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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by ed_uk on August 15, 2005, at 5:51:25
How do you explain these results? - SSRI vs SSRI
Ann Clin Psychiatry. 2005 Apr-Jun;17(2):65-9.
A double-blind comparison of escitalopram and paroxetine in the long-term treatment of generalized anxiety disorder.
Bielski RJ, Bose A, Chang CC.
Summit Research Network, 4084 Okemos Road. Suite C, Okemos, MI 48864, USA. rbielski@summitnetwork.com
BACKGROUND: This study compared the efficacy and tolerability of escitalopram, a newer SSRI, with paroxetine in the treatment of generalized anxiety disorder (GAD). METHODS: Patients with DSM-IV-defined GAD were randomized to receive 24 weeks of double-blind flexible-dose treatment with either escitalopram (10-20 mg/day) or paroxetine (20-50 mg/day), followed by a 2-week, double-blind, down-titration period. Mean change from baseline to endpoint (LOCF) in Hamilton Anxiety Scale (HAMA) scores was the primary efficacy variable. RESULTS: Mean baseline HAMA scores for the escitalopram (N = 60) and paroxetine (N = 61) groups were 23.7 and 23.4, respectively. After 24 weeks of treatment, mean changes in HAMA scores were -15.3 and -13.3 for escitalopram and paroxetine, respectively (p = 0.13 - not significant). Significantly fewer patients withdrew from escitalopram than paroxetine treatment due to adverse events (6.6% vs. 22.6%; p = 0.02). The frequency of treatment-emergent adverse events was higher with paroxetine vs. escitalopram: overall (88.7% vs. 77.0%), insomnia (25.8% vs. 14.8%), constipation (14.5% vs. 1.6%), ejaculation disorder (30.0% vs. 14.8%), anorgasmia (26.2% vs. 5.9%), and decreased libido (22.6% vs. 4.9%). Conversely, diarrhea and upper respiratory tract infection were reported more with escitalopram than paroxetine (21.3% vs. 8.1%, and 14.8% vs. 4.8%, respectively). CONCLUSIONS: These results support the use of escitalopram as a first-line treatment for GAD.
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Here is my explanation....... (just a guess)........
1. Paroxetine doses >20mg/day have not been shown to be more effective than 20mg for GAD. Study patients received up to 50mg.
2. Many people who take escitalopram for anxiety appear to require doses up to ~40mg/day. Study patients recived a maximum of 20mg. In the short term, 40mg escitalopram is probably no more effective than 20mg. Some people may respond better to ~40mg in the long term?
3. Paroxetine caused more side effects due to the relatively high doses prescribed. Escitalopram was better tolerated because the doses prescribed were relatively low.
4. Diarrhea was more common with escitalopram because paroxetine is (very) weakly anticholinergic. Anticholinergics are constipating. Hmm, I'm not convinced about this one, paroxetine is only very weakly anticholinergic.
Second explanation........
I'm wrong about escitalopram. It really is better tolerated than paroxetine.
Yeah I know, escitalopram is a more selective SSRI than paroxetine....... but paroxetine's pretty selective too ya know? I'm not convinced that it effects NE reuptake enough to be relevent, especially at low doses.
~Ed
PS. Grrr. This was supposed to be a flexible dose study..... but the doses prescribed were limited by fixed ranges. Hmmmm.
PPS. Am I too cynical?
Posted by ed_uk on August 15, 2005, at 5:57:32
In reply to Paroxetine vs escitalopram, posted by ed_uk on August 15, 2005, at 5:51:25
Eur Neuropsychopharmacol. 2005 Jul 11; [Epub ahead of print] Related Articles, Links
Escitalopram versus paroxetine for social anxiety disorder: An analysis of efficacy for different symptom dimensions.Stein DJ, Andersen EW, Lader M.
University of Cape Town, South Africa and University of Florida, Gainesville, USA.
BACKGROUND: A previous factor analysis of pooled data demonstrated that the Liebowitz Social Anxiety Scale (LSAS) can be divided into six subscales. This paper examines data from a fixed-dose trial of escitalopram versus paroxetine, in order to determine the differential effects of these agents on symptom dimensions in social anxiety disorder (SAD). METHODS: Data from a 24-week randomised, placebo-controlled, comparative study of fixed doses of escitalopram (5 mg, 10 mg, 20 mg) versus paroxetine (20 mg) in SAD were examined. The six factors identified in a previous factor analysis of baseline data from escitalopram studies on the primary efficacy scale, the LSAS, were used to compute subscale scores. These were analysed using analysis of covariance (ANCOVA), and standardised effect sizes were calculated. RESULTS: The combined escitalopram data and the paroxetine data both demonstrated significant superiority to placebo on each of the 6 LSAS factors at week 24 (OC analysis). Escitalopram doses of 5 mg, 10 mg, and 20 mg were generally more effective than placebo for each of the factors. Escitalopram 20 mg was significantly more effective than paroxetine 20 mg on 5 of the 6 symptom dimensions. CONCLUSION: Factor analysis of the LSAS allows for useful secondary analyses that support and extend the primary efficacy analysis of this instrument. The analysis here indicates that different escitalopram doses are effective across the various symptom dimensions of SAD.
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Perhaps the first study I posted would have been fairer if it compared escitalopram 10-20mg with paroxetine 20-30mg?
~Ed
Posted by ed_uk on August 15, 2005, at 6:19:35
In reply to Paroxetine vs escitalopram, posted by ed_uk on August 15, 2005, at 5:51:25
Int Clin Psychopharmacol. 2005 May;20(3):131-7.
Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder.
Moore N, Verdoux H, Fantino B.
Departement de Pharmacologie, INSERM U657, Universite Victor Segalen, Bordeaux, France. nicholas.moore@pharmaco.u-bordeaux2.fr
Pre-clinical studies, active-control clinical trials and meta-analyses indicate that escitalopram (S-citalopram) might be more effective than citalopram, the racemic mixture of S- and R-citalopram. The present study aimed to confirm the superior efficacy of escitalopram over citalopram. A double-blind, randomized clinical trial was performed in which general practitioners and psychiatrists compared fixed doses of escitalopram (20 mg/day) with citalopram (40 mg/day) over 8 weeks in outpatients with major depressive disorder (MDD) [baseline Montgomery-Asberg Depression Rating Scale (MADRS) score > or =30]. Primary efficacy parameter was change from baseline to last assessment in the MADRS total score. Out of 138 (aged 44.1+/-10.9 years; initial MADRS score 36.3+/-4.8) and 142 (aged 46.2+/-11.1 years; initial MADRS score 35.7+/-4.4) evaluable patients who were randomized to escitalopram and citalopram, respectively, six and 15 withdrew prematurely (P=0.05). The MADRS score decreased more in the escitalopram than in the citalopram arm (-22.4+/-12.9 versus -20.3+/-12.7; P<0.05). There were more treatment responders with escitalopram (76.1%) than with citalopram (61.3%, P<0.01). Adjusted remitter rates were 56.1% and 43.6%, respectively (P<0.05). Tolerability was similar in both groups. This randomized double-blind trial confirms that escitalopram has a superior effect to citalopram in MDD.
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What the **manufacturer** says.......................
Psychopharmacology (Berl). 2004 Jul;174(2):163-76.
Escitalopram versus citalopram: the surprising role of the R-enantiomer.Sanchez C, Bogeso KP, Ebert B, Reines EH, Braestrup C.
Research and Development, H. Lundbeck A/S, Ottiliavej 9, 2500 Valby Copenhagen, Denmark. cs@lundbeck.com
RATIONALE: Citalopram is a racemate consisting of a 1:1 mixture of the R(-)- and S(+)-enantiomers. Non-clinical studies show that the serotonin reuptake inhibitory activity of citalopram is attributable to the S-enantiomer, escitalopram. A series of recent non-clinical and clinical studies comparing escitalopram and citalopram to placebo found that equivalent doses of these two drugs, i.e. containing the same amount of the S-enantiomer, showed better effect for escitalopram. These results suggested that the R-citalopram in citalopram inhibits the effect of the S-enantiomer. OBJECTIVE: To review the pharmacological and non-clinical literature that describes the inhibition of escitalopram by R-citalopram, as well as the implications of this inhibition for the clinical efficacy of escitalopram compared to citalopram. METHODS: The information in this review was gathered from published articles and abstracts. RESULTS: In appropriate neurochemical, functional, and behavioural non-clinical experiments, escitalopram shows greater efficacy and faster onset of action than comparable doses of citalopram. The lower efficacy of citalopram in these studies is apparently due to the inhibition of the effect of the S-enantiomer by the R-enantiomer, possibly via an allosteric interaction with the serotonin transporter. Data from randomised clinical trials consistently show better efficacy with escitalopram than with citalopram, including higher rates of response and remission, and faster time to symptom relief. CONCLUSION: The R-enantiomer present in citalopram counteracts the activity of the S-enantiomer, thereby providing a possible basis for the pharmacological and clinical differences observed between citalopram and escitalopram.
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The manufacturer claims that 10mg escitalopram is 'equivalent' to 40mg citalopram - I'm still not convinced about this. One would expect 10mg escitalopram to be 'equivalent' to 20mg citalopram. LOL, if R-citalopram really does reduce the efficacy of escitalopram, perhaps 10mg escitalopram is 'equivalent' to about 30mg citalopram.
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Observations which are difficult to explain.............
1. Some babblers seem to find citalopram more 'sedating' than escitalopram
2. Some babblers seem to find escitalopram more anxiety-provoking that citalopram.Citalopram is a more potent H1 antagonist than escitalopram - but they're both very weak. I don't think this explains the above observations.
Posted by ed_uk on August 15, 2005, at 6:22:25
In reply to Re: Citalopram vs escitalopram, posted by ed_uk on August 15, 2005, at 6:19:35
Hmmm, I can't believe I'm saying this but I'm actually thinking of trying escitalopram instead of citalopram!! I might try 20mg escitalopram istead of 60mg citalopram.
Neuropsychopharmacology. 2005 Jul;30(7):1269-77.Effects of acute and long-term administration of escitalopram and citalopram on serotonin neurotransmission: an in vivo electrophysiological study in rat brain.
El Mansari M, Sanchez C, Chouvet G, Renaud B, Haddjeri N.
Laboratory of Neuropharmacology and Neurochemistry, Faculty of Pharmacy, University of Claude Bernard Lyon I, Lyon Cedex, France.
The present study was undertaken to compare the acute and long-term effects of escitalopram and citalopram on rat brain 5-HT neurotransmission, using electrophysiological techniques. In hippocampus, after 2 weeks of treatment with escitalopram (10 mg/kg/day, s.c.) or citalopram (20 mg/kg/day, s.c.), the administration of the selective 5-HT(1A) receptor antagonist WAY-100,635 (20-100 microg/kg, i.v.) dose-dependently induced a similar increase in the firing activity of dorsal hippocampus CA(3) pyramidal neurons, thus revealing direct functional evidence of an enhanced tonic activation of postsynaptic 5-HT(1A) receptors. In dorsal raphe nucleus, escitalopram was four times more potent than citalopram in suppressing the firing activity of presumed 5-HT neurons (ED(50)=58 and 254 mug/kg, i.v., respectively). Interestingly, the suppressant effect of escitalopram (100 microg/kg, i.v.) was significantly prevented, but not reversed by R-citalopram (250 microg/kg, i.v.). Sustained administration of escitalopram and citalopram significantly decreased the spontaneous firing activity of presumed 5-HT neurons. This firing activity returned to control rate after 2 weeks in rats treated with escitalopram, but only after 3 weeks using citalopram, and was associated with a desensitization of somatodendritic 5-HT(1A) autoreceptors. These results suggest that the time course of the gradual return of presumed 5-HT neuronal firing activity, which was reported to account for the delayed effect of SSRI on 5-HT transmission, is congruent with the earlier onset of action of escitalopram vs citalopram in validated animal models of depression and anxiety.
~ed
Posted by ed_uk on August 15, 2005, at 6:27:53
In reply to Paroxetine vs escitalopram, posted by ed_uk on August 15, 2005, at 5:51:25
I don't like disagreeing with myself but..............
Pharmacol Biochem Behav. 2003 Jul;75(4):903-7. Related Articles, Links
R-citalopram counteracts the effect of escitalopram in a rat conditioned fear stress model of anxiety.
Sanchez C, Gruca P, Bien E, Papp M.
Neuropharmacological Research, H. Lundbeck A/S, Copenhagen-Valby, Denmark. cs@lundbeck.com
S-citalopram (escitalopram) mediates the serotonin reuptake inhibitory effect of the racemate, R,S-citalopram. The effect of escitalopram (0.5-3.9 mg/kg) was investigated in a rat conditioned fear stress model of anxiety and compared to the effects of R-citalopram (1.0-7.8 mg/kg), R,S-citalopram (4.0 and 8.0 mg/kg), and escitalopram (2.0 mg/kg)+R-citalopram (7.8 mg/kg). Diazepam (0.95 mg/kg) and buspirone (4.6 mg/kg) were included as positive controls. During an acquisition session, rats were allowed to freely explore a novel cage for 9 min. During that time, they received two inescapable footshocks through an electrifiable grid floor. Groups of nonshocked control rats were run in parallel. During an expression session on the next day, rats were treated with drug or vehicle 30 min before they were reintroduced into the test cage for a 9-min period this time without receiving footshocks and the total distance travelled was recorded. The distance travelled by vehicle-treated rats was markedly suppressed compared to a vehicle-treated group of nonshocked controls. Escitalopram produced a dose-dependent inhibition of the conditioned suppression of exploratory behaviour (minimal effective dose 1.0 mg/kg). Interestingly R,S-citalopram 4.0 and 8.0 mg/kg produced significantly smaller effect than escitalopram 2.0 and 4.0 mg/kg, receptively. R-citalopram, 7.8 mg/kg, produced a significant effect. However, in spite of this, R-citalopram (7.8 mg/kg) significantly inhibited the effect of escitalopram (2.0 mg/kg). The activity in drug-treated nonshocked groups was similar to the vehicle-treated group, except for the buspirone-treated group where a significant reduction was observed. The finding that R-citalopram inhibits the effect of escitalopram may be relevant to the improved clinical efficacy seen with escitalopram compared to R,S-citalopram in the treatment of anxiety and depression.
Eur J Pharmacol. 2003 Mar 19;464(2-3):155-8.
R-citalopram attenuates anxiolytic effects of escitalopram in a rat ultrasonic vocalisation model.
Sanchez C.
Neuropharmacological Research, H. Lundbeck A/S, Ottiliavej 9, DK 2500 Copenhagen-Valby, Denmark. cs@lundbeck.com
Escitalopram mediates the serotonin reuptake inhibitory effect of citalopram. To investigate the potential interactive effects between escitalopram and R-citalopram, they were studied at standard and elevated serotonin levels in a model predictive of anxiolytic activity (inhibition of footshock-induced ultrasonic vocalisation in adult rats). At standard levels, citalopram partially inhibited (64%) and escitalopram abolished (97%) vocalisation. Co-treatment with L-5-hydroxytryptophan resulted in complete inhibition with citalopram and a substantially enhanced response to escitalopram, while R-citalopram increased the vocalisation significantly. Furthermore, R-citalopram attenuated the effect of escitalopram. These findings may be relevant to the enhanced clinical efficacy seen with escitalopram compared to citalopram.
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I found paroxetine more sedating than citalopram, I don't want to take it again. Citalopram helps my anxiety but it's been getting worse lately. Perhaps I should try escitalopram. It's £6.50 whatever I get a prescription for. I might as well try it.
Posted by ed_uk on August 15, 2005, at 7:49:03
In reply to Re: Citalopram vs escitalopram, posted by ed_uk on August 15, 2005, at 6:27:53
Hmmm, more info (kindly) provided by the manufacturer......... (independent info would be better!).........
Br J Pharmacol. 2004 May;142(1):172-80. Epub 2004
R-citalopram functionally antagonises escitalopram in vivo and in vitro: evidence for kinetic interaction at the serotonin transporter.
Storustovu S, Sanchez C, Porzgen P, Brennum LT, Larsen AK, Pulis M, Ebert B.
Department of Electrophysiology, H. Lundbeck A/S, 9 Ottiliavej, Valby DK-2500, Denmark.
1. Clinical observations with the selective serotonin reuptake inhibitor (SSRI), S-citalopram, indicate that S-citalopram is more efficacious and produces earlier symptom relief than RS-citalopram. Since R-citalopram is at least 20-fold weaker than S-citalopram as inhibitor of the 5-HT transporter (SERT) in preclinical studies, the clinical data suggest an unexpected antagonistic interaction between the two enantiomers. We therefore characterised the interaction of R- and S-citalopram with the SERT in in vivo and in vitro assays. 2. In both behavioural (potentiation of 5-hydroxytryptophan (5-HTP)-induced behaviour) and electrophysiological studies (inhibition of 5-HT-elicited ion currents in Xenopus oocytes expressing the human SERT (hSERT) R-citalopram inhibited the effects of S-citalopram in a dose-dependent manner. With S-citalopram : R-citalopram ratios of 1 : 2 and 1 : 4, 5-HTP potentiation was significantly smaller than with S-citalopram alone. 3. R-citalopram did not antagonise the effects of another SSRI (fluoxetine) in either behavioural or electrophysiological studies. 4. In oocytes, inhibition of hSERT-mediated currents by R-citalopram was almost completely reversible and characterised by fast on- and off-sets of action. In contrast, the off-set for S-citalopram was 35-fold slower than for R-citalopram. 5. Kinetic analysis of the oocyte experiments suggests that S-citalopram binding to SERT induces a long-lasting, inhibited state of the transporter and that coapplication of R-citalopram partially relieves SERT of this persistent inhibition. 6. We propose that the kinetic interaction of R- and S-citalopram with SERT is a critical factor contributing to the antagonistic effects of R-citalopram on S-citalopram in vitro and in vivo.
Pharmacol Biochem Behav. 2004 Feb;77(2):391-8.R-citalopram inhibits functional and 5-HTP-evoked behavioural responses to the SSRI, escitalopram.
Sanchez C, Kreilgaard M.
Neuropharmacological Research, H. Lundbeck, Ottiliavej 9, DK 2500 -Valby, Copenhagen, Denmark. cs@lundbeck.com
Escitalopram mediates the serotonin re-uptake inhibitory and antidepressant effect of citalopram racemate. However, recent studies have shown that R-citalopram inhibits the escitalopram-induced increase of extracellular 5-HT levels in the frontal cortex of rats. Here, we investigated the inhibitory effect of R-citalopram on the escitalopram-induced increase of 5-HT neurotransmission at the behavioural [potentiation of 5-hydroxytryptophan (5-HTP)-induced behavioural changes in mice and rats] and functional (increase in serum corticosterone in rats) levels. The effect of escitalopram was inhibited by R-citalopram in all three models, and R-citalopram, given alone, was inactive. The effects were more pronounced using an escitalopram to R-citalopram ratio of 1:4 than ratios of 1:2 and 1:1, suggesting a dose-dependent effect. The ED(50)-value of escitalopram in mouse 5-HTP potentiation studies corresponded to a serum concentration of approximately 50 ng/ml, which can be considered to be in the range of clinically relevant serum concentrations.In conclusion, R-citalopram inhibited the escitalopram-induced increase of 5-HT activity in functional, as well as behavioural, animal models. The mechanism involved in this interaction is currently unknown, but may be related to an improved clinical effect seen with escitalopram in comparison with citalopram.
Behav Pharmacol. 2003 Sep;14(5-6):465-70.
R-citalopram counteracts the antidepressant-like effect of escitalopram in a rat chronic mild stress model.
Sanchez C, Gruca P, Papp M.
Neuropharmacological Research, H. Lundbeck A/S, Copenhagen-Valby, Denmark. cs@lundbeck.com
The selective serotonin (5-HT) reuptake inhibitor, citalopram, is a racemic mixture of the stereoisomers, S-(+)-citalopram (escitalopram) and R-(-)-citalopram (R-citalopram). R-citalopram has been shown to counteract the 5-HT enhancing properties of escitalopram in acute studies in animals. In the present study we report, for the first time, on an interaction between R-citalopram and escitalopram after repeated dosing in a rat chronic mild stress (CMS) model of depression. The effect of escitalopram (2.0, 3.9 and 7.8 mg/kg per day), R-citalopram (7.8 mg/kg per day) and escitalopram 3.9 mg/kg per day plus R-citalopram 7.8 mg/kg per day were studied and compared to the effect of citalopram (8.0 mg/kg per day), imipramine and R-fluoxetine (8.9 mg/kg per day). Significant effects relative to a vehicle-treated group were achieved from week 1 for escitalopram (3.9 and 7.8 mg/kg per day), from week 2 for citalopram (8.0 mg/kg per day), from week 3 for R-fluoxetine (8.9 mg/kg per day) and from week 4 for escitalopram (2.0 mg/kg per day) and imipramine (8.9 mg/kg per day). R-citalopram (7.8 mg/kg per day) and escitalopram (3.9 mg/kg per day) plus R-citalopram (7.8 mg/kg per day) did not differ significantly from vehicle. There were no drug-induced effects in non-stressed control groups. In conclusion, escitalopram showed a shorter time to response in the rat CMS model of depression than citalopram, which was faster acting than R-fluoxetine and imipramine. R-citalopram counteracted the effect of escitalopram. The mechanism of action of R-citalopram is, at the moment unclear, but may be relevant to the improved clinical antidepressant activity seen with escitalopram in comparison with citalopram, and may also indicate an earlier response to escitalopram compared to other selective serotonin reuptake inhibitors (SSRIs).
Pharmacol Biochem Behav. 2003 Jul;75(4):903-7.
R-citalopram counteracts the effect of escitalopram in a rat conditioned fear stress model of anxiety.Sanchez C, Gruca P, Bien E, Papp M.
Neuropharmacological Research, H. Lundbeck A/S, Copenhagen-Valby, Denmark. cs@lundbeck.com
S-citalopram (escitalopram) mediates the serotonin reuptake inhibitory effect of the racemate, R,S-citalopram. The effect of escitalopram (0.5-3.9 mg/kg) was investigated in a rat conditioned fear stress model of anxiety and compared to the effects of R-citalopram (1.0-7.8 mg/kg), R,S-citalopram (4.0 and 8.0 mg/kg), and escitalopram (2.0 mg/kg)+R-citalopram (7.8 mg/kg). Diazepam (0.95 mg/kg) and buspirone (4.6 mg/kg) were included as positive controls. During an acquisition session, rats were allowed to freely explore a novel cage for 9 min. During that time, they received two inescapable footshocks through an electrifiable grid floor. Groups of nonshocked control rats were run in parallel. During an expression session on the next day, rats were treated with drug or vehicle 30 min before they were reintroduced into the test cage for a 9-min period this time without receiving footshocks and the total distance travelled was recorded. The distance travelled by vehicle-treated rats was markedly suppressed compared to a vehicle-treated group of nonshocked controls. Escitalopram produced a dose-dependent inhibition of the conditioned suppression of exploratory behaviour (minimal effective dose 1.0 mg/kg). Interestingly R,S-citalopram 4.0 and 8.0 mg/kg produced significantly smaller effect than escitalopram 2.0 and 4.0 mg/kg, receptively. R-citalopram, 7.8 mg/kg, produced a significant effect. However, in spite of this, R-citalopram (7.8 mg/kg) significantly inhibited the effect of escitalopram (2.0 mg/kg). The activity in drug-treated nonshocked groups was similar to the vehicle-treated group, except for the buspirone-treated group where a significant reduction was observed. The finding that R-citalopram inhibits the effect of escitalopram may be relevant to the improved clinical efficacy seen with escitalopram compared to R,S-citalopram in the treatment of anxiety and depression.
Posted by ed_uk on August 15, 2005, at 7:53:37
In reply to Re: Citalopram vs escitalopram, posted by ed_uk on August 15, 2005, at 6:27:53
Milligram for milligram, escitalopram is clearly more potent than citalopram - this much is obvious.
However..... potency is not the same as efficacy.
The question is....... (at optimal doses)..... is escitalopram more effective?
~ed
Posted by anneL on August 15, 2005, at 15:23:11
In reply to Re: Citalopram vs escitalopram » ed_uk, posted by ed_uk on August 15, 2005, at 7:53:37
I have observed that many of my patients have had a robust response in terms of anxiety reduction with Lexapro. Might be worth a try. . . :) Laurie
Posted by ed_uk on August 15, 2005, at 15:29:14
In reply to Re: Citalopram vs escitalopram » ed_uk, posted by anneL on August 15, 2005, at 15:23:11
Thanks :-)
~ed
Posted by linkadge on August 15, 2005, at 17:23:26
In reply to Paroxetine vs escitalopram, posted by ed_uk on August 15, 2005, at 5:51:25
I've taken all the SSRI's. You are right that paxil's noradrenic effects are not terrably potent, but they certainly are detectable.
Serotonin and norepinephrine play different roles in preventing panic. Noradrenic meds can be usefull for panic, but I think they may take longer to work (just a hunch)
Paxil was bad news for me. I think it kind a made me psychotic.
Linkadge
Posted by linkadge on August 15, 2005, at 17:31:26
In reply to Re: Citalopram vs escitalopram » ed_uk, posted by ed_uk on August 15, 2005, at 6:22:25
Interesting. The article said that citalopram desensitiezed the 5-ht1a autoreceptor. A study I read about clomipramine said it desensitized the 5-ht1b autoreceptor, but not the 1a autoreceptors prshaps a TCA SSRI combination would lead to a greater facilitation of serotonergic neurotransmission.
See:
http://www.hadassah.org.il/Atarim/biopsych/abstracts/3.html
Linkadge
Posted by ed_uk on August 15, 2005, at 17:49:29
In reply to Re: Paroxetine vs escitalopram, posted by linkadge on August 15, 2005, at 17:23:26
Hi Link,
>You are right that paxil's noradrenic effects are not terrably potent, but they certainly are detectable.
You could be right there.
~ed
Posted by linkadge on August 15, 2005, at 21:03:08
In reply to Re: Paroxetine vs escitalopram » linkadge, posted by ed_uk on August 15, 2005, at 17:49:29
Well, I guess when I say detectable, I mean that I noticed some of the noradrenic effects like minor cardiac stuff, and some visual sparkleyness.
Linkadge
Posted by linkadge on August 15, 2005, at 21:03:52
In reply to Re: Paroxetine vs escitalopram » linkadge, posted by ed_uk on August 15, 2005, at 17:49:29
I would like to try escitalopram if it ever comes to canada.
Linkadge
Posted by ed_uk on August 16, 2005, at 5:21:47
In reply to Re: Paroxetine vs escitalopram, posted by linkadge on August 15, 2005, at 21:03:52
Hi Link,
It's already available in Canada isn't it?
The brand name is Cipralex - same as the UK.
Yes.... it's available. See........
~Ed
PS. I searched for it here: (under active ingredient)
http://search.hc-sc.gc.ca/cgi-bin/query?mss=dpd/english/active/simple
Posted by ed_uk on August 16, 2005, at 5:24:03
In reply to Re: Citalopram vs escitalopram, posted by linkadge on August 15, 2005, at 17:31:26
Hi Link,
>prshaps a TCA SSRI combination would lead to a greater facilitation of serotonergic neurotransmission.....
SSRI + clomipramine has been used to treat severe OCD. Citalopram, sertraline and escitalopram are the most appropriate SSRIs due to the relative lack of pharmacokinetic drug interactions with TCAs.
Kind regards
~ed
This is the end of the thread.
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