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Re: Neurontin helpsChills + Sweats when coming off » kaleidoscope

Posted by yxibow on February 9, 2007, at 18:46:40

In reply to Re: Neurontin helpsChills + Sweats when coming off » yxibow, posted by kaleidoscope on February 9, 2007, at 13:55:32

> Hi J
>
> >"unclean" agents like Prozac
>
> Why do you say that? Fluoxetine isn't a 'dirty drug'. It isn't such a 'selective' SSRI as some of the others (eg. citalopram) but all this means is that it is an extremely weak NE reuptake inhibitor. If this is what you mean by 'unclean', duloxetine (Cymbalta) is much less 'clean' than fluoxetine.

Cymbalta has something like a 6:1 ratio (varying by patient) of 5HT to NE. But it still has a NE kick to it.

Yes, I mean it is not as selective as Amitriptyline is not as selective either.


> >I wouldn't recommend it as a first line SSRI to someone because once you commit to a dose, its gonna be there for a month, whether you tolerate it or not
>
> Not really. As with all SSRIs, side effects appear rapidly. If someone has only been taking it for a few days, its active metabolite norfluoxetine (the one with a long half life) won't have built up in the body. Fluoxetine itself does not have such a long half life.

Rapidly for some, but I'm talking about ramping up dose to a therapeutic level. And if you're at that therapeutic level and you're still having problems, it will take a month to go away. So that's why I wouldn't recommend it.


> Personally, I think that (generic) floxetine is a suitable first-line SSRI for many patients suffering from depression. For elderly people, and for people on multiple medications, generic citalopram is a better first-line SSRI because of the reduced risk of drug interactions. IMO, Lexapro should never be a first-line SSRI because it is so overpriced - its alleged advantages over citalopram are somewhat dubious.


I was going to suggest citalopram in general or Luvox. Yes, Lexapro is another one of those metabolite patented agents, some people do benefit from fewer side effects but I would agree that in general the cases where that are true are lower than the profits. Same with desvenlafaxine.

 

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