Posted by SLS on December 5, 2008, at 6:47:12
In reply to Re: Study Of Antidepressants Show All Same!!!! » SLS, posted by azalea on December 4, 2008, at 18:50:04
> > General?: MAOI -> TCA -> SNRI > SSRI -> amfebutamone -> NaSSA -> NARI -> phenylpiperazine> > > Another crappy drug is selegiline.
> I'm curious why you consider selegiline a crappy drug. MAOIs top your list and high-dose selegiline is an MAOI I believe.Yes, it is. Unfortunately, for depression, it just doesn't work that often as monotherapy.
Not all MAOIs are alike, just as not all SSRIs are alike. Each one has its strengths and weaknesses. I have been following L-deprenyl (selegiline) since 1983 when the only thing it was being looked at was for depression. It just never showed itself to be as robust as the other MAOIs. In fact, it never showed efficacy anywhere near that of the other antidepressants being studied at the time. Of course, there were some clinicians whom fell in love with the drug. One in particular was J. J. Mann, MD., and he is one smart guy. Making a selegiline patch doesn't seem to have made much difference as I see it. I think too much theory went into developing the patch system and too little time measuring its efficacy.
Any explanation of why selegiline should be inferior to the other MAOIs would be conjecture at best. Afterall we are all but clueless why they work at all. It is my opinion that MAO-A is the more important of the two isoenzymes when it comes to treating depression. Even at high dosages, selegiline might not get to where it needs to go to act therapeutically. Drugs like clorgyline that are selective for MAO-A make robust antidepressants - MAO-B, not so much.
My listing of antidepressant efficacy are impressions gathered through my obvservations rather than any scientific investigation. I wouldn't rely on it for making decisions. Here, the thesis of the article we are discussing makes its point. For any one individual, each drug will produce a therapeutic responses at a rate that is roughly equal statistically. It is the "roughly" part that inspired me to make my hastily drafted list.
- Scott
poster:SLS
thread:866316
URL: http://www.dr-bob.org/babble/20081204/msgs/866817.html