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Re: A BIG thank you to Linkadge for his wealth of info

Posted by NKP on September 24, 2021, at 12:39:06

In reply to Re: A BIG thank you to Linkadge for his wealth of info SLS, posted by undopaminergic on September 23, 2021, at 12:17:14

> > Hi, all.
> >
> > I posted this within a thread earlier, but I felt it was important to post it as a new thread.
> >
> > I have never met any clinician that knows as much as Linkadge does. I am pretty sure that there are only a few researchers who would have his *scope* of detailed knowledge. I am also impressed by his tempered use of critical thinking and logic. He never demonstrates the slightest hint of pretense.
> >
> > I know that people respect my knowledge and thoughts, but perhaps they overestimate me.
> >
> > THANK YOU, Linkadge.
> >
> > I wouldn't be surprised if Linkadge preferred that I hadn't praised him this way. Humility.
> >
> >
> > - Scott
> >
>
> A toast to Linkadge!
>
> He is useful to have around, sometimes as a counter-balance to myself. In the thread you're referring to, he cast some doubt on Gillman's conclusions about venlafaxine, which is all the more significant in light of the fact that in general Gillman knows better than most.
>
> -undopaminergic
>

I also disagree with the views that Dr Gilman expresses on venlafaxine in his article "Venlafaxine: an enduring SNRI myth". He seems to argue that venlafaxine is basically just an SSRI at lower doses.

Curiously, Dr Gilman does recommend venlafaxine in one of his antidepressant algorithms, under Step 2a in

https://psychotropical.com/ken-gillman-ad-algorithm/.

The reasons for my disagreement with his appraisal are as follows:

1. On the SSRI front I've taken citalopram and sertraline. Neither of these ever caused insomnia. The first time I took venlafaxine, at only 75 mg per day, I had insomnia for two nights.

2. Venlafaxine has a reputation for its relatively worse side-effects compared to SSRIs. How can venlafaxine be basically just an SSRI, when it does not have the side-effect profile of an SSRI? The fact that it has worse side-effects that SSRIs suggests that it is doing something beyond what SSRIs do.

3. Linkadge has posted a study that utilises PET scans which seems to indicate that venlafaxine has greater in vivo noradrenergic activity than suggested from its in vitro binding affinities.

4. A 2007 study of Blier, often cited to substantiate the claim that venlafaxine isn't an NRI at lower doses, had only six subjects in each of its arms. The amateur statistician in me is sceptical whether one can reach statistical significance with a sample of only six subjects, especially for something like blood pressure readings which are fairly variable to start with.

In light of the fact that there is a widespread perception that the noradrenergic effects of venlafaxine only manifest at higher doses, I think that Dr Gilman's article should be re-titled: "Venlafaxine: an enduring SRI myth".


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poster:NKP thread:1117048
URL: http://www.dr-bob.org/babble/20210723/msgs/1117064.html