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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 74. Go back in thread:
Posted by cloudnine on February 18, 2007, at 6:41:31
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by blueberry1 on February 18, 2007, at 6:03:26
I do not know, but Ive tried every single AD that is out there including Clomipramine and Parnate,and the only ADs thar really gave me a benefit were Imipramine,Fluoxetine and now the other great AD Venlafaxine (Duloxetine was useless).So I guess everyone is different and it what works for x may not work for another.Im grateful there are many types of medications,but I agree that some big pharmas produce nearly the same medications just to benefit like Mianserin/Mirtazapine , Trazodone/Nefaxodone, Citalopram/Escitalopram
Just an opinion
Posted by Squiggles on February 18, 2007, at 7:31:45
In reply to Why Most New Antidepressants Are Ineffective, posted by bulldog2 on February 17, 2007, at 13:07:07
How depressing! Whether true or false,
I'm glad I am on lithium. It's a relatively
difficult drug to adjust and monitor for the
physician, and very old (Carl Lange of 'Theory of Emotions' first used it),
but it works - no doubt.I don't know if everything that is said by
this camp is true. I read materials like Robert
Whitaker's book, and can't help but feel indignant about this medical area. But then, I never really know whether the problem is the drugs, or the sloppy treatment and lack of understanding in applying them.Squiggles
Posted by linkadge on February 18, 2007, at 8:38:18
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by blueberry1 on February 18, 2007, at 6:03:26
>Regardless, judging from real world experiences >with ssris, it appears maybe 35% - 45% of people >really benefit from them. That is a far cry from >saying they are ineffective.
Yeah, and 35-45% of people benifit from placebo.
Linkadge
Posted by willyee on February 18, 2007, at 9:34:43
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by blueberry1 on February 18, 2007, at 6:03:26
> The title is misleading. Forget the clinical studies. Go to remedyfind.com and askapatient.com to see real world people experiences with ssris. A good number of them do very well with ssris. The title is an inaccurate over-generalization.
>
> I understand the manipulation of clinical data, ghost writers, big pharm influence, and behind the scenes scandals of facts. That stuff really disturbs me.
>
> Regardless, judging from real world experiences with ssris, it appears maybe 35% - 45% of people really benefit from them. That is a far cry from saying they are ineffective.
>
> I'm not sure why he praises parnate so much. There have been plenty of people here and other places that did poorly with. Side effects often require 2 or 3 other meds to deal with, when it works. I would guess in the real world the actual positive benefits of parnate compared to ssris are probably a little higher than ssris, but not enough to totally trash ssris and put parnate on a pedestal.
>
> Anyway, bottom line, mileage varies. I totally respect the authors views, but feel the title is a bit inaccurate and overgeneralized.Actualy ive read and i wish i had the article/articles handy that documented studies did show parnate to be one of the most fast & effective drugs for depression,Nardil the old one as well,in fact the old Nardil used to be nick named the GOLD STANDERD.
Along with the parnate statistics however the drug prob holds the highest or close to addiction potential,so you always get some form of major con.
Your right however,studies from any source,PERIOD doesent overide actual experiance,and mileage varies,although i do agree with the findings i also agree if someone does well on any drug that is helpng all around then they have no reason to look else where just because of some documented study.
Remedyfind shows parnate less effective overall because u can see the users invovled are far far far less than a user of ssris,this is prob common since again maois are strayed by most docs as not to be used.
Also,like maois,most people on ssris will also have a adjunct med like a benzo or mood stablizer as most ssris,especaily when working well tend to cause some over excitement,im sure you know the term polypharmacy which is multiple drugs used,and with the complex way the brain works,during the lentgh of a day it actualy makes sense that more than a single drug would be best.
Sadest thing of all to me is that a drug "parnate" from the what..50`s is still even considered one of the better ones,it just shows to me the slow advancments were making,i truly believe as long as patients listen to docs about not going off on there own to research,sometimes scared into doing a thing without talking to them,etc,.....as long as these drugs and cousin drugs make such big money,im afraid and almost certain i wont see any serious new line treatments in my lifetime,and ill be either off or juggling drugs for a very long time.
All debates aside,everyone has a similiar goal,and if you feel better on any form of treatment,then recomend it as a option,and from there on dont worry what others say and enjoy it,we spend to much time defending what works i think,aim to live life as full as you can !
Posted by flmm on February 18, 2007, at 10:32:51
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by willyee on February 18, 2007, at 9:34:43
Antidepressants help many people, period! Are they perfect? NO! They make a significant difference in my, and many other people I know, lives. Anxiety and depression is a complex and difficult disease. The drugs can only do so much! Maybe some of you complainers should look at other ways to help yourself, and be grateful for the help available to us!
Posted by linkadge on February 18, 2007, at 10:41:02
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by flmm on February 18, 2007, at 10:32:51
I don't consider stating facts complaining.
Linkadge
Posted by Squiggles on February 18, 2007, at 11:13:13
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 10:41:02
> I don't consider stating facts complaining.
>
> LinkadgeI think it would be interesting to see how many
posters here aredoctors
medical students
patients
SSRI takers
AD takers
ATYPICAL AD takers
Benzo takers
Lurkers
Drug company reps
Naturo or herbal therapy takers
Addicts on hard drugs- and see how many are currently unhappy or
mentally distraught from their medical condition.I have noticed that many are very lucid in their writing (are they stable on the meds or not taking meds?) and some cannot spell or have trouble posting their complaints (are they non-medicated or perhaps over-medicated). And then there are the ones who are too sick to post or have left for some reason or another.
I think that would be revealing of how well this group is doing on medications.
Squiggles
Posted by madeline on February 18, 2007, at 11:51:06
In reply to Why Most New Antidepressants Are Ineffective, posted by bulldog2 on February 17, 2007, at 13:07:07
That big pharma has with intention misled the public, the medical community and all of the regulatory agencies.
Let's also assume that these new drugs are actually awful and any efficacy that has been noted has been disproportionally reported.
I would even go so far as to say, as the author quoted, that the for profit venture of making medicine has fueled every bit of this deceit. That a mere 10% of the operating budget devoted to R&D is a mere pittance of what it should be in these companies.
All that being true what, exactly, are we prepared to do about it?
10% R&D of the operating budget from big pharma is probably more than 1000X money than the best NIH funded laboratory in the US gets from the gov't.
If you combined all of the R&D budgets from big pharma it is probably more than the ENTIRE NIH budget, and the NIH funds everything from basic research on up and not just drug discovery.
If you took the for profits out of the game entirely, then you wouldn't have anything at all.
So regulate them? They already are. Expose them? Keep going. Demand better drugs and reporting? Absolutely, the market drives the product.
But nothing is going to change until people start putting their money where their mouth is.
Posted by Squiggles on February 18, 2007, at 11:54:40
In reply to So let's just assume that it's all true., posted by madeline on February 18, 2007, at 11:51:06
I think they should build clinics
and hire doctors, nurses and medical
technicians-- to help the present
stressed situation of dr. and hospital
overload.There should be economic and educational
collaboration between the drug companies
and the medical public sector.Squiggles
Posted by willyee on February 18, 2007, at 12:19:11
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by flmm on February 18, 2007, at 10:32:51
> Antidepressants help many people, period! Are they perfect? NO! They make a significant difference in my, and many other people I know, lives. Anxiety and depression is a complex and difficult disease. The drugs can only do so much! Maybe some of you complainers should look at other ways to help yourself, and be grateful for the help available to us!
Perhaps re read the thread,no one is stating they are not grateful meds are available,but im not gonna sit down and never be concerned if there is misleading facts being presented,i WANNA KNOW.
Im not the guinia pig in the maze,i wanna know that what im told when i reasearch a drug is not half truths,im sorry if you feel this is complaning.
Is my concern to simply feel safe and that i can trust information any less important than yourself benfiting from it?
Posted by Quintal on February 18, 2007, at 13:39:54
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by blueberry1 on February 18, 2007, at 6:03:26
Blueberry, haven't you yourself taken umpteen different meds over recent months and found not only were they ineffective, but they made your depression worse? It surprises me then, to hear you being so critical of this author's work. Have you ever taken Parnate or any other MAOI? From what I recall from your posts you have not. I suggest you actually try one and see if it helps your depression rather than relying on reports from RemedyFind, most of which don't seem to reflect your own experiences with newer antidepressants in any case.
Q
> The title is misleading. Forget the clinical studies. Go to remedyfind.com and askapatient.com to see real world people experiences with ssris. A good number of them do very well with ssris. The title is an inaccurate over-generalization.
>
> I understand the manipulation of clinical data, ghost writers, big pharm influence, and behind the scenes scandals of facts. That stuff really disturbs me.
>
> Regardless, judging from real world experiences with ssris, it appears maybe 35% - 45% of people really benefit from them. That is a far cry from saying they are ineffective.
>
> I'm not sure why he praises parnate so much. There have been plenty of people here and other places that did poorly with. Side effects often require 2 or 3 other meds to deal with, when it works. I would guess in the real world the actual positive benefits of parnate compared to ssris are probably a little higher than ssris, but not enough to totally trash ssris and put parnate on a pedestal.
>
> Anyway, bottom line, mileage varies. I totally respect the authors views, but feel the title is a bit inaccurate and overgeneralized.
Posted by Quintal on February 18, 2007, at 13:59:10
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by Squiggles on February 18, 2007, at 11:13:13
Okay, I for one am not taking any prescribed psych meds at the moment. I am taking codeine in the form of OTC painkiller tablets, which I seem to be addicted to. I am in the process of weaning myself off them. I also take these herbs;
Rhodiola Rosea in the morning as a mild stimulant and mood elevator (think caffeine but without jitteriness).
Agnus Castus - as is often the case with naturals I'm not entirely sure why I'm taking it to be honest, but it does seem to have a positive effect on my mood and anxiety as I've found out from skipping doses for a few days and finding myself nervous and overwrought. I seem to find emotional balance again after a day or two of taking it again. Scientific studies have shown it is (among many other things) a mild D2 antagonist (like antipsychotics) and balances hormone levels (quite how I don't know).
Valerian, hops, passion flower, melissa, opium lettuce; a compound preparation of sedative/hypnotic herbs take at night to aid restful sleep. It does seem to be effective.
Melatonin; 3-9mg slow-release tablets as a sleep cycle regulator and hypnotic. It does seem to be effective.
I have a hard time convincing some people here that I'm not anti-med or anti-psychiatrist because of the above, but I can assure you I was once *very* anti-alternative and very pro-med and nobody is as surprised as myself to find me in this position after five years of taking nearly every psychoactive substance available in the BNF (that is not an exaggeration). I'm in the process of compiling a spreadsheet of all the drugs I've taken along with doses, side effects, tolerability etc. I may post it here after I'm finished if anyone would like to see it.
Q
> I think it would be interesting to see how many
> posters here are
>
> doctors
> medical students
> patients
> SSRI takers
> AD takers
> ATYPICAL AD takers
> Benzo takers
> Lurkers
> Drug company reps
> Naturo or herbal therapy takers
> Addicts on hard drugs
>
> - and see how many are currently unhappy or
> mentally distraught from their medical condition.
>
> I have noticed that many are very lucid in their writing (are they stable on the meds or not taking meds?) and some cannot spell or have trouble posting their complaints (are they non-medicated or perhaps over-medicated). And then there are the ones who are too sick to post or have left for some reason or another.
>
> I think that would be revealing of how well this group is doing on medications.
>
> Squiggles
Posted by Squiggles on February 18, 2007, at 14:22:12
In reply to Re: Why Most New Antidepressants Are Ineffective » Squiggles, posted by Quintal on February 18, 2007, at 13:59:10
Well, you sound lucid; and content with
your herbal meds. I'm not going to remark
on this... thanks for your response.Squiggles
Posted by linkadge on February 18, 2007, at 15:36:31
In reply to Re: Why Most New Antidepressants Are Ineffective » Squiggles, posted by Quintal on February 18, 2007, at 13:59:10
>Scientific studies have shown it is (among many >other things) a mild D2 antagonist (like >antipsychotics) and balances hormone levels >(quite how I don't know).
I was under the impression that agnus cascus was a d2 agonist not antagonist.
Linkadge
Posted by Quintal on February 18, 2007, at 15:54:11
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 15:36:31
Is it? Well that would explain the increased sex drive (despite the suggestive name) and increased energy and alertness. I'll double check but I thought I read a report of agnus castus beign a D2 antagonist.
Q
Posted by bulldog2 on February 18, 2007, at 15:56:54
In reply to Re: Why Most New Antidepressants Are Ineffective » Squiggles, posted by Quintal on February 18, 2007, at 13:59:10
Most physicians seem to have a poor knowledge of pharmaceuticals in my opinion. What I often find is that docs prescribe the latest drug that the pharmacuetical rep has given samples to the doc. Often the doctor's knowledge of a drug is the info he has gotten from the rep. There seems to be an assumption that newer is better which is just not the case.
When prozac came out it was the new god of ads. Than came zoloft, paxil, effextor and so on. So the new best ad just kept changing. I remember when zoloft came out my doc back than said to stop my ativan as zoloft would take care of my anxiety to. Well my blood pressure shot up and I almost had a stroke. To this day many docs still think that an ssri will act as a tranquilizer when in fact many will need more benzos or will need to start one on an ssri. Guess where their getting their info ? (pharmaceutical reps).
I've never tried parnate or nardil due to the dietary restrictions and fear of hypertensive reactions. But from what I've have read and talking to people who have suffered from depression the maois seem to work in many cases where all else has failed.
Let's be honest about this the pharmaceutical industry makes it's money from marketing new drugs that are under patent. I guess we really haven't made a lot of strides in pyschotropic meds when the older ads from the 50's and 60's are probably more effective than the new wonder drugs of today.
Posted by Quintal on February 18, 2007, at 16:02:43
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 15:36:31
Yes, you're right link. Agnus castus appears to act as a dopamine agonist as well as having some effects on the opiod system. So my feelings of wellbeing and euphoria are not paradoxical afterall? I wonder if an increased dose of Agnus Castus would help with codeine withdrawal?
__________________________________________________Pharmacological activities of Vitex agnus-castus extracts in vitro.Meier B, Berger D, Hoberg E, Sticher O, Schaffner W.
Zeller AG, Herbal Medicinal Products, Romanshorn, Switzerland. beat.meier@zellerag.chThe pharmacological effects of ethanolic Vitex agnus-castus fruit-extracts (especially Ze 440) and various extract fractions of different polarities were evaluated both by radioligand binding studies and by superfusion experiments. A relative potent binding inhibition was observed for dopamine D2 and opioid (micro and kappa subtype) receptors with IC50 values of the native extract between 20 and 70 mg/mL. Binding, neither to the histamine H1, benzodiazepine and OFQ receptor, nor to the binding-site of the serotonin (5-HT) transporter, was significantly inhibited. The lipophilic fractions contained the diterpenes rotun-difuran and 6beta,7beta-diacetoxy-13-hydroxy-labda-8,14-dien . They exhibited inhibitory actions on dopamine D2 receptor binding. While binding inhibition to mu and kappa opioid receptors was most pronounced in lipophilic fractions, binding to delta opioid receptors was inhibited mainly by a aqueous fraction. Standardised Ze 440 extracts of different batches were of constant pharmacological quality according to their potential to inhibit the binding to D2 receptors. In superfusion experiments, the aqueous fraction of a methanolic extract inhibited the release of acetylcholine in a concentration-dependent manner. In addition, the potent D2 receptor antagonist spiperone antagonised the effect of the extract suggesting a dopaminergic action mediated by D2 receptor activation. Our results indicate a dopaminergic effect of Vitex agnus-castus extracts and suggest additional pharmacological actions via opioid receptors.
PMID: 11081988 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11081988
__________________________________________________Q
Posted by linkadge on February 18, 2007, at 16:05:24
In reply to Re: Why Most New Antidepressants Are Ineffective » linkadge, posted by Quintal on February 18, 2007, at 15:54:11
I think so, I could be wrong though. I remember reading that it was a potential treatment for parkinsons, and that it decreased prolactin.
Linkadge
Posted by linkadge on February 18, 2007, at 16:09:22
In reply to Re: Why Most New Antidepressants Are Ineffective » linkadge, posted by Quintal on February 18, 2007, at 16:02:43
Agnus castus gave me a feeling of being more in tune with the universe. I know thats kind of... (strange noise), but I could expect it from a drug that does the opposite as antipsychotics.
I seemed to experience a feeling of beauty about things while on it. It really seemed to be an anhednoia buster.
Linkadge
Posted by Quintal on February 18, 2007, at 16:17:01
In reply to Re: Why Most New Antidepressants Are Ineffective » Quintal, posted by linkadge on February 18, 2007, at 16:05:24
Yup, here is a wiki article and some studies showing the effectiveness of Agnus Castus in lowering prolactin levels in women with premenstrual problems:
__________________________________________________
The berries are considered a tonic herb for both the male and female reproductive systems. The leaves have the same effect, but to a somewhat lesser degree. It is used in some supplements for male bodybuilders as a secondary component, as some studies suggested that it may decrease the prolactin levels, which, in turn, increases LH (luteinizing hormone)and testosterone levels. It has been assumed to not have the same effect on the female hormonal balance, but recent studies contradict this.
http://en.wikipedia.org/wiki/Vitex_agnus-castus
__________________________________________________Since AC extracts were shown to have beneficial effects on premenstrual mastodynia serum prolactin levels in such patients were also studied in one double-blind, placebo-controlled clinical study. Serum prolactin levels were indeed reduced in the patients treated with the extract. The search for the prolactin-suppressive principle(s) yielded a number of compounds with dopaminergic properties: they bound to recombinant DA2-receptor protein and suppressed prolactin release from cultivated lactotrophs as well as in animal experiments. The search for the chemical identity of the dopaminergic compounds resulted in isolation of a number of diterpenes of which some clerodadienols were most important for the prolactin-suppressive effects. They were almost identical in their prolactin-suppressive properties than dopamine itself. Hence, it is concluded that dopaminergic compounds present in Vitex agnus castus are clinically the important compounds which improve premenstrual mastodynia and possibly also other symptoms of the premenstrual syndrome.
PMID: 12809367 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12809367&query_hl=2&itool=pubmed_docsum
__________________________________________________Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study.Schellenberg R.
Institute for Health Care and Science, 35625 Huttenberg, Germany. med@t-online.deOBJECTIVES: To compare the efficacy and tolerability of agnus castus fruit (Vitex agnus castus L extract Ze 440) with placebo for women with the premenstrual syndrome. DESIGN: Randomised, double blind, placebo controlled, parallel group comparison over three menstrual cycles. SETTING: General medicine community clinics. Participants: 178 women were screened and 170 were evaluated (active 86; placebo 84). Mean age was 36 years, mean cycle length was 28 days, mean duration of menses was 4.5 days. INTERVENTIONS: Agnus castus (dry extract tablets) one tablet daily or matching placebo, given for three consecutive cycles. MAIN OUTCOME MEASURES: Main efficacy variable: change from baseline to end point (end of third cycle) in women's self assessment of irritability, mood alteration, anger, headache, breast fullness, and other menstrual symptoms including bloating. Secondary efficacy variables: changes in clinical global impression (severity of condition, global improvement, and risk or benefit) and responder rate (50% reduction in symptoms). RESULTS: Improvement in the main variable was greater in the active group compared with placebo group (P<0.001). Analysis of the secondary variables showed significant (P<0.001) superiority of active treatment in each of the three global impression items. Responder rates were 52% and 24% for active and placebo, respectively. Seven women reported mild adverse events (four active; three placebo), none of which caused discontinuation of treatment. CONCLUSIONS: Dry extract of agnus castus fruit is an effective and well tolerated treatment for the relief of symptoms of the premenstrual syndrome.
PMID: 11159568 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11159568
__________________________________________________Q
Posted by Quintal on February 18, 2007, at 16:36:03
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 16:09:22
>Agnus castus gave me a feeling of being more in tune with the universe. I know thats kind of... (strange noise), but I could expect it from a drug that does the opposite as antipsychotics.
That's pretty much what I've been experiencing myself. I was thinking this is odd for a dopamine antagonist, but I assumed it was some sort of paradoxical effect. How much were you taking and what brand?
I'm taking Nature's Aid Herbal Range Standardised Agnus Castus Extract 1000mg equivalent (100mg extract equivalent to 1000mg of dried Agnus Castus berries - standardised to 600 micrograms of Aucubin). The Nature's Aid brand looks, well, cheap for want of a better word (and is quite cheap too), but I've noticed they seem to be manufactured to a higher standard than some of the big-name brands like Solgar.
Q
Posted by linkadge on February 18, 2007, at 16:48:54
In reply to Re: Why Most New Antidepressants Are Ineffective » linkadge, posted by Quintal on February 18, 2007, at 16:36:03
I was taking herbal select, 450mg of mixed herb powder and extract per cap. I was taking about 2 of those per day.
I was also thinking that combining it with inostitol might provide synergy. Inostiol supposdely sensitizes the d2 recetors, and acts as a second messenger at the receptor.
Some studies have linked antidperessant action to upregulation of d2 mediated neurotransmission.
Linkadge
Posted by flmm on February 18, 2007, at 17:03:49
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by linkadge on February 18, 2007, at 16:48:54
SSRIs act as a tranquilizer in me!
Posted by halcyondaze on February 18, 2007, at 17:15:09
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by Squiggles on February 18, 2007, at 11:13:13
> > I don't consider stating facts complaining.
> >
> > Linkadge
>
> I think it would be interesting to see how many
> posters here are
>
> doctors
> medical students
> patients
> SSRI takers
> AD takers
> ATYPICAL AD takers
> Benzo takers
> Lurkers
> Drug company reps
> Naturo or herbal therapy takers
> Addicts on hard drugs
>
> - and see how many are currently unhappy or
> mentally distraught from their medical condition.
>
> I have noticed that many are very lucid in their writing (are they stable on the meds or not taking meds?) and some cannot spell or have trouble posting their complaints (are they non-medicated or perhaps over-medicated). And then there are the ones who are too sick to post or have left for some reason or another.
>
> I think that would be revealing of how well this group is doing on medications.
>
> Squiggles
I am a medical student.I am also a patient.
I take Parnate.
I take Halcion.
I am currently doing research in psychopharmacology, sponsored by NIMH. I have done research sponsored by pharmaceutical companies in the past but found them utterly distasteful in the way that data was ignored or "dropped" or dismissed.
Parnate has changed my life. I agree with this doctor's assessment about SSRIs and I will be one psychiatrist who, upon graduation, will not be afraid to use MAOIs as a first line treatment.
Posted by Quintal on February 18, 2007, at 17:18:32
In reply to Re: Why Most New Antidepressants Are Ineffective, posted by flmm on February 18, 2007, at 17:03:49
You don't 'sound' very tranquil to me. Many people find them agitating.
Q
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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
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