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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by Griobhtha on August 4, 2004, at 14:31:24
Pharmaceuticals
With Drug Approval, Lilly Sighs Relief
FORBES.com, Matthew Herper, 08.04.04, 12:20 PM ETNEW YORK - The long-awaited heir to Prozac has finally been approved.
Cymbalta represents an attempt by drugmaker Eli Lilly (nyse: LLY - news - people ) to re-establish itself in the market it built with Prozac. The drug had been delayed as the U.S. Food and Drug Administration asked for more data. As forecast in New Drugs To Watch, our list of promising experimental drugs, the approval came in August. The same drug is expected to be approved under a different brand name to treat urinary incontinence later this year.
Because it is no longer experimental, Cymbalta is being removed from New Drugs To Watch. Click here, however, for a full list of such graduates.
Lilly's re-entry into the antidepressant market won't be a cinch. Prozac is now off-patent and is not a significant source of revenue for the drugmaker. In its wake, similar drugs hit the market from Pfizer (nyse: PFE - news - people ), GlaxoSmithKline (nyse: GSK - news - people ) and Forest Laboratories (nyse: FRX - news - people ). Of special importance to Lilly will Effexor, from Wyeth (nyse: WYE - news - people ). Like Cymbalta, Effexor works by preventing the brain from reabsorbing the neurotransmitters serotonin and norepinephrine. Medicines such as Prozac and Forest's Celexa work only on serotonin.
To market its medicine in a crowded field, Lilly is emphasizing that Cymbalta helps not only with the mental symptoms of depression but also with physical aches and pains that often accompany the disease. Some 19 million Americans are thought to struggle with depression in any given year. Lilly, known for having one of the best new drug pipelines in the pharmaceutical industry, has also had cancer drug Alimta and erectile dysfunction treatment Cialis approved within the past 12 months.
Posted by Griobhtha on August 4, 2004, at 14:35:06
Associated Press
Eli Lilly's Depression Drug Is Approved
08.04.2004, 09:40 AMPharmaceutical maker Eli Lilly and Co. on Wednesday said the Food and Drug Administration approved the company's Cymbalta drug for the treatment of emotional and physical symptoms associated with depression.
Cymbalta, a balanced inhibitor of serotonin and norepinephrine, has been studied in more than 6,000 adults with major depression worldwide. The company said that most anti-depressants only affect serotonin levels, but with the dual action of Lilly's drug, patients have the opportunity to have physical symptoms relieved as well.
"Depression is a whole-body illness, but most modern antidepressants treat the emotional symptoms, such as crying and sadness, better than they treat the physical symptoms of depression," said Dr. Stephen Stahl, chairman of the Neuroscience Education Institute and adjunct professor of psychiatry at the University of California at San Diego School of Medicine.
Eli Lilly said current data shows that only 25 percent to 35 percent of patients treated for depression in clinical studies experience relief from all of their symptoms. About 19 million people in the United States suffer from depression, according to the National Institute of Mental Health.
The safety and efficacy of Cymbalta has not been studied in children.
Eli Lilly shares were up 94 cents, or 1.5 percent, at $64.16 in pre-market activity on the New York Stock Exchange.
Posted by Griobhtha on August 4, 2004, at 14:53:21
FDA Approves Lilly's Cymbalta for the Treatment of Depression
August 04, 2004
Dual-reuptake inhibitor judged safe and effective, giving doctors and patients a new option for treating the emotional and painful physical symptoms of depression
The U.S. Food and Drug Administration has approved Cymbaltaź (duloxetine HCl; pronounced SIM-BALL-TA), judging it a safe and effective treatment for major depressive disorder, Eli Lilly and Company announced today.
Cymbalta, a balanced and potent reuptake inhibitor of serotonin and norepinephrine, has been studied in more than 6,000 adults with major depression worldwide. Its approval gives healthcare professionals and patients a long-awaited new option for treating the broad range of emotional and physical symptoms of depression. Today, only 25-35 percent of patients treated for depression in clinical studies experience relief from all of their disease symptoms.1
"Depression is a whole-body illness, but most modern antidepressants treat the emotional symptoms, such as crying and sadness, better than they treat the physical symptoms of depression," said Dr. Stephen Stahl, chairman of the Neuroscience Education Institute and adjunct professor of psychiatry at the University of California at San Diego School of Medicine. "Because of its dual action on serotonin and norepinephrine, Cymbalta offers physicians a new opportunity to help patients with depression, particularly those who experience the common physical symptoms of the disease, such as vague aches and pains."
Neurotransmitters are believed to help regulate a person's emotions and sensitivity to pain. Scientists believe that if these neurotransmitters are out of balance, a person may become depressed and be more likely to feel painful physical symptoms. The combination of emotional and painful physical effects of depression can have a tremendous negative impact on a person's quality of life.2
"Lilly's leadership in neuroscience and dedication to the treatment of depression is well established," said Sidney Taurel, Lilly's chairman, president and chief executive officer. "Lilly is committed to solving the world's most pressing neuroscience problems, through research programs in Alzheimer's and Parkinson's as well as through our established expertise in depression, schizophrenia, bipolar disorder and Attention-Deficit/Hyperactivity Disorder."
Lilly demonstrated Cymbalta's effectiveness in treating major depression with data from four placebo-controlled clinical studies, all in adults. The safety and efficacy of Cymbalta in children have not been studied.
Milt Meyers, a participant in a Cymbalta clinical trial, found it worked for him. "Cymbalta worked for me," Meyers said. "I felt really good for the first time in a long time. I really felt like I was on the right track."
Cymbalta comes in a capsule and can be taken once a day. In clinical trials, Cymbalta was studied in a dose range of 40-120 mg per day. The recommended daily dose is 60 mg.
Duloxetine hydrochloride also is being studied for the treatment of stress urinary incontinence and diabetic neuropathic pain, conditions believed to respond to treatment with both serotonin and norepinephrine.
About Depression
Nearly 19 million Americans suffer from depression each year, making it one of the leading causes of disability according to the World Health Organization. Current medical literature suggests that patients who are successfully treated for all their depressive symptoms, including both the emotional and painful physical ones, may be more likely to achieve remission than those whose physical symptoms are not alleviated.1, 3, 4, 5Patient Experience
In clinical trials, Cymbalta was safe and effective. Not all patients respond the same. The experience of the patient quoted in this release might not be typical.Important Safety Information
Depression, as a disease, can be associated with periods when the symptoms can worsen or thoughts of suicide can emerge. Patients and their families should watch for these as well as for anxiety, agitation, panic, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or overexcitement and hyperactivity. Call the doctor if any of these are severe or occur suddenly. Be especially observant at the initiation of antidepressant drug therapy and whenever there is a change in dose.Prescription Cymbalta is not for everyone. People who are allergic to duloxetine hydrochloride or the other ingredients in Cymbalta should not take it. If you are taking thioridazine or if you are taking or have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI), you should not take Cymbalta. It also should not be administered to patients with any hepatic insufficiency, end-stage renal disease or uncontrolled, narrow-angle glaucoma. Cymbalta ordinarily should not be prescribed to patients with substantial alcohol use. Women who are pregnant should talk with their doctor before taking Cymbalta. Nursing while taking Cymbalta is not recommended.
In clinical studies, the most common side effects were nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness and increased sweating. Most people were not bothered enough by side effects to stop taking Cymbalta. Your doctor may periodically check your blood pressure. Don't stop taking Cymbalta without talking to your doctor.
For full patient information, visit www.Cymbalta.com.
Posted by Torque on August 4, 2004, at 15:15:35
In reply to Lilly News: FDA Approves Lilly's Cymbalta, posted by Griobhtha on August 4, 2004, at 14:53:21
A Lilly rep told me it might Pharmacies as early as late August...........
Torque
Posted by sageblue on August 4, 2004, at 21:52:22
In reply to CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by Griobhtha on August 4, 2004, at 14:31:24
i really hope my neuro will consider letting me try this. *sigh*
Posted by bob on August 5, 2004, at 2:14:19
In reply to CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by Griobhtha on August 4, 2004, at 14:31:24
I'm really not sure what this drug is bringing to the party that Effexor XR isn't already doing. Surely it will have astounding sexual side effects, delayed weight gain, withdrawl syndrome, urinary hesitancy, and so on, and so on. I guess you never know until you try, but my body can't take these "trials" very well anymore. Is there anything novel about this drug, other than the ratio of reuptake being more towards norepinephrine than Effexor?
Posted by KaraS on August 5, 2004, at 2:32:30
In reply to Re: CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by bob on August 5, 2004, at 2:14:19
> I'm really not sure what this drug is bringing to the party that Effexor XR isn't already doing. Surely it will have astounding sexual side effects, delayed weight gain, withdrawl syndrome, urinary hesitancy, and so on, and so on. I guess you never know until you try, but my body can't take these "trials" very well anymore. Is there anything novel about this drug, other than the ratio of reuptake being more towards norepinephrine than Effexor?
For one thing Lilly claims that it decreases appetite (though I'll need a lot of first-hand evidence to believe that one!)
Posted by SLS on August 5, 2004, at 7:04:28
In reply to Re: CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by bob on August 5, 2004, at 2:14:19
> Is there anything novel about this drug, other than the ratio of reuptake being more towards norepinephrine than Effexor?
For those people who respond to Cymbalta and not to other drugs, that should be novel enough. And there always are people who find a newly approved antidepressant better for them than any that had been previously available. Scientists don't know why these drugs affect different people differently. They just do.Bring on more new drugs! - at least until one comes out that works for me. You don't have to take them if you don't want. Let me worry about the side effects and withdrawal syndrome.
I'll let you know how things turn out.
:-)
- Scott
Posted by SLS on August 5, 2004, at 9:01:08
In reply to Re: CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by bob on August 5, 2004, at 2:14:19
> I'm really not sure what this drug is bringing to the party that Effexor XR isn't already doing. Surely it will have astounding sexual side effects, delayed weight gain, withdrawl syndrome, urinary hesitancy, and so on, and so on. I guess you never know until you try, but my body can't take these "trials" very well anymore. Is there anything novel about this drug, other than the ratio of reuptake being more towards norepinephrine than Effexor?
Hi Bob.I apologize for the tone of my previous post. It probably sounded angry. I don't have much patience for people who would want to take potentially life-saving pills out of my mouth.
One thing to take into consideration is the possibility that Cymbalta might do the same thing as Effexor, but in different parts of the brain.
- Scott
Posted by bob on August 5, 2004, at 12:48:27
In reply to Re: CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by SLS on August 5, 2004, at 7:04:28
> > Is there anything novel about this drug, other than the ratio of reuptake being more towards norepinephrine than Effexor?
>
>
> For those people who respond to Cymbalta and not to other drugs, that should be novel enough. And there always are people who find a newly approved antidepressant better for them than any that had been previously available. Scientists don't know why these drugs affect different people differently. They just do.
>
> Bring on more new drugs! - at least until one comes out that works for me. You don't have to take them if you don't want. Let me worry about the side effects and withdrawal syndrome.
>
> I'll let you know how things turn out.
>
> :-)
>
>
> - Scott
>
>
>
>Well, if I haven't found a suitable drug, then I pretty much have to try it, right? Either that, or stay on the unsuitable I'm on. How is that I can just sit back and let you worry about the side effects?
I am not saying they shouldn't come out with new drugs. It just would be nice to have something slightly novel, one of these days. The more drugs out there, the better, but hopefully one day they will understand something about what's going on, so that they don't make "me too" drugs forever and ever.
Just like you, I will probably try this drug too, so I won't need to hear what it does for you. Thanks anyway.
Posted by caraher on August 5, 2004, at 13:01:04
In reply to Re: CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by bob on August 5, 2004, at 2:14:19
> I'm really not sure what this drug is bringing to the party that Effexor XR isn't already doing. Surely it will have astounding sexual side effects, delayed weight gain, withdrawl syndrome, urinary hesitancy, and so on, and so on. I guess you never know until you try, but my body can't take these "trials" very well anymore. Is there anything novel about this drug, other than the ratio of reuptake being more towards norepinephrine than Effexor?
I did some reading about trials completed to date and got the impression that sexual side effects weren't as bad. Nothing about withdrawal syndrome but my understanding is that it has a half-life of something like 14 hours, which my amateur grasp of such things suggests might make withdrawal a problem.
The trouble is that based on what we know about the systems it works on, kinetics, etc. I totally sympathize with saying it's not a whole lot different from Effexor. But you can also make exactly the same argument to the effect SSRIs are all basically the same, so why should there be more than one available? But it's pretty clear that not all SSRIs are created equal, which makes me inclined to think that there's plenty of room for another option like Cymbalta alongside Effexor.
Posted by bob on August 5, 2004, at 13:06:05
In reply to Re: CYMBALTA - With Drug Approval, Lilly Sighs Relief » bob, posted by SLS on August 5, 2004, at 9:01:08
> > I'm really not sure what this drug is bringing to the party that Effexor XR isn't already doing. Surely it will have astounding sexual side effects, delayed weight gain, withdrawl syndrome, urinary hesitancy, and so on, and so on. I guess you never know until you try, but my body can't take these "trials" very well anymore. Is there anything novel about this drug, other than the ratio of reuptake being more towards norepinephrine than Effexor?
>
>
> Hi Bob.
>
> I apologize for the tone of my previous post. It probably sounded angry. I don't have much patience for people who would want to take potentially life-saving pills out of my mouth.
>
> One thing to take into consideration is the possibility that Cymbalta might do the same thing as Effexor, but in different parts of the brain.
>
>
> - ScottScott:
No problem - don't beat yourself up over it. Both of us are dealing with a lot of frustration related to these issues and our problems. I will not ever tell anyone to take, or not take, any of these meds (although I may come across thiat way). I've been on literally over 30 of these things, with not much happiness. I personally have a whole lot of trouble getting on and off meds, so it's not easy to just drop what I'm taking and try another.
As for Cymbalta acting on different parts of the brain, I have no doubt that will be true. Like you said, science just doesn't understand how these things work, despite the bouncing-egg Zoloft commercials you see on tv that would have you believe otherwise.
Posted by bob on August 5, 2004, at 13:19:22
In reply to Re: Cymbalta/Duloxetine--Something's Up, posted by caraher on August 5, 2004, at 13:01:04
Again, I am not advocating that any drugs not be allowed to come to market just because there are other drugs like it there already. I'm sure the drug companies won't let that happen anyway, since most of their money comes from making approximate copies of someone else's idea anyway. Like was mentioned before, we understand almost nothing about the mechanisms at work in the brain, so the more the merrior in terms of pharmacological compounds. By the way, what are you talking about with the "kinetics"? I don't think I've heard of that before in this context.
As for all the SSRI me too drugs, I think it's a similar situation. For me they were all quite similar in the end, with the exception of prozac, which has a very long half-life. They do have subtle differences, though, so I guess that's why we need many variations of them. One thing I don't understand is, why don't companies make slight tweaks to their drug compounds in order to make it "patentable" and then bring it to market. Heck, make 10 different variations. This was done with Celexa and Lexapro, so why not do it more?
Lastly, I had heinous problems with Effexor withdrawl. I can guarantee that people who have withdrawl with SSRIs will not enjoy coming off of Cymbalta. Effexor half life is under 10 hrs. I just came off Celexa a month ago, and had some problems (although they paled in comparison to what I went through with Effexor). Celexa's half-life is something like 32 hours. I think Cymbalta is 14? That's not out of problem territory. Sustain release formulas doesn't really help the problem all that much in my mind, since it's the elimination rate that is the culprit, not the introduction rate. You can affect the former by changing the latter, but only to a certain extent.
Posted by linkadge on August 5, 2004, at 17:07:57
In reply to Re: Cymbalta/Duloxetine--Something's Up » caraher, posted by bob on August 5, 2004, at 13:19:22
I wouldn't really believe it when they say that cymbalta has reduced sexual dysfunction.
They have to say this. Seeing as it is another me too drug, people want to think that it is an improvement on previous drugs.
As far as side effects go, sexual dysfunction is the biggest one in terms of patient compliance so it only stands to reason that the drugs companies would over-emphasize the drug's supposed lack of side effects in this area.
Lexapro was supposed to have considerably fewer sexual side effects than celexa, is this the case? not really.
But I think it is pure bull gepirone was considered 'unaprovable' for anxiety/depression, and this drugs slips through the cracks. Gepirone was really a step forward.
Linkadge
Posted by bob on August 5, 2004, at 17:11:09
In reply to Re: Cymbalta/Duloxetine--Something's Up, posted by linkadge on August 5, 2004, at 17:07:57
Also beware of the reduced appetite thing. Plenty of drugs depress appetite in the short, stunted trial lengths they use (12 weeks). Check back in a year or two when true long term data exists.
Posted by nmk on August 5, 2004, at 18:12:58
In reply to Re: CYMBALTA - With Drug Approval, Lilly Sighs Relief, posted by bob on August 5, 2004, at 2:14:19
My pdoc can't wait for this drug to be released and has been talking it up for months. He thinks I may benefit from it but I am very frightened due to my horrible experience with Effexor. I was on Effexor for approx. 3 months and all it did for me was increase the depression, anxiety, and agitation. I won't even go into the withdrawal experience.
Help me out here please. I have been on this med merry-go-round for 2 1/2 years and am tired of all the med trials. Is it worth a shot or should I go with plan B which is to try Parnate? I am so confused.
Thanks,
Nicole
Posted by nmk on August 5, 2004, at 18:24:31
In reply to Re: CYMBALTA - I am VERY afraid!, posted by nmk on August 5, 2004, at 18:12:58
Sorry to post again....I forgot to hit the "notify follow-up thread" box the first time.
Posted by KaraS on August 5, 2004, at 22:25:21
In reply to Re: CYMBALTA - I am VERY afraid!, posted by nmk on August 5, 2004, at 18:12:58
> My pdoc can't wait for this drug to be released and has been talking it up for months. He thinks I may benefit from it but I am very frightened due to my horrible experience with Effexor. I was on Effexor for approx. 3 months and all it did for me was increase the depression, anxiety, and agitation. I won't even go into the withdrawal experience.
>
> Help me out here please. I have been on this med merry-go-round for 2 1/2 years and am tired of all the med trials. Is it worth a shot or should I go with plan B which is to try Parnate? I am so confused.
>
> Thanks,
>
> NicoleWhy not start on the Parnate and see how that goes? Keep checking these boards to see if those who reacted like you did to Effexor have similar
experiences with Cymbalta for your future reference. You may not need to know about the Cymbalta if the Parnate works out well for you. If the Parnate doesn't work out adequately, you may have a better sense of whether you want to try it from reading about others experiences. Of course, you can't predict with certainty how you're going to react by reading about others but it can give you more info in making your decision.
-K
Posted by bob on August 6, 2004, at 0:27:39
In reply to Re: CYMBALTA - I am VERY afraid!, posted by nmk on August 5, 2004, at 18:12:58
> My pdoc can't wait for this drug to be released and has been talking it up for months. He thinks I may benefit from it but I am very frightened due to my horrible experience with Effexor. I was on Effexor for approx. 3 months and all it did for me was increase the depression, anxiety, and agitation. I won't even go into the withdrawal experience.
>
> Help me out here please. I have been on this med merry-go-round for 2 1/2 years and am tired of all the med trials. Is it worth a shot or should I go with plan B which is to try Parnate? I am so confused.
>
> Thanks,
>
> NicoleI think I would agree with KaraS. Maybe Parnate should be tried first, since it is more different from Effexor than Cymbalta, at least on paper. You can always go and try the Cymbalta. It is a very unfortunate fact, that there is really no way to predict any particular person's reaction to any particular drug. There is very little science to that aspect of taking these meds.
Posted by Cecilia on August 6, 2004, at 4:51:19
In reply to Re: CYMBALTA - I am VERY afraid!, posted by bob on August 6, 2004, at 0:27:39
Anyone know what the main difference between these three drugs is? They all supposedly work on both serotonin and norepinephrine. I couldn`t tolerate Effexor at all-the smallest dose made me sick as a dog. Having tried pretty much every antidepressant available in the U.S., (as well as going to Canada for TMS) I started trying overseas drugs (with my doctor`s permission-and don`t worry, Dr. Bob, I won`t say from where). First I tried moclobemide-did nothing but make me grind my teeth. Now I`m trying tianeptine-no effects so far (one month) side or otherwise. My plan was to try milnacipran next, but now that duloxetine has actually been approved (I never thought it would) I suppose I should go for that 1st. Except, like others have mentioned, I am very afraid. Of the side effects-Effexor was like poison for me, and of the side efeects we don`t know about yet. The article on Cymbalta made a big deal about how it has been studied in 6000 people. Six thousand-that`s nothing!!!. They`re talking about taking Serzone off the market for liver failure that affects one in 250,000. I actually feel safer with non FDA approved drugs that have been around for years in other countries. Milnacipran has been around for years as an AD, but is only being studied in the U.S. for fibromyalgia. Is there any rhyme nor reason about any of these drugs, which ones get studied and for what indications, which ones get approved or not? When I asked my doctor about tianeptine, which supposedly works exactly opposite to the SSRI`s, decreasing serotonin instead of increasing it, all he could say was, well, nobody knows how any of these drugs work. Very reassuring. Can they really all just be placebos? I`m sure, like the rest of us, I`ll end up being a guinea pig for Cymbalta, because you can`t stand to live without hope. But I just can`t believe that after all these years we`ve been waiting for it they`ve only tried it on 6000 people. Cecilia
Posted by linkadge on August 6, 2004, at 7:31:44
In reply to Effexor, Duloxetine, Milnacipran, posted by Cecilia on August 6, 2004, at 4:51:19
I thought that effexor would be better than celexa because I would get more energy and perhaps a better AD effect.
Quite the opposite. It made me very depressed and melancholic, something like what some people report with reboxetine. Effexor made me ANGRY, something that the SSRI's never did. Some people mistakenly think that they need a noradrenic boost, when in reality they are like me very highly motivated to begin with, and need something to push the pause button.
Linkadge
Posted by bob on August 6, 2004, at 9:54:29
In reply to some people just don't do well with norepinephrine, posted by linkadge on August 6, 2004, at 7:31:44
> I thought that effexor would be better than celexa because I would get more energy and perhaps a better AD effect.
>
> Quite the opposite. It made me very depressed and melancholic, something like what some people report with reboxetine. Effexor made me ANGRY, something that the SSRI's never did. Some people mistakenly think that they need a noradrenic boost, when in reality they are like me very highly motivated to begin with, and need something to push the pause button.
>
> LinkadgeEffexor caused anger in me also, at higher doses.
Posted by Cecilia on August 7, 2004, at 2:09:25
In reply to Re: some people just don't do well with norepinephrine, posted by bob on August 6, 2004, at 9:54:29
I definitely don`t do well with anything stimulating. I can`t say any AD has ever made me feel better, but plenty have made me feel worse. And yet I keep trying-sometimes I think it`s not because I have any real expectation of anything working, but more to punish myself for being depressed. I`m annoyed that duloxetine is only going to be available in enteric coated capsules, not tablets, as I`ve learned over the years (through the school of bitter experience) to start any med on the smallest possible dose. And weaning off-people have no choice but to go from 20 mg to zero-a recipe for disaster. Cecilia
Posted by SLS on August 7, 2004, at 7:19:44
In reply to some people just don't do well with norepinephrine, posted by linkadge on August 6, 2004, at 7:31:44
Hi Linkadge.
> I thought that effexor would be better than celexa because I would get more energy and perhaps a better AD effect.
>
> Quite the opposite. It made me very depressed and melancholic, something like what some people report with reboxetine. Effexor made me ANGRY, something that the SSRI's never did. Some people mistakenly think that they need a noradrenic boost, when in reality they are like me very highly motivated to begin with, and need something to push the pause button.I would like to offer the suggestion that things are not always that simple when it comes to psychobiology. For instance, one of the few medications that have helped me is desipramine. By contrast, reboxetine exacerbated my depression and pushed me into an anxious suicidal state. Both of these drugs are considered to be selective NE reuptake inhibitors, yet, for me, they affected me in opposite ways. On the other hand, as you have noted, there are often trends in someone's history of drug reactions that can serve to guide treatment selection. I would just hate to see anyone try to guess their way out of a potentially successful treatment by using an overly simple and often unreliable model of psychopharmacology to errantly exclude effective alternatives. (This is not a commentary on your post so much as it is an observation of mine that this approach has been pervasive among publishing investigators for years).
Someone here posted something quite provocative the other day that has stuck in his mind. His doctor described the differences between the NE actions of nortriptyline and atomoxetine in the following manner:
nortriptyline - NE - brainstem = antidepressant
atomoxetine - NE - cortex = anti ADD/ADHDI'm not sure of the accuracy of these statements, but they do serve to illustrate the importance of determining not only WHAT a drug does, but also WHERE it does it. Location, location, location. You have a good grasp of the division of brain functions among circuits and anatomical structures. When you read the data offered by investigations in psychobiology, take note of where in the brain ligands accumulate or measures of functional change occur. You should be able to do a great deal with this kind of information.
- Scott
Posted by linkadge on August 7, 2004, at 8:07:03
In reply to Re: some people just don't do well with norepinephrine » linkadge, posted by SLS on August 7, 2004, at 7:19:44
That sounds kind of fishy to me. If a drugs is a reputake inhibitor it works at the uptake sites equally. I don't know how it could not.
It is just like ritalin, the ADD effect is presumably by dopamine action in the frontal cortex, but it is certainly not selective to the frontal cortex. It can cause psychosis by lower brainstem activation as well.
I think that perhaps some of the *secondary properties* of the drug can control its actions. All TCAs have affinity for the 2a receptors, although for desipramine this is very small it could be involved in mood regulation.
I don't think there is anything wrong with using the drugs properties to predict a theraputic responce, the problem is that there are virtually no drugs for which we know all the properties :)
Linkadge
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