Freethought & Rationalism Archive

Pseudonymph · 04-17-2002, 05:43 PM

MadMordigan...Unfortunantly I am not at all surprised to hear your story. This happens so much more than most people realize.

Mad...your case is a direct copy of mine, and many other people I have known, and in terms of classwork, have studied.

Quote:

The diagnosis of clinical depression was rendered based exclusively on a single verbal interview

As is usually the case.

Quote:

In my opinion, there was no way for my doctor to determine whether I was actually depressed or simply lying about being depressed.

I'm sure he or she really though you were...but the travesty lies in the fact you probably dont need these medications and you were prescibed them anyway. If you do need them, then you may never know for sure.

Quote:

When asked how this drug works, the answer from both the doctor and the JAMA website was 'We don't know'.

This is true, not enough is known to call the bit we do know useful.

Gurder:

Quote:

Other psychomeds start at 600 mg a day, and veer sharply upwards if it doesn't work.

sharply...well put.

the problem is, its standard procedure to not wait very long before they increase the dosage. IMO not near enough time to make a real judgement about progress or not.

Gurdur · 04-17-2002, 06:17 PM

Quote:

Originally posted by SirenSpeak:

... the problem is, its standard procedure to not wait very long before they increase the dosage. IMO not near enough time to make a real judgement about progress or not. ...

Look, these days it's expensive to spend time on patients.

You want to argue for higher taxes to support GP's and mental support staff to really pay lots and lots of attention to patients ?

Be my guest; I'll support you to the hilt.
But let me say: we got little chance.

As for the hasty diagnosis in MM's case or others, a very good case can be made that in view of the immediate situation then in those cases, the diagnosis and treatment was fully justified.

As for the fact that doctors are not omniscient, omnipotent healers, well yes. And ?
Please pardon me, but as someone who has worked on the outskirts of this field, would you mind either giving better real options - ones that will be paid for - or admitting that no-one is perfect ?

Excuse me please if I sound a bit heated about this, but it is in fact an area I care deeply about.

DRFseven · 04-17-2002, 07:07 PM

SirenSpeak, I'm afraid your fears are groundless; depression is way undertreated, not overtreated. Antidepressants have had a huge impact for the better on sufferers of depression, many of whom do not benefit from psychotherapy alone. Also, antidepressants often work even on mildly depressed people. And the brain doesn't care if the chemical soup changes due to talk therapy or antidressant meds; it's all the same - thinking is a bunch of electrochemical action, you know.

I don't understand the concern; why should people have to suffer needlessly?

MadMordigan · 04-17-2002, 08:51 PM

Look, these days it's expensive to spend time on patients.

Please pardon me, but as someone who has worked on the outskirts of this field, would you mind either giving better real options - ones that will be paid for - or admitting that no-one is perfect ?

Just an admission that it is witch doctory with a healthy dose of voodoo would be refreshingly honest. ADMIT that it is too expensive to do the job properly, and even if the money was availible, they really wouldn't know what to test anyways.

Gurdur · 04-18-2002, 03:18 AM

Quote:

Originally posted by MadMordigan:

....
Just an admission that it is witch doctory with a healthy dose of voodoo would be refreshingly honest. ADMIT that it is too expensive to do the job properly, and even if the money was availible, they really wouldn't know what to test anyways.

Um, no, I'm afraid I'm going to have to disagree with you strongly here, MM.
Given your own experience, I don't want to step on sore toes; and if you want to ask or tell me anything not for the public, then you can always email me.

First off: it ain't voodoo.
The anti-depressents work in the target patient groups; it certainly isn't a case of placebo effect.

Second: I've already discussed to a degree why a doctor's diagnosis on the basis of a verbal interview (which also contains clues from body posture and emotional overtones etc.) can be considered quite valid. Depression and certain other mental illnesses are categorizable; they fall into often easily identifiable groups.

Third: as for not knowing what to test, they do, to a large degree; and research in this field is always continuing, usually done by a horde of badly under-paid but idealistic doctoral dissertation candidates.

NialScorva · 04-18-2002, 05:17 AM

I'm not sure of other's experience, but all the anti-depressents I was prescribed were given with the admonition that it was a tool to supplement therapy, not a treatment itself.

Another thing to remember is that depression must be diagnosed by the symptoms rather than a direct observation. There's quite a bit of scientific backing for treating it, and many other diseases, by the symptoms rather than by directly knowing the biological source. If you have class of symptoms X, then treatment Y is 90% effective. If Y fails, Z is 80% effective, and so on. Various inventories are intended to describe the symptoms. Last time I went to a GP, the nurse asked me about 4 questions about how long I'd been sick, the fever, and got a few general symptoms. The doctor looked at my throat and said "Here's some antibiotics". How is that any more direct?

The only difference is that in our society depression is probably more deadly than a stomach bug, and definately affects quality of life more.

Mad Kally · 04-18-2002, 02:40 PM

From <a href="http://www.mhsanctuary.com/rx/medications.htm" target="_blank"> this site. </a>

Quote:

Antidepressant Medications
The kind of depression that will most likely benefit from treatment with medications is more than just "the blues." It's a condition that's prolonged, lasting 2 weeks or more, and interferes with a person's ability to carry on daily tasks and to enjoy activities that previously brought pleasure.

The depressed person will seem sad, or "down," or may show a lack of interest in his surroundings. He may have trouble eating and lose weight (although some people eat more and gain weight when depressed). He may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. He may speak of feeling guilty, worthless, or hopeless. He may complain that his thinking is slowed down. He may lack energy, feeling "everything's too much," or he might be agitated and jumpy. A person who is depressed may cry. He may think and talk about killing himself and may even make a suicide attempt. Some people who are depressed have psychotic symptoms, such as delusions (false ideas) that are related to their depression. For instance, a psychotically depressed person might imagine that he is already dead, or "in hell," being punished.

Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them. A depression can range in intensity from mild to severe.

Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. Antidepressants, although they are not "uppers" or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed.

Antidepressants are also used for disorders characterized principally by anxiety. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. They can also be used to treat some phobias.

The physician chooses the particular antidepressant to prescribe based on the individual patient's symptoms. When someone begins taking an antidepressant, improvement generally will not begin to show immediately. With most of these medications, it will take from 1 to 3 weeks before changes begin to occur. Some symptoms diminish early in treatment; others, later. For instance, a person's energy level or sleeping or eating patterns may improve before his depressed mood lifts. If there is little or no change in symptoms after 5 to 6 weeks, a different medication may be tried. Some people will respond better to one than another. Since there is no certain way of determining beforehand which medication will be effective, the doctor may have to prescribe first one, then another, until an effective one is found. Treatment is continued for a minimum of several months and may last up to a year or more.

While some people have one episode of depression and then never have another, or remain symptom-free for years, others have more frequent episodes or very long-lasting depressions that may go on for years. Some people find that their depressions become more frequent and severe as they get older. For these people, continuing (maintenance) treatment with antidepressants can be an effective way of reducing the frequency and severity of depressions. Those that are commonly used have no known long-term side effects and may be continued indefinitely. The prescribed dosage of the medication may be lowered if side effects become troublesome. Lithium can also be used for maintenance treatment of repeated depressions whether or not there is evidence of a manic or manic-like episode in the past.

Dosage of antidepressants varies, depending on the type of drug, the person's body chemistry, age, and, sometimes, body weight. Dosages are generally started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects.

There are a number of antidepressant medications available. They differ in their side effects and, to some extent, in their level of effectiveness. Tricyclic antidepressants (named for their chemical structure) are more commonly used for treatment of major depressions than are monoamine oxidase inhibitors (MAOIs); but MAOIs are often helpful in so-called "atypical" depressions in which there are symptoms like oversleeping, anxiety, panic attacks, and phobias.

The last few years have seen the introduction of a number of new antidepressants. Several of them are called "selective serotonin reuptake inhibitors" (SSRIs). Those available at the present time in the United States are fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). (Luvox has been approved for obsessive-compulsive disorder , and Paxil has been approved for panic disorder.) Though structurally different from each other, all the SSRIs' antidepressant effects are due to their action on one specific neurotransmitter, serotonin. Two other antidepressants that affect two neurotransmitters serotonin and norepinephrine have also been approved by the FDA. They are venlafaxine (Effexor) and nefazodone (Serzone). All of these newer antidepressants seem to have less bothersome side effects than the older tricyclic antidepressants.

The tricyclic antidepressant clomipramine (Anafranil) affects serotonin but is not as selective as the SSRIs. It was the first medication specifically approved for use in the treatment of obsessive- compulsive disorder (OCD). Prozac and Luvox have now been approved for use with OCD.

Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin. Wellbutrin has not been associated with weight gain or sexual dysfunction. It is contraindicated for individuals with, or at risk for, a seizure disorder or who have been diagnosed with bulimia or anorexia nervosa.

In my opinion, it would be terrible to return to the days of overflowing mental hospitals and ice pick lobotomies..

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04-17-2002, 07:07 PM	#13
DRFseven Veteran Member Join Date: Mar 2001 Posts: 2,322	SirenSpeak, I'm afraid your fears are groundless; depression is way undertreated, not overtreated. Antidepressants have had a huge impact for the better on sufferers of depression, many of whom do not benefit from psychotherapy alone. Also, antidepressants often work even on mildly depressed people. And the brain doesn't care if the chemical soup changes due to talk therapy or antidressant meds; it's all the same - thinking is a bunch of electrochemical action, you know. I don't understand the concern; why should people have to suffer needlessly?

04-17-2002, 08:51 PM	#14
MadMordigan Beloved Deceased Join Date: Jul 2000 Location: Vancouver BC Canada Posts: 2,704	Look, these days it's expensive to spend time on patients. Please pardon me, but as someone who has worked on the outskirts of this field, would you mind either giving better real options - ones that will be paid for - or admitting that no-one is perfect ? Just an admission that it is witch doctory with a healthy dose of voodoo would be refreshingly honest. ADMIT that it is too expensive to do the job properly, and even if the money was availible, they really wouldn't know what to test anyways.

04-18-2002, 05:17 AM	#16
NialScorva Veteran Member Join Date: Jan 2001 Location: Median strip of DC beltway Posts: 1,888	I'm not sure of other's experience, but all the anti-depressents I was prescribed were given with the admonition that it was a tool to supplement therapy, not a treatment itself. Another thing to remember is that depression must be diagnosed by the symptoms rather than a direct observation. There's quite a bit of scientific backing for treating it, and many other diseases, by the symptoms rather than by directly knowing the biological source. If you have class of symptoms X, then treatment Y is 90% effective. If Y fails, Z is 80% effective, and so on. Various inventories are intended to describe the symptoms. Last time I went to a GP, the nurse asked me about 4 questions about how long I'd been sick, the fever, and got a few general symptoms. The doctor looked at my throat and said "Here's some antibiotics". How is that any more direct? The only difference is that in our society depression is probably more deadly than a stomach bug, and definately affects quality of life more.

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