Posted by Elizabeth on July 15, 2001, at 17:50:09
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 13, 2001, at 13:37:14
> The excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that).
Nope. Sibutramine is very long-acting -- you'd only have to take it once a day.
> Well, there must be something more to it; it's scheduled as a class IV, isn't it?
Yeah. Totally ridiculous.
> The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine).
FWIW, Moban is supposed to be better in this department. Some of the newer ones (Seroquel, Geodon) are supposed to cause less weight gain than Clozaril and Zyprexa, but I don't know if that's just hype or what.
> I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
They also help with negative symptoms, which are largely untouched by the older drugs.
> Uh...yeah...putative. Sometimes I accidently make up new words (LOL!)
Me too.
> When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition.
Ahh, ok. That's a looser use of the term "agonist."
> I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
I think that it probably just isn't a very good diet pill. < g > Seriously: people don't really lose much weight on SSRIs or Effexor, and a lot of people gain weight on them. I don't see any reason to suppose that Meridia would be any different.
> Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative).
I'm sure that accounts for some of it. But I don't think that's all.
> Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
(Man, that sucks!)
Yeah, we do. That doesn't mean we should stop trying to figure it out, of course.
> I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g >
No, I don't think so. Looking at which drugs work on which symptoms (or clusters of symptoms) seems to have paid off where it's been tried, but it hasn't been tried much.
> Like you said, it seems that the best that doctors can do is to classify based on medication response.
Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
> So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls
I think it's a little of both.
> (I assume that the axial nexus would be "normalcy," whatever *that* is).
< g >
-elizabeth
poster:Elizabeth
thread:59947
URL: http://www.dr-bob.org/babble/20010714/msgs/70228.html