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Old 04-07-2008, 10:19 PM   #11
Dale Kimberlin
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Re: Common ground...less is more

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Originally Posted by Brandon Oto View Post
The lesson being, of course, that all elective surgery has some risk associated with it, which I hope anyone getting liposuction or a coronary bypass is already aware of.
WFS

http://news.aol.com/health/story/ar/...07091609990001

This may also be a reason why medics on strike threatens to put the funeral parlor out of business.
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Old 04-08-2008, 04:48 AM   #12
Robert Pierce
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Re: Common ground...less is more

Dale, I want to be clear...I do use SSRIs, I think that they are effective drugs. But exercise and activity are also recommended. I would say that people who are depressed have a terribly hard time getting started with exercise, wouldn't you agree, Susie?
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Old 04-08-2008, 06:51 AM   #13
Jared Buffie
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Re: Common ground...less is more

Uh-oh, I see another 18 pager coming on.

SSRI's have not been proven more effective than placebo according to a study that looked at all the data from the drug company trials, not just the stuff they published to get the drugs approved.

http://medicine.plosjournals.org/per...l.pmed.0050045

(above wfs)

Couple that with the known side effects (this is an image directly from the pages of the prescribing info of Effexor, but they are all the same):

http://i3.photobucket.com/albums/y62...ideeffects.jpg

Notice suicidal ideation and homicidal ideation, then check out some of the stories on this page (also wfs)

http://www.ssristories.com/index.php

So basically you're prescribing a drug that's no more effective than a placebo that will ultimately result in someone causing harm to themselves or someone else (as admitted by the manufacturer), because it's too hard to get someone to exercise.

Some notables who were on the drugs:
Andrea Yates (on three)
Columbine shooters
Virginia Tech Shooter

That's enough for now, we'll look at the validity of depression as a medical diagnosis at another time.
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Old 04-08-2008, 07:31 AM   #14
Scott Mahn
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Re: Common ground...less is more

My dirty little secret is that my regular laptop is on the fritz, so I did all that vaccine research at on an Ikea table that off-gasses so much that it irritates my arms and throat after 30 mins near it. I really think it's significantly harmful. I have other particle board shelves in the house too, and it's all bad, but for some reason this particular table top is aggressively wretched. I pity the landfill it's soon to contaminate.

When will I just say no to particle board and Melamine garbage?
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Old 04-08-2008, 07:51 AM   #15
Susie Rosenberg
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Re: Common ground...less is more

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Originally Posted by Robert Pierce View Post
Dale, I want to be clear...I do use SSRIs, I think that they are effective drugs. But exercise and activity are also recommended. I would say that people who are depressed have a terribly hard time getting started with exercise, wouldn't you agree, Susie?
There was interesting article cited in my Journal Watch bulletin:

Hunsberger JG et al. Antidepressant actions of the exercise-regulated gene VGF. Nat Med 2007 Dec 2: 1476.

Basically, the reseachers compared exercising mice to sedentary mice. Exercise induced (turned on) genes that signal the brain to produce more VGF, a neuropeptide precursor involved in energy balance, and other neurochemicals that are involved in "neuroplasticity." Neuroplasticity refers the ability of the brain to be flexible---ie, more efficient at new learning. (Susie's note: this is why regular exercise is one of those things thought to be protective against dementia.)

In addiiton, exercise turned on 33 hippocampal genes. (The hippocampus is one of those areas of the brain that regulate mood tone and arousal) The exercising mice showed less "depression" than the sedentary mice on subsequent experimental conditions that are widely used as an animal model for depression.

The conclusion? "....exercise seems to induce multiple interacting genes that enhance neuoronal resilience."

But I'm a moderate. To say SSRIs are uniformly bad is as irresponsible as saying they should be prescribed for every little bump in the road. If you have a holistic bent, as I do, even when I prescribe medicines, I try to address the life context of my patient, which includes stress management, often meditation, mindfulness practice, diet, etc.

But we all knew it makes you feel better, right?

Susie
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Last edited by Susie Rosenberg : 04-08-2008 at 07:55 AM. Reason: I keep forgetting things! Need to get off computer and go work out!
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Old 04-08-2008, 08:36 AM   #16
Dale Kimberlin
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Re: Common ground...less is more

With regard to be too depressed to exercise I would submit that we are not talking about doing Fight gone bad or annie are you ok?

30-40 min of a brisk walk 3 times a week is what produced the benefit without the violant behavior.


The mentality that SSRI's are a lifestyle drug in that people are told they are to be on these things for the rest of their life is not good management IMO.

Could these folks be depressed as a result of physiological changes from movement deficiency, refined sugar and deficiency in DHA/EPA (omega 3)?

Exercise (movement) has far more to do with physiologic function than looking good naked (look at the hippocampus).



My point is that our culture expects drugs when they go to the doctor. The doctors need to lead our people as they have an ethical responsibility to first do no harm. The evidence is there that SSRI's ruin lives and when all you have is a hammer then everybody looks like a nail.

Medicine has 2 tools. Drugs and surgery. Good for emergencies. Not restoring health. I don't have a problem with doctors I have a problem with the model that a better life is achieved through chemistry I must pay someone for.
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Old 04-08-2008, 09:56 AM   #17
Emily Mattes
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Re: Common ground...less is more

A few clarifications on my position.

When I talk about non-pharmaceutical solutions to medical problems, I meant diet, exercise, and things like taking probiotics. I view energy crystal healing or whatever silly stuff that some alternative medicine practitioners tote with an EXTREMELY healthy dose of skepticism.

Dale, for the severely depressed even trying to go for thirty minutes of brisk walking three times a week is a big deal. I have been there--if you are at the point where you're barely showering or moving out of bed, asking them to change their diet or start an exercise plan is like asking a recreational hiker to climb Kilimanjaro tomorrow. In that case, I think intensive therapy and medication COMBINED with the various life-context measurements Susie described would be perfect.

I would argue for only diet and exercise at the start for those people who don't have a history of serious, debilitating depression. The depression that comes after a spouse's death, or three months of unemployment after a job loss, or simply going through a mid-life (or quarter-life) crisis can be pretty well-addressed by both re-examining priorities and improving your lifestyle.
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Old 04-08-2008, 03:51 PM   #18
Robert Pierce
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Re: Common ground...less is more

I don't think it is another 18 pager, Jared. The weaknesses of the SSRI study can be reviewed here (wfs): http://medicine.plosjournals.org/per....0050045#r2133 Briefly, 2 of the 4 drugs listed are not SSRIs, two of the four drugs aren't used much anymore (at least not in primary care) and postmarketing studies were not included, and the F/U interval was too short. I don't use antidepressants for bumps in the road, either, but they can be very helpful.

Susie, aren't you a psychiatrist? Don't you don't think that teaching/counselling/listening are also tools in medicine?
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Old 04-08-2008, 05:31 PM   #19
Karin Jonczak
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Re: Common ground...less is more

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Originally Posted by Robert Pierce View Post
I don't think it is another 18 pager, Jared. The weaknesses of the SSRI study can be reviewed here (wfs): http://medicine.plosjournals.org/per....0050045#r2133 Briefly, 2 of the 4 drugs listed are not SSRIs, two of the four drugs aren't used much anymore (at least not in primary care) and postmarketing studies were not included, and the F/U interval was too short. I don't use antidepressants for bumps in the road, either, but they can be very helpful.

Susie, aren't you a psychiatrist? Don't you don't think that teaching/counselling/listening are also tools in medicine?
I think I might have gotten through my battle with depression without antidepressants, but it would have taken much, much longer and quite possibly would have not been a positive outcome. I did not have suicidal ideation's, but I as I explained it to my shrink I didn't care if a bus hit me or not.

But, I do COMPLETELY agree that antidepressants are over-rx'd (as with many meds where benign neglect are probably all that is really needed) and (again personal opinion) I don't think ANYONE should be one them without having to also undergo therapy at the same time. What good is it to treat the depression without treating the underlying cause? Its kind of like treating diabetes with insulin without addressing diet.

We are a society that wants the quick fix, the pill, the shot, or the cream to health. Change is hard freaking work (and as CrossFitters I think we all know that!).

Karin

(my opinions above and below... I do believe depression and mental illness is real and am saddened by a society that shuns the mentally ill and continues to place stigmas on it... )
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Old 04-08-2008, 06:25 PM   #20
Susie Rosenberg
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Re: Common ground...less is more

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Susie, aren't you a psychiatrist? Don't you don't think that teaching/counselling/listening are also tools in medicine?
Yes, I'm a psychiatrist. And yes, teaching, etc. are tools in the ideal world. But there's too little of it going on because the economic pressures are to move people through the office fast.

Susie
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