Depression

[uniQ]

Not sure if it's been mentioned but their is a books on prescription service available from GPs the list of books can be found here:

http://readingagency.org.uk/adults/BoP core booklist April 2013.pdf

 

[elmarko]

As someone who has never been diagnosed with a mental illness I think many forms of it are simply not conditions, just feelings.

When I see someone say 'yeah I suffer with anxiety', well hey ho, we all do. Many of us feel 'down in the dumps', kind of depressed, but to me they are just feelings that need controlling.

Maybe there are some with some chemical imbalance that causes feelings to get out of control... but for most sufferers I would stake my life on the fact they just need to chin up and get on with life.

I'm sorry if the above sounds harsh, but it's just my view and it's no worse than anyone elses.

I do feel sorry for those whose chemistry means they cannot cope, but I suspect most people actually could cope if they stopped focusing on themselves and looked at the bigger picture.

I'm not concerned about offending anyone here, as if anyone has a true medical condition an internet forum is not the place to be talking about it in the first place.

What a garbage post, void of any insight, wisdom or compassion.

0/10.

Just because I have different views from you doesn't mean i'm ignorant. I just posted something I feel quite strongly about.

Ego has no place on a forum either... if you think someone has a ego purely on the fact that they have different views to you, then maybe the ego problem lies within yourself

You may feel strongly about it, but you clearly know nothing about it.

 

[grumpysculler]

If I lost my job, family, health... maybe all at once I could imagine feeling very low indeed.

It isn't just about feeling low. You get low and then the depression leaves you unable to pick yourself up. You are stuck low.

You can't look at the way a depressed person feels from a rational perspective because their feelings aren't rational. Most of us can climb out of a hole, depression removes that ability and just keeps you stuck there.

0/10.

Too generous IMHO.

 

[Xordium]

It's more what NICE, the NIMH and CDC thinks based on the meta-analyses and systematic reviews.

http://publications.nice.org.uk/fir...alised-anxiety-disorder-ktt8/evidence-context

What you are saying does not back up your argument. Your sources demonstrate that there actually is a statistical difference in efficacy across a whole meta-analysis that may or may not have clinical significance. That is no way equals your statement that 'all antidepressants are equal'. We can say many drugs are broadly similar across a great big population but it does not actually mean they are actually similar or can be classed as equivalent which is what your post is suggesting.

The problem here is that a lot of the trial are not that fair and should be excluded. Also some of the bigger trials people quote actually were methodologically flawed. Also it is a hefty ask (which I guess is my point) to assume that there action is similar across all age groups and ethnicities on something as ill defined as depression. Therefore, to say things are equal (when the evidence actually showed they were not) on a big populations is meaningless when the groups you will be dealing with may well have differing needs and reactions to the global whole.

I do understand what you are saying and why you said it it's just I think it is clinically wrong even if you may want to argue something from a manufacturing point of view of overall guidance. Moreover, the problem with NICE is that they are very very behind what actually occurs in practice and whilst their guidance may be practical for the non-specialist I am of the opinion that if you have to follow protocol to the extent you are taking their guidance then you should be referring as you clearly are working outside your area of expertise and therefore remit (outside of primary care).

 

[Energize]

What you are saying does not back up your argument. Your sources demonstrate that there actually is a statistical difference in efficacy across a whole meta-analysis that may or may not have clinical significance. That is no way equals your statement that 'all antidepressants are equal'. We can say many drugs are broadly similar across a great big population but it does not actually mean they are actually similar or can be classed as equivalent which is what your post is suggesting.

I never said "all antidepressants are equal".

The evidence so far just does not suggest that in the generalised case that any one drug or group is more effective than another.

 

[LordSplodge]

although it does have the fun side effect of turning you into a sex god as it takes about 3 bloody hours to cum on the stuff.

Might sound like fun but it isn't.

 

[Xordium]

I never said "all antidepressants are equal".

You are correct, my apologies, you said there were all as effective as each other.

The evidence so far just does not suggest that in the generalised case that any one drug or group is more effective than another.

The studies show a difference in efficacy across all the samples. What they then don't say is whether that is clinically significant even if it is statistically. I don't agree that you can say they are all as effective as each other. I think that is a misleading statement and it not backed up by any data - even the NICE guidelines are based upon research which does show a difference. And again the datasets are old. There is plenty of research that does show a difference in efficacy. What you can't do is extrapolate results from such a varied set of sample groups (differing ages, classifications of disease) and then apply them onto particular groups saying they are as effective. If one were to apply a population property and apply it onto an individual from a sociological point of view we would call it discrimination. If anything it highlights how poor our understanding of the disease and its treatment. I think it also indicates whether we should be offering an pharmacological intervention in a primary setting. Clinical is different from theoretical. The job of the clinician is to ensure the protocols fit around the individual patients not just place patients into protocols. That is why medicine is both an art and a science.

 

[AndyT]

Some utterly cretinous and ignorant posts have appeared on this thread. Basically tantamount to "just pull yourself together", "sort yourself out", "there's nothing wrong with you". "You're just having a down day".

The brain and the human psyche are not black and white. For people to say "it's nature's way of clearing the genepool"... well, that is just disgusting and offensive.

Depression is just natures way of saying 'You ought to be eaten by a lion'.

Was this you from the "Some People are Disgusting" thread stood at the bottom of the car park with your phone out????

I've just been sat in work and watched a group of people build up at the end of the street, all there with phones out recording laughing and joking. I went over to see what was going on and saw that there was a girl stood on the top of the car park behind our shop ready to jump.

One or two were joking about how they had a front row seat and that this girl was just after attention, by the time I got back to the shop there was a big gasp outside as this poor girl has jumped.

I haven't heard much since then but I can't see anybody surviving that kind off fall

I've already had people coming into the store playing videos and sharing it all over Facebook and stuff, I can't believe the lack or respect some people have, I can't imagine how I would feel if that was a loved one of mine and people were plastering it all over their social media.

It's just so disappointing that this kind if stuff happens after something so tragic. My thoughts are with that person's friends and family.

 

[Tefal]

Might sound like fun but it isn't.

i know mate been on it for about 10 months now lol.

 

[Tefal]

Nice guidelines recommend citalopram or sertraline before any other antidepressant. In no school of thought is venlafaxine an appropriate first line drug given it's toxicity in overdose.

that's gotta be out dated given fluoxitine is the front line AD.

citalopram is dangerous in hgiher doses or long term perscription which inevitably ADs are.

 

[koolpc]

Escitalopram is what i am on. Been on it for approx 10 years now.

 

[Xordium]

that's gotta be out dated given fluoxitine is the front line AD.

The NICE report does not tally with the research they are basing it upon. Which was my point that you can not say they are equally effective.

For example to actually quote one of the meta analysis from the NICE guidelines:

In the present review we assessed the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with all other antidepressants in the acute-phase treatment of major depression. Thirty-seven randomised controlled trials (more than 6000 participants) were included in the present review. In terms of efficacy, citalopram was more efficacious than other reference compounds like paroxetine or reboxetine, but worse than escitalopram. In terms of side effects, citalopram was more acceptable than older antidepressants, like tricyclics. Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations including differences in efficacy and side-effect profiles.

And

Findings
Mirtazapine, escitalopram, venlafaxine, and sertraline were significantly more efficacious than duloxetine (odds ratios [OR] 1·39, 1·33, 1·30 and 1·27, respectively), fluoxetine (1·37, 1·32, 1·28, and 1·25, respectively), fluvoxamine (1·41, 1·35, 1·30, and 1·27, respectively), paroxetine (1·35, 1·30, 1·27, and 1·22, respectively), and reboxetine (2·03, 1·95, 1·89, and 1·85, respectively). Reboxetine was significantly less efficacious than all the other antidepressants tested. Escitalopram and sertraline showed the best profile of acceptability, leading to significantly fewer discontinuations than did duloxetine, fluvoxamine, paroxetine, reboxetine, and venlafaxine.

NICE is all about cost effectiveness not best practice. And it is quite clear from the evidence they present that all antidepressants are not equally effective. Hell they are saying the efficacy is not even the same let alone the other aspects eg side-effects which all go to encompass the picture that is effectiveness. Which is why I challenged that assertion. It is misleading and could lead people to make bad decisions.

 

[Energize]

The studies show a difference in efficacy across all the samples. What they then don't say is whether that is clinically significant even if it is statistically. I don't agree that you can say they are all as effective as each other. I think that is a misleading statement and it not backed up by any data - even the NICE guidelines are based upon research which does show a difference. And again the datasets are old. There is plenty of research that does show a difference in efficacy. What you can't do is extrapolate results from such a varied set of sample groups (differing ages, classifications of disease) and then apply them onto particular groups saying they are as effective. If one were to apply a population property and apply it onto an individual from a sociological point of view we would call it discrimination. If anything it highlights how poor our understanding of the disease and its treatment. I think it also indicates whether we should be offering an pharmacological intervention in a primary setting. Clinical is different from theoretical. The job of the clinician is to ensure the protocols fit around the individual patients not just place patients into protocols. That is why medicine is both an art and a science.

Right key word, clinically significant.

One study says one is more effective than another by some marginal amount, which is then contradicted by another study. The escitalopram vs citalopram studies I view with even greater skepticism given that they are virtually the same compound.

There is nothing to consistently show that in the general case one is more effective than another, even studies that look at specific groups produce equivocal data. So I think "similar effectiveness" is a perfectly reasonable statement.

that's gotta be out dated given fluoxitine is the front line AD.

citalopram is dangerous in hgiher doses or long term perscription which inevitably ADs are.

Outdated? It was published last year.

As I said fluoxetine is one of the older SSRI's and doctors have more experience with it, which is why it's often prescribed over citalopram and sertraline despite having more pharmacokinetic interactions and a problematically long half life.

And evidence regarding citaloprams cardiac side effects is equivocal to say the least. If it was as dangerous as you make it out to be, it would not be used.

 

[Xordium]

So I think "similar effectiveness" is a perfectly reasonable statement.

Well I don't. For all the reasons I have described:

a) there is a difference in efficacy shown (even in the studies you presented)
b) effectiveness is not solely about efficacy it is also to do with tolerance etc
c) you are attributing a population statistic onto what will be an individual case.

And evidence regarding citaloprams cardiac side effects is equivocal to say the least. If it was as dangerous as you make it out to be, it would not be used.

Again this is a case of poor study. Forensic examination from suicide - err hello they are dead of course it was toxic, through to short-term studies and low dosage studies. My understanding is that there will be probable QTc increase in a small number of cases. There is a bigger problem in pregnancy but that is another issue.

Whilst that guidance was published last year we have to take on board how old the data it bases its findings on is. NICE is typically behind the curve there is nothing we can do about that. They have to have things checked and agreed, egos stroked, etc and that causes delays. In fast moving areas then the guidance they offer is unreliable in many cases and outdated and bad practice in others.

 

[Energize]

Well I don't. For all the reasons I have described:

a) there is a difference in efficacy shown (even in the studies you presented)
b) effectiveness is not solely about efficacy it is also to do with tolerance etc
c) you are attributing a population statistic onto what will be an individual case.

Differences which don't amount to clinical significance though. After looking at hundreds of high quality antidepressant trials, some funded by pharmaceutical companies, some independent and some by national institutions like the NIMH, the results produce a picture of no clinically significant difference in efficacy between any of the commonly used antidepressants like SSRI's, TCA's, MAOI's, TeCA's, duloxetine and bupropion, in either the general case or specific classification such as youth, elderly, melancholic, or atypical. And this is the same conclusion NICE, CDC and the NIHM have come to.

Certainly I would not for example personally recommend say tranylcypromine for an anxious patient because when I was prescribed 120mg/day it had the same effects as methylphenidate, but I was clearly speaking in the general context when being asked about NICE guidelines, and you said "where 1 million people are given drug A and another drug B", and now you are changing the discussion to a highly specific individual patient basis.

 

[jas72]

This,

This this this, 100000x.

This is why I sleep in a blacked out room so no light pollution. I don't eat any processed crapp, I don't drink and ESPECIALLY do not eat takeaways... I slam down tonnes of green veg, vegetables funnily enough contain seratonin

http://www.livestrong.com/article/447943-what-food-or-fruit-contains-serotonin/

Amongst tonnes of other important things. I am completely baffled and almost think people ask for it who don't eat a natural clean diet. You are playing the lottery. But i seems literally people can't help themselves, junk food is addictive I think lacking willpower is a massive problem too.

I also exercise with a weights routine 3x a week, i'm not specifically looking to get jacked and all that ********. But I lift weights for health and emotional benefits.


I find happiness is a combination of lots of small things. Ever since I started taking care of myself depression vanished.

I get some people have depression and may need pills. But tbh the doctor would have given me pills the state I was in, I turned around and said no and started taking action to fix my life. I really think pills are like a last ditch attempt after you've tried EVERYTHING else... they are just a band aid and don't fix the problem.

was just about to post something like this.

I'm just trying at the moment to persuade my wife that we need to seriously look at our whole food eating process, how much rubbish goes into processed food and how it affects us on every level both physical and mental.

I'm not a health physician but I'm really interested in this as my family suffer a range of issues and I really want to see if the change will help. As far as i can see changing our eating habits for the better can, at least, have no detrimental effects.

Thanks Creative

 

[tibbsey]

Just getting ready to head off to my first appointment with an Occupational Therapist.

Been up the surgery already today to see the GP as I had 3 panic attacks within 2hours last week (first time I've ever had panic attacks).

Haven't been officially diagnosed with anything but GP reckons it's dysthymia and he's hesitant to put me on drugs (I'm quite fine with not being on drugs for a couple of reasons).

Really hoping that something good will happen, I've been like this for as long as I can remember and my life hasn't moved at all for over 4years.

 

[Baron C]

I was diagnosed with depression in my mid 20's.
I clearly had it from a young age, but it didn't fully manifest till I was under a lot of pressure at work. Corporate law. (being a workaholic didnt help, still doesn't)
Its taken me nearly ten years to get myself into a decent state. Still have bouts of doom and gloom, but they are manageable and forseeable and less acute.

I'm glad that my condition never spiraled into substance abuse.
It takes time to work out which method of treatment will work for you. It's a process of elimination to a large extent. There is no magic bullet.

Take proffesional advice. If your prescribed pharma then I suggest letting someone you know and trust to check in on you.


Peace.

 

[MookJong]

I am surprised at the number of people on these forums who are medicated for these disorders. Two of my close family members have recently been put on a low dose of antidepressant after they went to the doctor complaining of stress.

Does anyone know the figures for the % of the population who are prescribed these drugs? If it is high one has to wonder at what point some of the normal feelings and reactions to events in life that we have experienced for thousands of years are now being medicated for.

I am not against it by any means, but I am interested in the social aspect and how it might drive our society in a different direction. Could there be a time when we try and mute all but the most basic negative reactions?

 

[Energize]

Depression is often a lack of reaction, apathy, anhedonia, avolition, hypersomnia etc. And a panic attack where someone collapses is certainly not a normal reaction and feeling to events.