Posted by SLS on September 17, 2012, at 7:06:15
In reply to Re: Pristiq dosages of 200 - 400 mg/day., posted by jono_in_adelaide on September 16, 2012, at 21:55:28
> What I am saying is that in clinicaly used doseages, the SNRI's dont inhibit noradrenalin reuptake as much as nortriptyline or desipramine
That's hard to say. At high but clinically relevant dosages (300 - 375 mg/day), absolute occupancy of NET at full saturation in the brain might be quite high. I have never seen assays comparing venlafaxine to TCA in this regard. That's too bad. Even if desipramine inhibits NET more potently, the potency of venlafaxine is probably more than adequate to generate a therapeutic effect. Assays of venlafaxine alone demonstrate NET inhibition at dosages as low as 75 mg/day.
> Of course there are some people who will respont spiffingly to effexor or cymbalta, however, more would respond to an SSRI + nortriptyline/bupropion/desipramine
Can you cite any scientific evidence to support this statement?
> In commonly used doseages, Effexor is just an overpriced SSRI
It would be difficult to explain this to someone who responds to venlafaxine who does not respond to SSRIs.
Even if your opinion reflected reality pharmacodynamically, it does not reflect clinical observation. My opinion is that venlafaxine will get more people well than any SSRI. Another opinion of mine is that paroxetine will get more people well than any other SSRI. Lexapro comes close. Both of these opinions are based upon my impressions rather than scientifically arrived at statistics, so they aren't terribly significant. Some meta-analyses show venlafaxine to be unequivocally superior to SSRIs. Some show these drugs to be almost equally effective, usually with a slight advantage to venlafaxine. In my opinion, the bottom line is that venlafaxine is different enough from all other antidepressants to justify its continued availability. I would say the same thing about any antidepressant. I would have to reach a bit to include moclobemide and maprotiline, but as long as there are people who respond preferentially to these drugs, it is difficult to regard them as equivalent to any other drug.
Some see things as they are and ask why.
I dream of things that never were and ask why not.
- George Bernard Shaw