Posted by Elizabeth on December 1, 2001, at 14:11:59
In reply to Re: SSRIs and MAOIs for SP, posted by PaulB on November 30, 2001, at 19:11:53
> > Inhibition of MAO probably increases serotonin concentrations to a greater degree than serotonin reuptake blockade does: metabolism of serotonin by MAO accounts for a lot more of the "cleanup" of stray serotonin than does reuptake into cells.
> >
> THATS A GREAT THEORY AND YOU MAY BE RIGHTI think it's more than just a theory: I bet that if we did some research, we could uncover plenty of evidence showing that quite a bit more serotonin is eliminated by metabolism (via MAO) than by reuptake. In any case, there are many reasons to suppose that this is true.
> LET ME GET THIS STRAIGHT. YOUR NOT SAYING FLUOXETINE IS MORE POWERFUL THAN SERTRALINE ALTHOUGH I AGREE SERTRALINE COMPETES WITH CELEXA AND PAXIL. I MAY HAVE MISUNDERSTOOD YOU HERE.
That might be. Try reading it again -- I hope I wasn't too unclear. If there's something there that didn't make sense, please let me know and I will try to clarify it.
The point of what I was trying to say is that "potent" has a specific meaning, and it does not mean the same thing as "effective" or "strong." Saying that Prozac is more "potent" than Zoloft doesn't mean that Prozac is a stronger AD or that it works better than Zoloft; it just means that Prozac works at much smaller *doses*. (A person who feels well on 20 mg of Prozac would probably feel no effect at all from 20 mg of Zoloft, for example, but 50 or 75 mg of Zoloft might work just as well as the 20 mg of Prozac for that person.)
> > > The reason I would prefer to take a SSRI than a MAOI is because of their selectivity which allows them to work for longer.
> >
> Allows them to work for longer? I'm not sure how you came to this conclusion.???
> >
> I TRIED TO EXPLAIN IT BUT COULDNT. WE CAN AGREE TO DIFFER AND THATS OKAY. I WOULD ADD THAT VENLAFAXINE WORKED FOR TWO WEEKS AND PAROXETINE WORKED FOR SEVEN MONTHS SO????.Okay, if I read you right, it sounds like you're saying that you concluded that Paxil's selectivity made its effects last longer than those of Effexor. (Please let me know if I've got it wrong -- I want to help.) There are a couple of problems with this reasoning.
First of all, you can't generalize what happened to you and assume that it says something about what the drug usually does. People have an amazing variety of responses to these drugs, for reasons that we just don't understand yet. So, what happened to you may have nothing to do with what happens for most people. And indeed, your particular situation is not a common one; it's specific to you, and while there is probably someone out there who had a similar experience, it's certainly not the usual result of trying Paxil and Effexor separately. There probably is no "usual result" -- people's response patterns vary so much.
Second, you can't draw the conclusion that the selectivity difference is what made Paxil work for a while while Effexor only seemed to work for two weeks. There are differences between these drugs that we don't know about. For whatever reason, it's possible that Paxil just works better for you than Effexor does.
Also, since Paxil worked for such a brief time (a few months really isn't that long), it's possible that what you were experiencing was a temporary lift in your mood, and not a true drug response. This is actually pretty common. Depression and other long-lasting conditions often get better temporarily (for a few days, a few weeks, or even a few months), and the hope that comes with a new medication can also cause your mood to lift for a while.
The same principle applies to the Effexor, even more so since you said the Effexor worked for only two weeks. Two weeks really isn't long enough to know if an AD is working at all. If you were feeling better in the first two weeks that you were taking Effexor, it probably wasn't due to the Effexor -- it probably was a coincidence. It's likely that what you had was not a true drug response, but a temporary improvement, which may have been contributed to by your and your doctor's hope that the new medicine would work. But again, this doesn't mean that the improvement was a response to the medication.
So, my guess is that, for whatever reason, Effexor didn't work for you. The Paxil may have worked and "pooped out" after a brief time, or it may not have been working at all, either. But again, we don't know *why* this would be, and we don't have any reason to believe that selectivity would cause drugs to work longer. (SSRIs do poop out quite often. So do other types of ADs. There's no evidence that it is less likely to happen with SSRIs.)
> I have recurrant bouts of depression and with Paroxetine I found that the effect lasted much longer than Venlafaxine which is not selective.
Right, but as I've explained, that doesn't mean that selectivity is the reason that Paxil worked longer (or -- and this seems more likely -- that Paxil worked and Effexor did not). Sometimes people don't respond to one SSRI but a different SSRI will work; we don't know why this is, but it is true.
I'd be interested to know what dose of Effexor you were taking and how long you took it, if you can recall.
> YES, YOU KNOW EXPERTS SAY WE THINK THAT THESE PILLS WORK BY INCREASING SEROTONIN, NOREPINEPHRINE AND DOPAMINE BUT WE CANNOT SAY FOR SURE ALTHOUGH I THINK WE ALL KNOW THAT THERE IS MONOAMINE INCREASE THAT EXERTS THE ANTIDEPRESSANT EFFECT.
Well, the monoamine increase causes a cascade of other things to happen. I think researchers believe that it is one (or more) of these indirect effects that causes the relief from depression. One thing that we do know is that the old "monoamine hypothesis" of depression is not the correct explanation -- it used to be thought that depression was caused by inadequate amounts of monoamines, but we now know it's more complicated. How much more complicated, and what the real answer is, nobody knows.
-elizabeth
p.s. Typing in all-caps is usually considered to mean that you're "shouting." I know that's not what you meant by it, but in the future, it'd probably be a good idea to avoid all-caps, so as to prevent misunderstandings.
poster:Elizabeth
thread:85575
URL: http://www.dr-bob.org/babble/20011123/msgs/85744.html