What's the appropriate use for antidepressants?

[OliverH]

*Originally posted by FranticMad *
**I made no such claim, but rather I pointed out that there have been a variety of hypotheses over the years by others.
**

They are only a ‘variety’ when they are distinct of each other, and not, in fact, one larger concept and several subsets thereof.

**
Hence, your enthusiasm for a few papers published within the last two years has nothing to do with the OP. There is a gap in the level of analysis of the problem; this year’s research papers rarely translate to effective clinical results and policies in the same year. **

Um, did you actually look at the papers? Review papers are usually not written on the latest weird idea. Not to mention that papers (at least those I read) usually reference previous papers and rarely describe completely out of thin air concepts.

**
Most doctors are not researchers, and wait for a long time before they adjust their practices. **

That is, unfortunately, a point that I made already a while ago, but doesn’t really change a lot for the discussion. Not to mention that changes have been speeding up, and large hospitals frequently DO adjust their practices pretty quickly.

**
Invariably, historically, the precious hypotheses have had many flaws when applied in individual clinical situations. They have to work in individual clinical situations or the work is of purely academic interest. My perspective is that hypotheses come and go out of fashion. **

My perspective is that the fact that a hypothesis turned out to describe a subset or special case in no way invalidates a concept. There is a profound difference between a hypothesis turning out to be only one aspect of a more complex scenario, and a hypothesis being flat wrong.

**
That, sir, is the monoamine hypothesis, or some variant of it. You didn’t mention anything about the complexities of synaptic plasticity there did you? No, you stated that the simple “level of neurotransmitters” is what’s important. Your statement implies that you know which neurotransmitter levels make us feel certain emotions. Can you list the neurotransmitter levels that make us feel: anxious, afraid, friendly? Your statement was simplistic especially considering the research articles you yourself posted.
**

First of all, your accusation of implications lacks any and all factual basis. I never said that the level of neurotransmitters is what’s important, and I never described it as simple. I said it is those neurotransmitters which make us experience the emotions. If you want to claim something different, go ahead. But I’d like to see some convincing proof as to your hypothesis of signal evocation in total absence of any and all activators, and in the absence of any and all feedback mechanisms. Synaptic plasticity does in no way eliminate neurotransmitters from the equation, it deals with the strength of the response and it is itself modulated by the strength of the incoming signal.

Second, last I checked, this was not an academic board, and precious few of the posters have any background in molecular biology. I don’t consider it particularly polite to throw around technical terms no one will understand. I provided references for those with deeper knowledge to reference my statements. I suggest you took the wrong door if you expected ‘Science’ level exchanges here. It is strange that you would accuse me of arrogance but at the same time demand discussion on a level only a tiny proportion of board members would actually understand.

**
By the way, I used an insulting tone in my last post in order to mirror your own insulting and arrogant manner, and to provoke a response from you about it. But look at your previous posts and you will see that you began the ad hominems where you called AHunter3 a moron, and you continued in other subtle forms. If you don’t like insults, and I certainly don’t, then examine your own behavior and clean up your act. **

I didn’t call AHunter3 a moron, I stated that AHunter3 is free to consider scientists, psychiatrists and members of pharmaceutical companies (that includes you, if your claim of being a published author in neurosciences is actually factual) altogether morons, but that if AHunter3 does so, AHunter3 should accept being considered one, too. That’s an if … then clause. AHunter3 is free to revise his position. I merely stated what it amounts to.

As for mirroring my own insulting and arrogant manner and provoking a response, the only thing you did was demonstrate that rather having superior manners, yours are even worse. If you don’t like insults, as you claim, you would not have resorted to them. And if you were superior in manner, you would not have let yourself mirror allegedly bad manner. And not the least, you would have thought twice before, failing to make any factual points, you resort to chastizing a non-native speaker on his tone.

[OliverH]

*Originally posted by Broomstick *
**I think psychotropic drugs in many situations are like a wheelchair. Most people would see a requirement to use as wheelchair as “confinement” as “confined to a wheelchair” and a terrible thing. On the other hand, a parapelegic might see a wheelchair as liberating since it enables the person to move about the world. Still, folks would consider it wrong to force a person to use a wheelchair when it’s not necessary, and if a person can be rehabilitated enough to not need a wheelchair that’s a good thing. **

You continue to reference to people being forced, without being able to show that the number of such cases is significant enough to warrant any kind of change in procedure. I disagree that most people would see a wheelchair as a terrible thing. They might do so, if the need for one is permanent, but even then, they might appreciate the mobility it grants them. Yes, if a person can be rehabilitated enough to not need a wheelchair, that’s a good thing. That doesn’t change the fact that until then, the wheelchair empowers them to not have to stay in one spot all the time, and allows them to be mobile.

**
However, at this point in time, there is a contingent that is doing the equivalent of insisting on wheelchairs for people with broken legs when crutches would do, and making no effort to get folks out of the wheelchairs. Yes, the SSRI’s and others (including even such things as Thorazine for extreme cases of psychosis) are wonderful tools. But, on general principals, I think it is best if multiple approaches are considered, even tried, and that the best course is to use the lowest level of pharmaceuticals required to produce the desired benefit. If behavioral modification, “talking cures”, and other approaches reduce maladaptive patterns in a person, resulting in a lower dose of drug, that’s all to the good. But the people footing the bill find it ever so much easier to just hand out pills, and the pharceutical companies love it, and to heck with the ultimate good of the patient. **

You assume that the patient is actually interested in his or her ultimate good, and completely ignore how many people are out there who love to ‘pop a pill’ for everything. Go outside and ask someone if he’d rather exercise to lose 20lbs, or if he’d rather pop a pill, if one existed. Or, and let’s assume we’re talking about a safe quarter in a city for a moment, ask people if they were willing to do their groceries on foot. When I lived in the US, I lived a five minutes’ walk from the local Safeway-associated store. Funnily enough, when I usually walked there to buy what I needed, I rarely ever saw one of my neighbors on the way…

**
Very few - unfortunately. But even if they did, I’m not sure it would change the behavior. They are not, of course, looking for brain damage - they’re looking for the feeling they get from ecstasy, the emotional high. Many of the users are young, still in the stage where they feel immortal. By the time they learn otherwise the damage will already be done. **

Which is precisely why I say that those who ‘apply’ recreational drugs rarely know what the drug they apply really does.

**
Single patient results are hardly relevant on the global scale, as are biased researchers. And your arguments can easily be generalized for any and all clinical trials, not just in the mental field.

Single patient results are not relevant in research but when you move to treating the general population the doctor deals with nothing BUT individuals. **
[/quote]

Yet we were talking about clinical trials.

**
I know from personal experience that doctors can have a very ridgid notion of what consitutues “normal” in the female reproductive system and can be quite agressive at medicating women to achieve that standard. (Possibly TMI: my cycle runs several days longer than “normal” and I’ve had at least a half dozen doctors in my life pressure me quite strongly to go on the Pill to “correct” this “problem” - it’s nothing pathological (in fact, a common trait in my family) and why the heck would I want to bleed every four weeks instead of every five? To be “normal”? Normality, at least in that sense, is highly overrated) **

Suggestion: Could it be that the problem here is rather the moral conceptions (and their rigidity) of some people rather than the drugs themselves?

**
How many post-menopausal women were put on hormones for extended periods? One of the justifications used (in addition to supposedly stronger bones and protection against heart disease) was that it would keep a woman interested in sex and her vagina lubricating better – in other words, better able to serve a man’s desires. Nevermind that treating a woman with respect and love, and a tube of lubricant, will achieve the same effect with less potential for side effects. And cheaper, too. Just one more example of how our society would rather medicate the symptoms (lack of interest, vaginal dryness) with a pharmaceutical that has effects on the entire body rather than direct the solutions to the primary causes alone.
**

Um, I think you are interpreting something here in a fashion supporting your argument that could equally well be interpreted otherwise…

**
I do my part… but as the Straight Dope banner says about fighting ignornace, it’s taking longer than we thought.

…

Well, I’m not quite sure how I got appointed to the position of “saving society” here, but in fact my company does try to educate people. It’s an uphill battle, though, because we just do not have the dollars of the big pharmaceutical companies and, of course, like everyone else, we are perceived to be biased. And when it comes to medicine you are often dealing with frightened, desparate people who are functioning more with emotions than intellect. **

Well, it isn’t totally necessary to change ignorance into knowledge to create better conditions in that direction. A healthy dose of skepticism is entirely sufficient. Compare the attitude towards hormone-treated meat in the US with that in Europe…

[Broomstick]

*Originally posted by OliverH *
You continue to reference to people being forced, without being able to show that the number of such cases is significant enough to warrant any kind of change in procedure.

I’m sorry I didn’t clarify this sooner - even just one person being forced into unnecessary medical treatment against their will is unacceptable to me. Of course, we then get into sticky things like “what’s necessary” and “what’s normal” and so forth.

Are we ever going to achieve a perfect state? No - we’re dealing with humans which are, by nature, imperfect. But perfection is a worthy goal to strive for.

]I disagree that most people would see a wheelchair as a terrible thing. They might do so, if the need for one is permanent, but even then, they might appreciate the mobility it grants them. Yes, if a person can be rehabilitated enough to not need a wheelchair, that’s a good thing. That doesn’t change the fact that until then, the wheelchair empowers them to not have to stay in one spot all the time, and allows them to be mobile.

I think it’s the folks who actually need to use wheelchairs who appreciate their uses and see them as a positive - I still hear all too often comments like “Oh, how terrible that that poor little girl will be in a wheelchair forever!” or (and this one is really terrible) “I couldn’t live like that - I’d kill myself if I wound up in one of those.” Wow, that’s a heck of a statement for someone in a wheelchair to hear - but I’ve seen people say that to the face of someone in one.

I think we’re actually fairly close in this area, OliverH, just expressing it differently.

You assume that the patient is actually interested in his or her ultimate good, and completely ignore how many people are out there who love to ‘pop a pill’ for everything. Go outside and ask someone if he’d rather exercise to lose 20lbs, or if he’d rather pop a pill, if one existed.

I don’t deny that that attitude exists. However, I don’t think it’s either morally right or a good solution to force people to act in a certain way because “authority” thinks it’s the right thing to do.

I do believe this is, in part, a cultural divide between Europe and the United States, and something Europeans really do not understand about us. We feel the rights of the individual are so paramount that adults should be permitted to act as they desire even if it’s not always in their best interests. Europe, on the other hand, seems to have a more paternalisitc view, that people who are acting in error should be corrected by some authority (government, doctor, whatever) even if they don’t wish to be corrected.

This, of course, is a generalization - certainly the entire spectrum between those two points exists on both continents - but if you consider the above as tendencies then a lot of the differences between laws and attitudes in Europe versus those in the US start to make more sense.

I like to think there’s room in the world for both viewpoints - but then, I’m an American and want to go my own way (and let you go yours). Europe, however, seems of late to want to “correct” our attitudes and actions. I’m sure this is offered with the best of intentions, but (because of a lack of understanding of American culture) it rubs entirely the wrong way. And that’s as far afield as I’m going to go politcally.

But, coming back to medicine, you see these tendencies even here. In the US, people are very concerned about choices, about being able to choose when it comes to medical care. In Europe, however, goverment run health care systems seem to be the norm and you don’t have the same range of choices as in the US. Perhaps, on average, the ignorant consumer gets better care in Europe. I don’t know - even when I was in Europe I was fortunate enough not to need health care.

Which is precisely why I say that those who ‘apply’ recreational drugs rarely know what the drug they apply really does.

You’re concentrating on biochemical effects and damage. The drug user doesn’t care about that - they’re only concern is “can I use this to achieve a mental state that I desire?” In the sense of what mental state the drug will induce the user does know what the drug “really does” - in that sense, better than a researcher who has never taken the drug. It’s a matter of what the person in question considers important or not. You emphasize one angle, they another.

(In many ways, I do agree with you - they don’t know the damage some of these things are doing to their bodies, including their brains.)

Single patient results are not relevant in research but when you move to treating the general population the doctor deals with nothing BUT individuals. **

Yet we were talking about clinical trials.

Actually, I thought we were talking about both. From my viewpoint, discussing the use of antidepressents would range from a discussion of clinical trials to biochemical effects (good and bad) to individual use to how a person taking the drugs in question actually experiences their altered mental state. The subject is quite broad.

Suggestion: Could it be that the problem here is rather the moral conceptions (and their rigidity) of some people rather than the drugs themselves?

Oh, yes, definitely. But moral conceptions and societal attitudes do affect how drugs are used, which side effects are tolerated, pressure on an individual to use or not use a drug for a condition, and so forth.

Well, it isn’t totally necessary to change ignorance into knowledge to create better conditions in that direction. A healthy dose of skepticism is entirely sufficient. Compare the attitude towards hormone-treated meat in the US with that in Europe…

That is an intersting comparison. If I’m not mistaken, European countries have either banned or severely restricted such beef. Here in the US it is commonly available - yet non-hormone treated beef is also available. Certainly in large urban areas there is no trouble finding “no hormone” beef, “free range” beef, “organic beef”… And here we’re back to that cultural divide again. In Europe, the tendency for some entity to make the decision for “the people”. In the US it is the consumer who must make the choice, but the choice is there for them to make.

To be fair, although I am a champion of the “rights of the individual” side of the spectrum (What do you expect? I am an American, after all) I will admit that it doesn’t always work well. It’s impossible to be an expert on everything. It’s impossible for any one individual to always make the correct choice in everything. Still, I’m willing to run the risk of being wrong as a trade-off for what I perceive to be greater freedom.

It may be that, in medicine, Europe has taken the better course. I honestly don’t know. It may be that this is an area where paternalism works better than absolute free will. I don’t know that either - which is why I’m here in this thread, to talk about it and think about and consider it.

(Maybe we need to start a thread on this topic of paternalism vs. individual freedom?)

[Guinastasia]

*Originally posted by lekatt *
**Couldn’t get your link to work.

I think the bottom line of these debates lies in answering the question of: Where and What is Consciousness?

If an individual is considered mentally ill and out of control, medications seem to help. But don’t really, because when they are stopped the illness returns. All medication does is prevent the body from operating normally and at full capacity.

If consciousness is not a product of the brain, medication will never effect any cures. Although it may be helpful until a cure is found.

I believe that depression is easily cured when the cause is understood. We will have to look into the spiritual nature of man for our cures.

http://ndeweb.com/info01.htm **

Bullshit.

Without medication, for my brain, “operating normally” means panic attacks and irrational fears. It’s like being possessed by demons. You literally CANNOT get rid of it.

I am so sick and tired of people telling me that my problem is “religious” or “spiritual”. Why don’t you try stepping into my shoes when I was 18 and see if YOU can cope with it.
:mad:

[j.c]

TVAA, I was going to bump this to say how much I appreciate your measured, reasonable contribution… but FranticMad beat me to it.

Jsgoddess – I’m pretty we defined as allergy by looking at whether or not the allergy antibody was produced – pretty clear cut. 9 out of 10 clinicians, at least, would get exactly the same results.

Broomstick – Love the wheelchair analogy. I think that’s the best answer to the OP.

[wonky]

*Originally posted by j.c. *
**Jsgoddess – I’m pretty we defined as allergy by looking at whether or not the allergy antibody was produced – pretty clear cut. 9 out of 10 clinicians, at least, would get exactly the same results.
**

Except that the tests to determine who has the antibody are often, possibly usually, not performed.

They give you the Allegra and see if it works rather than running extensive tests.

It’s very similar to how antidepressants are prescribed.

Julie

[j.c]

jsgoddess - I’m gonna need a cite for allergy prescriptions without allergy test being a norm. Allergy/sinus-type symptoms have many cause that need to be ruled out. The tests aren’t extensive.

If you’re talking about people who walk into a new doctor and claim to have allergies, then the patient is at fault.

[MLS]

I developed an allergy a few years ago that was obviously seasonal and environmental. It went away when I was in a climate-controlled building and got worse on weekends at home when we had the windows open. There is a large wooded area adjacent. My doctor said I could probably find out which vegetation I was allergic to, but what would be the point? I am not going to move away, and it is easily controlled with a non-drowsy prescription medicine during the seasons when it happens.

[TVAA]

*Originally posted by OliverH *
False.

No, unfortunately true.

Which is the point of a therapy.

No, that is not generally considered to be the point of any therapy, although that may be changing.

**False in the first part and irrelevant in the second. The testing isn’t done inside pharmaceutical companies, but in hospitals, ALL ACROSS THE WORLD.

** :rolleyes:

**The results are published and reviewed. Saying that they ‘choose what results to report’ is hogwash. The fact what huge ruckus was created by a single case of death in a trial for genetic therapy and cases of leukemia in others shows quite well that problems get out, quite simply because the doctors who conduct the trial do not defer to the company first and foremost, but to the public, and because people start to ask serious questions when seriously weird things happen.

** Not true, sadly. While there are laws and standards against withholding certain kinds of experimental results from the FDA, the FDA doesn’t actually have any say about the nature (and quality) of the tests performed. Problems with overinflating statistically insignificant differences between treatments and placebos have been a major issue for decades now.

[wonky]

*Originally posted by j.c. *
**jsgoddess - I’m gonna need a cite for allergy prescriptions without allergy test being a norm. Allergy/sinus-type symptoms have many cause that need to be ruled out. The tests aren’t extensive.

If you’re talking about people who walk into a new doctor and claim to have allergies, then the patient is at fault. **

The patient is at fault? Just who is supposed to be in charge when it comes to prescribing medicine.

I don’t have a cite. I have anecdotal evidence. Every person I know who is on prescription medicine for allergies, including me, my husband, my mother, my sister, and two coworkers were given allergy medication as a first step.

Only my sister ended up having allergy tests done, and that was because the allergy medication didn’t work. (Turns out she’s severely allergic and is currently taking shots.)

I went to the doctor for sinus problems. He put me on Clarinex. If this is “my fault” I’d like to know how.

And no, I wasn’t going to volunteer to have allergy testing done. My insurance won’t pay for it (which is probably why most doctors don’t order it).

These were all different doctors, by the way.

So, in the real world, it appears many doctors prescribe allergy medication without testing. Or, rather, that the “test” involves taking the meds and seeing if they help.

Julie