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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by ed_uk on November 20, 2006, at 15:12:58
"SSRIs’ effect on depression apparent within first week
Treatment with a selective serotonin reuptake inhibitor (SSRI) is associated with symptomatic improvement in depression by the end of the first week, according to a meta-analysis published in the Archives of General Psychiatry (2006;63:1217).
The researchers analysed data from 28 trials involving 5,872 subjects who received an SSRI or placebo. The pattern of response seen was tested against alternative models of onset of response.
The researchers found that the model that fit best was that where the incremental treatment effect was greatest in the first week, with a gradual decline in the magnitude of incremental benefits week by week.
A secondary outcome indicated an increased chance of achieving a 50 per cent reduction in Hamilton Depression Rating Scale scores by one week with SSRI treatment compared with placebo (relative risk 1.64; 95 per cent confidence interval 1.2–2.25). The absolute benefits increase further with time, say the researchers, so prescribers will continue to need to wait several weeks for key treatment goals, such as remission, to be met."
Posted by Quintal on November 20, 2006, at 17:49:44
In reply to An SSRI can sometimes help within one week, posted by ed_uk on November 20, 2006, at 15:12:58
I've certainly experienced dramatic improvements in my mood from SSRIs in the first week. I remember this especially with Lexapro - I was euphoric after three days but crashed back down again a few weeks later when it pooped out. My GP denies this happens but the psychiatric nurse says otherwise.
Q
Posted by Phillipa on November 20, 2006, at 23:05:45
In reply to Re: An SSRI can sometimes help within one week » ed_uk, posted by Quintal on November 20, 2006, at 17:49:44
This never happened to me . Does this mean SSRI's aren't for me never a remission. Love Phillipa
Posted by madeline on November 21, 2006, at 5:56:54
In reply to An SSRI can sometimes help within one week, posted by ed_uk on November 20, 2006, at 15:12:58
I've known for a long time that SSRI's can work in as little as a week.
I began to feel better on prozac in about 5 days.
I'm really lucky in that it hasn't really pooped out on me yet - although my doctor and I have had to jockey with the dose a few times.
Posted by blueberry on November 21, 2006, at 7:16:44
In reply to An SSRI can sometimes help within one week, posted by ed_uk on November 20, 2006, at 15:12:58
Years ago I believed that if a med wasn't showing any benefit at all within a week that it should be dropped in favor of trying something else. That was because any med that wasn't working early never really did do much for me in a full trial. I had a theory that the closer the med is to targeting the real underlying problem, and the closer the med is to agreeing with the person's unique genetics, the faster it would work. Actually I still do believe this, but not as enthusiastically as I used to. I have seen people here improve a lot after waiting a month or so when nothing had happened until then.
Generally speaking, all meds that ended up being longterm meds for me worked within the first week, some of them in just 1 to 3 days.
Posted by Crazy Horse on November 21, 2006, at 12:33:59
In reply to An SSRI can sometimes help within one week, posted by ed_uk on November 20, 2006, at 15:12:58
> "SSRIs’ effect on depression apparent within first week
>
> Treatment with a selective serotonin reuptake inhibitor (SSRI) is associated with symptomatic improvement in depression by the end of the first week, according to a meta-analysis published in the Archives of General Psychiatry (2006;63:1217).
>
> The researchers analysed data from 28 trials involving 5,872 subjects who received an SSRI or placebo. The pattern of response seen was tested against alternative models of onset of response.
>
> The researchers found that the model that fit best was that where the incremental treatment effect was greatest in the first week, with a gradual decline in the magnitude of incremental benefits week by week.
>
> A secondary outcome indicated an increased chance of achieving a 50 per cent reduction in Hamilton Depression Rating Scale scores by one week with SSRI treatment compared with placebo (relative risk 1.64; 95 per cent confidence interval 1.2–2.25). The absolute benefits increase further with time, say the researchers, so prescribers will continue to need to wait several weeks for key treatment goals, such as remission, to be met."
>I most definitely noticed improvement in the first week when my pdoc put me on Zoloft, i thought perhaps it was placebo. It doesn't really matter..all that matters is that i felt better with-in a week of starting it.
-CH
Posted by linkadge on November 21, 2006, at 14:52:07
In reply to Re: An SSRI can sometimes help within one week, posted by blueberry on November 21, 2006, at 7:16:44
Doctors don't want them to work so quickly as it makes them look lik pep pills. If a person can take a drug and feel better the next day, then they're more likely to be used as a quick pickmeup.
Most antidepressants have some actions similar to street drugs.
Linkadge
Posted by Quintal on November 21, 2006, at 15:39:01
In reply to Re: An SSRI can sometimes help within one week, posted by linkadge on November 21, 2006, at 14:52:07
I know of a few people using Prozac and other SSRIs to cushion the comedown of the Ecstacy they use recreationally. I did read a review of one SSRI somewhere and the guy had been using it p.r.n to help with his depression and anxiety similar to they way he used the herb Kanna. I think the drug was either Zoloft or Paxil.
Q
Posted by linkadge on November 21, 2006, at 15:45:12
In reply to Re: An SSRI can sometimes help within one week » linkadge, posted by Quintal on November 21, 2006, at 15:39:01
I react to SSRI's like they were recreational drugs. The first dose has the most effect, and then its downhill from there.
Linkadge
Posted by Phillipa on November 21, 2006, at 17:54:58
In reply to Re: An SSRI can sometimes help within one week, posted by linkadge on November 21, 2006, at 15:45:12
Nope not for me they make me feel horrible. That's why the benzos for so long. Love Phillipa
Posted by stargazer on November 21, 2006, at 21:15:35
In reply to Re: An SSRI can sometimes help within one week » linkadge, posted by Phillipa on November 21, 2006, at 17:54:58
I had response to MAO (Nardil and Marplan) w/i 1 week. I usually know if a med will work for me when i have some response in the first week. Any drug that takes a long time to work usually never works, despite an attempt at staying on it as long as I can. I usually have to d/c it d/t SE's which are too severe to continue the drug.
Posted by Phillipa on November 21, 2006, at 21:31:58
In reply to Re: An SSRI can sometimes help within one ? MAO 2, posted by stargazer on November 21, 2006, at 21:15:35
So why do docs and people make you feel guilty if you stop a med if your head feels like it will explode? And everyone seems to say stick it out in 6-8 weeks the start up side effects will go away? Love Phillipa
Posted by stargazer on November 22, 2006, at 8:55:13
In reply to Re: An SSRI can sometimes help within one ? MAO 2, posted by stargazer on November 21, 2006, at 21:15:35
I should have said "doesn't usually work for me"...but I'm of the opinion if a drug makes you feel worse than the original symptoms, you shouldn't take it.
If the side effects get very bad, of course, the dose should be reduced in an attempt to reduce those SE's so that the trial can continue and not be prematurely aborted. A way I avoid this, is to start with a small dose and increase the dose very slowly. If I still have SE's at a very low dose, I make the decision to abort the trial. My pdoc used to do this but after so many years he knows I can only decide when to stop. Many who are depressed lack the ability to say enough is enough and may go on to actually kill themselves because the seriousness of the SE was not recognized in time to abort the trial.
So you stop the trial but at least you don't kill yourself in an attempt to tough it out through severe symptoms like suicidality...NO BRAINER for me...SG
Posted by Phillipa on November 22, 2006, at 19:21:10
In reply to Re: An SSRI can sometimes help within one ? MAO 2 » stargazer, posted by Phillipa on November 21, 2006, at 21:31:58
I started a thread on something similar and was chastized cause the doc knows more than me. But it's my body not his. Why not start a thread? Maybe one from you worded differently and with different people on the board will make a difference I'd love to see. Love Phillipa
Posted by stargazer on November 22, 2006, at 23:36:29
In reply to Re: An SSRI can sometimes help within one ? MAO 2 » Phillipa, posted by Phillipa on November 22, 2006, at 19:21:10
Phillipa,
OK, I think I understand what you are saying and it is a good question for discussion.
I think the basic question is when should a drug trial be stopped and how is that decision made.
Is this what you're asking? I don't think there is a hard and fast answer and some may feel it is the pdoc's call, but it's not always that simple. Alot of this stuff is very complicated.
Go ahead and start a thread about this since you felt that others disagreed with what you had done, not sure what happened but it may be something you still have questions about.
What tends to happen here, online, is that all of the nuances of communication get in the way of clearly describing a situation that is very complex.
We know there will be many strong opinions voiced and that is a good thing because it is a highly charged issue, but the bottom line is you have to do what you feel is the right thing for Phillipa and no one else can tell you what that is.
I'm a firm believer in trusting your instincts. If you think you're too sick to continue a drug than it's really your decision to make. Your pdoc should be aware of the decision, either in a phone call or at an appt, and if your pdoc is anything like mine, he knows that I will not quit a drug trial w/o good reason. He just has to be included in the decision if you are really working together.
That's my 2 cents worth. I may take a hiatus from here for a few days and recharge my batteries, they're running down again. Have a nice holiday tomorrow, or I should say today.
Stargazer
Posted by linkadge on November 23, 2006, at 10:18:16
In reply to Re: An SSRI can sometimes help within one ? MAO 2, posted by stargazer on November 22, 2006, at 23:36:29
I would be willing to bet that SSRI's and MAOI's can reduce REM sleep very early in treatment.
Early response is psudo-sleep deprivation IMHO.
Linkadge
Posted by Phillipa on November 23, 2006, at 19:28:02
In reply to Re: An SSRI can sometimes help within one ? MAO 2, posted by linkadge on November 23, 2006, at 10:18:16
Link so if you can't sleep on an SSRI that means it's working or will work? What if you are on benzos too? Love Phillipa
Posted by hgi698 on November 23, 2006, at 22:19:21
In reply to Re: An SSRI can sometimes help within one ? MAO 2 » linkadge, posted by Phillipa on November 23, 2006, at 19:28:02
The first antidepressant i ever tried was paxil. I took it at night immediately after filling the prescription. When I woke up the next morning i already obtained the "antidepressant" effect. It definitely felt like a serotonin overload. I would describe it as "ecstacy" like but with no euphoria (I have never actually taken ecstacy so i can only guess). The world looked about 5 shades brighter, peoples faces appeared more beautiful. I was not anymore social and did not have any increase in sex drive, talkativeness etc. (dopamine?) so it was definitely not a manic reaction. This change in perception, though was definitely positive. My head felt vary clean, I looked better in the mirror, and had fewer negative thoughts. Unfortunately after about a week and a half the positive effects dissappeared (downregulation?). I have built up a tolerance to basically any drug that increases serotonin.
Posted by linkadge on November 24, 2006, at 8:47:21
In reply to Got effect after one night, posted by hgi698 on November 23, 2006, at 22:19:21
Your reaction was very much like mine. The first few doses produced the best effect, then it was downhill from there.
Linkadge
This is the end of the thread.
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