![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1327 to 1351 of 8406. Go back in thread:
Posted by Kairos on November 24, 2002, at 14:47:18
In reply to Fiery Rhetoric, posted by Mr.Scott on November 24, 2002, at 14:35:27
"Fiery Rhetoric" OR Plain - UNVARNISHED TRUTH?
AMEN & AMEN Mr. Scott!
Thank you a million - trillion times over!
SMOOTCHES for this one!
PEOPLE - YOU ARE THE AUTHORITY!
HEAL - and don't be duped - let's DO our homeowrk and KEEP the AMA etc in LINE and honest - telling ALLL the truth - so that HEALING takes precedence and not a renewable market!
Consumer Driven Markets are Lacking ONE thing - The INFORMED "Consumer".
In Unity -
Kairos
> I think this thread will serve as a fine place to insert my fiery rhetoric...
>
>
> Some psychiatrists are stupid (even though they excel at algebra & geometry).
>
> Some pharmreps are interested only in commissions generated from scripts written for their drug. They are tenaciously persistent sociopaths disguised as helpers (yet are actually minions). They are line items in a marketing budget and human advertising vehicles sent from evil and self-serving corporate entities.
>
> Look at all they provide with extreme caution and generality. The doctors conducting the studies are 'generally' without conscience.
>
> You will do best to be your own doctor in many ways. How many of you are so passionate about your jobs that you would be comfortable letting people entrust their lives to you. Do you think these wise scholars are any different?
>
> Don't let them (MD's and large corporations) make you fat, impotent, and sedated and then send you the bill. They are your employees. Make them do their job of making you feel better (numb and too full of side-effects to care doesn't count). If they can't do their jobs fire them and move on. Ultimately your destiny is in your hands. Do not relinquish it to the self-serving.
Posted by Squiggles on November 24, 2002, at 15:07:08
In reply to Fiery Rhetoric, posted by Mr.Scott on November 24, 2002, at 14:35:27
If only it were so easy: the reason
why psychiatrists may not be able to
put you right again, is not because they
are necessarily any more stupid than
a brain surgeon. The reason (imho) is
complex:- the drugs are often new, poorly tested,
unpredictable, only seen on rats for a few
months;- the push to sell the drugs may be so urgent
that there has not been enough time to see
how this drug fares in the long run;- the psychiatrist does not know you as
intimately as your spouse or brother e.g.,
they do not know your idiosyncrancies -- what
is normal or not normal for your character- the diagnosis itself is at best a good guess,
as we do not have blood tests for mental illness
or anything quite so concrete, except in some
cases;- and matching the drug with the symptom is
like matching two colours to get the exact
hue of torquoise or majenta;So, "firing" your psychiatrist because he or she
does not fix your state, does not guarantee you
that the next shrink you employ will be of a
superiour calibre.Squiggles
Posted by dr. dave on November 24, 2002, at 15:46:01
In reply to Re: Side-effects - best data » dr. dave, posted by ayuda on November 24, 2002, at 12:20:36
The plain truth is that there are NO SIDE-EFFECTS that any scientific study has shown to be significantly less on Lexapro than Celexa. The scary thing is that while this is absolutely clear cut, and the research is available publicly, people are still being led to believe Lexapro has an advantage on this.
While it cannot be proved that you will definitely get the same disconnected feeling on Lexapro, it seems overwhelmingly likely. There is abundant evidence that the side-effect profiles are essentially identical (see below). So, do you judge for yourself on the basis of the evidence, or do you just go with what you're being told even though it makes no sense? It's up to you. You have the power (as does everyone else reading this) to refuse to accept being told what to believe and to find out the facts for yourself.
=======================================================================
> The worst side effect I had from Celexa, and the number one reason I had to go off of it, was a feeling of what I called "disconnection." That is, I felt like I wasn't part of the experiences I was going through. It's kind of hard to explain, but it isn't one of those things that is usually listed from any study, because you can't measure it physically. I just felt like I wasn't there, that my "self" had left me. If anyone has ever seen Jerry Seinfeld's stand-up routine about being in a NYC taxi-cab -- or if you've ever been in a NYC taxi-cab -- it's a similar thing: you know you are there, and (intellectually) that you are part of the experience, but emotionally or psychically you are just watching.
>
> So my point is this: my doctor (a psychiatrist) is under the impression that Lexapro has NONE of the side effects that Celexa has. From Dr. Dave's post, I can see that that is not true, and in some cases (such as insomnia) it has a higher instance of adverse effects. When I told my doctor last week that several people on this site have been experiencing insomnia, she said that that has not been her experience. I don't know who else she has on this medication, or how comfortable they are with telling her about their s/e's, but I think that she is buying into the idea that this medication has NO s/e's, and will be unwilling to listen to my complaints about it. Especially if I start to experience that disconnection again.
>
> Does anyone have any experience with the side effect I am talking about, or something similar? What are the chances that it is something that I will also find in Lexapro? I know that that is an unfair question, but I am also not all that knowledgeable about what s/e's the scientists think are not a part of Lexapro that are present in using Celexa -- I have read the website for the medications, etc., and still don't have a clue. I am a PhD student and my mom's a nurse -- if I can't figure out what these things are saying, I can't imagine what anyone who is less familiar with this kind of information will get out of it.
>
>
> > Dear Pharmrep,
> >
> > Good to see you back! The idea that Lexapro has fewer side-effects than Celexa seems to be floating around again. I presented the most recent and accurate data on this a while back and invited your comments. I may have missed them so forgive me if I am needlessly repeating myself, but it would be good to be clear about your views on this.
> >
> > > The relative side-effects of Lexapro and Celexa are as follows
> > >
> > >
> > > Side effect..........................Lexapro..............Celexa
> > >
> > > Headache............................15.8%..............19.9%
> > > Nausea................................15.0%..............17.2%
> > > Ejaculation disorder..............9.3%(of men)...8.8%
> > > Insomnia..............................9.2%................8.6%
> > > Diarrhoea.............................8.0%...............10.8%
> > > Somnolence.........................6.9%................4.7%
> > > Mouth dry............................6.2%...............8.1%
> > > Upper resp tract infection.....6.2%...............3.9%
> > > Dizziness..............................6.0%...............5.6%
> > > Flu-like symptoms................5.0%...............6.1%
> > > Rhinitis.................................4.9%...............5.6%
> > > Sinusitis................................4.3%...............5.1%
> > >
> > >
> > > 'Overall, the type and frequency of TEAEs (treatment-emergent adverse events) reported with escitalopram and citalopram were very similar, and are in line with AEs reported for citalopram previously. For the TEAEs listed (above) there were no statistically significant differences for incidences of these events between the escitalopram and citalopram treatment groups.'
> > >
> > >
> > > This is the official information from Lundbeck about relative side-effects. I wonder if you still stand by the comments that Lexapro has fewer side-effects than Celexa, and that Celexa causes somnolence while Lexapro does not?
> > >
> > >
> >
>
>
Posted by Geezer on November 24, 2002, at 15:47:34
In reply to Fiery Rhetoric, posted by Mr.Scott on November 24, 2002, at 14:35:27
WOW!! What an important and honest message. "You will do best to be your own doctor in many ways..." - how true that is. In fact, the patient would be well ahead of the game to rely on the anecdotal information found on this board as opposed to trying to reason it out with your average "in the dark psychiatrist". Once the patient comes to the realization that there is not one empirical medical test (PET and SPEC scans prove nothing and have no diagnostic value) in psychiatry, sooooo...everything from the DX forward is guess work and a "roll of the dice".
The drug companies are simply making a product as close to what they already have as possible. Big inovations risk too much legal exposure and the "powers that be in Washington" wouldn't approve the drug anyhow. Looking for altruism in the public or private sector is a waste of time - INCENTIVE is what is needed.
The most important point here is to "take controll of your own care", in psychiatry, no one else will.
Posted by Squiggles on November 24, 2002, at 15:56:02
In reply to Re: Fiery Rhetoric » Mr.Scott, posted by Geezer on November 24, 2002, at 15:47:34
I think that this is a very presumptuous
attitude, and maybe dangerous too. Why
should i know more than a doctor who has
studied this stuff for 20 years? And has
seen so many examples of patients.If there is doubt, and doctors are not
always right - they make mistakes - you might
do best to get a doctor who cooperates with
your knowledge found on the net regarding
your case, as mine did.I think playing your guessing game can land
you in really hot water, unless you are a
Scientologist or a Shaaman or something like
that, who has access to spiritual strength.
Squiggles
Posted by JLM on November 24, 2002, at 16:02:31
In reply to Re: Side-effects - best data » dr. dave, posted by ayuda on November 24, 2002, at 12:20:36
Dear Sir,
I believe what you are describing is termed 'depersonalization'. I had the same thing happen when I took Prozac. Like you say its somewhat hard to describe. For me it was like watching a movie of my day to day life, rather than participating in it myself, if that makes sense.
I'd get another doc personally. The idea that there is ANY drug out there that has 0 SE's is just plain nut.
On a side note, I predict that Pharmrep will never address the issue of SE frequency, at least not in our lifetimes ;)
Posted by ayuda on November 24, 2002, at 16:08:17
In reply to Re: Side-effects - best data - get a new doctor... (nm), posted by Alan on November 24, 2002, at 13:44:21
Unfortunately, not that easy. I am graudate student, living on a 12K/year stipend, in Miami, not a cheap city. I use the university's health services because I only have a $5 copay -- I would have to pay out-of-pocket for a shrink otherwise. And even though my mental health is important, and worth the money, so is electricity and having a working telephone. And trust me, I am that financially strapped that one visit with another doctor would be the difference between lights and no lights. So I have to work with who I have access to.
Posted by Mr.Scott on November 24, 2002, at 16:10:37
In reply to Re: Fiery Rhetoric » Geezer, posted by Squiggles on November 24, 2002, at 15:56:02
Studied what for twenty years...how to exploit sick people? Is that why the best treatment and the only one that anyone seems to be excited about hass usually just been approved by the FDA!
In the last 20 years almost everything has been completely turned on it's head almost twice anyways. How many people have suffered at the hands of ineptitude or the fad of the times?
My advice is that you better know what you have and what might benefit you before you walk into a shrinks office. Otherwise you're liable to spend a great deal of time and money getting nothing but added misery and weiight at your own expense.
Posted by Squiggles on November 24, 2002, at 16:12:59
In reply to PoppyCock! » Squiggles, posted by Mr.Scott on November 24, 2002, at 16:10:37
Just because doctors make mistakes, and
psychiatrists use bad drugs, often, does
not imply that your own crock pot is going
to be superious for your health.Squiggles
Posted by ayuda on November 24, 2002, at 16:32:25
In reply to PoppyCock! » Squiggles, posted by Mr.Scott on November 24, 2002, at 16:10:37
Both of you are right -- there needs to be a mixture of trust and mistrust when you deal with any professional, whether it be a medical doctor, a shrink, a lawyer, or the mailman. You HAVE to trust your gut reactions. I've learned that is true in life, in general.
This is why I read the posts on this site for 2 weeks prior to becoming involved, and why I greatly appreciate the info I am getting here -- especially this spirited debate, which is a very enlightening one: I want all the info I can possible get.
Like I said in answer to Alan, it's not as simple for me to get a new doctor, I can't afford to go outside of the university's health system right now. Being a graduate student with health problems sucks -- but I can make it better, and make the system work more for me, if I get all the common sense info I can. But even people who can shop around for a responsive doctor should do the same. We all should be active participants in our health care -- it is really a matter of life and death.
Like I said in response to Dr. Dave, I don't like it that my doctor has seemingly bought into the b.s. about side effects and Lexapro. But if any of you knew me, you'd know that there is no one on this earth less likely to lie down and let a doctor (or anyone else for that matter) walk all over them -- doesn't get me to where I want to go in life. In fact, I infuriate doctors much more than they do me, because I always have my best interests, and only my best interests, in mind, and if they don't like that, they are going against their Hippocratic oath.
However, there are doctors who DO want to help -- my doc is sensitive to my problems, it's just that we've been going at this for a year now, and she is trying to find a med I can tolerate AND that will help the depression and anxiety. But she is also stuck with what is on the market -- and the crappy info she also gets.
So we are both searching around -- her in the semi-lighted world of psychiatry, my in the semi-lighted world of the internet (and my mom, the nurse, as a resource). I am just trying to "predict" the future of my s/e's here because I am getting frustrated with the process. That is my "type A" personality, I am impatient. If I'm going to experience the "depersonalization" -- and thanks for that term, JLM (and by the way, I'm a 37-yr-old woman) -- which is something I have to be prepared for, then we, my doctor and I, are back at square zero, because I will have gone through the best meds out there with no toleration for any of them.
Okay, back to the debate....
Posted by Squiggles on November 24, 2002, at 16:38:44
In reply to fiery rhetoric, poppycock everything in between, posted by ayuda on November 24, 2002, at 16:32:25
I think the debate is adjourned, thanks
to your good common sense :-)for my part anyway;
Squiggles
Posted by ayuda on November 24, 2002, at 16:50:58
In reply to Re: fiery rhetoric, poppycock everything in between » ayuda, posted by Squiggles on November 24, 2002, at 16:38:44
> I think the debate is adjourned, thanks
> to your good common sense :-)
>
> for my part anyway;
>
> Squiggles
Thanks, I was hoping I didn't sound self-righteous. I am also working on a PhD, and will be called "doctor" in a few years, and I know I don't know everything (I'm a historian, it's not possible to know all of history anyhow -- that's my mantra). So my perspective on people called doctor is that your education and training only get you so far, and then it's on you to have the sense to do your job right, and to admit when you can't.Which is why my students probably think I'm an idiot -- I feel comfortable saying, "I don't know the answer to that" (I try not to say it too often!). But the world makes you think that, hey, I'm called doctor, so I know something.
Besides, I like pretending like my doctors are not as good of researchers as I -- makes me feel smart!!! (that's a joke, but only partially, I will admit)
Posted by Geezer on November 24, 2002, at 17:26:55
In reply to Re: Fiery Rhetoric » Geezer, posted by Squiggles on November 24, 2002, at 15:56:02
> I think that this is a very presumptuous
> attitude, and maybe dangerous too. Why
> should i know more than a doctor who has
> studied this stuff for 20 years? And has
> seen so many examples of patients.
>
> If there is doubt, and doctors are not
> always right - they make mistakes - you might
> do best to get a doctor who cooperates with
> your knowledge found on the net regarding
> your case, as mine did.
>
> I think playing your guessing game can land
> you in really hot water, unless you are a
> Scientologist or a Shaaman or something like
> that, who has access to spiritual strength.
>
>
> SquigglesHi Squiggles,
First, I am not the one doing the guessing, the shrinks are. Actually, I can't find a whole lot of difference between Scientologists, a Shaaman, and a Psychiatrist.....I've been in hot water more than once and I can thank the Psychiatrist for that. If we could legally write our own prescriptions there wouldn't be any reason to have them around at all. I promise Squiggles, it's not my ego getting in the way, the point is the complete and total failure on the part of Psychiatry.
Posted by Mr.Scott on November 24, 2002, at 17:37:06
In reply to Re: Side-effects - best data - get a new doctor... » Alan, posted by ayuda on November 24, 2002, at 16:08:17
Understood and appreciated!
To me that means you need to spend more time in the science library than the rest of us as well as talking to others who have the real problems and have endured the solutions. You must learn how to manipulate the ineptitude you have access to into something that works to meet your needs.
Sometimes you can mold the slow-witted math genius psychiatrists into a halfway decent physician.
Scott
Posted by Squiggles on November 24, 2002, at 17:37:54
In reply to Re: Fiery Rhetoric » Squiggles, posted by Geezer on November 24, 2002, at 17:26:55
Well,
to give the devil his due (nothing personal)
i am not familiar with psychiatrists; my dr.
is a GP. And when i studied psychology ( i
have an undergraduate degree in that ), i
was past the reading of Freud and Jung, and
Maslow, etc... I was beginning to get an
interest in neurophysiology; one of the funniest
course i took was Human Information Processing,
which i guess at that time was in vogue because
of technology making its debut.My own personal "opinion" of psychiatrists is
that unless they know drugs very well, i may
as well go to a priest or a good friend to
talk about my dark secrets.Squiggles
Posted by Mr.Scott on November 24, 2002, at 17:41:12
In reply to Re: PoppyCock! » Mr.Scott, posted by Squiggles on November 24, 2002, at 16:12:59
Unless of course I am genuinely more skilled that is... And I have met only one psychiatrist in 12 years that truly out knew me in terms of pharmacology. Another one was truly compassionate but not super-knowledgable(unfortunately he passed away). My current one is pretty good, yet I was actually truly 'sociopathed' on two occassions as well.
The talent pool is not that good out there.
Posted by Mr.Scott on November 24, 2002, at 17:44:45
In reply to fiery rhetoric, poppycock everything in between, posted by ayuda on November 24, 2002, at 16:32:25
I enjoy your input and couldn't agree more!
You are your only true advocate besides a few family members and friends who will never really know what's it like to be you anyways.
Posted by Squiggles on November 24, 2002, at 17:46:20
In reply to Re: PoppyCock!, posted by Mr.Scott on November 24, 2002, at 17:41:12
Consciousness - the final frontier;
I think it is more mysterious and more
difficult to understand, let alone change
or correct, than nuclear physics.Squiggles
Posted by Mr.Scott on November 24, 2002, at 17:47:38
In reply to Re: Fiery Rhetoric » Geezer, posted by Squiggles on November 24, 2002, at 17:37:54
I hear you...
If my best friend could write scripts I'd be in pretty good shape...
Scott
Posted by Mr.Scott on November 24, 2002, at 17:50:36
In reply to Re: PoppyCock! » Mr.Scott, posted by Squiggles on November 24, 2002, at 17:46:20
I like NASA and all, but they should spend that money (and much other moneys) on elucidating the secrets of the mind before we bother venturing into outerspace to study rocks and gas.
Obviously I am biased!
Scott
Posted by ayuda on November 24, 2002, at 17:53:37
In reply to Re: Fiery Rhetoric » Squiggles, posted by Mr.Scott on November 24, 2002, at 17:47:38
> I hear you...
>
> If my best friend could write scripts I'd be in pretty good shape...
>
> ScottIf my best friend could write scripts, he'd tell me I don't need one -- it's the rest of the world that needs to chill! (At least, that's what he'd better tell me!)
Posted by Alan on November 24, 2002, at 19:51:49
In reply to Fiery Rhetoric, posted by Mr.Scott on November 24, 2002, at 14:35:27
> I think this thread will serve as a fine place to insert my fiery rhetoric...
>
>
> Some psychiatrists are stupid (even though they excel at algebra & geometry).
>
> Some pharmreps are interested only in commissions generated from scripts written for their drug. They are tenaciously persistent sociopaths disguised as helpers (yet are actually minions). They are line items in a marketing budget and human advertising vehicles sent from evil and self-serving corporate entities.
>
> Look at all they provide with extreme caution and generality. The doctors conducting the studies are 'generally' without conscience.
>
> You will do best to be your own doctor in many ways. How many of you are so passionate about your jobs that you would be comfortable letting people entrust their lives to you. Do you think these wise scholars are any different?
>
> Don't let them (MD's and large corporations) make you fat, impotent, and sedated and then send you the bill. They are your employees. Make them do their job of making you feel better (numb and too full of side-effects to care doesn't count). If they can't do their jobs fire them and move on. Ultimately your destiny is in your hands. Do not relinquish it to the self-serving.
=============================================
The docs aren't all to blame, the system is moreso in my opinion.Well, how would one improve the FDA regulatory process for instance, and what would be the practical consequence to patients via their doctors of such improvement?
First of all, take oversight of clinical trials away from the FDA and give it to the NIH. That is, accept as evidence only trials designed and supervised by the NIH.
Failing that, ban cross-employment between the FDA and any company that it regulates for 10 or 15 years in either direction. Right now, there is a revolving door between the fox's house and the henhouse. It's bad enough that regulators are hired directly from the regulated companies. It's even worse that the FDA's "internal advocate" for a drug can and often does leave the FDA after approval of the drug to earn hundreds of thousands of dollars a year working for the maker of the drug.
Actually, we probably need both of the steps above.
And of course we need a law placing all directly or indirectly maker-funded research about a drug into the public domain when that drug receives FDA approval.
I also believe the "control groups" in the research should be better defined.
Alan
Posted by Squiggles on November 24, 2002, at 20:35:07
In reply to Re: Fiery Rhetoric » Mr.Scott, posted by Alan on November 24, 2002, at 19:51:49
Assuming that a drug has successfully
passed the FDA, and is truly a benign
drug with a good safety margin, there
is another problem in health care in
general, which i believe is totally
ignored.The tests that are taken for a certain
condition are not frequent enough; take
for example blood tests for diabetes--
if a test is taken once a year, then it
is not likely that a true, rounded picture
of the blood condition will show. All
the good drugs in the world will not help
if you don't check the gas or the water
frequently enough.I really think that this is a serious
problem in medicine. If we could have
something analogous to a gas pump station
to even self-monitor for a myriad of blood
pictures, much misery and disease could
be prevented.Squiggles
Posted by Donna Louise on November 24, 2002, at 20:44:06
In reply to Re: Side-effects - best data » dr. dave, posted by ayuda on November 24, 2002, at 12:20:36
I think I know what you are talking about with the disconnection. I have thought of it as depersonalization. It is hard to describe,but I had it with paxil. I would tell people it felt like I was dreaming. I am taking Lexapro now and am happy to tell you that I am not having this side effect. As a matter of fact, the only side effects I am having are the sexual ones and a slight emotional numbing. Of course that may be what normal feels like, I wouldn't know!
Donna Louise
Posted by ayuda on November 24, 2002, at 20:58:35
In reply to Re: Fiery Rhetoric » Alan, posted by Squiggles on November 24, 2002, at 20:35:07
People need to be monitored constantly on these meds. My gyn was shocked that my shrink hadn't ordered blood tests with all the meds I'm on. Even though the ones he ran showed no problems, no one ruled out physical problems OR checked to make sure that I was okay physically. The thought hadn't even crossed my mind.
Another issue that I have is with what they consider to be adverse events worth mentioning. You can't measure, or even test for, some of the worst s/e's, and they don't give enough time during these trials to catch many of the adverse events that happen over time.
Plus the information that does come out can be interpreted in so many different ways, and what it means for different people is not clear. If only 11% of people in a trial had "x" s/e, that doesn't mean that I won't, or will, have that s/e, so it is kind of useless information. If I'm a person who does have that s/e, then it doesn't matter if I'm the only one or if I'm one of a several hundred who've experienced it. And doctors misinterpret those numbers and their meanings all the time.
Again, that's why online groups such as this can be important. We find out what other people are experiencing, even if it isn't our experience or it turns out it isn't related to the drugs we are taking. Who's to say that we don't constitute a "control group" of our own?
> Assuming that a drug has successfully
> passed the FDA, and is truly a benign
> drug with a good safety margin, there
> is another problem in health care in
> general, which i believe is totally
> ignored.
>
> The tests that are taken for a certain
> condition are not frequent enough; take
> for example blood tests for diabetes--
> if a test is taken once a year, then it
> is not likely that a true, rounded picture
> of the blood condition will show. All
> the good drugs in the world will not help
> if you don't check the gas or the water
> frequently enough.
>
> I really think that this is a serious
> problem in medicine. If we could have
> something analogous to a gas pump station
> to even self-monitor for a myriad of blood
> pictures, much misery and disease could
> be prevented.
>
> Squiggles
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