin it for the rest?
>Problem is if you compare an equivalent dopamine >block in an atypical v typical comparison one >gets all the traditional side effects + a lot of >new ones from blocking all the other receptors >as well. So they are if anything more potent and >more dangerous than the old ones,Not necessarily. We have not yet identified significant negative consequence of say histamine blockade, or 5-ht2a receptor blockade. This does not mean that the drugs are perfectly safe, it just means that it by conventional tests, they could be safer than traditional drugs. For instance, 5-ht1a agonists generally have little toxicity. In very high doses they can cause hypothermia, but many food substances are 5-ht1 agonists, such as olemide.
>Risperidone does have a particularly short half >life while olanzapine has a medium half life >which could build up in the brain tissue over a >couple of days. So this means that psychiatrists >can up the doses of Atypicals as high as they >wish whenever they wish, and the neurological >damage they can exact is now even more severe.
High doses of atypicals are very rarely used for anxiety disorders. In low doses, drugs like risperidal probably achieve their so called anti-anxiety effect through serotonin receptor blockade. I never said the drugs were perfectly safe.
>Notwithstanding the half life issue, they are >portraying more potent and toxic drugs as less >potent and less toxic to gain acceptance when >they are not that at all.
We do not know whether the drugs are more toxic, or less toxic at this point. Only time will tell.
>I believe they are the presenting to us a pack >of wolves and via the design of the research >studies, dressing them as sheep.You could be right.
>That's a high rate of TD for a 1mg daily dose >for less than a full year of treatment, think >about it! I wonder what the 1 year TD score >would be at a dose of 6mg+?
But that rate was not accounting for the what dyskinesias people had on startup. The study highlights said that dyskinesease dropped in some patients switched from typicals.
When I took risperidal for anxiety, I took like 0.25-0.5 mg.
>They have all been shown to cause TDYes that is a possability.
>pointed to a study regarding low dose >risperidone as this thread is about risperidone, >and is often seen by many to be one of the least >damaging atypicals, but TD data exists for all >APs atypical or typical and all the drug company >information admits as much.
I personally didn't think that study was all that scarry.
>Although as has been already shown the atypicals >also come with a whole new array of side effects >from their wider receptor profile and effects, >including more significant metabolic disorders >such as diabetes and heart disease.
Again, I never said they were perfectly safe. There are risks to treatment as well as risks to nontreatment. I understand that sorting things out can be maddening.
>I think you'll agree that when the drug company >itself admits this to be the case in their drug >information pamphlet, then it is fairly well >established.
I never doubted that TD is a possable side effect of antipsychotic treamtment.
>Of course it is. Without any medical evidence >that schizophrenia is real, it can only be an >imaginary disease. Without evidence seeing an >imaginary disease in a healthy patient is a >medical delusion.Well then I guess alzheimers, migrane, parkinsons etc, CFS, are just medical delusions too.
There is medical evidence that shizophrenia is a medical disease. There are usually a number of physical alterations/abnormalities of the brain's of those with schizophrenia, namely hippocampal and temporal lobe abnormalties, grey matter abnormalities. Disorder of the prefrontal cortex, mitochonidial dysfunction, abnormalties of glutamatergic function. Abnormalties in intracellular activity, PKC, GSK-3b, GAP-43, calcuium, etc. Those who research the genetics and anatomy of shizophrenia have little doubt that it is a disease, however there is not a whole lot of take home points from these findings, nor any clear tests to identify it in living patients.
>Now we have moved from the scientifically based >world of medical science into the alternate >universe of theoretical medicine.Nobody is forcing you to believe that this is infact a disease. If you want to believe that schizophrenia is just a figment of the imagination, then go right ahead.
This affliction will still continue to plague humanity whether people want to believe that it a result of some brain abnormality, or possesion by spawn of Lucfer.
>From reality to imaginary, from fact to fiction >we go. We can hypothesize that a person may have >some sort of unknown disease, however, such a >disease is hypothetical, imaginary, unproved, >unsupported, not based on evidence, not >scientific fact.Of course it is not a scientific fact. There are a lot of things in life that we respond to without having to beforehand establish them as scienfific fact.
>A person cannot be diagnosed with an imaginary >theoretical disease, it is an unsupportable >diagnosis, it is not medical science.
It is supportable, just not 100% conclusive. There are a lot of things in life that are not 100% conclusive. Scientists are still in the realm of collecting data and formulating hypothesis about many of these problems. But in the meantime, I urge you to establish a treatment modality which is more efficatous than the one at present.
But, if you feel there is nothing wrong, then this conversation is pointless. If your reason for visiting this site is simply to tell us that we are all perfectly healthy people, then your comment is duely noted.
>Without evidence of disease we cannot ever be >justified in treating anyone against their will;
I agree with you 110%.
>Horrifying stuff when you consider that >risperidone now has a FDA warning for diabetes. >Is involuntary treatment of a patient by a >doctor without evidence of disease a criminal >activity?
I think that anybody has the legal right not to take medication if they so choose. But legality is a separate issue.
>The medical profession, the psychiatrists are >the main culprits but gps do it too, shouldn't >be allowed to go around diagnosing people with >imaginary diseases and treating them for it by >giving them pesticides, lobotomies or >electricity, but that's exactly what they do.
For starters I don't even think the lobotomy occurs anymore. So we can stratch that one off the list. I agree with you 100% that people should never be treated against their will. But for those who concentually want to be treated with antipsychotics, antidepressants, or ECT, I beleive they should have the right.>Sometimes the best medicine is no medicine at all.
I agree.
>How can you help someone without a disease?
Thats a good question. I don't know why TCA antidepressants worked when they did. I don't know why sedatives work. Do I not have a disease? I don't really care. I'm here because medications have helped me in the past.
>from a medical point of view you can't, in fact >if you treat a healthy person, then you run the >risk of introducing iatrogenic disease in an >otherwise healthy person.
What is your defintion of a healthy person? When I was getting 2 hourse of sleep, vomiting from anxiety, crying 3+ hours a day, shaking, eating nothing, hiding in a courner and activly suicidal, I suppose there was nothing at all wrong with me. Just a healthy person going about their daily living. All I care was that the medications helped me to get better.
>If a patient feels depressed or anxious then >they shouldn't necessarily think that it is due >to a disease.
I agree.
>If there is something genuinely wrong with the >patient, it will be possible to find it, there >will be changes in brain structure or activity, >enzyme, chemicals, t cell or cortisol changes, >something indicating that something is amok with >the body or brain.
Sorry, but I totally disagree with you. There are *no* conventional diagnostic tests for depressive or anxiety disorders. Like I said above, only a fraction of depressed patients show cortisol abnormalities. There is some evidence of regional brain hypofunction in depressed patients, but it is not unique to depression, ie it occurs in all sorts of other psychiatric disorders. The levels of monoamine metabolities in the cerebral spinal fluid is only a measure of monoamine breakdown, it says nothing about how well a particular monoamine is functoning. It says nothing about the inegrity or responsivness of the receptors.
>Without any hard evidence, it is not possible to >confirm a diagnosis of disease and treating a >medical delusion may only serve to injure an >otherwise healthy patient.
Or it may help. I was diagnosed with depression without any "hard" evidence. I was not injured by treatment, and I believe the treatment aided in my recovery. I am no longer on any medications.
>Once a patient starts taking the antipsychotics >they can measure all manner of iatrogenic >disease, including brain, blood and heart >diseases.I reiterate. Those are possable side effects. There is no data to proove that all patients will get such side effects.
Linkadge
poster:linkadge
thread:730044
URL: http://www.dr-bob.org/babble/20070213/msgs/732852.html