(1) Should young people be given antidepressants?
(Head to Head: Should young people be given antidepressants?)
Yes: http://www.bmj.com/cgi/content/full/335/7623/750
No: http://www.bmj.com/cgi/content/full/335/7623/751
Not sure whether this is free or not
Click here to hear the Reviewer's comments via MP3.Moncrieff, J., et al, Can J Psych 52(2):96, February 2007
This British author challenges the tenet that antidepressant drugs specifically act on abnormal cerebral states to relieve depression. She points out that meta-analyses of the myriad of published randomized, controlled trials comparing antidepressants and placebo generally show only a small advantage of active treatment, further noting that trials with negative results are much less likely to be published. The author suggests that reported effects of antidepressant drugs might be due to nonspecific sedative effects of these agents on outcomes such as sleeping difficulties and anxiety rather than to a truly antidepressant effect. She cites the findings of naturalistic studies that have reported that patients treated with antidepressants do less well than those who are not so treated. The prevalence of depressive episodes, suicide and sickness absence due to depression has been progressively increasing in western countries, despite a profound increase in antidepressant prescribing, suggesting that the use of antidepressants has done little to reduce the consequences of depression. Addressing studies reporting relapse of depression after discontinuation of long-term antidepressant therapy, this author feels that this phenomenon does not necessarily provide evidence of the effectiveness of antidepressants but rather might reflect the occurrence of discontinuation symptoms that are mistakenly diagnosed as early signs of relapse. In support of this premise, she cites the findings of one meta-analysis of maintenance antidepressant studies reporting that relapses tended to cluster after withdrawal of treatment, with the risk declining thereafter. The author concludes that there is no reason to suppose that the diverse problems that are labeled as "depression" can be reversed by antidepressant drugs. 9 references (j.moncrieff@ucl.ac.uk)
Gravity wins in the end. When one hits 60, denial isn't really an option anymore.
Insight and transformation can wash away years of resentment, bitterness, righteous anger, disappointment and other such stuff and change how we look but only transcendence can beat gravity. Transformation I have tasted. Transcendence is the stuff of miracles, way beyond my reach or comprehension.
But what about insight and its resulting transformation, is it within our reach - subject to our choice and decision?
I don't think so. It's more like a gift. When it comes it's a surprise.
If and when, for whatever reason, we move into truth and out of pretense, magical 'things', like insight, sometimes happen - that's all I know.
A prerequisite to insight (new knowing) is not knowing.
Insight is about truth in action not the imposition of what we may think, feel, believe and know.
Can we choose truth? I don't think so - insight is prior to it.
Catch 22!
Bugger.
But we can 'choose' to be our present truth - deliberately and consciously be the lie, the pretense - tell our loved ones our game.
Whoooops! Embarrassing! Yes but changing too!
Newer antipsychotic drugs are no better than older ones, study finds
Older antipsychotic agents are just as effective as the newer, more expensive "second generation" agents, a new study concludes.
A UK site - good starting place with heaps of basic information on mental health issues.
Mind is the leading mental health charity in England and Wales. We work to create a better life for everyone with experience of mental distress
Another site
Endorsed by the Royal College of Psychiatrists' Changing Minds anti stigma campaign, the site features articles from service users, carers, mental health professionals and experts in various fields. The site was launched at the House of Commons on 13 February 2001 with speeches from opinion leaders and advocates in mental health and the Internet:
The devastation, the public's inability to empathise, the sadness, the possibilities
Visit this blog from Shiny Happy Person - a psychiatrist with bipolar.
Visit this website - a mothers response to her son Christian
SHP is a dissatisfied and stroppy junior psychiatrist working in the crumbling institution that is the NHS. She loves her job and gets very pissed off when she is prevented from doing it properly, which happens a lot.Visit shiny happy person for some more NHS madness coming our ( NZ) way in the not too distant future.
Belated pressie from some friends - a couple of bottles of plonk with a personalised label.
That young dude over there is me, 30 odd years ago. Bloody hell!! I will, at max, only see 30 more springs - maybe with a miracle 40. More likely only 20 and if I die at the age my dad died, only another 16 wisteria spring time displays. It could be a lot fewer. I could have seen my last spring.
This ageing business is really weird.
Hang on while I get myself another G and T.
Grey hair, thin skin, bifocals, poor stream, less stamina and a belly that is a little protuberant. I am mortal. I will die.
Not too many years ago life felt like it was forever. Now I really know it isn't. I knew before but now I really know. This life isn't any kind of dress rehearsal. There is no coming back. This is it.
I have been told a few times in my life that I could do with getting my hands dirty - that is, getting out of my head and in touch with something real and actual - dirt. I have told myself the same thing many many times.
We humans spend too much time playing with and locked into mental abstractions - man made imagery and beliefs - shoulds, old hurts, future fears and other stuff. And in the process we miss out on life, reality and the enjoyment of being with self and others.
There may or may not be any point to life. There may or may not be any god or gods. Our beliefs are probably all off the mark. We are all sinners. We all struggle. In our negativity we are so boringly similar and hurtful.
Your opinions are yours and mine are mine - why fight over them. If we disagree, why not have fun heated discussions and leave it at that.
Stop trying to change self and others.
Please let those you love be who they are - let them be! Let yourself be too! And while you are at it let everyone else be too! Yes lets lock up those that are a danger to themselves and others but please let us all be more understanding and less punitive. Revenge in the end destroys the revenge seeker. Those that do damage have a screw or two loose and we all have one hell of a lot less choice than we imagine we have and pontificate about. If you ain't one of the baddies stop imagining you are such a clever dick and feel grateful you are not so afflicted. Or is that nasty little righteous game you play your inescapable prison.
WE ARE ALL IGNORANT FOR GOODNESS SAKE!! THIS IS WHAT WE ALL HAVE IN COMMON.
Violence is on the increase so the TV announcer tells us - why are we so surprised?
The haves are getting more of the pie, super houses on hills and huge pensions. Walled and locked communities are all the rage. There is little sense of gratitude - just judgements about the worker bees who are rapidly becoming redundant in this new brave world.
If you were one of them, you would of course rise up and find your place on top of the hill and look down on them and fuel your 'smart arse' sense of self - wouldn't you?
There isn't enough hills for us all you idiot. If we make being on top of the hill what life is all about, there will be wars - personal and global.
Just another wee rave - too many G and Ts.
A withdrawal reaction has been reported with all SSRI antidepressants: citalopram (CELEXA); escitalopram (LEXAPRO), fluoxetine (PROZAC, SARAFEM); fluvoxamine (LUVOX); paroxetine (PAXIL); and sertraline (ZOLOFT). The symptoms generally start within one to three days after stopping the drug and generally resolve within one to two weeks after the drug has been discontinued. Withdrawal symptoms may occur even when the dosage of the drug is gradually decreased. The main symptoms of this reaction are dizziness, vertigo,
lack of coordination, nausea and vomiting, and flu-like symptoms that include fatigue, lethargy, muscle pain, and chills.
ymptomsShe is a 45 yr old diabetic with poor circulation to her legs. She is also a smoker. She presented today with two small punched out holes in one lower leg. Smoking in her situation is total madness.
Mrs Jones I want your permission to scare the living daylights out of you?
Why?
Because you know what I am going to tell you already and what you know hasn't changed you. I intend to get in behind your defensive words and shake your core.
Okay
Within a year or two the surgeons will start chopping off bits of your legs and over a year or so work their way up past your knees. By then it will be time to start on your fingers. You are only 45 Mrs Jones and by the time you are fifty you'll be chair bound with painful non healing stumps. I asked her what I had told her. I repeated bits she missed. I looked her in the eye and made sure she heard.
I think she let the image touch her but I doubt it was enough to change anything.
It seems as if folk like her just can not be bothered, that health is just a choice away and so it is. But that choice does not lie within her realm of possibility. It seems so obvious to the rest of us. However, I reckon we all have our 'can't be bothered' aspects. We see those of others and not our own. What's your addiction - it may not be drugs, it may be anxiety, worry, guilt and so on. Whatever it is, it will seem like you don't have a choice. However, when others look in on your world they'll see your addiction, which you don't even see as a problem, as a choice you should change.
Classic side effects of antipsychotics
The first is Extrapyramidal Symptoms, or EPS, including Tardive Dyskinesia, or the worst facial tics ever. Everything you wanted to know about TD, HERE
Treatment here
The other rare side effect is a potentially deadly one, Neuroleptic Malignant Syndrome. While TD is more likely to hit old ladies, NMS is more likely to hit young men. The risk of NMS increases when mixing the older typicals with lithium. Early symptoms include fever, rigidity and increased heartbeat. Unlike TD, NMS requires a lot of intervention in addition to cessation of the medication. More than you ever wanted to know about it at http://www.nmsis.org/general_information.shtml.
The new antipsychotics increase the options of your doctor - however, they do not live up to the hype that you may have read about. Plenty links here to get you started. The chart see above could be really helpful.
Antipsychotics / Really Old School and New Stylee Mood Stabilizers.
lots of links
Lost In Translation: What We Really Learned From CATIE
Jeffrey Lieberman, M.D.
Government Antipsychotic Study Finds No Clear Winner in `Horse Race'
The Good, the Bad, and the Unexpected
The Wall Street Journal reported this morning that "Old Schizophrenia Drug Works As Well as Newer Treatments"
The CATIE Trial: It’s the Dosing, Stupid!
