Originally posted by Triangulation
wow. we've got some serious contention up in this board. I love it. Alright, I'll have to find more details to substantiate claims made.
i do agree that baggy was waaaaay outta line though (and i like you a lot dude). i remember when someone likened accupuncture to voodoo and I wanted to tear their heart out. Your beliefs are yours, but don't ridicule others, especially when it comes to the health of people's loved ones. there's no place for that. none.
Back to the success of SSRIs, I'll have to dig around. Anecdotally, it worked for me. We must rememer that the goal of all of this is to alleviate suffering. Once again, there is always a cost for the benefit, but I certainly think the benefit far outweighs the cost. I do remember the whole brooha about paxil withdrawal, but that's why they taper down. Dunno.
But are you guys saying you either wouldn't prescribe SSRIs or youwould preferentially recommend Benzos for depression?
I wasn't ridiculing anyone, all I said was.... well never mind what I said. My comment was misconstrued because there are two conversations going on here. I was addressing the professional thread and I threw in some gallows humor for impact, but I neglected the other thread which involves treating loved ones and some folks got miffed. I apologize. Regarding gallows humor, you run into this in healthcare. Classic examples are ICU nurses talking about bed three swirling the drain or a resident making rounds watering the vegetables. It is a coping mechanism, shop talk, bad news when family overhears...
Variation happens, but that doesn't mean I don't care. Hardly.
A point I am trying to make is that the state of the art sux.
You try to improve the quality of life of an individual by destroying bits of their gray matter. It works and works well in some patients. But at what cost? We don't know why it works because we really don't know what is wrong. Treatment is empiric and result based. ("Take this and see what happens") Don't let them con you otherwise. Remember that there is not a person on the planet that does not have a diagnosis in the DSMIV. According to the model we are all deviant in some manner even if it is abnormally well adjusted (the guys that write the books place themselves in this category). You talk about voodoo magic! But it still doesn't answer why this patient likes to tear the heads off of barbie dolls. Secundum Artum. Psychiatry is more art than science.
The second point I would like to make is don't ignore the minority view. A visiting prof said this when I was a P2. They will beat you bloody with receptor site theory (for example). There are other minority opinions which talk about absorption rates to steady state as an alternative explanation. A theory is a theory but it becomes gospel when you are trying to pass a test. There is a status quo maintained by the powers that be. Anything that conflicts with the paradigm (or the profits) is quashed. So, suddenly, reporting adverse effects secondary to ECT becomes a career threatening act. Finding reliable data on SSRI induced violence would be impossible without the internet and nosey people that won't let well enough alone. Gulf War Syndrome would still be a figment of your imagination without grass roots efforts connecting and comparing notes.
Does this mean ECT and pharmaceutical intervention is evil? No.
When the only tool in your tool chest is a hammer all your problems begin to look like nails. We have much to learn and many will be poorly served while we learn it.
I have a customer who is crazy as a loon. She had a definite manic component talking a mile-a-minute with ideas racing through her head faster than she could verbalize them. When she visited I could count on at least thirty minutes of my time being eaten, but she was delightful with her antics showing me the books she was writting and the artwork she dragged from home. She also had a darker side and it got her into trouble when she attacked and bit the security guard in a local ER. That got her admitted and restrained. They adjusted her medication and she is now unlikely to bite anyone. She is socially acceptable, but they have effectively removed her personality. Chemical lobotomy comes to mind. Her affect is totally flat. The twinkle and the smile are gone replaced with rounded shoulders, a blank stare, and a monotone voice. She is a success story having integrated well back into society. She functions. It is the best we can do....
I didn't go to her for counseling, I went to get drugs. It wasn't just my current problems that plagued me; I remember feeling like that since kindergarten, and I don't feel sorry for myself, but many years of an emotionally abusive marriage pushed me over the edge. 
