Posted by Racer on January 24, 2006, at 12:59:46
In reply to Re: Suicide on Effexor, posted by Devastated Mother on January 23, 2006, at 7:07:59
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> However, I wonder if I have possibly misunderstood the black box. Is the patient expected to warn his/her family about the potential problems? Is this a reasonable expectation from someone who is depressed?And therein lies the rub...
I think the theory is that doctors monitor their most vulnerable patients closely enough to ensure their safety, and let parents or caregivers know that there is some danger during the adjustment phase.
And pigs fly through the air on great multicolored wings.
All I meant is that the FDA has *very* limited means to ensure the safety of people taking these drugs. The Black Box is the strongest thing they have. Beyond that, the doctors who prescribe these drugs are the ones who really have to step in to ensure the safety of their patients.
In a perfect world, there would be a therapist monitoring the patient and coordinating care with the psychiatrist. In the world of HMOs, of course, this doesn't always happen, and pdocs often don't see patients frequently enough during the adjustment phase, and in many cases GPs are prescribing these drugs rather than pdocs. All of those contribute to the problem.
As for why Effexor is not the last resort drug -- and it's not, because there are much more problematic ADs out there -- it's partly because it's generally well tolerated, and it's different from SSRIs. Doctors prescribing antidepressants go through a sort of protocol that starts with SSRIs because they're pretty benign drugs from a medical viewpoint. From there, they'll usually go to the SNRIs, of which there are two: Cymbalta, which is a bit of a disappointment, and Effexor. Effexoer has been around a while, Cymbalta has been out for about a year and a half. Most doctors will go for what they know a bit better first -- hence, Effexor is often a second choice, rather than last choice. How can I call them benign drugs? From a medical viewpoint, they are: no cardiotoxicity, no hypertensive crisis, no hypotension, no known LD50 in many cases, etc. And they tend to be effective for many people, and generally with far fewer side effects than the TCAs or MAOIs. The other newer drugs, Remeron, Wellbutrin, etc, have their own drawbacks, which make them somewhat less popular. So, most doctors will start with SSRIs and go on to Effexor.
I am sorry about your experience.
poster:Racer
thread:601406
URL: http://www.dr-bob.org/babble/20060122/msgs/602362.html