Posted by SLS on January 11, 2014, at 7:35:32
In reply to Re: Anecdotally The Best Drugs IMO add-on, posted by diego on January 11, 2014, at 0:17:00
Hi Diego.
> Among the TCA's, I found Vivactyl, protriptyline most effective. Is it still made anymore?
I believe it is. It was the absolute worst tricyclic I ever took. It exacerbated an already severe depression. The autonomic side effects were the worst. I got a nice mood lift when I abruptly discontinued protriptyline. It lasted for less than a day, though.
> Ever since Prozac was introduced the definition of depression keeps loosening and loosening.
The diagnostic "loosening" is the result of:
1. Psychiatrists and psychologists don't get paid without a a coded diagnosis. More patients. More money.
2. In an effort to increase the number of people who enter a clinical study, eligibility criteria are applied loosely in order to enroll more subjects. This means more money for the paid investigators. More money.
3. The drug company is in a rush to produce statistics with high power (number of subjects) in order to get their product to market more quickly. More money.
Of course, the drug companies shoot themselves in the foot by operating this way. People complaining of milder depressions are allowed to particapate in modern studies. Most of them don't have the disease being studied. You end up with a smaller separation between active drug and placebo. Clinical trials performed in the 1960s and 1970s showed more convincing separation because they were motivated by medical science to conduct pure research. Subjects employed in studies of depression were unequivocally severely affected with very little ambiguity that they were suffering from MDD or BD. Response rates for imipramine were about 65-70%; response rates for placebo were about 25-30%.
> DSM-V is a joke.
What is it about DSM V that you find to be a joke? I haven't seen it yet.
I thought DSM III and DSM IV were jokes when it came to diagnosing axis I disorders. Their descriptions were primitive, brief, and crude.
> Truly disabling melancholic depression ought to be treated swiftly and promptly by whatever mean necessary. MAOIS are the gold standard, followed by ECT. Ipronaizid was the prototype.
For melancholic depression, I would choose a tricyclic first. Imipramine is the true gold standard for this presentation. In addition, MAOIs do carry a certain liability for producing dangerous sequalae if diet and drug interactions are not followed strictly. For that reason, I would wait until imipramine - and possibly venlafaxine are tried first before going to MAOI.
One thing that I am not sure of is which MAOI is the best to try first when treating melancholic depression. Do you have a preference?
- ScottSome 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:1058183
URL: http://www.dr-bob.org/babble/20140104/msgs/1058265.html