Would a Sane Man...

[Gladys]

Psychiatry ... has made huge advancements since the 60s.

Considering that mainstays of psychiatry in earlier decades included lobotomy, organ removal and ECT, the scope for advancement has been boundless.

My reading of the research suggests that - for most of the mentally ill - pharmaceuticals and talk therapy are equally effective but somewhat inferior to Behaviour Modification, yet none of these works well. While they may work for community peace of mind, the benefit for many sufferers is small or negative. The rate of increase in mental illness last century suggests that societal change is a significant factor.

But there is a difference between mood disorder, organic illness, and incurability.

I wonder whether overtly neurological disorders are sometimes moderated by amicable society and environment.

[Nax]

All interesting posts. Its continuingly befuddlying for me. To outside lookers, I am very functional. I have a job, I am studying at uni, I have friends (though I struggle to make new ones) I have some semblance of direction as much as anyone. And yet on the inside I am anything but ok.

I will not put any names to what I think I have, but I will go so far as to describe some of the issues I face day to day, as a starting point for what I am going to have to tell the people at the clinic it might be good to get some things more clearly explained and it might be fun to see what diagnosis you couch psychs come up with anyways

The biggest is depression. Severe depression, sometimes in waves throughout the day, sometimes for a sustained length of time ranging from a few days to a few weeks. Generally this results in very antisocial behaviour. I will sit inside, on the couch or in bed, reading, or just feeling miserable. Ive tried writing a journal, taking my mind off it, but its impossible. It saturates every level of my conciousness to the point even my dreams are depressing. It makes me have incredibly low self esteem aswell. Suicide is always on my mind, even when im not depressed it generally is, but when im depressed it becomes an active thought rather then just a day to day consideration. When I am not depressed it is always there in the back of my head saying "hey, u know u could just run infront of that car, or drive your car into a tree like your mother did, or ride ur motorcycle under a truck, etc etc" As of about 3 months ago I started smoking for this very reason. It helps the suicidal thoughts because I know I am doing it little bit at a time rather then all at once which seems to help.

Besides the depression and the suicide I feel generally fine day to day and I am quite jolly and chipper which is how most people know me.

In outside the house situations I am extremely paranoid of what people think and see of me. I am always adjusting my clothes, attempting to stand in a way that I think wont single me out, holding a bag a certain way, pointing my feet in a certain direction. Even with all this careful consideration I still believe that everyone around me, from pedestrians to passing cars to people in the office buildlings around me are looking at me, and judging me, and laughing at me and talking down of me. I know they arent deep down, but I feel compelled.

Its hard to explain, but its sorta like have you ever had that feeling like someones watching you, imagine that, but times 1000, and all the eyes are antagonistic. For the most part I just try to ignore it (as most of my symptoms I just push through them as I know they are manufactured of my brain and not real) but it is incredibly difficult and makes things like going shopping, or going to concerts or events very uncomfortable. I will go generally for the enjoyment of other people and because I dont desire to be a hermit, but I can never fully enjoy myself.

I also have a compelling to do incredibly random things. Sometimes this means I get a tattoo I didnt quite want. Sometimes it results in an unexpected holiday. Sometimes it makes me face up to the unseen eyes that torment me and strike up conversations with random people, at bus stops, at parties, etc. which helps me feel less watched. These things can all be construed as positive results to a symptom, but there are many that are negative as sometimes the random act isnt something you would normally do at all and would quite rather not do either way. The result is me having zero money, as I constantly buy things which I dont need, but am unable to logically talk myself away from them. It also means I end up in Adelaide instead of back in Canada (which was my original plan, but I was derailed). It also means I tend to drop friends and lovers with no warning at all. I go from 100 to 0 in a day with them, and many dont understand why I woke up one morning like any other and simply cut them adrift. But I just feel compelled to leave them behind and start something new and no amount of logic can stop me. This is also the root of my infedelity in relationships. Previously I was incredibly loyal, despised those who were unfaithful and swore I would never do it. The same compelling feeling comes over me from time to time and I find myself doing just that.


I despise myself for it, but I cannot stop it, its almost as if I am watching myself do these random things from a distance, but cant make contact with my body or the part of my mind doing it. Its very frustrating, and incredibly demoralizing and generally results in a sever bout of depression. Its not very nice being forced to do horrible things that make u hate yourself.

Some more recent symptoms (as of about 3 months ago) are constantly talking and singing to myself when no one is talking to me or Im alone. Also from time to time the floor or walls will appear slightly ripply, as if someone has thrown a rock into a pond, but the pond being a floor or a wall or a fridge. I also hear my name being called, and when I go to find who is calling me, no one is.

I try to not drink too much these days as it makes almost every symptom substancially worse, or because my mind is inhibited it seems so much worse as my condition seems to run rampent with my gaurd being down.

There is a bit more to some of the last symptoms, but if i explained that it would take some of the fun out of it as it would be plain as day to you as it is to me.

[Gladys]

it might be fun to see what diagnosis you couch psychs come up with anyways

Speaking as a keen couch psych, have you implemented recent, research-based, practical advice for dealing with depression. On a daily basis:

1. Expose bare skin to ultra-violet rays from the sun - much more so in winter.
   
   
2. Do thirty minutes of heart-thumping exercise.
   
   
3. Have a large meal of oily fish.
   
   
4. Get at least eight hours sleep (if possible).

On the psychological front, have you considered that almost everyone has experienced all of your symptoms at one time or other. But the sane seek ways of forcefully channelling their errant thoughts and perceptions in different, more useful directions.

[Nax]

besides the fish, for fund reasons, and the exercise yes.

This isnt really a "one time or another" thing, its a constant for the last seven years. And as I said, sometimes the "errant thoughts" are used for good, sometimes no good can come of them.

[Jozanny]

Nax, try treatment. With everything I feel about medical model systems, this does not mean it doesn't work at all, and if you are male, between 19 and 30ish, medications may help. The right working relationship with the right medical professional can lead to better emotional health--give it a shot, as we say in the American idiom. I am sure Australian policies are similar enough to our own that you will do just fine.

[Gladys]

besides the fish, for fund reasons, and the exercise yes.

Tinned sardines and salmon are excellent and fairly cheap here. Research link: Fish Oils May Beat Mental Illness

...sometimes the "errant thoughts" are used for good...

Certainly - for inspiration, invention, lateral thinking - but a constant stream of errant thoughts are not good and must be a hard burden to bear.

Incidentally, research broadcast here yesterday indicates that psychotropic drugs typically decrease life expectancy as much as smoking.

[soundofmusic]

I commend you for noticing and admitting these symptoms; most of us suffer with them for years and make excuses. There are many reasons why a person might suffer from depression, many times it is a chemical imbalance that can be easily treated with some of the lighter antidepressants. With an intellegent person like yourself, who is self aware, it will be easy to establish a rapport with a psychiatrist and get on the proper medication regimen. If the medication increases suicidal thoughts, report immediately to your doctor.
You may also request something to decrease anxiety with your depression medication. At first, the medication may make you tired; you may want to take it at night and advise the doctor if you would like to decrease the dosage. You will probably benefit from a mixture of talk therapy and medications. Psychiatric medications are not always permanent, sometimes your body begins to increase serotonin and dopamine and you begin to feel better, have more self esteem. The slight effects of these medications on your liver are not nearly as harmful as your current condition.

Pharmaceutical studies are based on a small number of individuals in limited cross sections and all variables are not considered.

[Katy North]

Talk therapy is always important... When I feel especially overwhelmed or start to feel depressed, just getting it off my chest to a counselor for a session or two is a great relief, even if they don't actively help.

[OrphanPip]

Pharmaceutical studies are based on a small number of individuals in limited cross sections and all variables are not considered.

It's unfortunate that medical studies can't be perfect, but nothing really is in this world. If we are to get anywhere in life, whether it be in medical treatment or any other aspect, we have to take risk sometimes.

The standard size of a phase III clinical trial is around 2000 individuals, this is more than enough to have statistically significant results. Occasionally you'll miss out on the 1/1,000,000 complication, like with the Vioxx debacle, but for the most part clinical trials are more than enough to determine safety and efficacy. We can't forget about the large number of animal trials that are performed prior to it getting anywhere near a human being. Most medications will have unfortunate side effects, but it is up to the patient and their physician/psychiatrist to discuss and decide whether the risk is worthwhile to them.

As to all variables not being considered, they consider as many variables as is reasonably possible. Eventually, you have to stop wondering if the humidity levels in the air have an effect on a condition, it's unreasonable to consider "all variables". The system isn't perfect, but it is damn near as good as we'll ever get.

[soundofmusic]

It's unfortunate that medical studies can't be perfect, but nothing really is in this world. If we are to get anywhere in life, whether it be in medical treatment or any other aspect, we have to take risk sometimes.

The standard size of a phase III clinical trial is around 2000 individuals, this is more than enough to have statistically significant results. Occasionally you'll miss out on the 1/1,000,000 complication, like with the Vioxx debacle, but for the most part clinical trials are more than enough to determine safety and efficacy. We can't forget about the large number of animal trials that are performed prior to it getting anywhere near a human being. Most medications will have unfortunate side effects, but it is up to the patient and their physician/psychiatrist to discuss and decide whether the risk is worthwhile to them.

As to all variables not being considered, they consider as many variables as is reasonably possible. Eventually, you have to stop wondering if the humidity levels in the air have an effect on a condition, it's unreasonable to consider "all variables". The system isn't perfect, but it is damn near as good as we'll ever get.

You're brilliant, as well My understanding of phase 3 testing is that the numbers in the study depend on financing and clinic size. What I have found in my personal and professional life, is that the studies are conducted on a person who has the target illness, and eliminates persons with complications.
In Veterans hospitals and state assisted institutions, it is rare to find a patient who has the target illness alone. In addition to this, the drugs are often not used for their prescribed use; but used for the side effects of the drugs.

Talk therapy is always important... When I feel especially overwhelmed or start to feel depressed, just getting it off my chest to a counselor for a session or two is a great relief, even if they don't actively help.

Yes, I had forgot to mention that there are a number of online networks, such as about.com, for people suffering from depression, suicidal thoughts, etc. It often helps to talk with others and share feelings and information.

[OrphanPip]

You're brilliant, as well My understanding of phase 3 testing is that the numbers in the study depend on financing and clinic size. What I have found in my personal and professional life, is that the studies are conducted on a person who has the target illness, and eliminates persons with complications.
In Veterans hospitals and state assisted institutions, it is rare to find a patient who has the target illness alone. In addition to this, the drugs are often not used for their prescribed use; but used for the side effects of the drugs.

Well you know what they say about all the good ones .

The issue of excluding people with other conditions from trials is definitely there, but without doing that it would be near impossible to get definitive answers about the efficacy of the drug. It is also arguably unethical to include individuals with other illnesses, because they may be at higher risk of complication than is necessary to test the efficacy of the drug.

As to clinical practice with prescription, that's a whole different issue. At least with the major drug companies they do extensive Phase 4 research as well.

[Nax]

In my mind this has been an extremely successful thread so far. Not just for me but for anyone who may be trolling the forums and experiencing other issues.

We have had personal experiences, we have had informative debates and statistics, and even some info on the medications. I am very happy indeed I started this thread.

I am however incredibly unhappy with the clinic I made an appointment with (danger rant imminant) I booked in for an initial consult, which then leads to a GP to get a psych plan slip which entitles me to 6 free consults with a psych as well as getting me a contact with a GP. The contact they assigned me (Steve) was relatively helpful and booked me in right away. However he did this with no consulting of my schedule and when I was informed that both my initial consult and gp appoingments were on days I have uni and were impossible for me to attend. No sweat he says, he gets the scheduler on the phone and we redo them fro suitable times.

Today I get a reminder text, the apts. were not changed at all, so I had to deal with someone else and they have now been rescheduled at a later time (they are sending me out a letter with the details) This is incredibly frustrating to me as its taken me 7 years to finally get the courage and determination (as well as be stable enough to talk and follow thro) and the last week has been torture. Waiting for the apt. not sure what will happen next, terrified its worse then I thought or something and now I have to wait at least another week. BLAH!

Anyways. Rant over, just very frustrating.

On a side note, I would just like to extend a special thanks to JuniperWoolf. You all have been very helpful and understanding with all this, but she has really gone above and beyond. We do know each other personally but are on literally the other side of the world from each other, and she has spent alot of time talking with me and helping me through some myths and thoughts and things. So *cyberapplause* for her.

HOPEFULLY this time next week Ill have a bit more to share with u guys on the process over here, we can go on the journey together, should be fun

[Gladys]

Since these drugs - with serious side effects - have efficacy similar to talk therapies and are little better than placebo, why not collar a good friend or pastor for a weekly chat? Shouldn't most drugs be seen as a short term or last ditch solution?

Isn't there evidence that vested interests in psychiatry and big pharma are pushing drugs of questionable value? While drug trials may prove significant (once any negative trial is quietly buried), the effectiveness of most of these drugs seems marginal. For instance: Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.

[OrphanPip]

I'm always wary of editorials in newspapers from journalist who's only source of knowledge on the subject they are writing about is the opinion of the person whose book they then plug at the end of the article.

I looked up Kirsch paper. Apart from being published in PLoS, an open source journal with minimal peer review, the journalist conveniently ignores some elements of his findings. For example, that paper reports that in cases of severe depression the efficacy of the drugs remains the same, but the placebo effect is decreased the more serious the depression is. So, drugs seem to be effective for people with severe depression, and the efficacy seems to derive from something other than the placebo effect.

I'm also skeptical of meta-analysis as a means of assessing efficacy in general. As someone without an advanced degree in mathematics, I have a hard time wrapping my head around the statistics, and it would take me hours of research to look at all the papers they used in their analysis to determine if their conclusions are accurate.

Anyway, I do think that drugs should be used only in severe cases of depression.

My education is in microbiology and immunology, so my knowledge of psychiatric drugs is relatively limited.

Edit: I'm also concerned with the fact that they only looked at short term studies, covering only a few weeks of treatment. I can imagine reporter bias and the placebo effect over a much longer period being greatly diminished.

[Nax]

I am of the belief you both may be right. I believe that drugs are helpful to a majority of people and a variety of illnesses. However I also believe that in many cases there is alot of pressure (and financial gain) for Physicians to overperscribe things and to perscribe things which may not be neccisary with other treatments.

However there is also alot of pressure from the client to be medicated, not just in psychiatric terms but also for alot of medical conditions. People want quick fixes and are of the belief that drugs can solve everything (or get them really high).

Different things work for different people, in my case they may determine I am functional enough not to need them, or they may believe that preventative measures are best to stop further progression of the psychosis and depressive aspects. Just have to wait and see.