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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by SLS on December 2, 2008, at 19:21:55
In reply to Study Of Antidepressants Show All Same!!!!, posted by Phillipa on December 2, 2008, at 19:00:24
They can't be all the same if they are all different. In fact, no two are alike. That's why one person doesn't respond to all antidepressants.
Just what do you think this article is saying?
- Scott
Posted by Phillipa on December 2, 2008, at 20:22:35
In reply to Re: Study Of Antidepressants Show All Same!!!! » Phillipa, posted by SLS on December 2, 2008, at 19:21:55
I agree with you. Unfortunately it's meant for Nurse Practitioners , Doctors for extra credit so to speak. I think they are saying in the end they all do the same. And only a low percentage respond to one and might have to try another or add other meds. Kind of contradicts itself. But does say the side effects differ. Also if first depression stay on med four to six months after remission if occurs if more than two depressions may need to take for years or life. Love Phillipa ps how do you read it???
Posted by Phillipa on December 2, 2008, at 21:12:49
In reply to Re: Study Of Antidepressants Show All Same!!!! » Phillipa, posted by SLS on December 2, 2008, at 19:21:55
Scott I could send it to you. But thought I'd add my second husband was a lot older than me lived in Holland War War II and had to sneak out to steal potatoes at night no food and sent away to fatten up after war. When married lost his job Fortune 500 bought and he was high up the ladder so fired with years salary headhunters. Anyway I thought maybe a pdoc he said if I had a job wouldn't be depressed he got a job and wasn't depressed so feel a lot is self-esteem motivated too. Situational depression. Just have made contact with him he's getting older but his emotionally healthy. It was just that statement he used to make to me "If I had a job I'd be fine". He got a job consulting. Love Phillipa
Posted by yxibow on December 2, 2008, at 23:01:20
In reply to Re: Study Of Antidepressants Show All Same!!!! » Phillipa, posted by SLS on December 2, 2008, at 19:21:55
> They can't be all the same if they are all different. In fact, no two are alike. That's why one person doesn't respond to all antidepressants.
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> Just what do you think this article is saying?
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> - ScottI would concur, there doesn't seem to be numbers of patients listed in this article, it seems a little odd in fact.
Exactly, I mean there are about 16 antidepressants I can think of at least, and they're certainly not the same nor is anyone's brain and biochemical system cut from the same mold.
One person may respond to Lamictal, someone may respond to Imipramine, someone may respond to Cymbalta, some may respond to a polypharmacy of some of the above (due caution about serotonin syndrome and I haven't even included APs)
-- Jay
Posted by Phillipa on December 3, 2008, at 0:19:43
In reply to Re: Study Of Antidepressants Show All Same!!!! » SLS, posted by yxibow on December 2, 2008, at 23:01:20
Like I said this is sent to medical professionals for their licenses so that's evidently what is being taught. Love Phillipa hence why I posted it.
Posted by yxibow on December 3, 2008, at 1:51:25
In reply to Re: Study Of Antidepressants Show All Same!!!! » yxibow, posted by Phillipa on December 3, 2008, at 0:19:43
> Like I said this is sent to medical professionals for their licenses so that's evidently what is being taught. Love Phillipa hence why I posted it.
Not every CE /CEU course, while peer reviewed, is the only viewpoint or the best written. Some are better then others...
-- Jay
Posted by seldomseen on December 3, 2008, at 5:42:18
In reply to Study Of Antidepressants Show All Same!!!!, posted by Phillipa on December 2, 2008, at 19:00:24
Actually, what I think this article is saying is that all are equally likely to work, or not.
Which is definately not the same as saying all the same.
Now, given that premise, the article indicates that patient preference, tolerance of side effects and close follow-up is essential in prescribing.
The article is geared for the family physician who is involved in prescribing the anti-depressant and make recommendations for them.
If you are interested in reading the article in the archives, and not the CME summary, then just babblemail me.
Posted by Glydin 3.9 on December 3, 2008, at 8:10:47
In reply to Re: Study Of Antidepressants Show All Same!!!! » Phillipa, posted by seldomseen on December 3, 2008, at 5:42:18
I agree with seldom and the stats for effectiveness have been around for some time and been consistent... nothing really new there.
Also, the older versus newer generations of meds have held to the same rate of efficacy as far as I can tell. The continued use for at least six months of a successful med has been advocated for as long as I can remember also.
I think the title says it all and is the goal of the educational offering....
To use an analogy - all shoes might have the same % of effectiveness for what the goal is to one's feet but their modes and "styles" and suitability can be very different and most individual. Therefore, they are not all the same.
The offering, to me, seems to go for making treatment plans more individual rather than less. I believe if the thought is: "they're all the same" why have individualized and choices treatments? I don't think that's what the CEU article is saying...
Posted by SLS on December 3, 2008, at 10:29:26
In reply to Re: Study Of Antidepressants Show All Same!!!! » seldomseen, posted by Glydin 3.9 on December 3, 2008, at 8:10:47
I think you guys pretty much hit the target. One needs to be very careful for how statistics and tenets are portrayed. Yes, with some exceptions, all traditional antidepressants have demonstrated roughly equal efficacy when viewed in the context of how many people, when selected at random, will respond to any given drug.
My earliest impressions would place a slight difference between various drugs that would look something like this.
Nardil -> Parnate -> clomipramine -> amitriptyline -> imipramine -> Effexor -> Lexapro -> Prozac -> Wellbutrin -> Remeron
At the end would be trazodone, reboxetine, moclobemide, and maprotiline.
I would love to know how other people would rate antidepressants. Clinical impressions are used by doctors to determine the order of trying various treatments on their patients. So, are these drugs all the same as characterized by the study? Perhaps in a global statement, yes. In the eyes of many practicing physicians, no.
- Scott
Posted by Phillipa on December 3, 2008, at 12:39:47
In reply to Re: Study Of Antidepressants Show All Same!!!!, posted by SLS on December 3, 2008, at 10:29:26
Scott just what looking for as I said in beginning don't agree with test and study. Too simplistic and we are all different. See what bothers me the most is my own experience and that was before ad's for me that we were taught that if an ad wasn't working for patient. They must have stopped taking their meds and admitedly we were biased and belived it. Love Phillipa
Posted by bulldog2 on December 3, 2008, at 15:45:40
In reply to Study Of Antidepressants Show All Same!!!!, posted by Phillipa on December 2, 2008, at 19:00:24
> Sure don't agree with this one but needed some Cme's so read the articles. I don't agree. Love Phillipa
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> Adverse Effects, Patient Preference, Cost Should Dictate Antidepressant Choice
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> November 24, 2008 Clinicians should consider adverse effects, cost, and a patient's personal preferences when prescribing second-generation antidepressants, since research shows all of these agents have equivalent efficacy, according to a new guideline issued by the American College of Physicians (ACP).
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> This was 1 of 4 recommendations included in the new guideline published in the November 18 issue of the Annals of Internal Medicine.
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> The other recommendations highlight the importance of regularly assessing patients for response and adverse effects, changing drugs when necessary, and continuing therapy for an adequate period.
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> "With 16% of the American population diagnosed with depression at some point in their lives, and with the economic burden of depression approaching $85 billion, it's important to provide primary-care physicians with evidence-based information on what steps to take to treat patients with this disorder," the guideline's lead author, Amir Qaseem, MD, PhD, senior medical associate in ACP's clinical programs and quality-of-care department, told Medscape Psychiatry.
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> In developing the guideline, investigators conducted a systematic review of published research. Using various medical databases, they searched for studies that included at least 1 of 12 antidepressants (bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine) that were restricted for use in adults 19 years of age or older. Their review included 203 head-to-head or placebo-controlled trials.
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> Same Efficacy, Effectiveness and Qualify of Life
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> Among various categories of antidepressant drugs, including selective serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine-reuptake inhibitors (SNRIs), or selective serotonin-norepinephrine-reuptake inhibitors (SSNRIs), the researchers found no difference in efficacy, effectiveness, or quality of life in patients with major depressive disorder (MDD).
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> The review also did not reveal any difference in efficacy among these drugs in patients with accompanying symptoms or subgroups based on age, sex, race or ethnicity, or other comorbid conditions.
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> However, the researchers did find several differences among these drugs with respect to response rate and the incidence of certain adverse events. For example, some studies found that mirtazapine had a faster onset of action than citalopram, fluoxetine, paroxetine, or sertraline and that bupropion has fewer sexual adverse events than fluoxetine, paroxetine, or sertraline.
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> SSRIs in general were associated with an increased risk for suicide attempts compared with placebo. "The side effects of these medications vary from mild ones like constipation and diarrhea to some major ones like suicidality and sexual dysfunction," said Dr. Qaseem. Since each of these drugs has benefits and drawbacks, clinicians should be sure to discuss these issues with patients, he added.
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> Patient Preferences Also Important
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> Patients themselves may have drug preferences, and clinicians need to explore these. For example, they may have had a previous negative experience with a particular antidepressant and want to avoid further use of the drug. Discussions with patients should also include cost, as insurance companies may have varying coverage, said Dr. Qaseem.
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> The review also showed that 38% of patients did not achieve a treatment response during 6 to 12 weeks of therapy and more than 50% did not achieve remission.
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> The guideline also recommends that clinicians assess patient status, therapeutic response, and adverse effects on a regular basis starting 1 to 2 weeks after initiating therapy. "The major reason for this is that the risk of suicide attempts is greater during the first 1 to 2 months of treatment," said Dr. Qaseem.
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> In addition, the guideline recommends treatment modification if the patient does not adequately respond within 6 to 8 weeks after starting therapy. "The response might not be sufficient, and you might need to add an additional drug, or multiple drugs may be required," he said.
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> Keep Relapse in Mind
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> Finally, the guideline suggests patients with a first episode of MDD continue treatment for 4 to 9 months after a satisfactory response and possibly longer in patients with a history of relapse.
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> "In depression, relapse and recurrence are important to keep in mind. Patients with 2 or more episodes may need to take [antidepressant] mediation for years or even for life," said Dr. Qaseem.
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> Prescribing maximum but tolerable doses for at least 8 weeks seems at least as important as the choice of specific drug, according to the authors of an accompanying background article created for the ACP.
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> "Given the difficulty in predicting what medication will be both efficacious for and tolerated by an individual patient, familiarity with a broad spectrum of antidepressants is prudent," they write.
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> With first author Gerald Gartlehner, MD, from Danube University, in Krems, Austria, the investigators assert more research is needed on the most appropriate duration of drug treatment and the effects of different doses on maintaining response and remission.
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> Future studies should evaluate whether different formulations affect adherence and relapse or recurrence.
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> Encouraging News
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> Psychiatrists have long known that second-generation antidepressants are about the same when it comes to efficacy, so it is encouraging to see that this information is being extended to the field of primary care, said Alan Gelenberg, MD, from the University of Wisconsin, in Madison, who is developing a new guideline on major depression for the American Psychiatric Association.
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> "What's newsworthy to me as a psychiatrist is that this organization of internal-medicine doctors has seen depression as important," he said. "Depression should be recognized. It's treatable, but no treatment works if the patient doesn't take it. Therefore, you should discuss the treatment with the patient, see them at regular intervals and monitor the patient for side effects."
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> The guideline was supported by the ACP's operating budget and by a contract with the Agency for Healthcare Research and Quality to the RTI InternationalUniversity of North Carolina Evidence-based Practice Center. A complete list of disclosures for the authors appears in the original articles.
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> Ann Intern Med. 2008;149:725-733, 734-750.
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> Clinical Context
> The lifetime prevalence of depression among adults in the United States is approximately 16%. Many of these patients receive antidepressant medications, and second-generation antidepressants, including SSRIs, SNRIs, and SSNRIs, have largely supplanted older medications such as tricyclic antidepressants because of improved safety and tolerability. However, clinicians may struggle with the choice of antidepressant for a particular patient.
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> The current clinical practice guideline from the ACP provides recommendations regarding how to use antidepressant medications most effectively. They focus on questions regarding efficacy in treating depression and associated symptoms as well as tolerability.
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> Study Highlights
> Reviewers gathered evidence from research published between 1980 and April 2007. Specifically, they examined the following 12 second-generation antidepressants: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine.
> 80 trials focused on antidepressant efficacy in the acute phase of MDD. There were no major differences between different SSRIs or in comparing SSRIs vs SNRIs. Any statistical differences noted between treatments were thought to be clinically insignificant.
> 18 trials examined quality-of-life data, and several medications were demonstrated to improve health-related quality of life. However, there was no significant difference between antidepressants in this outcome.
> Mirtazapine has been demonstrated to have a faster onset of action vs citalopram, fluoxetine, paroxetine, and sertraline. However, after 4 weeks, the overall response to medications is similar.
> 38% of patients did not achieve a treatment response during 6 to 12 weeks of treatment with an antidepressant, and 54% did not achieve remission. However, switching medications for nonresponders has been found to be effective in 25% of patients.
> There was limited evidence that the presence of anxiety, insomnia, melancholia, or pain significantly altered the generally similar effectiveness of medications for depressive symptoms.
> There was no significant difference between medications regarding the effectiveness of treating anxiety or pain associated with depression. Nefazodone and trazodone might be more effective to treat insomnia in depression.
> No studies focused directly on subgroups of the general population, but several contained subgroup analyses. They demonstrated limited difference in efficacy based on age or sex.
> Some antidepressants were associated with a higher rate of particular adverse events:
> Venlafaxine: nausea and vomiting
> Sertraline: diarrhea
> Mirtazapine, paroxetine: weight gain
> Trazodone: somnolence
> Bupropion and paroxetine promote a lower risk for sexual dysfunction vs other antidepressants.
> SSRIs as a class have been associated with a higher risk for suicide attempts.
> The authors' final recommendations are as follows:
> Clinicians should select second-generation antidepressant medications based on adverse event profiles, cost, and patient preference. Efficacy is not a primary consideration in this choice, given that these medications have similar efficacy data.
> Clinicians should assess patient status within 1 to 2 weeks after initiation of therapy, particularly for signs of worsening depression or suicidal ideation.
> If patients do not have an adequate response to treatment in 6 to 8 weeks, the clinician should modify depression therapy.
> For a first episode of MDD, patients should continue treatment for 4 to 9 months after a satisfactory response. After 2 or more episodes of depression, patients should continue therapy for years or even lifelong.
> Pearls for Practice
> Among second-generation antidepressants, venlafaxine is associated with nausea and vomiting; sertraline, with diarrhea; mirtazapine and paroxetine, with weight gain; and trazodone, with somnolence. Bupropion and paroxetine promote less sexual dysfunction vs other antidepressants.
> Clinicians should select second-generation antidepressant medications based on adverse event profiles, cost, and patient preference. Efficacy is not a primary consideration in this choice, given that these medications have similar efficacy dataI noticed that the older tcas and maois are not included in the study. There is nothing new here that most ads have the about response rate in the general population. However the big question is whom will respond to what ad. Certain depressions seem to respond better to certain ads.
Your use of the term situational depression seems to be misunderstood. If it's situational it often resolves by itself in a limited amount of time. However if so called situational depression drags out into months or years and does not resolve than it's unlikely to resolve on it's own and should be treated.
Posted by bulldog2 on December 3, 2008, at 16:09:05
In reply to Re: Study Of Antidepressants Show All Same!!!!, posted by SLS on December 3, 2008, at 10:29:26
> I think you guys pretty much hit the target. One needs to be very careful for how statistics and tenets are portrayed. Yes, with some exceptions, all traditional antidepressants have demonstrated roughly equal efficacy when viewed in the context of how many people, when selected at random, will respond to any given drug.
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> My earliest impressions would place a slight difference between various drugs that would look something like this.
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> Nardil -> Parnate -> clomipramine -> amitriptyline -> imipramine -> Effexor -> Lexapro -> Prozac -> Wellbutrin -> Remeron
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> At the end would be trazodone, reboxetine, moclobemide, and maprotiline.
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> I would love to know how other people would rate antidepressants. Clinical impressions are used by doctors to determine the order of trying various treatments on their patients. So, are these drugs all the same as characterized by the study? Perhaps in a global statement, yes. In the eyes of many practicing physicians, no.
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> - Scott
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>Scott is the ordering of ad's your order of efficacy?
Posted by linkadge on December 3, 2008, at 20:14:06
In reply to Re: Study Of Antidepressants Show All Same!!!! » SLS, posted by yxibow on December 2, 2008, at 23:01:20
Posted by Dr. Bob on December 3, 2008, at 22:57:13
In reply to Re: of course, they're all placebos (nm), posted by linkadge on December 3, 2008, at 20:14:06
> of course, they're all placebos
Please don't exaggerate.
But please don't take this personally, either, this doesn't mean I don't like you or think you're a bad person.
More information about posting policies and tips on alternative ways to express oneself are in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by SLS on December 4, 2008, at 8:14:13
In reply to Re: Study Of Antidepressants Show All Same!!!!, posted by bulldog2 on December 3, 2008, at 16:09:05
> > Nardil -> Parnate -> clomipramine -> amitriptyline -> imipramine -> Effexor -> Lexapro -> Prozac -> Wellbutrin -> Remeron
> > At the end would be trazodone, reboxetine, moclobemide, and maprotiline.
> Scott is the ordering of ad's your order of efficacy?Yes. It is a rather ad hoc list off the top of my head. It is the efficacy of drugs that I tried to rate, and not side effects or tolerability. I might rate SSRIs as:
Lexapro, Zoloft, Prozac, Paxil, Celexa, Luvox.
Again, this is a listing off the top of my head based on personal experience and professional contacts.
I'm not sure where to place Cymbalta yet. I guess I would rate it more efficacious than nefazodone, but less efficacious than Effexor. I forgot to include nefazodone and a few others in the original list. I would place it after Remeron and before Luvox.
General?: MAOI -> TCA -> SNRI > SSRI -> amfebutamone -> NaSSA -> NARI -> phenylpiperazine
Another crappy drug is selegiline.
- Scott
Posted by bulldog2 on December 4, 2008, at 9:36:49
In reply to Re: Study Of Antidepressants Show All Same!!!!, posted by SLS on December 4, 2008, at 8:14:13
> > > Nardil -> Parnate -> clomipramine -> amitriptyline -> imipramine -> Effexor -> Lexapro -> Prozac -> Wellbutrin -> Remeron
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> > > At the end would be trazodone, reboxetine, moclobemide, and maprotiline.
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> > Scott is the ordering of ad's your order of efficacy?
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> Yes. It is a rather ad hoc list off the top of my head. It is the efficacy of drugs that I tried to rate, and not side effects or tolerability. I might rate SSRIs as:
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> Lexapro, Zoloft, Prozac, Paxil, Celexa, Luvox.
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> Again, this is a listing off the top of my head based on personal experience and professional contacts.
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> I'm not sure where to place Cymbalta yet. I guess I would rate it more efficacious than nefazodone, but less efficacious than Effexor. I forgot to include nefazodone and a few others in the original list. I would place it after Remeron and before Luvox.
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> General?: MAOI -> TCA -> SNRI > SSRI -> amfebutamone -> NaSSA -> NARI -> phenylpiperazine
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> Another crappy drug is selegiline.
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> - Scott
>Scott what prompted you to switch from nardil to parnate? Is nardil not safer in terms of hypertensive crisis than parnate?
Posted by SLS on December 4, 2008, at 11:59:26
In reply to Re: Study Of Antidepressants Show All Same!!!!, posted by bulldog2 on December 4, 2008, at 9:36:49
> Scott what prompted you to switch from nardil to parnate? Is nardil not safer in terms of hypertensive crisis than parnate?
I felt that I was receiving diminishing returns with Nardil. Of course, the body weight thing entered into the equation. Unfortunately, nortriptyline is a major culprit for this, too. I am having a difficult time losing the weight that I gained over the last few years. Efficacy was my major reason for switching, though.
I think you are probably right about Parnate being more liable to produce hypertensive events. My only episode occurred while I was taking a combination of Parnate and desipramine. In contrast to the conjecture of many, my taking a potent and selective NE reuptake inhibitor did not prevent the hypertensive event from occurring.
I find Parnate to be a "cleaner" drug with regard to side effects. Hypotension is not a problem as the weeks go by with Parnate. However, I find that hypotension with Nardil is a long-term effect that doesn't disappear after the passage of years. Nardil is tough on the liver, whereas Parnate is not. No edema. Very little, if any, weight gain.
I hate to have to say it, but I have been on both of these drugs numerous times, and their behavior for me over the last 20 years has been consistent. I have become intimate with them. My guess is that Nardil poops out at a significantly higher rate than Parnate. I think Nardil has a greater propensity to produce mania than Parnate. Both can do this, however. I think Parnate is better for bipolar disorder than is Nardil. Nardil is probably the better choice for atypical unipolar depression, especially where social anxiety is a comorbid symptom.
- Scott
Posted by desolationrower on December 4, 2008, at 14:30:11
In reply to Re: Study Of Antidepressants Show All Same!!!! » bulldog2, posted by SLS on December 4, 2008, at 11:59:26
As a parallel to TCP causing hypertensive crisis, I wonder if serotonin syndrom is more common with phenelzine. I haven't found anything published on this, but most people say it feels much more serotonergic.
-d/r
Posted by SLS on December 4, 2008, at 17:54:27
In reply to Re: Study Of Antidepressants Show All Same!!!! » SLS, posted by desolationrower on December 4, 2008, at 14:30:11
> As a parallel to TCP causing hypertensive crisis, I wonder if serotonin syndrom is more common with phenelzine. I haven't found anything published on this, but most people say it feels much more serotonergic.
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> -d/r
Great thinking!!! Very impressive.I believe that your appraisal of Nardil and serotonin syndrome is actual fact. I can take Parnate + imipramine with no trouble at all. When I added imipramine to Nardil, I experienced an episode of moderate serotonin syndrome which included muscle rigidity and severe hypotension. The symptoms lasted for weeks until we finally figured out what was going on. Imipramine is more serotoninergic than either nortriptyline or desipramine - both drugs I can tolerate when added to Nardil.
- Scott
Posted by azalea on December 4, 2008, at 18:50:04
In reply to Re: Study Of Antidepressants Show All Same!!!!, posted by SLS on December 4, 2008, at 8:14:13
I'm curious why you consider selegiline a crappy drug. MAOIs top your list and high-dose selegiline is an MAOI I believe.
> General?: MAOI -> TCA -> SNRI > SSRI -> amfebutamone -> NaSSA -> NARI -> phenylpiperazine
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> Another crappy drug is selegiline.
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> - Scott
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Posted by Phillipa on December 4, 2008, at 22:59:06
In reply to Re: Study Of Antidepressants Show All Same!!!! » desolationrower, posted by SLS on December 4, 2008, at 17:54:27
Scott not to sound negative just curious is it the combos with both nardil and parnate that caused you to switch back and forth? Anyway home from pdoc just now and upping luvox which I'm doing I see it low on your list of meds. Still will take with 15valium .5 xanax and see how far up get again. Seriously why don't you like luvox? Choice of ad's was mine and I don't get side effects from luvox. Hence my choice? Love Phillipa
Posted by SLS on December 5, 2008, at 6:47:12
In reply to Re: Study Of Antidepressants Show All Same!!!! » SLS, posted by azalea on December 4, 2008, at 18:50:04
> > General?: MAOI -> TCA -> SNRI > SSRI -> amfebutamone -> NaSSA -> NARI -> phenylpiperazine> > > Another crappy drug is selegiline.
> I'm curious why you consider selegiline a crappy drug. MAOIs top your list and high-dose selegiline is an MAOI I believe.Yes, it is. Unfortunately, for depression, it just doesn't work that often as monotherapy.
Not all MAOIs are alike, just as not all SSRIs are alike. Each one has its strengths and weaknesses. I have been following L-deprenyl (selegiline) since 1983 when the only thing it was being looked at was for depression. It just never showed itself to be as robust as the other MAOIs. In fact, it never showed efficacy anywhere near that of the other antidepressants being studied at the time. Of course, there were some clinicians whom fell in love with the drug. One in particular was J. J. Mann, MD., and he is one smart guy. Making a selegiline patch doesn't seem to have made much difference as I see it. I think too much theory went into developing the patch system and too little time measuring its efficacy.
Any explanation of why selegiline should be inferior to the other MAOIs would be conjecture at best. Afterall we are all but clueless why they work at all. It is my opinion that MAO-A is the more important of the two isoenzymes when it comes to treating depression. Even at high dosages, selegiline might not get to where it needs to go to act therapeutically. Drugs like clorgyline that are selective for MAO-A make robust antidepressants - MAO-B, not so much.
My listing of antidepressant efficacy are impressions gathered through my obvservations rather than any scientific investigation. I wouldn't rely on it for making decisions. Here, the thesis of the article we are discussing makes its point. For any one individual, each drug will produce a therapeutic responses at a rate that is roughly equal statistically. It is the "roughly" part that inspired me to make my hastily drafted list.
- Scott
Posted by azalea on December 5, 2008, at 13:20:34
In reply to Re: Study Of Antidepressants Show All Same!!!! » azalea, posted by SLS on December 5, 2008, at 6:47:12
Thanks for the explanation! Always glad to learn more about psychopharm :)
> > > > Another crappy drug is selegiline.
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> > I'm curious why you consider selegiline a crappy drug. MAOIs top your list and high-dose selegiline is an MAOI I believe.
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> Yes, it is. Unfortunately, for depression, it just doesn't work that often as monotherapy.
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> Not all MAOIs are alike, just as not all SSRIs are alike. Each one has its strengths and weaknesses. I have been following L-deprenyl (selegiline) since 1983 when the only thing it was being looked at was for depression. It just never showed itself to be as robust as the other MAOIs. In fact, it never showed efficacy anywhere near that of the other antidepressants being studied at the time. Of course, there were some clinicians whom fell in love with the drug. One in particular was J. J. Mann, MD., and he is one smart guy. Making a selegiline patch doesn't seem to have made much difference as I see it. I think too much theory went into developing the patch system and too little time measuring its efficacy.
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> Any explanation of why selegiline should be inferior to the other MAOIs would be conjecture at best. Afterall we are all but clueless why they work at all. It is my opinion that MAO-A is the more important of the two isoenzymes when it comes to treating depression. Even at high dosages, selegiline might not get to where it needs to go to act therapeutically. Drugs like clorgyline that are selective for MAO-A make robust antidepressants - MAO-B, not so much.
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> My listing of antidepressant efficacy are impressions gathered through my obvservations rather than any scientific investigation. I wouldn't rely on it for making decisions. Here, the thesis of the article we are discussing makes its point. For any one individual, each drug will produce a therapeutic responses at a rate that is roughly equal statistically. It is the "roughly" part that inspired me to make my hastily drafted list.
>
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> - Scott
Posted by JadeKelly on December 5, 2008, at 16:51:51
In reply to Re: Study Of Antidepressants Show All Same!!!!, posted by SLS on December 3, 2008, at 10:29:26
Hey Scott,
My parnate dosage has strayed a little from the norm, hoping to get your opinion. Been on 6 weeks 30mg, one dose in morn. Stayed at 30 so long cause of ht. All has been fine, been on 40mg almost two weeks, one dose in morn. Saw everyone else split dose so tried 20 morn/20 afternoon, yesterday. Horrible nightmare last night, felt like he*l yesterday and today. Called Pdoc today, upped dose to 50mg, took in one dose late morn.
So now starting 50mg after: 30mg/6 weeks, 40mg/2 weeks, each day one morn dose. Total 8 weeks so far. Had nice rush for a week at start of Parnate, and again at dose increase to 40mg.
Any advice: how long I should stay at 50mg, OK to take all in one dose even at 50 or 60mg? When I split dose, seems to wreak havok on my mood and sleep. Maybe hooked on NE boost after morn dose? Not planning to quit, but how long should I stay on 50mg, and how long should trial last? What/when for augment? Lethargic/Apathy. Any advice?
Thanks, Jade
Posted by SLS on December 5, 2008, at 18:35:00
In reply to Re: Study Of Antidepressants Show All Same!!!! » SLS, posted by JadeKelly on December 5, 2008, at 16:51:51
Hi Jade.
I have never heard of someone taking their whole dosage of Parnate at one time as part of the prescribing practice for moderate to high dosages. What I would recommend is to take 1/2 of your daily dosage in the morning and the other half between noon and 2:00pm. Parnate seems to disrupt sleep most if taken after 3:00pm.
If daytime sleepiness doesn't resolve in a month or so, you might possibly profit from adding Provigil (modafinil). It could have the dual effect of reducing sleepiness and actually might enhance the antidepressant response. I really can't think of any reason why such a combination would be contraindicated.
From my experience with MAOIs, if nothing happens after 3 weeks at a certain dosage, it might be time to increase it.
Good luck!
- Scott
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