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Re: Nardil vs Parnate Article - pdoc was right?

Posted by blueboy on August 24, 2007, at 9:48:40

In reply to Re: Nardil vs Parnate Article - pdoc was right? » girlnterrupted78, posted by girlnterrupted78 on August 22, 2007, at 23:46:55

This looks like a pretty good study. However, let me point out a logical flaw: The study neither attempts to prove, nor proves, that people who do not improve when they take Nardil will (or will not) improve if they take Parnate. That just isn't what the study says.

In practical terms, the study lets a pdoc know that Nardil and Parnate have about an equal, 50% chance of being effective. It says nothing about whether or not some percentage of patients who have taken Nardil and have not shown improvement will improve if given Parnate.

Let me give an analogy. I'm going to do a double-blind study about giving testosterone or estrogen to random people who complain of infertility. Assume that 50% of the people respond favorably to estrogen, and 50% respond favorably to testosterone.

Does this mean that the people who did not improve on estrogen would not improve if given testosterone? Duh!

The chance that patients who were given Nardil and did not improve might respond to Parnate could be anywhere between 0% and 100%. The study just doesn't answer that question.

> Efficacy and tolerability of tranylcypromine versus phenelzine: a double-blind study in antidepressant-refractory depressed inpatients.
>
> BACKGROUND: The aim of this study was to examine whether phenelzine is a suitable alternative to tranylcypromine in antidepressant-resistant depression.
>
> METHOD: A total of 77 severely depressed in-patients, meeting the DSM-IV criteria for major depressive disorder, who failed to respond to fixed plasma level treatment with either tricyclic antidepressants or fluvoxamine were withdrawn from psychotropic medication and included in a double-blind flexible-dose 5-week comparison of tranylcypromine and phenelzine.
>
> RESULTS: Of the 77 patients, 67 (87%) completed the trial, of whom 35 (52%) responded. No significant differences in response between both drugs were observed.
>
> Seventeen (44%) of 39 patients responded to tranylcypromine and 18 (47%) of 38 to phenelzine (> or = 50% reduction in Hamilton Rating Scale for Depression [HAM-D] score). The mean reduction in HAM-D score was 10.4 +/- 8.3 for the tranylcypromine sample versus 8.3 +/- 8.4 for the phenelzine-treated patients.
>
> Only a few patients (10%) used concomitant psychotropic medication. A substantial number of patients experienced severe side effects, mainly dizziness, agitation, and insomnia; the incidence was the same in both samples (21%).
>
> CONCLUSION: No difference in efficacy was observed between both monoamine oxidase inhibitors in a sample of patients with severe antidepressant-refractory depression. Phenelzine appears to be a suitable alternative to tranylcypromine.
>
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15554763&ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum


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