Posted by MB on July 16, 2001, at 1:22:19
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 15, 2001, at 17:50:09
> > 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.
Hmmm...I wonder what he was talking about, then. Have you had a chance to watch that video about the metabolic effects of atypical antidepressants? I may not of completely grasped what he was saying about sibutramine. I would be interested to hear your feedback on the lecture.
> > Well, there must be something more to it; it's scheduled as a class IV, isn't it?
> Yeah. Totally ridiculous.
The way the commercial goes: "...people who abuse Meridia may become dependent," I thought this stuff was like an amphetamine or something. Why do you think they're treating it like this?
> > 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 some people can actually *lose* weight on Moban!
> > 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.
Negative symptoms...like flat affect, etc?
> > Uh...yeah...putative. Sometimes I accidently make up new words (LOL!)
> Me too.
heh heh heh...
> > 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.
It will be interesting to see what the outcome of the drug's use is in the long term. I remember when there was discussion in the late eighties (and early nineties) about using SSRIs as diet drugs...whoops!
> > 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.
No, of course not...but can it be figured out? If the brain were simple enough to be figured out, would the mind of such a brain be intellegent enough to do the figuring? Did that make any sense? wait...huh...? ;-P
> > 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.
yeah, I was just being a smart allec (sp?) :-)
but kinda serious at the same time...I think treatment plans need to be highly individualized
> > 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!
That's kinda funny...but if it works and helps people get well...why not use that definition?
> > 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.
It's a partical, it's a wave, it's...
> > (I assume that the axial nexus would be "normalcy," whatever *that* is).
> < g >