Posted by SLS on September 15, 2012, at 7:05:09
In reply to Re: Pristiq dosages of 200 - 400 mg/day., posted by jono_in_adelaide on September 15, 2012, at 4:16:35
> Effexor, Cymbalta and Pristique only have a significant effect on noradrenalin reuotake at doses in excess of those commonly used (300mg per day of effexor is a much weaker noradrenalin reuptake inhibitor than 75mg of nortriptyline) - if you want an effective SNRI, take Sertraline along with nortriptyline or bupropion.
I don't agree with this type of approach. I don't think one can substitute sertraline 200 mg + nortriptyline 150 mg for
venlafaxine 300 mg and guarantee for someone equivalent efficacy.Do you think there are people who respond to clomipramine who do not respond to sertraline + nortriptyline or sertraline + bupropion? If so, how do you account for this?
The point I am making is that things are seemingly not so simple, and I would hate to dissuade someone from trying a potentially effective treatment.
I respond better to nortriptyline + venlafaxine than to nortriptyline + sertraline.
I respond better to nortriptyline + sertraline than to desipramine + sertraline.
I don't respond to nortriptyline + bupropion at all. It makes me feel worse.
I don't think that we can design effective treatments for each individual using theoretical recipes of ingredients we haven't fully characterized yet and without knowing more about the cooking process itself. This becomes obvious when someone responds to one SSRI but not another. Even SNRIs are not interchangeable in the real world. We don't need to know the first thing about pharmacology to make these clinical observations and use them effectively.
From the very beginning, doctors observed that there are people who respond to Nardil whom do not respond to Parnate and vice versa. They also observed that imipramine and amitriptyline were not interchangeable. They did this without understanding the pharmacology of these drugs. Scientists are still unable to fully account for these observations. Educated guesses are fine, but that's all they are - guesses. Personally, I don't know enough to suggest to someone that a SNRI will be ineffective if they fail to respond to sertraline + nortriptyline.
If I had to guess, I would say that bupropion + venlafaxine will get more people well than bupropion + sertraline. I would also guess that nortriptyline + venlafaxine will get more people well than nortriptyline + sertraline. This should not be true if all that were necessary was to combine serotonin and norepinephrine reuptake inhibition. And what's the deal with clomipramine? Why is this SNRI considered more effective than any other, especially for treating melancholic depression? Calcium channel inhibition? Sodium channel inhibition? Sigma receptor stimulation? 5-HT2a receptor blockade? Muscarinic receptor blockade? NMDA receptor modulation? Opioid kappa and delta receptor stimulation? Glutamate receptor blockade?
I really don't know.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1024121
URL: http://www.dr-bob.org/babble/20120912/msgs/1025698.html