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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by misty99 on March 2, 2002, at 19:29:09
While doing research on SSRI Apathy Syndrome, I came upon this particular paragraph that I think has been the subject of many debates on this board:
"Nonresponse through the second week of therapy, at least with SSRIs, appears predictive of subsequent nonresponse. However, antidepressant medications should be changed only after it has been established that patients are not responsive after four to six weeks of treatment at therapeutic serum concentrations, at therapeutic doses, or at the maximum dose the patient tolerates if therapeutic dose precipitates bothersome side effects."
I find that first statement interesting because my psychiatrist has said pretty much the same thing. My question would be what type of percentages are we talking about? It seems that if there is a 60% or greater chance that a non response to an SSRI med after two weeks is predictative of a subsequent non response, then there is no way a patient should be kept on that med unless that person prefers to stay on it.
If the percentage is less, that that's telling me that with the extra time to get up to a therapeutic level, that perhap it would be prudent to keep the patient on the medicine.
If there is something I am missing, please let me know. Otherwise, I think we need a translation as to exactly what these folks mean.
Here is the link to the website where this information came from in case anybody is interested:
http://www.oqp.med.va.gov/cpg/MDD/MDD_cpg/content/appendices/mdd_app5_fr.htm
You might have to cut and paste the link into where you type the URL
Misty
Posted by JohnX2 on March 2, 2002, at 19:51:35
In reply to Need a translation, posted by misty99 on March 2, 2002, at 19:29:09
Misty,
I always wonder how long to wait out on a new
medicine knowing how long my body responded to old
medicines? I almost always get a response in 1.5-2 weeks
for medicines that kick in (at therapeutic dose). Does that mean I should dump
a new medicine if it doesn't work in that time frame?
I've gone ahead and held out for 2+ months on many medicines
and it seems as though for me that 2 week rule always holds
up. Do you get the same sort of phenomena ? (same response
time for good medicines?)-John
> While doing research on SSRI Apathy Syndrome, I came upon this particular paragraph that I think has been the subject of many debates on this board:
>
> "Nonresponse through the second week of therapy, at least with SSRIs, appears predictive of subsequent nonresponse. However, antidepressant medications should be changed only after it has been established that patients are not responsive after four to six weeks of treatment at therapeutic serum concentrations, at therapeutic doses, or at the maximum dose the patient tolerates if therapeutic dose precipitates bothersome side effects."
>
> I find that first statement interesting because my psychiatrist has said pretty much the same thing. My question would be what type of percentages are we talking about? It seems that if there is a 60% or greater chance that a non response to an SSRI med after two weeks is predictative of a subsequent non response, then there is no way a patient should be kept on that med unless that person prefers to stay on it.
>
> If the percentage is less, that that's telling me that with the extra time to get up to a therapeutic level, that perhap it would be prudent to keep the patient on the medicine.
>
> If there is something I am missing, please let me know. Otherwise, I think we need a translation as to exactly what these folks mean.
>
> Here is the link to the website where this information came from in case anybody is interested:
>
> http://www.oqp.med.va.gov/cpg/MDD/MDD_cpg/content/appendices/mdd_app5_fr.htm
>
> You might have to cut and paste the link into where you type the URL
>
> Misty
Posted by JohnX2 on March 2, 2002, at 23:27:36
In reply to Need a translation, posted by misty99 on March 2, 2002, at 19:29:09
Misty,Say 150 people were in a study.
and 100 responded (the standard 2/3).so, 100 people who were responders.
60 people responded in weeks 1-2.
40 people responded in weeks 3-12.I could say that "It was indicated from our study
that a non-response by week 2 was predictive of a non-response"
and this would be a true statement for the population.
Yet 40% of the people who benefited from the medicine
needed to hold out, right? So when was the right time to
bail? Good question. Some people will always take
longer to get a response on medication. The cost
of not bailing is time lost not investing in another
medication. You're wondering what the web page
bases their statement on, i.e. you want some hard
numbers, and I would too!-John
> While doing research on SSRI Apathy Syndrome, I came upon this particular paragraph that I think has been the subject of many debates on this board:
>
> "Nonresponse through the second week of therapy, at least with SSRIs, appears predictive of subsequent nonresponse. However, antidepressant medications should be changed only after it has been established that patients are not responsive after four to six weeks of treatment at therapeutic serum concentrations, at therapeutic doses, or at the maximum dose the patient tolerates if therapeutic dose precipitates bothersome side effects."
>
> I find that first statement interesting because my psychiatrist has said pretty much the same thing. My question would be what type of percentages are we talking about? It seems that if there is a 60% or greater chance that a non response to an SSRI med after two weeks is predictative of a subsequent non response, then there is no way a patient should be kept on that med unless that person prefers to stay on it.
>
> If the percentage is less, that that's telling me that with the extra time to get up to a therapeutic level, that perhap it would be prudent to keep the patient on the medicine.
>
> If there is something I am missing, please let me know. Otherwise, I think we need a translation as to exactly what these folks mean.
>
> Here is the link to the website where this information came from in case anybody is interested:
>
> http://www.oqp.med.va.gov/cpg/MDD/MDD_cpg/content/appendices/mdd_app5_fr.htm
>
> You might have to cut and paste the link into where you type the URL
>
> Misty
Posted by misty99 on March 3, 2002, at 11:16:42
In reply to Re: Need a translation » misty99, posted by JohnX2 on March 2, 2002, at 19:51:35
> Do you get the same sort of phenomena ? (same response
> time for good medicines?)
>
> -JohnJohn,
It seems that has been true for me. Also, if I get an unbearable side effect, it's bye bye med as I feel that's an indication that this is not the right medicine for me.
Way before I even knew about psychobabble, I remember having a quick response to Paxil. Because I was a med newbie and it was causing insomnia, I discontinued it because I didn't want to take another med at night for sleep. After having taken various sleep meds, it seems so silly but what did I know?
Anyway, after hearing horror stories about Paxil, it probably worked out for the best. In spite of that quick Paxil response and having great success with Zoloft for over a year before poopout, the other SSRI's have not been good for me. I just ditched Luvox after two days because at only 25mg, it was already causing a severe blunting of emotions.
Actually, if I could have taken Effexor at a certain high dose, it was great but unfortunately, it caused insomnia in spite of my taking 3 sleep medications at once. By the way, I think Effexor was the lone exception to my quick response rule as initially, it seemed to be a dud. But still, as you and I agree, those odds are so low, why take the risk of wasting so much time?
Anyway, the med saga continues.
Misty
Posted by misty99 on March 3, 2002, at 11:21:41
In reply to Re: Need a translation » misty99, posted by JohnX2 on March 2, 2002, at 23:27:36
The cost
> of not bailing is time lost not investing in another
> medication. You're wondering what the web page
> bases their statement on, i.e. you want some hard
> numbers, and I would too!
>
> -JohnThanks John for validating my beliefs. I was worried because of my med problems that maybe I wasn't thinking clearly so I reread the web page three times. But when I realized I still had the same questions, I decided to post about the situation on this board to see what others thought.
Thanks again for responding.
Misty
This is the end of the thread.
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