Posted by dcruik518 on August 8, 2008, at 12:55:28
In reply to SSRI vs SNRI - Efficacy Comparison Article (long), posted by SLS on August 6, 2008, at 6:41:57
Scott,
Thanks for this excellent and apropos article. I think the truth is that none of the so-called SNRI's are really any more effective than the SSRI's, but based on what I've read the main reason is that they do not sufficiently boost Norepinephrine.
I'm not sure this author is making that argument, though, and maybe that's why he doens't bring up potential solutions--namely adding a very strong NE tricyclic like Nortryptyline or Desimpramine to an SSRI. There are also studies that show that clomipramine which is a truly "balanced" SNRI is superior for severe depression than Effexor; (Clomipramine gets an underserved bad rap in my opinion; i worked quit well for me when I took it, once I got past the initial grogginess.) I'm currently taking Pristiq which may be a more potent NE reuptake inhibitor at lower doses than Effexor, but I'm a bit skeptical since Wyeth obviously developed the drug solely for profit reasons after the effexor patent has expired. Still, so far it seems to be helping a bit, and I like your idea of adding Nortryptyline to it.
A thought: Isn't it probable that the drugs and drug combos that work best would hit all three neurotransmitters? For instance:
MAOIs, (I wonder if Parnate might be a better/healthier choice, since its causes much less weight gain than Nardil)
Zoloft + Nortryptyline (+ Wellbutrin)
(Note that Zoloft is the only SSRI that has significant dopamine reuptake inhibition activity on its own)Anyway, thanks again for the enlightening article.
Dwight
poster:dcruik518
thread:844518
URL: http://www.dr-bob.org/babble/20080805/msgs/844949.html