Posted by Racer on January 26, 2006, at 18:28:59
In reply to Re: Cymbalta » Racer, posted by Berberis on January 26, 2006, at 14:00:26
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> What's 5HT and NE?Hey, stick around and you'll be able to throw these terms around, too. I learned most of this stuff by looking up information in order to understand what people were writing about here.
5HT: 5-hydroxytryptophan, known to its friends as serotonin ;-D
NE: norepinephrine, which is just too long to type over and over again.
What I was trying to say is that Cymbalta is pretty well balanced in its effects on serotonin and norepinephrine, rather than being dose dependent as Effexor is. While the thinking regarding SSRIs is that serotonin -- also too long to keep typing -- is the major player in depression, that probably isn't true for everyone. The older ADs, the TCAs and MAOIs, hit all three of the major monoaminic neurotransmitters, pretty scattershot, not a lot of selectivity. And they worked. The MAOIs are the most powerful, in that they just plain hit all three like a ton of bricks. And the MAOIs are often said to be the most reliable ADs, the ones that don't poop out, the ones that stay pretty consistent.
If you've been on drugs in the past that helped, that can often give clues about what will work in the future. And the mechanism of the drug will also offer clues about the side effect profile, too. For instance, NE is related to the whole adrenal system, so drugs that target it are more likely to trigger anxiety. 5HT is most active in the digestive system, so those drugs will generally have adverse GI effects and then weight gain during later stages of treatment.
Does that help?
Where do you learn about all this?
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> Sometimes I wonder if my pdoc is pushing the new drugs because the drug reps are giving him nice *incentives*.Nope. Trust me -- all those pens and paper pads? The lunches? They don't have much effect at all. In fact, if you've ever worked in an environment where you get those pens, etc, they tend to be annoying. And the lunches, at least in my non-medical experience of company reps taking us to lunch to hype their products, are laughable.
I think the reason that doctors get excited about new drugs is twofold: 1, they want to see what happens. Just plain curiousity, will this work? What side effects will it have? Etc. Secondly, I think doctors get so frustrated by how little they really have to work with. Something new, which just might work better? I'm gonna prescribe it to ALL my suffering patients who haven't been helped so far. Make sense?
Hope my thoughts have been helpful.
poster:Racer
thread:602680
URL: http://www.dr-bob.org/babble/20060122/msgs/603133.html