here's some scary stuff, re: medication, suicide & viole

I see “our” Brian (or is it Brian1, Brian2, 3, 4 version 8.7, NT??) got a new moniker.

—des
currently totally out of control on Prilosec OTC . :-)

Actually, this is a real, though vastly overstated by the media, concern with SSRI antidepressants. The important thing to remember is that it currently is unknown whether a link between these medications and agitation or suicidal ideation actually exists. There is a temporal association, but that is only the beginning of a link. It has been theorized that the medications may energize a severely depressed, already suicidal patient before they lift the depression, with the result that the person gains enough “strength” to carry through with his suicidal intentions. The families of those who are just beginning SSRIs need to be aware of this potential risk and to keep a close eye on their loved ones. If there is going to be a problem, it will be early in the course of the medication. If someone has been taking an SSRI for a number of months and is responding well and receiving therapy, there really is little cause for concern. The real risk here may be that too much overstated concern will lead those who might benefit from medication to reject it as an option. That may actually increase sucide. Indeed, the rate of suicide among teenagers has steadily decreased and there is the possibility that the greater prescribing of SSRIs may be the reason. Again, there is only a temporal association at this point, so it is hard to say for sure. The bottom line is that we need to be aware that the question is unresolved and we need to be vigilant about looking after our loved ones when they are not able to do that for themselves.

I think that this problem is larger than the drug companies will admit, if not so large as some critics of the pharmas wish to believe. Certainly the media attention is not helped by revelations that the pharmas are neither obligated nor willing to share the results of internally conducted studies which show negative results. Add to this the fact that there are more than a few physicians and psychiatrists in this country will prescribe medication like there is no need to monitor for adverse reactions and use trial and error methods with often very potent drugs.

We need full disclosure of test results, good and bad, period. To hide behind proprietory information is disingenuous at best. We need full disclosure when obtaining informed consent, period. It is bad enough when someone who has a major mental problem has to take a less than perfect drug to protect themselves and others around. When you are talking about a child with a much milder condition whose parents must make the call for them anything less than full honesty is morally indefensible and should be seen as a criminal act.

Never assume that Merck, Lilly, et al are anything other than for-profitventures looking to maximize sales to pad the bottom line. If they were truly benevolent, socially responsible entities they would not hide the downside of their products, seek legal indemnity for adverse reactions, employ highly questionable marketing strategies or charge so darn much for their products.

>[quote=”Anonymous”]Actually, this is a real, though vastly overstated by the media, concern with SSRI antidepressants. The important thing to remember is that it currently is unknown whether a link between these medications and agitation or suicidal ideation actually exists. There is a temporal association, but that is only the beginning of a link. It has been theorized that the medications may energize a severely depressed, already suicidal patient before they lift the depression, with the result that the person gains enough “strength” to carry through with his suicidal

I’ve wondered about this as well, it used to be they’d say the tricyclics would take 3 weeks to work, and they really did. And that these work much faster. The trouble is maybe they DO work faster but not completely faster.

I just have lots of trouble with taking depressed people who end up committing suicide (where depresssion itself causes that) and then blaming it entirely on the drug. We also know that kids with depression are at a greater risk for aggression as well. These are often kids who “were good kids” never caused any trouble.

>cause for concern. The real risk here may be that too much overstated concern will lead those who might benefit from medication to reject it as an option. That may actually increase sucide. Indeed, the rate of suicide among teenagers has steadily decreased and there is the possibility that the greater prescribing of SSRIs may be the reason.

Well that’s true. I’ve heard these reports for years, but you never hear it with the other side.

This stuff has been bantied about for years with totally negative info like the original post, never mentioning the other side (the people who’s lives have been saved). The Church of Scientology has been very active in its spreading of this type of one sided info on psychotropics. Sure there is ALWAYS a bad side— there are side effects, etc. but there is the other side too.

OTOH, I agree with Dad, that we can’t necessarily depend on the drug companies info!!
I’m a bit more troubled by the drug companies profits at this point however.

—des

> A popular honors student who played on his varsity high-school basketball and baseball teams in rural Washington state, Corey Baadsgaard nevertheless would come home complaining that no one liked him. His family physician prescribed Paxil, a popular antidepressant.
But Baadsgaard, then 16, sunk deeper into depression. The doctor switched him to a different antidepressant, Effexor, and stepped up
the dose over a three-week period from 40 milligrams to 300. The first morning Baadsgaard took 300 milligrams, he felt rotten and went
back to bed.

Looking at the original post again, the doctor’s action wasn’t questioned here but I don’t know the prescribing info on Effexor, but from 40 to 300 is a big jump here. Is that a known safe dose?

—des

To des, who wrote: “I see “our” Brian (or is it Brian1, Brian2, 3, 4 version 8.7, NT??) got a new moniker. ”

des, I’m not Brian, but I know all about him from his postings on this board, and none of it is good. Aren’t you not just jumping, but leaping to a conclusion here? I take that as an insult, but will not insult back. I am a mother who really DOES care, not a troll out to attack anyone.

All I did was post a reputable article about a very serious topic, that contains information relevant to the posters here on this board. Perhaps you don’t like the content of the article, but the article is real, and I didn’t write it or make it up.

Dad, I am in complete agreement with every single word you wrote in your post, but only have a problem with this part:

“We need full disclosure of test results, good and bad, period. To hide behind proprietory information is disingenuous at best. We need full disclosure when obtaining informed consent, period. It is bad enough when someone who has a major mental problem has to take a less than perfect drug to protect themselves and others around. When you are talking about a child with a much milder condition whose parents must make the call for them anything less than full honesty is morally indefensible and should be seen as a criminal act.”

If you are referring to depression in children as a “much milder condition”, that is not an accurate statement. The remotest possibility of the suicide of a child is pretty major in my book.

<<Looking at the original post again, the doctor’s action wasn’t questioned here but I don’t know the prescribing info on Effexor, but from 40 to 300 is a big jump here. Is that a known safe dose?>>

Des,

I am not a doctor but as a med veteran, who was on Effexor at one point. To answer your question, yes, 300mg is within the prescribing range from what I remember. However, my question is why did the doctor give up on the Paxil and not try increasing the dosage with that medication? There might have been a very good reason but the article seems to imply that the medication had just been started so that’s why I am curious.

Obviously, the dosage was increased faster than usual because of the doctor’s concern. But I can’t be too critical because one time, I did that in my own situation. I was having med problems which resulted in a very depressed mood and about to go away on a trip with my family so it was not a good situation. So I did a mini version of what this doctor had done and it worked out great. Yes, I do work closely with my doctor for those of you who think I am a renegade patient.

Back to what the doctor did. Trust me, I am as critical of doctors as anybody but if he hadn’t been aggressive in increasing the dose and the kid committed suicide, he would have been sued for malpractice and rightfully so.

Hey, if there are problems with meds, I am definitely in favor of all the necessary scrutinies. But as one who is in the .01% side effect category, I also know antidepressants have saved my life and others who have had the misfortune to also suffer from depression. As a result, I fear people are going to lose sight of the big picture. Hopefully, I will be proven wrong.

PT

I do not consider depression (overall, there will always be a bell curve of severity) to be in the same class as say paranoid schizophrenia or profound psychosis. I am not meaning to belittle the seriousness of depression, but I do think that there is a difference in scale between being at risk to harm yourself (which is troubling to say the least) and being a very real threat to others around you.

Again, do not take me wrong, but a great many people in this country will face depression at some point in their lives (I have heard 1 in 5 mentioned several times but that does seem a bit high to me) and yet our suicide rate is actually small (in comparison). I know some will say that suicide can take many forms, including self-detructive actions like willful drug abuse. That still can’t compare to people like Bundy, Dhamer, the Shoemaker, etc.

Some people can make it through depression without resorting to medication. Some people can’t. I think we have a new religion in this country that too many people fall into - the cult of pharmacology, where every ill shall have a pill.

I have seen firsthand in family and close friends how doctors who are quick to ink a presciption pad with poewrful medications not fully understood can become trapped into their three month cycle of re-upping their head medication. It makes me angry that “practicing” medicine can sometimes loose sight of that most basic premise of the business “first, do no harm”.

Again, I am not one to make absolute statements about either efficacy or safety. Like almost all areas of human life both are abell curve. But there is just as much danger in ignoring the down as their is in denying the up. When you are talking about people whose problems are very profound, we as a society must be willing to roll the dice for higher personal stakes. But when the problem is not assevere, we must begin to err on the side of caution, all the more when we are making decisions for children who cannot make their own choices in the matter.

The two studies the Canadians exposed had very high rates of attempted and successful suicides among the test teenagers, very near 15%. I find that at once alarming and unnaceptable to be concealed to preserve market. One of the girls who succeeded had followed a “challenge - dechallenge - rechallenge” path when she killed herself. That is far more indicative of the medication being a triggering factor than the underlying condition.

I find it very odd how so many people are quick to assume that the oil companies and other multi-national corps are to be watched closely because we expect them to screw us in the name of profits, but we will give far too much benefit of the doubt to the pharmas, who are in the end businesses seeking to extend market share for their products. We have evidence that they lie about their products, we have evidence that they buy influence both in Congress and in the regulatory agencies and we have evidence that they abuse our market with price gouging. I find it hard to accept their assurances that those who warn against the adverse side of medication are simply misguided.

>des, I’m not Brian, but I know all about him from his postings on this board, and none of it is good. Aren’t you not just jumping, but leaping to a conclusion here? I take that as an insult, but will not insult back. I am a mother who really DOES care, not a troll out to attack anyone.

Yes, I do apologize. And I don’t think you are him as he would be attacking the heck out of everyone. (Ironically I attacked you or what I thought was not you. I actually don’t think he reads this particular board anyway.)

I have seen these arguments before though. However, I understand that the topic has come up more recently.

So for what it is worth, I hope you will accept my apology.

>All I did was post a reputable article about a very serious topic, that contains information relevant to the posters here on this board. Perhaps you don’t like the content of the article, but the article is real, and I didn’t write it or make it up.

Yes, it was an article. And I think you were right to post it. I don’t agree with the info in the article, but it *is* a serious topic. I am worried about the sensational nature of this topic, but I recognize you are basically quoting what you read, and it is not hearsay.

—des

>I do not consider depression (overall, there will always be a bell curve of severity) to be in the same class as say paranoid schizophrenia or profound psychosis. I am not meaning to belittle the seriousness of depression, but I do think that there is a difference in scale between being at risk to harm yourself (which is troubling to say the least) and being a very real threat to others around you.

Well maybe not compared to schizophrenia, no. For one big difference, depression is treatable. But as far as functioning goes, a person with a severe depression may be unable to live and the quality of life is zip.
There is a risk of depresssion and the more severe it is and the higher anxiety the higher the risk. It is not a no risk thing NOT to medicate.
Also the SSRIs are used for other conditions that are less amenable to therapy, such as anorexia, OCD, etc.

>Again, do not take me wrong, but a great many people in this country will face depression at some point in their lives (I have heard 1 in 5 mentioned several times but that does seem a bit high to me) and yet our suicide rate is actually small (in comparison).

Well there are levels of depression, like there are levels of autism, learning disabilities, and hearing loss. There are some that are fairly short, self-limiting. However, depression and sadness and grief are different. Not sure where you got the 1 in 5, maybe seems a little high, esp. for more severe, not situation specific type.

>Some people can make it through depression without resorting to medication. Some people can’t. I think we have a new religion in this country that too many people fall into - the cult of pharmacology, where every ill shall have a pill.

For actual depression, as opposed to sadness and grief, there aren’t too many effective non-drug interventions. Mild depression can be treated with specific forms of psychotherapy (cognitive for example). Most therapy depensed is prolly not of that sort.

>I have seen firsthand in family and close friends how doctors who are quick to ink a presciption pad with poewrful medications not fully

I have seen the other side first hand.

>personal stakes. But when the problem is not assevere, we must begin to err on the side of caution, all the more when we are making decisions for children who cannot make their own choices in the matter.

I agree with your statement,
I just don’t agree that depression is usually a mild problem.

>market. One of the girls who succeeded had followed a “challenge - dechallenge - rechallenge” path when she killed herself. That is far more indicative of the medication being a triggering factor than the underlying condition.

The problem with blaming the medication is that you have a condition that in teenagers is often explosive. You don’t always know the severity of what you are dealing with teenagers as they often act rather than verbalize. Since there is no real medical test for depression, it is based on clinical evidence and behavior, it is hard to get an accurate picture for teenagers.

The other is that it is pretty hard to separate cause from effect here. You have a condition that does lead to suicide and violence in some cases. So when a case happens, you have to be pretty sure that the link is actually there. Would these kids have done these things without the medication? Are the complicating factors, like the medication giving the energy to act before lifting the depression? To associate cause with effect is hard anyway and doubly hard with this condition and maybe triply hard with teens.

>businesses seeking to extend market share for their products. We have evidence that they lie about their products, we have evidence that they buy influence both in Congress and in the regulatory agencies and we have evidence that they abuse our market with price gouging. I find it hard to accept their assurances that those who warn against the adverse side of medication are simply misguided.

I am very critical of the drug companies and don’t take their assurances
at face value. But I am skeptical when I hear sensationalistic reports of individual cases. I am also very aware of the numbers of people who’s lives have been made better or were saved by this class of drug. Yes they are powerful drugs and perhaps more caution should be observed, but these arguments tend to lead to the idea that they should be withdrawn.

I can see, “We should be more careful, we should monitor patients more carefully, we should be more careful during early stages, we should not use unless fully indicated.” That I see as fine.

The trouble I see with the “These are really dangerous drugs that CAUSE suicide, violence, etc.” Well isn’t the logical conclusion that they shouldn’t be given?

—des

> Well maybe not compared to schizophrenia, no. For one big difference, depression is treatable.

Schizophrenia is treatable. There is a halfway house a block from where I live with for women living in it. Two have schizophrenia, and as long as they stay on their medicine they are fine (still very odd but fine) I am frineds with a woman who works case management and her clients have a variety of issues ranging from MR to psychosis. Many live on their own with managed assistance from the state. Again, when they continue to medicate they manage to stay out of “trouble”. When they go off their medicine they sometimes end up before the hearing officer and my friend then has to go to bat for them, explaining why they need to be either placed into more restricitve settings (for willfully going off their medications) or why this was an “accidental” occurance, and they really pose little immediate threat.

>Well there are levels of depression, like there are levels of autism, learning disabilities, and hearing loss. There are some that are fairly short, self-limiting. However, depression and sadness and grief are different. Not sure where you got the 1 in 5, maybe seems a little high, esp. for more severe, not situation specific type.

Again, this is my point, that there is a bell curce to severity, and medication is and should be seen as one tool to work on the problem. But I do know that for some doctors, medication is THE tool, and an over-reliance upon a single aspect of treatment is illogical. The 1:5 is repeated very often on radio-health programs concerning depression and I believe it is presented from the information from the NIMH, although the research I have done does not include depression (I focus mainly on autism and Sped concerns).

>For actual depression, as opposed to sadness and grief, there aren’t too many effective non-drug interventions. Mild depression can be treated with specific forms of psychotherapy (cognitive for example). Most therapy depensed is prolly not of that sort.

Again, this is my point, that perhaps we are over-reliant upon the use of medications which are dispensed in trial and error fashion. Another therapy which has had some degree of success is electro-shock (not that I advocate wiring everyone in to the 110 either, but it has helped some people break the cycle of depression). Psychotherapy involving hypnosis has also improved the lives of some people with or without accompianing drug therapy.

>I have seen firsthand in family and close friends how doctors who are quick to ink a presciption pad with poewrful medications not fully

> I have seen the other side first hand.

And perhaps this underlies or differing opinions. We form our opinions based upon our firsthand experiences foremost, and then the research we do (and there is plenty of quality literature available to support nearly any opinion on this topic) reinforces our position. I know several women who have been hooked on benzos, and this drug begins to take over their lives in a way that is equally as bad as the problem that they were prescribed for. A woman I work with, a delightful girl, was prescribed medication for a bout of depression, and then got hooked on it. Her dr. weened her from one and got her onto SSRI’s. When our insurance company dropped that dr., she was forced to take one that was still covered. This quack stopped her script for the medication cold, switching her to a different SSRI. I don’t know why one SSRI will be well tolerated by a person and not another (biochemistry is still a wide open field) but the quality of her life plummeted. She became extremely manic, a very real danger to herself, had to be hospitalized for months while this “dr.” played with her dosage. Finally this girl’s mother fired the dr. (should have sued IMO) and her new dr. immediately switched her back, and then tapered the dosage. Nw she is back to work (thankfully she was taken back) and back to “normal”, and at a lower dosage.

>The other is that it is pretty hard to separate cause from effect here. You have a condition that does lead to suicide and violence in some cases. So when a case happens, you have to be pretty sure that the link is actually there. Would these kids have done these things without the medication? Are the complicating factors, like the medication giving the energy to act before lifting the depression? To associate cause with effect is hard anyway and doubly hard with this condition and maybe triply hard with teens.

You didn’t reply directly to the “challenge-dechallenge-rechallenge” scenario that occured in the one “successful” suicide (which occured in a test with 12 teens, one other of which attempted suicide as well). If, as you suggest, the medication “energizes” patients to fulfill a deathwish, then that isn’t a very good prognosis, is it… I am reminded of the old chestnut “the operation was a complete success, however the patient died”. I do not know the level of severity of the depression in the teens (the article printed in the Times did not delve that deep) but the Candian Health authorities were impressed enough with the data to severely chastize the pharma industry for suppressing the results of the trial in question.

We have also seen testing in perfectly healthy patients where SSRI’s have induced manic conditions leading to acts of violence. The tests were likewise not well published, and a team of persons led by Dr. Breggin (who is on the extreme end of this issue I will admit) used them as well as others in several successful court cases defending people who had unnexpected reactions to SSRI’s, the first of which was won in CT in 1996. Again, this is not well published by those who have a stake in market expansion for their product, or the mainstream medical health authorities who rely upon these companies for funding, and are expected to provide solutions to practitioners who work with the members of the public.

I do not like glossing over or actual concealment of very real data that points to the downside of treatment. Drs. need ALL the information concerning drugs so that they can accurately treat patients and be fully prepared to change tactics should adverse reactions begin to occur.

> I am very critical of the drug companies and don’t take their assurances at face value. But I am skeptical when I hear sensationalistic reports of individual cases. I am also very aware of the numbers of people who’s lives have been made better or were saved by this class of drug. Yes they are powerful drugs and perhaps more caution should be observed, but these arguments tend to lead to the idea that they should be withdrawn.

There are two different types of proof involved here. In sience, if you are trying to prove that something does not or cannot happen, you must have extremely large populations of test and control subjects, to derive statistically significant results. If however you are trying to prove that something does or can happen, you only need one. To establish prevalance of incidence requires larger pools of data, but to show that it does happen very few occurances are needed.

> I can see, “We should be more careful, we should monitor patients more carefully, we should be more careful during early stages, we should not use unless fully indicated.” That I see as fine.

If more drs. and psyches would follow this I believe this would be a moot issue. There are too many accounts of drs. who use trial and error presciption practices, who increase dosages or compound the situation with multiple medications when they get an unexpected reaction, or who use other questionable practices to ignore the issue.

> The trouble I see with the “These are really dangerous drugs that CAUSE suicide, violence, etc.” Well isn’t the logical conclusion that they shouldn’t be given?

In some patients I believe that yes, that is the logical conclusion. If you see every problem as a nail, the only tool you need is a hammer. Conversely, if the only tool you posess is a hammer, it stands to reason that you will see every problem as a nail.

We have not yet begun to scratch the surface on the workings of the mind. We do not begin to comprehend how interrelated the bodies systems are, how issues of the gut can impact the workings of the mind. Over-reliance upon medications of the mind which can sometimes be tricky to use and have unexpected adverse reactions is frightening. We do not have the quality of data to make proper evaluation of this situation (drs. and hospitals are not likely to share data which shows adverse reactions, as this data can also support litigation against them).

des posted:

“>des, I’m not Brian, but I know all about him from his postings on this board, and none of it is good. Aren’t you not just jumping, but leaping to a conclusion here? I take that as an insult, but will not insult back. I am a mother who really DOES care, not a troll out to attack anyone.

Yes, I do apologize. And I don’t think you are him as he would be attacking the heck out of everyone. (Ironically I attacked you or what I thought was not you. I actually don’t think he reads this particular board anyway.)

I have seen these arguments before though. However, I understand that the topic has come up more recently.

So for what it is worth, I hope you will accept my apology.

>All I did was post a reputable article about a very serious topic, that contains information relevant to the posters here on this board. Perhaps you don’t like the content of the article, but the article is real, and I didn’t write it or make it up.

Yes, it was an article. And I think you were right to post it. I don’t agree with the info in the article, but it *is* a serious topic. I am worried about the sensational nature of this topic, but I recognize you are basically quoting what you read, and it is not hearsay.

—des”

Thank you for the apology, des.

Dad wrote:

<<Again, this is my point, that perhaps we are over-reliant upon the use of medications which are dispensed in trial and error fashion. Another therapy which has had some degree of success is electro-shock (not that I advocate wiring everyone in to the 110 either, but it has helped some people break the cycle of depression). Psychotherapy involving hypnosis has also improved the lives of some people with or without accompianing drug therapy. >>

Electro-shock??? OMG.

I realize you aren’t referring to the hideous and cruel shock treatments from 50 years ago, but still… For me, medicating my child would be an absolute, last resort, act of desperation. But I wouldn’t rule it out if it actually came to that. Electro-shock, even for an adult? Never in a million years.

Well said Dad. One only need look at the controversy with Paxil and the seriousness of withdrawl to understand that drug companies do not tell all and that many doctors either don’t care or are ignorant to a drugs research. We all want to help our children and as parents it is our responsibility not to turn a blind eye to the less discussed and more negative side to the pharmacuticals that are availbale to help them.

>> Well maybe not compared to schizophrenia, no. For one big difference, depression is treatable.

>Schizophrenia is treatable. There is a halfway house a block from where I live with for women living in it. Two have schizophrenia, and as long as they stay on their medicine they are fine (still very odd but fine)

Well manageable might be more the point. Or maybe I should say depression is *curable*. I have known a few people who had schizophrenia. The newer medications are very exciting but some have extremely serious side effects (fatal anemia), say.

>Again, this is my point, that there is a bell curce to severity, and medication is and should be seen as one tool to work on the problem. But I do know that for some doctors, medication is THE tool, and an over-reliance upon a single aspect of treatment is illogical. The 1:5 is

I agree with that as well.

>Again, this is my point, that perhaps we are over-reliant upon the use of medications which are dispensed in trial and error fashion. Another

Yes I would agree. I think other factors have come into play. Such as insurance. Insurance is fairly liberal paying for medication and drs. who use medication but quite stingy about paying for psychotherapy.

And then there is psychotherapy that is almost totally unproven, such as the long time psychoanalyis based (or perhaps some so-called “supportive” or eclectic) that does pretty much no good at least for depression. (It is maybe similar to the teaching of reading??)

No doubt there are people who would not go thru psychotherapy using a proven approach (like cognitive therapy) as they have had lots of bad experience with unsuccessful and unproven approaches.

>therapy which has had some degree of success is electro-shock (not t

Yikes dad!!!

>> I have seen the other side first hand.

>And perhaps this underlies or differing opinions. We form our opinions based upon our firsthand experiences foremost, and then the research we do (and there is plenty of quality literature available to support nearly any opinion on this topic) reinforces our position.

Yes I would agree with that assessment as well.

> I know several women who have been hooked on benzos, and this

Well but benzos aren’t SSRIs!

>medication cold, switching her to a different SSRI. I don’t know why one SSRI will be well tolerated by a person and not another (biochemistry is still a wide open field) but the quality of her life plummeted. She became extremely manic, a very real danger to

It’s not mine either! I do know it happens. I know that the chemical formulas are somewhat different. My mom had a similar exp. on an Alzheimer’s drug— became all crampy and nauseated on one and really improved on another. The chemical formulas are very similar but must
be different enough…

>You didn’t reply directly to the “challenge-dechallenge-rechallenge”

I didn’t because I didn’t read the specific research and don’t know the particulars.

>scenario that occured in the one “successful” suicide (which occured in a test with 12 teens, one other of which attempted suicide as well). If, as you suggest, the medication “energizes” patients to fulfill a deathwish, then that isn’t a very good prognosis, is it… I am reminded of the old

Well not sure if that was a bit misstated. I think the point someone else made was that there is a time lag between the time it works for depression and the time it energizes the patient. The old tricyclics were said to take 3 weeks and really did— so people were watched fairly carefully for the full 3 weeks. The SSRIs are said to work faster, maybe in a week. But say this is not always or entirely true. That they energize the patient in a few days, but don’t lift depression for a couple weeks. It might be that the person needs to be watched lots longer, esp. teens.

>We have also seen testing in perfectly healthy patients where SSRI’s have induced manic conditions leading to acts of violence.

But it would be fairly logical wouldn’t it? If a the drug increases a chemical that is already in sufficient quantities in normal brains, then giving them MORE would be a bad thing wouldn’t it? You are basically creating a mentally ill brain from a normal brain, if we think of mental illness as a change in the normal chemical balance of the brain.

>The tests were likewise not well published, and a team of persons led by Dr. Breggin (who is on the extreme end of this issue I will admit)

A little. :-) Still I consider if fairly logical. I would think high serotonin would be no more desirable than low serotonin.

>I do not like glossing over or actual concealment of very real data that points to the downside of treatment. Drs. need ALL the information concerning drugs so that they can accurately treat patients and be fully prepared to change tactics should adverse reactions begin to occur.

I’d agree with this. Actually that might (the change from low to high serotonin) might account from some of the bad outcomes. I think it would be useful to know what people are at risk for this problem and how widespread it is. If the data is glossed over, it is hard to figure out what the actual risks are and how prevalent they actually are.

>There are two different types of proof involved here. In sience, if you are trying to prove that something does not or cannot happen, you must have extremely large populations of test and control subjects, to derive statistically significant results. If however you are trying to prove that something does or can happen, you only need one. To establish prevalance of incidence requires larger pools of data, but to show that it does happen very few occurances are needed.

Ok I’ll buy that one as well. But what’s the conclusion? If you say, well you only give this class of drugs to the more severe cases of depression, ocd, etc. then you still don’t know if the bad reactions are not ever going to happen either. In fact the case in the paper sounds like a more severe case to me anyway.

>> I can see, “We should be more careful, we should monitor patients more carefully, we should be more careful during early stages, we should not use unless fully indicated.” That I see as fine.

>If more drs. and psyches would follow this I believe this would be a moot issue.

Unfortunately there is no way that you can in any way regulate or enforce appropriate medical practice. You can sue someone once they DON’T use it, but to prevent it is another story.

>> The trouble I see with the “These are really dangerous drugs that CAUSE suicide, violence, etc.” Well isn’t the logical conclusion that they shouldn’t be given?

>In some patients I believe that yes, that is the logical conclusion.

Well I buy that as well, but then you get to the question of who you use them for and who you don’t and so on. But when you say that these are extremely dangerous drugs and these are the potential side effects and so on, I don’t think that we are in much of a position to indicate EXACTLY how they are going to be used and when. I think even two very conscientious and careful physicians might make two entirely different decisions in identical situations. The only COMPLETELY safe answer is to take them off the market which in the case of SSRIs would not be completely safe, as there are many people alive because of them.

—des

Hi Des,

You have made some excellent points which I completely agree with as a med veteran. I do have one question and perhaps I am missing something.

From what I remember in reading about depression and antidepressants, it has always been known that a prime danger point is after someone with severe depression starts taking antidepressants. As you said, their depression hasn’t been lifted but now, they may feel energized in wanting to commit suicide.

Anyway, I don’t understand the big commotion about this warning as it seems old news to me. What am I missing?

By the way, I do realize there are other concerns but it seems the warning is based on that period after taking the medicine.

PT

I think the missing link between what may have been known previously and what is occuring today is a matter of adequate publishing of information. As reported in the Times, the FDA ia aware that some of the people prescribing the medication either are unaware of this window of danger or do a poor job of relating this to the patients and especially the parents of younger patients. It is completely counter-productive to the intent (treating depression) if those who must monitor the patient do not know to keep a close watch for the warning signs of a rash action.

Whether this is a case of outright adverse reaction or a case of “energization” is still I believe a matter of conjecture. I believe the latter is a likely scenario, but their is no proof that the former does not or can not occur, and tests run with SSRI’s in patients who do not have depression have had similar occurances. (It was two independant tests that had a case of suicide amongst otherwise healthy test subjects which formed the core of the Breggin team’s successful suit in 1996.)

Failure to publish events that do occur does not allow for true informed consent either. A large number of lay people who are unable to research as thoroughly as some people can lead them to believe that once you start taking the medication you are home free. By ensuring that psychiatrists and physicians must discuss the possible downside you will reduce the chance that an unfortunate incident will occur.

I think too that there is a trend in psychiatry to assume that the doctor knows best, even when they may not. Just because you are an MD or a PhD does not mean that you cannot or do not make mistakes (there would be no need for malpractice insurance were these people above human faults.)

What I find curious is that the number of suicides both successful and attempted does not seem to hinge on availability or subscription to SSRI’s. We have higher rates per capita of both in this country than in some other countries with similar standards of living, despite consuming the overwhelmin majority of head medications. Curious, no?

Dad wrote:

<<Whether this is a case of outright adverse reaction or a case of “energization” is still I believe a matter of conjecture. I believe the latter is a likely scenario, but their is no proof that the former does not or can not occur, and tests run with SSRI’s in patients who do not have depression have had similar occurances. (It was two independant tests that had a case of suicide amongst otherwise healthy test subjects which formed the core of the Breggin team’s successful suit in 1996.) >>

While it had been speculated that a period of “energization” does occur the first few weeks after an SSRI is started, either this or the other article from the Times posted on this topic also stated that “agitation” and “irritability” have also been reported.

Here’s the article from yesterday’s Times, I just found it:

Overprescribing Prompted Warning on Antidepressants
By DENISE GRADY and GARDINER HARRIS

Published: March 24, 2004

he government’s warning on Monday that people newly taking antidepressants can become suicidal and must be closely monitored grew at least in part from a concern that the drugs were being handed out too freely and without enough follow-up, especially in children and teenagers.

Dr. Wayne K. Goodman, chairman of psychiatry at the University of Florida College of Medicine and a member of an expert panel that advised the Food and Drug Administration, said, “I think many physicians, and particularly nonpsychiatrists, have been lulled into the notion that these drugs are safe.”

He emphasized that the drugs carried few serious physical side effects and a low risk of overdose. But, Dr. Goodman added, “I think what’s been underestimated is this behavioral toxicity, which can indirectly lead to problems, including possibly suicidal behavior.”

Yesterday many doctors acknowledged that the new warning was sound advice and yet said they worried it might discourage doctors and patients from treating depression.

Dr. Eva Ritvo, an associate professor of psychiatry at the University of Miami, said: “A depressed patient needs to be watched closely, particularly in the initial stages of treatment or when the dosage is raised. This is something we should be doing anyway as mental health professionals.”

But, she added, “Untreated depression is dangerous and takes a huge toll on people’s lives, and we can only hope this warning doesn’t discourage people from seeking treatment.”

Patients had mixed reactions.

Some people who suffered depression in the past but shunned medication said the new warnings reinforced their wariness.

Barry Owen, 51, a magazine consultant in San Francisco, refused antidepressants during an emotional crisis.

He said his doctor recommended the drugs a few years ago “because at that point I was pretty severely depressed and having panic attacks and couldn’t eat and sleep.” Mr. Owen added: “I decided then not to take her advice. And while I don’t doubt the usefulness for a lot of people, this new information gives me one more question about them.”

But patients who have done well on the drugs were not troubled by the new warnings. Paul Festa, 33, a San Francisco artist and writer, took Zoloft for about a year in 1999, and then Paxil for a year or so after the 2001 terrorist attacks. He said: “I would never hesitate to go back on these medications because I already know that I react extremely well to them. I feel like there should be a warning for people who are depressed that not taking these medications could lead to suicide. If you’re depressed, you’re putting yourself at risk for all sorts of self-destructive behaviors, up to and including suicide.

“When I was depressed, the thought of suicide was crossing my mind more than it ought to have, and the antidepressants got me out of that loop.”

The advisory issued Monday by the drug agency asked manufacturers to put detailed warnings about a possible increased risk of suicidal behavior and the need for monitoring on the labels of 10 antidepressants: Prozac, Zoloft, Paxil, Wellbutrin, Luvox, Celexa, Lexapro, Effexor, Serzone and Remeron. The warning included both children and adults.

Studies in children taking the antidepressants have not found an increase in suicide. But studies of some drugs have suggested that they might increase the risk of suicidal thoughts and behaviors. Research has also failed to provide convincing evidence that the drugs are effective in children, making the potential risks even less acceptable. There is no solid data linking use of the drugs to suicide in adults.

Dr. Goodman of Florida said that panelists who met last month were troubled by reports that some doctors were giving patients samples of antidepressants and saying casually “Tell me how you do,” rather than scheduling frequent follow-up appointments to make sure patients were tolerating the drugs.

“That is problematic,” Dr. Goodman said, “and probably reflects people becoming a little lackadaisical about the downside of these medications in children.”

Most antidepressants are now prescribed by primary care physicians, whose patients may never see a psychiatrist, because of concerns about cost or the perception of stigma attached to mental illness. Prozac, Paxil and other modern antidepressants became hugely popular in part because drug companies convinced family physicians that they were safe enough to use without a psychiatrist’s intervention. Antidepressants are the third biggest selling category of drugs in the world behind cholesterol and heartburn pills.

Some psychiatrists speculated yesterday that their family-care colleagues might lose confidence in the drugs and become reluctant to prescribe them.

“We’re hoping that doesn’t happen, because primary care physicians have a major role to play in combating depression,” said Dr. James H. Scully Jr., medical director of the American Psychiatric Association. “We hope they won’t be scared off.”

Dr. Robert Lee, a San Francisco physician of holistic medicine who sometimes prescribes antidepressants, said: “I don’t think people already taking them will be concerned. But a lot of people who I think would benefit from these meds already won’t take them because of various stigma reasons, so I’m a little concerned that this will raise that barrier even higher.”

Dr. Lee said the new warning would not make him hesitate to prescribe the antidepressants.

He said, “People can get agitated from them, but I’ve never seen somebody get suicidal from them.”

Dr. Joseph Gonzalez-Heydrich, chief of psychopharmacology at Children’s Hospital Boston, said: “I’ve heard anecdotally that a lot of antidepressants were being prescribed by pediatricians without a lot of training or experience. I think the warning is appropriate. If it makes prescribers more vigilant or parents more vigilant, that’s a good thing.”

Dr. Gonzalez-Heydrich said that a sizable minority of children became more agitated and irritable on the antidepressants in question. “If we see it, we take them off it or reduce the dose,” he said. “Doing it that way there are a lot of kids we feel do benefit from these medications, especially long term. But they’re not for everybody.”

Dr. Harold Koplewicz, director of New York University’s Child Study Center, said, “The fear I have about this warning is that many teenagers will not get the medicine because it will build resistance among their parents, and that’s really a tragic outcome.” He noted that suicide rates in teenagers had gone down in the United States and Sweden as use of the drugs increased.

Several primary care doctors said that they had prescribed antidepressants with success for so many years that it was unlikely the F.D.A.’s new warnings would lead them to stop. Still, the warnings have given them pause, they said. They may think a bit harder before prescribing them to patients who are simply stressed, they said. And they will watch how the warnings play in the legal field, some said.

“We’re going to continue to use these drugs pretty freely until we start seeing the ads in the newspapers from lawyers saying, `Have you or your family member been prescribed these drugs? If so, you may have a case,’ ” said Dr. Phillip Kennedy, a family practice physician in Augusta, Ga. “When the big L word, liability, raises its ugly head, that’s when things will really change.”

Spokesmen for drug companies said that they would emphasize to physicians that the F.D.A.’s warning did not conclude that antidepressants cause suicide. “My hope is that people won’t make a link with the drugs,” said Jennifer Yoder, a spokeswoman for Eli Lilly & Company, maker of Prozac. “I think the message will be that suicide is an inherent part of the disease of depression, and physicians should carefully monitor their patients.”

Critics of the medicines said the F.D.A.’s warning was long overdue.

“These warnings are not as strong as I would like, but they’re an important first step,” said Tom Woodward of North Wales, Pa. Mr. Woodward’s teenage daughter, Julie, hanged herself six days after starting therapy with Zoloft.

David Tuller and Terry Aguayo contributed reporting for this article.

Oops, I meant TODAY’S NY Times…

I am not an LD child or adult, but have been taking the benzodiazipines for many years, for my severe, debilitating anxiety and panic attacks. I was prescribed the benzos for the first in the mid-80’s, when they were the *popular* drug of choice for doctors to prescribe, for these VERY REAL disabling, quality of life-destroying problems.

Since then, 15 years or so later, I have a different docter (I moved), and he has pressured me non-stop for the last few years to switch to the SSRI’s. I had tried the SSRI’s before, and have had adverse reactions to them, and told the doctor so. In fact, I had begun to feel like a human guinea pig, trying this and that, when in reality, the benzos were the only medication that seemed to help me. Adverse reactions to the SSRI’s were: Extreme fatigue, zombie-like state, i.e. not giving a care about anything, being unable to cry, even when I felt I NEEDED to, and feeling like I was in a fog/depersonalization. Call me narcissistic, but I rather like my personality, and it was all but gone. Also absolutely no sex drive at all, it’s like my genitals (sorry) are numb. Also, some short-term memory loss. How to describe? I sit down at the computer, then can’t remember what I was going to do. It’s frightening.

About 4 months ago, in a severe depression, I did finally cave in, and agree to go on the SSRI’s again. I was so depressed I was weeping in his office uncontrollably. My doctor was pleased. I am up to 20mg of Prozac per day now, and am now experiencing the exact same adverse reactions I had before. They swiftly came back again. I have to say, during the first 6 weeks on Prozac this time, I did have more energy, but not anymore. Now I am having a great deal of difficulty getting out of bed at all, and need at least one nap during the day, for the accompanying fatigue.

Which SSRI’s have I tried in my lifetime? Zoloft, Luvox, and Prozac twice. I want to give up on the SSRI’s again, as they are NOT helping, but now I doubt my doctor will agree.

I forgot one of the adverse side effects, sorry. Lack of appetite. It’s strange, it’s like the appetite is no longer there. Not like taking diet pills or the like. I *forget* to eat, skipping breakfast, lunch, etc. I’ve lost weight, as I did the last time I was on SSRI’s.

The doctor made a joke the other day. He said he thinks he should maybe take them, since he needs to drop a few pounds.

[quote=”kitty kat”]I am not an LD child or adult, but have been taking the benzodiazipines for many years, for my severe, debilitating anxiety and panic attacks. I was prescribed the benzos for the first in the mid-80’s, when they were the *popular* drug of choice for doctors to prescribe, for these VERY REAL disabling, quality of life-destroying problems.

.[/quote]

Kitty Kat,

Benzodiazepines are HIGHLY addictive and you should not have been prescribed them as a daily medication for many years. They are quite effective at controlling anxiety, but should not be used as the sole means of doing so. Have you tried cognitive behavioral therapy for your anxiety? It has a good track record. Also, Celexa or Lexapro (pretty much the same drug, but Lexapro has fewer side effects) are better choices than the SSSRIs you received for your anxiety.

Guest wrote:

“Kitty Kat,

Benzodiazepines are HIGHLY addictive and you should not have been prescribed them as a daily medication for many years. They are quite effective at controlling anxiety, but should not be used as the sole means of doing so. Have you tried cognitive behavioral therapy for your anxiety? It has a good track record. Also, Celexa or Lexapro (pretty much the same drug, but Lexapro has fewer side effects) are better choices than the SSSRIs you received for your anxiety.”

Guest, I’m sure I shouldn’t have been prescribed the benzos to be taken on a daily basis for all these years, but I was, by a doctor.

I thank you for trying to help, but according to the Lexapro website, both it and Celexa ARE SSRI’s.

http://www.lexapro.com/home/default.asp

kitty kat

Again, we see that the problems with medication may not be directly related to the medication per se, but in how they are being used. The benzo family of drugs were a great improvement over the previous generation of drugs which were more addictive and had greater risk of side effects than benzos have. Klonopin represents an improvement over valium (both in the benzo family) because the klonopin does not have the same degree of intoxication that valium has.

Benzos however are still highly addictive, both psychologically and physically. Patients find that dosages have to be increased over time as you the original dosage can soon lose its effectiveness. Abruptly stopping this medication is associated with a very high risk of convulsions and can actually lead to death.

The pharmas cover their fannies on this by stating clearly in the PDR that patients need to be closely monitored for the signs of the onset of addiction. Too many psychiatrists and physicians do not do their job properly in this regard. You also cannot rely upon patients who have serious problems with anxiety, panic disorder, PTSD or depression to have the inner strength needed to kick a habit (we see this same phenom occur with addicts of other substances; addiction can only be “cured” when the patient comes to the realization that they have to do it, and can receive proper support from therapists, family and friends to do so.)

This is not a new phenomena either. I believe Mick & Co had a Top 40 hit about this very subject all the way back in 1966.

I am not anti-medication, but I do think that we as a society need to better understand what we are experiencing with this. I think the incentive to take corrective actions for those aspects that need it needs to be supported by our Federal regulators and our state officials who do the licensing of practitioners. We cannot assume the pharmas will take any action which will cut sales or that practitioneers will begin any corrective measures which could lead to litigation against them.

[quote=”Anonymous”]Guest wrote:

“Kitty Kat,

I thank you for trying to help, but according to the Lexapro website, both it and Celexa ARE SSRI’s.

http://www.lexapro.com/home/default.asp

kitty kat[/quote]

Yes, of course they are SSRIs. Perhaps I should have clearly stated as much. The point is that they are SSRIs that have a good track record at treating panic attacks and (especially in the case of Lexapro) have far fewer side effects than the SSRIs you have been prescribed.

I think it’s a little strange that there’s such a strong aversion to electroshock therapy and the same isn’t tagged onto awfully potent meds. (Then again, I saw the “Head on a Post” episode of The Rockford Files a few times and it perhaps had the same effect as the abuse of electrosock therapy has had on otehrs). In either case, we’re talking about very dangerous stuff, not to be taken lightly… but then, the conditions they are helping are also very dangerous and not to be taken lightly.
And p’raps it’s my general inability to automatically respect any given authority figure (and, in fact, to consider them more suspect because of the power that “authority figure” types ave), but I am also deeply aggravated by the incredible meds push from the medical/pharmaceutical professions (it’s the toenail fungus one that really grabs me… side effects a mile long — but heaven forfend that I should live with a discolored toenail! SOrry, that’s SICK. I’m sure there’s a med out there to assuage anxiety about one’s appearance that we could take instead.) And I’m annoyed that Mick & Co haven’t re-released that little ditty… when I hear it, it sounds like prophecy.

Funny you should mention the toenail fungus drug! I have seen this ad a number of times— you know side effects are SERIOUS! Liver damage, etc etc. Yikes I’m thinking who would take this stuff?! Yep there does indeed need to be a benefits/ risk analysis. I think it bizarre to let that drug on the market when the benefits/ risk analysis must weigh heavily on the risk side.

I think it would be wise to take the benefit risk analysis in each medication given.

As for shock therapy? I’m sure what gave it the really bad name was the movies. I think it sounds rather nasty as well. (not that I have directly heard anything so good about it either).

—des

Sue - The Stones actually have re-released, just not as a single. It has been on two live albums (albums? can you tell I am old?) since it first came out, hoever it does not get much airtime in any version these days because the structure of the song is too dated (it does pop up frequently on “electric lunch” type radio programs that specialize in playing classics from the mid 60’s thru mid 70’s). And to think Mick penned those words when Lithium was the drug of choice and valium was just being introdiced,and the number of people (women) taking it was a fraction of the people (women) taking benzos today…

On electro shock…

While I agree that it is a disturbing concept, it has shown to be effective on problems like depression and alcoholism, and people who have undergone the procedure have overwhelmingly been happy with the results and have willingly gone for further applications. The movies have indeed given it a bad name by portraying it as a punishment in graphic detail (Cuckoo’s Nest is probably the most well known). I do not advocate this procedure per se, but just suggest that alternatives to “chemical shock” are out there. The main side effect from elctroshcok has been memory loss, however this can happen with medications too (we don’t really know the rate of adverse reactions because of the tendancy of the pharmas to conceal the downside and refuse to fund groups who would publish full disclosure).

More recent developments in elctroshock involve treting seizure disorder which does not respond to medication with very low voltage magnetic fields (no more dangerous than MRI) and also by determining which area of the brain is responsible for triggering the seizure and using precision shock to seer that area. Both have had good intitial results, although there is yet to be enough followup to make the efficacy/safety determinations.

Again, I mention them not to push their use, but to suggest that alternatives to our current mass use of powerful chemicals are out there. We need to dedicate more research dollars into alternative therapies, and pharmas bottom line profits be damned! Regardless of the success of medications in some, there are large numbers of people who experience the opposite (6% of healthy tests adults have psychotic episodes from Prozac, 4% have induced depression from Paxil, 6-10% of teens taking Paxil attempted suicide). We do not know how many people taking neuroleptics, SSRI’s and other medications (billions are spent each year on buying these drugs, so even a small adverse rate will mean a great many people).

I think a better way to gauge the risk/benefit ration, and perhaps to get enough information to better determine who should NOT take them would be to remove the voluntary patronage of NIH/FDA testing and instead levy taxes that will create equal levels of spending. When you remove teeconomic arm-twisting the pharmas current have over our regulators, you will get more honest reporting, better designed studies to address concerns, and less money wasted on irrelevant topics.

Hi Sue,

Great example. I was offered that “wonderful” medicine but like you, I chose to live with that ugly looking toenail. That made alot more sense to me than adding another medication and dealing with god knows what in side effects. I was already taking stimulant and antidepressant medication.

PT

Hi Dad,

You make some good points but it is my understanding that alot of people who undergo electric shock therapy still have to continue with antidepressant medication.

Because I have various LDs and ADHD, I would would definitely worry about the memory side effect. But you did make an excellent point about medications causing this and I have been meaning to ask my doctor about this possibility. Maybe what I am experiencing are middle aged moments complicated by having LD/ADHD but I still wonder. Anyway, thanks for your reminder even though I know you had no idea I needed one<g>.

PT

Hi Kitty Kat,

As a med veteran who has only had limited success with SSRIs, I definitely know exactly what you’re saying. Man, you’re bringing back some painful memories unintentionally as I felt after one day, that Luvox was parallising my brain. Lexepro caused a severe panic attack at 5mg. No, I am not manic depressive but simply someone who seems to be in the 1% side effect category. Zoloft did work for about a year and a half before it started causing problems.

What I experienced before convincing my doctor of my point of view is that they are all hooked on the theory that SSRIs should be the first option. Actually, I understand where they are coming from and probably for alot of people, that makes sense. The problem I have is when it is obvious that they are disasters as they appear to be for you and I is getting them to think outside the box.

Out of desperation one day, I tried St. Johns Wort and overall, I felt it worked the best and the therapist I was seeing, agreed with me. My doctor knows what I am doing by the way and as long I feel it is helpful, he supports me.

Unfortunately, I am beginning to wonder if it is really helping that much. But because of my past experiences with meds, I am very reluctant to change. Because I had previously convinced my doctor that perhaps I should try a tricyclic, he has said that if I feel a need to switch from St. Johns Wort, it would either be Norpramin or Desiprimine.
That thought scares me to be honest but stay tuned.

In your own situation, what about Wellbutrin? Also, if you’re feeling bold, you might want to try St. Johns Wort on your own. Of course, please research throughly the drug interactions. If you have been on Prozac, it takes several weeks before it completely clears your system.

I am not a medical professional so check with your doctor. If you feel he/she is not willing to be flexible, you might want to consider someone else. I went through 7 of them in 95 before I settled on the person I still have.

Good luck and let me know if you need anything else.

PT

PT -

I have not done the depth of research into depression and anxiety that I have done on some similar topics, so I do not wish to come across as an expert in this. I see some parallels between the approach currently being used with depression and the approach being used with other conditions of the mind tho, and I think that they are very similar in how they are done.

Electroshock as it is used today is reserved (and probably rightly so) for extreme cases of depression which do not respond well to antidepressant medication. It is almost certain that these patients have been on these medications for quite some time, and as they build dependancy (psychological or physical is not the relevant issue, the dependancy is) it is unlikely that these patients would just cease to use any medication they were on just because they were undergoing electroshock, yes?

Good luck to you PT and I hope that you find your dr. is receptive to your quetions.

Hi PT,

OMG, finally someone who sounds like they might understand me! I’m sorry for unintentionally bringing back any bad memories for you.

I tries St. John’s wort a couple of times, and it didn’t seem to do much for me. I may try it again. I also tried Kava Kava, even though I understand if misused, it can damage the liver. It helped a little bit, but so far, in my experience, in my life, in my shoes, the only thing that has ever truly helped my panic and anxiety were the benzos. Sorry if that isn’t PC for some of you readers. It does happen to be the truth, however.

kitty kat

Hi Dad,

<<Electroshock as it is used today is reserved (and probably rightly so) for extreme cases of depression which do not respond well to antidepressant medication. It is almost certain that these patients have been on these medications for quite some time, and as they build dependancy (psychological or physical is not the relevant issue, the dependancy is) it is unlikely that these patients would just cease to use any medication they were on just because they were undergoing electroshock, yes?>>

I am not a doctor so keep that in mind but it is my understanding that they can’t even go off the meds eventually even in spite of electric shock therapy. You have a point as how do you know what it is the dependancy vs. the need? But I guess if someone is that severely depressed, it is kind of hard to tell.

<<Good luck to you PT and I hope that you find your dr. is receptive to your quetions.>>

Thanks! He had better be or there will be h— to pay:)).

PT

Kitty Kat,

If benzos help, they help. Of course, getting doctors to prescribe them is another issue.

Try out various forms of St. Johns Wort as they aren’t all the same. I hear Nature’s Way Perika is good which I am going to probably try next.

I forgot what you said about triclyclics but a low dose can be helpful with panic and anxiety.

Hey, it is good you reminded me about the fun I have had with SSRIs so I remember not to get sucked into taking them again. Interestingly, I took the Amen online brain tests and the results indicated I needed an SSRI. I don’t think so.

Also, on a related note, and I can’t remember if this has been discussed but one reason for so many side effects are that doctors start many patients, particularly women at too high of a dose. My psychiatrist finally learned I needed a lower starting dose but I am not sure other doctors are aware of this situation..

PT

I was just re-reading through this thread, and this caught my eye. I’m surprised it didn’t leap out at me before.

Dad wrote:

“Again, we see that the problems with medication may not be directly related to the medication per se, but in how they are being used. The benzo family of drugs were a great improvement over the previous generation of drugs which were more addictive and had greater risk of side effects than benzos have. Klonopin represents an improvement over valium (both in the benzo family) because the klonopin does not have the same degree of intoxication that valium has.”

Sorry, Dad, but this is not an accurate statement. If the patient truly DOES have a panic or anxiety disorder, one does not become “intoxicated” by ANY of the benzodiazapines, taken at the proper dosage prescribed by the patients physician. And by the way, the best benzos for anxiety by far are Xanax and Ativan, NOT Valiun or Klonopin.

Yes, the benzos are indeed addictive, but the last time I looked around, this is not a perfect world. In a perfect world we would not need these meds, for we would not have these so very debilitating and quality-of-life destroying disorders that need to be, and should be, treated.

“I have not done the depth of research into depression and anxiety that I have done on some similar topics, so I do not wish to come across as an expert in this. ”

Not to worry, Dad, you haven’t come across as an expert, at least, not on this topic. I do not say this to annoy or disrespect you, nor to start an argument, because in many of your posts I have read, you sound very knowledgable and intelligent.

kitty kat

Kitty -

Not to pick a fight, but I believe that you have misundertsood what I had said…

I do not disbelieve that taken at proper dosage benzos are intoxicating. However, that is the point that I was making, that some patients were given these in dosages that were in excess of their need. Individual chemistry can very greatly between patients and what works well for one may have unwarranted side effects in another.

The information I had read about klonopin vs valium had been presented by developers of klonopin, was perhaps less than ingenuous (sometimes it can be hard to distinguish what is factual, scientifically based information and whatis marketing, yes?) I tried to google it up, but came up blank. I did find some other useful information though:

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682047.html

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682279.html

I am more than a little shocked that the makers of these drugs, with the full support of our Federal overseers suggest that you should not take either in excess of 4 months because of the addictive nature of benzos. Why then would any dr. or psyche allow patients to be on them for YEARS? Again, problems with these medications may well be in application more so than strictly with the drug in question.

As far as comparing Valium to Klonopin, valium has a much longer effect in the body (valium’s blood halflife > 7 days vs. klonopin’s blood halflife < 2 days) which may add to a cumulative intoxication effect in valium that klonopin does not present.

Question for you Kitty… If xanax is the best one in your experience, why won’t the dr. prescibe it for you instead of klonopin?

Here is another interesting site that may be of some help:

http://www.benzo.org.uk/ashvtaper.htm

http://brain.hastypastry.net/forums/forumdisplay.php?f=3

http://www.geocities.com/benzowebsites/

Good luck to you Kitty.

Dad wrote:

“Question for you Kitty… If xanax is the best one in your experience, why won’t the dr. prescibe it for you instead of klonopin? ”

I do not believe I said I was taking Klonopin, or that my doctor will not prescribe Xanax for me??? I did say that I was prescribed benzos for 15 years or so, beginning in the mid-80’s. And for the record, the best benzodiazapine ever prescribed for me for MY anxiety was Ativan, not Xanax. I did say that my doctor has been pushing the SSRI’s on me for years, and I did list Zoloft, Luvox and Prozac as the SSRI’s I’ve tried, with adverse side effects, and very little, if any, help.

If the question was SUPPOSED to be, Xanax vs. Klonopin, Xanax has a comparatively short half-life, I believe it is only a few hours, maybe only 4 to 6. Klonopin’s half-life is approximately 18 to 50 hours, while Valium’s is about 200 hours.

This is what I have posted on this board:

“I am not an LD child or adult, but have been taking the benzodiazipines for many years, for my severe, debilitating anxiety and panic attacks. I was prescribed the benzos for the first in the mid-80’s, when they were the *popular* drug of choice for doctors to prescribe, for these VERY REAL disabling, quality of life-destroying problems.

Since then, 15 years or so later, I have a different docter (I moved), and he has pressured me non-stop for the last few years to switch to the SSRI’s. I had tried the SSRI’s before, and have had adverse reactions to them, and told the doctor so. In fact, I had begun to feel like a human guinea pig, trying this and that, when in reality, the benzos were the only medication that seemed to help me. Adverse reactions to the SSRI’s were: Extreme fatigue, zombie-like state, i.e. not giving a care about anything, being unable to cry, even when I felt I NEEDED to, and feeling like I was in a fog/depersonalization. Call me narcissistic, but I rather like my personality, and it was all but gone. Also absolutely no sex drive at all, it’s like my genitals (sorry) are numb. Also, some short-term memory loss. How to describe? I sit down at the computer, then can’t remember what I was going to do. It’s frightening.

About 4 months ago, in a severe depression, I did finally cave in, and agree to go on the SSRI’s again. I was so depressed I was weeping in his office uncontrollably. My doctor was pleased. I am up to 20mg of Prozac per day now, and am now experiencing the exact same adverse reactions I had before. They swiftly came back again. I have to say, during the first 6 weeks on Prozac this time, I did have more energy, but not anymore. Now I am having a great deal of difficulty getting out of bed at all, and need at least one nap during the day, for the accompanying fatigue.

Which SSRI’s have I tried in my lifetime? Zoloft, Luvox, and Prozac twice. I want to give up on the SSRI’s again, as they are NOT helping, but now I doubt my doctor will agree.”

I also posted this:

“OMG, finally someone who sounds like they might understand me! I’m sorry for unintentionally bringing back any bad memories for you.

I tries St. John’s wort a couple of times, and it didn’t seem to do much for me. I may try it again. I also tried Kava Kava, even though I understand if misused, it can damage the liver. It helped a little bit, but so far, in my experience, in my life, in my shoes, the only thing that has ever truly helped my panic and anxiety were the benzos. Sorry if that isn’t PC for some of you readers. It does happen to be the truth, however.

kitty kat”

Dad wrote:

“I am more than a little shocked that the makers of these drugs, with the full support of our Federal overseers suggest that you should not take either in excess of 4 months because of the addictive nature of benzos. Why then would any dr. or psyche allow patients to be on them for YEARS? Again, problems with these medications may well be in application more so than strictly with the drug in question. ”

I agree with you. I find it shocking too. Why DID a doctor, and then 3 subsequent ones, keep me on the benzos for years, and STILL DO? I don’t have an answer to that question, except that perhaps it could be because the benzos worked for me, and the other meds they tried to push on me just DIDN’T work.

I’ll tell you what does un-nerve me, Dad…how easy it is to buy these meds online nowadays. I saw ads for the benzos all over the internet when I was looking for information.

kitty kat

That was me above.

Here’s a link on panic disorder.

http://www.algy.com/pdi/FAQ/cluster.html

I too came up short trying to google up info on Klonopin vs. Xanax.

kitty kat

My understanding of Klonopin vs. Xanax is the same as Dad’s. I believe the addictive potential is decreased with Klonopin. Btw, I have been on Klonopin for about ten years or so for seizures, as an adjunct to the regular seizure drug, Tegretol. I have been on it for years and the dose was only increased once in something like 15 years or so— years ago.

I have also heard of two people in the same psyche ward taking Xanax taking EXACTLY the same dose. One is taking it for panic attacks and another on it and addicted. The worrisome thing is that the therapeutic dose and addictive dose appear to be identical. No doubt I could not go off Klonopin too easily (one element of addiction) but at least there seems minimal risk that I will have other addiction type problems. I think you could not say the same re: Xanax.

—des

Not meaning to be accusatory or anything, so don’t take this the wrong way, but…

I wonder what taking Benzos or SSRI’s really does do to the unborn. They have to be shared with the fetus in the same manner that other drugs and substances are. Has anyone ever read a really good study that compares large numbers of women taking these drugs to see if they have higher rates of children with either birth defects or neurological problems? I can’t help but wonder if that doesn’t have some hand in the 200% increase in ADHD and the 300% increase in LD’s over the last 30 years.

(And not to sound toooooo paranoid or cynical, but I tend to be highly skeptical of any study funded fully by the business which stands to profit by proving its product is “perfectly safe”.)

Dad — you are asking a real can’t win question here.

On the one hand, it is highly illegal, immoral, and unethical to experiment on pregnant women and fetuses. So absolutely no drug tests are planned to include pregnant women, in fact they are specifically excluded. For many years scientists got around this by testing only men. Well, since drugs may react differently on women and fetuses — as always, remember thalidomide — that system is out. Now drug tests include some women, but they have to be using at least one and sometimes two birth control methods, and you are getting information on drugs plus birth control and still not on fetuses.

Scientists do tests on pregnant rats and that spots really outstanding problems, but not all of them. Thalidomide unfortunately did not seem to affect rats.

Because of my allergies, I read the PDR (Physician’s Desk Reference) religiously. Almost all drugs have a warning of “effects unknown” in pregnant women, because there is no way to test safely.

OK, now suppose you have a woman whose life has been saved by modern medications. If she goes off them, she may have severe seizures (or whatever) and die, or have a reaction that will damage the fetus even worse. In many cases, doctors suggest avoiding pregnancy. But it happens. Birth-control fails, people fall deeply in love and want their genetically own child, and so on. Now what? Some mothers drop their medications and take the risks, some go to the lowest dose possible, some take the medication and just pray, and some have abortions. How can you possibly advise a person in this situation? There just isn’t any easy answer.

One example: a friend of mine with two lovely kids. She had had her family very late, in her forties, when finally a drug came on the market that prevented miscarriages. When her kids were in grade school, the news came out that this drug caused reproductive abnormalities, including cancers, in the children. She was of course frightened and distressed and feeling very guilty. I told her that she could not have predicted the future so there was no point in feeling guilty, and the only thing to do was to ensure that the kids had frequent in-depth medical checkups so that anything that went wrong could be caught fast. What else could you do?

As far as increasing numbers, that’s a big question and a trade-off. Remember that infant mortality was over 50% until a century ago and still is in some places, and a lot of handicapped kids just didn’t make it. Remember also the epidemic number of kids whose brains were damaged by German measles and whose limbs were damaged by polio, up to and including my youth.
Speculation is very tricky stuff.

I really have to agree with Victoria on this one. No one can possibly expect experiments to be done on pregnant women, and/or God forbid, their fetuses. There are no acceptable answers and no acceptable studies that have been carved in stone, and every single *individual* case is unique, and needs to be treated differently. We can’t all be lumped together like a “herd”.

No study has ever proven that the benzodiazepines have actually caused birth defects; however, nor have birth defects (such as cleft palate) allegedly caused by benzodiazepines ever been disproven. There just isn’t enough information, not enough proof, even after all these years of the widespread use of the benzos. Google this topic, and you won’t find proof. Just differing opinions and ceaseless debating.

Here is what I was told during my pregnancy. Well, first, let me say that I didn’t think I would ever have the beautiful experience of having a child of my own, in my lifetime. It was recommended by my pysch to NOT go off the benzos, because of my panic disorder and anxiety. It was heartbreaking, but I had pretty much resigned myself to the fact that I couldn’t have children.

Then I found myself pregnant when I was thirty-one years old. I didn’t know what to do. One psychiatrist actually told me straight out I should have an abortion. I called my primary psych, literally in tears after that, begging him for help. My psych sent me straight away to a different FEMALE psychiatrist, who was kind and gentle, and who followed my benzo script, and she and my FEMALE OB/GYN, who knew from the outset I was on a relatively low dosage of a benzo (3 mgs per day), and I, stayed in constant contact throughout my entire pregnancy.

I went to Barnes and Noble and bought that huge PDR, and read it religiously, as you did, Victoria. I made it my mission in life to find out for myself ALL there was to know about the benzo I was taking, and the possibility of birth defects to my unborn child. I did not leave myself and my child blindly and ignorantly in the hands of doctors, no matter how good their reputations were.

Worst case scenario, according to my psychiatrist and OB/GYN? That my child could be born dependent on the benzo, and in that event, they would wean her in the hospital, and they said that would only take a few days. Still, this caused me many sleepless nights of worry and guilt regarding my unborn child. You see, it isn’t black and white with this particular issue, there is so much grey area. I have feelings, because I’m a human being, a woman, and now a mother, and not a human incubator. After finding out I was pregnant, abortion was NOT an option for me, when there just weren’t any concrete negative studies.

What my psychiatrist and my OB/GYN agreed upon, was that it would have been far more dangerous to the fetus to have me off the benzo than to be on it. And no, I didn’t have to search high and low to find doctors who were of this thinking/mindset, and who would help me. It took one afternoon, and this was the early nineties.

Dad wrote: “I wonder what taking Benzos or SSRI’s really does do to the unborn. ”

So do I, Dad, and absolutely I did during my pregnancy. I do know that I took impeccably good care of myself during my pregnancy, and tried to the best of my abilities to do everything “right”. No alcohol, not one drop, I don’t smoke anyway, cut way back on the caffeine, etc., and I ate well even when the very thought of food sickened me. I felt like I was walking on eggshells most of the time, terrified that I would miscarry. I remember sliding on the ice and falling on the way to work one day, when I was about 4 months pregnant, and my boss consoling me when I reached work, and sending me home in a taxi for the day.

Long story short, my daughter was born healthy. She had no cleft palate, was not underweight nor a preemie, even though she was born early, and she did NOT have to be weened from the benzo. Neither did my second child, who I gave birth to 2 years later.

Neither of them have suffered any birth defects or learning disabilities. On the contrary, they are intelligent, talented, and even considered “gifted” (BOTH of them).

Was I lucky? Oh YES! I’m blessed to have two beautiful children. But was I just lucky? Maybe. Probably. Who knows. I don’t. And neither does anyone else.

And there’s your answer. We just DON’T KNOW. So please try not to judge me, just because I have to take a med that I wish to God I didn’t have to take.

kitty kat

Believe me, I am not judging any mother in this forum or any other. I will however reserve the right to question the assertations of for profit ventures such as Lilly as well as Federal regulators who may at best scenario be asleep at the switch, and at worst on the take.

I do not suggest ever experimenting upon pregnant women. We can however collect and collate data on the grand experiment that has been going on in this country for the last 40+ years. We as a nation consume the overwhelming majority of the world’s production of psychotropic medications, children as young as 2 and women of child bearing age (some some children are taking them as they begin life).

Kitty, I find it incredibly unbelievable that a psyche and OB would suggest that a medication that takes months, maybe longer than a year for an adult to wean off of would not be a problem for a newborn for more than a few days. That is completely an indefensible supposition. We have seen kids whose mothers used crack, heroin or heavy alcohol consumption that have long periods of withdrawal, sometimes needing treatment, and are left with lasting neurological problems. I will grant that benzos are not in the same class as smack, but they do alter the brain’s chemistry (the reason that they create dependancy is that they do so).

I also am troubled that a different psyche would immediately suggest abortion. What did that dr. know?

As I said, I am not judging any individual here. It cannot be left up to the patient to know all the dangers of their treatment. That is why THEY are the highly paid drs. Kitty I am glad that your children were born healthy. Perhaps you have a stronger constitution than you think and passed that along to them. Perhaps you were just lucky.

Absense of hard data is not the same thing as prrof something does not occur. On the contrary it is proof that someone who should be asking these questions has their head in the sand (I find a direct parallel to the thimerosal issue, where the closed door meeting at Simpsonwood when the issue was brought before IOM persons by the CDC ellicited not “we have to get to the bottom of this” but rather “this is going to look bad that we missed this”).

Thalidomide is a very good example Victoria. Never tested, widely used in England for morning sickness, it spurred a rash of horrifying birth defects that could not be denied. This is doubly tragic because thalidomide is actually a very good drug for treating specific forms of cancer, and is actually making a comeback in that regard (with the stipulation that any women who take it be beyond child-bearing either by age or by surgery).

An ugly choice for the mother indeed… Face withdrawal, potential life-threatening convulsions, a return of the panic or depression, or roll the dice on her child’s health. And all the while the FDA refuses to study the issue, the drs and psyches expand off-label uses and Lilly and friends post record high profit sharing for their stockholders…

I think that it is a question that should be answered, unpleasant as it may be to deal with. We have to know if the medication which increases the quality of life in one is reducing the quality of life in another. I shouldn’t think it would be too difficult to do (although I will wager a month’s pay that there will be opposition to a serious concerted effort to answer the question).

We have a very good idea what the rate of various LD’s and behavioral issues are in this country (give or take a couple percentage points). We should pick 5 localities, say 2 cities, 2 suburban areas and a large chunk of smalltown rural America. Survey a large chunk of the women who are taking these medications to see how many of them have children receiving Sped services.

We have a good idea how many women are taking these drugs as well. We could take the same types of areas and survey all the children receiving Sped services and see how many of their mothers were taking them while they were pregnant.

In either case, if the percentage of “hits” is more than double the rate of control (societal average), we will have our answer. We can’t ignore the issue regardless at how unpleasant the cgoices are. Should it turn out their is no correlation, then we will have settled the matter and we can set our minds to rest on it. But if it comes back their is a correlation I believe their will be some people in Washington who should get the axe from their well compensated positions, and I also believe that those who have profited from the prescriptions need to be the ones who are funding the remediation programs needed to undo the harm they have caused with their carelessness.

Sped services are grossly underfunded, by the Feds and the States. Parents are forced to fight for every small scrap of service they get, and the schools are in the impossible position of being told they must provide programming that they do not have any money to impliment. These are billion dollar drugs we are talking about. What could we accomplish in Sped if we had billions more to spend on it?

Dad wrote:

“Kitty, I find it incredibly unbelievable that a psyche and OB would suggest that a medication that takes months, maybe longer than a year for an adult to wean off of would not be a problem for a newborn for more than a few days. That is completely an indefensible supposition. ”

Neither of my babies needed to be weaned off the medication that I, not the fetus(es), was taking. It was 3 mgs of Xanax for the duration of both pregnancies. And that is the truth, I swear it. The docs were fully prepared to wean the babies, if it were necessary, but it wasn’t.

“We have seen kids whose mothers used crack, heroin or heavy alcohol consumption that have long periods of withdrawal, sometimes needing treatment, and are left with lasting neurological problems. I will grant that benzos are not in the same class as smack, but they do alter the brain’s chemistry (the reason that they create dependancy is that they do so). ”

Obviously I was NOT taking anything that remotely resembled “smack” or crack. It was Xanax. And I have said, I did not drink alcohol at all during my pregnancies, either of them.

Xanax isn’t “smack”. Xanax isn’t crack. Xanax isn’t heavy consumption of alcohol.

“I also am troubled that a different psyche would immediately suggest abortion. What did that dr. know? ”

The quack psychiatrist who suggested abortion to me, was the very first pysch who prescribed the benzos for me in the first place. I was highly distressed to say the least by his immediate suggestion of abortion, and as I said, consulted my pyschologist/therapist, who is by the way, FANTASTIC, and he right away recommended a different psychiatrist to follow my Xanax script. What did that first doctor know? Obviously, not much. But this quack did do that. He told me I should have an abortion. I looked at my beautiful little girl tonight, the best thing I have ever accomplished in my life, my reason for living, after I typed my post of earlier, and do you have any IDEA how thankful I am I was STRONG enough NOT to take his advice?

“Kitty I am glad that your children were born healthy. Perhaps you have a stronger constitution than you think and passed that along to them. Perhaps you were just lucky. ”

I’m glad they were born healthy too, obviously. And maybe I WAS just lucky. But as I said before, we don’t know.

kitty kat

It took me some time, but I did find some bits of info on Alprazolam (Xanax), pregnancy and breastfeeding.

For what it’s worth:

http://www.fetal-exposure.org/BENZOUPDATE.html

“Initial concern regarding BZD exposure in pregnancy arose because they act upon GABA receptors; GABA is an amino acid neurotransmitter that may be related to palatal development (Kellogg, 1988). Early studies on Valium (diazepam), a commonly prescribed BZD, showed an increased risk for oral clefting in both animals (Zimmerman, 1984) and in retrospective and case-control studies in humans (Saxon and Saxen, 1975; Safra and Oakley, 1975). This has, however, been contradicted by several recent prospective and case-controlled studies and a meta-analysis that all uniformly found no association between diazepam use and clefting (Altshuler et al., 1996; Bracken, 1986; Czeizel, 1988; Ornoy et al., 1998; Pastuszak et al., 1994; Rosenberg et al., 1983; Shiono and Mills, 1984). In recent years, several prospective studies have addressed the potential teratogenicity of multiple BZDs. The association between BZDs and clefting, and birth defects in general, remains unclear, and it will be reviewed in more detail in this RISK//NEWSLETTER. BZDs were reviewed in the September, 1995 (RISK//NEWSLETTER 4(2)); this newsletter serves as an adjunct to that issue. ”

“Reproductive Data on Specific BZDs

Alprazolam (Xanax)

Several human studies exist on alprazolam exposure in pregnancy. Postmarketing research of 411 women with first trimester exposure to alprazolam did not suggest an increased frequency of malformations (St. Clair et al., 1992). Separate prospective studies of 133 and 149 women, respectively, found no increased risk of malformations nor any pattern to the malformations described (Johnson et al., 1995; Ornoy, 1998). Neonatal withdrawal symptoms have been noted after exposure to alprazolam in late pregnancy (Barry and St.Clair, 1987) and breast-feeding (Anderson and McGuire, 1989). Alprazolam has a relatively short half-life (<12 hours) compared to other BZDs.”

and…

http://www.perinatology.com/exposures/druglist.htm#Alprazolam

“Alprazolam (Xanax)
Antianxiety, Benzodiazepine
CATEGORY: D
No data on placental passage . However, benzodiazepines as a class freely cross the placenta and may accumulate in the fetus. 1st trimester exposure to alprazolam specifically in 542 infants, studied prospectively, resulted in no increase in major or minor anomalies, or rates of miscarriage.
BREAST FEEDING: The American Academy of Pediatrics has classified alprazolam as a drug “for which the effect on nursing infants is unknown but may be of concern” [G3].
NEONATAL SIDE EFFECTS:Withdrawal,neonatal flaccidity and respiratory problems at birth. ”

kitty kat

Interesting Kitty…

The studies that you present freely acknowledge the manor in which benzos could be harmful (disruption of the GABA formation process), that they cross placenta barrier with ease AND accumulate in the developing child, and that they pass in breastmilk. Also, withdrawal has been noted in newborns both from birth and from addiction due to breastfeeding. Considering how hard it is for an adult to break away after even a short period of addiction (< 2 years), I wonder how traumatic it is to a baby who has spent their entire life exposed to them…

When evaluating studies, merely reading an abstract cannot answer enough of the background to determine either the accuracy of the comcluded findings as presented, nor about the structure of the study. For instance, the question of whether or not malformations of the palate are tied to prenatal exposure to benzos is completely irrelevant to the question I presented; CD, ED and LD are not malformations. Additionally, it is quite common for CD to be undiagnosed until the child is 3 yr+, and ED and LD until about 3rd grade, long after any immediate tie-in to obvious signs of benzo dependancy in the child to have passed.

Meta analysis as well cannot answer a new question as they only collate those questions which have previously been asked. And again, depending upon the slant of the person designing the analysis, the same datasets can a question in two separate ways that contradict each other (best example of this is the Geier report, which re-collated the dataset ver Straetten used to disprove the thimerosal link to autism and showed that actually the data showed a legally acceptable direct correspondance between the two. Further refinement by teh Geiers showed that the exposure in just a single series of shots, the DPT (w/ thimerosal) and the DTaP (w/o thimerosal) have a 2700% direct causal effect in autism; to put this in perspective, cigarettes have a 2200% causal relationship to cancer in men and an 1800% causal relationship in women).

I find the suggestion that the half-life being so short as being a mitigating factor to be rather questionable. The benzos with short half-lifes are actually harder to kick because of the short half-life, and valium is sometimes used to help people get off of klonopin because the longer half-life makes the risk of cold turkey less. Additionally, taking medications like Xanax two or three times a day would keep the baby in utero or nursing supplied with a steady stream of the substance.

I think the conclusion that ” the effect on nursing infants is unknown but may be of concern” and the statements about the lack of immediately obvious signs of birth defect without mention of neurological effects as the most telling. As I stated before, I think a large scale study is needed to answer the question. Even a relatively small risk of say less than 1% of children adversely affected becomes a significant issue when you start talking about millions of women taking these medications during child bearing years.

And this hasn’t even begun to touch on the additional complicating factor of synergy between the SSRI’s, benzos and the myriad of other medications, substances, toxins and biological products we may add to the mix. Synergy plays a significant factor in the estimated 150,000 deaths that occur each year just in prescription medication deaths occuring in hospitals (all told legal drugs kill about 10 Americans for every American killed by illegal drugs).

In the words of that great American poet Mr. Horse, “No Sir, I don’t like it.”

Dad,

My concern about the current discussion is that according to Dr. Valerie Ruskin, MD, pregnant women with psychiatric issues already put off treatment way longer than they should. I know you’re not doing this but the last we need is pregnant women with mental health disorders feeling feeling guilty because after weighing all the risks, the best option might still be the meds.,

As an FYI, everyone might want to check out the book she has written called “When Words Aren’t Enough” . When I was having a very unusual reaction to meds that both my internist and psychiatrist could not figure out, this book answered the question as to why I was having problems.

The book does have a section on pregnancy and it is very non judgmental but sticks to the facts. I just reread it very quickly and my attention is waning so bear with me. Dr Raskind does say that alot of obgyns and psychiatrists are not very knowledgeable about pregnancy and mental health issues.

Also, she mentions that an aspirin can be quite risky while tyroid hormone may be safe. So obviously, the psych drugs aren’t only culprits.

Kitty Kat, I am inferring from what I just read, that Dr. Raskin would have tried you on a low dose trycyclic since they have a longer track record and they work well for panic. She does feel the benzos do carry a greater risk of harming the fetus and says the same thing about mood stabalizers.

With depression, again the tricylics would be her first choice and if an SSRI was necessary, she would go with Prozac. Dad, she pretty much says it is too soon to make a judgment on whether Prozac is harmful or not. But the studies she has seen, say no. I am unclear why she would go with Prozac over the other SSRIs. Maybe because it has a longer track record?

Also, she makes the point that it is hard to really test to see if there is a correlation between a mother taking prozac and LD because obviously, it isn’t ethical to give pregant women the medicine if there isn’t a need. Additionally, while my mother didn’t take meds, she did have a condition which is known to cause LDs. But then again, I have a clear family history of LD/ADHD going back to my grandparents to it is kind of hard to separate things out.

Another excellent point Dr., Raskin makes is that an unmedicated woman can make it through 9 months but then it might be harder to treat her afterwards. Basically, her attitude echos Victoria’s - women on psych drugs are going to get pregnant and it is her job to advise the patient of the risks/benefits with certain options and go from there.

Please understand Dr. Raskin is definitely not a med pusher. But I wanted to post this message in light of the way this discussion was going.

PT

Dad wrote:

“Interesting Kitty…

The studies that you present freely acknowledge the manor in which benzos could be harmful (disruption of the GABA formation process), that they cross placenta barrier with ease AND accumulate in the developing child, and that they pass in breastmilk. Also, withdrawal has been noted in newborns both from birth and from addiction due to breastfeeding. Considering how hard it is for an adult to break away after even a short period of addiction (< 2 years), I wonder how traumatic it is to a baby who has spent their entire life exposed to them…”

Well, number one, Dad, I am not the type to post lies to support my position. Of course I “freely acknowledge” and present info I found to be relevant here. I would post what I saw as the truth, and what I posted was what I found on Google, after much searching.

I have never said the benzos couldn’t be potentially harmful. I certainly didn’t say they were perfectly harmless. I DID say this is not a black and white issue; in fact it is far from it. Do you think it’s black and white, Dad? One must weigh the risks against the benefits, and vice versa, to the mother AND to the child. Quite often, the mother NOT taking the medication is far worse for the unborn child than the mother taking it, and that is what 3 physicians determined was the case during my 2 pregnancies.

I don’t believe my babies were traumatized at birth, nor after. I am speaking from MY OWN EXPERIENCE here, not for the whole world. They were not weaned off the Xanax, nor did they need to be. Neither one of them displayed any signs of withdrawal, and the doctors were specifically looking for that. Can I say that any more clearly? What I said was, that the *possibility* of the babies being born addicted to Xanax DID NOT HAPPEN, in our case. I am not speaking for anyone else. My children were born at a world famous, very reputable hospital, and had they required emergency help at birth, it would have been there STAT. We were all AWARE of the potential for trouble.

My first daughter’s Apgar score was 10 at birth, and 10 five minutes later. It doesn’t get any better than that. My second daughter’s Apgar score was 9 at birth, and 10 five minutes after.

I am not trying to say that it’s a great thing to take benzos while one is pregnant. What I AM saying, is that sometimes it cannot be avoided. I have already posted on this board that I thought I would never be able to have children. Heartbreaking for me, but I didn’t think I had a choice. You read my posts; I know I don’t need to insult your intelligence by recapping them for you.

In my posts, I am not talking about the benzos as a whole. I am referring strictly to Xanax, the med I took while I was pregnant, under the intense scrutiny of my doctors.

A few excerpts from the info I posted on pregnancy and Alprazolam, and only Alprazolam:

—“Several human studies exist on alprazolam exposure in pregnancy. Postmarketing research of 411 women with first trimester exposure to alprazolam did not suggest an increased frequency of malformations (St. Clair et al., 1992). Separate prospective studies of 133 and 149 women, respectively, found no increased risk of malformations nor any pattern to the malformations described (Johnson et al., 1995; Ornoy, 1998).”

—“BREAST FEEDING: The American Academy of Pediatrics has classified alprazolam as a drug “for which the effect on nursing infants is unknown but may be of concern”

—“No data on placental passage.”

—“1st trimester exposure to alprazolam specifically in 542 infants, studied prospectively, resulted in no increase in major or minor anomalies, or rates of miscarriage.”

—“Early studies on Valium (diazepam), a commonly prescribed BZD, showed an increased risk for oral clefting in both animals (Zimmerman, 1984) and in retrospective and case-control studies in humans (Saxon and Saxen, 1975; Safra and Oakley, 1975). This has, however, been contradicted by several recent prospective and case-controlled studies and a meta-analysis that all uniformly found no association between diazepam use and clefting (Altshuler et al., 1996; Bracken, 1986; Czeizel, 1988; Ornoy et al., 1998; Pastuszak et al., 1994; Rosenberg et al., 1983; Shiono and Mills, 1984). In recent years, several prospective studies have addressed the potential teratogenicity of multiple BZDs. The association between BZDs and clefting, and birth defects in general, remains unclear…”

Number 2, Dad, you’re treading on some potentially dangerous ground when you say things like this:

“Even a relatively small risk of say less than 1% of children adversely affected becomes a significant issue when you start talking about millions of women taking these medications during child bearing years.”

My question to you, Dad, is this: What do you suggest should be done about women of childbearing age with severe anxiety and panic disorders if they do become pregnant? Should they be counseled to abort, as I was? Should they somehow (and I don’t care to speculate how this would be achieved…) be forced to do without the medicine they so desperately need? Death could ensue, as you know, and then the fetus would die as well, yes? What will that solve? Or, should women who have a lifelong history of anxiety and panic disorders who take medications on a daily basis, and more than likely will continue to do so simply be sterilized, so they can continue with their medication therapy, without the worry of a possible pregnancy?

Dad wrote:

“…the question of whether or not malformations of the palate are tied to prenatal exposure to benzos is completely irrelevant to the question I presented; CD, ED and LD are not malformations.”

The only risks I have ever read regarding Alprazolam and pregnancy are the ones I “freely acknowledged” in my previous post. And as I said before, I made it my mission in life to find out all I could about the medication I was taking, and all the possible problems that could occur in the beginning of my first pregnancy. Of course, that doesn’t mean other possibilities aren’t out there, such as LD’s, ADHD, Autism, etc. But a case like that has never been documented, to my knowledge, that remotely related to use of the BENZOS.

I am not an evil, selfish woman, who didn’t care about my unborn child. Quite the contrary. There were just no easy answers; to some questions, no answers at all, and I did the best I could. And today, I thank God and my lucky stars I trusted my own instincts, and did not abort my daughter.

kitty kat