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Re: I want to try milnacipran but doc said not approve

Posted by bleauberry on October 16, 2011, at 6:29:16

In reply to I want to try milnacipran but doc said not approve, posted by Laney on October 15, 2011, at 11:15:09

My guess is the most likely reason he said that is because he is protecting himself from any troubles with his Board or with insurance carriers. That's because if something goes wrong in the treatment, he could be scrutinized for prescribing an off label med when he should have prescribed firstline meds instead. Off label doesn't seem to be a problem after it has been done a while and a lot of doctors do it. With savella however it hasn't been on the market very long so I don't think it has built a following or a pattern yet.

The fact that it is new could be a factor as well. Maybe the doctor is just more comfortable sticking within his comfort zone?

The manufacturers of savella I think must have been very concerned about the risks of psychiatric prescriptions because they went out of their way to overemphasize in their label that savella is not an antidepressant and could have suicide risk or cause depression. That is actually true of all the psych meds equally, but they purposely put it right on the table so no one could miss it. That, I believe, in an attempt to protect themselves while entering the dangerous waters of the USA prescription market. I think they were perfectly happy going for the fibromialgia market and didn't want the risk of the depression market.

That said, savella has been approved as an antidepressant in other countries for many years. It's one of the few primary antidepressants in Japan. It has a large number of clinical studies on it including some with treatment resistant depression. Speaking only for myself, it put a significant dent in my ECT resistant depression rather quickly at a super low dose.

So I don't know what the fuss is all about. Some people are comfortable managing their own decisions. If that were the case, savella is easily ordered by mail without a prescription from overseas. Not recommending it, just sayin.

What you could do maybe is ask the doctor what he wants you to try. Go along with it and show some enthusiasm and interest in the idea. Then tell him you are even more excited than that with savella. Then strike a deal. Tell him you would like to try savella right now, and that the deal is if it goes badly then the doctor's idea is next up. The doctor/patient relationship really should be one of that kind of trust and give-n-take. If it's not, then it's not a good relationship and either needs to be nurtured or dissolved.


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Psycho-Babble Medication | Framed

poster:bleauberry thread:999790
URL: http://www.dr-bob.org/babble/20111016/msgs/999878.html