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#11
March 9th 05, 04:38 AM
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#12
March 9th 05, 04:47 AM
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In article , Helen Wheels
wrote: What gets to me about the antidepressant drug business is that it's very well known that some drugs will work for some people while others will work better for other people. But, the only way to find out which one's right for you is the brute force approach - try 'em all until you find one that works for you. There's very little research that examines which antidepressants work best for which people out in the community and why. cynic After all, drug manufacturers are probably doing quite well out of the brute force approach... it wouldn't be in THEIR best interests to sponsor research that might find a better way. would it? /cynic Actually, there is a lot of research, or at least experience that gets shared among the psychiatrists that really want the information. They may be specialists in psychopharmacology. Sometimes, the extra training there can get them networking with the right people. I remember a scathing editorial on Medscape.com by a pediatric psychopharmacologist, who was furious at all too many psychiatrists who overprescribe the newer drugs. Why? Not studying? Too much influence by pharmaceutical companies? Now, pharmacology has always been one of my interests. I've found a surprising number of doctors that don't know the biochemistry of the multiple classes of drugs useful in different kinds of depression and with different patients, including: Post-synaptic nonselective of ST and NE, operating on the catechol-O-methyl-transferase enzyme system Post-synaptic nonselective of ST and NE, operating on the monoamine oxidase enzyme system Pre-synaptic selective ST reuptake inhibitors "Atypical" pre-synaptic ST reuptake inhibitors Pre-synaptic nonselective ST/NE reuptake inhibitors Pre-synaptic selective NE reuptake inhibitors Anticonvulsants Lithium Stimulant amines like Ritalin Strattera .... need I go on? Something that often gets missed is a patient with mixed anxiety and depression, who may need an anxiolytic as well as an antidepressant. There are also drugs that can help minimize the side effects of some of the psychotropics, such as beta-blockers to minimize the hand tremor common with the anticonvulsant valproate.
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#14
March 9th 05, 04:52 AM
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In article
outpets.com, "Gabey8" wrote: Is there a different antidepressant, with fewer side effects, that your doctor can help you switch over to? Nobody wants to be on meds for the long haul. That goes double for a med that's causing side effects that are as disruptive to daily living as the problem the medicine is supposed to be relieving. But some people, including me, would be in a permanent state of depression without meds. In my case, even what I USED to think of as a normal state was a low-level state of depression, and I've wavered between that and flat-out clinical depression since I was 10. (Which means I've been dealing with this for over 30 years.) But it was being downsized a few years ago that brought on a really, REALLY severe and unrelenting case of depression. Finally, I went to the doctor because the symptoms were not only debilitating, they were showing no signs of lifting. The prescription I'm on right now is Celexa (citalopram), and it has helped a lot. It also doesn't have the side effects you were describing. Maybe you can discuss switching over to that or to a different prescription that will help the depression, minus the side effects you're getting from the Effexor. Celexa is in a different family than Effexor. Celexa, along with Paxil and a few others, is considered an "atypical" selective serotonin reuptake inhibitor. I've gotten biochemical enough without getting into why these are considered "atypical" with respect to Prozac, Zoloft, etc. Yes, yes, yes. If one psychotropic drug doesn't work well, there tend to be alternatives, both within the same family and in different families. For example, I have intolerable dry mouth with the tricyclic antidepressant amitriptyline (Elavil), but not with the closely related nortriptyline (Pamelor). My husband is on thyroid medication, permanently, because his thyroid doesn't produce enough hormone on its own. Friends and relatives of mine take insulin or pills to regulate diabetes, since their bodies don't produce enough insulin. And there's no difference between their permanent need for meds, and the fact that my body needs some help getting the serotonin level right. There's no shame in needing any of those meds, or any other prescription, not even if it's necessary over the long haul. It's not fun AT ALL to have to deal with these issues.  ( But see if youcan work with your doctor to change to a different medication. And if this doc won't work with you on that, it's time for a second opinion. Exactly. I find more physicians "stuck" with a very few psychotropic drugs than almost any other class of medications. If an infectious disease specialist only wanted to use 2 or 3 classes of antibiotics, they'd be considered candidates for psychotherapy, or at least intensive retraining. Why can't psychiatrists bother with the alternativews available to them?
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#15
March 9th 05, 06:15 AM
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Enfilade wrote:
This is my first vent here... I want to get off the Effexor I've been taking for depression for almost a year now. I've been more stable than DP's seen me to be in the past 8 years, in the last 6 months. Unfortunately, in those last 6 months I also sleep about 12 hours a day, and occasionally I get this "Stoned" sensation where stuff gets blurry and I have trouble thinking of words or figuring out just where I am...I'll wander and then snap out of my reverie like, two hours later, wondering where the time went. The stuff's expensive as hell, I have no drug coverage, and there's no way I can do a master's thesis in September if I'm sleeping more than I'm awake. If I want back on flight operations, I have to lose the drugs that could affect my ability to control an aircraft. So today I'm at the doctor's and he tells me that if I quit the stuff, I'm almost guaranteed to relapse. DP's afraid I will, sometime when no one's around to stop me from cutting my throat--or someone else's. I'm in my 20s. I don't want to be on this crap for the rest of my life. Hell, the concept of being stuck on drugs is one of the big reasons I left my depression untreated until I became a menace to people around me as well as myself. I think I know the symptoms well enough--if I start inflicting injury on myself and viewing life through a red rage haze, it's time to go back on the pills. I was depressed, I think, since about age 4 or so, but during that time I only had two severe (ie, want-to-kill-myself) episodes, and those 8 years apart. The minor rounds I could handle without chemical interference. At that rate, it'd be 2013 before I needed pills again. That's a lot of money and a lot of drug-free years. That red haze is starting to creep back a little, since the doc didn't in any way suggest that this was a "for the rest of my life" kind of thing until just now. I feel like I've gotten suckered into this situation, and that ****es me off. --Enfilade Effexor isn't the only antidepressant out there, and your doc is greatly remiss in not considering exploring other meds. There are ADs that don't cause hypersomnia, and which might be less expensive than Effexor. The problem with Effexor is that quitting cold is not an option; it has to be done gradually and incrementally. Quitting all at once produces an extremely undesirable sensation known as "brain spins," "brain shivers," "brain surges," and other unsavory encephalitic phrases. One person described it to me as feeling like your brain is spinning inside your head. Alternatives are out there, and you deserve to have the chance to explore them.
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#16
March 9th 05, 07:31 AM
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Howard Berkowitz wrote: In article , Helen Wheels wrote: What gets to me about the antidepressant drug business is that it's very well known that some drugs will work for some people while others will work better for other people. But, the only way to find out which one's right for you is the brute force approach - try 'em all until you find one that works for you. There's very little research that examines which antidepressants work best for which people out in the community and why. cynic After all, drug manufacturers are probably doing quite well out of the brute force approach... it wouldn't be in THEIR best interests to sponsor research that might find a better way. would it? /cynic Actually, there is a lot of research, or at least experience that gets shared among the psychiatrists that really want the information. They may be specialists in psychopharmacology. Sometimes, the extra training there can get them networking with the right people. I remember a scathing editorial on Medscape.com by a pediatric psychopharmacologist, who was furious at all too many psychiatrists who overprescribe the newer drugs. Why? Not studying? Too much influence by pharmaceutical companies? Now, pharmacology has always been one of my interests. I've found a surprising number of doctors that don't know the biochemistry of the multiple classes of drugs useful in different kinds of depression and with different patients, including: Post-synaptic nonselective of ST and NE, operating on the catechol-O-methyl-transferase enzyme system Post-synaptic nonselective of ST and NE, operating on the monoamine oxidase enzyme system Pre-synaptic selective ST reuptake inhibitors "Atypical" pre-synaptic ST reuptake inhibitors Pre-synaptic nonselective ST/NE reuptake inhibitors Pre-synaptic selective NE reuptake inhibitors Anticonvulsants Lithium Stimulant amines like Ritalin Strattera ... need I go on? Something that often gets missed is a patient with mixed anxiety and depression, who may need an anxiolytic as well as an antidepressant. There are also drugs that can help minimize the side effects of some of the psychotropics, such as beta-blockers to minimize the hand tremor common with the anticonvulsant valproate. OK, I'm only a number-cruncher - I freely admit that I know nothing about pharmacology and I'm just spouting speculation. But it does seem to me that an awful lot of published drug studies don't reflect how medications are really used in the community as opposed to what happens in carefully controlled clinical trials. In Australia (don't know whether things are different in the USA) hardly anyone would be able to get their antidepressants prescribed by a psychiatrist - there are just so few of them that even if you're able to pay privately, the waiting list for an appointment will be months long. You really have to be so ill that you're a danger to other people (a danger to yourself isn't enough) to be able to see a psychiatrist quickly. So, most people have to go to a GP to get a prescription, and I guess the shared experience of specialist psychiatrists on choosing an antidepressant isn't reaching them. Then again, the shrinks are probably too darned overworked to publish what they know... I must say that cuddling a cat is one of the best ways I've found to deal with depression in the short term. I personally find a big, heavy one with long whiskers and loud purrs most effective.
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#17
March 9th 05, 12:20 PM
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Noon Cat Nick wrote:
Effexor isn't the only antidepressant out there, and your doc is greatly remiss in not considering exploring other meds. There are ADs that don't cause hypersomnia, and which might be less expensive than Effexor. The problem with Effexor is that quitting cold is not an option; it has to be done gradually and incrementally. Quitting all at once produces an extremely undesirable sensation known as "brain spins," "brain shivers," "brain surges," and other unsavory encephalitic phrases. One person described it to me as feeling like your brain is spinning inside your head. Alternatives are out there, and you deserve to have the chance to explore them. I can only add to what everyone else has said. AD medication is not yet totally understood. As sufferers, we have to accept that. After all, we all would like a perfect world, but it just isn't there yet. The best thing is to find a practitioner who is willing to try different medication until the benefit outways the side-effects. Don't forget you need a few weeks to wean off the old drug, and a few weeks for the new one to start to work properly. It took me a year or two of trying several different drugs until we found one that has almost no side-effects and works really well. If this sounds like a long time, it's not really. Almost the first drug you try will help with the AD and you will feel better; from there it's just a matter of fine-tuning the process so that the side-effects are reduced. Some people will put up with a bit of sleeplessness, others loss of libido, others jitterness. You just need to find a drug whose side-effects are acceptable to you. Good luck, and don't give up, because it *does* help in the long run. I am feeling fine with my drugs and I've almost *no* side-effects.
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#18
March 9th 05, 02:32 PM
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"Enfilade" wrote in message
om... This is my first vent here... I want to get off the Effexor I've been taking for depression for almost a year now. I've been more stable than DP's seen me to be in the past 8 years, in the last 6 months. Unfortunately, in those last 6 months I also sleep about 12 hours a day, and occasionally I get this "Stoned" sensation where stuff gets blurry and I have trouble thinking of words or figuring out just where I am...I'll wander and then snap out of my reverie like, two hours later, wondering where the time went. The stuff's expensive as hell, I have no drug coverage, and there's no way I can do a master's thesis in September if I'm sleeping more than I'm awake. If I want back on flight operations, I have to lose the drugs that could affect my ability to control an aircraft. So today I'm at the doctor's and he tells me that if I quit the stuff, I'm almost guaranteed to relapse. DP's afraid I will, sometime when no one's around to stop me from cutting my throat--or someone else's. I'm in my 20s. I don't want to be on this crap for the rest of my life. Hell, the concept of being stuck on drugs is one of the big reasons I left my depression untreated until I became a menace to people around me as well as myself. I think I know the symptoms well enough--if I start inflicting injury on myself and viewing life through a red rage haze, it's time to go back on the pills. I was depressed, I think, since about age 4 or so, but during that time I only had two severe (ie, want-to-kill-myself) episodes, and those 8 years apart. The minor rounds I could handle without chemical interference. At that rate, it'd be 2013 before I needed pills again. That's a lot of money and a lot of drug-free years. That red haze is starting to creep back a little, since the doc didn't in any way suggest that this was a "for the rest of my life" kind of thing until just now. I feel like I've gotten suckered into this situation, and that ****es me off. --Enfilade Over the years, I worked my way through just about all the prescription drugs for depression. At this time, I've been on Venlafaxine for several years now; according to my shrink, I'll never develop an "immunity" to it, the way I gradually did to each other. Ask your doctor to consider it.
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#19
March 9th 05, 03:17 PM
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In article , Helen Wheels
wrote: Howard Berkowitz wrote: In article , Helen Wheels wrote: What gets to me about the antidepressant drug business is that it's very well known that some drugs will work for some people while others will work better for other people. But, the only way to find out which one's right for you is the brute force approach - try 'em all until you find one that works for you. There's very little research that examines which antidepressants work best for which people out in the community and why. cynic After all, drug manufacturers are probably doing quite well out of the brute force approach... it wouldn't be in THEIR best interests to sponsor research that might find a better way. would it? /cynic Actually, there is a lot of research, or at least experience that gets shared among the psychiatrists that really want the information. They may be specialists in psychopharmacology. Sometimes, the extra training there can get them networking with the right people. I remember a scathing editorial on Medscape.com by a pediatric psychopharmacologist, who was furious at all too many psychiatrists who overprescribe the newer drugs. Why? Not studying? Too much influence by pharmaceutical companies? Now, pharmacology has always been one of my interests. I've found a surprising number of doctors that don't know the biochemistry of the multiple classes of drugs useful in different kinds of depression and with different patients, including: Post-synaptic nonselective of ST and NE, operating on the catechol-O-methyl-transferase enzyme system Post-synaptic nonselective of ST and NE, operating on the monoamine oxidase enzyme system Pre-synaptic selective ST reuptake inhibitors "Atypical" pre-synaptic ST reuptake inhibitors Pre-synaptic nonselective ST/NE reuptake inhibitors Pre-synaptic selective NE reuptake inhibitors Anticonvulsants Lithium Stimulant amines like Ritalin Strattera ... need I go on? Something that often gets missed is a patient with mixed anxiety and depression, who may need an anxiolytic as well as an antidepressant. There are also drugs that can help minimize the side effects of some of the psychotropics, such as beta-blockers to minimize the hand tremor common with the anticonvulsant valproate. OK, I'm only a number-cruncher - I freely admit that I know nothing about pharmacology and I'm just spouting speculation. But it does seem to me that an awful lot of published drug studies don't reflect how medications are really used in the community as opposed to what happens in carefully controlled clinical trials. Precisely. In the US, the manufacturer applies to the Food and Drug Administration (FDA) with a New Drug Application (NDA) seeking licensing of a new drug. The FDA and the manufacturer agreee on the clinical trials that have been done [1] or need to be done, and, when there is sufficient information, an approval officer or panel decides whether to authorize a license. [1] Earlier in the process, a manufacturer, or independent researcher, can apply for an Investigational New Drug (IND) application, which gives the authority to use it in clinical trials. INDs are not available by prescription, although there is a "compassionate use" procedure by which a clinician can request a supply of the experimental drug for a patient in whom all other therapies have failed. Each NDA is for a specific list of "indications", or conditions the manufacturer asserts the drug will treat. Physicians are permitted to prescribe drugs for "off-label" indications not in the manufacturers' literature. Part of the time, off-label prescribing can be a good way to use the knowledge of experienced physicians, especially for rarer conditions where the manufacturer didn't want to pay for clinical trials for the other indication. An unfortunate other part of the time, however, we have seen pharmaceutical company representatives pushing off-label indications to increase sales, with no data backing it up. Incidentally, I'm not opposed to all pharmaceutical representatives, often called "detail men". Some are extremely knowledgeable, help independent researchers and clinicians meet one another, and act as a channel between practicing physicians and the company research department. Others have the ethics of used car salesmen --- and that's increasingly common in their profit-driven upper management. It's sad to remember that the accepted term for the US prescription drug manufacturers was the "ethical pharmaceutical industry." At one time, many of the manufacturers really did have a commitment to medicine over short-term profit. In Australia (don't know whether things are different in the USA) hardly anyone would be able to get their antidepressants prescribed by a psychiatrist - there are just so few of them that even if you're able to pay privately, the waiting list for an appointment will be months long. You really have to be so ill that you're a danger to other people (a danger to yourself isn't enough) to be able to see a psychiatrist quickly. So, most people have to go to a GP to get a prescription, and I guess the shared experience of specialist psychiatrists on choosing an antidepressant isn't reaching them. Then again, the shrinks are probably too darned overworked to publish what they know... Quite frankly, then, I'll put in a suggestion to the Australian medical authorities that they might do well to use computer assistance from one of my research areas: expert systems for prescribing. While my work has more been in cardiology and infectious disease, it's quite possible to construct a "consultant in a box" that can help a primary physician select drugs and find alternatives. Unfortunately, there is an overall problem of specialist knowledge reaching GPs. In the US, there are several annual studies that show poor dissemination of knowledge. For example, cardiologists (a subspecialty of internal medicine, with their own subspecialties beyond that) usually know what drugs have been found good and bad in treating heart attack or congestive heart failures. Some of the effective drugs are NOT intuitive. Internists don't have as high a knowledge of the correct drugs. The percentage of primary care physicians that know the most up-to-date therapies tends to be even lower. I must say that cuddling a cat is one of the best ways I've found to deal with depression in the short term. I personally find a big, heavy one with long whiskers and loud purrs most effective. Absolutely. Purring time should be reimbursable under all insurance plans!
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#20
March 9th 05, 03:37 PM
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