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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by sweetmarie on July 13, 2001, at 16:40:48
I recently posted a question about time-scale for meds `kicking in` on another website.
I received a reply from a bloke who said that his meds took 9 months for a effective response to be shown.
I imagine that his case was extreme, but it might be worth bearing in mind that time-scales may exceed the `official` ones as generally cited. It would seem that this very much depends on the individual.
I also know from experience that it can take considerable time for med(s) to begin to be effective - it was over 5 months before Seroxat (Paroxetine) began to be effective for me. I think that a common mistake is that meds can be discontinued too early.
This is my opinion - obviously I am not a doctor, but I just thought it was info worth passing on.
Anna.
Posted by SalArmy4me on July 13, 2001, at 17:03:11
In reply to It Might Be Worth Knowing ..., posted by sweetmarie on July 13, 2001, at 16:40:48
Clinical Psychopharmacology Seminar
http://www.vh.org/Providers/Conferences/CPS/11.html
Treatment of Refractory Depression
Original Author(s): Bruce Alexander, Pharm.D."Two studies of the same design have investigated the effect of duration of treatment on response rate (Dornseif et al 1989, Schweizer et al 1990). Patients were treated with fluoxetine 20 mg/d for 3 weeks. The nonresponders were randomized to receive an additional 5 weeks of fluoxetine 20 mg/d or to have their dose increased to 60 mg/d. After the additional 5 weeks, 50% of patients in both groups responded. Thus, a therapeutic trial of fluoxetine could be considered to be 6 to 8 weeks.
A more recent placebo-controlled study by Quitkin et al (1996) reported on 693 patients treated prospectively with a variety of antidepressant regimens. A response criterion was a sustained score on the CGI of much improved or very much improved. All patients were rated weekly. They concluded that those patients with some improvement in depressive signs/symptoms by week 4 should have their antidepressant regimen continued until week 6. This was based on the observation that 39% (versus 8% of placebo) of patients at week 4 that had minimal improvement were responders at week 6. However, if at week 4 the patient has had no improvement, then the treatment should be changed. This was based on the observation that for drug and placebo only 13% and 6%, respectively went on to respond at week 6.
Conclusion
It is important for comparison purposes that studies of "TRD" include specific details about dose, serum levels, and duration of treatment as well as diagnostic subtypes.
It is generally recommended that a patient should receive at least 4 weeks of an antidepressant at maximal tolerated doses before being considered a treatment failure (Wager and Klein 1988, Shelton 1999). Doses up to 400 mg/d should be considered in a patient that tolerates lower doses..."
Posted by pellmell on July 13, 2001, at 17:12:01
In reply to It Might Be Worth Knowing ..., posted by sweetmarie on July 13, 2001, at 16:40:48
> I received a reply from a bloke who said that his meds took 9 months for a effective response to be shown.
>
..snip..
> I also know from experience that it can take considerable time for med(s) to begin to be effective - it was over 5 months before Seroxat (Paroxetine) began to be effective for me.
>Are you and this other guy being treated for OCD? From what I've read it takes many months for current drug therapies to relieve those symptoms. In depression, one should feel the effects in 4-8 weeks.
>I think that a common mistake is that meds can be discontinued too early.
>You're probably right...Maybe I've been giving bad advice with that 2 week thing. Maybe I push through start-up side-effects faster than some.
For myself, though, if I'm still feeling hard-to-tolerate side-effects from an antidepressant after that amount of time, I won't be inclined to stay with it. In the absence of debilitating side effects, I'll definitely wait 4-6 weeks once I'm at a "theraputic" dose to decide whether it's effective.
-pm
Posted by sweetmarie on July 14, 2001, at 4:02:39
In reply to Re: It Might Be Worth Knowing ... » sweetmarie, posted by SalArmy4me on July 13, 2001, at 17:03:11
> Clinical Psychopharmacology Seminar
> http://www.vh.org/Providers/Conferences/CPS/11.html
> Treatment of Refractory Depression
> Original Author(s): Bruce Alexander, Pharm.D.
>
> "Two studies of the same design have investigated the effect of duration of treatment on response rate (Dornseif et al 1989, Schweizer et al 1990). Patients were treated with fluoxetine 20 mg/d for 3 weeks. The nonresponders were randomized to receive an additional 5 weeks of fluoxetine 20 mg/d or to have their dose increased to 60 mg/d. After the additional 5 weeks, 50% of patients in both groups responded. Thus, a therapeutic trial of fluoxetine could be considered to be 6 to 8 weeks.
>
> A more recent placebo-controlled study by Quitkin et al (1996) reported on 693 patients treated prospectively with a variety of antidepressant regimens. A response criterion was a sustained score on the CGI of much improved or very much improved. All patients were rated weekly. They concluded that those patients with some improvement in depressive signs/symptoms by week 4 should have their antidepressant regimen continued until week 6. This was based on the observation that 39% (versus 8% of placebo) of patients at week 4 that had minimal improvement were responders at week 6. However, if at week 4 the patient has had no improvement, then the treatment should be changed. This was based on the observation that for drug and placebo only 13% and 6%, respectively went on to respond at week 6.
>
> Conclusion
>
> It is important for comparison purposes that studies of "TRD" include specific details about dose, serum levels, and duration of treatment as well as diagnostic subtypes.
>
> It is generally recommended that a patient should receive at least 4 weeks of an antidepressant at maximal tolerated doses before being considered a treatment failure (Wager and Klein 1988, Shelton 1999). Doses up to 400 mg/d should be considered in a patient that tolerates lower doses..."Sal,
Does this mean that I`m completely wrong? (seems that way)
Sorry - I`m not entirely sure of how to interpret the above.
Let me know.
Anna.
Posted by sweetmarie on July 14, 2001, at 4:11:48
In reply to Re: It Might Be Worth Knowing ... » sweetmarie, posted by pellmell on July 13, 2001, at 17:12:01
> Are you and this other guy being treated for OCD?No.
From what I've read it takes many months for current drug therapies to relieve those symptoms. In depression, one should feel the effects in 4-8 weeks.
Hmmmmm.
I think that a common mistake is that meds can be discontinued too early.
For myself, though, if I'm still feeling hard-to-tolerate side-effects from an antidepressant after that amount of time, I won't be inclined to stay with it.I agree. I wasn`t taking into account difficult side effects - sorry.
In the absence of debilitating side effects, I'll definitely wait 4-6 weeks once I'm at a "theraputic" dose to decide whether it's effective.
I`m not entirely sure what can be seen as `effectiveness`. I`ve been on Mirtazapine/Venlafaxine for 9 weeks now (4 weeks at max dose), and I have started having the odd `window` - maybe 5 - 6 times a week I feel a little better for approx 3 - 4 hours. About 3 - 4 times a weeks I feel totally better for the same amount of time. Also, the `bottom` has lifted slightly, i.e. when I go down, it`s not as far as previously.
I don`t know, it`s all very confusing. I guess that I would hate to miss out if this turns out to be the `right` combination for me (I`ve been on so bloody many now).
Cheers for replying.
Anna.
Posted by pellmell on July 14, 2001, at 11:58:01
In reply to Re: It Might Be Worth Knowing ... » pellmell, posted by sweetmarie on July 14, 2001, at 4:11:48
Anna,
Thanks for sharing your real experience. I've been repeating mostly what I've read, which is knowledge anyone could get from an adequately informed doctor.
I guess I forgot for a moment that we're here to share our experiences with these meds that *aren't* prophecised in the sample package inserts, the sacred paper wads of the medical profession. Just because the studes Sal and I have read say that these drugs work a certain way doesn't mean they're going to in you; to say otherwise would be to emulate the worst of the M.D.'s out there: hard-nosed by-the-book psychaitrists. You know, the kind who wish now that they'd gone into mechanical engineering instead. :)
Until next time,
-pm
Posted by sweetmarie on July 14, 2001, at 14:53:34
In reply to Re: It Might Be Worth Knowing ... » sweetmarie, posted by pellmell on July 14, 2001, at 11:58:01
> Thanks for sharing your real experience. I've been repeating mostly what I've read, which is knowledge anyone could get from an adequately informed doctor.
>
> I guess I forgot for a moment that we're here to share our experiences with these meds that *aren't* prophecised in the sample package inserts, the sacred paper wads of the medical profession. Just because the studes Sal and I have read say that these drugs work a certain way doesn't mean they're going to in you; to say otherwise would be to emulate the worst of the M.D.'s out there: hard-nosed by-the-book psychaitrists. You know, the kind who wish now that they'd gone into mechanical engineering instead. :)Pell,
It sounds as though you thought that I was put out by your post. I wasn`t at all.
One more thing on the subject of time-scale, though.
My sister is a psychiatric nurse at Addenbrookes` hospital, Cambridge. She is very keen for me to give this med combo a `decent time` (her words). She doesn`t think that the `official` time span given is nearly enough, and I trust her - she works with depressed patients on a day-to-day basis.
So, there you go.
All good things,
Anna.
This is the end of the thread.
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