![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 328 to 352 of 8406. Go back in thread:
Posted by psycHarvard on September 6, 2002, at 23:01:56
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by Dinah on September 6, 2002, at 9:03:22
> > I am trying to keep this as simple as possible...
>
> Well, if you were speaking only to me, it would probably be best to keep it as simple as possible. But a lot of people on this site are quite comfortable with this sort of talk (moreso than my pdoc in fact) and would relish a complex explanation. Then they could translate for those of us who need a simpler explanation. :)
>
> > I have a lot of information that I am willing to share but I will only mention a bit at a time.
> >
>
> Well it's your choice of course, but again, I think people would enjoy hearing it all at once. It might take a while to digest it all, but it might also allow the information to be coalesced in a way that hearing it a bit at a time wouldn't allow. So feel free to hit us with it all at once.
>
> > at any rate the SNRIs available only hit both 5HT and NE at the highest titrated dose so if you are on anything less you have fallen for a marketing ploy.... not that I do not believe that they are efficacious.
> >
> Hmm. Okay, as I admitted, I am *not* one of the people who understand neurotransmitters that well. Are you saying that a SNRI such as Effexor is doing for both 5HTP and NE what Lexapro will do for only 5HTP? Or am I totally misunderstanding? Because I have to say that Effexor was just as bad at sexual side effects for me as a straight SSRI. The fact that its effect on NE was disastrous for me is probably beside the point.
>Yes you do have it a little wrong... if you hit on multiple neurotransmitters you will basically only have increased AEs... yes sex dys can be one of them (AEs... sorry.. Adverse Events) so if you hit on one very selectively then you should have increased potency with fewer AEs...
> At any rate, the whole discussion is probably only important from a theoretical point right now. Phil and others are going to try Lexapro. In just a few short weeks, the anecdotal evidence will start coming in. And I trust the anecdotal evidence more than all the studies in the world because in my experience it has been more accurate. I've had doctors tell me over and over again that this or that experience can't be caused my my med, when I come here and find out it's pretty common.
>
> You are exactly correct... the real events are the ones that effect you...... all the studies do have some bearing for the majority of the population but there will be some pats that have AEs with any med..... I mean think about it... some people and nuts... allergies... it all depends on a much bigger picture... and not even science can predict or comment on in such a way that will answer your questions...
Posted by psycHarvard on September 6, 2002, at 23:13:15
In reply to Who are you? » psycHarvard, posted by Anyuser on September 6, 2002, at 11:48:29
> In my opinion, any posters that announce themselves as a physician, whether teaching, research, or clinical, should identify themselves further. Dr. Dave did this, sort of, by linking to an article in which he was quoted and identified.
>Sorry I am not Dave and I have had people contact me before and my time is limited and I am only doing this to shed a little light for the people that are confused.
> Pharmrep let us know where he is coming from, so we can take into account his bias when weighing what he has to say. I suspect there is a least one other poster on this topic with commercial interests, who has not been as candid as pharmrep.
Well if you think that my commercial interests are in Forest you may .... lets just say.... Celexa has treated about 40 million pats..... and now Lexapro.... perhaps more in the next wee while... so what I am saying is... by me telling everyone who reads this page (perhaps say 100 people) that Lexapro is the most amazing drug go and get on it tomorrow.... do you really think that this in any way would ever effect Lexapro and its share .... the pats will decide for themselves... if they start on Lexapro and it works... good.... and if it does not work then everyone in the world will know and the F.D.A. will be wrong and the multitudes of people in Europe on Escitalopram will also be wrong... so I don't mean to be so blunt but to think that I would waste my time doing this to some how make people take Lexapro is really silly...
Posted by psycHarvard on September 6, 2002, at 23:35:03
In reply to Re: Fewer s/e with Lexapro - ? » psycHarvard, posted by johnj on September 6, 2002, at 11:23:27
> I have a question for you maybe you can give me a hint upon the causes. I am at 50 mg nortrypline,
sorry I assume you mean Nortryptaline
600 mg lithobid, and 15 to 22.5 or tranzene.
Sounds as if you have severe panic attacks...manic...based on the meds you are on.
I have depression with a high level of anxiety. The problem is if I excercise I feel like crap after a regime has been started. Sometimes the next day I will feel more depressed and have sleep disturbances. I have taken care to watch the time I work out, what I do and what I eat. I take in enough sodium so it is not a spike in lithium. I believe it is the TCA somehow. Have you ever run across this? What have atheletes used that have been sucessful to treat anxiety and depression.
This is not something that I want to comment on... I do not want to put information on here that may mislead you as all pats are different on meds... I have not come across this... I know you have probably spoken to your psyc about it and they will know you much better than I do.
I am hoping a switch to lexapro will give me the power back to help myself through excercise. Also, what is the deal with increased anxiety with ssri's? I went to a Celexa board and almost 90% complained of worsening anxiety. Any thoughts? Thank you.
> PS. I tried remeron and it gave me a "sponge head" and messed with short term memory.Yes SSRIs do cause increased Anx in the first few weeks... that is why a lot of psycs now start there pats off on an SSRI and Wellbutrin... in combination for a few weeks...
In regards to Lexapro and increased Anx... the info that I am aware of shows that the rates of anxiety will decrease as early as week one or two and after that remain low... and that the rates prior to this... the first week or so shows that it is not increasing actually comparable to placebo... but in some pats as I keep on saying they may find an initial increase... or they may find that they feel better as early as a few days...
Posted by pharmrep on September 7, 2002, at 0:01:22
In reply to Re: Serious question for pharmrep, posted by ZyprexaNumbTongue on September 6, 2002, at 15:12:38
> Hi Pharmrep, I would like to know about the types of depressives who took part in these Lexapro clinical trials.
>
> 1) How many of them had severe depression, the type generally referred to as the "melancholia subtype" of depression? This type of depression is also known as endogenous depression and consists of severe deteriorations in sleeping cycles especially severe insomnia, losing weight and appetite without trying, losing sex drive and losing sexual functioning, losing normal cognition such as inability to concentrate, remember, decide, think clearly, etc. Also, melancholic depressives tend to lose their sense of taste and smell. Did Lexapro restore sense of smell and taste?
>
> 2) How many of the depressives in the Lexapro trials were recruited and had milder to moderate forms of depression known as "dysthymia."
>
> 3) what were the full remission rates for Lexapro?
>
> 4) What were the full remission rates for the people who had the severe melancholic form of depression? Or did these people just get a "response" and improve some, but not get totally well?
>
> How many of these depressives in the Lexapro trials were considered disabled and unable to work? Did Lexapro restore their disability and make them undisabled and able to work?
>
> These are very important questions for you. I am not sure you will even know the answers to these questions, but Im asking anyway.
>
> thanks,
>
> ********* Wow, tough questions...here's what I can offer: In Gorman, all patients scored at least 22 on the MADRS which meets criteria for a major depressive episode. Candidates were excluded if there was evidence of active suicide ideation or attempt, or if they had any DSM-IV Axis I disorder other than major depression. Study had 1321 patients.
In Burke, same as Gorman and No concomitant psychotropic medication was permitted, except zolpidem for insomnia. (491 patients )
In Wade, same as Gorman, except patients were also excluded if met criteria for mania, or any bipolar disorder, schizophrenia or any psychotic disorder, ocd, eating disorders, mental retardations, any pervasive developmental disorder or cognitive disorder. Not allowed were any antipsychotics, antidepressants, hypnotics, anxiolytics, antiepileptics, barbiturates, chloralhydrate or other 5HT receptor agonists or ec treatment or behaviour therapy. (380 patients)
Other studies are out, but I only have posters which are limited on info...If I get full blown study...I will update.
As for remission rates...Need to get the specifics in the Rappaport study....it was just approved for the indication (maintenance therapy..based on achieved remission) last week from FDA. All I know is it was a good result as far as 6 months post med and not having relapse. (actual remission #'s vary...I just know it was a good "response" and another "positive" study. As for disabled...dont know anything about that.
"WHEW" that was a lot of typing...hope that helps.
Posted by pharmrep on September 7, 2002, at 0:35:53
In reply to Re: questions » ZyprexaNumbTongue, posted by pharmrep on September 7, 2002, at 0:01:22
I cant believe I did all that work typing and researching before reading all the Posts. It does take time to be here sometimes...I like it, and I learn too. I appreciate others who do the same...especially Dr's who have a professional insight that not everyone has...so hang in there everyone...and keep it peaceful.
Posted by Alan on September 7, 2002, at 0:52:21
In reply to Am I bleeding?, posted by pharmrep on September 7, 2002, at 0:35:53
This is what's becoming an old trick to keep revenues up. Lexapro doesn't give you anything you weren't already getting in Celexa, it's just sort of "purified". By doing that, they can get a new patent for what is essentially the same medication. And by investing many times as much money in marketing as they do in development, the drug companies can convince an amazing number of naive doctors that Lexapro actually IS newer, better, and amazingly free of all the side effects and withdrawal phenomena that have emerged with all previous miracle drugs for the mind.
And speaking of side effects, get a load of the statistics cited on for instance sexual dysfunction. You wonder how a doctor can cite numbers like that without smirking all the way to the bank. He HAS to know they're fictitious. He can't be that blind to his own patients. Can he?
The whole thing is pretty close to putting new paint on an old pill and selling it again. The makers of Prozac tried to do the same thing but had to abandon it before getting to market because the "purified" Prozac turned out to cause dangerous heart arrhythmias.
The patent on Prozac was close to expiring and its manufacturer was scrambling to hold on to revenues and came out with a "new" prozac to treat PMS.
It makes you think. If they can get a patent on Prozac Weekly, the same active ingredient as normal Prozac in a different delivery matrix, they're not patenting medications -- they're patenting the physical pills!!!
So why don't they just patent something like a 2 mg (or whatever size) pill of every med to begin with? Then when that patent is about to expire, they can "invent" a 1 mg pill and patent that as a new medication that needs only half the dosage of the old one. Hell, with enough money spent on marketing, they can probably persuade tens of thousands of doctors that the 1 mg pill has less than half the side effects of the old, obsolete, addictive 2 mg pill.
It's a good thing for the drug companies that the FDA exists to keep a short leash on the patent office and other arms of government. Otherwise all kinds of rational thinking might break loose.
To make a profit these days, the co's have to differentiate. The best way to do that within a single class of drugs is to claim to have fewer side effects. Because of a serious loophole in our laws about drug research, they just keep doing trial after trial until they figure out how to get some of them to come out as desired. Then they negotiate with the FDA about what trials to include and how to summarize them in the prescribing info.We need to change our laws so that as part of the price for approval of a drug, ALL studies on its use in humans (at the least) get placed into the public domain. That way it won't be as easy to make distorted claims. For instance, the public and the FDA have seen only a small fraction of SKB/GSK's studies on Paxil. In the majority of them it worked worse than placebo to a statistically significant degree*. At least that's what plaintiffs in one of the class-actions suits alleged, promising to provide supporting evidence. It just shouldn't be legal to hide things like that. And now that scandals like the HRT and cox-2 inhibitor surprises are emerging (i.e. it affects more than just us "head cases") I think there's some chance the regulatory environment may change.
=============
* Still, that's an average response. It doesn't negate the fact that some people respond and some of those respond extremely well. Statistical truth and statistical inference, important as they are, have considerable limits. The closer you narrow it down to an individual case, the fuzzier the picture gets until there is no statistical picture at all when dealing with a sample of one. Just because the number of people doing well on a drug is less than the number doing well on placebo does not prove that all those people are experiencing a placebo effect or spontaneous remission. Some of them may very well be experiencing a bona fide pharmacologically therapeutic effect. It's just that one can't prove it statistically. With the right tools, one could hypothetically prove it chemically or by doing repeated double-blind crossover trials on one or more individuals.
Posted by _alii_ on September 7, 2002, at 1:17:20
In reply to Re: Marketing, Lexapro, etc. - in general (Long), posted by Alan on September 7, 2002, at 0:52:21
...break loose.
Alan,
That sentence alone slayed me. Thank you for a thought provoking post. The smile and chuckle from that sentence though is what made me respond.
Namaste.
--Alii
Posted by pharmrep on September 7, 2002, at 2:10:04
In reply to Re: Marketing, Lexapro, etc. - in general (Long), posted by Alan on September 7, 2002, at 0:52:21
> This is what's becoming an old trick to keep revenues up. Lexapro doesn't give you anything you weren't already getting in Celexa, it's just sort of "purified". By doing that, they can get a new patent for what is essentially the same medication. And by investing many times as much money in marketing as they do in development, the drug companies can convince an amazing number of naive doctors that Lexapro actually IS newer, better, and amazingly free of all the side effects and withdrawal phenomena that have emerged with all previous miracle drugs for the mind.
>
> And speaking of side effects, get a load of the statistics cited on for instance sexual dysfunction. You wonder how a doctor can cite numbers like that without smirking all the way to the bank. He HAS to know they're fictitious. He can't be that blind to his own patients. Can he?
>
> The whole thing is pretty close to putting new paint on an old pill and selling it again. The makers of Prozac tried to do the same thing but had to abandon it before getting to market because the "purified" Prozac turned out to cause dangerous heart arrhythmias.
>
> The patent on Prozac was close to expiring and its manufacturer was scrambling to hold on to revenues and came out with a "new" prozac to treat PMS.
>
> It makes you think. If they can get a patent on Prozac Weekly, the same active ingredient as normal Prozac in a different delivery matrix, they're not patenting medications -- they're patenting the physical pills!!!
>
> So why don't they just patent something like a 2 mg (or whatever size) pill of every med to begin with? Then when that patent is about to expire, they can "invent" a 1 mg pill and patent that as a new medication that needs only half the dosage of the old one. Hell, with enough money spent on marketing, they can probably persuade tens of thousands of doctors that the 1 mg pill has less than half the side effects of the old, obsolete, addictive 2 mg pill.
>
> It's a good thing for the drug companies that the FDA exists to keep a short leash on the patent office and other arms of government. Otherwise all kinds of rational thinking might break loose.
>
>
> To make a profit these days, the co's have to differentiate. The best way to do that within a single class of drugs is to claim to have fewer side effects. Because of a serious loophole in our laws about drug research, they just keep doing trial after trial until they figure out how to get some of them to come out as desired. Then they negotiate with the FDA about what trials to include and how to summarize them in the prescribing info.
>
> We need to change our laws so that as part of the price for approval of a drug, ALL studies on its use in humans (at the least) get placed into the public domain. That way it won't be as easy to make distorted claims. For instance, the public and the FDA have seen only a small fraction of SKB/GSK's studies on Paxil. In the majority of them it worked worse than placebo to a statistically significant degree*. At least that's what plaintiffs in one of the class-actions suits alleged, promising to provide supporting evidence. It just shouldn't be legal to hide things like that. And now that scandals like the HRT and cox-2 inhibitor surprises are emerging (i.e. it affects more than just us "head cases") I think there's some chance the regulatory environment may change.
>
> =============
> * Still, that's an average response. It doesn't negate the fact that some people respond and some of those respond extremely well. Statistical truth and statistical inference, important as they are, have considerable limits. The closer you narrow it down to an individual case, the fuzzier the picture gets until there is no statistical picture at all when dealing with a sample of one. Just because the number of people doing well on a drug is less than the number doing well on placebo does not prove that all those people are experiencing a placebo effect or spontaneous remission. Some of them may very well be experiencing a bona fide pharmacologically therapeutic effect. It's just that one can't prove it statistically. With the right tools, one could hypothetically prove it chemically or by doing repeated double-blind crossover trials on one or more individuals.
>
> ***** Do you just want to get kicked off? All your statements appear without any proof-sources. You speak like somebody who hasnt read any studies at all. Have you? Do you know anything about isomer science? Yes, Prozac failed this twice, because the molecule didnt lend itself to being separated well. I dont see how over 9 studies and the FDA can all be biased to Forest. Do you really believe that?..."negotiate with the FDA"? "figure out how to control trial results" You're funny.
Posted by Dinah on September 7, 2002, at 4:34:05
In reply to Re: (Long)see bottom » Alan, posted by pharmrep on September 7, 2002, at 2:10:04
> > You speak like somebody who hasnt read any studies at all. Have you? Do you know anything about isomer science? Yes, Prozac failed this twice, because the molecule didnt lend itself to being separated well. I dont see how over 9 studies and the FDA can all be biased to Forest. Do you really believe that?..."negotiate with the FDA"? "figure out how to control trial results" You're funny.
Pharmrep, I've asked you before to be civil, not to be sarcastic, jump to conclusions about others or their experiences, or post anything that could lead to others being feeling accused or put down.
So now, I'm sorry, but now I'm going to have to block you for one week.
Dinah
Posted by Anyuser on September 7, 2002, at 9:58:54
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by dr dave on September 5, 2002, at 2:31:05
FWIW, here's a link to a Forest press release on "Examining Clinical Experience with Escitalopram in Depression"
http://www.frx.com/servlet/financial.displayDoc?doc_id=09-05-2002/0001795321
Posted by johnj on September 7, 2002, at 10:37:56
In reply to Re: Fewer s/e with Lexapro - ?, posted by psycHarvard on September 6, 2002, at 23:35:03
thanks for the info, but your condescending tone is not appreciated. There are people with mood disorders that are not as ignorant as you apparently think. Who knows, the pressure of your job could lead you down the same path as many of us. It didn't hit me until 27.
Posted by johnj on September 7, 2002, at 10:45:57
In reply to Re: Blocked for one week » pharmrep, posted by Dinah on September 7, 2002, at 4:34:05
Dinah:
Considering how much pharmrep has been verbally abused at times what do you expect? Did you read the psycHarvard's response to me? Whoever it is made me feel like an ass, like I couldn't even spell my own med, but then again neither could he. Define what is appropriate when someone makes you feel stupid? If that is the case block psycHarvard for a week. And before you respond to this just remember you can't tell me HOW the post made me feel.
johnj
Posted by hawkeye on September 7, 2002, at 11:17:04
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by Phil on September 6, 2002, at 8:27:35
Why is everyone so critical of Lexapro without even trying it or giving it a chance to prove itself????
Did it ever cross your mind that what Forest Labs says about Lexapro is true???????
Surely, Lexapro couldn't be less effective than Celexa.
I suspect that it's because we all have been disappointed by drugs in the past.
No one is forcing you to take Lexapro - No one is shoving it down your throat.
Why all of this pre-judgement?
We all know that the only way to judge a drug is to try it. Why shouldn't someone who is taking Celexa try Lexapro?????
Do you think Forest would risk its reputation of success with Celexa by introducing a dud into the market???
I started taking Lexapro yesterday evening??? Why? Because maybe it will help me. Maybe it will fit my condition. Yes, it's a crap-shoot, but I have no reason to disparage something that I haven't tried.
I have taken Celexa and found it to be one of the few drugs that really worked for me. But I stopped it because of unacceptable side-effects. I am looking forward to seeing if Lexapro is any more effective without those side-effects. I will let you know.
Posted by Dinah on September 7, 2002, at 11:39:52
In reply to Re: Blocked for one week » Dinah, posted by johnj on September 7, 2002, at 10:45:57
Since discussions on posting policies are supposed to be posted to the Admin board, I am redirecting my reply there.
Here is a link, or you can follow the links at the top of the page.
http://www.dr-bob.org/babble/admin/20020725/msgs/7319.html
All further discussion of posting policies should take place there.
Thanks,
Dinah
Posted by johnj on September 7, 2002, at 12:21:46
In reply to WHAT IS ALL THIS BICKERING ABOUT???????, posted by hawkeye on September 7, 2002, at 11:17:04
Hawkeye:
Please continue to post your experiences I am slated for a trial in the near future and it will be my first ssri, and hopefully a welcome switch from my current TCA. Any input would be greatly appreciated. Heck, I think even Celexa is worth a try, but by pdoc said lets wait until Lexapro comes out. Thanks
johnj
Posted by Phil on September 7, 2002, at 13:02:54
In reply to Re: WHAT IS ALL THIS BICKERING ABOUT??????? » hawkeye, posted by johnj on September 7, 2002, at 12:21:46
How did rats get to the lab? "Well, the rats are doing well, let's bring in the humans." Why don't they test stuff on, say, the Shetland pony?
Or alligators? The forced swim test with alligators would be more interesting than rats.
Anyway, I'm starting Lex Tuesday and will let you know also.
I'm telling my pdoc that I demand samples, ball point pens, and a coffe mug. If it works really well, I'll demand a Lexapro windbreaker.
Posted by Phil on September 7, 2002, at 13:19:11
In reply to Re: severe depression, posted by ZyprexaNumbTongue on September 6, 2002, at 15:46:52
You need to read the book; scanning is not the same. Andrew Soloman knew depression. The book is an incredible work from someone that was hammered hard by depression.
To say his problems were just issue related, in my opinion, is an insult to the author and sufferers of depression in general.
Posted by Roastmarshmellows on September 7, 2002, at 15:55:39
In reply to Re: Soloman's book » ZyprexaNumbTongue, posted by Phil on September 7, 2002, at 13:19:11
> You need to read the book; scanning is not the same. Andrew Soloman knew depression. The book is an incredible work from someone that was hammered hard by depression.
> To say his problems were just issue related, in my opinion, is an insult to the author and sufferers of depression in general.Im not ZyprexaNumbTongue, but I have looked at Solomon's book. I agree with ZNT that much of Solomon's book is introspective psychobabble BS. Solomon seems to have a lot of issues and a person like that isnt likely to have the melancholia subtype of depression as much.
Id also like to say that I wish I had a rich daddy like Solomon, so that I could write my own book about my own depression experiences and get it published. I wonder if Solomon's book would have been published had he not had rich connections. Probably not.
In all honestly, there is a guy on here named LostboyinNC who could write a book ten times better than Solomon, which would be more informative than Solomon's. Whether LostBoyinNC could actually get it published is another story, as LostBoy is not rich, the guy doesnt have any connections in the publishing world.
I also wish I had a rich daddy like Solomon who could go to the ends of the Earth looking for a better antidepressant for me. I understand this is what happened with Andrew Solomon. My parents dont even like to admit I have major depression, much less are they going to exert themselves trying to find something to help me.
My Mom told me if I just smiled real big and built a campfire and sang campfire songs and roasted marshmellows that my severe depression would be gone. I wonder if thats what Solomon's mom told him?
Posted by Roastmarshmellows on September 7, 2002, at 16:00:50
In reply to Re: Soloman's book » ZyprexaNumbTongue, posted by Phil on September 7, 2002, at 13:19:11
I know one thing, I cant even get SS disability for my severe depression. It sure would be nice to have a rich daddy like Andrew Solomon does, whose daddy is CEO of a huge pharmaceutical company to help me out with some cash from time to time. Bet that would take a lot of the stress out of my situation.
Posted by Dinah on September 7, 2002, at 17:22:58
In reply to Re: Soloman's book, posted by Roastmarshmellows on September 7, 2002, at 15:55:39
Please don't continue to reregister while blocked. I am now blocking you for 8 weeks.
Dr. Bob will be back tomorrow or Monday and you may appeal this decision with him if you like.
Dinah
Posted by jane d on September 7, 2002, at 21:15:38
In reply to Re: 'Poop out' » johnj, posted by dr dave on September 4, 2002, at 13:41:42
> I haven't really found that people on SSRIs are more likely to relapse than people on other antidepressants. I do find that people can feel better on an antidepressant for a while and then relapse - which doesn't necessarily mean the drug has stopped working.
>
> Antidepressants can successfully elevate an individuals mood, but it can be the case that the factors that have led to that depressive state in the first place can continue and overwhelm what effect the drug has had. I don't think people's mood state can be permanently elevated by a drug such that other influences cannot have an effect. If someone's life is chronically difficult, be that because of external problems or because of unhelpful ways of thinking or reacting to circumstances, this can lead to depression. Antidepressants can alter the balance of positive and negative influences on that persons mood, but if the difficulties continue they can reverse that shift. If your life has felt devoid of pleasure for six months, that exerts a certain downward pressure on your mood. If your life has felt devoid of pleasure for six years, that is going to depress your mood more strongly. In this situation the pressures that are chronically exerting a negative influence on your mood need to be identified and sorted out, as any medication may be fighting an unwinnable battle.
> I haven't really found that people on SSRIs are more likely to relapse than people on other antidepressants. I do find that people can feel better on an antidepressant for a while and then relapse - which doesn't necessarily mean the drug has stopped working.
>
> Antidepressants can successfully elevate an individuals mood, but it can be the case that the factors that have led to that depressive state in the first place can continue and overwhelm what effect the drug has had. I don't think people's mood state can be permanently elevated by a drug such that other influences cannot have an effect. If someone's life is chronically difficult, be that because of external problems or because of unhelpful ways of thinking or reacting to circumstances, this can lead to depression. Antidepressants can alter the balance of positive and negative influences on that persons mood, but if the difficulties continue they can reverse that shift. If your life has felt devoid of pleasure for six months, that exerts a certain downward pressure on your mood. If your life has felt devoid of pleasure for six years, that is going to depress your mood more strongly. In this situation the pressures that are chronically exerting a negative influence on your mood need to be identified and sorted out, as any medication may be fighting an unwinnable battle.
>Dave (and anyone else out there),
For some reason this description resonated with me in a way that other descriptions of non physical factors in depression haven't. I'm not sure why. I'm definately a fan of medication but I've not been able to recapture that first feeling of really being "ok" that I experienced the first time.
Among other things, I've been wondering how this view fits with the seeming success of maintenance medication. Does maintenance medication only work to prevent a long lasting relapse in people exposed to periodic short term stresses? Or does it give some small level of protection against chronic stresses - enough for mild ongoing problems. Or could it be not the medication itself, but just change - any change - in your brains neurochemistry that gives you a window in which habits of thought and feeling are no longer so firmly embedded?
A muddled Jane staring out from behind the "medication camp" lines.
Posted by dr. dave on September 9, 2002, at 9:03:54
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by psycHarvard on September 6, 2002, at 23:01:56
PsycHarvard's posts have been interesting but fail to provide any evidence of fewer side-effects with Lexapro compared to Celexa. I haven't been quite clear as to whether PsycHarvard is saying that there are fewer side-effects. If he is, I would be interested to know what evidence is behind the claim.
Posted by Geezer on September 9, 2002, at 11:15:51
In reply to Re: Fewer s/e with Lexapro - where's the evidence? » psycHarvard, posted by dr. dave on September 9, 2002, at 9:03:54
> PsycHarvard's posts have been interesting but fail to provide any evidence of fewer side-effects with Lexapro compared to Celexa. I haven't been quite clear as to whether PsycHarvard is saying that there are fewer side-effects. If he is, I would be interested to know what evidence is behind the claim.
Dr. Dave,
I suspect the reason you are not receiving an answer to your question (evidence of less side effects for Lexapro vs Celexa) is because there isn't any SCIENTIFIC EMPERICAL evidence. If we are to continue using psychological "evidence" (in the form of HAMD testing and other such nonsense) we never will have scientific evidence. Psychology is very much like Philosophy-subjective, anecdotal, metaphysics. It does a great disservice to those of us with genetically transferred, biochemical, and PHIOLOGICAL (interesting post mortum studies on depressed suicide victums-malformations in prefrontal cortex and hippocanthus [spelling]) brain disorders. When genetic markers, intracelular ADs, and diagnostic blood tests come into play, then maybe we will see scientific evidence. Until that time people will use the FDA as there proof source for efficacy.......the most powerful impediment to medical progress that ever existed.
Best regards,
Geezer
Posted by Dr. Bob on September 9, 2002, at 17:10:32
In reply to Re: Fewer s/e with Lexapro - where's the evidence? » dr. dave, posted by Geezer on September 9, 2002, at 11:15:51
> If we are to continue using psychological "evidence" (in the form of HAMD testing and other such nonsense) we never will have scientific evidence. Psychology is very much like Philosophy-subjective, anecdotal, metaphysics. It does a great disservice to those of us with genetically transferred, biochemical, and PHIOLOGICAL (interesting post mortum studies on depressed suicide victums-malformations in prefrontal cortex and hippocanthus [spelling]) brain disorders. When genetic markers, intracelular ADs, and diagnostic blood tests come into play, then maybe we will see scientific evidence. Until that time people will use the FDA as there proof source for efficacy.......the most powerful impediment to medical progress that ever existed.
I'd like discussion of the pros and cons of different types of evidence -- and of the FDA -- to be redirected to Psycho-Social-Babble, thanks.
Bob
PS: And follow-ups regarding posting policies to be redirected to Psycho-Babble Administration.
Posted by moxy1000 on September 9, 2002, at 22:49:59
In reply to Re: Fewer s/e with Lexapro - where's the evidence? » dr. dave, posted by Geezer on September 9, 2002, at 11:15:51
Dr. Dave, I believe evidence has already been offered to you but it seems as if the conclusions arrived at in any clinical studies are usually contrary the conclusions you draw for yourself, as far as I can tell from your posts.
I would not think that a direct comparison of Celexa's side effect profile versus Lexapro's side effect profile would be of any value to you, would it? I mean, there are different patient populations involved, different dosages of each agent given. Lexapro's side effect profile was based on a 8 week study, dosed at 10-20 mg (the starting/maintanance dose and the maximum dose.) Celexa's side effect profile was based on a 6 week study, dosed from 10-80 mg (half the starting dose of 20mg to 20mg past the max dose of 60mg.)
If there are is still value to you, even recognizing those vast differences in study design, I would be happy to post the numbers for you. But keep in mind, both studies were sponsored by the manufacturer, and from your prior posts, I know you don't care for those types of studies, either.
I guess what I'm saying is if you will overlook those "flaws" I will go through the work to get the information for you. If those things are too bothersome to get past in the first place, then what's the point? I don't mean to sound cynical, but you've been a tough critic on this board and I guess I just thought you were past convincing at this point. (And that's not necessarily a bad thing.)
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