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Re: It's called PROPAGANDA Racer

Posted by Sad Panda on April 18, 2004, at 15:53:22

In reply to It's called PROPAGANDA Joslynn, posted by Racer on April 13, 2004, at 18:15:45

Hi Racer, I'd disagree with your sweeping 40% efficacy statement.

> Here's what I've learned in the last 15 years:
> All the antidepressants, from MAOIs to TCAs to SSRIs and beyond have about the same level of efficacy. All of them have their own side effects. All of them work for about 40% of the people who take them.
> The drawbacks to the MAOIs are pretty major. The dietary changes alone are so significant that it's a drug of last resort for most people. They also have a pretty high drug interaction rate, which is a concern if there's a chance you'll ever need to take another drug for anything at all. While they are life saving for a lot of people, for most depressed patients they're not worth the difficulties.
> The TCAs are also about 40% effective, but they have a much more benign profile than the MAOIs. The problem is, they're pretty non-specific in what they do -- which neurotransmitters they effect, etc -- and so they cause a fairly high incidence of adverse effects. They are also a risk in overdose, so for profoundly depressed patients who are unsupervised during initial treatment, they may not be the best idea.
> SSRIs have about the same level of effectiveness as the older ADs, but they have -- reletively speaking -- far fewer and more benign side effects.

Some AD's are above average & stand out to some degree. These would be the MAOI's Nardil & Parnate, the TCA's Clomipramine & Amitriptyline & the SSRI Zoloft.

MAOI's are less restrictive than you think, you could get through as much sour cream as you like provided it hasn't gone rotten. The dangers of a hypertensive crisis or serotonin syndrome is there & real, but the likelihood is overhyped. TCA's & SSRI's also have various drug interaction problems, so it's unfair to single out MAOI's for their drug interaction problems.

You can clump the SSRI's together to some degree, but their side effects all differ. Personally I would avoid Paxil & Luvox, while Zoloft is probably the safest & has the least amount of drug interactions.

Clumping TCA's together is wrong as no two are alike. Clomipramine & Amitriptyline are proven AD's that are superior to the SSRI's and are suitable for monotherapy. Desipramine & Nortriptyline are good to add on to SSRI's & may also be usefull for ADD sufferers. Doxepin & Trimpiramine in low doses are great for sleep & would be good for SSRI or MAOI induced insomnia. Clomipramine, Amitriptyline & Nortriptyline also are good for migraine sufferers & people that have neuropathic types of pain.

> The hype about suicide risk has been there since Prozac first came on the market. These people are shouting it so loud -- and they're shouting PART of the story, but not all of the story. The consensus in the psychiatric field seems to be that the risk of suicide is not from the drug per se. The risk is that SSRIs increase energy and motivation before complete remission from the depression happens. That means that there are a lot of people who feel well enough to ACT on their suicidal impulses, but don't feel well enough to function in their lives. When you first start taking an AD, of any sort, there's often an initial period when the placebo effect makes you think that you're feeling better. Then, that wears off, often before the ADs have really kicked in. Can't you imagine how devastating that is? Here you think you're going to get better, and one morning you wake up feeling just about as bad as you did before? Doctors, in general, don't discuss this with their patients. Patients who wake up with this sudden reversion to their depressed state -- but with more energy -- may think that they've failed, it was as hopeless as they'd thought, etc. Yes. Many of them do attempt or commit suicide. The psychiatric community has known this for decades. The highest risk for suicide isn't while a patient is lying on the sofa crying. It's when that patient gets up off the sofa and starts cleaning the house. The risk with SSRIs is part of the same phenomenon.

SSRI's probably exsist because they are difficult to overdose on, where as the TCA's can cause heart problems in overdose realtively easily, so doctors are happy to hand out the SSRI's. Some people, especially children & teenagers can have a suicidal or violent reaction to SSRI's & this is being recognised & they are no longer recommended. TCA's, OTOH, don't seem to have this problem and pardoxially are actually safer than SSRI's.





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