Psycho-Babble Medication | about biological treatments | Framed
This thread | Show all | Post follow-up | Start new thread | List of forums | Search | FAQ

Re: Shorter Trials with ADs

Posted by Scott L. Schofield - SLS on April 30, 2000, at 22:40:15

In reply to Shorter Trials with ADs, posted by AndrewB on April 30, 2000, at 19:33:32

> Though SSRI trials may for many need to last 6 weeks or longer,

They may.

> many studies indicate that 2 week trials will suffice for MAOIs and tricyclics.

Many studies may indicate this, but they are wrong. 2 week trials will not suffice. An absolute minimum of 3 weeks is required.

> If two week trials should be possible with MAOIs and tricyclics,

They are not.

> even faster trials are possible with direct acting D2 and D3 meds. such as amisulpride, sulpiride, pramipexole, ropinirole and amineptine.

Adam, I don't understand the logic behind this supposition. Anyway, it is not necessary to propose an association. If these other drugs work quicker, then they just work quicker.

As monotherapy, postsynaptic DA agonists may produce an improvement in depression more quickly than SSRIs, tricyclics, and MAOIs, but I don't think they work as well or last as long. Performing trials with these drugs as adjunctive agents is a different story.

Sulpiride and amisulpride (presynaptic DA antagonists) should not be placed in the same category as pramipexole and ropinirole (postsynaptic DA agonists), either pharmacologically or conceptually. This is not a meaningless technicality. Even if both groups of drugs initially potentiate dopaminergic neurotransmission, they would accomplish this through entirely different mechanisms. It would not be prudent nor justified to pretend that the phenomenology behind how these different drugs produce an antidepressant response is the same.

Do neurons adjust their receptor sensitivities similarly to both groups of drugs? Of course not. They respond in opposite ways.
Perhaps amisulpride monotherapy lasts longer than pramipexole monotherapy. Perhaps it takes less time for pramipexole to work than it does for amisulpride. Are there any differences? I would expect pramipexole to produce an improvement in one to three days. Does amisulpride take longer than three days to work? What has been your experience?

Lumping agonists and antagonists together is no different than lumping together reuptake-inhibitors and releasers. We know that Prozac and Pondamin are not equipotent antidepressants.

Amineptine is not a direct acting DA med. It is a reuptake inhibitor. I know that this was just an oversight on your part.

> Their fast antidepressant action is probably due to their direct action on the D2/D3 receptors within the nucleus accumbens.
The neurotransmission of this area of the brain is improved by use of various antidepressants (SSRIs, MAOIs, etc.), but the direct acting D2/D3 drugs are able to act on this area more rapidly.

This is probably true. But what if a reduction in activity within the nucleus accumbens is due to hippocampal malfunction? Where is the location of the first domino? How long can the last domino be held up superficially if the first domino keeps falling down? Is it even necessary to reset the first domino? These are rhetorical questions, but I am trying to present the complexity of the workings of the brain, and how an anomaly in one area can lead to a perfectly appropriate reaction in a healthy area and thus produce disease.

I lost my train of thought. What was my point?

Sorry. :-)


- Scott


Share
Tweet  

Thread

 

Post a new follow-up

Your message only Include above post


Notify the administrators

They will then review this post with the posting guidelines in mind.

To contact them about something other than this post, please use this form instead.

 

Start a new thread

 
Google
dr-bob.org www
Search options and examples
[amazon] for
in

This thread | Show all | Post follow-up | Start new thread | FAQ
Psycho-Babble Medication | Framed

poster:Scott L. Schofield - SLS thread:31785
URL: http://www.dr-bob.org/babble/20000429/msgs/31803.html