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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by orbital on October 12, 2010, at 15:51:34
After reading med user experiences and comparing them to my own, I'm becoming increasingly convinced that, in broad terms, med dosaging seems to be far too aggressive. I'm thinking SSRIs, mostly.
How are these numbers determined? Mean doses found in initial clinical trials that involve a relatively small number of people, versus the millions of patients who go on to take these meds?
Maybe the TCA's toxicity potential is a blessing of sorts, as it has forced researchers to determine their therapeutic indexes in cold, hard numbers?
My depression usually responds well to SSRIs during the first few weeks of treatment but, pretty soon, thymoanaesthesia sets in. Wouldn't cutting down the dosage solve this, instead of upping it?
Doesn't the SSRI's flat-dose response "curve" imply that say, in theory, 1mg of escitalopram could be just as effective as 20mg, without these disabling side effects?
I'm still trying to find a workaround to reap the benefits of SSRI/SNRI meds, without turning into a zombie.
Posted by Phillipa on October 12, 2010, at 16:55:12
In reply to AD Overkill: How to Avoid It?, posted by orbital on October 12, 2010, at 15:51:34
I agree hence take low doses. Sometimes its confusing as it seems that so many people are on an SSRI. I wonder if there are any clinical studies? Phillipa
Posted by linkadge on October 12, 2010, at 17:25:18
In reply to AD Overkill: How to Avoid It?, posted by orbital on October 12, 2010, at 15:51:34
I hear ya. Some studies have showed that lower doses are virtually as effective as higher doses, less many of the side effects.
If a particular dose is not working for you, I guess you can only go up, go down or add something else. I'd like to get some liquid escitalopram if it existed in canada.
Linkadge
Posted by orbital on October 13, 2010, at 14:08:42
In reply to Re: AD Overkill: How to Avoid It? » orbital, posted by Phillipa on October 12, 2010, at 16:55:12
There are plenty of clinical studies. For instance, this is from the Zoloft insert:
"Study 3 involved depressed outpatients who had responded by the end of an initial 8-week open
treatment phase on ZOLOFT 50-200 mg/day. These patients (N=295) were randomized to
continuation for 44 weeks on double-blind ZOLOFT 50-200 mg/day or placebo. (...) The mean dose for completers was 70 mg/day."If I'm not mistaken, the suggested doses are overall averages. Just as some people end up requiring higher than average doses, I wonder if taking lower doses will work over time.
> I agree hence take low doses. Sometimes its confusing as it seems that so many people are on an SSRI. I wonder if there are any clinical studies? Phillipa
Posted by orbital on October 13, 2010, at 14:16:01
In reply to Re: AD Overkill: How to Avoid It?, posted by linkadge on October 12, 2010, at 17:25:18
The main side effect I get on my meds (usually an AD and a benzo) is blunting of emotions. I'm finding that lowering the dose works sometimes, upping it tends to make it much worse.
I'd love to get liquid escitalopram too. Those Lexapro tabs are so ridiculously small, it's impossible to customize doses. I wonder if every other-day Lex dosing would be feasible.
> I hear ya. Some studies have showed that lower doses are virtually as effective as higher doses, less many of the side effects.
>
> If a particular dose is not working for you, I guess you can only go up, go down or add something else. I'd like to get some liquid escitalopram if it existed in canada.
>
> Linkadge
Posted by Phillipa on October 13, 2010, at 21:23:31
In reply to Re: AD Overkill: How to Avoid It? » linkadge, posted by orbital on October 13, 2010, at 14:16:01
I have a pill splitter and can split a l0mg tab into quarters most of the time. Sometimes one is down the drain. I just don't feel that ad's were meant to be taken for life without changes. Do You? Phillipa
Posted by bleauberry on October 14, 2010, at 5:11:59
In reply to AD Overkill: How to Avoid It?, posted by orbital on October 12, 2010, at 15:51:34
Well, I have shared it here several times, but my doctor frequently starts lexapro at 1 drop (that is 1/10th mg) and works up to a range of 1mg to 5mg. A study of milnacipran showed that low doses worked as good as high doses....but it took significantly longer. I would suspect the same applies to all meds.
My doc has a population of mostly tough cases, so it kind of goes against the grain that he would get the best results with seemingly tame doses. But that;s what he has learned over the years and that's what he does. He doesn't care about trends or what anyone else does....he just wants what he does in his own office to work. Super low doses do that. They just take a lot longer to get to the goal line. But once there, all the side effects and complications are minimal or absent.
Posted by orbital on October 14, 2010, at 10:41:19
In reply to Re: AD Overkill: How to Avoid It?, posted by Phillipa on October 13, 2010, at 21:23:31
I definitely agree with you. I think periodic re-evaluations are a must. Renewing prescriptions without even bothering to see a patient is barbaric, imo.
> I have a pill splitter and can split a l0mg tab into quarters most of the time. Sometimes one is down the drain. I just don't feel that ad's were meant to be taken for life without changes. Do You? Phillipa
Posted by orbital on October 14, 2010, at 10:44:07
In reply to Re: AD Overkill: How to Avoid It?, posted by bleauberry on October 14, 2010, at 5:11:59
That's really interesting, B! I wonder if the reverse works too - using tiny dosages for maintenance, after a patient has been on a "normal" dose for a while.
> Well, I have shared it here several times, but my doctor frequently starts lexapro at 1 drop (that is 1/10th mg) and works up to a range of 1mg to 5mg. A study of milnacipran showed that low doses worked as good as high doses....but it took significantly longer. I would suspect the same applies to all meds.
>
> My doc has a population of mostly tough cases, so it kind of goes against the grain that he would get the best results with seemingly tame doses. But that;s what he has learned over the years and that's what he does. He doesn't care about trends or what anyone else does....he just wants what he does in his own office to work. Super low doses do that. They just take a lot longer to get to the goal line. But once there, all the side effects and complications are minimal or absent.
Posted by Maxime on October 14, 2010, at 23:14:41
In reply to AD Overkill: How to Avoid It?, posted by orbital on October 12, 2010, at 15:51:34
I remember that my first psychiatrist told me that it was like a bathtub. You keep putting water in until it is going to overflow and then you play with the dosage from there. It made sense at the time ....
Posted by Maxime on October 14, 2010, at 23:23:24
In reply to Re: AD Overkill: How to Avoid It?, posted by linkadge on October 12, 2010, at 17:25:18
Hey Link, Liquid Lexapro is available in Canada.
Have you tried that?Maxie
Posted by SLS on October 15, 2010, at 4:58:58
In reply to Re: AD Overkill: How to Avoid It? » bleauberry, posted by orbital on October 14, 2010, at 10:44:07
> That's really interesting, B! I wonder if the reverse works too - using tiny dosages for maintenance, after a patient has been on a "normal" dose for a while.
This notion has been demonstrated to be a fallacy. You can search for stuff by Kupfer and Prien from the early 1990s. They performed extensive longitudinal studies of this. Whatever is the dosage that gets you well acutely is the same dosage that must be used in maintenance treatment.
- Scott
Posted by linkadge on October 15, 2010, at 16:34:13
In reply to Re: AD Overkill: How to Avoid It? » linkadge, posted by Maxime on October 14, 2010, at 23:23:24
I was told by a pharmacist that it wasn't. Hmmm.
Linkadge
Posted by Maxime on October 15, 2010, at 18:27:27
In reply to Re: AD Overkill: How to Avoid It?, posted by linkadge on October 15, 2010, at 16:34:13
> I was told by a pharmacist that it wasn't. Hmmm.
>
> LinkadgeWell, either the pharmacist is lying or Health is. Here is the link to the database I always use to see of a med is available in Canada http://webprod.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp
Posted by linkadge on October 16, 2010, at 9:20:48
In reply to Re: AD Overkill: How to Avoid It? » linkadge, posted by Maxime on October 15, 2010, at 18:27:27
Hi Maxime. I typed in escitalopram (into active ingredient field) and all I got was 2 results for the 2 tablet strengths (no liquid?).
Linkadge
Posted by Maxime on October 16, 2010, at 19:37:49
In reply to Re: AD Overkill: How to Avoid It? » Maxime, posted by linkadge on October 16, 2010, at 9:20:48
> Hi Maxime. I typed in escitalopram (into active ingredient field) and all I got was 2 results for the 2 tablet strengths (no liquid?).
>
> LinkadgeEeep! Sorry,it was Lexapro.
This is the end of the thread.
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