Posted by Geezer on February 27, 2002, at 11:30:39
In reply to Are SSRIs and MAOIs equally effective?, posted by Else on February 26, 2002, at 22:15:46
> If MAOIs were viewed as more effective than TCAs for the treatment of atypical depression and social phobia before the arrival of Prozac, then why are we comparing new antidepressants to imipramine or, simply placebo. SSRIs may be as effective as TCAs as far as these disorders are concerned but so what? If TCAs are not that effective to begin with, this is completely irrelevant. Is anyone aware of one single study comparing a standard MAOI like Nardil or Parnate with Prozac, Paxil, Zoloft, Remeron, Effexor or any other new drug for that matter, in the treatment of SP and/or Atypical depression? I looked everywhere but I couldn't find anything. Are we putting up with less effective drugs because they don't make GPs (and some pdocs) as nervous? My doctor continues to refuse to give an MAOI a try even though, based on my symptoms, these drugs would probably be the most effective ones. I think I have a right to know. Am I putting up with this "so-so feeling" because there is no alternative or because the alternative is something my doctor is uncomfortable with? I would be very grateful if anyone could provide some information about this.
Hi Elise,
Your post raises one of the most interesting questions I have been struggling with lately. I have searched the internet and read the pharm/psyc books like you and come away with the same question. If I may - just a few thoughts and opinions. Every article I have read states MAOIs are most affective for atypical depression and social phobia. IMHO if that is the CORRECT DX and the ONLY DX then MAOIs are the correct meds to take.....end of discussion. The study comparisons of SSRIs to TCAs and/or placebo is nothing more than a pharmacology "shell game" the results of which are already predetermined by the AMERICAN MODEL for treating depression.....simply stated if serotonin modulation doesn't work your out of luck. You don't mention your DX so I don't want to go off half cocked here.
One experience I had in this regard recently. A pdoc I had seen for many years all but tossed me out of his office and refused to let me make future appoints because I mentioned selegine. His comment: "I gave that to a patient who had been off Prozac for a month and the patient ended up in the ER for 48 hours". Makes me wonder if the patient really was off his Prozac or did he eat a large double cheese pizza and wash it down with a quart of aged ale.
Its just my opinion that American pdocs, at least the ones I have come in contact with, are going to cover there own butt first and keep the lawyers at a distance - if you respond to "safe" serotonin drugs good, if not, your clinical outcome might not be so good. You also have to factor in the influence of the FDA (we would be better off if they were limited to labeling cans of corn in the grocery store), they always disallow the European study results in approving a drug and it's uses for the American market. This is why our brief (yet delayed) in-country studies never show the late complications and side affects of new drugs.
Sorry to wander but you have recognized a problem none of us can change. Keep reading and keep hopeing good drug "availability" will eventually overcome conservative ignorance and beaurocratic dysfunction.
Geezer
poster:Geezer
thread:95651
URL: http://www.dr-bob.org/babble/20020222/msgs/95706.html