Read this unless you are insane

Sepulchritude Forum: The Absinthe Forum Archive Thru March 2002: Archive thru January 2002:Read this unless you are insane
By Lordhobgoblin on Sunday, January 13, 2002 - 02:35 am: Edit

So an enzyme was responsible for the Cultural Revolution. I didn't realise a single enzyme could have such dramatic effects on huge nations.

By Don_Walsh on Saturday, January 12, 2002 - 03:53 am: Edit

Blackjack says MAOI. For the uninitiated in psychopharmocology, that is Mono Amine Oxidase Inhibitor. MAO being an enzyme.

In ze Olde Daze various mood altering drugs would have bizarre interactions with Chianti or some cheeses...go to the wrong wine tasting and really trip out.

By Lordhobgoblin on Saturday, January 12, 2002 - 01:04 am: Edit

Blackjack,

In the UK psychiatrist 'talk-therapy' is available on the UK National Health Service if your GP refers you (so too is accupunture, chiropratic etc. in many cases).

In fact people who do have their own private/company health insurance soon find out that if you're suffering from anything other than an acute straightforward illness that can be sorted out quickly by relatively cheap drugs then your private health insurance isn't worth the paper it's written on. At best all private insurance helps with is convenient queue jumping for acute conditions (and of course you get served coffee in fine bone-china cups). For chronic, ongoing illnesses or anything psychological then forget it. (Anyway enough of my pro public-health for all rant).

In the UK a person's GP is the hub of your treatment and ultimately holds your medical notes, he/she refers you to whatever specialists he sees fit depending his initial opinion and the state picks up the tab (paid for of course by the tax-payer).

As for mal-practice etc, well there isn't really big a 'compensation culture' over here so GPs are not all that shit-scared of making a professional judgement in what they genuinely believe to be in the interests of their patients. The idea some people have that it's ok to 'sue-the-pants' of doctors at any opportunity only leads to a poor service of treatment with many more people suffering because the doctor will not do anything that has a slight risk involved. All these compensation claims just fuck things up for everyone else.

The law should not allow this. Where do some people get the idea that they are entitled to live a risk-free life? Bollocks to them, sometimes your lucky, sometimes you're unlucky and you die, that's the way it goes.

Hobgoblin

By Mr_Carfax on Friday, January 11, 2002 - 11:20 pm: Edit

"Psychiatrists have very successfully been using anticonvulsants to stablize biopolar disrder for years, but since it isn't the FDA-approved use, a GP would be too scared of malpractice to suggest it. "

Sodium valproate has had an FDA approved indication in the US for biploar for at least 5 years- I know, I was involved in the use of the US submission obtained under FOI to get it registered in Australia for manic phase of bipolar.

By _Blackjack on Friday, January 11, 2002 - 09:19 pm: Edit

Talk therapy is very useful for things like personality disorders, but it doesn't appear to be any better than placebo against hardcore illness like depression.

Psychiatrists are physicians. Their job is to treat illness, not to hold your hand. A great many psychiatrists these days deal almost purely in psychophamacology, and leave the talking to psychologists and social workers. Add to that the fact tht most insurance won't pay for talk therapy, and it's unlikely anybody is going to expect you to open your hear to the guy any more than is necessary to get an accurate diagnosis.

The point of seeing a psychiatrist to treat depression is the same point of seeing a cardiologist to treat your heart disease or an oncologist to treat your cancer: they are specialists. They have direct experience of numerous patients, while your GP probably only knows what he can get out of the DSM, the PDR and the drug ads that the companies send him. A psychiatrist will know what to look for with side effects, and be aware of new treatments. If it's not on the label, a GP won't know about it. Psychiatrists have very successfully been using anticonvulsants to stablize biopolar disrder for years, but since it isn't the FDA-approved use, a GP would be too scared of malpractice to suggest it.

By Heiko on Friday, January 11, 2002 - 12:59 pm: Edit

"Personally I have little faith in councilling, therapy etc. etc. I'm the sort who thinks (perhaps wrongly) that it's basically all a load of 'wishy-washy', 'touchy-feely' bullshit."

You're not the only one :-)
I know that even before I see such a talk-therapist I know exactly what he is going to ask me and I know what answers will lead him to what ideas about me.
I've tried to talk myself into better moods so often and tried to think about my situation from any angle I could imagine - I've been my own talk-therapist so to speak, but I have given up... whereas in chemistry you can trust :-)

Maybe this keeps a lot of people from seeing a psychiatirst. It's like if you had a severe cold and you knew your doctor wouldn't prescribe you some effective drugs but try voodoo and homoeopathic stuff first - would you go see him? I wouldn't...

Maybe this whole talk-therapy thing only exists because you can't abolish the whole trade and in addition to that: where else could all the bored rich ladies spend their money? ;-)

By Cheri on Friday, January 11, 2002 - 12:13 pm: Edit

The psychiatrist that I see, after the initial counseling session where we talked through my symptons and such, all other appointments that follow are known as "med checks". There is no real talk therapy involved. That's the job of the "therapist". I'm not in talk therapy. Just on medication. It's pretty much like seeing a "specialist" as far as doctors are concerned.

By Lordhobgoblin on Friday, January 11, 2002 - 11:17 am: Edit

Blackjack,

If you had to see a psychiatrist even intitially for depression then very few people would go. I was given the option of medication prescribed by the GP or seeing a psychiatrist for a 'programme'. Personally I have little faith in councilling, therapy etc. etc. I'm the sort who thinks (perhaps wrongly) that it's basically all a load of 'wishy-washy', 'touchy-feely' bullshit. I'd have far more faith in the judgement of a regular GP, who at least has his/her feet on the ground, than some shrink (who could well blame it on some incident that happened in my childhood). I being a bit sarcastic but you get the point and this is basically how I, and many others, think. Just give me the drugs and save the counselling. If seeing a GP for treatment (at the very least as a first port of call) isn't he norm then people will just continue to suffer unnecesarily.

Hobgoblin

By _Blackjack on Thursday, January 10, 2002 - 01:22 pm: Edit

Well, yes, nobody denies that the US healtcare system is a travesty, except all the people making tons of money off of it, and the politicians that they bribe.

Fortunately, we've got lots of guns, so if we need to see a doctor, we can always hold one hostage!

By Heiko on Thursday, January 10, 2002 - 12:00 pm: Edit

You're not even allowed NOT to have an insurance in Germany. You must have a minimum health care insurance, and minimum coverage here means more than normal people can afford in the States. We still complain about it...

By Verawench on Thursday, January 10, 2002 - 10:56 am: Edit

What goes in must come out and boy, does it come out!

By Anatomist on Thursday, January 10, 2002 - 09:16 am: Edit

I took some of that St. John's Wort for a while, just to see what would happen... a very short while, as all the effects were undesirable. I don't know if it's just my body chemistry, or if you really shouldn't be taking it unless you are depressed. I don't think I've ever been 'depressed' for more than a couple days - I deal with a lot of sadness, but I always have plenty of motivation and a high activity level, and I only engage in mildly self-destructive behaviors for fun.

Anyway, I started taking about half of what you're supposed to take. Within 2 days I started getting persistent nausea and loss of appetite. In about a week, all my emotions were gone - I felt like an android going through the motions of my life out of habit. Worse yet, the nausea became steadily more intense, 24/7. I had a dream wherein I was literally eating shit. No more wort of the so-called "saint" John shall enter this body.

K.

By _Blackjack on Wednesday, January 09, 2002 - 07:26 pm: Edit

Well, a general practitioner CAN prescribe antidepressants, but you really should see a psychiatrist at least for the initial diagnosis, or if you have any issues at all with the medication. GP's shied away from prescribing psychiatric drugs until recently, when newer drugs with less severe side effects made it easier for them, and the insurance industry began pressuring them to keep referrals to a minimum.

Honestly, depression is a very serious, potentially deadly illness (suicide is the number 11 cause of death, and number 2 for teenagers and adults under 40) and most GP's just don't have the experience and knowlege to treat it effectively. It has certainly made it easier for people to seek treatment, since there is still stigma in seeing a psychiatrist, but you also have problems with inaccurate diagnosis and lack of effective follow-up. Most GP's get their drug information from the drug companies, so if it's not on the monograph, they don't know about it.

More to the point, however, is that the patient is not qualified to treat depression. If you thought you had cancer, would you give yourself chemotherapy if you could get the drugs at the health-food store?

As far as cost goes, well, if you're uninsured, it sucks big-time, but that is true for any illness. Most health insurance carries mental-health coverage, tho only a few states require it. Federal law does require that, if mental health coverage is offered, it must be at equivalent levels to other coverage. This doesn't keep them from making it really complicated, however.

You don't have to pay $150 to see the shrink every month. Once initial evaluation is taken care of, they usually just have what are called "medication maintenance" appointments, which are about 15 minutes to make sure you're doing OK. In fact, your insurance will probably INSIST that you only get M.M. after a certain point.

The drugs themselves can be outrageously exensive, but fortunately the patents Prozac and a few of the other SSRI's are up and generic versions are becoming availible. But, again, if you don't have insurance, having any severe illness is going to be awful.

By Lordhobgoblin on Wednesday, January 09, 2002 - 01:53 pm: Edit

"I don't have to pay some damned shrink $150 every few months to get a new prescription."

Shit, I'm glad I was living in the UK at the time. Do you really need a shrink to prescribe anti-depressants? In the UK a normal doctor can do it under the National Health Service and then all you pay is a prescription fee of under £10 to the chemist (and we complain about having to pay that).

As for ramping-up times, well Seroxat took 4 days to work with me (I was told it would take 2 weeks). I suppose it all depends on your individual body chemistry.

By _Blackjack on Wednesday, January 09, 2002 - 10:42 am: Edit

Incidentally, St. Johnswort most definiately does have side effects in some patients. When I tried it, I suffered from orthostatic hypotension ("headrush" dizzyness when standing) moreso than I did even on the MAOI Parnate, which is notorious for that side effect. Also, SJW deactivates a liver enzyme that metabolizes many other medications, so it may reduce the efficacy of things like antivirals. It's exact mechanism of action is still very poorly understood, but it may act in part as an MAOI, and while it doesn't appear to have any of the dietary restrictions of the older MAOI's, it may well cause drug interactions, especially at higher doses.

The thing to keep in mind is that the herbal nature of the drug severely reduces the dose of the active ingredients. The lack of side-effects is in part due to the low dosage. This is also probably why SJW has only been shown to be effective against mild-moderate depression. As a remedy for dysthymia (chronic, mild depressed mood), it has some potential, but I still think it encourages people to self-medicate instead of consulting a professional. At least get your thyroid and bloodwork checked to make sure the depressive symptoms aren't coming from something else...

By _Blackjack on Wednesday, January 09, 2002 - 10:25 am: Edit

Moclobemide is pretty high on the Geez-Will-The-FDA-Hurry-Up list for a lot of folks, but it doesn't appear to be quite as effective as the the non-reversable, non-selective MAOI's, and it is still unclear exactly what the drug-interaction risks are. Still, it certainly would fill a good niche for less severe depressives who don't respond to SSRI's.

DISCLAIMER: don't go taking medication without a physician's supervision, ESPECIALLY psychiatric medications. You need an informed, objective opinion to evaluate their efficacy...

By Verawench on Wednesday, January 09, 2002 - 09:14 am: Edit

There you go.

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