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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 honeybee on June 7, 2006, at 10:38:52
Does anyone out there have experiences starting new drugs and those drugs seeming to get things going early on? I remember going on Effexor (long long ago) and believing I could feel a difference immediately. Supposedly, I could also feel Cymbalta immediately.
But everyone always says that those are placebo reponses. Is that really the case? Because they *feel* so very, very chemical.
Any other theories?
hb
Posted by pseudoname on June 7, 2006, at 11:18:04
In reply to Question about placebo effect, posted by honeybee on June 7, 2006, at 10:38:52
When I reported the striking but brief effects of Wellbutrin after taking for it a couple days, my ex-pdoc scoffed and sneered (literally!) and said it was just placebo effect, certainly not due to the drug.
Arrgh!
I regret that I didn't try to educate him. Those early responses are very common among patients; lots of Babblers report them.
As my pdoc should've known, SSRIs, TCAs etc can increase various brain neurotransmitter levels almost immediately (within days). It seems obvious that they could have some effects right away, even the target therapeutic changes don't come until later.
> But everyone always says that those are placebo reponses.
"everyone" = maddeningly naive pdocs; not patients here at Babble
Posted by bassman on June 7, 2006, at 11:25:01
In reply to real effects » honeybee, posted by pseudoname on June 7, 2006, at 11:18:04
I agree, big time. Every time I've started a new SSRI (too many times :>}) or changed the dose, I would always get an absolute blast out of depression the next day-followed by several days of worse depression-or being tired. When I took Paxil, I would do that on occasion-increase the dose from 40 to 50 mg for a day or two and feel excellent immediately. The doc I was going to said, "that can't happen". I said, "it did happen. I was there, you weren't". :>}
Posted by Larry Hoover on June 7, 2006, at 12:11:48
In reply to Question about placebo effect, posted by honeybee on June 7, 2006, at 10:38:52
> But everyone always says that those are placebo reponses.
Whoever said that is incorrect.
There are short-term effects, and long-term effects. Acute effects. Chronic effects.
Diabetes analogy. Acute effect: insulin reduces blood sugar. Chronic effect: insulin treats/reverses peripheral neuropathy.
Why would SSRIs, or *any* drug, be different than that? Except by fluke, I mean?
Lar
Posted by bassman on June 7, 2006, at 12:20:42
In reply to Re: Question about placebo effect » honeybee, posted by Larry Hoover on June 7, 2006, at 12:11:48
There's something fishy about it being a fluke. :>}
Posted by Caedmon on June 7, 2006, at 12:35:00
In reply to Re: Question about placebo effect, posted by bassman on June 7, 2006, at 12:20:42
It's entirely possible for someone to respond right away. I don't know why this is sometimes attributed to placebo effect either. How would one even know?
- Chris
Posted by Klavot on June 7, 2006, at 13:29:43
In reply to Question about placebo effect, posted by honeybee on June 7, 2006, at 10:38:52
> Does anyone out there have experiences starting new drugs and those drugs seeming to get things going early on? I remember going on Effexor (long long ago) and believing I could feel a difference immediately. Supposedly, I could also feel Cymbalta immediately.
>
> But everyone always says that those are placebo reponses. Is that really the case? Because they *feel* so very, very chemical.
>
> Any other theories?
>
> hbI have had similar experiences with Zoloft and Wellbutrin.
I think what happened is this: the pharmaceutical industry said that resonse may take *up to* two weeks - "up to" being the operative phrase. From there, to simplify things, doctors simply take *two weeks* as the response period, to the point where it as become a piece of SSRI folklore.
Posted by honeybee on June 7, 2006, at 13:45:51
In reply to Re: Question about placebo effect, posted by Klavot on June 7, 2006, at 13:29:43
I seem to remember seeing, somewhere, that the ADs "real" effects were to stimulate nerve cell regrowth which would happen sometime in that 2-6 week window.
Funny that psychiatrists don't seem to be willing to acknowledge that it happens. It actually seems like a selling point to me--feel good for at least one day! Etc.
Posted by yxibow on June 7, 2006, at 16:53:55
In reply to Re: Question about placebo effect, posted by honeybee on June 7, 2006, at 13:45:51
It's not necessarily that its a placebo effect, but its a small jolt on transmittters that havent been touched ever or in quite a while. To actually build a blood level of a drug, which in turn raises, or lowers certain neurotransmitters, takes many days to weeks. There are initial effects, mostly transitory side effects are what one feels during the stages of antidepressant therapies at the beginning. There may be indeed a very mild lift, but its not typical to have a full effect for some weeks, except for perhaps neuroleptics. Remeron I think is also shorter acting in that regard, but that's just my feeling.
Anyway as it is always stated, the placebo effect can be as much as 1/3 of the treatment -- and if it is, so be it -- either way, something good happened.
Posted by linkadge on June 7, 2006, at 20:34:26
In reply to Re: Question about placebo effect, posted by yxibow on June 7, 2006, at 16:53:55
I don't think it is a placebo effect.
When I did have a responce to an antidepressant, I seemed to have some immediate positive effects.
Doctors and scientists have always tried to maintain that antidepressants cannot work right away because they are trying to distinguish them from being seen as pep pills.
They are pep pills in many ways, and they can have immediate effects. The noradrenergic antidepressants can also have some significant and immediate effects.
The TCA's are strong anticholinergics. Anticholinergic agents are potentially abusable because they actually do increase dopamine in pleasure centres of the brain. In this sence, TCA's can have immedate effects too.
Occasionally drugs like prozac and effexor have been used recreationally.
Linkadge
Posted by Phillipa on June 7, 2006, at 21:50:55
In reply to Re: Question about placebo effect, posted by linkadge on June 7, 2006, at 20:34:26
Link Prozac? Horrible anxiety attacks. Love Phillipa
Posted by pulse on June 8, 2006, at 10:29:46
In reply to Re: Question about placebo effect » linkadge, posted by Phillipa on June 7, 2006, at 21:50:55
link is right - prozac has been used recreationally - sold on the streets.
pulse
Posted by honeybee on June 8, 2006, at 10:34:10
In reply to Re: Question about placebo effect, posted by pulse on June 8, 2006, at 10:29:46
Hmm.
Can I ask a question about this? If I responded well to Effexor and needed to go on something (not Effexor), what would be my best bet? An energizing AD like prozac or zoloft? Lexapro made me feel pinned under a 1000 lb. weight.
Thanks,
hb
Posted by pulse on June 8, 2006, at 10:57:24
In reply to Re: Question about placebo effect, posted by honeybee on June 8, 2006, at 10:34:10
i loved prozac, as after the first few days any slight overstimulation subsides - for me. it was my mainstay of the newer generation ads, but nowdays, i can no longer tolerate GI problems even from it, and it caused me these the least of any.
lexapro i simply hated..i found it way too stimulating and impossible on the stomach, although the GI stuff didn't show up until 2 weeks in. i ended up crying in bed nightly with the cramping. i know of one young guy - his very first ad - who had to be hospitalized for pancreatitis caused - for sure - by lex. i wrote to a pdoc in another state who said he's been getting reports of lex causing GI probs of all kinds, including those as extreme as pancreatitis - from all over the usa.
zoloft i would never try again - it's stimulating , at least for quite a few weeks, but the teeth-clenching it causes is unparelled. insomnia is a very significant problem also.
pulse
Posted by Larry Hoover on June 8, 2006, at 15:23:09
In reply to Re: Question about placebo effect, posted by pulse on June 8, 2006, at 10:29:46
> link is right - prozac has been used recreationally - sold on the streets.
>
> pulseYou mean all those barely used prescriptions I can't bear to throw out (waste not, want not?), might actually be worth something? <joking>
Lar
Posted by pulse on June 9, 2006, at 15:05:46
In reply to Re: Question about placebo effect » pulse, posted by Larry Hoover on June 8, 2006, at 15:23:09
yep, but i have no idea just how much $, Lar. i'd wager not all that much....and i do realize you're joking.
i never sold any myself, just know that some ppl apparently have.
fyi: i finally got up the courage, i.e., disgust, to throw out all my barely used scripts. with my guts (GI) problems, it was beyond obvious they had all long since been a done deal.
i DID save the nifty paper tote bag i'd kept them in, of course. rofl. ocd - hoarding variety - never completely dies...
pulse
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