Posted by JohnX2 on March 31, 2002, at 20:07:05
In reply to Re: Zyprexa *never* for depression! » JohnX2, posted by Tye on March 31, 2002, at 14:35:38
>
> > > Hey John,
> > >
> > > Nah, I wouldn't retract my statement. I agree 5-HT2 antagonism reduces anxiety, I am not sure it improves mood directly. Other 5-HT2 antagonist are not antidepressants per say.
>
> > Hi Tye,
> >
> > I don't think the medicine alone would be effective for vanilla depression (it would for many other disorders). In fact this has already been shown with medicines like Ketanserin. But the sertonin system has been studied, and there is a greater understanding of what makes the SSRI medicines "suck". Blocking out a few receptors would substantially alleviate side effects like anxiety, sexual dysfunction, insomnia, etc. Many people can not tolerate taking SSRIs for Panic disorder, even though they are effective medicines because initially the SSRIs will increase serotonin conductance on these anxiety causing receptors. So these people go after the benzos instead. Also, non compliance from SSRIs from the side effects is a huge issue.
> >
> > The atypical APs are potentially useful *adjuncts* (not primary medicines in general) for non-pychotics and manics, mainly for their sertonergic blocking properties. The chemical structures that achieve this most always block dopamine receptors however. I have seen a few clean medicines in the pipeline that might not mangle the dopamine system.
> >
> > But i also agree that the risk of TD is something to take seriously. But they do work fast, and a quick trial of an AP beats taking the long road of an AD for some issues. Also, I have seen many people with depression, generally comorbid with certain other disorders, do well on APs (as well as have bad experiences) just like every other medicine, so I'm not sure what you base your statement regarding efficacy on.
> >
> > Regards,
> > John
>
> Hey John,
>
> If people need the 5HT antagonism for anxiety, why not just add a safer med like serzone or trazodone?
>
> Any thoughts...
>
> Your Friend,
>
> TyeSerzone is not an antagonist at the 5-ht2c receptor. In fact, one of its metabolites mCpp is an agonist at that receptor and may cause start up anxiety for some people.
Remeron is another medicine that is a possibility. But Remeron antagonizes the alpha-2 noradrenaline receptor, an action which increases norepinephrine firing in the locus coeruleus, a key stress center of the brain (but generally the 5ht-2 antagonism in Remeron prevents anxiogenic side effects for many).
Sorry, no perfectly clean medicine.
John
poster:JohnX2
thread:100817
URL: http://www.dr-bob.org/babble/20020327/msgs/101166.html