Posted by Else on March 1, 2002, at 19:38:06
In reply to Re: Are SSRIs and MAOIs equally effective?, posted by Geezer on February 27, 2002, at 11:30:39
> > 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.
>
> GeezerHey Geezer,
I don't think doctors should take all the blame although I find it rather questionnable that they had very little trouble prescribing the highly toxic (but usually not deadly) phenothiazines for years but that for some reason MAOIs were as bad as morphine. But I think the real question is: Why aren't these drugs being compared? Let me submit a theory: Glaxo SmithKline produces both Paxil and Parnate while Pfizer (who has recently acquired Parke-Davis, makers of Nardil) acts as though Zoloft is the only antidepressant it is responsible for. No GP in his/her right mind would risk prescribing an MAOI but SSRIs are a piece of cake. It would not be in the best interest of a pharmaceutical company to prove that a relatively inoccuous drug (like, say, Paxil) is less effective than a more problematic one (like Parnate.) What if they ended up confirming that MAOIs are indeed more effective? Can you imagine one of those Paxil/Zoloft-type TV ads for Parnate or Nardil ("Feel like yourself again,(then much faster)Drug A is not for everyone, it may trigger potentially lethal reactions when taken with beer, cheese, wine, cold syrup, coffee and just about everything else you can think of...").
I'm not saying SSRIs are NOT effective, I'm just saying it may be a while before we find out whether these drugs are AS effective as MAOIs. Right now, everybody involved seems satisfied with the vague notion that SSRIs are "probably effective enough". The confusion serves those who may be held liable if things go wrong (doctors for the most part) as well as the companies who produce these drugs that are safe enough to be advertised (and, consequentely, generate much more profit.) As a result, it's not likely they'll want to finance a comparative study. It would be way too risky. It's obvious SSRIs are much easier to market. Drug companies will not risk losing money by puting their cash-cows to the test. But if they don't do it, who will?
(I don't mention my diagnosis because, at this point, I'm really not sure what it is. Right now I am being treated for ADD, Depression (Atypical) and SP. It's just that when I read the profile for good MAOI-responders, I feel like I'm reading about myself: lethargic, hypersomniac, mood reactive and rejection sensitive, suffering from comorbid anxiety disorders (especially social phobia) and histrionic and avoidant personnality traits.)
poster:Else
thread:95651
URL: http://www.dr-bob.org/babble/20020301/msgs/95994.html