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#325619 - 10/14/10 04:12 PM Re: J.P.'s office [Re: fredk]
medic8r Offline
axiomite

Registered: 02/05/06
Posts: 6404
Loc: Fredericksburg, Virginia
Effectiveness really depends on the type/design of study, but I'm no statistician. Overall, I'd say the meds we have are pretty good for the majority of people with depression. They could definitely be better, though, and the pipeline has stalled. There's not been anything really new in about 15 years, just a lot of "me-too" drugs (Company A has a product that sells, and other companies develop other meds in the same family) and minor tweaks on old meds (Now it's extended release! / Now it's the active metabolite, not the parent medicine! / Now it's the active isomer, not the racemic mixture! ....)

Plus, while I make my bread and butter as a Pez dispenser, I'm a big believer in psychotherapy. There is usually at least some psychotherapeutic process at work in my sessions, though I have heard of some psychiatrists who basically ask how the meds are working, if there are any side effects, and how many refills you have left. NEXT! Anyway, when a person is motivated, he/she can learn major, life-altering techniques, perspectives, attitudes, and behaviors with a good psychotherapist. It really is mind over mood, and it works.

Side effects of antidepressants aren't generally that bad, but the new generation of antipsychotics/mood stabilizers can be very rough: weight gain and secondary blood sugar elevations to the point of developing diabetes; increased cholesterol, permanent and irreversible involuntary muscle movements (though the chance is much less than that of the older generations of these meds) ....

Still, for the majority, the benefits outweigh the risks, as not everybody gets side effects, and some meds are much cleaner than others in the same family. However, the cleaner meds are not always as reliable as the meds with more side effects. So it's a mutual decision between the medic8r and the medic8d.
_________________________
"The Universe is the game of the self, which plays hide and seek forever and ever" - Alan Watts

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#325623 - 10/14/10 04:57 PM Re: J.P.'s office [Re: medic8r]
Da_Gimp_Pimp Offline
connoisseur

Registered: 06/23/07
Posts: 4042
Loc: Sitting down somewhere
Originally Posted By: medic8r
It really is mind over mood, and it works.


Yeppers-

"That is why it is important, as I said, to understand the process, the ways of our own thinking. Self-knowledge cannot be gathered through anybody, through any book, through any confession, psychology, or psychoanalyst. It has to be found by yourself, because it is your life; and without the widening and deepening of that knowledge of the self, do what you will, alter any outward or inward circumstances, influences - it will ever be a breeding ground of despair, pain, sorrow. To go beyond the self-enclosing activities of the mind, you must understand them; and to understand them is to be aware of action in relationship, relationship to things, to people, and to ideas. In that relationship, which is the mirror, we begin to see ourselves, without any justification or condemnation; and from that wider and deeper knowledge of the ways of our own mind, it is possible to proceed further; then it is possible for the mind to be quiet, to receive that which is real."

Jiddu Krishnamurti.
_________________________
Does a dyslexic atheist not believe in dog?

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#325624 - 10/14/10 04:59 PM Re: J.P.'s office [Re: Da_Gimp_Pimp]
CatBrat Offline
axiomite

Registered: 08/05/09
Posts: 5931
Loc: Milky Way Galaxy
Shrink!

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#325626 - 10/14/10 05:22 PM Re: J.P.'s office [Re: CatBrat]
Da_Gimp_Pimp Offline
connoisseur

Registered: 06/23/07
Posts: 4042
Loc: Sitting down somewhere
LOL!
_________________________
Does a dyslexic atheist not believe in dog?

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#326327 - 10/22/10 02:17 PM Re: J.P.'s office [Re: Da_Gimp_Pimp]
medic8r Offline
axiomite

Registered: 02/05/06
Posts: 6404
Loc: Fredericksburg, Virginia
Here's a knowledge throwdown I did by commenting on the death of Harvey Pekar. That coroner either is doing somebody a solid or is very dumb.
_________________________
"The Universe is the game of the self, which plays hide and seek forever and ever" - Alan Watts

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#326364 - 10/22/10 06:24 PM Re: J.P.'s office [Re: medic8r]
Adrian Offline
axiomite

Registered: 12/27/08
Posts: 6622
Loc: It's all about the location.
You got THE last word on that one, JP.
_________________________
Half of communication is listening. You can't listen with your mouth.

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#326387 - 10/22/10 08:09 PM Re: J.P.'s office [Re: Adrian]
CatBrat Offline
axiomite

Registered: 08/05/09
Posts: 5931
Loc: Milky Way Galaxy


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#326399 - 10/22/10 10:35 PM Re: J.P.'s office [Re: medic8r]
fredk Offline
axiomite

Registered: 12/06/07
Posts: 7217
Loc: Canada
Lost track of this thread.

Quote:
Effectiveness really depends on the type/design of study, but I'm no statistician.

True. I am no statistician either. It seems there are a number of more recent studies that suggest medication is less effective than thought by the medical community. It is certainly much less effective than the manufacturers would have you believe.

Quote:
I'm a big believer in psychotherapy.

It works. In fact the one consistent theme in studies on depression is that medication and psychotherapy are much more effective than either on their own.

Depression has many causes and many pathways. I think that it is much like autism, a spectrum of 'disorders'. My depression was situational: who I was married to. My Aunt's was hormonal and took the medical profession a good 40 years to figure out. For others it seems to be how the brain is wired, but even there, the neurological pathways are not always the same.

The most fascinating recent research is around a part of the brain labeled area 25. It seems for a significant portion of people with 'un-treatable' depression. A single treatment of low level electrical stimulation to this part of the brain had immediate, significant, and lasting (somewhere around 4 months) effect. The research was undertaken by a Montreal neuro biologist and a Boston (I think) brain surgeon. The first round was very limited and they are not in their second round now.

Depression sucks. Many treatments are only partially effective, the causes are complicated and it is socially unacceptable. In the recent surveys I have seen, only 30% of people are successfully treated. For the rest any treatment is only partially effective.

Think on this. If an anti-depressant is 60% effective, it is considered a huge success. If you're broken arm is 60% fixed, you are on your way to see your lawyer.

Looking from the outside in we have made large strides in treating depression in the last 50 years. From the inside 40% less depressed is still not anything approaching a good experience.

This is not a slam on your profession JP, just my observation as an insider.
_________________________
Fred

-------
Blujays1: Spending Fred's money one bottle at a time, no two... Oh crap!

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#329389 - 11/23/10 09:07 AM Re: J.P.'s office [Re: fredk]
medic8r Offline
axiomite

Registered: 02/05/06
Posts: 6404
Loc: Fredericksburg, Virginia
Hey, I just saw your post, Fred. Hadn't stepped into my Axiom Office in a while. You're right, the subjectivity built into my specialty is both a blessing (keeps it interesting and less monotonous) and a curse (means cures are usually elusive - we can only treat).

I came back to post a link to a local Craigslist ad for a 1958 Harman Kardon tube tuner and tube amp. Thought it was interesting and that you guys would appreciate it.
_________________________
"The Universe is the game of the self, which plays hide and seek forever and ever" - Alan Watts

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#337545 - 02/08/11 01:53 PM Re: J.P.'s office [Re: medic8r]
medic8r Offline
axiomite

Registered: 02/05/06
Posts: 6404
Loc: Fredericksburg, Virginia
Another fun day at the office. One of my patients just showed up in the lobby (without an appt) with lottery tickets affixed to his forehead. He had wrapped them up with tie-down straps.
_________________________
"The Universe is the game of the self, which plays hide and seek forever and ever" - Alan Watts

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