> [Thorazine] was an antipsychotic given to mentally ill people, often in institutions, that was so sedating, it gave rise to the term "Thorazine shuffle."
I think the term "Thorazine shuffle," refers to the characteristic locked-knee shuffling gait that develops because Thorazine frequently causes tardive dyskinesia as a side effect.
Edit: ignore this, see below; though, the drug does induce discomfort and restlessness in the limbs that prompts patients to pace around.
It's tardive dyskinesia, and the term is typically used to denote the facial tics that are a sometimes permanent side effect of older antipsychotics. The "shuffle" is a separate effect, and calling it that is often regarded as pejorative.
I have heard that people in post-acute care (think nursing homes) frequently end up taking Seroquel because it appears on their hospital discharge paperwork, despite never having any diagnosis of psychosis.
It turns out that certain hospital physicians find it a convenient sleep aide for use in the hospital, and the prescription unintentionally follows the patient, sometimes for months or years.
(Source: I sell software to long-term care facilities and their pharmacists.)
I've had periods of insomnia. Personally, I liked https://en.wikipedia.org/wiki/Trazodone and it comes in generic. I've only ever needed to use it on a short-term basis.
Also, I think banning drug ads and the profession of pharmaceutical sales rep would go a long way toward fixing over-prescribing and medical costs. When the new Congress wants to reform Obamacare, someone should add this ban.
This is a great read for anybody with issues sleeping. The vast majority of sleep problems are in your head and after reading this I never had another issue. He debunks the utility of sleeping pills and give you lots of strategies for improving your sleep. http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0...
I sometimes get severe insomnia. After the third day, the most productive thing I could do is menace in a deranged and hallucinatory fashion anybody who dares hand out this kind of advice.
I've always had what you might call severe insomnia. I rarely sleep for more than four hours, and I've found I do pretty well on two. As far as I know I've never slept eight without either being up 2-3 nights beforehand or being very, horribly drunk. In my experience if you are not sleeping, staying in bed will just make you more tired. It is better to embrace it, get up and do something. So that's where I'm coming from, I'm sorry if it caused offence.
Three days/two nights without sleeping, as in without going to bed at all, should not cause you to hallucinate. That's just a weekend. That's as uncommon as you might think. If you are hallucinating there might be something else going on.
I have really bad insomnia, due to genetic anxiety and depression (apparently "of a bipolar nature", but only a drug can make me manic), and without a low dose of Seroquel before bed I'd only be getting ~4 hours of sleep a night (and my anxiety would be much worse). It's been pretty much a life saver.
Seroquel is ... interesting in that it hits a histamine receptor harder than anything else; for someone like me, who also suffers from bad allergies, this duel side effect is particularly advantageous.
As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.
> apparently "of a bipolar nature", but only a drug can make me manic
Insomnia is, in my experience, symptom of low dopamine. You need to exert executive function to intentionally drop trains of thought that are keeping you awake—without enough dopamine to do so, you end up increasingly exhausted but unable to sleep. Vyvanse is the best thing that ever happened to my sleep schedule.
There are several kinds of insomnia. In my case, getting to sleep is seldom a problem (and when it is, it's indeed often if not most often that kind of "thinking too much"), waking up too early is the big one. So, besides this being a generic disorder (my uncle the engineer followed the same path as I at the same times in our lives, but he's frankly bipolar with anxiety being of less significance), the effects of Seroquel on dopamine are not much if anything of an issue for me. Then again I'm taking a low dose of it (50-100 mg in one dose before bed, therapeutic dose of it for its formal indications don't go below 300 mg/day).
One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me).
Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough.
As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808... is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.
> As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.
Yes, there has been a major push by Medicare and others to reduce anti-psychotic use in the elderly.
Saint John's Wort in conjunction with therapy is one that comes to mind. All antidepressants should be combined with active, regular therapy. Often the cause of depression is not chemical imbalance, but an actual issue in the person's life.
The causation is simple - hypericin becomes toxic when activated by light. While that doesn't mean that it definitely causes cataracts, given available data I think it's more likely that it does.
I met a Swedish nurse who worked in a ward where they treated young people who'd had mental breakdowns. She said the most common cause was a tough life situation. In the short term they would prescribe drugs, but ultimately their treatment was focused on changing that persons life to remove the negativity which spurned the breakdown. Whether it be encouraging them to get a new job or move out of their current living/ relationship situation.
I would be more happy to accept the idea that depression was usually a result of a chemical imbalance in your brain if this was able to be reliably diagnosed by measuring the balance of chemicals in your brain, rather than the current method of divining the supposed chemical imbalance by filling in a short questionnaire.
St John's wort can have serious drug interaction consequences, so talk to a pharmacist if you're already taking any other meds.
St John's wort is not sold as a medicine so the products you can buy are subject to much lower levels of quality control. St Johns Wort varies in quality across different brands.
Here's a big problem - in the US St Johns Wort isn't regulated like a drug, it is regulated as a supplement. Which in practice means when you buy a bottle of St Johns Wort it can contain almost anything and may or may not contain any actual St Johns Wort.
Plus St Johns Wort interacts with practically everything.
>16 of the 40 supplements tested contained pesticide residues that appeared to exceed legal limits, the investigators found. In some cases, the government has not set allowable levels of these pesticides because of a paucity of scientific research.
>DNA tests show that many pills labeled as healing herbs are little more than powdered rice and weeds.
>Two bottles labeled as St. John’s wort, which studies have shown may treat mild depression, contained none of the medicinal herb. Instead, the pills in one bottle were made of nothing but rice, and another bottle contained only Alexandrian senna, an Egyptian yellow shrub that is a powerful laxative.
>out of more than two dozen supplements that were pulled from shelves after they were found to contain anabolic steroids or powerful prescription drugs, roughly two-thirds were back on the market a year later with the same illicit ingredients
The endorphins from exercise work wonders against depression. Of course, getting the patient to "take their medicine" is non-trivial, but even a short walk can be helpful.
>> The endorphins from exercise work wonders against depression.
When I was a in fairly deep depression, the only thing which kept me sane was playing hockey and pushing my cardio to the max every time I stepped on the ice.
The rush of adrenaline and release of endorphins and making my brain engage in something other than why my life is so miserable did wonders for me.
A few years later, I was seeing a psychologist and told her about how hockey in essence saved my life. She posited the same thing. The release of endorphins and adrenaline actually help combat the depression and helped me, at least for periods of time, overcome the feelings of despair and isolation.
These are all rather small trials which would require a fairly large effect to be noticeable.
1191 total from 16 studies of children and
2336 from 39 studies for adults.
Note: A single stuidy of 200 people is generally better than 10 studies of 50 people because you can't combine raw data from different studies. And treatments for mental issues are generally only useful for sub populations.
> ...the current meta-analysis examines the effects of exercise on depressive symptoms in 58 randomized trials (n = 2982). An overall effect size of -0.80 indicates participants in the exercise treatment had significantly lower depression scores than those receiving the control treatment. This frac34; SD advantage represents level 1, Grade A evidence for the effects of exercise upon depression.
1. Traveling
2. Sunlight
3. Walking
4. Meeting new people (travel, couchsurfing meetings, classes)
Taking an herbal drug can be very helpful psychologically even if it is not proven medically effective (the placebo effect). Just do some research because natural drugs can have harmful side effects too.
I hear B and D vitamins help. I also hear that doctors aren't really sure if vitamin supplements even work, so eat leafy greens and beans and get some sun.
Vitamin D supplements are very well attested to work, but it's true that some other kind of supplements either don't matter or aren't really bioavailable to humans. Those chewy multivitamins and plant-based omega-3 sources don't seem to really help anything, for instance.
By the way, omega-3 from fish oil has strong evidence of an effect on major depression[1], but not the everyday kind. And that doesn't mean take it just in case, it could be bad for you!
The most common is Hypericum Perforatum (St. John's Wort). It's an (considerably strong) SSRI inhibitor and potent CYP450 inducer. Better not take it if you're regularly taking any other kind of drug. If you do ask your pharmacist/doctor, if you're already into any kind of anti-depressants also it's better to avoid it, excessive SSRI activity could lead to serotonin-syndrome.
S-ame (s-adenosylmethionine) is probably the most effective natural anti-depressant. I know it's widely used in Germany. There's extensive research on PubMed regarding it's effectiveness--if it weren't naturally occurring and therefore not subject to patent, it would likely be a blockbuster drug given that it outperforms most prescription drugs.
From my own personal experience, it reduces my anxiety within hours of taking it. And relieves depression in about a week. In the US, you can buy it off the shelf at any CVS/Walgreens. But it's certainly not cheap.
It's natural in the sense that the healthy human body produces s-ame on it own, and if your body ever stopped producing s-ame, you'd probably die since (quoting Wikipedia) "more than 40 metabolic reactions involve the transfer of a methyl group from SAM to various substrates, such as nucleic acids, proteins, lipids and secondary metabolites."
I find meditation and strong exercise help quite a bit.
I also took classes with a Tibetan Buddhist monk. He had pretty good insights into how the mind works.
Not sure if that can be generalized though.
Check out the book Perfect Health Diet, a nutrition book written by an ex-Astrophysicist (Harvard, MIT, ... ) . Plural of anecdote etc., but I am a very satisfied customer.
The title is misleading. Abilify is being prescribed for people who are already on SSRI's for depression because the combination helps accelerate recovery and not because these people need traditional anti-psychotic medicine. With this headline you give people a reason to be hesitant before asking for help.
A few months ago I succumbed to a particularly drawn-out case of the hiccups. Two nights in, sleepless from constant hiccuping, I made it to the ER. The cause was heartburn, triggered by an earlier night of celebratory drinking, irritating my esophagus. The irritation was close enough to my diaphragm to stimulate it.
One dose of thorazine, given by the ER doctor, and the hiccoughs subsided. Thorazine dampens the vagus nerve. This was the intended effect. Less intended was my complete lack of motivation to do anything outside the confines of my apartment for the rest of the weekend. (I also took great interest in my neighbourhood parks, for once.)
I'm an MD who specializes in Psychiatry. Although much of this article is somewhere between a little and a lot inaccurate, the basic premise that an absurdly expensive antipsychotic is the most popular drug is alarming. It is a useful and effective medication with a clear role for a relatively small subset of the population. Why it is being prescribed so widely is a question worth asking.
budesonide is #1 which is used to treat asthma (in puffers I believe).
I spent some time scraping medication information and learned that pharmacies in the US mine massive amounts of data about pharmaceutical purchases and there are a few billion dollar companies that collect/sell this data. Customer information is "anonymized" of course at the pharmacy level. You can find the sales of the top 100 drugs drugs pretty easily online, but there are thousands of drugs and the data-mining companies charge you to see sales of the smaller ones (from my experience).
You are correct! Budesonide is available as a generic inhalable steroid for asthma.
As for Rx data, IMS is king. They pay pharmacies, wholesalers, etc to report all of their sales. It's used heavily by pharma companies. I've seen some of the data and it goes all the way down to individual Rxs by doctor. Incredible stuff.
It's about 1/2 way down the page. Of course this is by total number of Rxs, not dollars. Hydrocodone/APAP is pretty cheap. Also it's from 2012, so it might have changed.
These issues are sociologically complex and they are being addressed as if all mental health issues can be treated on an individual level. There should be regulation that prevents rate of expansion into new 'fuzzily defined' target markets that is scientifically regulated with scientific, precisely and pedantically defined, formalized language. This personally horrifies me, and I watched this happen over and over again in federally funded facilities:
> When someone's antidepressant didn't work, Pharma marketers began floating the idea that it wasn't that the drugs didn't work; it wasn't that the person wasn't depressed to begin with but had real life, job and family problems—it was "treatment-resistant depression."
Over-prescription in general seems to come from ill equipped / underfunded facilities. These are places that can't afford to give every person individual therapy. They are communal, so there is lots of personality clashing that goes on inside of the facilities that exacerbates disorders which stem from or are composed largely of adaptive socialization behaviors that become maladaptive in different environments. A person who grew up in poverty or from an abusive environment is going to be angry and depressed. Just because there is no one available to have an intelligent kind of compassion for that person, doesn't make them psychotic. People are afraid of what they don't understand in general. It's easier and cheaper to zonk someone out than actually have to think about or pay how to help them.
I really don't mean to come off so cynical, but some of these public facilities can be blackholes for many of the people they treat, with the possibility of re-traumatizing people on top of the problems they already have.
Oh, and on top of that, the humorous part (read with heavy sarcasm): people at these places are called "clients" and the facility stresses that that specific phrasing is used. No one is called a patient. They are a "client", a consumer.
A large percentage of the people there are there on a court order. Rape victims are potentially in the same groups as convicted rapists and murderers. These are not happy places for finding and maintaining well-being; they are chaotic hellholes. If you lose your sense of self in there, all you have left are labels of insanity reflecting back at you to tell you who you are. You can call that person a client, but they are still a psychotic, borderline, {etc} client, whom can be drugged, physically restrained, and held against their will.
That said, I'm sure there exist people who don't experience that. But that doesn't imply that it does not happen.
You have no idea about the level of conflicting messages you receive in these places. The advice is so diluted that it can't be practically applied, it only describes very generally the way the mind functions when it is operating at an average baseline. It doesn't mean it creates mental stability. These places run on belief systems, not science.
I am absolutely certain this is one side of a coin. On the other hand, these are difficult, systemic issues for which places like this serve as a sinkhole for. The people who work there have to deal with this every day, and I'm sure many of them are trying their best and are not abusing the power and authority they have been given over the lives of other people. But that doesn't mean it can't be improved, and it doesn't mean it doesn't warrant a real, socially active and involved discussion.
I'm not a doctor, but back when my doctor and thought I might have true bipolar disorder (vs. as it turns out "depression of a bipolar nature" that only goes manic when I take the wrong drugs), I studied up on the disorder.
What's prescribed for people with is are "mood stabilizers" (and all of them but the "gold standard" of lithium were originally developed for other indications like psychosis and convulsions). So people who have true bipolar disorder by definition have manic phases, and they need their mood stabilizer all the time to deal with both that and depression phases.
I used to work in a pharmacological research lab, and while I'm frequently discomfited by the misalignment between commercial incentives and social good in the pharmacology industry, this statement isn't quite fair:
> Everyone has heard of "mission creep." In the pharmaceutical world, approval creep means getting the FDA to approve a drug for one thing and pushing a lot of other drug approvals through on the coattails of the first one.
This is more accurately referred to as "drug repurposing," and it's hardly the unalloyed evil that it's characterized as here. It's true that drug companies love to repurpose existing FDA-approved drugs, both because it saves them money and because it typically permits them to patent the compound again in a new context, but there are nonetheless real benefits to the public at large when a drug whose side effects are comparatively well-characterized over the long term is put into service to treat a different malady.
To take the atypical anti-psychotics as an example, it turns out they or at least some of them are good mood stabilizers, i.e. can be used to treat bipolar disorder (manic depression). And while they have their fair share of nasty side effects, there pretty much aren't any nasty side effect free mood stabilizers....
I was prescribed an atypical antipsychotic* originally for bipolar disorder in my late teens. At the time, it was an absolute lifesaver. I had almost completely lost my ability to function, and the treatment brought me back to an operating state sufficient to complete high school without completely sinking my GPA.
I had to stop using it because of unacceptable side effects (rapid weight gain and sexual dysfunction), and it took me a long time to find something else that worked as well. The medication that ended up working for me was originally developed as an anticonvulsant. My symptoms lessened over time in adulthood, but if I hadn't had the course correction provided by repurposed 'Big Pharma' medications I would be living a much harder life.
*: I'm not naming medications because I don't want to promote them. What worked for me isn't necessarily what will work for anyone else.
Back when my doctor and I didn't know if I had true bipolar disorder vs. what seems to be "depression of a bipolar nature" (with my never going manic unless I'm taking a drug that triggers it), I was prescribed the atypical antipsychotic Zyprexa at full dosage, initially by my previous doctor, and also found its infamous side effects to be unacceptable. Tried another with that previous doctor and got orthostatic hypotension, then with this doctor tried an anticonvulsant, which I had to stop because of bad skin side effects (still have little bright red flecks on my skin here and there). At that point, especially with the very slow ramp up of the anticonvulsant (meaning for a long while I didn't have a therapeutic dose), we crossed our fingers and stopped trying mood stabilizers, which lead to the change in diagnosis. (Elsewhere in this topic I mention how I later started taking a low dose of another antipsychotic to deal with anxiety in general, with very useful side effects for insomnia and allergies.)
I did name one drug name because if any other atypical anti-psychotic will do the trick it should perhaps be tried, Zyprexa is pretty infamous for weight gain among other things.
The real problem isn't drug repurposing, but off-label promotion. If you want to take a drug through FDA approval for another set of indications, that's fine and dandy. What isn't cool is actively promoting the use of a drug without market approval - having reps drop subtle hints, funding third-party publication, paying doctors to speak at conferences about their off-label prescribing and so on.
Eli Lilly, Pfizer and AstraZeneca have collectively paid out more than $2.5bn in settlements over the off-label promotion of atypical antipsychotics. The drugs that they unlawfully promoted are now being used widely for the treatment of a variety of conditions for which there is little evidence of efficacy. Lilly were marketing Zyprexa for the treatment of dementia, in spite of having extensive unpublished research showing that it was ineffective.
Atypical antipsychotics are being used by far too many psychiatrists as a catch-all where other lines of treatment have failed - OCD, autism, PTSD, ADHD, anorexia, substance abuse, you name it. In most cases the evidence of efficacy is slim-to-none. That's not medicine, it's quackery. Frankly, I'd be happier if they were prescribing placebo; Nobody has ever died from the side effects of sugar pills.
But turning an off-label use into an on-label one to promote it has its own nasty consequences, even if the drug is proven to work for the new indication (or whatever).
Consider Lucentis vs Avastin. Ophthalmologists were using Avastin off-label for wet AMD. Genentech was making a huge multifaceted effort to discourage off-label use because they had sunk a bunch of effort/$ into the order-of-magnitude-more-expensive Lucentis for not much of an improvement. Similar situation and different ending with Lumigan (glaucoma/ocular hypertension eyedrops) vs Latisse (eyelash enhancer), where Latisse's patent (afaik) was thrown out because Allergan was trying to patent a known major side effect of Lumigan.
I'm not a fan of misleading promotions of off-label uses either, but I wish there was a middle ground still banning that that didn't also involve more patents and protection.
It was a shock for me to have worked in the US for a few years, and slowly realize that I was in the distinct minority in my circle of friends in not taking any medications consistently (I'm in my thirties). Made me think of Brave New World.
I have noticed that too. It's pretty much standard that people take at least some prescription drugs regularly. Also the children of some friends know all the ins and outs of different pills. I don't think I ever had had a headache pill when I was the same age.
That's pretty shocking indeed. So what do these people think of their own med use? When I was on antipsychotics I couldn't wait to get off of them, and my psych was very supportive regarding that.
I'm Dutch, but I grew up with many Americans around me. It always shocked to see the huge amount of pill-bottles in the bathrooms of my American friends, and how much part of daily life these things were.
Anti-bacterial wipes for everything, pills at the smallest sign of illness (even just the sniffles), copious use of sleeping aids, and so on.
In my upbringing (which was kind of 'typically' Dutch), we took medication as a last resort. Even painkillers were not something you took unless your headache was unusually bad.
I have no doubt that this is also changing in Holland, especially when it comes to prescription drugs for psychological issues, but in general it seems a bit healthier to me to allow the body to take care of itself when it can, rather than stuffing it with foreign bodies that often have all kinds of adverse side-effects.
This state of affairs often makes me think about how malleable societies really are, for both good and bad, and how much variation there is even within 'Western-European' nations.
"The standardized United States Product Insert says Abilify's method of action is "unknown" but it likely "balances" brain's neurotransmitters."
The whole neurotransmitter imbalance hypothesis is itself not proven for Abilify or any other anti-depression drug (like SSRIs). At best, it is a guess since there is no way to measure levels of neurotransmitters in live subjects. At worst it is a lie. Regardless, the method of action is irrelevant if medicines work, but considering the efficacy of such drugs (not very good) and their frequency of prescription (very high) it's not surprising that the medical industry would work so hard to push an unproven theory as fact simply to sell more drugs.
Not only is it not proven for <insert drug here>, it's not even a useful hypothesis in the scientific sense. No one has ever proposed a useful model of the "chemical balance" that is hypothesized to be "imbalanced", so the whole theory is a non-sequitur. It is proposed because the more accurate explanation of "this is a powerful drug that introduces long-term changes to the structure of your brain. A few cherry-picked studies funded by pharmaceutical companies seem to show that there might be some short term amelioration of your symptoms. We have no idea how it works, but that's not surprising, as we have no idea why you have your disorder, or what it is other than a particular constellation of symptoms. We won't find out in the near future, because there's really no money being invested in finding out the ultimate causes for mental illness or in studying the long term effects of these treatments." doesn't get you invited to the really nice pharma-sponsored conferences.
I always find it interesting that these kind of articles points the fingers at Big Pharma and completely forget that there's a key element needed for prescription: Doctors. So, why not blame doctors as well, at least as much as Big Pharma? They share a huge part of responsibility in the situation.
The insinuation of headlines like this is that antipsychotics are inherently hardcore drugs for people with severe, possibly dangerous mental illness. This delegitimizes depression by suggesting it is not or cannot be a serious mental illness; furthermore, it stigmatizes people who suffer from psychosis by suggesting that their symptom is beyond the pale of what a normal person might suffer.
That is: Antipsychotics are for people who experience psychosis, and people who experience psychosis are crazy lunatics, so it's absurd that so many normal people are being prescribed antipsychotics.
The issue is not that they are portrayed as too "hardcore", but rather in general things like depression are over-simplified and dumbed down to stoke consumer demand for narcotic remedies.
20 years ago, I dated a pharmacist and she said that two of the most prescribed drugs that she dispensed was ritalin and Prozac. It shocked me back then, so hearing that anti-psychotics are amongst the highest these days is no surprise, unfortunately.
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[ 3.1 ms ] story [ 47.7 ms ] threadI think the term "Thorazine shuffle," refers to the characteristic locked-knee shuffling gait that develops because Thorazine frequently causes tardive dyskinesia as a side effect.
Edit: ignore this, see below; though, the drug does induce discomfort and restlessness in the limbs that prompts patients to pace around.
It turns out that certain hospital physicians find it a convenient sleep aide for use in the hospital, and the prescription unintentionally follows the patient, sometimes for months or years.
(Source: I sell software to long-term care facilities and their pharmacists.)
Also, I think banning drug ads and the profession of pharmaceutical sales rep would go a long way toward fixing over-prescribing and medical costs. When the new Congress wants to reform Obamacare, someone should add this ban.
Three days/two nights without sleeping, as in without going to bed at all, should not cause you to hallucinate. That's just a weekend. That's as uncommon as you might think. If you are hallucinating there might be something else going on.
Seroquel is ... interesting in that it hits a histamine receptor harder than anything else; for someone like me, who also suffers from bad allergies, this duel side effect is particularly advantageous.
As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.
Insomnia is, in my experience, symptom of low dopamine. You need to exert executive function to intentionally drop trains of thought that are keeping you awake—without enough dopamine to do so, you end up increasingly exhausted but unable to sleep. Vyvanse is the best thing that ever happened to my sleep schedule.
One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me).
Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough.
As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808... is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.
Yes, there has been a major push by Medicare and others to reduce anti-psychotic use in the elderly.
So far I have only found lavender oil, sardines and chocolate to work.
http://www.ncbi.nlm.nih.gov/pubmed/16814590 http://www.ncbi.nlm.nih.gov/pubmed/19739671
Not trying to be contrary, but do you have a source?
I think it's more complicated than a simple either-or proposition.
St John's wort is not sold as a medicine so the products you can buy are subject to much lower levels of quality control. St Johns Wort varies in quality across different brands.
Plus St Johns Wort interacts with practically everything.
Sources: http://www.nytimes.com/2010/05/26/health/policy/26herbal.htm...
>16 of the 40 supplements tested contained pesticide residues that appeared to exceed legal limits, the investigators found. In some cases, the government has not set allowable levels of these pesticides because of a paucity of scientific research.
http://www.nytimes.com/2013/11/05/science/herbal-supplements...
>DNA tests show that many pills labeled as healing herbs are little more than powdered rice and weeds.
>Two bottles labeled as St. John’s wort, which studies have shown may treat mild depression, contained none of the medicinal herb. Instead, the pills in one bottle were made of nothing but rice, and another bottle contained only Alexandrian senna, an Egyptian yellow shrub that is a powerful laxative.
http://well.blogs.nytimes.com/2014/10/21/dangerous-dietary-s...
>out of more than two dozen supplements that were pulled from shelves after they were found to contain anabolic steroids or powerful prescription drugs, roughly two-thirds were back on the market a year later with the same illicit ingredients
When I was a in fairly deep depression, the only thing which kept me sane was playing hockey and pushing my cardio to the max every time I stepped on the ice.
The rush of adrenaline and release of endorphins and making my brain engage in something other than why my life is so miserable did wonders for me.
A few years later, I was seeing a psychologist and told her about how hockey in essence saved my life. She posited the same thing. The release of endorphins and adrenaline actually help combat the depression and helped me, at least for periods of time, overcome the feelings of despair and isolation.
There is very little benefit from exercise for people who have depression.
Children and adolescents: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004691...
Adults: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004366...
Exercise is better than a placebo, if the trial is low quality. Once you get better quality trials the benefit is less significant.
There's some evidence that exercise might build resilience against depression in people currently not depressed.
Note: A single stuidy of 200 people is generally better than 10 studies of 50 people because you can't combine raw data from different studies. And treatments for mental issues are generally only useful for sub populations.
Link: http://www.ncbi.nlm.nih.gov/pubmed/19453207
From the abstract:
> ...the current meta-analysis examines the effects of exercise on depressive symptoms in 58 randomized trials (n = 2982). An overall effect size of -0.80 indicates participants in the exercise treatment had significantly lower depression scores than those receiving the control treatment. This frac34; SD advantage represents level 1, Grade A evidence for the effects of exercise upon depression.
Taking an herbal drug can be very helpful psychologically even if it is not proven medically effective (the placebo effect). Just do some research because natural drugs can have harmful side effects too.
By the way, omega-3 from fish oil has strong evidence of an effect on major depression[1], but not the everyday kind. And that doesn't mean take it just in case, it could be bad for you!
[1] http://examine.com/supplements/Fish+Oil/
If you want natural, I would try tobacco (it can be snuff, no need to smoke, although smoking works faster). For synthesized, try moclobemide.
How would you describe your symptoms?
From my own personal experience, it reduces my anxiety within hours of taking it. And relieves depression in about a week. In the US, you can buy it off the shelf at any CVS/Walgreens. But it's certainly not cheap.
http://en.wikipedia.org/wiki/S-Adenosyl_methionine#Therapeut...
One dose of thorazine, given by the ER doctor, and the hiccoughs subsided. Thorazine dampens the vagus nerve. This was the intended effect. Less intended was my complete lack of motivation to do anything outside the confines of my apartment for the rest of the weekend. (I also took great interest in my neighbourhood parks, for once.)
I wouldn't be surprised if Ativan/lorazepam is still #1 in terms of prescriptions.
http://www.drugs.com/stats/top100/units
acetaminophen/hydrocodone is #2
budesonide is #1 which is used to treat asthma (in puffers I believe).
I spent some time scraping medication information and learned that pharmacies in the US mine massive amounts of data about pharmaceutical purchases and there are a few billion dollar companies that collect/sell this data. Customer information is "anonymized" of course at the pharmacy level. You can find the sales of the top 100 drugs drugs pretty easily online, but there are thousands of drugs and the data-mining companies charge you to see sales of the smaller ones (from my experience).
As for Rx data, IMS is king. They pay pharmacies, wholesalers, etc to report all of their sales. It's used heavily by pharma companies. I've seen some of the data and it goes all the way down to individual Rxs by doctor. Incredible stuff.
It's about 1/2 way down the page. Of course this is by total number of Rxs, not dollars. Hydrocodone/APAP is pretty cheap. Also it's from 2012, so it might have changed.
> When someone's antidepressant didn't work, Pharma marketers began floating the idea that it wasn't that the drugs didn't work; it wasn't that the person wasn't depressed to begin with but had real life, job and family problems—it was "treatment-resistant depression."
Over-prescription in general seems to come from ill equipped / underfunded facilities. These are places that can't afford to give every person individual therapy. They are communal, so there is lots of personality clashing that goes on inside of the facilities that exacerbates disorders which stem from or are composed largely of adaptive socialization behaviors that become maladaptive in different environments. A person who grew up in poverty or from an abusive environment is going to be angry and depressed. Just because there is no one available to have an intelligent kind of compassion for that person, doesn't make them psychotic. People are afraid of what they don't understand in general. It's easier and cheaper to zonk someone out than actually have to think about or pay how to help them.
I really don't mean to come off so cynical, but some of these public facilities can be blackholes for many of the people they treat, with the possibility of re-traumatizing people on top of the problems they already have.
Oh, and on top of that, the humorous part (read with heavy sarcasm): people at these places are called "clients" and the facility stresses that that specific phrasing is used. No one is called a patient. They are a "client", a consumer.
A client is a more engaged partner in the activity of achieving and maintaining well-being; a patient is a more passive victim of their situation.
That said, I'm sure there exist people who don't experience that. But that doesn't imply that it does not happen.
You have no idea about the level of conflicting messages you receive in these places. The advice is so diluted that it can't be practically applied, it only describes very generally the way the mind functions when it is operating at an average baseline. It doesn't mean it creates mental stability. These places run on belief systems, not science.
I am absolutely certain this is one side of a coin. On the other hand, these are difficult, systemic issues for which places like this serve as a sinkhole for. The people who work there have to deal with this every day, and I'm sure many of them are trying their best and are not abusing the power and authority they have been given over the lives of other people. But that doesn't mean it can't be improved, and it doesn't mean it doesn't warrant a real, socially active and involved discussion.
What's prescribed for people with is are "mood stabilizers" (and all of them but the "gold standard" of lithium were originally developed for other indications like psychosis and convulsions). So people who have true bipolar disorder by definition have manic phases, and they need their mood stabilizer all the time to deal with both that and depression phases.
> Everyone has heard of "mission creep." In the pharmaceutical world, approval creep means getting the FDA to approve a drug for one thing and pushing a lot of other drug approvals through on the coattails of the first one.
This is more accurately referred to as "drug repurposing," and it's hardly the unalloyed evil that it's characterized as here. It's true that drug companies love to repurpose existing FDA-approved drugs, both because it saves them money and because it typically permits them to patent the compound again in a new context, but there are nonetheless real benefits to the public at large when a drug whose side effects are comparatively well-characterized over the long term is put into service to treat a different malady.
I had to stop using it because of unacceptable side effects (rapid weight gain and sexual dysfunction), and it took me a long time to find something else that worked as well. The medication that ended up working for me was originally developed as an anticonvulsant. My symptoms lessened over time in adulthood, but if I hadn't had the course correction provided by repurposed 'Big Pharma' medications I would be living a much harder life.
*: I'm not naming medications because I don't want to promote them. What worked for me isn't necessarily what will work for anyone else.
I did name one drug name because if any other atypical anti-psychotic will do the trick it should perhaps be tried, Zyprexa is pretty infamous for weight gain among other things.
But the article is clearly talking about its abuse.
Eli Lilly, Pfizer and AstraZeneca have collectively paid out more than $2.5bn in settlements over the off-label promotion of atypical antipsychotics. The drugs that they unlawfully promoted are now being used widely for the treatment of a variety of conditions for which there is little evidence of efficacy. Lilly were marketing Zyprexa for the treatment of dementia, in spite of having extensive unpublished research showing that it was ineffective.
Atypical antipsychotics are being used by far too many psychiatrists as a catch-all where other lines of treatment have failed - OCD, autism, PTSD, ADHD, anorexia, substance abuse, you name it. In most cases the evidence of efficacy is slim-to-none. That's not medicine, it's quackery. Frankly, I'd be happier if they were prescribing placebo; Nobody has ever died from the side effects of sugar pills.
Consider Lucentis vs Avastin. Ophthalmologists were using Avastin off-label for wet AMD. Genentech was making a huge multifaceted effort to discourage off-label use because they had sunk a bunch of effort/$ into the order-of-magnitude-more-expensive Lucentis for not much of an improvement. Similar situation and different ending with Lumigan (glaucoma/ocular hypertension eyedrops) vs Latisse (eyelash enhancer), where Latisse's patent (afaik) was thrown out because Allergan was trying to patent a known major side effect of Lumigan.
I'm not a fan of misleading promotions of off-label uses either, but I wish there was a middle ground still banning that that didn't also involve more patents and protection.
Anti-bacterial wipes for everything, pills at the smallest sign of illness (even just the sniffles), copious use of sleeping aids, and so on.
In my upbringing (which was kind of 'typically' Dutch), we took medication as a last resort. Even painkillers were not something you took unless your headache was unusually bad.
I have no doubt that this is also changing in Holland, especially when it comes to prescription drugs for psychological issues, but in general it seems a bit healthier to me to allow the body to take care of itself when it can, rather than stuffing it with foreign bodies that often have all kinds of adverse side-effects.
This state of affairs often makes me think about how malleable societies really are, for both good and bad, and how much variation there is even within 'Western-European' nations.
The whole neurotransmitter imbalance hypothesis is itself not proven for Abilify or any other anti-depression drug (like SSRIs). At best, it is a guess since there is no way to measure levels of neurotransmitters in live subjects. At worst it is a lie. Regardless, the method of action is irrelevant if medicines work, but considering the efficacy of such drugs (not very good) and their frequency of prescription (very high) it's not surprising that the medical industry would work so hard to push an unproven theory as fact simply to sell more drugs.
That is: Antipsychotics are for people who experience psychosis, and people who experience psychosis are crazy lunatics, so it's absurd that so many normal people are being prescribed antipsychotics.
Read this, perhaps instead.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518694/
The issue is not that they are portrayed as too "hardcore", but rather in general things like depression are over-simplified and dumbed down to stoke consumer demand for narcotic remedies.
(Trivializing the subject is not a good thing.)