Posted by yxibow on September 10, 2006, at 5:04:33
In reply to What's your take, the med and the question JAY?? (nm), posted by qbsbrown on September 9, 2006, at 23:11:35
One really can't evaluate a medication for an entire population of people. Or even an entire population of people suffering from a specific type of depression. Genetics, sex, race, background, environmental effects, placebo response to a substance, will affect outcome. And I haven't even described all possible factors.
I ran across an article a while ago written by a doctor that said if he had to be castaway on an island, what would be the one medication he would bring, and his narrowing down said:
http://www.preskorn.com/columns/9803.html
"...If I were on a desert island and could have only a single medication (an antidepressant) available, my choice would be amitriptyline. My rationale is as follows: A low dose of amitriptyline could be taken for its antihistamine properties if I was exposed to the tropical variant of poison ivy while on the island. A somewhat higher dose of amitriptyline could be taken for its anticholinergic effect, if I inadvertently ate "bad" food and got diarrhea. A somewhat higher dose could be taken for its alpha-1 adrenergic antagonism if I developed hypertension-perhaps from too much salt. Obviously, one could also take it if a depressive episode developed. I could even use amitriptyline, because of its effect on NA+ fast channels, to treat certain types of cardiac arrhythmias. However, too high a dose would carry the risk of a fatal arrhythmia for the same pharmacological reason."
But he goes on to the narrowing of modern medications.
In other words, for some people certain targets work and certain produce nasty results.
For myself, at least as of the moment, while it doesn't cover all breakthrough depression since it is both primary and secondary to the complex at hand, Cymbalta at 120mg provides a palatable substitute for Effexor which is like a epinephrine and caffeine drip at the same time, and is probably the reboxetine that never surfaced in the US.For some it may be a complete placebo -- I can't speak for them -- for others its total agony, I've seen numerous postings of people who split the lowest 20 (or is it 10, I forget) mg capsule into the little pulsules and count them. (Although this is not a good thing for two reasons: one, they're not even, the weight is by the capsule as a whole, and two, this risks chewing the enteric coated pulsules and having an immediate NE and 5HT rush, counter to what is being attempted.)
So is it a panacea, no -- no drug is a panacea, I think that is what you're trying to get at me to say and I can't say that. Because some people have very severe depression and take MAOIs (or RIMAs in other countries). Some have light dysthymia and really only need a small prescription of Zoloft or the like and are content. Some can't stand the current crop of medications and do take tricyclics.
Advertising is just that, advertising. The current wave of antidepressants and their television and newsprint ads will eventually be replaced by the next generation of compounds.
The first antidepressants were MAOIs, discovered by accident because one was being used to treat tuberculosis in the 1950s. They had (and still do) great dangers in their use, although for some they are a life saver. Then came the tricyclics, which had some danger in overdose but were, despite the lethargic nature of some, quite effective. Then SSRIs were discovered, the first to actually not cause liver damage was Prozac, and was the first true marketed SSRI. (Anafranil could be considered an SRI, though a tricyclic).
Inbetween there were tetracyclics (Trazodone, and more recently Remeron.) and stimulant like agents, Wellbutrin. Finally the most recent has been an SNRI, Cymbalta (and previously Effexor, mostly related)What is the next on the horizon ? I don't know -- there are various drugs in II and III stage research, not to mention recycling of old antidepressants or anxiolytics for new purposes (fibromyalgia, e.g.). Valdoxan, a melatonin related drug was refused by EMEA, but not for safety reasons, but lack of provable efficacy.
For now, patients (including myself) will probably find themselves on more than one agent to cover more than one issue, and of course that means more than one side effect, alas.
While I believe in better living through chemistry, it is not the only ingredient in a treatment program. Unfortunately the once a month HMO mode of treatment doesn't address this well -- psychotherapy, psychodynamic therapy, behavioural therapy really needs to accompany medication to have a full program, or one is left with figuring out the most important things -- the ways to cope, prosper, and enjoy to the best of one's abilities and society in this random thing we call life.
-- tidingsJay
poster:yxibow
thread:684607
URL: http://www.dr-bob.org/babble/20060909/msgs/684654.html