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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by qbsbrown on September 9, 2006, at 22:11:25
Is this just a matter of time, and more marketing dollars? Typically as we see, the newest is always better, yet Cymbalta hasn't caught on yet, why is this?
I did read an article that did show that it is the fastest growing AD in terms of percent increase of sales (almost 100 percent)
Or do u feel that this drug really isn't that great, or much better than effexor? If you look on remedyfind.com, u really don't see many ratings for it.
We all know of the placebo effect of lexapro and patients being told that it's the best/cleanest drug in the world. Of course it has the highest ratings.
I'd like to hear your thoughts.
Brian
Posted by Phillipa on September 9, 2006, at 22:28:59
In reply to When is Cymbalta going to be the latest/greatest??, posted by qbsbrown on September 9, 2006, at 22:11:25
I hear they are now saying it causes liver damage too. I tried it twice. First time nothing second time I couldn't tolerate it. I think all these ad's are hype and money. Love Phillipa
Posted by qbsbrown on September 9, 2006, at 22:31:25
In reply to Re: When is Cymbalta going to be the latest/greatest?? » qbsbrown, posted by Phillipa on September 9, 2006, at 22:28:59
Geesh, what med doesn't cause liver problems, it has to filter it all anyway. Then again if you think of the crap we eat, and the booze we drink, people don't care about the liver damage there.
Brian
Posted by yxibow on September 9, 2006, at 23:09:10
In reply to Re: When is Cymbalta going to be the latest/greatest?? » qbsbrown, posted by Phillipa on September 9, 2006, at 22:28:59
> I hear they are now saying it causes liver damage too. I tried it twice. First time nothing second time I couldn't tolerate it. I think all these ad's are hype and money. Love Phillipa
I think the liver damage is overdramatized on this particular medication -- it was mentioned here before, but I don't think as I also mentioned, that there is anything wrong with getting an ALT test every so often (or at your physical) while on Cymbalta. Liver damage is most pronounced (obviously) with people with predefined genetic liver deficiencies to begin with, and therefore should be careful with dosage of a particular medication. Also, the first sign of any liver troubles is jaundice, yellow in the eyes, and unnatural yellow patchy spots on the skin where no known bruising has occurred. This occurs way before any serious damage happens and when caught is quite reversible.
-- tidings
Jay
Posted by qbsbrown on September 9, 2006, at 23:11:35
In reply to Re: When is Cymbalta going to be the latest/greate » Phillipa, posted by yxibow on September 9, 2006, at 23:09:10
Posted by Racer on September 10, 2006, at 0:59:27
In reply to When is Cymbalta going to be the latest/greatest??, posted by qbsbrown on September 9, 2006, at 22:11:25
Just based on people here and my own experience with it, I would say that Cymbalta just ain't living up to its pre-approval hype. It just doesn't seem all that effective for depression, and at least in my case the pain relief didn't last. (It was VERY effective for pain for me, though, while it worked.)
So, that's my take on why Cymbalta ain't shooting up to the top of the charts. It's got a pretty good beat, but ya just can't dance to it.
Posted by yxibow on September 10, 2006, at 5:04:33
In reply to What's your take, the med and the question JAY?? (nm), posted by qbsbrown on September 9, 2006, at 23:11:35
One really can't evaluate a medication for an entire population of people. Or even an entire population of people suffering from a specific type of depression. Genetics, sex, race, background, environmental effects, placebo response to a substance, will affect outcome. And I haven't even described all possible factors.
I ran across an article a while ago written by a doctor that said if he had to be castaway on an island, what would be the one medication he would bring, and his narrowing down said:
http://www.preskorn.com/columns/9803.html
"...If I were on a desert island and could have only a single medication (an antidepressant) available, my choice would be amitriptyline. My rationale is as follows: A low dose of amitriptyline could be taken for its antihistamine properties if I was exposed to the tropical variant of poison ivy while on the island. A somewhat higher dose of amitriptyline could be taken for its anticholinergic effect, if I inadvertently ate "bad" food and got diarrhea. A somewhat higher dose could be taken for its alpha-1 adrenergic antagonism if I developed hypertension-perhaps from too much salt. Obviously, one could also take it if a depressive episode developed. I could even use amitriptyline, because of its effect on NA+ fast channels, to treat certain types of cardiac arrhythmias. However, too high a dose would carry the risk of a fatal arrhythmia for the same pharmacological reason."
But he goes on to the narrowing of modern medications.
In other words, for some people certain targets work and certain produce nasty results.
For myself, at least as of the moment, while it doesn't cover all breakthrough depression since it is both primary and secondary to the complex at hand, Cymbalta at 120mg provides a palatable substitute for Effexor which is like a epinephrine and caffeine drip at the same time, and is probably the reboxetine that never surfaced in the US.For some it may be a complete placebo -- I can't speak for them -- for others its total agony, I've seen numerous postings of people who split the lowest 20 (or is it 10, I forget) mg capsule into the little pulsules and count them. (Although this is not a good thing for two reasons: one, they're not even, the weight is by the capsule as a whole, and two, this risks chewing the enteric coated pulsules and having an immediate NE and 5HT rush, counter to what is being attempted.)
So is it a panacea, no -- no drug is a panacea, I think that is what you're trying to get at me to say and I can't say that. Because some people have very severe depression and take MAOIs (or RIMAs in other countries). Some have light dysthymia and really only need a small prescription of Zoloft or the like and are content. Some can't stand the current crop of medications and do take tricyclics.
Advertising is just that, advertising. The current wave of antidepressants and their television and newsprint ads will eventually be replaced by the next generation of compounds.
The first antidepressants were MAOIs, discovered by accident because one was being used to treat tuberculosis in the 1950s. They had (and still do) great dangers in their use, although for some they are a life saver. Then came the tricyclics, which had some danger in overdose but were, despite the lethargic nature of some, quite effective. Then SSRIs were discovered, the first to actually not cause liver damage was Prozac, and was the first true marketed SSRI. (Anafranil could be considered an SRI, though a tricyclic).
Inbetween there were tetracyclics (Trazodone, and more recently Remeron.) and stimulant like agents, Wellbutrin. Finally the most recent has been an SNRI, Cymbalta (and previously Effexor, mostly related)What is the next on the horizon ? I don't know -- there are various drugs in II and III stage research, not to mention recycling of old antidepressants or anxiolytics for new purposes (fibromyalgia, e.g.). Valdoxan, a melatonin related drug was refused by EMEA, but not for safety reasons, but lack of provable efficacy.
For now, patients (including myself) will probably find themselves on more than one agent to cover more than one issue, and of course that means more than one side effect, alas.
While I believe in better living through chemistry, it is not the only ingredient in a treatment program. Unfortunately the once a month HMO mode of treatment doesn't address this well -- psychotherapy, psychodynamic therapy, behavioural therapy really needs to accompany medication to have a full program, or one is left with figuring out the most important things -- the ways to cope, prosper, and enjoy to the best of one's abilities and society in this random thing we call life.
-- tidingsJay
Posted by qbsbrown on September 10, 2006, at 12:24:34
In reply to Re: What's your take... different strokes... » qbsbrown, posted by yxibow on September 10, 2006, at 5:04:33
I would have never of guessed that effexor was bringing in almost TWICE as much as lexapro.
Brian
Posted by Jay on September 10, 2006, at 16:51:07
In reply to What's your take, the med and the question JAY?? (nm), posted by qbsbrown on September 9, 2006, at 23:11:35
Hi...
I'd just say what most here have already. I'd also add it has similar functions of existing meds out there. IMHO, these meds work best in combinations. (Not 100% of the time..but maybe in particular for treatment-resistant...which seem to be more the norm.) The thinking now seems to be that anxiety and depression are opposite heads on the same coin, but they still must be fought with different medications.(At least with forward-thing docs.) Same with BP 2/3, manifesting itself as extreme anxiety and depression. Many of these symptoms cross-over. Anyhow, until a better treatment comes along,(likely with some different mode of action) these SSRI/SNRI's will just be "standard". Nothing to really get excited about.
Best,
Jay
Posted by Phillipa on September 10, 2006, at 19:18:30
In reply to Re: When is Cymbalta going to be the latest/greate » Phillipa, posted by yxibow on September 9, 2006, at 23:09:10
Jay just came from the ER. Had mine repeated again. They are falling. I asked the ER doc why they would rise other than meds, tumors, chirrosis. There is also an autoimmune form that destroys the liver. Never knew that one before. Did you? Love Jan
Posted by yxibow on September 10, 2006, at 21:58:16
In reply to Re: When is Cymbalta going to be the latest/greate » yxibow, posted by Phillipa on September 10, 2006, at 19:18:30
> Jay just came from the ER. Had mine repeated again. They are falling. I asked the ER doc why they would rise other than meds, tumors, chirrosis. There is also an autoimmune form that destroys the liver. Never knew that one before. Did you? Love Jan
Yes, there is autoimmune form of cirrhosis, which according to medical sources occurs more commonly with young girls or women. I don't see figures just offhand but I would say that is a more rare etiology than medication or alcohol induced liver disease (not saying that is your problem.) Medications contribute to at least 5% of hepatitis hospitalizations in the US. I also would not place it is as Hepatitis A as you I believe were a nurse and were probably vaccinated anyhow, not to mention it rarely goes to a hospitalization state.
Liver levels can idiopathically rise, and you are taking psychiatric medications which while as I recall are not red flag issues, nonetheless go through the liver. As an older woman (no offense meant), your liver may not be 100% as strong as when you were an adolescent and therefore liver levels may also be slightly off.
But its a good thing that it is falling down (if I understand, you mean they are returning to normal) -- I would just chalk it up to the original body trauma of your diverticulosis in the first place, if anything. Some things aren't terribly explainable in science, like why did I have 99.5% "fevers" from around 4pm to midnight for an entire year, then a lapse down from it before the *** hit the fan and I was struck with this visual disorder. Why do I have this disorder other than a possible explanation of my extreme hysteria over 9/11 converted to a somatiform condition? And why, except for one person on here with some other visual snow issue, am I the only person in the western hemisphere it seems with both of those issues having happened or happening?Not everything can turn up on an MRI or tests unfortunately, I had everything except lyme tested against me (I wanted that one too, but I would really know if I had it actually.)
But to health and well being, Jan!-- Jay
This is the end of the thread.
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