![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 42. This is the beginning of the thread.
Posted by ross on June 24, 2002, at 10:23:05
it is twice as effective as Celexa.
this is going to be a great med when we get it.
go to forest labs home page.
ross
Posted by Phil on June 24, 2002, at 12:21:17
In reply to new news on LEXAPRO!!!!!!!!!!!, posted by ross on June 24, 2002, at 10:23:05
I hope you're right. I thought the same about Reboxetine, it sucked.
Posted by Phil on June 24, 2002, at 12:38:53
In reply to Re: new news on LEXAPRO!!!!!!!!!!!, posted by Phil on June 24, 2002, at 12:21:17
It seems to begin to work within one week and was a lot better than placebo.
I'd still be willing to bet it kills the sex life in 80% of people taking it and causes an average body weight gain of 10-15%.
I REALLY hope I'm wrong.
Posted by Cecilia on June 26, 2002, at 21:18:55
In reply to new news on LEXAPRO!!!!!!!!!!!, posted by ross on June 24, 2002, at 10:23:05
I don`t think that the studies actually show that it is twice as effective as Celexa; only that you need a smaller dose for the same effects (i.e. 20 mg Lexapro equals 40 mg Celexa). Cecilia
Posted by katekite on June 27, 2002, at 17:37:02
In reply to Re: new news on LEXAPRO!!!!!!!!!!!, posted by Cecilia on June 26, 2002, at 21:18:55
Cecilia's makes a lot of sense.
Lexapro is "twice as effective" only in name. If you took 40 mg of celexa you would only need 20 of lexapro to get both the good (and most likely the bad) side effects. Celexa weighs twice as much for the same amount of effect, that's all. It is remotely possible that Lexapro is more potent, as well, but just remotely.
Celexa is composed of two versions of one chemical, two enantiomers. One is a mirror image of the other. They call one version the R version, and the other version the L version. It happens in Celexa that it is the L version that is helpful psychologically. (or at least most of the effect seems to come from it). Celexa has equal numbers of the R and the L, by weight, in the pill. There is always the possibility when a drug is a mixture of two things, that one of the things is causing the bad side effects and the other is causing the good effects.
Lexapro is pure L version... they have somehow refined the chemical process so the mirror images are not made. The good news is that it is an active drug. It is hard to know yet if it will have the same side effects as celexa or not.
A completely separate reason for developing a new drug is if the patent is running out on the old one: I don't know if this is the case for Lexapro and Celexa but it seems a bit suspicious.
This same drug development strategy has been used already many times. For example, for Focalin, which is one version of the two mirror-image chemicals that are in Ritalin. (One is active, the other not.) People report that Focalin is a little cleaner feeling than Ritalin: it's pretty new, so I think that's just anecdotal at this point. Focalin definitely is functional and works as well as Ritalin.
My opinion on the issue is that Lexapro will not be a wonder drug. The best thing about Lexapro is that Celexa has been around a while (as far as new gruesome side effects go we should be fairly safe with it). Lexapro may even have fewer side effects but its hard to know so far. I would try it if I had been trying to increase my dose of celexa for therapeutic effects but had hit a wall of side effects. Or if offered celexa first time out, might opt for Lexapro instead.
kate
(If you look at Dr. Bob's new picture his question marks are backwards, which makes one wonder: is he more or less effective this way? Is his patent running out? :)
Posted by pharmrep on July 31, 2002, at 2:48:27
In reply to mirror images: lexapro and focalin and dr.bob, posted by katekite on June 27, 2002, at 17:37:02
Oh Kate...I'm so sorry you have been schtooped by other pharm companies with the patent game. I market Celexa, and will switch to Lexapro when it's out (August is expected) Celexa has 3 years left...and Forest is moving to Lexapro because studies show it is better. But why? Since you know 20 mg of Celexa is 10mg of r-citalopram, and 10mg of s-citalopram. If the r is removed you have Lexapro...what you havent seen (but you will when the studies are out in about 1 month) is that even though Celexa is just as effecacious as other antidepressants. Lexapro is better because the r-citalopram actually inhibits the s-citalopram. So, Lexapro is a purer form, will have fewer side effects, and be faster acting. (and will be less expensive than Celexa) I dont know if it will be a "wonder drug" like you suggest, but throwing out uneducated opinions on a drug not out yet seems pretty harsh...If you feel "controlled" on Celexa,(or any drug)...stay there. If you feel you need change, try Lexapro
Posted by katekite on July 31, 2002, at 9:45:20
In reply to Re: mirror images: lexapro and focalin and dr.bob, posted by pharmrep on July 31, 2002, at 2:48:27
Well I'm so shocked. Someone (me) said something critical about a new not yet marketed drug, and now a person who wants to sell that drug is disagreeing.
How could I possibly know much of anything about a drug that's not even out yet? About a drug with few published clinical reports? All I can do is make educated guesses based on other similar types of situations, such as Focalin. I chose to do that and now you are choosing to pick this one post out of hundreds I've made similar guesses in and shoot it down. Gee I wonder why?
Oh wait, its because you SELL Lexapro.
Or am I mistaken, are you just a magnanamous well educated individual who happens to be in possession of knowledge you know the rest of us would like to have? How generous of you.
Of course the two forms inhibit eachother! They are almost identical so they fit in the same places. That means nothing whatsoever with regard to side effects and efficacy! At least not by itself. Maybe there is great information out there, but you didn't give it to me. Lexapro might be better, but it might be worse!
Maybe it alone, without the antagonism of the other form, causes irreversible binding somewhere and 10 years from now people on it will discover their blood no longer clots. Do you know it won't? Don't you think someone just like you sold thalidomide enthusiastically and thinking they understood?
Any dimwit can use their judgement to know an opinion I've made on an unknown drug with no relevant clinical experience is just that, an opinion, a guess. A strong guess, OK. Am I opinionated: apparently. Have I tried Lexapro? No. And no, I'm not on Celexa, though I have tried it. I did not hate it, I have no personal problem with Celexa or with Lexapro. Celexa had some side effects for me but so did most other things.
I'm offended that you used the word "controlled". That sounds more like a dog than a human. How about, "helped by". That might go over better. Most people don't like being 'controlled'.
Your opinion on Lexapro is a guess, no matter how much education (read "company research briefs") you've had. Even if you or the research had no connection to the company it would be a guess. There is close to zero clinical experience with it and until there is you can't tell me its more or less useful than a bar of soap.
I am not saying that it is not worth trying. It might be fantastic. It might be the next penecillin. Yes, a wonderdrug. Maybe it will not only treat depression, but cure it forever. Honestly, I don't know, and it could turn out to be awesome. I clearly said that. You didn't. You said Lexapro was 'better'.
To think that anyone could suggest a drug will be better than any other before its been widely used, is just a load of crap.
You would like everyone to believe that you have some magic information that is only available to you. You would like everyone to run out and buy your drug. You sell the drug and your paycheck depends on you convincing doctors to use it and as many people as possible to take it.
Furthermore, though I can't think that anyone already being a drug rep would care, you have a responsibility you clearly aren't working on. That responsibility is to the consumers. It's to your siblings and your parents and relatives and the rest of the world who might consider following your biased advice.
Your responsibility is to not misinform people. Your responsibility is to be cautious. Doctors will respect you much more than they currently do if and when you learn to say you don't know.
People may respect your opinion more here because they think you have more information to work with and more training. The only way you can avoid misinforming people in your job (and you are never off duty), is to avoid misinforming yourself.
You've been schtooped by your own drug company! You said, "Even though Celexa is just as efficacious as other antidepressants, Lexapro is better...." That statement IS incorrect and MISLEADING. You said Lexapro is BETTER. Consider reevaluating exactly how you know that it's BETTER. It may be "theoretically more effective" or "clinically have promising results", but no unmarketed drug is simply "BETTER".
You go and criticize a strong opinion and then in the same breath give out an even stronger one, stronger because it comes from someone who seems like they would know.
So I'd like an apology for you saying Lexapro is BETTER. And then I'd like you to either offer unbiased advice in the form of direct quotes from peer reviewed journals, without passing judgement on them in the form of words like "BETTER", from now on, or, alternatively, I'd like to see you leave us alone here and get back to your kickbacks.
This website is supposed to be for mutual support and exchange of information. Sales pitches are equivalent to spam and are not needed here. I'm not feeling particularly supportive of you and your struggle to push Lexapro pills down everyone's throat without waiting to see whether or not it works or has negative effects. And you were not supportive of my right to an opinion. The information you give out is biased, and you don't want any in return. That's not exchange and its not mutual.
Which is BETTER, an uneducated opinion or one biased by a paycheck?
Kate
Posted by JaneB on July 31, 2002, at 10:24:45
In reply to Lexapro rep pushes Lexapro, what a shock! » pharmrep, posted by katekite on July 31, 2002, at 9:45:20
Kate,
My pdoc said exactly the same thing as pharmrep 2 months ago. He is the head of psychiatry at a large teaching university. Should I question his motives?
JaneB
Posted by pharmrep on July 31, 2002, at 10:34:47
In reply to Lexapro rep pushes Lexapro, what a shock! » pharmrep, posted by katekite on July 31, 2002, at 9:45:20
Part of me wants to say blah blah blah, and the other part wants to find out why
you are so pessimistic. I am rather new to this forum and want to play fair, so
no more smack-talk ok? You dont know me, and to judge me as a "sales" rep only, and
think my perspective is purely biased is not fair. I can see you might think so, but
try to use me as a resource for info instead of a punching bag, and you will get more info.
In response to your statements/questions... "controlled" is not from me, this is how Dr's
talk, you are a person, but you are scored on tests, and lowering those scores is the goal,
trying to influence those scores is what they meen by control. I meant no insult, and will
apologize for that (I am not insensitive). The non-bias opinion smack you gave was harsh, but
you dont know me yet...I can understand your position (I am only trying to share info here
that I have and most others dont). Respect. Again, you dont know me, but I can tell you I am
respected by mey physicians. I carry myself professionally, and am not "salesy" and they
appreciate it. I do not misinform anyone..it is to no benefit, and for you to insinuate I do
is wrong. Kickbacks? I am a paid Pharmaceutical rep. I happen to work for a company that has
some great products...many companies do. I dont know what you meen by that. Anyway, I propose a
new beginning, a truce, or whatever you want so that my fingers will stop cramping from so much typing.
We have been quite prolific here, and should try to keep the novels to 1 page. ok?
PS Regarding the "better" statement. I'm afraid I wont be taking that back. I will answer any
questisons you have to support that...including the over 1300 patients studies, etc.
Posted by Dr. Bob on July 31, 2002, at 11:47:12
In reply to Lexapro rep pushes Lexapro, what a shock! » pharmrep, posted by katekite on July 31, 2002, at 9:45:20
> Well I'm so shocked. Someone (me) said something critical about a new not yet marketed drug, and now a person who wants to sell that drug is disagreeing.
> You would like everyone to believe that you have some magic information that is only available to you.
> I can't think that anyone already being a drug rep would care...
I understand your skepticism, but please don't be sarcastic, jump to conclusions about others, or post anything that could lead them to feel accused or put down:
http://www.dr-bob.org/babble/faq.html#civil
Thanks,
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by katekite on July 31, 2002, at 12:08:50
In reply to Re: Lexapro rep pushes Lexapro, what a shock » katekite, posted by JaneB on July 31, 2002, at 10:24:45
No, I think you should trust in someone's opinion based on how honest, intelligent, experienced, and educated they are, their credentials, and how unbiased they seem. Your psychiatrist sounds like all of those things and I would trust him if he suggests one drug over another. I do think its weird that a psychiatrist would say that any un-marketed drug is 'better' than any other. I would think it more likely they would say it was "promising" or "might be great". My own psychiatrist thinks similarly to yours, that it sounds good.
Please understand I have nothing against Lexapro itself. I have high hopes that it will turn out to be a great drug.
What bugs me is someone who has something financial to gain making overgeneralizations or using their authority to plug a drug. Especially using studies and facts and putting them all together to make it sound as if they can prove something will work or be better when the numbers of people who have tried it are still so small.
Like saying that because one isomer competes with another that a drug that is a single isomer will work better for that reason. The drug may work better in a study than the other drug. They may show that the two isomers interact in another separate study. But they don't show a causal connection between the two so they can't say the one thing causes the other. The drug rep is trying to confuse people into just trying the drug hoping that people will like it. I wish they would instead say "we don't know how Lexapro would affect you but we wish you would try it. It seems to help some people." That would at least be honest.
Kate
Posted by katekite on July 31, 2002, at 12:17:31
In reply to Re: please be civil » katekite, posted by Dr. Bob on July 31, 2002, at 11:47:12
I think its the dexamethasone suppression test I'm doing today making me overly fiesty. It's a low dose but has my pulse up about 30 points. I apologize, Pharmrep, for being sarcastic and accusing you of getting kickbacks. I appreciate you taking it in stride. I can argue my points in another post.
Kate
Posted by katekite on July 31, 2002, at 12:26:47
In reply to Re: Lexapro rep pushes Lexapro, what a shock!, posted by pharmrep on July 31, 2002, at 10:34:47
Hi,
Thanks for offering to be a resource. I understand that you believe in the usefullness of Lexapro. I don't disbelieve that it may well be a way better drug than Celexa. I just feel I don't have enough information yet to make that judgement.
Could you give some details on actual clinical experience of the first 1300 people in the Lexapro trials versus the first 1300 people in the Celexa trials at an equivalent dose?
I guess what I object to when you said "better" is that you said that it was better because of a study that showed that people benefited clinically plus a separate study that showed that the two isomers competed. But the study that explains why people are doing so well clinically is likely in a dish or in rats -- it just doesn't seem like one thing proves the other. So you say, "better because" and I feel a sudden rush of skepticism.
Can you explain in more detail why you think it is better.?Once again, please don't think I disagree that it could be better. I've no personal problem with new drugs in general or with Celexa or Lexapro themselves, just wondering how you are so sure it is better?
Thanks,
Kate
Posted by Anyuser on July 31, 2002, at 12:54:37
In reply to Re: Lexapro rep pushes Lexapro, what a shock » JaneB, posted by katekite on July 31, 2002, at 12:08:50
I'd like to butt into your conversation, because I think the points you raise are interesting. Whom do you trust the most among (1) "scientific" drug studies posted on the internet, (2) your physician, and (3) complete strangers on the internet? If all three are in agreement, no problem, but what if they disagree? The drug studies are a necessary first step, but as you say they're really just a shot in the dark. All the talk about 5HT this and agonist that and down-regulation yada yada sometimes seems like witchcraft. Every bit as much of a metaphor as Freud talking about an Oedipus complex. A really good practicing doctor should have better practical knowledge as to what really works, but we've all encountered doctors who just write prescriptions for whatever was recommended at the most recent CME seminar without even trying to understand the science behind it. And what about doctors and psychologists that market long term talk therapy? Don't they have an economic intererst in talk therapy? In my case, my doctor is nuttier than I am. And what about people's actual experience related on the internet? I've learned a lot on PB, but posters on PB can't possibly be a representative sample. I only look at PB when I am down. My husband says I'm in "Psycho Babble mode." When I dispute something my doctor tells me on grounds that I heard different on PB, he wants to strangle me. How do we know pharmrep is really a pharmrep? When the Magic Pill we've all been waiting for is finally invented, won't it inevitably be delivered by a pharmrep? What's the alternative? I'm so confused about who or what to believe.
Posted by johnj on July 31, 2002, at 16:47:45
In reply to Re: mirror images: lexapro and focalin and dr.bob, posted by pharmrep on July 31, 2002, at 2:48:27
Can you tell me what the poop out rate has been on Celexa since it has been out so long in Europe. The poop out of ssri's makes me leary of them. Thank you
Posted by katekite on July 31, 2002, at 17:13:11
In reply to Whom do you trust? » katekite, posted by Anyuser on July 31, 2002, at 12:54:37
You raise good points. For all we know, I could be pharmrep arguing with myself to increase publicity... we'd go back and forth a few rounds and 'I' would finally say I was going to get on Lexapro. Some of the personal experiences here could really be drug reps. It's hard to know.
Here's what I trust: my own carefully chosen (recommended by other doctors I like) psychiatrist who never says he categorically "know's" something that is clearly impossible to know. And I also tend to trust studies that are meta-analyses: studies that are reviews of many other studies. They are good, I think, in that they look at many studies performed under many circumstances with all kinds of different funding and they determine an overall efficacy and side effect profile. I look at the journal title too: I tend to trust western european and north american journals most. I tend not to put much weight in studies other than in people. Then after that, if I'm going to try a drug, I look it up here to see what everyone's personal experience is so I'm not surprised and so if there is something new (like effexor withdrawal wasn't known about for a while) I will be up on it. So that's my attempt to rationalize trust.
It's a difficult field and even harder on the internet. My husband looks at me like that occasionally too when I quote something from psychobabble.
kate
Posted by Dr. Bob on July 31, 2002, at 18:45:28
In reply to apology for sarcasm , posted by katekite on July 31, 2002, at 12:17:31
Posted by Anyuser on August 1, 2002, at 10:06:52
In reply to Re: thanks! (nm) » katekite, posted by Dr. Bob on July 31, 2002, at 18:45:28
Here's a link to a recent Medscape article by the good Dr. Kramer entitled Drug Development: http://www.medscape.com/viewarticle/439156?mpid=1801.
Here's the concluding paragraph:
"The studies that are done in clinical trials must demonstrate that the drug is safe and effective but nothing more. The idea is to test a potentially commercial product, not to find out scientific truth. Thus, the studies are not designed to gather the most or the best data; they are designed to tell the FDA what they need to know and nothing more. Issues of different pharmaceuticals being more or less effective in different kinds of patients are unable to be determined by the kind of studies that are done for drug trials. While there is much virtue in drug development in that it brings us new pharmaceuticals, it is important to note that these clinical trials are not a substitute for real scientific research done outside of the context of pharmaceutical company drug development. It is only with studies separate and apart from drug development that we will find out information about comparative treatments and the complicated, comorbid, usual patients that are actually seen in practice."
Posted by pharmrep on August 1, 2002, at 11:01:16
In reply to Truth, posted by Anyuser on August 1, 2002, at 10:06:52
I was all over...but have combined all my threads to 1...find me and my last few posts so we can keep going.
Posted by katekite on August 1, 2002, at 20:16:26
In reply to Kate...find me, posted by pharmrep on August 1, 2002, at 11:01:16
Can you post a link to your message? I don't see it. Thanks -- kate
Posted by utopizen on August 1, 2002, at 20:25:30
In reply to Kate...find me, posted by pharmrep on August 1, 2002, at 11:01:16
All I got on my 6 months of Celexa was this:
first few days:
I felt like I was stoned. I sometimes got disinhibition for a few minutes now and then, saying things out of myself without any thought process, while feeling very happy at the same time- same thing I did when I was stoned.few days after going off:
same thingplus:
vivid dreams, very happy vivid dreams,
for first few weeks of taking itgoing off, I paid back I guess, getting
vivid NIGHTMARES!If you guys controlled this whole vivid dream
thing, and isolated the isomer responsible
for making happy vivid dreams and not nightmares,
and made it so I always got them, I'd buy it
and worry about blood clotting later.I like happy dreams, it's why I don't use Klonopin much. When I take lots of Klonopin (repeated dosing during day as prescribed) I get vivid nightmares after coming off it, and that's only after a few days of being on the stuff!
I get vivid nightmares from anything when I go off it, even during my vikodin withdrawls.
Posted by BekkaH on August 2, 2002, at 1:40:26
In reply to Lexapro rep pushes Lexapro, what a shock! » pharmrep, posted by katekite on July 31, 2002, at 9:45:20
Hey Lexapro-pusher:
I get the feeling that you're a salesperson, a con artist and a sleazeball. Other than spin-doctoring Lexapro, which is nothing more than yet another SSDD SSRI (same s**t, different day SSRI), I get the feeling that you don't know what the heck you're talking about.
Have you ever taken Organic Chemistry? What grade did you get in it? At what school was the course offered? What is your background/training? How much is Forest paying you to infiltrate Psychobabble? By the way, I have taken Cipralex, which is exactly the same as Lexapro. Cipralex is the proprietary name for escitalopram in Europe. I think it's even worse than Celexa. The most positive thing I can say about citalopram and escitalopram is that neither of them is as sickening as your dishonest posts.
Posted by pharmrep on August 2, 2002, at 2:05:55
In reply to Lexapro-rep. Did you ever take Organic Chem?, posted by BekkaH on August 2, 2002, at 1:40:26
Ouch. Where's the love? 1st of all, I haven't "pushed" Lexapro at all, I have only jumped into topics pertaining to Celexa/Lexapro with what unique information/perspective I have. My input has been purely educational, and I am entitled to my opinion as much as you. And before you continue to rant some more and get a "civil" note from DR. BOB, what exactly have I done to appear dishonest? Nothing. So if you have something constructive to share/say...great. Actually, I'm sorry to hear about your Cipralex experience...how long did you try it? I thought it just came out 3 months ago? PS...have you read any studies on it? (to know how it's different)
Posted by pharmrep on August 2, 2002, at 2:09:24
In reply to Re: Kate...find me, posted by katekite on August 1, 2002, at 20:16:26
Not sure how to connect you...I just wrote a post "isomer science is more like it" find me on this thread.
Posted by johnj on August 2, 2002, at 10:28:36
In reply to Re: PBE, not PBC + poll to answer too. , posted by pharmrep on August 2, 2002, at 10:13:06
And I read a study done at Nebraska(?) I think that says Lexapro has tested very well. Anyone know about this or can link it? Thanks for joing PB.
johnj
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