![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 8406. Go back in thread:
Posted by Anyuser on July 31, 2002, at 13:52:06
In reply to Re: Lexapro update » pharmrep, posted by Ritch on July 31, 2002, at 13:11:24
Good point. Maybe he's an FNG. Businessweek had a cover story on Forest Laboratories, and apparently they are hiring zillions of marketing reps for Lexapro. The BW article is not online, but if you come across it, it offers a very interesting (albeit capitalist tool, of course) perspective on Forest Labs. Apparently the founder's son had devastating depression, so the founder and the company at large are true believers in antidepressants.
Posted by Anyuser on July 31, 2002, at 13:53:58
In reply to Re: Lexapro update, posted by Anyuser on July 31, 2002, at 13:52:06
Posted by pharmrep on July 31, 2002, at 20:46:51
In reply to Re: Lexapro update » pharmrep, posted by Ritch on July 31, 2002, at 13:11:24
Yet another "watch out" note....I just got home and am going to try to comment to about 30-something hits on the topic.
If I knew this would be such a hot topic, I don't think I would have participated. Anyway...here goes (and I will only
be using this thread from now on..hope that is ok) Forest has no idea what I do online, I am not a rogue-rep, and this
is not a sinister marketing plan to promote Lexapro....although I could really be Kate just trying to fool you.(sorry Kate
I had to get a chuckle.) However...Mitch, you do have a point, I don't want to do the wrong thing here, so I might not be
as specific as I have been in the past to protect myself from getting in trouble. So if you have more questions please fire
away, but I am not DR Bob, and it may take time to respond.
PS...Dr Bob, if you see this, can you and I have a private chat before I continue? please email me, you have my address.
Posted by pharmrep on July 31, 2002, at 21:30:49
In reply to Re: Captain Mitch and the downers, posted by pharmrep on July 31, 2002, at 20:46:51
I need to be brief, so I hope this helps several of the last threads.
Poop out? if this means patent..Celexa is not going to have a generic
available for 3 years. Sex side effects..anorgasmia, ejaculatory delay,
impotence, ED, decreased libido, etc. Celexa showed 6%, (ejac delay only) but was more like
20%. This is a tricky one...the doctors dont ask the patients the question,
it is volunteered (5+ yrs ago (pre-viagra..etc) nobody wanted to admit it, now
it is much more open. All ssri's deal with seratonin, so it cant me avoided, but the
more selective, the less the effects...ie, Celexa only needed to list ejac delay since
greater than 5%, the other side efx are less that that. early Lex studies show good
promise in this arena. 9%, and this is a more accurate read since people are more willing
to talk about it, but maybe teens will be reality, only time will tell.
Celexa is indicated 20/40/60 mg. 20 is used 62%, then 40 is the next 30%...60 and higher is usually
for major dp or ocd component. Lex will be 10/20 mg 10 is starting and maintenance dose, and will
be for most. Early studies show 10/mg Lex is slightly more efficacious than 40mg/Celexa, as early of
an onset as 1-2 wks for most. (Journal of Clin Psych 2002; 63:331-336 by William Burke.
Sorry, I cant give cost analysis for everywhere other than Lex will be slightly less than Celexa.
LLL, are you 5'2" or so and in So. Cal? Anyway, the initial studies are showing efficacy, head to head vs.Celexa and placebo, and anxiety..I'm sure other head to head and others will come. I know that other indications have
already been filed too. Another good study by Burke is more about stereoisomers (journ. Clin Psych 2002;4(1)
Posted by pharmrep on July 31, 2002, at 21:49:05
In reply to Re: Captain Mitch and the downers, posted by pharmrep on July 31, 2002, at 21:30:49
oops..forgot to retitle the last one..sorry. Kate, I like your trust note, I will continue to earn yours.
You said you like Meta-regression analysis, well try this. Nick Freemantle British Journal of Psych. 2000, 177, 292-302
(It is sponsored by Wyeth Labs but backfired) ultimately it is a compilation of 105 studies/11000+ patients to see if hitting
other receptor sites other than serotonin is better (ie Effexor hitting Norepinephrine at above 150mg)...it says "This analysis does not provide evidence that anti-
depressants acting at more than one pharmacological site differ in efficacy from drugs selective for serotonin reuptake in the
treatment for major depression". Even though Wyeth sponsored, he goes on to say that "dual action" has "become a marketing concept
for a number of antidepressants, and this study raises the question as to whether it has a legitimate scientific basis, in considering
mechanisms behind antidepressant efficacy." Again...wow. Anyway, I wanted to show this study to you so you can see that Dr's dont care
who is paying them...they just run the tests, they wont destroy their credibility for a paycheck.
Posted by johnj on July 31, 2002, at 22:27:51
In reply to Re: Captain Mitch and the downers, posted by pharmrep on July 31, 2002, at 20:46:51
chance to stop workin after a period of time. Basically, they lose their effectivness. What are the poop out rates for Celexa? Or hasn't this been a problem? Thanks
Posted by pharmrep on July 31, 2002, at 22:37:46
In reply to Poop out refers to ssri's having the high » pharmrep, posted by johnj on July 31, 2002, at 22:27:51
I get it...I havent been taught it in training, nor have I heard it from my Dr's. There is nothing worse than misleading Dr's, and if Forest has info (even if not positive) it will share it with us or others ...ie 6% ejac delay is not really accurate...it's more like teens or 20%...the 6% is based on voluntary input from patients, and over 5 yrs ago, people didnt really want to share that kind of stuff.
Posted by Ritch on July 31, 2002, at 23:10:57
In reply to continued info, posted by pharmrep on July 31, 2002, at 21:49:05
> oops..forgot to retitle the last one..sorry. Kate, I like your trust note, I will continue to earn yours.
> You said you like Meta-regression analysis, well try this. Nick Freemantle British Journal of Psych. 2000, 177, 292-302
> (It is sponsored by Wyeth Labs but backfired) ultimately it is a compilation of 105 studies/11000+ patients to see if hitting
> other receptor sites other than serotonin is better (ie Effexor hitting Norepinephrine at above 150mg)...it says "This analysis does not provide evidence that anti-
> depressants acting at more than one pharmacological site differ in efficacy from drugs selective for serotonin reuptake in the
> treatment for major depression". Even though Wyeth sponsored, he goes on to say that "dual action" has "become a marketing concept
> for a number of antidepressants, and this study raises the question as to whether it has a legitimate scientific basis, in considering
> mechanisms behind antidepressant efficacy." Again...wow. Anyway, I wanted to show this study to you so you can see that Dr's dont care
> who is paying them...they just run the tests, they wont destroy their credibility for a paycheck.
PharmRep,Thanks for the added information! Well, well, it looks like we are headed for a slugfest between Lexapro and Cymbalta, eh? :) Cymbalta (duloxetine-Lilly) is supposed to be out on the market just after the first of the year from what I understand. Serotonin reuptake inhibition (selective or not), does tend to cause similar side effects and that is really no big revelation. Just a hunch, but the *differing* side effect profiles among SSRI's must be accounted for by something other than just their relative lack of "selectivity", no?
Mitch
Posted by pharmrep on July 31, 2002, at 23:35:51
In reply to Re: continued info » pharmrep, posted by Ritch on July 31, 2002, at 23:10:57
Maybe...if Lilly can get their manufacturing out of the toilet. They are in trouble right now. read up on them on your favorite news site...yahoo, hoovers, etc..their stock is in the dumps and rumors of a buyout are all over. they have a decent pipeline of products on the way, but if they cant get out the QA/manufacturing disaster they are in...who knows how long it will be. My Lilly rep friend says it was suppossed to be out in spring, and now...maybe 1+ years away. Anyway, with the Freemantle study about other sites not being better, it will be interesting to see how this new drug can perform. It's a shame that the company who introduced ssri's and got us out of tricyclics is having trouble. They need to get it together fast, or all credibility will be lost. As far as side effects...naseua is common with nearly any new med, but the activating and gastrointestinal side effects for all the ssri's (and other classes) do vary greatly from each other. Only a few s/e are common between them.
Posted by pharmrep on August 1, 2002, at 0:11:44
In reply to Re: slug-fest (get it..like a snail), posted by pharmrep on July 31, 2002, at 23:35:51
If you dont know where to access studies, this is a good site. Mostly abstracts, but you can order.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12000207&dopt=Abstract
Posted by Ritch on August 1, 2002, at 0:26:06
In reply to Re: slug-fest (get it..like a snail), posted by pharmrep on July 31, 2002, at 23:35:51
> Maybe...if Lilly can get their manufacturing out of the toilet. They are in trouble right now. read up on them on your favorite news site...yahoo, hoovers, etc..their stock is in the dumps and rumors of a buyout are all over. they have a decent pipeline of products on the way, but if they cant get out the QA/manufacturing disaster they are in...who knows how long it will be. My Lilly rep friend says it was suppossed to be out in spring, and now...maybe 1+ years away. Anyway, with the Freemantle study about other sites not being better, it will be interesting to see how this new drug can perform. It's a shame that the company who introduced ssri's and got us out of tricyclics is having trouble. They need to get it together fast, or all credibility will be lost. As far as side effects...naseua is common with nearly any new med, but the activating and gastrointestinal side effects for all the ssri's (and other classes) do vary greatly from each other. Only a few s/e are common between them.
PR,
Thanks yet again for the added information. What is really great about this site is the personal experiences of the people that are trying the new meds. I was personally interested in a trial of escitalopram or duloxetine (whenever either is available). We are all pretty much guinea pigs here. A lot of folks will be here to compare and contrast.
Mitch
Posted by Phil on August 1, 2002, at 6:15:48
In reply to Re: slug-fest (get it..like a snail) » pharmrep, posted by Ritch on August 1, 2002, at 0:26:06
pharmrep, Are you saying Celexa is around 20% sexual dysfunction, mostly delayed ejaculation?
Or are you saying only 20% will talk about it?
I would think in the real world that it's 50-70%.
And from personal experience, the sexual problems are more varied. I'm taking 40mg, down from 60mg and don't even think about getting as far as ejaculation. I take Wellbutrin and Adderall and Viagra occasionally and I've still written off sex. It's so frustrating, it's not worth the effort.
I cannot believe the numbers that companies get away with putting on package inserts.
Do you, as a rep, encourage doctors to bring the subject up with patients or does every rep say, well, patients just don't want to talk about it.
If you know that's true, why don't $200.00 an hour psychiatrists bring the subject up? I think that nobody, including drug companies and doctors, want to bring it up. It's difficult to say anything in a 15 minute med check.Is Forest aggressively trying to overCOME this problem? The first company that makes an effective AD without this SE will never have cash flow problems again. I'm sure pharm co. are aware that they could make a fortune.
What's the figure going to be on Lexapro..2%?
Have you ever been on meds? Does your company realize that the choice we are given is semi-normalcy at the expense of sex? Semi-normalcy at the expense of 100% apathy?
Not trying to blame you for the world's depression problems but after 20 of my best years spent on meds, it's all getting a bit tiresome.Phil
Posted by pharmrep on August 1, 2002, at 10:54:11
In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48
Hi Phil...yes, I am saying Celexa at around 20%, mostly ejac delay. This has been said nationally. Although I account for a small pool (300 dr's or so) I do talk about it to learn more from my dr's. They say the same 20% for Celexa, and 30-40% for other ad's. I am seeing more of the combo Celexa and Wellbutrin...its called cel-well (its big on the East coast...and moving West. 20-40mg Celexa/100mg Wellbutrin, maybe higher on Celexa, but not Wellbutrin (due to seizure risks). I agree that sex s/e are not aggessively addressed, but I wouldnt say it's being ignored. 5-10 years is all that co's know of it..remember only 6% of patients reported it for Celexa back then. But
now that it's a more open topic, maybe co's will cater to it more. (yes, it would be a $-maker). On a personal note, no..I've not taken any ad's, I do have experience through some family& friends.
And I do hear the semi-normalcy vs sex s/e a lot from my Dr's. They are more concerned with treating the depression and other components 1st, before worrying about weight gain, any s/e,p450
inhibitions (liver metabolization) etc only secondary. I wouldnt say Forest or myself for that matter is apathetic on the matter. It's just not easy to have 1 drug do everything. I'm sure it's on the way some day. As for Lexapro...no it's not it. I believe it will have the least sex s/e, but again 9% voluteered the info (last year). With todays heightened awareness, I believe that's good...maybe in low to mid teens in reality. But only large volume experience and time will tell.
PS 15 med check? That's funny...when I go into an office, I get on average 1-2 minutes with the Dr's. (and thats more than most reps) They see 10+ reps a day, and 5-10 seconds just to sign for samples is not uncommon. I try to be concise with Dr's (90% of time, there are patients waiting). Any questions I can ask to learn about their practice or prescribing habits usually take 4-5 visits or so to develop. I focus more on the Dr's and patients as topics...not the samples.
Posted by Phil on August 1, 2002, at 11:21:26
In reply to Re: sex. s/e, posted by pharmrep on August 1, 2002, at 10:54:11
SSRI sexual problems are about 70% according to people in your field. I'll try to find the info.
Read the archives on this board. I think Celexa is better but it's not to me.Anyway, I like Forest Labs for what I know about them. Lilly strikes me as operating from Billy Bob Gates book of ruthless business practice. Sarafem, please.
Here's my combo, give me your thoughts, if you will.
Celexa 60mg
Wellbutrin 400mg
Clonazepam 3mg
Adderall XR 60-90mgIn the last few days, I dropped Celexa to 40mg to see if: a. My unit would work...no. b. See if I could wake up. I've talked to others on this board about Celexa sleepiness which is horrendous.
I went to 90mg of Adderall and have been guzzling coffee! I've taken Clonazepam with a lot of drugs and it's not the culprit. When I dropped Celexa to 40mg the first day, while at 90mg Adderall, I stayed up till 3 a.m.
A lady here, can't remember who, took Dex for years. After starting Celexa, her once steady dose had to be escalated several times to no avail. What up? It has been the worst for me in that area.I know you aren't a shrink but appreciate your input. How long have you been in that business?
Posted by pharmrep on August 1, 2002, at 11:50:17
In reply to Re: Another question and statement, posted by Phil on August 1, 2002, at 11:21:26
You know what..I just printed your combo, and will take it with me to see what my PD'rs think. As for sleepyness, I know Cx can do that for some, do you take it at night or morning? My Dr's say if you feel to relaxed...take it at night, you will sleep well, and my morning, it isnt as "relaxing" for your day . As for the rest of the combo, I will get back to you.
Posted by Phil on August 1, 2002, at 12:12:38
In reply to Re: Phil combo, posted by pharmrep on August 1, 2002, at 11:50:17
That's very generous of you. I took Celexa in the a.m. when I started it but when I realized what was happening, went to p.m.
Your docs will probably say I'm too maxed out on too many meds but it will be interesting.
Don't forget the pens. *wink*Oh, when I started AD's 20 years ago, I took Amitriptyline 250mg. Fast metabolizer, I guess.
Thanks again
Posted by inertia on August 1, 2002, at 18:50:33
In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48
> pharmrep, Are you saying Celexa is around 20% sexual dysfunction, mostly delayed ejaculation?
> Or are you saying only 20% will talk about it?
> I would think in the real world that it's 50-70%.
> And from personal experience, the sexual problems are more varied. I'm taking 40mg, down from 60mg and don't even think about getting as far as ejaculation. I take Wellbutrin and Adderall and Viagra occasionally and I've still written off sex. It's so frustrating, it's not worth the effort.
> I cannot believe the numbers that companies get away with putting on package inserts.
> Do you, as a rep, encourage doctors to bring the subject up with patients or does every rep say, well, patients just don't want to talk about it.
> If you know that's true, why don't $200.00 an hour psychiatrists bring the subject up? I think that nobody, including drug companies and doctors, want to bring it up. It's difficult to say anything in a 15 minute med check.
>
> Is Forest aggressively trying to overCOME this problem? The first company that makes an effective AD without this SE will never have cash flow problems again. I'm sure pharm co. are aware that they could make a fortune.
>
> What's the figure going to be on Lexapro..2%?
> Have you ever been on meds? Does your company realize that the choice we are given is semi-normalcy at the expense of sex? Semi-normalcy at the expense of 100% apathy?
> Not trying to blame you for the world's depression problems but after 20 of my best years spent on meds, it's all getting a bit tiresome.
>
> PhilPhil, I think your guess-timate of sexual s/e in 50%-70% of SSRI users is right on target.
I hope this isn't overkill, but I looked for all the GOOD studies on sexual dysfunction from different antidepressants and the 50%-70% is just about what they found.
I included one abstract on the TYPE OF QUESTIONAIRE the Salamanca group used to get their data so you could see that they have a pretty valid measuring instrument.
Study design is EVERYTHING. Generally I think you should be skeptical of any study sponsored by a pharmaceutical company (unless, maybe, the researchers are known to be of top-notch caliber) and you want to see a result replicated by other researchers.
The German study below is interesting because it shows that when MDs used their (presumably sensitive) questionaire to ask about sexual s/e they came up with a vastly greater incidence than if they left it to the patients to mention it (61.5% vs 21.6% for SSRIs).
1) Authors .Ferguson JM. Shrivastava RK. Stahl SM. Hartford JT. Borian F. Ieni J. McQuade RD. Jody D.
Institution Pharmacology Research Corporation, Salt Lake City, Utah, USA.
Title Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline.
Source Journal of Clinical Psychiatry. 62(1):24-9, 2001 Jan.Abstract BACKGROUND: Several different classes of antidepressants have been associated with sexual adverse effects. This double-blind, randomized trial compared the effects of nefazodone and sertraline on reemergence of sexual dysfunction in depressed patients who had experienced sexual dysfunction as a result of sertraline treatment. Depressive symptoms were also monitored. METHOD: One hundred five patients with DSM-III-R major depressive episode who were experiencing sexual dysfunction attributable to sertraline (100 mg/day) were screened for entry. Eligible patients entered a 1-week washout period that was followed by a 7- to 10-day single-blind placebo phase. Patients without symptoms of sexual dysfunction at the end of the single-blind placebo phase were randomly assigned to receive double-blind treatment with either nefazodone (400 mg/day) or sertraline (100 mg/day) for 8 weeks. RESULTS: Nearly 3 times more sertraline-treated patients (76%; 25/33) experienced reemergence of sexual dysfunction (ejaculatory and/or orgasmic difficulty) than did nefazodone-treated patients (26%; 10/39) (p < .001). In addition, patients treated with nefazodone were more satisfied with their sexual functioning than were patients treated with sertraline. Both treatment groups demonstrated a similar and sustained improvement in depressive symptoms. Both drugs were well tolerated, and the overall incidence of adverse reactions was similar for both treatment groups; however, 9 sertraline-treated patients (26%) discontinued because of adverse events compared with 5 nefazodone-treated patients (12%). Of the patients discontinuing therapy for adverse events, 5 of the sertraline-treated patients did so because of sexual dysfunction reported as an adverse event, whereas only 1 of the nefazodone-treated patients discontinued therapy secondary to sexual dysfunction. CONCLUSION: In this sample of patients with major depression who had recovered from sexual dysfunction induced by treatment with sertraline, nefazodone treatment resulted in significantly less reemergence of sexual dysfunction than did renewed treatment with sertraline and provided continued antidepressant activity.
2) Authors .Montejo AL. Llorca G. Izquierdo JA. Rico-Villademoros F.
Institution University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain. angelluis.montejo@globalmed.es
Title Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.
Source Journal of Clinical Psychiatry. 62 Suppl 3:10-21, 2001.Abstract BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
3) Authors Montejo AL. Garcia M. Espada M. Rico-Villademoros F. Llorca G. Izquierdo JA.
Institution Hospital Universitario de Salamanca, Facultad de Medicina, Universidad de Salamanca. angelluis.montejo@globalmed.es
Title [Psychometric characteristics of the psychotropic-related sexual dysfunction questionnaire. Spanish work group for the study of psychotropic-related sexual dysfunctions]. [Spanish]
Source Actas Espanolas de Psiquiatria. 28(3):141-50, 2000 May-Jun.Abstract BACKGROUND: The presence of sexual function impairment in patients with psychiatric disorders is very common and could be an effect of the medication (mainly antidepressant and neuroleptics). The patient frequently has difficulties to communicate this adverse effect and the assessment of these changes by the physician should be encouraged. The real SD incidence is underestimated and the use of a specific questionnaire is needed. METHODS: The authors analyse psychometric characteristics of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ) that includes questions about libido, orgasm, ejaculation, erectile function and general sexual satisfaction. The questionnaire was applied to 62 patients who were taking nefazodone "de novo" (n = 18) or were switched to nefazodone (n = 44) due to bad tolerated sexual dysfunction secondary to other antidepressant. RESULTS: The PRSexDQ has shown an excellent feasibility with nil percentage of patients with missing responses on all items except on items 1 and 2 (1.7% and 15.5% of patients with missing response). Cronbach's alpha value was 0.93, which indicates adequate reliability. The PRSexDQ also showed adequate construct validity. As it may be expected, the PRSexDQ showed a high correlation with a Clinical Global Impression scores on Sexual Dysfunction (r = 0.79) and moderate correlation with Hamilton Depression scores (r = 0.63). PRSexDQ also showed good discrimination between naive and pretreated depressed or dysthymic patients, with statistically significant differences between those groups of patients. Finally, the instrument showed adequate sensitivity for detecting clinical changes on sexual dysfunction with greater changes in the patients treated previously with antidepressants and who were switched to nefazodone than in naive patients (SES = -3.77 in patients switching to nefazodone; SES = -0.64 in naive patients).
4) Authors Arias F. Padin JJ. Rivas MT. Sanchez A.
Institution Unidad de Psiqiatria, Fundacion Hospital de Alcorcon, Madrid. farias@fhalcorcon.es
Title [Sexual dysfunctions induced by serotonin reuptake inhibitors]. [Spanish]
Source Atencion Primaria. 26(6):389-94, 2000 Oct 15.Abstract OBJECTIVE: To assess the incidence of serotonin reuptake inhibitor (SRI) antidepressant-induced sexual dysfunction (SD) and to compare the sexual side effects of SRI. DESIGN: Naturalistic, prospective, observational study. SETTING: Two urban health centers. PATIENTS: 235 outpatients (164 women, 71 males) who began treatment with some of the following SRI: fluoxetine, sertraline, paroxetine, citalopram and venlafaxine, who had engaged in regular sexual practices with stable partner, who were suffering from different mental disorders who were being treated with SRI. The assignment to each group was according to clinical criteria. INTERVENTIONS: Patients completed questionnaires that allowed reporting of both SD induced by the illness and the treatment, evaluating changes in libido, arousal, and orgasm. The patients were observed over 6 months of treatment. RESULTS: 147 patients (62.6%) reported one or more SD related to SRI treatment. There were differences in the incidence between the different SRI: 39% with fluoxetine, 75.5% with paroxetine, 78.8% with sertraline, 28.9% with citalopram and 80% with venlafaxine. In 78.2% of patients the SD showed no improvement by the end of this period. In a predictive logistical regression model of the presence of SD induced by the SRI, the female category and the presence of previous sexual problems were favourable predictors and the treatment with paroxetine, sertraline or venlafaxine were increased the risk of SD. CONCLUSIONS: SD is one of the most frequent and persistent SRI adverse effect. We recommended to inquiry about SD in patients who were treated with SRI. Significant differences were found in the occurrence of SD between the different SRI. Such data would be particularly valuable to physicians when choosing a specific antidepressant from this therapeutic group.
5) Authors Philipp M. Tiller JW. Baier D. Kohnen R.
Institution Bezirkskrankenhaus Landshut, Klinik fur Psychiatrie/Psychotherapie, D-84034, Landshut, Germany. phillip-landshut@t-online.de
Title Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults. The Australian and German Study Groups.
Source European Neuropsychopharmacology. 10(5):305-14, 2000 Sep.Abstract OBJECTIVE: To compare the emergent sexual effects of moclobemide and selective serotonin reuptake inhibitors (SSRIs) during acute and maintenance therapy in routine practice. METHOD: 268 patients were evaluated for sexual function at baseline, 6 weeks, 3 and 6 months of treatment using physician ratings and self-rating questionnaires. Patients received moclobemide, an reversible monoamine oxidase A inhibitor (RIMA), or a SSRI (fluoxetine, fluvoxamine, paroxetine, sertraline). RESULTS: Baseline values were similar in all groups. Incidences of impairments of sexual functioning with treatment, whether clinically relevant or not, were 24.3% with moclobemide and 61.5% with SSRIs (physician ratings), with no significant tolerance to these effects. There was a suggestion of differences between the SSRIs in their specific dysfunctions they cause. SSRIs (21.6% of patients) had about ten times the moclobemide rate (1.9%) of sexual dysfunction reported as adverse events. Antidepressant efficacy was comparable between treatments. CONCLUSION: In patients for whom sexual function is important or sexual dysfunction is present, moclobemide should be considered a first line antidepressant.
Posted by pharmrep on August 3, 2002, at 0:20:36
In reply to Re: Another question and statement, posted by Phil on August 1, 2002, at 11:21:26
Well, I got some general answers since they dont know you. But the one commonality I heard was you have some pretty high doses, and the feeling sleepy yet not able to fall to asleep til 3am.
Everyone thought 400mg Wellbutrin was too high (going to 1/2 was something I heard a couple of times) Adderall at 40 came up too (2x 20mg's). The Dr's thought this was your insomnia problem. I asked specifically if Celexa could be the "relaxed/tired" culprit...they didnt think so...they often go to 80+ without the "tired" effect, but everyone is different. There was the strong belief that more likely that there are both activating and relaxing meds in you at the same time...at the higher dosing, you could be getting adverse events as well. Your Dr. may have more experience with these meds at the higher doses than the pool I spoke with, but one thing I would recommend is to see how each one of these meds metabolizes in to make sure they are in fact doing that rather that fighting for the same pathway in you body and just floating around...this causes s/e and adverse events as well...I'll give you Celexa...it's a very mild inhibitor of the 2D6 and 1A2 pathways in the liver.
Posted by .tabi.T.ha. on August 3, 2002, at 3:28:08
In reply to Re: phil's combo, posted by pharmrep on August 3, 2002, at 0:20:36
Hi pharmrep,
Saw the note about Phil's combo, can't resist asking a question. For me Celexa is activating and causes insomnia. I take 10mg in the morning, and can't sleep at all unless I take something sedating at night. For now the sedating med is neurontin, but even with that I'm awake til 3am. Do you know of any better way to deal with the insomnia side effect from celexa?
Also, how does lexapro compare on insomnia? Sorry if you've answered this elsewhere, I didn't read the entire thread.
-Tabitha
Posted by Phil on August 3, 2002, at 7:21:23
In reply to Re: phil's combo, posted by pharmrep on August 3, 2002, at 0:20:36
Insomnia was a problem only when dropping the Celexa dose. In the monograph, Celexa rates high in somnolence. If you search 'celexa sleepy' on this site, it's not uncommon.
Thanks for checking. I'll do some science stuff and seek an interpretation.
Posted by pharmrep on August 3, 2002, at 11:00:24
In reply to Re: phil's combo, posted by pharmrep on August 3, 2002, at 0:20:36
> Well, I got some general answers since they dont know you. But the one commonality I heard was you have some pretty high doses, and the feeling sleepy yet not able to fall to asleep til 3am.
> Everyone thought 400mg Wellbutrin was too high (going to 1/2 was something I heard a couple of times) Adderall at 40 came up too (2x 20mg's). The Dr's thought this was your insomnia problem. I asked specifically if Celexa could be the "relaxed/tired" culprit...they didnt think so...they often go to 80+ without the "tired" effect, but everyone is different. There was the strong belief that more likely that there are both activating and relaxing meds in you at the same time...at the higher dosing, you could be getting adverse events as well. Your Dr. may have more experience with these meds at the higher doses than the pool I spoke with, but one thing I would recommend is to see how each one of these meds metabolizes in to make sure they are in fact doing that rather that fighting for the same pathway in you body and just floating around...this causes s/e and adverse events as well...I'll give you Celexa...it's a very mild inhibitor of the 2D6 and 1A2 pathways in the liver.These are the adverse events incidence in the clinical trials (listed in the package insert) for Celexa vs placebo. I'm only listing those at 10% or greater or interesting #'s. (this is 8wk study) celexa (1063 patients) placebo (446)
dry mouth 20%/ 14
increased sweating 11 / 9
nausea 21 / 14
fatigue 5 / 3
somnolence 18 / 10
insomnia 15 / 14
yawning 2 / 0
**in the 6mo-24mo trial the numbers stayed about the same. except for nausea..cx=6% and placebo=10%.So Phil, you seem to have somnolence with Cx, and .tabi, you get insomnia. I hate that the same drug
can contradict itself in different people. I will get you some ideas to help next week. (I cant remember
the Lexapro #, but I think it was about 5 or so...FDA is saying "similar to placebo")
Posted by allisonm on August 3, 2002, at 16:10:16
In reply to contradictions, posted by pharmrep on August 3, 2002, at 11:00:24
The FDA makes drug companies test their drugs for only 8 weeks. But most literature says a depressive ought to take an AD for about a year to make sure the depression is gone. Many of us here take these drugs for years and will do so for the rest of our lives (I'm one of those). It gives many of us pause when we think about that and the possible future ramifications of longterm use. I for one don't like being a guinea pig, but figure the only other choice is death. The chance of getting cancer or some other malady later on because of these chemicals seems like an unfair but necessary (not to mention expensive) alternative to ending my life now. Do drug companies ever go back and study longterm use? Will there ever be any reassurance that these drugs are "safe" save for the lack of reports and warnings if nothing bad turns up?
Posted by pharmrep on August 4, 2002, at 22:20:13
In reply to pharmrep trial question, posted by allisonm on August 3, 2002, at 16:10:16
> The FDA makes drug companies test their drugs for only 8 weeks. But most literature says a depressive ought to take an AD for about a year to make sure the depression is gone. Many of us here take these drugs for years and will do so for the rest of our lives (I'm one of those). It gives many of us pause when we think about that and the possible future ramifications of longterm use. I for one don't like being a guinea pig, but figure the only other choice is death. The chance of getting cancer or some other malady later on because of these chemicals seems like an unfair but necessary (not to mention expensive) alternative to ending my life now. Do drug companies ever go back and study longterm use? Will there ever be any reassurance that these drugs are "safe" save for the lack of reports and warnings if nothing bad turns up?
*** Responsible companies do long term studies as well...there are such studies for Celexa, and I know that Lexapro studies are being done as we speak. The good news about Lexapro is that it is not a foreign matter in the human body. It is half of the Celexa molecule, and has been used by over 30 million people for over 15 years in Europe and the US. As far as the "FDA 8-weeks", you're right, unless there is something obviously wrong, or no separation from placebo, it usually passes.
Posted by Fuscia on August 5, 2002, at 13:09:14
In reply to Re: Lexapro update, posted by pharmrep on July 31, 2002, at 2:04:24
Hello pharmrep,
Do you know what the transport system(s) is for citalopram? The following was posted by James Ferrell, but does not include information about citalopram.
Thanks in advance for any information you can share! Fuscia
Dr. Bob's Psychopharmacology Tips
http://www.dr-bob.org/tips/"Date: Wed, 2 Apr 1997 15:05:51 -0800 (PST)
From: ferrell@cmgm.stanford.edu (James Ferrell)
Subject: Transport systems and antidepressantsHere are some data to give you an idea of what transport systems are
likely to be tweaked by the different antidepressants.From: Bolden-Watson C, Richelson E. Blockade by
newly-developed antidepressants of biogenic amine uptake into rat
brain synaptosomes. Life Sciences. 52 (12): 1023-9, 1993.------------------------------------------------------
Ki (nM)
Drug ------------ Selectivity for 5HT
5HT NE (Ki NE / Ki 5HT)
------------------------------------------------------
desipramine 180 0.6 0.003
doxepin 220 18 0.08
amitriptyline 84 14 0.2
imipramine 41 14 0.3venlafaxine 39 210 5.4
fluoxetine 14 143 10
norfluoxetine 25 410 17
paroxetine 0.7 33 45
sertraline 3 220 64
------------------------------------------------------From: Hyttel J. Pharmacological characterization of selective
serotonin reuptake inhibitors (SSRIs). International Clinical
Psychopharmacology. 9 Suppl 1: 19-26, 1994 Mar.------------------------------------
Drug Selectivity for 5HT
(IC50 NE / IC50 5HT)
------------------------------------
clomiprimine 14
fluoxetine 54
fluvoxamine 160
paroxetine 280
sertraline 840
------------------------------------"
Posted by allisonm on August 5, 2002, at 14:36:29
In reply to Re: trial question, posted by pharmrep on August 4, 2002, at 22:20:13
Sorry. I tend to disagee. A drug is a chemical. There are lots of things that are not foreign matter to the body but which cause disease just the same. Also, I appreciate your enthusiasm about what you sell, but I was not referring to Celexa specifically. I was referring to antidepressants in general. Witness the recent black box warning on Serzone and liver damage, for example. How many years has Serzone been on the market and how many millions of people have used it? That's my point. I remember when red dye #3 (or was it #5?) was withdrawn from the market and there were all kinds of things we couldn't have for awhile until they came up with a healthier shade of red. My memory is vague, but I think Kool-Aid had red dye #3 in it... Certainly, Wellbutrin, Remeron, Effexor, Celexa, Serzone, Prozac, Zoloft etc. have chemicals much less benign than what one would presume to be harmless food coloring...
Thanks.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.