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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by West on March 4, 2009, at 4:53:46
The SSRI escitalopram is probably (marginally) the leader of its class.
However, all drugs have side effects which may conflict with the ability to remit and compromise drug compliance.
My question is whether the 3% or so difference in remission rate with escitalopram over sertraline is significant if somebody finds escitalopram to have distressing side effects, such as overeating (3 successive bowls of country crisp AFTER a heart and fulsome dinner), somnolence (zombie, blah) and poor motivation (as above)
It is great for panic and anxiety but achieves this through ways i'm not entirely comfortable with.
Though i anticipate a lot of shared side effects among all ssris, how was sertraline for you in regards to:
* Mood - specifically related to depressed feelings. Were you buoyant and hopeful. making plans, getting out and seeing old friends etc. or a bit flat and downbeat?
* Anxiety - did you feel calm in public and around strangers as well as friends/associates. How was your 'follow through' with seeing people?
* Sleep - did you have any trouble getting off to sleep (ignorong the adjustment period)? Could you maintain a night's sleep without too much waking up?
* Energy - did you find yourself motivated or would you prefer to curl up with a book or film?
* Cognition - I've read, as have many of you i'm sure, of sertraline's neutral effects on cognition? Please opine.
In a nutshell, I have a feeling that modafinil, the glue of my treatment, will very soon be pulled from underneath my feet by my doctor.It is stopping escitalopram's side effects of lethargy and dullness. Therefore, i need to know if switching ssris is a sensible move. Sertaline is the only one i'm interested in moving to.
Thanks
West
Posted by Sanguine on March 4, 2009, at 10:09:51
In reply to Sertraline: the best ssri - your thoughts?, posted by West on March 4, 2009, at 4:53:46
My only experience is with sertraline (Zoloft). I have had minimal side effects with it (sleepiness)and would point you to a recent study that stated escitalopram and sertraline were best for treating depression. Incidentally, as I was fruitlessly trying to find the journal and article I mentioned, something came up about sertraline being an effective treatment for night eating. ;)
Posted by Sanguine on March 4, 2009, at 10:42:25
In reply to Re: Sertraline: the best ssri - your thoughts?, posted by Sanguine on March 4, 2009, at 10:09:51
> My only experience is with sertraline (Zoloft). I have had minimal side effects with it (sleepiness)and would point you to a recent study that stated escitalopram and sertraline were best for treating depression. Incidentally, as I was fruitlessly trying to find the journal and article I mentioned, something came up about sertraline being an effective treatment for night eating. ;)
It was in The Lancet. Here is an article describing it:
Posted by West on March 4, 2009, at 10:45:17
In reply to Re: Sertraline: the best ssri - your thoughts?, posted by Sanguine on March 4, 2009, at 10:09:51
Thanks sanguine. I think i saw the study you're talking about, so i know i'm on to a good thing depression wise.
Actually i just got an email from pdoc saying a switch wasn't feasible and something about doing bupropion alone? He's reductionist in his approach apparently. First the mod, now cipralex.
Just to clarify. Are you saying that you do have sleepiness with it or not?
Ta
West
> My only experience is with sertraline (Zoloft). I have had minimal side effects with it (sleepiness)and would point you to a recent study that stated escitalopram and sertraline were best for treating depression. Incidentally, as I was fruitlessly trying to find the journal and article I mentioned, something came up about sertraline being an effective treatment for night eating. ;)
Posted by Phillipa on March 4, 2009, at 12:32:38
In reply to Re: Sertraline: the best ssri- Sanguine, posted by West on March 4, 2009, at 10:45:17
West why wellbutrin as opposed to zoloft? What doses were you planning? Took 50mg once and felt nothing. But then also take benzos on ad's. Phillipa
Posted by West on March 4, 2009, at 13:01:15
In reply to Re: Sertraline: the best ssri- Sanguine » West, posted by Phillipa on March 4, 2009, at 12:32:38
> West why wellbutrin as opposed to zoloft? What doses were you planning? Took 50mg once and felt nothing. But then also take benzos on ad's. Phillipa
150mg bid wellbutrin is what he would like but i can't see it being that simple. Zoloft, not sure, whatever equivalent dose to 10mg lexapro is.
Posted by Phillipa on March 4, 2009, at 20:56:21
In reply to Re: Sertraline: the best ssri- Sanguine, posted by West on March 4, 2009, at 13:01:15
West I think it would be l0mg of lexapro not sure. Phillipa
Posted by bleauberry on March 7, 2009, at 18:53:53
In reply to Sertraline: the best ssri - your thoughts?, posted by West on March 4, 2009, at 4:53:46
Well, if you go by metastudies, each will come up with variations based on how they picked apart the numbers on paper.
If you go by what patients actually have to say, it could be a different story.
For example, if one were to study the sites askapatient.com and revolutionhealth.com, they can see how real people graded their ADs on a scale of 1-5. All SSRIs and SNRIs fall in the area of about 3.0-3.6, with not much apparent difference in any of them. Zoloft is a miracle to some and a disaster for others, and the same applies to every other med. They all scored low 3's.
If you jump to the Parnate category the picture changes. Score 4.2.
Other high scores included Provigil and Tramadol.
Any of the above 3 meds blew Zoloft and Lexapro out of the water. Based on real people that is. The metastudies looked at other stuff not necessarily related to the real world. It's all based on clinical studies, which themselves are an artificial atmosphere with inaccuracies, biases, and flaws.
Posted by betrayed on March 10, 2009, at 19:28:38
In reply to Re: Sertraline: the best ssri - your thoughts?, posted by Sanguine on March 4, 2009, at 10:09:51
My only and worst experience was with citalopram found 2 FDA Alerts today. I feared taking it and was treated like a child and crazy woman who was ordered by my primary care physician that I'd better take it or there was nothing else he could for me! Just info, thanks
Posted by manic666 on March 14, 2009, at 13:59:49
In reply to Re: Sertraline: the best ssri - your thoughts?, posted by betrayed on March 10, 2009, at 19:28:38
if your planing 150 zoloft . stay close to the toilet as thats were you will spend most your time. 100mg is about right for your bowels to cope with, also it takes longer to act, 8 weeks of missery, but somthing is happening now so stick with it, an dont give up on the long wait because you only have to do it again with something else
Posted by metric on March 14, 2009, at 19:27:57
In reply to Sertraline: the best ssri - your thoughts?, posted by West on March 4, 2009, at 4:53:46
> The SSRI escitalopram is probably (marginally) the leader of its class.
>
> However, all drugs have side effects which may conflict with the ability to remit and compromise drug compliance.
>
> My question is whether the 3% or so difference in remission rate with escitalopram over sertraline is significant if somebody finds escitalopram to have distressing side effects, such as overeating (3 successive bowls of country crisp AFTER a heart and fulsome dinner), somnolence (zombie, blah) and poor motivation (as above)
>
> It is great for panic and anxiety but achieves this through ways i'm not entirely comfortable with.
>
> Though i anticipate a lot of shared side effects among all ssris, how was sertraline for you in regards to:
>
>
>
>
> * Mood - specifically related to depressed feelings. Were you buoyant and hopeful. making plans, getting out and seeing old friends etc. or a bit flat and downbeat?
>
>
> * Anxiety - did you feel calm in public and around strangers as well as friends/associates. How was your 'follow through' with seeing people?
>
>
> * Sleep - did you have any trouble getting off to sleep (ignorong the adjustment period)? Could you maintain a night's sleep without too much waking up?
>
>
> * Energy - did you find yourself motivated or would you prefer to curl up with a book or film?
>
>
> * Cognition - I've read, as have many of you i'm sure, of sertraline's neutral effects on cognition? Please opine.
>
>
> In a nutshell, I have a feeling that modafinil, the glue of my treatment, will very soon be pulled from underneath my feet by my doctor.
>How much modafinil do you take? Have you tried it by itself? I found modafinil to be a decent antidepressant by itself, though the minimum effective dose was about 400 mg. It can cause some tension and anxiety at high doses, but this is amenable to modest doses of benzodiazepines (clonazepam or alprazolam work well IME).
I think dextroamphetamine is much more efficacious than modafinil for augmentation of SSRIs, although doctors favor the former because it has less "abuse potential". OTOH, modafinil seems to uniquely complement mirtazapine IME, but I wouldn't recommend the long-term use of mirtazapine.
> It is stopping escitalopram's side effects of lethargy and dullness. Therefore, i need to know if switching ssris is a sensible move. Sertaline is the only one i'm interested in moving to.
>
>Unfortunately, none of the SSRIs work for depression, and they all have horrible side-effects.
> Thanks
>
>
> West
>
>
>
>
Posted by metric on March 14, 2009, at 19:43:17
In reply to Re: Sertraline: the best ssri - your thoughts?, posted by metric on March 14, 2009, at 19:27:57
> I think dextroamphetamine is much more efficacious than modafinil for augmentation of SSRIs, although doctors favor the former because it has less "abuse potential". ...former = latter
Posted by Justherself54 on March 17, 2009, at 22:32:41
In reply to Re: Sertraline: the best ssri - your thoughts?, posted by manic666 on March 14, 2009, at 13:59:49
Yeah..I hear you..I once was on 200 mg..bowels couldn't take it..seems the higher you go, the closer you need to be to the loo.
This is the end of the thread.
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