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Re: What to do if Nardil and Parnate were discontinued » linkadge

Posted by Tomatheus on December 28, 2005, at 21:14:16

In reply to Re: What to do if Nardil and Parnate were discontinued, posted by linkadge on December 28, 2005, at 18:33:24

Linkadge,

My responses are below...

> MAO's could also be targeted towards the cigarette smokers. Parnate could probably get more people off the cigarettes than could say wellbutrin, since smoking is not purely dopaminergic. Tobacco inhibits both MAO A, and B.

That might not be such a bad idea. The only problem I see with it is that some smokers might not be willing to give up the forbidden tyramine-containing foods if they're not willing to give up smoking.

> If MAOI's were not as "dangerous", the drug companies could probably do the same with the MAOI's that they did with the SSRI's.

I think you're absolutely right.

> I would argue that the only reason the SSRI's are so widely distributed is reated to their presumed safety. I think that even the notion that MAOI's "only help a small subset of depressed people", is just a drug company attempt to direct us towards the newer SSRI drugs. How do we know that they only help a small subset of the depressed population? They've only been given to a small subset of depressed people. Maybe if they were used first line, remission rates would be higher.

It looks like I wrote my statement regarding the drug companies' lack of interest in helping a small subset of depressed people without thinking of the context I was putting it in. I do think that the drug companies are more interested in making drugs that they can market to large numbers of people than they are in making drugs that would likely only be prescribed to a relatively small number of depressed individuals. And I think you're absolutely correct in stating that MAOIs would help more people if more doctors were to prescribe them.

With respect to the idea that MAOIs only help a small subset of depressed patients, I would actually argue (or perhaps I should say "speculate") that most, if not all, antidepressants only help relatively small percentages of patients -- at least when factors such as the placebo effect and the lack of long-term studies are taken into account. As critics of psychiatry often argue, it's difficult to determine whether or not any given antidepressant actually "helps" depressed patients based on clinical trials that only last four to six weeks. I know that I'm just speculating here, but my guess is that all antidepressants would actually turn out to be effective in less than 50 percent of those with endogenous depressive disorders if an "effective" drug were to be defined as one that produces a clinically significant response in a patient over an extended period of time.

So, I'm not really trying to say that the MAOIs only help a small number of depressives in comparison to the SSRIs. I haven't personaly come across any reserch studies that have directly compared an MAOI with an SSRI, but I would be surprised if such a study hasn't been done. Based on the limited amount of research material that I've read, it seems that the MAOIs would be at least comparable to the SSRIs in terms of their efficacy. After all, judging from meta-analysis data that moclobemide tends to be about equally as effective as the SSRIs but less effective than the irreversible MAOIs (Lotufo-Neto et al., 1999), it would seem that MAOIs might actually be more effective than the SSRIs. So, even though I think that the notion of the MAOIs only being effective in a small subset of depressed patients is somewhat problematic (mostly because a "small subset" can mean a minority as small as 1 percent or something more like 30 percent), I think the bigger problem is the tendency of the drug companies to create the impression that SSRIs are highly effective.

> For all the placebo's I have ingested over the years, parnate was really the only "active drug".
> I won't likely get another shot at an MAOI. No doctor wants to take the "risk"

I'm sorry to hear that. :(

Tomatheus

==

REFERENCE

Lotufo-Neto, F., Trivedi, M. Thase, M. E. (1999). Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology, 20, 226-47.


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poster:Tomatheus thread:591969
URL: http://www.dr-bob.org/babble/20051221/msgs/592904.html