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Re: Cam...what say you.

Posted by JohnL on January 5, 2001, at 3:43:05

In reply to Cam...what say you., posted by stjames on January 4, 2001, at 16:09:31

> Glad to see you back posting often on the list. i would like to get your
> opinions on some issues. Here goes:
>
> AD's take 6-8 weeks for true antidepressant effects to be felt. This is supported
> by the facts of 50 years of people taking AD's, most drug monographs on specific AD's,
> and my personal experience. AD effect builds over the first 2 months and can take 6 months
> to max out, during which time dosage adjustments help max AD effects.
>
> When one feels something sooner (first few weeks) this is not the AD effect but sideeffects,
> which can have positive effects, such as greater energy (as with many SSRI's) and sedation (which
> helps with sleep and anxiety)
>
> So Cam, what say you ?
>
> James

Hi James and Cam,
I totally agree that full effects of medications usually (not always) take at least 8 weeks and longer. In my own experience, I remember years ago Paxil worked better at 2 months than at 1 month, better at 3 months than 2, and even better at 4 months than 3. Even now with my favorites Amisulpride and Adrafinil, I find the benefits continue to accrue slowly over time.

In contrast to popular believe though, I do support the notion that a drug can work very fast, like one day to two weeks. Not completely of course. But definitely enough to give a hint at the drug was a good choice. Side effects? Maybe 30%. Placebo effects? Maybe 30%. The real thing? 30%.

Actually it's more than just a notion. If one examines clinical trials with this concept in mind, there are hundreds of documented studies where some patients responded very quickly and maintained the good response longterm. It happens. Even here at this board one can find dozens, maybe hundreds, of examples showing fast response times that were maintained longterm. They weren't side effects or placebo. One has to pick and choose which data he/she wants to back up one's theory, but if all the data is looked at then it becomes obvious that this is not an either/or issue. It's both. That is, fast responses do occur. Slow responses do occur. Neither one is abnormal or more valid than another. As further evidence that fast responses can and do occur, many medication labels specify that though the patient may feel some benefits in a few days, the most benefits will occur in 3 to 4 weeks. I'm sure millions of dollars and tons of research went into those labels. They didn't just print that haphazardly.

I believe chain reactions occur, as Cam described. I think what makes the difference between a fast response or a slow response (or no response) is how fast the body can make those changes, or how close those changes are to the real problem. For example, if low serotonin is the true problem, an SSRI will work fast. Serotonin is increased immediately. If instead receptors need to be down-regulated, then then response will be a bit slower. To take it further, perhaps the receptors need to be down regulated in order to again affect something else further down the chain. That will take even longer. A drug that would have targeted whatever it was further down the chain would have worked much faster, bypassing all the non-necessary sidesteps along the way.

Regardless, I haven't seen any facts to completely support any of our theories. It's probably a situation where there are no rights and no wrongs. Every theory is probably partially correct, but no theory is totally correct.

The one thing that continually puzzles me though is why we tend to WANT it to be so that these drugs take so long. I don't want ANYone to suffer more than one day. I would think that we would instead be wanting to find out how to hasten response, rather than believe that long responses times are fact and that's the end of the story. I believe there's a lot more to the story. As advanced as psychiatry is, I believe we've only nipped at the edges. It is still very very early in its evolutionary discovery, with only a few decades of hardcore research behind it.
John



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poster:JohnL thread:50902
URL: http://www.dr-bob.org/babble/20001231/msgs/50936.html