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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by Lindenblüte on November 2, 2006, at 16:10:28
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 2, 2006, at 15:57:56
People who spend longer times on medication tend to have more complicated circumstances than people with a fairly straightforward single diagnosis and no comorbidity.
I'm comorbid. *grin*
And I'm addicted to being me.
-Li
Posted by Phillipa on November 2, 2006, at 18:31:11
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » linkadge, posted by Lindenblüte on November 2, 2006, at 16:10:28
Is seems that once you're on a med you're on one for life. I use myself as an example. In my 20's valium for anxiety. Now I'm becoming tolerant and no pdoc will give me higher doses. I'm faced with staying basically nonfunctional in the world at my age to trying a med that may cause me more health problems. As the atypical antipsychoics seem to be leading to a lot of diaabetes. And back when valium was the thing what doc would have ever let it cross his mind that they might be addiciting? They just worked. So what is next? Love Phillipa ps my Daughter is taking seroquel to sleep and after only a few weeks is afraid to stop it as she fears waking up and not being able to sleep so to me this is addictive to. I just don't know what to think anymore.
Posted by linkadge on November 2, 2006, at 19:00:32
In reply to Re: SEROQUEL...monotherapy for Depression?, posted by deniseuk190466 on November 2, 2006, at 16:10:06
There are other actions of zyprexa which may help your depression. Zyprexa has a strong gabergic effect, for instance.
Linkadge
Posted by linkadge on November 2, 2006, at 19:05:51
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by Phillipa on November 2, 2006, at 18:31:11
Well, I'm not going to start this rant since it always hits a cord with a lot of people.
Meds are addicting, they stop working, they fry your brain, they leave you worse off than when you started.
There I got it out, no no more from my lips.
Linkadge
Posted by Phillipa on November 2, 2006, at 19:24:54
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 2, 2006, at 19:05:51
No Link there are two sides to everything. You make me question things very important. Love Phillipa
Posted by Lindenblüte on November 3, 2006, at 8:41:04
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 2, 2006, at 19:05:51
I'm glad you got the rant out of your system for the moment.
I guess in addition to being "addicted" to meds, I'm "addicted" to water, fresh air, calories, hugs, music...etc.
If meds left me worse off than when I started, I would be dead by now. At the time when I started meds for the first time, I was fairly certain that would not live another month.
so? maybe I've done some good stuff with my life in the last 6 months. These are things that I would not have been able to do if I were not in treatment for my depression.
I think depression fries a lot of brains too.
-Li
Posted by linkadge on November 3, 2006, at 10:00:44
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » linkadge, posted by Lindenblüte on November 3, 2006, at 8:41:04
Just to play the devils advocate, I think that if you were going to kill yourself you would have already. Antidepressants have not statistically altered the rate of suicide since their introduction.
Being addicted to a drug does is not always directly apparent right away.
The connotation of *addiction* sounds so harsh. You are right, we are addicted to air. I guess the real acid test is wheather the drugs continue to work for you. I define my experience as one of addiction owing to the fact that the drugs stopped working. In this case, I was faced with a regular pattern of tollerance and dose escalation in order to acheive the same effect. This is why I think of my case as being addicted to antidepressants.
Again, my disclamer is that I really don't know your case, and I am trying to rant in as general a sense as possable.
Linkadge
Posted by stargazer on November 3, 2006, at 13:52:37
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 3, 2006, at 10:00:44
Interesting dialogue ...I like the way both of you have kept it impersonal but have gotten your points made for and against medications. I would love to not take meds and have tried to do this several times but the depression always returns. I will say that I have NEVER felt addicted to them but have only been on modest dosages. My tolerance for meds is very low.
I'm at 50 mg seroquel as of last night, tonight I go to 100 mg. I am not noticing that much of a sedative effect, like I thought I would. I wish I was off the Cymbalta since I cannot truly say what is the effect of the Cymbalta and what is the effect of the seroquel. But on Cymbalta alone, before seroquel, I felt pretty miserable so seroquel must be doing something positive for me.
On one hand I have more motivation and my appetite has improved but I remain with a feeling of lightheadness. I think it is the effects of Cymbalta. If I can eliminate the Cymbalta then I will know what seroquel alone is doing. This may happen at my next pdoc appt Monday, as long as he feels Cymbalta is doing nothing.
Ensam would be the next AD if seroquel alone doesn't do the trick.
Posted by Lindenblüte on November 3, 2006, at 16:43:01
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 3, 2006, at 10:00:44
> Just to play the devils advocate, I think that if you were going to kill yourself you would have already. Antidepressants have not statistically altered the rate of suicide since their introduction.
I am not aware of these statistics. Could you provide a citation? I'm not sure that I feel comfortable arguing this point with you until I've evaluated the research you refer to.
> Being addicted to a drug does is not always directly apparent right away.
yes, of course. good point. i'm biased in favor of pharma and everything else I'm doing at the moment since I am feeling a little better every day. so, I may be the voice of ADDICTION, rather than a sane voice of impartial reason.
> The connotation of *addiction* sounds so harsh. You are right, we are addicted to air. I guess the real acid test is wheather the drugs continue to work for you. I define my experience as one of addiction owing to the fact that the drugs stopped working. In this case, I was faced with a regular pattern of tollerance and dose escalation in order to acheive the same effect. This is why I think of my case as being addicted to antidepressants.
Tom Wolfe "The Electric Kool-Aid Acid Test". An interesting example to throw some color into the mix. I think it's interesting to view "addiction" through a cultural lens. For example, my friend G is terrified of becoming dependent or addicted to any person or substance. She even eschews lip balm, romance, caffeine and other creature comforts. I'm not at all convinced that her choices have made her happier or more satisfied. Some religions consider the use of intoxicants wrong, and discourage devotees to avoid substances that act as intoxicants.
I'm not sure if the drugs work for me. I suppose I have been feeling more hopeful, and I'm able to get more pleasure out of simple things like food and sex and sunshine. These are all very subtle things that unfolded over months. Months that were accompanied by major lifestyle changes, psycho-therapy, nutritional changes, etc. And the meds are one piece of the puzzle. I'm pretty sure that if I went off of them (especially cold-turkey!) I would feel like utter sh*t.
This is not unique to psych meds, though. Yesterday evening I didn't drink enough water. I felt thirsty for 8 hours and for various reasons was unable to obtain any liquids before bed. My pee was a not-happy color in the am, and I had headache and felt like crap. I guess I'm hooked on water. ((((hydration)))). I probably don't need to keep on increasing my amount of water though, to feel satiated. Fortunately, my kidneys and brain have evolved in such a way to provide good feedback about thirst. But-- what if the signals become mixed up in the hypothalamus- and instead of "thirst" we feel "munchies"? We eat more food, our blood becomes even thicker, more saline, and we are left with ... even more munchies! Hopefully one would wise-up at this point and reach for a glass of H2O, but-- what if your psychology never allowed you to make this connection? Would you keep on eating and eating and eating until?
> Again, my disclamer is that I really don't know your case, and I am trying to rant in as general a sense as possable.That's fine Linkadge, and I respect your candor. Although I must admit that I was kind of shocked by your opening sentence. A sick and twisted depressed Li would view that as a "challenge". Luckily I'm a well-hydrated, exercised, Omega-three-ed and cognitively stimulated Lindenbluete.
And I'm really sorry to hear that the drugs did not give you a long-term improvement. Sometimes having an instability (getting better-getting worse-getting better-getting worse) is more damaging to the psyche that a low-level feeling yucky. I hope you won't give up on other ways to obtain relief- perhaps through lifestyle changes, seeing a therapist or alternative treatments.
>
> Linkadge-Li
Posted by linkadge on November 3, 2006, at 18:46:01
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » linkadge, posted by Lindenblüte on November 3, 2006, at 16:43:01
>I am not aware of these statistics. Could you >provide a citation? I'm not sure that I feel >comfortable arguing this point with you until >I've evaluated the research you refer to.
I'll babblemail you the link, since Dr. Bob banned the page because it has some links to how to obtain drugs without a prescription.
>yes, of course. good point. i'm biased in favor >of pharma and everything else I'm doing at the >moment since I am feeling a little better every >day. so, I may be the voice of ADDICTION, rather >than a sane voice of impartial reason.
I'm just saying that drugs (even prescription drugs) can be great till its time to come off. But then why would you want to come off it if its working right? Because it may stop working for you. Not saying it will. Just saying that this seems to happen to a lot of people thats all.
When people say, I know my drug was working because when I tried to come off I felt like crap. Well that logic only kindof works, since the brain recruits systems to oppose drug action when the drug is being taken. When the drug is discontinued, these systems work, unopposed for a period of time, leaving you with withdrawl which is hard to distinush from ones originial condition.>Tom Wolfe "The Electric Kool-Aid Acid Test". An >interesting example to throw some color into the >mix. I think it's interesting to >view "addiction" through a cultural lens. For >example, my friend G is terrified of becoming >dependent or addicted to any person or >substance.
Well, we're all addicted to something. It obviously creates a lot of confusion, and turmoil about the decision to take medications. If I could go back I woudn't have taken medications, but thats just because I still havn't learned to walk straight after discontinuing zyprexa + zoloft. Withdrawl was hell, and it lasted forever. For a long time, I was worse than before I started.
>I'm not sure if the drugs work for me. I suppose >I have been feeling more hopeful, and I'm able >to get more pleasure out of simple things like >food and sex and sunshine. These are all very >subtle things that unfolded over months. Months >that were accompanied by major lifestyle >changes, psycho-therapy, nutritional changes, >etc. And the meds are one piece of the puzzle. >I'm pretty sure that if I went off of them >>especially cold-turkey!) I would feel like >utter sh*t.
You might, and thats why its not my purpose to tell anyone what do do. I can tell people what I think, and how drugs affected me, but thats all.
For me, my life was crap. Drugs made me forget that for a little while, but my life is still crap, they did not change that.>I guess I'm hooked on water. ((((hydration)))). >I probably don't need to keep on increasing my >amount of water though, to feel satiated.
Its really about context. Take effexor withdrawl for instance. Effexor withdrawl for some, is so severe that it can ruin doctor patient relationships. When you take methamphetamines, it is very hard to believe that something that makes you feel so good, could be so bad. Its the same thing with antidepressants. They make you feel good, so the tendancy is to believe all the good stuff you hear, and discredit the bad stuff. If you ever decide to discontinue, then obviosly I hope you have a smooth transition, but that is the only context during which one can truely *sses the adiction potential (in my opinion).
>That's fine Linkadge, and I respect your candor. >Although I must admit that I was kind of shocked >by your opening sentence. A sick and twisted >depressed Li would view that as a "challenge". >Luckily I'm a well-hydrated, exercised, Omega->three-ed and cognitively stimulated Lindenbluete.
You must understand that I have these kind of debates all the time here on babble. With SLS, and others. I have nothing against you.
>And I'm really sorry to hear that the drugs did >not give you a long-term improvement. Sometimes >having an instability (getting better-getting >worse-getting better-getting worse) is more >damaging to the psyche that a low-level feeling >yucky. I hope you won't give up on other ways to >obtain relief- perhaps through lifestyle >changes, seeing a therapist or alternative >treatments.
Thats why I feel so bad about attacking drugs. When I do, I come across as some appologist for mental suffering. I don't want to see people in pain, and of course I want people to get better.
Linkadge
Posted by SLS on November 4, 2006, at 6:50:29
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 3, 2006, at 10:00:44
> Antidepressants have not statistically altered the rate of suicide since their introduction.
I guess that depends upon whose statistics you look at.
"Suicide rates rose steadily from 1960 to 1988, when Prozac [fluoxetine], the first SSRI drug, was introduced," he said. "Since then, suicide rates have dropped precipitously, sliding from the eighth to the 11th leading cause of death in the United States."
http://pn.psychiatryonline.org/cgi/content/full/40/7/29
- Scott
Posted by linkadge on November 4, 2006, at 8:13:21
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by SLS on November 4, 2006, at 6:50:29
I think its important to read some of the limitations of that study. In addition, I have a hard time believing that the SSRI's are any more effective in reducing suicide than TCA's or MAOI's, perhaps less lethal.
***Change in the rank**** of suicide as a cause of death is meaningless, as it does not account for changes in the comparitor classes of mortality.
If you look at a graph of the trends in suicide rate over the past century, you will see that the reduction in sucide since the late 80's is very insignificant, compared to what it was prior this apex.
What about other coutries? Suicide has risen significantly in Russia and other countries which use antidepressants. In russia it is the leading cause of death among young males.
It is rising in Irelan, Ausralia, and New Zealand.
No change in the Canadian suicide rate. (every third person is on drugs here)
http://fathersforlife.org/health/cansuic.htm
And you're right it depends on who's data you analyze. This data shows no such reduction, (source, national centre for injury prevention and control)
See first graph:
http://fathersforlife.org/suicides/US_suicide_deaths.htm#Suiciderates
Linkadge
Posted by Lindenblüte on November 4, 2006, at 9:58:35
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 4, 2006, at 8:13:21
So, stargazer, how's the seroquel treatment working?
Mine is working okay. I'm almost thinking like I used to back in the good old days!
I really appreciate not being distracted by those bad thoughts of self-hatred and anxiety.
-Li
I'm off to take a walk in the sunshine. I guess monotherapy is not my style. I like psychotherapy, and sunshine therapy, and happy eating therapy, and socializing therapy.
Posted by Phillipa on November 4, 2006, at 19:02:05
In reply to Seroquel » linkadge, posted by Lindenblüte on November 4, 2006, at 9:58:35
Li you really like the seroquel? Any weight gain? Or are you more active since you feel better? Love Phillipa
Posted by Lindenblüte on November 4, 2006, at 22:19:00
In reply to Re: Seroquel » Lindenblüte, posted by Phillipa on November 4, 2006, at 19:02:05
> Li you really like the seroquel? Any weight gain? Or are you more active since you feel better? Love Phillipa
Well, I like the seroquel. the fatigue went away after about 5-7 days. But then I increased my AD, and I still feel pretty groggy all afternoons.
Weight gain? None yet. I have been more active, but that's because I have been inspired by the lovely autumn weather and my husband got me back on the bike.
In the last 6 months of virtually NO regular exercise (aside from walking about a mile a day) I have gained about 8-ish pounds. I have also been eating a lot of ice cream and other carbs (self medicating- the body is trying to increase 5-HTP on the brain side of the BBB.
Crappy diet + Crappy exercise + Crappy mental health = increased blubber. Hoping that it won't be too resistant to my efforts to reform myself.
Have to get in shape for ski season...! That's always been a great motivator.
-Li
Posted by SLS on November 4, 2006, at 22:44:00
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 4, 2006, at 8:13:21
> I think its important to read some of the limitations of that study.
Yes. It is limited to an association of observations.
> In addition, I have a hard time believing that the SSRI's are any more effective in reducing suicide than TCA's or MAOI's, perhaps less lethal.
It is a demonstration of treatment practices in the US, not drug efficacy. Once Prozac hit the market and became popularized in the media in 1988, it became more acceptable to seek treatment for depression.
- Scott
Posted by stargazer on November 5, 2006, at 18:51:53
In reply to Seroquel » linkadge, posted by Lindenblüte on November 4, 2006, at 9:58:35
Li and others,
Still on Seroquel, 100 mg at night. Is defintately helping with negative thoughts which are the cornerstone of my depressive symptoms.
I'm still on 30 mg Cymbalta which I was on before adding seroquel but may be causing some symptoms of lightheadedness. Hopefully I can discontinue that tomorrow when I see my doc.
Overall though I would recommend seroquel to anyone who is frozen in a negative cycle of depression from which they cannot escape.
I am even thinking of working again which had been too frightening to think about before now.
But its a bit too early to think about that yet, I need a little more time adjusting the Seroquel to say I'm at the best dose yet. And if I discontinue Cymbalta I have to make sure I don't regress being on Seroquel alone.SG
Posted by Phillipa on November 5, 2006, at 19:32:23
In reply to Re: Seroquel Update...Improving...on 100 mg, posted by stargazer on November 5, 2006, at 18:51:53
Stargazer you are giving me hope as I'm kind of over the benzos as they are not working for agoraphobia and fear and this gloom. I do have seroquel but since I just saw the endocrinologist for now hyper my hypo thyroid has changed again. I'm waiting to see the medical first if I can make it. My Daughter is taking seroquel 50mg at bedtime and is happier than I've ever seen her not that she was ever very depressed maybe not happy. Love Phillipa
Posted by stargazer on November 5, 2006, at 20:05:32
In reply to Re: Seroquel Update...Improving...on 100 mg, posted by stargazer on November 5, 2006, at 18:51:53
Phillipa,
If you do try Seroquel, start at 25 mg and gradually increase it. I took 25 mg x 2 days, went to 50 mg x 2 days and have just increased to 100 mg x 2 days. I'm seeing my doc tomorrow and I think 100 is enough for right now since I'm not having any bad side effects, just some minor dizziness.
If you experience any negative effects with an increase in dose I would back down to the previous dose and hold at that level.
My experiences with any meds are to opt for a lower dose rather than a higher dose since I can get bad side effects rather quickly which causes me to have to stop the drug early.
Also, if you are on other meds, it's best to stop them (if possible) before trying something new so you can really know if the med is working on it's own. But then there may be withdrawl symptoms which can interfere with evaulating the effects. I can't remember what you are currently on.
And remember...I have only just started to feel better so it's early to tell whether this feeling will last. It would be odd to not be on an AD but a AP for depressive symptoms. It's really not the diagnosis that is being treated but the brain chemistry. If I stop Cymbalta I'm not sure that Seroquel will keep my depression away. We'll see...
SG
Posted by Phillipa on November 5, 2006, at 21:38:45
In reply to Re: Seroquel Update...Improving...on 100 mg/Phil., posted by stargazer on November 5, 2006, at 20:05:32
Stargazer thanks so much. After the results of my endocrinologist and the labs he took I will be ready to change. I'm also seeing a new pdoc hope the results are back first in two weeks. My Daughter saw him and she's on 50mg of seroqel to sleep and 25mg of zoloft and doing well happy. She will probably stop the zoloft as he cut her dose in half in a month. Seems to work for her. Google V Sagar Sethi he wrote a book I goofed up the double double quotes before so don't want to name it. But I like his philosophy. He's Indian and is sad that the pschiatric care has gone so far downhill. He cares about his patients. I hope he's good. And currently I'm on only 25mg of luvox and 20mg of valium. Now that will not be able to be discontinued at least not now. Love Phillipa thanks again
Posted by Lindenblüte on November 5, 2006, at 22:32:52
In reply to Re: Seroquel Update...Improving...on 100 mg, posted by stargazer on November 5, 2006, at 18:51:53
> Li and others,
>
> Still on Seroquel, 100 mg at night. Is defintately helping with negative thoughts which are the cornerstone of my depressive symptoms.That's GREAT! Isn't it amazing how much mental real-estate those negative thoughts can take over?
> I'm still on 30 mg Cymbalta which I was on before adding seroquel but may be causing some symptoms of lightheadedness. Hopefully I can discontinue that tomorrow when I see my doc.
>
> Overall though I would recommend seroquel to anyone who is frozen in a negative cycle of depression from which they cannot escape.
>
> I am even thinking of working again which had been too frightening to think about before now.
> But its a bit too early to think about that yet, I need a little more time adjusting the Seroquel to say I'm at the best dose yet. And if I discontinue Cymbalta I have to make sure I don't regress being on Seroquel alone.That's great- baby steps, you know? keep it up, and don't get discouraged if you have a bad days mixed in with the improving days. That's part of the excitement... I found that seroquel did take away the bad thoughts, but that I was still having a lot of depressive symptoms. Those symptoms have responded really well to increasing my cymbalta. I noticed difference even within 3 days. no joke.
-Li
Posted by stargazer on November 8, 2006, at 14:03:16
In reply to Re: Seroquel Update...Improving...on 100 mg » stargazer, posted by Lindenblüte on November 5, 2006, at 22:32:52
Hi,
Still on 100 mg Seroquel but cutting back on Cymbalta since I don't think it's doing anything but making me lightheaded and dizzy, at least that's what I think has happened.
I'm thinking that the quick response I had to seroquel might be used to pull someone out of a major depression which usually doesn't happen soon enough with an AD.
Just for my own feeling of security, I would use an AP (antipsychotic) instead of say, ECT, which I had almost tried in the past when my feeling of despair were so great, there was no time to wait for an AD to work.
I'm not sure that the Seroquel as a MONOTHERAPY will be enough, but at least I'm functional (eating...sleeping...able to leave the house without fear). The fine tuning will probably begin once I'm off Cymbalta. I was only on 30 mg, so it may only take a week to come off. Then, if necessary, we may add Wellbutrin first, and if no improvement, perhaps try Ensam, but you know how that goes with a 2 week washout....
SG
Posted by Lindenblüte on November 8, 2006, at 14:15:05
In reply to Re: Seroquel Update...in lieu of ECT? thoughts., posted by stargazer on November 8, 2006, at 14:03:16
Hi Stargazer,
I'm so happy that you had a quick response. I think my response was pretty quick too, although it's hard to tell since it took me 10 days to increase from 100mg- 300mg.I think it's really good to have a medication option for crisis situations. Now that you are somewhat stabilized, I hope that you get a good response to your next antidepressant.
Seroquel is a good augmenter for antidepressant therapy. It will help you sleep well, and think clearer (if you're like me)- and that will help make life more tolerable as you go off of cymbalta and on to the greener pastures.
moo,
-Li
Posted by Phillipa on November 8, 2006, at 20:01:10
In reply to Re: Seroquel Update...in lieu of ECT? thoughts. » stargazer, posted by Lindenblüte on November 8, 2006, at 14:15:05
Li seriously did it make you think clearer? Was it the good sleep? And you never took even a tiny bit during the day? Love Phillipa
Posted by Lindenblüte on November 8, 2006, at 21:18:54
In reply to Re: Seroquel Update...in lieu of ECT? thoughts. » Lindenblüte, posted by Phillipa on November 8, 2006, at 20:01:10
I noticed clearer thinking even when I was only taking a small dose (25 mg) at night.
I've never taken seroquel during the day. Not sure I could walk straight if I did.
The reason for my clearer thoughts was that the anxious worried voices and intrusive thoughts were diminished or GONE. Without that "background chatter" it's a lot easier to concentrate.
-Li
This is the end of the thread.
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