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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by SLS on December 30, 2009, at 8:14:17
I'm not sure they got it exactly right, but I would agree with these two drugs would make good choices for an initial treatment.
- Scott
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Initiating antidepressant therapy? Try these 2 drugs firsthttp://www.jfponline.com/Pages.asp?AID=7678&issue
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Posted by mtdewcmu on December 30, 2009, at 8:41:14
In reply to Zoloft and Lexapro best choices for first-line?, posted by SLS on December 30, 2009, at 8:14:17
I have looked at the paper by Cipriani, et al that they got the data from. It also seems to support Wellbutrin and Celexa as good choices for the first line.
Posted by SLS on December 30, 2009, at 8:54:24
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by mtdewcmu on December 30, 2009, at 8:41:14
> I have looked at the paper by Cipriani, et al that they got the data from. It also seems to support Wellbutrin and Celexa as good choices for the first line.
There are some doctors who advocate starting someone off with a combination of antidepressants with different mechanisms of action.
- Scott
Posted by Phillipa on December 30, 2009, at 10:51:42
In reply to Re: Zoloft and Lexapro best choices for first-line? » mtdewcmu, posted by SLS on December 30, 2009, at 8:54:24
If the trials were for eight weeks and it seems that responses are not apparent for that long after initial start up are they saying the zoloft and lexapro work faster? Phillipa
Posted by Phillipa on December 30, 2009, at 12:51:49
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by Phillipa on December 30, 2009, at 10:51:42
Seriously another thought. If a Mother has post partum depression does she stay depressed for a long time. Seriously don't know. I know my neighbor said her daughter in law was after first baby took lexapro and next day was fine???? I don't get it????? See more hormone connections? Phillipa
Posted by manic666 on December 30, 2009, at 13:18:09
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by Phillipa on December 30, 2009, at 12:51:49
scott are you stressed, i posted that a while back before i went on sertraline. i read it months ago that why i asked the p doc for generic zoloft, because thats all i could get.an lexapro is not generic so i could not have that,i could have had citalopram its poor sister, but i went for sertraline because of the weight gain was reckond to be less, a lie like most meds.so now if i change ?????????Because of generics i will go citalopram
Posted by bulldog2 on December 30, 2009, at 14:53:54
In reply to Zoloft and Lexapro best choices for first-line?, posted by SLS on December 30, 2009, at 8:14:17
> I'm not sure they got it exactly right, but I would agree with these two drugs would make good choices for an initial treatment.
>
>
> - Scott
>
> But than you get sexual sides that are bad. Other ads have less of that effect.
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>
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> Initiating antidepressant therapy? Try these 2 drugs first
>
> http://www.jfponline.com/Pages.asp?AID=7678&issue
>
>
> --------------------------------------------------
Posted by linkadge on December 30, 2009, at 16:30:53
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by bulldog2 on December 30, 2009, at 14:53:54
In their only head to head trial, SJW beat zoloft - in terms of efficacy and side effects. Does this make it first line?
Linkadge
Posted by bulldog2 on December 30, 2009, at 17:01:05
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by linkadge on December 30, 2009, at 16:30:53
> In their only head to head trial, SJW beat zoloft - in terms of efficacy and side effects. Does this make it first line?
>
> LinkadgeWell depends on how the study was conducted. Seems like many studies are conducted with a bias towards a certain result.
Also how about tcas and maois?
Also combination studies that show a ssri + tca gives even better results.
Posted by Phillipa on December 30, 2009, at 20:25:00
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by bulldog2 on December 30, 2009, at 17:01:05
Depends on the person, their chemistry, and type of depression and degree also I'd think Phillipa
Posted by mtdewcmu on December 30, 2009, at 22:55:08
In reply to Zoloft and Lexapro best choices for first-line?, posted by SLS on December 30, 2009, at 8:14:17
It's interesting to notice from that paper that Remeron was the most effective antidepressant, and that it was superior in all ways to Effexor. That suggests that Remeron should be used more widely.
Another interesting thing is the fact that Lexapro came out more effective than Effexor. Doesn't that shoot holes in the whole theory that two neurotransmitters are better than one?
I have some questions about how things were measured. For instance, if a person dropped out of a study due to side effects, were they counted as a non-responder? In that case, the dropouts would be double-counted, once in the efficacy and once in the acceptability. There is no other pharmacological reason I can conceive of that Paxil rated so low in efficacy.
Posted by SLS on December 31, 2009, at 2:03:13
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by mtdewcmu on December 30, 2009, at 22:55:08
> I have some questions about how things were measured. For instance, if a person dropped out of a study due to side effects, were they counted as a non-responder?
Yes. That is what they wanted to determine in their "intent to treat" statistics.
> In that case, the dropouts would be double-counted, once in the efficacy and once in the acceptability.
Exactly. You hit the target on that one.
"Efficacy" does not mean "effectiveness". Efficacy is a measure of how well an agent produces a therapeutic effect. Tolerability is a measure of untoward effect. Effectiveness is an index of efficacy and tolerability taken together.
> There is no other pharmacological reason I can conceive of that Paxil rated so low in efficacy.
That is a great observation. I think you are right, although I believe that "effectiveness" would be the operating word here.
Like I said, they might not have it exactly right, but I think they are close enough to at least use their concept as a guide to encourage similar investigations.
- Scott
Posted by manic666 on December 31, 2009, at 5:31:19
In reply to Re: Zoloft and Lexapro best choices for first-line? » mtdewcmu, posted by SLS on December 31, 2009, at 2:03:13
they are top in the ssri,s / lets face it there anint that much choice.someone metioned remeron now we all no why they drop out of that, you put weight on faster than a turkey at christmas, they give that med to anerxic,s for that reason. i have put weight on with sertraline but not at the rapid speed remeron does.i have just answered in a thread about sexuall side effects,on sertraline im ok even up to 150mg at 50, i wouldnt get bothered at all. the 150mg slowes the libedo but not the action, its like if you bothered it can happen.sertraline takes a long time to work up to 3 months. not many are prepeared to handle the crap that long. an it does leave some bad side effects . but dont they all. remember im 61 so the sex side is cool, but then again i have a high sex drive . soneone who dont is going to struggle on most ssri,i been reading forums on sertraline vs citalopram.I was lead to believe cit was worse for sexuall probs. but most forum,s i have read left sertraline for citalopram as the effects were not as bad, the opposite to what the manufactures say.citalopram ever didnt alter weight as much if at all as sertraline
Posted by janejane on December 31, 2009, at 6:24:05
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by Phillipa on December 30, 2009, at 10:51:42
> If the trials were for eight weeks and it seems that responses are not apparent for that long after initial start up are they saying the zoloft and lexapro work faster? Phillipa
I think this is a good point. I wonder what would win out long-term. Aren't SSRIs more likely to poop out or cause apathy after a while? So maybe other classes would beat them out for extended therapy?
By the way, anyone know, if celexa didn't work for someone, is it likely that lexapro would also be ineffective?
Posted by SLS on December 31, 2009, at 6:54:42
In reply to Re: Zoloft and Lexapro best choices for first-lin, posted by janejane on December 31, 2009, at 6:24:05
> > If the trials were for eight weeks and it seems that responses are not apparent for that long after initial start up are they saying the zoloft and lexapro work faster? Phillipa
> I think this is a good point. I wonder what would win out long-term.Yeah. I hadn't thought of that.
> Aren't SSRIs more likely to poop out or cause apathy after a while?
It seems so.
> So maybe other classes would beat them out for extended therapy?
I have never seen published an investigation into the poop-out rate of various antidepressants.
> By the way, anyone know, if celexa didn't work for someone, is it likely that lexapro would also be ineffective?
Not necessarily. People here have reported scenarios going both ways. If I were to be a non-responder to Celexa, I would not exclude from consideration performing a trial of Lexapro.
- Scott
Posted by mtdewcmu on December 31, 2009, at 11:30:12
In reply to Re: Zoloft and Lexapro best choices for first-line? » mtdewcmu, posted by SLS on December 31, 2009, at 2:03:13
> > I have some questions about how things were measured. For instance, if a person dropped out of a study due to side effects, were they counted as a non-responder?
>
> Yes. That is what they wanted to determine in their "intent to treat" statistics.
>
> > In that case, the dropouts would be double-counted, once in the efficacy and once in the acceptability.
>
> Exactly. You hit the target on that one.
>
> "Efficacy" does not mean "effectiveness". Efficacy is a measure of how well an agent produces a therapeutic effect. Tolerability is a measure of untoward effect. Effectiveness is an index of efficacy and tolerability taken together.
>
> > There is no other pharmacological reason I can conceive of that Paxil rated so low in efficacy.
>
> That is a great observation. I think you are right, although I believe that "effectiveness" would be the operating word here.
>
> Like I said, they might not have it exactly right, but I think they are close enough to at least use their concept as a guide to encourage similar investigations.
>
>
> - ScottOK. So that suggests that IF you can tolerate Paxil, then you can probably expect it to work as well as any other SSRI.
Posted by manic666 on December 31, 2009, at 12:36:21
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by mtdewcmu on December 31, 2009, at 11:30:12
in england they dont go by the get you better approach, they go by the less moaning a patient does,seeing that sertraline an citalopram both generics you will notice ,no real stuff for us brits.they go for those 2 for the low cost an the more easier start up with a good record.if you say doc its not happening, he will bang up the med. if you feel rough he wil drop it, thats your choise,s you have. if you say can i try another med ?the doc will say sure but there all the same? an you no what its like on withdrawl an start up.he gives you 10 minutes to go outside an bang your head against the wall .Then you come back an give him your answer.with snri,s it always effexor or remeron.what a choise . the first is the biggest nightmare to withdraw, the second is get a new set of cloths cos them your wearing aint going to fit you in two weeks. plus remember there is no cross tappering it never been heard of, if you dont play sneaky an save meds to cross tapper, then you have to wash out on the one your on before you start the next. Even if its ssri to ssri. Thats what you guys will be doing soon with the new health care,its a blast
Posted by SLS on December 31, 2009, at 13:07:51
In reply to Re: Zoloft and Lexapro best choices for first-line?, posted by mtdewcmu on December 31, 2009, at 11:30:12
> > > I have some questions about how things were measured. For instance, if a person dropped out of a study due to side effects, were they counted as a non-responder?
> >
> > Yes. That is what they wanted to determine in their "intent to treat" statistics.
> >
> > > In that case, the dropouts would be double-counted, once in the efficacy and once in the acceptability.
> >
> > Exactly. You hit the target on that one.
> >
> > "Efficacy" does not mean "effectiveness". Efficacy is a measure of how well an agent produces a therapeutic effect. Tolerability is a measure of untoward effect. Effectiveness is an index of efficacy and tolerability taken together.
> >
> > > There is no other pharmacological reason I can conceive of that Paxil rated so low in efficacy.
> >
> > That is a great observation. I think you are right, although I believe that "effectiveness" would be the operating word here.
> >
> > Like I said, they might not have it exactly right, but I think they are close enough to at least use their concept as a guide to encourage similar investigations.
> >
> >
> > - Scott
>
> OK. So that suggests that IF you can tolerate Paxil, then you can probably expect it to work as well as any other SSRI.
Yes. Paxil seems to be at least as efficacious as the other SSRIs for depression, and perhaps even better than the others for treating anxiety disorders.
- Scott
This is the end of the thread.
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