Posted by desolationrower on November 19, 2009, at 21:37:08
since methylphenidate felt like nothing, i'm going to try nortriptaline
only thing wondering about, i had trouble taking it everyday (same problem as w/ amphetamine). since it was part of the 'being productive' ritual/set of activities, where as an antidepressant you don't need to take in association with doing something
anyone have any ideas why NRIs take 2 weeks to reach effect? maybe not taking the stimulants nregularly hampered their effectiviness
also while filling Rx, the pharmacist came over to warn me about the interaction with the tranylcypromine (i use 3 pharmacies, whatever is cheapest for any drug, hadn't been there since i stopped the maoi). i started to argue with him, but decided not to bother.
saw this paper come out too, comparing w/ s-citalopram response trajectory
Trajectories of change in depression severity during treatment with antidepressants
Background Response and remission defined by cut-off values on the last observed depression severity score are commonly used as outcome criteria in clinical trials, but ignore the time course of symptomatic change and may lead to inefficient analyses. We explore alternative categorization of outcome by naturally occurring trajectories of symptom change.
Method Growth mixture models were applied to repeated measurements of depression severity in 807 participants with major depression treated for 12 weeks with escitalopram or nortriptyline in the part-randomized Genome-based Therapeutic Drugs for Depression study. Latent trajectory classes were validated as outcomes in drug efficacy comparison and pharmacogenetic analyses.
Results The final two-piece growth mixture model categorized participants into a majority (75%) following a gradual improvement trajectory and the remainder following a trajectory with rapid initial improvement. The rapid improvement trajectory was over-represented among nortriptyline-treated participants and showed an antidepressant-specific pattern of pharmacogenetic associations. In contrast, conventional response and remission favoured escitalopram and produced chance results in pharmacogenetic analyses. Controlling for drop-out reduced drug differences on response and remission but did not affect latent trajectory results.
Conclusions Latent trajectory mixture models capture heterogeneity in the development of clinical response after the initiation of antidepressants and provide an outcome that is distinct from traditional endpoint measures. It differentiates between antidepressants with different modes of action and is robust against bias due to differential discontinuation.
(Received April 21 2009)
(Revised July 20 2009)
(Accepted September 10 2009)