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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Larry Hoover on June 7, 2005, at 8:36:48
I really dislike the concept. I really dislike the representation itself.
Drugs have effects. Period.
Among the effects, some of them are ones we are glad to see, and some of them we wish did not occur. When someone takes an SSRI, I'm sure that sexual dysfunction isn't often greeted with a "Hooray!" I think it unlikely that I'll ever seen a television advertisement proclaiming this particular drug effect. However, declaring it to be a side effect trivializes it. My own psychiatrist, upon hearing of my antidepressant neutering, asked me, "Would you rather be depressed?", as if it was somehow a reasonable trade off. The success and popularity of Viagra and Cialis (despite their price) would answer that question.
When you read a drug monograph, you will see a long list of "adverse reactions" or "side effects", as compared to placebo, in clinical trials. Why are those not listed right together with positive reactions? Why is it not possible to just see the effects of the drug? If it is twice as likely that a person might have sexual dysfunction than it is that they might find relief from depression, then why is it that the drug is marketed as an antidepressant, rather than as a chemical neutering agent?
I just did a drug trial, of topiramate (Topomax). It was brief, and perhaps I exceeded the most conservative titration schedule. I think it is moot, as one drug effect I experienced simply cannot be ignored. It could be permanently disabling or fatal. In any case, here is my list of drug effects:
fatigue
flu-like symptoms
hot flushes
dizziness
speech problems (both aphasia and motor)
paresthesia
tremor
involuntary muscle contractions
reduction in neurasthenia/neuralgia
nausea
dyspepsia
abdominal pain
dry mouth
gingivitis
nervousness
memory problems
somnolence
confusion
emotional lability
difficulty with concentration
pharyngitis
sinus headache
taste perversion
micturition frequency
pruritus
oligohydrosis (inability to sweat)The last one on the list is dangerous. Some on the list are merely nuisances. Many are of sufficient intensity to interfere with affairs of daily living. One effect was beneficial.
On this basis, the effect of the drug did not improve my quality of life. There are no side effects. These are all main drug effects.
Some main drug effects are rare, but that doesn't matter one whit to the person who has those rare effects, because in that individual, the incidence is 100%.
I say, to hell with the concept of side effect. Let's talk drug effect, and get on with assessing the quality of life, before and after the drug.
Lar
Posted by Larry Hoover on June 7, 2005, at 9:49:26
In reply to Side effects, posted by Larry Hoover on June 7, 2005, at 8:36:48
I'm still not thinking clearly
Lar
Posted by ed_uk on June 7, 2005, at 11:33:09
In reply to Side effects, posted by Larry Hoover on June 7, 2005, at 8:36:48
Hi Lar,
>My own psychiatrist, upon hearing of my antidepressant neutering, asked me, "Would you rather be depressed?", as if it was somehow a reasonable trade off.
That's what my pdoc says to me when I tell him that citalopram makes me want to sleep all the time. Grrr!
Kind regards,
Ed.
Posted by Jakeman on June 7, 2005, at 12:19:18
In reply to Side effects, posted by Larry Hoover on June 7, 2005, at 8:36:48
>I say, to hell with the concept of side effect. Let's talk drug effect, and get on with assessing the quality of life, before and after the drug
I agree.
I feel sometimes like I am making a deal with the devil. The devil says, "Ok, I'll reduce your mental anguish enough so that you can be productive and social. In return, you will give up your sex life and three hours of sleep each night. Oh and by the way, I can end this agreement at any time without notice."
~J
Posted by Racer on June 7, 2005, at 12:30:29
In reply to Re: Side effects » Larry Hoover, posted by Jakeman on June 7, 2005, at 12:19:18
I just read a couple of journal articles where psychiatrists are starting to look, not at "medication response", but at quality of life. That doesn't mean our own psychiatrists are going to start behaving as though we're, you know, Real People; or that they'll suddenly start asking us if we feel as though the "side effects" are worth it. It just means that the basic issue is beginning to come up in professional discussions.
I'm of two minds about the "side effect"/"drug effect" issue, though. The meds are designed to do something fairly specific. Anything beyond that is an unintended effect -- even if, as in some cases like minoxidil, the unintended effect is still beneficial. In other words, it's a side effect.
Still, the question of whether it's an acceptable trade off between, say, a sex life and remission from depression? Any doctor asking that question is a little bit confused. "Depression" is a disorder made up of symptoms. Acting on one symptom is *not* synonymous with acting on the disorder. Returning a patient to optimal functioning should be the goal, and anything less should not be acceptable.
Larry, even if we don't entirely agree on this subject -- although I don't entirely disagree with your point -- I do think that what you've written here is good food for thought.
xoxo
Posted by ed_uk on June 7, 2005, at 12:51:26
In reply to The good news is..., posted by Racer on June 7, 2005, at 12:30:29
>I do think that what you've written here is good food for thought.
What Lar says is always food for thought :-)
Ed xx
Posted by ed_uk on June 7, 2005, at 12:52:46
In reply to Re: The good news is... » Racer, posted by ed_uk on June 7, 2005, at 12:51:26
>What Lar says is always food for thought :-)
Even when he's on Dopamax- and that's saying something!
Ed.
Posted by Maxime on June 7, 2005, at 13:22:21
In reply to The good news is..., posted by Racer on June 7, 2005, at 12:30:29
Racer, I think you should post the articles so we can all have a copy to bring with us. We can hand it over and say "I just want you to be aware of the latest trend" Now, about this second head I am growing ....
Hugs,
Maxime
> I just read a couple of journal articles where psychiatrists are starting to look, not at "medication response", but at quality of life. That doesn't mean our own psychiatrists are going to start behaving as though we're, you know, Real People; or that they'll suddenly start asking us if we feel as though the "side effects" are worth it. It just means that the basic issue is beginning to come up in professional discussions.
>
> I'm of two minds about the "side effect"/"drug effect" issue, though. The meds are designed to do something fairly specific. Anything beyond that is an unintended effect -- even if, as in some cases like minoxidil, the unintended effect is still beneficial. In other words, it's a side effect.
>
> Still, the question of whether it's an acceptable trade off between, say, a sex life and remission from depression? Any doctor asking that question is a little bit confused. "Depression" is a disorder made up of symptoms. Acting on one symptom is *not* synonymous with acting on the disorder. Returning a patient to optimal functioning should be the goal, and anything less should not be acceptable.
>
> Larry, even if we don't entirely agree on this subject -- although I don't entirely disagree with your point -- I do think that what you've written here is good food for thought.
>
> xoxo
Posted by Maxime on June 7, 2005, at 13:58:48
In reply to Side effects, posted by Larry Hoover on June 7, 2005, at 8:36:48
Larry, is it okay if I give you a hug? (((Larry)))
You are such a special and amazing person and I hate to see you suffer like this. That is one long list of side effects for Topomax! Are you prone to getting more side effects than most people, or was this med just not for you?
Like I said I hate Topomax. It gave me a wicked UTI, my face and back broke out with the worse acne I have ever had in my life. But I think going psychotic is what did me in. Then another doctor wanted me try it and I told him what happened the last time I took it. His response? "Well that's because you probably didn't titrate it properly". So I actually took it again (this was several years ago before I learned how to stand up to pdoc). Well guess what? I WENT PSYCHOTIC! *sshole.
I hope you find a solution. And you should ask you pharmacy when Cymbalta is expected to come out. A doctor told me July. Maybe you could even start getting samples of it?
Take care,
Maxime
> I really dislike the concept. I really dislike the representation itself.
>
> Drugs have effects. Period.
>
> Among the effects, some of them are ones we are glad to see, and some of them we wish did not occur. When someone takes an SSRI, I'm sure that sexual dysfunction isn't often greeted with a "Hooray!" I think it unlikely that I'll ever seen a television advertisement proclaiming this particular drug effect. However, declaring it to be a side effect trivializes it. My own psychiatrist, upon hearing of my antidepressant neutering, asked me, "Would you rather be depressed?", as if it was somehow a reasonable trade off. The success and popularity of Viagra and Cialis (despite their price) would answer that question.
>
> When you read a drug monograph, you will see a long list of "adverse reactions" or "side effects", as compared to placebo, in clinical trials. Why are those not listed right together with positive reactions? Why is it not possible to just see the effects of the drug? If it is twice as likely that a person might have sexual dysfunction than it is that they might find relief from depression, then why is it that the drug is marketed as an antidepressant, rather than as a chemical neutering agent?
>
> I just did a drug trial, of topiramate (Topomax). It was brief, and perhaps I exceeded the most conservative titration schedule. I think it is moot, as one drug effect I experienced simply cannot be ignored. It could be permanently disabling or fatal. In any case, here is my list of drug effects:
>
> fatigue
> flu-like symptoms
> hot flushes
> dizziness
> speech problems (both aphasia and motor)
> paresthesia
> tremor
> involuntary muscle contractions
> reduction in neurasthenia/neuralgia
> nausea
> dyspepsia
> abdominal pain
> dry mouth
> gingivitis
> nervousness
> memory problems
> somnolence
> confusion
> emotional lability
> difficulty with concentration
> pharyngitis
> sinus headache
> taste perversion
> micturition frequency
> pruritus
> oligohydrosis (inability to sweat)
>
> The last one on the list is dangerous. Some on the list are merely nuisances. Many are of sufficient intensity to interfere with affairs of daily living. One effect was beneficial.
>
> On this basis, the effect of the drug did not improve my quality of life. There are no side effects. These are all main drug effects.
>
> Some main drug effects are rare, but that doesn't matter one whit to the person who has those rare effects, because in that individual, the incidence is 100%.
>
> I say, to hell with the concept of side effect. Let's talk drug effect, and get on with assessing the quality of life, before and after the drug.
>
> Lar
Posted by Larry Hoover on June 7, 2005, at 16:08:48
In reply to Re: The good news is... » Racer, posted by ed_uk on June 7, 2005, at 12:51:26
> >I do think that what you've written here is good food for thought.
>
> What Lar says is always food for thought :-)
>
> Ed xxYou're too kind.
Lar
Posted by Larry Hoover on June 7, 2005, at 16:15:39
In reply to Re: Side effects » Larry Hoover, posted by Maxime on June 7, 2005, at 13:58:48
> Larry, is it okay if I give you a hug? (((Larry)))
Absolutely okay. Thanks.
> You are such a special and amazing person and I hate to see you suffer like this.
Watch, or you make me cry. (good cry)
> That is one long list of side effects for Topomax! Are you prone to getting more side effects than most people, or was this med just not for you?
Some people just are very med sensitive. I am very clearly med sensitive. This med particularly disturbed me. The loss of thermoregulatory capacity (that last side effect in my list) is very serious indeed.
> Like I said I hate Topomax. It gave me a wicked UTI, my face and back broke out with the worse acne I have ever had in my life. But I think going psychotic is what did me in. Then another doctor wanted me try it and I told him what happened the last time I took it. His response? "Well that's because you probably didn't titrate it properly". So I actually took it again (this was several years ago before I learned how to stand up to pdoc). Well guess what? I WENT PSYCHOTIC! *sshole.
Ya. Geez. Like it was your fault. I'm sorry that happened to you. I'm sorry you trusted that *sshole. I'm sorry he betrayed your trust. I'm sorry he got his medical license.
> I hope you find a solution. And you should ask you pharmacy when Cymbalta is expected to come out. A doctor told me July. Maybe you could even start getting samples of it?
>
> Take care,
> MaximeI was wondering how you knew that. I couldn't find anything on the Health Canada website. You can't get samples until it's approved, though. The only way you can get a drug that isn't approved is upon special application to the feds. I'm not going to even think about that sort of thing until I've worked my way through the list of available, reasonable options.
Thanks for the kind thoughts.
Lar
Posted by linkadge on June 7, 2005, at 19:38:04
In reply to Re: Side effects » Maxime, posted by Larry Hoover on June 7, 2005, at 16:15:39
If there is one person on this board who is knowlegable enough to appreciate this, it is larry.
The body body is a system. Its about time doctors started treating it as one.
Its about time doctors start telling their patients things like how their patients would be doing as well in 6 months on half as much prozac if they took a folic acid supplement.
That is why I am fed up. I need the doctors for their pills, but I don't need them for their insensitivies.
Linkadge
Posted by Phillipa on June 7, 2005, at 22:20:06
In reply to The body is a system, posted by linkadge on June 7, 2005, at 19:38:04
My pdoc will give me whatever I want. Go figure, and she says to "play with the doses". Because she admits knowing about poopout? Noted on internet for AMA articles, and others? She's the first one who really will Rx whatever I want. Although she was hesitant when I mentioned MAOI's just to check. Fondly, Phillipa
Posted by Cairo on June 8, 2005, at 19:17:57
In reply to Side effects, posted by Larry Hoover on June 7, 2005, at 8:36:48
Your list of Topamax adverse EFFECTS reads exactly like mine with induction of panic attacks to be added. I totally agree with the marginalization of adverse EFFECTS by the drug companies and especially doctors. However, if an uninitiated person would read the adverse EFFECTS of any drug, they would never take anything, I suspect. I think the doctor should be the one to put things in perspective. Only most don't seem to know much about drugs other than what is pitched to them by sales reps.
Cairo
> I really dislike the concept. I really dislike the representation itself.
>
> Drugs have effects. Period.
>
> Among the effects, some of them are ones we are glad to see, and some of them we wish did not occur. When someone takes an SSRI, I'm sure that sexual dysfunction isn't often greeted with a "Hooray!" I think it unlikely that I'll ever seen a television advertisement proclaiming this particular drug effect. However, declaring it to be a side effect trivializes it. My own psychiatrist, upon hearing of my antidepressant neutering, asked me, "Would you rather be depressed?", as if it was somehow a reasonable trade off. The success and popularity of Viagra and Cialis (despite their price) would answer that question.
>
> When you read a drug monograph, you will see a long list of "adverse reactions" or "side effects", as compared to placebo, in clinical trials. Why are those not listed right together with positive reactions? Why is it not possible to just see the effects of the drug? If it is twice as likely that a person might have sexual dysfunction than it is that they might find relief from depression, then why is it that the drug is marketed as an antidepressant, rather than as a chemical neutering agent?
>
> I just did a drug trial, of topiramate (Topomax). It was brief, and perhaps I exceeded the most conservative titration schedule. I think it is moot, as one drug effect I experienced simply cannot be ignored. It could be permanently disabling or fatal. In any case, here is my list of drug effects:
>
> fatigue
> flu-like symptoms
> hot flushes
> dizziness
> speech problems (both aphasia and motor)
> paresthesia
> tremor
> involuntary muscle contractions
> reduction in neurasthenia/neuralgia
> nausea
> dyspepsia
> abdominal pain
> dry mouth
> gingivitis
> nervousness
> memory problems
> somnolence
> confusion
> emotional lability
> difficulty with concentration
> pharyngitis
> sinus headache
> taste perversion
> micturition frequency
> pruritus
> oligohydrosis (inability to sweat)
>
> The last one on the list is dangerous. Some on the list are merely nuisances. Many are of sufficient intensity to interfere with affairs of daily living. One effect was beneficial.
>
> On this basis, the effect of the drug did not improve my quality of life. There are no side effects. These are all main drug effects.
>
> Some main drug effects are rare, but that doesn't matter one whit to the person who has those rare effects, because in that individual, the incidence is 100%.
>
> I say, to hell with the concept of side effect. Let's talk drug effect, and get on with assessing the quality of life, before and after the drug.
>
> Lar
Posted by Phillipa on June 8, 2005, at 19:26:34
In reply to Re: Side effects » Larry Hoover, posted by Cairo on June 8, 2005, at 19:17:57
I agree wholely. There have been many instances when I didn't take med after reading the insert. Fondly, Phillipa
Posted by Larry Hoover on June 9, 2005, at 9:13:08
In reply to Re: Side effects » Larry Hoover, posted by Cairo on June 8, 2005, at 19:17:57
> Your list of Topamax adverse EFFECTS reads exactly like mine with induction of panic attacks to be added.
And with that, I grant you membership in a very elite club that no one else wants to join. Sorry to hear it.
> I totally agree with the marginalization of adverse EFFECTS by the drug companies and especially doctors. However, if an uninitiated person would read the adverse EFFECTS of any drug, they would never take anything, I suspect. I think the doctor should be the one to put things in perspective.
It is about perspective, absolutely. But, for example, often the same doctor is treating one person *for* sexual dysfunction, while half an hour later trivializing it in another. If it is an attribute of healthy persondom to have full sexual function (it most certainly is not a trivial thing for me), then the doctor is practising a form of professional hypocrisy. Sanctioned professional hypocrisy.
> Only most don't seem to know much about drugs other than what is pitched to them by sales reps.
>
> CairoThere is no excuse for that. The PDR and equivalent databases are available for all the hand-held electronic storage devices.
The days of "doctor knows better" paternalism need to come to an end. Informed consent is non-negotiable. It is a legal right, which cannot be waived.
Lar
Posted by Phillipa on June 9, 2005, at 17:34:44
In reply to Re: Side effects » Cairo, posted by Larry Hoover on June 9, 2005, at 9:13:08
I had a young doctor in the hospital who used a computer hand held to look up a titration doseage for withdrawal from benzos. It was wrong. Fondly, Phillipa
Posted by Cairo on June 10, 2005, at 18:28:15
In reply to Re: Side effects » Cairo, posted by Larry Hoover on June 9, 2005, at 9:13:08
I agree. I should amend that to EDUCATED (about medications) doctors should help put things in perspective by actively discussing the risk/benefit with the patient. There's usually no patient input asked at all.
I have been labelled a "problem parent" when I simply ask my daughter's pdoc about meds or suggesting that we revisit augmentation when I told him that monotherapy is not effective enough. We're about to "fire" that pdoc and find someone new.
Cairo
>
> It is about perspective, absolutely. But, for example, often the same doctor is treating one person *for* sexual dysfunction, while half an hour later trivializing it in another. If it is an attribute of healthy persondom to have full sexual function (it most certainly is not a trivial thing for me), then the doctor is practising a form of professional hypocrisy. Sanctioned professional hypocrisy.
>
This is the end of the thread.
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