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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Bekka H. on March 10, 2002, at 2:09:21
I've read that Ritalin (methylphenidate) blocks the reuptake of dopamine while dexedrine causes the release of dopamine. By blocking the reuptake of the neurotransmitter, Ritalin's mechanism of action is similar to antidepressants, so why isn't Ritalin an antidepressant?
Posted by Bekka H. on March 11, 2002, at 0:45:45
In reply to Ritalin is not an antidepressant, posted by Bekka H. on March 10, 2002, at 2:09:21
Why isn't Ritalin an antidepressant?
Thanks for any ideas.
Posted by JohnX2 on March 11, 2002, at 3:28:49
In reply to Ritalin is not an antidepressant, posted by Bekka H. on March 10, 2002, at 2:09:21
> I've read that Ritalin (methylphenidate) blocks the reuptake of dopamine while dexedrine causes the release of dopamine. By blocking the reuptake of the neurotransmitter, Ritalin's mechanism of action is similar to antidepressants, so why isn't Ritalin an antidepressant?
Hi Bekka,
Dexedrine (d-amphetamine) is both a dopamine reuptake inhibitor
and a promoter of dopamine release.I don't know about Ritalin. I haven't looked at that pony.
The word "antidepressant" is subjective. I wouldn't
want to get dragged into a debate on that one.If you ran these medicines through an official
clinical trial for depression and collected HAM-D
scores, etc, I don't know how they stack up
against Prozac, etc.-John
Posted by fachad on March 11, 2002, at 8:47:10
In reply to Ritalin is not an antidepressant, posted by Bekka H. on March 10, 2002, at 2:09:21
Your post caught my eye.
Ritalin is an AD. YMMV, but for me it's been the most effective AD I've found yet and it has remained effective for over 7 years. It's just not MARKETED as ad AD.
Something that is very important to keep in mind as we try to understand these medications is that this industry (psychopharmacology/psychiatry) is not just about the science of brain chemistry and the improving of mental health.
There are two other major factors that go into it: economics and legislation.
When a drug is developed, it is done with the intention of making money for the drug company. That's just how the free market works. The company that makes it is hoping to capture market share, and in some cases create market share. An example of creating market share is the creation of the disorder PMDD for fluoxetine, marketed as Seraphim.
The other major factor is legislation. For a drug company to bring a drug to market, they have to jump thru certain regulatory hoops, including doing studies that the drug is effective for the indication that they are going to market it for.
Think about this statement: Paxil is not an anti-anxiety medication. That statement was absolutely true, at one time, in the same sense that your statement "Ritalin is not an AD" is true.
But a few years into Paxil's release, suddenly advertisements started appearing for Paxil for anxiety, panic, etc. What happened? Did they change the molecule? Did the reuptake properties change? Nope. They jumped thru the FDA required hoops, did some studies, and got Paxil approved by the FDA for anxiety. Now Paxil IS an anti-anxiety medication.
Doing those studies cost SKB money, but the investors saw an ROI (return on investment) because they were able to capture a whole new segment of the market, the anxiolitic market.
But it gets better. Free market economics are all about competition. Who was the competition for the anxiolitic market, whose market share was Paxil going to cut into? The benzodiazapines. What an easy target.
First, their patents have run out - you can buy cheap generics. That means that no one will bother funding studies trying to show that BZs are more effective than Paxil, because no patent=no research.
Second, BZs are regulated by the other government entity that factors into our care, the DEA. BZs are classified as Schedule IV under the Federal Controlled Substances Act. They have "abuse liability". This unfortunate fact was leveraged by SKB to position Paxil as a safer, equally effective treatment for anxiety. Why would a doctor give someone an "addictive" BZ, when they could give them a "non-addictive" (ahem??) med like Paxil?
Soon the makers of the other SSRIs saw how well the Paxil for anxiety was going and they all jumped on the bandwagon and spent the money to get their drugs approved for all sorts of things.
Something I said earlier is very key. No patent = no research. When we, as patients and consumers of psych meds get serious about investigating these medications, what they do, etc. we often turn to the academic, scientific, literature where studies are done and results are published.
What we often forget is that the drug companies fund these studies. They have the researchers on their payroll (thru grants), plus they have statisticians manipulating the data, plus they have marketing folks putting "spin" on the hard data to make their drugs attractive to prescribing physicians. So even the ivory tower of academia is being used to further the marketing (show benefit) and legislative (demonstrate efficacy for FDA req’s) objectives.
Finally, a general principal in medicine is "do no harm", and use the least harsh medicine that is effective for the problem.
So how does all of this tie into your original question of "Ritalin is / is not an AD"?
First, Ritalin WAS an AD, as was Dexedrine. It is printed in the Archives of General Psychiatry that Dexedrine is "probably the basic antidepressant".
http://balder.prohosting.com/~agpa/home/ritalin.htm
http://balder.prohosting.com/~agpa/home/dex.htm
But between then and now, two key things have happened. First Ritalin's patent has expired. No more research.
More importantly, the widespread recreational drug use of the 1960s and 1970s resulted in the Controlled Substances Act. Ritalin took a severe beating here, being classified as Schedule II, the most severely restricted category of drugs that are still legal to prescribe. If it weren't for ADD, these drugs (Ritalin, Dexedrine) would probably have faded into oblivion, being only seldom prescribed for narcolepsy.
So, to go back to the beginning, although Ritalin IS an effective antidepressant in some cases, and although it does fit the neruo-chemical profile of an AD, it is not marketed as an AD because it has no patent, and subsequently no profit motive, and even if it did, the DEA would shoot it down because of it's schedule II status.
This is very unfortunate, because it is very effective for some people, and has minimal side effects - it is far more effective, and far more tolerable - for me anyway - than any medication that is currently marketed as an AD.
But it’s not just about neurotransmitter reuptake and such. The marketing and legislative factors are a major influence on what is offered to us for our care.
Probably more than you wanted to know, but it's a subject that's near and dear to me.
> I've read that Ritalin (methylphenidate) blocks the reuptake of dopamine while dexedrine causes the release of dopamine. By blocking the reuptake of the neurotransmitter, Ritalin's mechanism of action is similar to antidepressants, so why isn't Ritalin an antidepressant?
Posted by JohnX2 on March 11, 2002, at 9:14:05
In reply to Ritalin is not marketed as AD (long detailed expl) » Bekka H., posted by fachad on March 11, 2002, at 8:47:10
This is a really good analysis!
Are you a fellow CNBC junkie by chance?-John
> Your post caught my eye.
>
> Ritalin is an AD. YMMV, but for me it's been the most effective AD I've found yet and it has remained effective for over 7 years. It's just not MARKETED as ad AD.
>
> Something that is very important to keep in mind as we try to understand these medications is that this industry (psychopharmacology/psychiatry) is not just about the science of brain chemistry and the improving of mental health.
>
> There are two other major factors that go into it: economics and legislation.
>
> When a drug is developed, it is done with the intention of making money for the drug company. That's just how the free market works. The company that makes it is hoping to capture market share, and in some cases create market share. An example of creating market share is the creation of the disorder PMDD for fluoxetine, marketed as Seraphim.
>
> The other major factor is legislation. For a drug company to bring a drug to market, they have to jump thru certain regulatory hoops, including doing studies that the drug is effective for the indication that they are going to market it for.
>
> Think about this statement: Paxil is not an anti-anxiety medication. That statement was absolutely true, at one time, in the same sense that your statement "Ritalin is not an AD" is true.
>
> But a few years into Paxil's release, suddenly advertisements started appearing for Paxil for anxiety, panic, etc. What happened? Did they change the molecule? Did the reuptake properties change? Nope. They jumped thru the FDA required hoops, did some studies, and got Paxil approved by the FDA for anxiety. Now Paxil IS an anti-anxiety medication.
>
> Doing those studies cost SKB money, but the investors saw an ROI (return on investment) because they were able to capture a whole new segment of the market, the anxiolitic market.
>
> But it gets better. Free market economics are all about competition. Who was the competition for the anxiolitic market, whose market share was Paxil going to cut into? The benzodiazapines. What an easy target.
>
> First, their patents have run out - you can buy cheap generics. That means that no one will bother funding studies trying to show that BZs are more effective than Paxil, because no patent=no research.
>
> Second, BZs are regulated by the other government entity that factors into our care, the DEA. BZs are classified as Schedule IV under the Federal Controlled Substances Act. They have "abuse liability". This unfortunate fact was leveraged by SKB to position Paxil as a safer, equally effective treatment for anxiety. Why would a doctor give someone an "addictive" BZ, when they could give them a "non-addictive" (ahem??) med like Paxil?
>
> Soon the makers of the other SSRIs saw how well the Paxil for anxiety was going and they all jumped on the bandwagon and spent the money to get their drugs approved for all sorts of things.
>
> Something I said earlier is very key. No patent = no research. When we, as patients and consumers of psych meds get serious about investigating these medications, what they do, etc. we often turn to the academic, scientific, literature where studies are done and results are published.
>
> What we often forget is that the drug companies fund these studies. They have the researchers on their payroll (thru grants), plus they have statisticians manipulating the data, plus they have marketing folks putting "spin" on the hard data to make their drugs attractive to prescribing physicians. So even the ivory tower of academia is being used to further the marketing (show benefit) and legislative (demonstrate efficacy for FDA req’s) objectives.
>
> Finally, a general principal in medicine is "do no harm", and use the least harsh medicine that is effective for the problem.
>
> So how does all of this tie into your original question of "Ritalin is / is not an AD"?
>
> First, Ritalin WAS an AD, as was Dexedrine. It is printed in the Archives of General Psychiatry that Dexedrine is "probably the basic antidepressant".
>
> http://balder.prohosting.com/~agpa/home/ritalin.htm
>
> http://balder.prohosting.com/~agpa/home/dex.htm
>
> But between then and now, two key things have happened. First Ritalin's patent has expired. No more research.
>
> More importantly, the widespread recreational drug use of the 1960s and 1970s resulted in the Controlled Substances Act. Ritalin took a severe beating here, being classified as Schedule II, the most severely restricted category of drugs that are still legal to prescribe. If it weren't for ADD, these drugs (Ritalin, Dexedrine) would probably have faded into oblivion, being only seldom prescribed for narcolepsy.
>
> So, to go back to the beginning, although Ritalin IS an effective antidepressant in some cases, and although it does fit the neruo-chemical profile of an AD, it is not marketed as an AD because it has no patent, and subsequently no profit motive, and even if it did, the DEA would shoot it down because of it's schedule II status.
>
> This is very unfortunate, because it is very effective for some people, and has minimal side effects - it is far more effective, and far more tolerable - for me anyway - than any medication that is currently marketed as an AD.
>
> But it’s not just about neurotransmitter reuptake and such. The marketing and legislative factors are a major influence on what is offered to us for our care.
>
> Probably more than you wanted to know, but it's a subject that's near and dear to me.
>
>
>
>
>
>
>
> > I've read that Ritalin (methylphenidate) blocks the reuptake of dopamine while dexedrine causes the release of dopamine. By blocking the reuptake of the neurotransmitter, Ritalin's mechanism of action is similar to antidepressants, so why isn't Ritalin an antidepressant?
Posted by Bekka H. on March 11, 2002, at 20:15:45
In reply to Re: Ritalin is not an antidepressant » Bekka H., posted by JohnX2 on March 11, 2002, at 3:28:49
Thank you JohnX2 for your help. I think that Ritalin and Dex. BOTH block the reuptake and release the NT, but each to a different degree.
Posted by Bekka H. on March 11, 2002, at 20:18:50
In reply to Ritalin is not marketed as AD (long detailed expl) » Bekka H., posted by fachad on March 11, 2002, at 8:47:10
Fachad, thank you for your help and for all the time you spent explaining that to me. It was a great help. I am bookmarking it so I can refer back to it.
May I ask whether you are on any meds now IN ADDITION to the stimulant? Do you not need an antidepressant with the stimulant?
Posted by fachad on March 11, 2002, at 20:51:13
In reply to Re: Ritalin is not marketed as AD (long detailed expl), posted by Bekka H. on March 11, 2002, at 20:18:50
Right now I am on:
Dexedrine 40 mg/day
Prozac 10 mg/day
Temazepam 30 mg/dayI did fine for quite a few years (about 5 yrs, I think) on Ritalin only for depression.
Last year I developed a herniated disk in my back, which caused me severe pain all the time. Being in pain day in, day out is not mentally healthy.
So I talked my GP into giving me some hydrocodone (Vicodan). Well, that worked moderately well for the pain. However, I discovered that being on Vicodin day in, day out is not mentally healthy, either.
So last March, a found myself in a Major Depressive Episode, after having done so well for so long with only Ritalin. I don't know if the constant pain or the extended usage of hydrocodone precipitated the MDD episode. Probebly both.
I hated starting an SSRI, because for me they cause a lot of problems including fatigue and lethargy, but I was really bad off and it was necessary.
The Prozac did relive my depression, but I got whopping insomnia. How ironic that I had been sleeping fine on a fairly high dose of stimulant (54 mg of Concerta), but now on an SSRI, I could not sleep. Anyway, the hypnotic is for insomnia caused by Prozac, not stimulants.
I hope to taper off the Prozac fairy soon. I'm thinking that I won't need help sleeping after that (provided I don't have rebound insomnia - you can't win), and I'll be able to quit temazepam and go back to stimulant only for prevention of depression and treatment of residual symptoms.
So that's where I'm at right now.
> Fachad, thank you for your help and for all the time you spent explaining that to me. It was a great help. I am bookmarking it so I can refer back to it.
>
> May I ask whether you are on any meds now IN ADDITION to the stimulant? Do you not need an antidepressant with the stimulant?
Posted by djmmm on March 12, 2002, at 21:10:36
In reply to Re: Ritalin is not marketed as AD (long detailed expl) » Bekka H., posted by fachad on March 11, 2002, at 20:51:13
Ritalin and serotonin
http://www.hhmi.org/news/caron2.html
Posted by Cam W. on March 13, 2002, at 1:04:21
In reply to Ritalin is not marketed as AD (long detailed expl) » Bekka H., posted by fachad on March 11, 2002, at 8:47:10
Wow, good explanation! - Cam
This is the end of the thread.
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