Posted by SLS on December 11, 2012, at 2:31:56
In reply to Re: Augment Effexor or TCS or MAOI or other?, posted by jono_in_adelaide on December 10, 2012, at 16:41:09
> "Why do you say this?"
>
> Because desipramine hits noradrenalin much harder than effexor, and antidepressants acting on noradrenalin are generaly better against dysthymic symptoms than ones actingmainly on seretonic (eg standard doses of Effexor)Is there any science behind this? You might be right, but I would like to know where you got this idea from?
> Effexor only has a clinicaly significant effect on NA at doses of 300mg a day,
According to whom?
> which few patients ever reach, at doses of 75-150mg 9the ones commonly prescribed)
If this is true, then I think it would be better said that few doctors ever reach doses of 75-150mg. Are you suggesting that few patients can tolerate dosages over 150mg?
> it isnt clinicaly superior to Zoloft or Lexapro.
Oh. That's a pretty conditional statement. Are we to handicap drugs now by limiting the dosages we use to compare them?
> The reason I suggested Zoloft/Lexapro + desipramine instead of Effexor + desipramine is cost effectiveness,
Do you mean in terms of money or in terms of pain suffered?
> there isnt a down side to taking Effexor instead of an SSRI, but there inst realy an upside,
...except that it might work better for the individual. I don't think we are doing anyone a service by excluding drug treatments from consideration based upon our laymen monoamine theories of depression and drug mechanisms. I am not saying that all of the information scientists have collected is useless. I think much of it can be used as a primitive guide, and I would not want to be without that information. If you were to discover that Effexor was also a sigma-1 receptor agonist in addition to being a SNRI, might you then reconsider your conclusions?
http://www.ncbi.nlm.nih.gov/pubmed/17532136
Actually, this study proves nothing other than to suggest that an intact system of sigma-1 receptor function is required for an antidepressant to work. It is something to think about, though. Do Psycho-Babblers know enough about disease and drugs to predict patient reactions to those drugs - especially in light of the admission by neuroscientists that they do not?
http://www.ncbi.nlm.nih.gov/pubmed/15089113
What about NMDA receptors? If you were to learn that Effexor affects the expression of the NR2B subtype while Lexapro does not, would you continue to assert that there is no "upside" to using Effexor?
http://www.ncbi.nlm.nih.gov/pubmed/21755298
I would like to see empirical evidence that (Zoloft/Lexapro) + desipramine is interchangeable with Effexor. Who is it that you always cite regarding the Zoloft + nortriptyline combination? I forget.
As for me, I benefited more from combining Effexor + nortriptyline than to Zoloft + nortriptyline. I had considered remaining on the Effexor combination based upon my positive response to it, even though it had plateaued. An argument can be made that something must be different between Effexor and Zoloft other than NE reuptake inhibition.
The more I learn, the dumber I get.
Okay.
I think I have laid the foundation for the understanding that "different is different". That's a pretty simple concept. I imagine that there are cases for which Zoloft + nortriptyline polypharmacy is more effective than high-dose Effexor monotherapy. However, I am sure that Effexor and Zoloft are not interchangeable when combined with nortriptyline. Something is different. The box may no longer be black, but it is still quite dark in there.
You know things that I do not. Perhaps you can provide evidence for why you would tell someone to abandon Effexor in favor of Zoloft + nortriptyline. I know you keep referring to a doctor who believes this. What is his name? It would be hard to argue with real-world results.
I think the best argument for switching out Effexor for an SSRI now is that Effexor was producing diminishing returns, and a new drug might recapture a robust antidepressant response. But without a biological test to prove otherwise, I think that it would be counterproductive to tell someone that (Zoloft + desipramine) is a better SNRI than Effexor.
I cannot predict the results of antidepressant treatments by performing a theoretical mixing and matching of monoamine reuptake inhibitions. That leaves me feeling pretty dumb.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1032720
URL: http://www.dr-bob.org/babble/20121130/msgs/1032808.html