Posted by IsoM on August 21, 2002, at 13:28:26
In reply to Re: Knowledge, posted by dr. dave on August 21, 2002, at 8:58:35
Dr. Dave, you've made two good points (the following quotes) but I'd like to show another slightly different argument for the possible use of Lexapro, if you'd like to consider my opinion.
"Having said that for a particular patient with a particular problem, where all other logical options have been tried, I would give the rather far-fetched claims for Lexapro a go, but I would prefer to make decisions based on strong evidence before satisfying curiosity about a new drug for which convincing support cannot be found."
"I don't think it is unreasonable to look to scientific evidence to inform my prescribing habits rather than just 'having a go' with something new in case it works. If we all did that prescribing would be even more chaotic than it already is. I think large-scale well designed studies actually do carry more weight than one doctor's anecdotal evidence."
I agree with you completely. BUT... There are always those few where available drugs haven't helped them. We still don't really understand how ADs work, but terms such as "...is thought responsible for its action..." or "...is believed to be related to its selective inhibition..." are used to describe how ADs are thought to work. Until researchers are truly able to understand all that's involved & tailor meds specifically, much of our prescribing treatments are still going to be based on conjecture. As much an art as a science in prescribing.
Even after large scale studies are done, it will be the individual doctors themselves who will be gathering the real data, long-term, on the efficiency of these new drugs in the general population. As you know, the initial studies are done in select groups & don't necessarily represent the ordinary population that will be using these medications long-term.
I know, personally, from my experience & that of my family, that I've appreciated a doctor's willingness to try a different, perhaps not thoroughly tested in the general population, drug. Surprisingly, against all obvious logic, such a drug will be the one that works for such a person where others have failed.
I know you may say that this is not a new drug but only the isomer of one already available, but it may be just the ticket for someone in whom Celexa has previously worked but has caused troublesome side effects - to the point that it was stopped. It may not be the choice for most, but in those few patients, it may be just what is needed.
It's up to doctors like you to be willing to give it a try for a select few, despite costs.
My doctor has never used Provigil (modafinil or Alertec in Canada) before & never heard of it either. But despite that, he was willing to prescribe it for me when asked & it's been a godsend for me. It's prohibitory expensive - costs me about $180/mo, but thankfully the union from my part-time job covers the total expense. Something similar may be true with others too, allowing them to use such expensive meds.