There are a whoooole bunch of antipsychotics.

Some of the (relatively) newer ones are not nearly as bad in terms of permanent side effects as some of the early ones like Thorazine and Haldol, but they still aren’t great and aren’t casually prescribed for long term use.

I understand that a lot of hospital ERs DO use antipsychotics pretty freely to help manage violent or noncompliant patients, but short-term use like that is supposed to be minimally risky.

I can't read anymore of the Medscape article than a few paragraphs before it wants me to join.

How many studies have shown this effect (or lack of)?? Why has it taken 40+ years to notice this lack of effect?

I'm not quite ready to jump on the bandwagon, just yet.

The study has some big flaws.

First, the quality of life measure they are using is a simple 12-question self-reporting form, linked below. Anything not on the form is not considered in the study.

https://www.hss.edu/physician-...s/huang/SF12-RCH.pdf

Second, as pointed out in the article, the study is looking at past data and assumes that the group of people who were diagnosed with depression and did take antidepressants is statistically identical to the group of people who were diagnosed with depression and didn’t take antidepressants. That seems like a questionable assumption.

None of that necessarily means they are wrong, but given the large number of studies that HAVE shown a benefit, skepticism is warranted.

One study by itself is usually not enough to overturn a scientific consensus, because studies are always about statistics, not certainties.

95% confidence is the usual standard for drawing a conclusion. That sounds like a lot, but it means if you did 20 studies of “the sky is actually green,” 19 of them would say “oops, we were wrong,” but one of them would say, “yep, we’re 95% sure the sky is green” and meet the standard for publication.

That’s massively oversimplified, but it illustrates a real problem in how research is done and published that has been getting a lot of attention lately in the scientific community.

A lot of people are arguing that studies that disagree with the majority or that can’t explain the cause of their result should be held to a higher statistical standard, because by basic statistics, if you do enough studies you will get some that are very sure about stuff that is completely wrong.

https://www.fastcompany.com/90...e-as-the-next-prozac

I am sure California will jump on this bandwagon. I did not post the article as it is very long. In essence we now have the alternative to Prozac. Big money is going into thisl

quote:

Originally posted by ZSMICHAEL:
https://www.fastcompany.com/90...e-as-the-next-prozac

I am sure California will jump on this bandwagon. I did not post the article as it is very long. In essence we now have the alternative to Prozac. Big money is going into thisl

Psychedelic therapy was a promising psychiatric research area in the 60s, but then Nixon’s war on drugs made continuing research on psychedelic therapy basically impossible. There have been people trying to get it going again ever since.

This is the biggest push since the 60s. Ketamine is out front so far. Lots of folks will need therapy for bad trips.

quote:

Originally posted by ZSMICHAEL:
This is the biggest push since the 60s. Ketamine is out front so far. Lots of folks will need therapy for bad trips.

As an anesthetist (now retired), I had given Ketamine infusions for depression for the last 3 or 4 years. IF given in appropriate doses for depression, I haven't seen any "bad trips". You give very small doses, quite slowly, by infusion. people remain arousable by simply speaking to them. They know where they are and what's going on.

Before I give these folks any Ketamine, I always talked about risks of "bad dreams". One thing that I saw frequently was and told them I could almost guarantee was very "vivid dreams" and that was frequently reported. They always denied "bad dreams" after the treatment, (as I always asked). I always gave the Ketamine in a quiet, darkened room withe least possible interruptions. I sat in the room and made as little noise as possible.

In my experience, Ketamine for depression can be very effective in quickly improving depression. It seems to work within hours, BUT the effects only last a few weeks. The idea is that this gives them, their doctor and therapist time to make real, long-lasting changes .

It can also be extremely effective in treatment of acutely suicidal patients, who are in immediate danger of killing themselves.

It's not a "cure all", just a very effective short term tool.

It is being marketed for six sessions at six grand. Of course it is being sold as a long term solution to complex human problems. That is the problem. ECT was the soluton for awhile and sadly is still used. The replacement is Transcranial Magnetic Stimulation another big moneymaker with questionable results.

Most folk's insurance wouldn't pay. So, the hospital "ate" the charges.

I did the infusions on Friday afternoons, when the surgeons wouldn't schedule cases anyway. I never made a nickel out of it but did them because these folks were hurting.

Where in the world are they charging $1000/infusion? California? The practitioners should be ashamed of themselves.

Yes. Other places as well. I congratulate you on helping people. Some folks are all about the money.

quote:

Originally posted by ZSMICHAEL:
ECT was the soluton for awhile and sadly is still used.

In some circumstances, ECT can be a really important tool. I know someone who suffers from bipolar disorder with mixed episodes (where, instead of just sometimes being manic and sometimes being depressed, there are periods of being both manic and depressed at the same time).

I think that person during a mixed episode was the most miserable, suffering state I have ever seen anyone in.

The suicide rate among people with bipolar disorder is EXTREMELY high (estimates range from 5-20%) and worst for those who experience mixed episodes.

ECT was the only thing that was able to break this person out of an extended mixed episode that I am pretty sure would have resulted in suicide if it had continued.

As recently as the 1970s schizophrenics at the state hospital were ALL treated with ECT. I agree that SELECTIVE treatment with ECT is fine. I know many people treated with ECT who have severe problems with long and short term memory.

I completely agree.

quote:

Originally posted by maladat:

quote:

Originally posted by ZSMICHAEL:
https://www.fastcompany.com/90...e-as-the-next-prozac

I am sure California will jump on this bandwagon. I did not post the article as it is very long. In essence we now have the alternative to Prozac. Big money is going into thisl

Psychedelic therapy was a promising psychiatric research area in the 60s, but then Nixon’s war on drugs made continuing research on psychedelic therapy basically impossible. There have been people trying to get it going again ever since.

The Vigilance Elite podcast has two episodes dealing with SEALs using psychedelics as treatment for their various traumas (with treatment taking place in Mexico). There's a full episode more or less dedicated to it and it plays a major part in the long interview with DJ Shipley. Shipley talks about how he had extensive stays at NICoE and other high quality military TBI, mental and drug facilities and it was the cross-border psychedelics that finally worked.

The podcasts are worth a listen.

Thanks. I will take a look. PTSD does respond to appropriate psychotheray both group and individual. The VA uses a lot of drugs with mixed results in their efforts. What is important intially is a careful assessment. Psychedelics do make some people worse. Not everyone is wrapped tightly if you know what I mean. Having more treatment modalties is a good thing. However, it will be a long time before this is standard practice in our VA clinics.