Posted by Racer on December 4, 2008, at 18:52:39
In reply to Re: Advice on effective antidepressant, posted by bleauberry on December 4, 2008, at 18:02:33
> It amazes me that the best antidepressants ever invented, and maybe the only true antidepressants, are so often ignored as if they don't exist.
I realize that we're unlikely ever to agree on this issue, but I'd like to add my opposing view to this statement. Respectfully, of course, because I don't expect you to agree with me, and that's fine.
The biggest reason for the algorithm so often used in choosing anti depressants has nothing to do with efficacy -- because most of the anti-depressants are about equally likely to be successful -- but with tolerability. Most of the studies I've read about use of MAOIs have mentioned that tolerability is a large factor in people discontinuing their use. The side effect profile is part of the problem, the dietary restrictions are another part.
Sure, there are a lot of doctors out there these days who won't prescribe MAOIs, or who will prescribe them only after adequate trials of the newer drugs and at least one TCA have failed. That doesn't mean they're wrong -- they're looking at factors other than the ones you're looking at.
I believe both views are quite valid. I, for one, would not take an MAOI. That's my choice. If you have found one that works for you, that's great -- it's simply not my choice. And despite the possibility that I am just biased, I think my choice is equally valid. ;-)