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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 bleauberry on January 10, 2014, at 9:25:38
I've been coming to pbabble for a really long time....somewhere in the 20 to 25 year range. I was here way back in the beginning. I have seen a lot here.
Based purely on what my own eyes have seen in the posts of pbabble over a period of about 20 years, this is the order of effectiveness of antidepressants.
Best: Nardil, Parnate.
Second Best: SSRI + AP combinations
Third Best: SSRI + stimulant combinations
Fourth Best: SSRI + TCA combinationsWorst: Mono SSRIs, mono TCAs.
Oddball meds such as Remeron fall somewhere in the middle.
These observations do not jive with clinical studies, which show pretty much the same results from one approach to another, plus or minus a few percentage points.
Despite what my eyes have seen, I tend to buck the trend and favor the SSRI + TCA route. Honestly, I wish everyone would receive Nardil or Parnate as first line therapy. That would save a ton of money and suffering. I think the risks are overblown in such a way that deserving patients never get the chance.
What have you observed on this board that seems....generally speaking...the most effective routes for a general population to pursue in terms of psych med choices?
Posted by Phillipa on January 10, 2014, at 9:37:07
In reply to Anecdotally The Best Drugs, posted by bleauberry on January 10, 2014, at 9:25:38
Sorry I disagree since people are all different there is no one med that is the "best" for anyone. It's all trial and error. This to me is a huge generalization. Let the pdocs or other docs decide what the best med for a person is and then they can come to babble to discuss them. I understand that you feel this is the perfect list of meds for you. But it wouldn't be for me. At my age some of those meds could be dangerous. People please discuss meds with a doctor. A second opinion is also fine. Phillipa
Posted by SLS on January 10, 2014, at 9:55:19
In reply to Re: Anecdotally The Best Drugs » bleauberry, posted by Phillipa on January 10, 2014, at 9:37:07
:-)
- Scott
Posted by bleauberry on January 10, 2014, at 12:25:01
In reply to Re: Anecdotally The Best Drugs » bleauberry, posted by Phillipa on January 10, 2014, at 9:37:07
> Sorry I disagree since people are all different there is no one med that is the "best" for anyone.
Did I say there was a best drug for anyone? No. I merely stated what my eyes have seen hanging out at the pbabble forum for over 20 years. It is not science, is not someone else's view, is not right or wrong, just what my eyes saw. Period. Please don't read something into that which isn't there.
>It's all trial and error.
Yep.>This to me is a huge generalization.
Exactly. I stated that pretty clearly. And that the generalization was based only on my eyes, only on this forum, and purely anecdotal.<Let the pdocs or other docs decide what the best med for a person is and then they can come to babble to discuss them.
Yep. As a sidenote, I would like to say that, again purely based on my own eyes, the patients who make the most improvement are the ones who become actively engaged in their own therapy, not the ones who act as puppets on the end of a doctor's string.<I understand that you feel this is the perfect list of meds for you.
I don't know how you could understand that because first of all I never said that at all, and second of all, not a single one of those was a perfect med for me. Not even close.<But it wouldn't be for me.
Me either.<At my age some of those meds could be dangerous.
At our age, simply living is dangerous. Lots of people in my age group and younger are already in the grave. In my opinion, not doing all that can be done is dangerous, far more dangerous than taking a risk. I do believe the risk of complacency is a far more dangerous crippling risk than the risk of most drugs. As always, it is a benefit-risk trade-off. Getting in the car is more dangerous, very likely.<People please discuss meds with a doctor.
And be prepared enough that you know at least as much about it as the doc, preferably more.<A second opinion is also fine. Phillipa
I would take it as far as a 3rd, 4th, or 5th opinion.....keep going until someone and something makes good sense. I did not believe I had any lyme issues. None of us do. It took a 4th opinion to finally make it pretty obvious.Anyway Phillipa, hope you have a good day. I was just listing meds as I have seen them perform, in general, anecdotal, over the years here. There is no advice. Just an observation. Period.
Posted by bleauberry on January 10, 2014, at 12:25:59
In reply to Re: Anecdotally The Best Drugs » Phillipa, posted by SLS on January 10, 2014, at 9:55:19
:-)
blue
Have a great day Scott.> :-)
>
>
> - Scott
Posted by bleauberry on January 10, 2014, at 13:39:47
In reply to Anecdotally The Best Drugs, posted by bleauberry on January 10, 2014, at 9:25:38
Added to the title:
Abbreviated "In my opinion"
Added to the body:
I was thinking about it a little more and can get a little more detailed.
In the SSRI camp, Prozac used to be the Queen, was gently taken over by Zoloft, barely, with Lexapro trying to overtake them. Cymbalta is somewhere behind all that, and is generally not viewed as an SSRI.
I have not seen any sales figures though they would be simple to find, because for purposes of this thread it is only the perception of one eye's over time at a particular place. Just for fun and discussion. The timeframe is over 20 years, probably close to 25 years, I used to be under two different user names, and the place is Dr. Bob's Psychobabble.
In the MAOI camp Nardil seemed more effective but frequently has difficult side effects. Parnate was almost as good with lesser side effects. This is in contrast to one popular internet psychiatrist, retired, who has some good writings on his experience with MAOIs. He saw Parnate as the big winner. Here at babble, I dunno, there were a lot of success stories with both of them, relatively speaking of course compared to the more frequent posts of other meds, but Nardil seemed the best.
In the TCA camp, well, it's almost always Nortriptyline. Sometimes Amitryptaline, Clomipramine, or one of the others.
In the antipsychotic camp, zyprexa and abilify share the winning spot, though seroquel is prescribed more frequently it is generally less effective or poops out sooner.
Just for fun. These are the trends that my eyes perceived over the years here. Of course, being a psych patient myself, who knows.
Posted by diego on January 11, 2014, at 0:17:00
In reply to Re: Anecdotally The Best Drugs IMO add-on, posted by bleauberry on January 10, 2014, at 13:39:47
As a Babble member going way, way back I concur with bleauberry's "anecdotal" observations.
Among the TCA's, I found Vivactyl, protriptyline most effective. Is it still made anymore?
I'm firmly in the MAOI camp. Ever since Prozac was introduced the definition of depression keeps loosening and loosening. DSM-V is a joke.
Truly disabling melancholic depression ought to be treated swiftly and promptly by whatever mean necessary. MAOIS are the gold standard, followed by ECT. Ipronaizid was the prototype.
Posted by SLS on January 11, 2014, at 7:35:32
In reply to Re: Anecdotally The Best Drugs IMO add-on, posted by diego on January 11, 2014, at 0:17:00
Hi Diego.
> Among the TCA's, I found Vivactyl, protriptyline most effective. Is it still made anymore?
I believe it is. It was the absolute worst tricyclic I ever took. It exacerbated an already severe depression. The autonomic side effects were the worst. I got a nice mood lift when I abruptly discontinued protriptyline. It lasted for less than a day, though.
> Ever since Prozac was introduced the definition of depression keeps loosening and loosening.
The diagnostic "loosening" is the result of:
1. Psychiatrists and psychologists don't get paid without a a coded diagnosis. More patients. More money.
2. In an effort to increase the number of people who enter a clinical study, eligibility criteria are applied loosely in order to enroll more subjects. This means more money for the paid investigators. More money.
3. The drug company is in a rush to produce statistics with high power (number of subjects) in order to get their product to market more quickly. More money.
Of course, the drug companies shoot themselves in the foot by operating this way. People complaining of milder depressions are allowed to particapate in modern studies. Most of them don't have the disease being studied. You end up with a smaller separation between active drug and placebo. Clinical trials performed in the 1960s and 1970s showed more convincing separation because they were motivated by medical science to conduct pure research. Subjects employed in studies of depression were unequivocally severely affected with very little ambiguity that they were suffering from MDD or BD. Response rates for imipramine were about 65-70%; response rates for placebo were about 25-30%.
> DSM-V is a joke.
What is it about DSM V that you find to be a joke? I haven't seen it yet.
I thought DSM III and DSM IV were jokes when it came to diagnosing axis I disorders. Their descriptions were primitive, brief, and crude.
> Truly disabling melancholic depression ought to be treated swiftly and promptly by whatever mean necessary. MAOIS are the gold standard, followed by ECT. Ipronaizid was the prototype.
For melancholic depression, I would choose a tricyclic first. Imipramine is the true gold standard for this presentation. In addition, MAOIs do carry a certain liability for producing dangerous sequalae if diet and drug interactions are not followed strictly. For that reason, I would wait until imipramine - and possibly venlafaxine are tried first before going to MAOI.
One thing that I am not sure of is which MAOI is the best to try first when treating melancholic depression. Do you have a preference?
- Scott
Posted by jono_in_adelaide on January 12, 2014, at 21:39:03
In reply to Anecdotally The Best Drugs, posted by bleauberry on January 10, 2014, at 9:25:38
I'd say that the people on this board arnt typical of the population at large - we are a highly self selected group, basicly we are the failiures who havent responded to first or second like drugs.
Those who have responded to an SSRI or Effexor or Remeron arnt posting here, because they have no need to, they have gotten well
Posted by Phillipa on January 13, 2014, at 21:06:26
In reply to Re: Anecdotally The Best Drugs, posted by jono_in_adelaide on January 12, 2014, at 21:39:03
Jono I think this is true. Phillipa
Posted by Dr. Bob on January 16, 2014, at 23:10:29
In reply to Re: Anecdotally The Best Drugs » Phillipa, posted by bleauberry on January 10, 2014, at 12:25:01
> Did I say there was a best drug for anyone? No. I merely stated what my eyes have seen hanging out at the pbabble forum for over 20 years. It is not science, is not someone else's view, is not right or wrong, just what my eyes saw. Period. Please don't read something into that which isn't there.
Over 20 years means you joined in 1994 or earlier?
Bob
Posted by 10derheart on January 17, 2014, at 1:40:56
In reply to Re: Anecdotally over 20 years » bleauberry, posted by Dr. Bob on January 16, 2014, at 23:10:29
Posted by Phillipa on January 17, 2014, at 18:10:16
In reply to Re: Anecdotally over 20 years » bleauberry, posted by Dr. Bob on January 16, 2014, at 23:10:29
I wondered the same as didn't babble start in 2000? I was not a member then. Phillipa
Posted by 10derheart on January 22, 2014, at 16:04:17
In reply to Re: Anecdotally over 20 years » Dr. Bob, posted by Phillipa on January 17, 2014, at 18:10:16
http://www.dr-bob.org/babble/19981001/msgs/1.htmlAge...about 15 1/2, give or take?
I think...anyway.
It will be ten years for me in May this year. Whew.
Posted by 10derheart on January 22, 2014, at 16:06:03
In reply to First post by Dr. Bob? » Phillipa, posted by 10derheart on January 22, 2014, at 16:04:17
>
> Age...about 15 1/2, give or take?
>
Lol. The site's age, not Dr. Bob's. Although, OTOH...nah...never mind... ;-)
Posted by Phillipa on January 22, 2014, at 22:30:54
In reply to Re: First post by Dr. Bob? » 10derheart, posted by 10derheart on January 22, 2014, at 16:06:03
10der how come the special link to year 2000? I figured this was when the site began? Phillipa
Posted by 10derheart on January 23, 2014, at 0:44:04
In reply to Re: First post by Dr. Bob? » 10derheart, posted by Phillipa on January 22, 2014, at 22:30:54
Not sure. Great question.
We'll have to ask Dr. Bob or one of the older timers than me. Something must have happened from 1998 to 2000, or in 2000, or why would the 2000 board exist?
Inquiring minds.... :-)
Posted by diego on January 25, 2014, at 0:26:59
In reply to Re: Anecdotally The Best Drugs IMO add-on » diego, posted by SLS on January 11, 2014, at 7:35:32
Scott,
We need to define our terms.
To me, "melancholic depression" is an old-fashioned term for depression characterized by physical symptoms: sleep disorder, weight loss and anorexia, and profound "psychomotor retardation"; as well as all the usual crap.
For ME, suffering from what *I* call "melancholic depression" MAOIs are wonder drugs. I was on Nardil for a number of years after running the gamut of TCAs, then switched to Parnate to fend off sexual SE.
I found Parnate more effective and w/ less SE than Nardil for *MY* "melancholic depression" and took it for a number of years, too.
Tried a washout and Zoloft, an SSRI, when they became all the rage after the introduction of Prozac, and became so depersonalized after a day or two I said, "Fusk this carp!" and went back to Parnate.
Marplan wasn't on the market then and I've never tried it.
So if I were shrink and met a patient with predominantly physical symptoms of major depression, I'd prescribe Parnate in an instant and bypass the TCAs, SSRIs and fancy new sh*t like venlafaxine.
IMX, the tyramine interaction of both Nardil & Parnate are over-rated at normal doses. In probably 15 years of using both I had exactly *one* "hypertensive reaction" and that was from eating too much salami (like 1/3 lb), and even it wasn't severe; just a headache and tachycardia and anxiety. Took a couple shots of vodka, a hot bath and laid down. It passed.
Which isn't to say I'm going to wolf down a a bunch of chopped liver or fava beans and a nice Chianti anytime soon, but just that one can be too cautious.
This is the end of the thread.
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