Posted by SLS on May 5, 2000, at 11:58:05
In reply to Re: Shorter trials: Scott , posted by SLS on May 5, 2000, at 10:22:26
Hi guys.
SUBJECT: The use of short trials of antidepressants to screen for efficacy and tolerability in individual patients.If anyone wants to pursue this, I thought perhaps we might want to create some structure.
I think the bottom line as to the value of the methods now being used by Dr. Jensen is whether or not they work. The definition of the word "work" has yet to be detailed. Although his suppositions as to why his methods work may be far from accurate, if the algorithms work, they must be considered viable. If they are, it does not matter whether or not he has published, whether or not he has presented them at peer recognized international symposiums, whether or not he is well known, or whether or not he is in it just for the money.
I do not want to try to tackle everything at once, as this would probably require a book of its own.
I would like to pay attention to details. It seems to me that this is the only way to ferret out the facts necessary to effectively evaluate the merits of using short trials of antidepressants.
Here are some questions that I thought we could ask to help establish the foundation for a discussion:
1. How do we define the word "WORK"?
I guess some of the features that would be desirable in a treatment method are that it brings about the best qualitative remission with the fewest side effects in the highest percentage of cases that are treatable with the drugs being tested while not hurting anyone. I think it is also critical that it not allow too many treatable cases go unresolved that would be successfully treated using other available methods. I hope other participants in this discussion will contribute to this definition.
2. What are antidepressants?
Since the core treatments of most cases of depression involve and often require the use of those drugs that are traditionally labeled as "antidepressants" and that have been approved for this indication worldwide, lets make a list. I'll start.
Some of these are no longer being marketed.
- amineptine
- amitriptyline
- amoxapine
- brofaromine
- bupropion
- chlomipramine
- citalopram
- desipramine
- dothiepin
- doxepin
- fluoxetine
- fluvoxamine
- imipramine
- indalpine
- iprindole
- isocarboxazid
- lofepramine
- maprotiline
- medifoxamine
- mianserin
- mirtazapine
- moclobemide
- nefazodone
- nomifensine
- nortriptyline
- oxaprotiline
- paroxetine
- phenelzine
- protriptyline
- reboxetine
- sertraline
- tianeptine
- toloxatone
- tranylcypromine
- trazodone
- trimipramine
- venlafaxine
- viloxazine
- zimelidine
3. How long is a "short trial" period. What is the maximum number of days allowed for each trial?
4. How are the trial dosages determined?
5. What qualifies as a "response" to a medication, and how is it measured?
6. Once it is determined that a specific antidepressant has produced the desired effect, what is the next step in the algorithm?
7. How are the results of these trials evaluated, and how are decisions reached as to which drugs to use, either alone or in combination.
8. How long is the trial of the chosen treatment regimen to be allowed to last without obtaining an adequate response?I hope this will begin a detailed and objective discourse.
- Scott
poster:SLS
thread:31785
URL: http://www.dr-bob.org/babble/20000429/msgs/32396.html