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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by 1980Monroe on July 3, 2004, at 18:19:32
I just wanted to know, i used to take wellbutrin, its the only dopamine reuptake inhibitor there is on the market for depression, exept Ritilin but thats for ADDers.
I know some MAOI's are potent but ive never tried any, and it would take forever to convice my doctor to try any of them, plus sacrifcing other meds.
Does anyone really know?
Posted by AMD on July 3, 2004, at 18:50:36
In reply to What really is the most potent antidepressant?, posted by 1980Monroe on July 3, 2004, at 18:19:32
I have read that Effexor is quite potent, in that it eventually affects serotonin, dopamine, and norepinephrine. Unsurprisingly, it is also one of the most difficult AD's to taper off of.
a
Posted by theo on July 4, 2004, at 7:59:29
In reply to What really is the most potent antidepressant?, posted by 1980Monroe on July 3, 2004, at 18:19:32
Paxil is supposed to be the most potent SSRI, which is why it works but also gives you the worst sexual dysfunction.
Posted by linkadge on July 4, 2004, at 8:22:19
In reply to Re: What really is the most potent antidepressant?, posted by theo on July 4, 2004, at 7:59:29
Posted by SLS on July 4, 2004, at 9:14:18
In reply to What really is the most potent antidepressant?, posted by 1980Monroe on July 3, 2004, at 18:19:32
> I just wanted to know,
I guess the wise-guy answer is: "the one that works".Probably Nardil. Anafranil is up there too. Depends on who you talk to. If clorgyline had ever made it to market, that would have been the one to pick.
- Scott
Posted by Sad Panda on July 4, 2004, at 11:19:35
In reply to What really is the most potent antidepressant?, posted by 1980Monroe on July 3, 2004, at 18:19:32
If you want to take just one drug then Nardil & Parnate are probably the best but least used. Amitriptyline has proven to be the winner overall, but has the worst side effects. Clomipramine would atleast equal Amitriptyline while having less side effects.
Cheers,
Panda.
Posted by Sad Panda on July 4, 2004, at 11:22:52
In reply to Re: What really is the most potent antidepressant?, posted by theo on July 4, 2004, at 7:59:29
> Paxil is supposed to be the most potent SSRI, which is why it works but also gives you the worst sexual dysfunction.
>
>Potency doesn't equate to efficacy however. The SSRI with the best efficacy is Zoloft.
Cheers,
Panda.
Posted by theo on July 4, 2004, at 12:06:50
In reply to Re: What really is the most potent antidepressant? » theo, posted by Sad Panda on July 4, 2004, at 11:22:52
But if one has any problems with anxiety or BP II even in the mildest degree, Zoloft is a very poor choice.
Posted by bluebird on July 4, 2004, at 12:48:27
In reply to Re: What really is the most potent antidepressant? » Sad Panda, posted by theo on July 4, 2004, at 12:06:50
> But if one has any problems with anxiety or BP II even in the mildest degree, Zoloft is a very poor choice.
Theo, So you have found that Zoloft causes anxiety. If you already have problems with severe anxiety then Zoloft probably woulndn't be a good choice. Right? Thanks, bluebird
Posted by KaraS on July 4, 2004, at 15:06:23
In reply to Re: What really is the most potent antidepressant?, posted by bluebird on July 4, 2004, at 12:48:27
Hard to believe that either Paxil or Zoloft would be considered for most potent or most effective ADs since neither of them did a thing for me. Just from personal experience and the other postings on this board, I would think Effexor would be considered more effective than either of those two.
Posted by theo on July 4, 2004, at 17:33:46
In reply to Re: What really is the most potent antidepressant?, posted by KaraS on July 4, 2004, at 15:06:23
I don't have a link readily available but several studies state this. The problem with Effexor XR is that its dose range is so broad, 37.5mg to 225mg, and you don't get NE effects until you hit arond 150mg. It'll be nice when Cymbalta comes out so you can get the benefit of a med that hits 5H-T & NE at starting dose. Effexor doesn't work as a combo until you reach high mg's. Also, stopping Effexor XR is worse than stopping an SSRI so the more you go up in dose, the longer it takes to stop it, and with Effexor every time you go down in dose you get full blown discontinuation syndrome.
Posted by KaraS on July 4, 2004, at 18:05:23
In reply to Re: What really is the most potent antidepressant?, posted by theo on July 4, 2004, at 17:33:46
Actually the dose range for Effexor goes up to (and sometimes over) 300 mg. That's true that the NE effects don't happen until you hit 150 mg. but with Zoloft and Paxil you don't get the NE effect at all - no matter how high you go in dosage. I hope that Cymbalta lives up to the hype. On paper it does sound like it could be great. Someone posted fairly recently who lives in Canada and her doctor is starting her in a duloxetine trial. She is not happy about it though. I told her that there are a lot of people here who would gladly welcome that opportunity.
I am going off of Effexor now and I didn't have any side effects at all until I got to 37.5 mg. Now I am going extremely slowly so that I don't get those awful effects. Going off of Paxil can be hell also. It was for me. Do you know anything about the half-life of Cymbalta?
Posted by Sad Panda on July 5, 2004, at 10:18:59
In reply to Re: What really is the most potent antidepressant? » Sad Panda, posted by theo on July 4, 2004, at 12:06:50
> But if one has any problems with anxiety or BP II even in the mildest degree, Zoloft is a very poor choice.
>What makes you think Zoloft would be a poorer choice than any of the other SSRI's? Celexa might be the best first choice for anxiety as it has some affinity for H1 receptors as an antagonist.
Cheers,
Panda.
Posted by theo on July 5, 2004, at 13:43:08
In reply to Re: What really is the most potent antidepressant?, posted by KaraS on July 4, 2004, at 18:05:23
From what I've read it's similar in 1/2 life to Paxil and is even prescribed once or TWICE daily, so it must be around 15 hours.
Posted by theo on July 5, 2004, at 13:51:36
In reply to Re: What really is the most potent antidepressant? » theo, posted by Sad Panda on July 5, 2004, at 10:18:59
For anxiety based depression, social, general etc., Zoloft is a poor choice. It's well documented and I speak from experience, my pdoc, and general doc. If you have anxiety as a root problem and/or hidden BPII, Zoloft can trigger a miserable experience.
For depression without much anxiety, I've heard good results from Zoloft.
Posted by KaraS on July 5, 2004, at 15:14:00
In reply to Re: What really is the most potent antidepressant? » KaraS, posted by theo on July 5, 2004, at 13:43:08
> From what I've read it's similar in 1/2 life to Paxil and is even prescribed once or TWICE daily, so it must be around 15 hours.
So Cymbalta will be hell to get off of also...
Posted by paulbwell on July 5, 2004, at 20:00:45
In reply to Re: What really is the most potent antidepressant?, posted by KaraS on July 5, 2004, at 15:14:00
When will people umderstand, most new Antidepresssants are more biopsychiatric sophistry, than advance in treatment, beginning in 1958 with Imipramine. Before this there was the Stimulants Dextroamphetamine Desoxyn-Methy/Amphetamine, the Opiods, Opium, Morphine and its drivatives. Agents which had many less harmfull side effects, where much less toxic, and save 'dependence'bought more subtle and comfortable relief to patients than todays agents. they also brought rapid relief, in hours/days not weeks /months.
Posted by 1980Monroe on July 5, 2004, at 21:30:38
In reply to Re: What really is the most potent antidepressant?, posted by KaraS on July 4, 2004, at 18:05:23
On a Scale of 1-bad) to 20-the best) what would it come in as? Is effexor more effective than wellbutrin?
Thnaks
Posted by harryp on July 6, 2004, at 10:01:04
In reply to What really is the most potent antidepressant?, posted by 1980Monroe on July 3, 2004, at 18:19:32
If you have truly serious depression, I honestly believe the tricyclics and MAOI's (plus lithium and some others) are the only drugs worth bothering with.
No credible study exists showing improved efficacy (or SE profile/in most cases)for modern AD's in treating severe depression.
The TCA's are active on NE and serotonin to varying degrees depending on the drug. I would highly recommend more than one TCA trial before going to Effexor (which would be my last choice of AD, period).
The MAOI's work quite differently from all other AD's by inhibiting oxidation of all amine neurotransmitters rather than their reuptake. I suspect this is responsible for their low "psychological side effect" profile.
The MAOI's DO affect Dopamine--I suspect that is why they turned out to be uniquely effective for me personally.
I have also heard of dopamine agonists like Mirapex being used for depression.
Posted by morel1 on July 6, 2004, at 15:18:49
In reply to Re: What really is the most potent antidepressant?, posted by bluebird on July 4, 2004, at 12:48:27
Celexa being the one with the least side effects
Posted by linkadge on July 7, 2004, at 16:33:20
In reply to Re: What really is the most potent antidepressant?, posted by morel1 on July 6, 2004, at 15:18:49
Sure, opiates and stimulants may bring relief in hours but the relief is short lived and can actually worsen the course of the illness.
Most antidepressants take months because it takes a while for them to trigger neurogenesis to patch up broken areas of the brain. Stimulants and opiates do not trigger neurogenesis and can generally waste what little circutry is left over.
Linkadge
Posted by Aserone on July 9, 2004, at 17:36:14
In reply to The quick fixes are no fixes at all..., posted by linkadge on July 7, 2004, at 16:33:20
> Sure, opiates and stimulants may bring relief in hours but the relief is short lived and can actually worsen the course of the illness.
>
> Most antidepressants take months because it takes a while for them to trigger neurogenesis to patch up broken areas of the brain. Stimulants and opiates do not trigger neurogenesis and can generally waste what little circutry is left over.
>
>
> Linkadge
Yes that is what the drug companies etc are trying to tell everyone but the thing is that noone knows what causes depression so everything is more or less a "quick" fix or whatever. Just because it takes a long time to work doesn't mean it's not toxic.It's all about what works for different people and just take a look around this board and try to tell me that ssri/snri's don't cause dependence. Many people have to take medication their whole life anyway so what's the difference? (Money?)
If you think the mystery of depression is solved just take a look at this for example.
"Both SSRIs and tianeptine are clinically effective; however, their opposite modes of action challenge the prevailing concepts on the need of enhancement of serotonergic neurotransmission. To better understand the differences between these two opposite pharmacological modes of action, we compared the changes induced by tianeptine and paroxetine on psychopathology, the hypothalamic-pituitary-adrenocortical (HPA) system, and cognitive functions in a double-blind, randomized, controlled trial including 44 depressed inpatients over a period of 42 days. Depressive symptomatology significantly improved in all efficacy measures, with no significant differences between tianeptine and paroxetine. There was a trend toward better response to the SSRI among women. Assessment of the HPA system showed marked hyperactivity before the beginning of treatment, which then normalized in most of the patients, without significant differences between the two antidepressants. Cognitive assessments showed no significant differences between the two drugs investigated. The results of the current study suggest that the initial effect, i.e., enhancement or decrease of 5-HT release, is only indirectly responsible for antidepressant efficacy, and they support the notion that downstream adaptations within and between nerve cells are crucial."
"This study establishes that "tianeptine enhances the presynaptic neuronal reuptake of 5-HT" leading to decreased availability of the transmitter at the postsynaptic 5-HT receptor "and thus decreases serotonergic neurotransmission," making its effect opposite to selective serotonin reuptake inhibitors (SSRIs). Since both types of medications work on depression, the authors speculate that antidepressant effects may occur "downstream," and that the usual theory of "a deficit in central synaptic neurotransmission, secondary to the deficiency in monoaminergic neurotransmission, mainly of serotonin (5-HT) and/or noradrenaline" as the cause of affective disorders, must be in error."
Opioids also regulate the HPA.
Posted by Sad Panda on July 10, 2004, at 9:17:33
In reply to Re: The quick fixes are no fixes at all..., posted by Aserone on July 9, 2004, at 17:36:14
The biggest difference between Opiates/Stimulants and Antidepressants is that you can't take Opiates or Stimulants for any length of time without rapidly building tolerance to the happy effect.
Cheers,
Panda.
This is the end of the thread.
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