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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by borderliner21 on March 16, 2002, at 19:27:54
I just don't get it, serzone and remeron do not have the serious side effects that ssri's do(restlessness, sexual dysfunction, dystonia, insomnia etc etc. ) and ssri's are still the first line treatment for depression! ssri side effects ruined a year of my life (no sex, serous dystonia) and I still suffer sexual dysfunction after 8 months after paxil. Is it because ssri;s work better?
Posted by OldSchool on March 16, 2002, at 20:31:29
In reply to wy do people prefer ssri's over serzone/remeron??, posted by borderliner21 on March 16, 2002, at 19:27:54
> I just don't get it, serzone and remeron do not have the serious side effects that ssri's do(restlessness, sexual dysfunction, dystonia, insomnia etc etc. ) and ssri's are still the first line treatment for depression! ssri side effects ruined a year of my life (no sex, serous dystonia) and I still suffer sexual dysfunction after 8 months after paxil. Is it because ssri;s work better?
This is a good question. I can tell you Remeron is not prescribed as much because Remeron is very sedating and causes bad weight gain. Remeron is the ideal antidepressant for agitated depression. But its not the best AD for the average depressive because of its sedation/weight gain side effect profile. Women in particular dont like Remeron cause they hate weight gain. However Remeron is a great drug...its one of the best ADs.
As for Serzone, well I dont really have a concrete answer. I do know Serzone kind of has a reputation as being a "wussy" antidepressant and not being one of the stronger ADs. SSRIs are more popular because they are EXTREMELY safe to use, you cant overdose on them and kill yourself, they have no real cardio toxicity.
SSRIs also came out first. Prozac was the first and many claim it is still the best overall antidepressant.
Eric
Posted by TSA West on March 16, 2002, at 20:32:29
In reply to wy do people prefer ssri's over serzone/remeron??, posted by borderliner21 on March 16, 2002, at 19:27:54
SSRIs are approved for more indications than Serzone or Remeron, such as Social Anxiety Disorder, Panic Disorder, and Bullemic Disorder. So that's why they are chosen first, because of their supposed versatility.
Posted by Cressida on March 16, 2002, at 21:24:46
In reply to wy do people prefer ssri's over serzone/remeron??, posted by borderliner21 on March 16, 2002, at 19:27:54
I just don't get it, serzone and remeron do not have the serious side effects that ssri's do(restlessness, sexual dysfunction, dystonia, insomnia etc etc. ) and ssri's are still the first line treatment for depression! ssri side effects ruined a year of my life (no sex, serous dystonia)and I still suffer sexual dysfunction after 8 months after paxil. Is it because ssri's work better?
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In general, I think SSRI's are considered safer, especially in overdose. Also, the SSRI class of psychotropic drugs are a little older than the atypical drugs such as Remeron and Serzone. I'm only assuming, as I honestly don't know the true reasons...
Posted by borderliner21 on March 16, 2002, at 21:38:48
In reply to only a follow-up post, posted by Cressida on March 16, 2002, at 21:24:46
I would conside serzone much safer because some people get EPS / permanent tardive dyskenesia from ssri's
Posted by Hal on March 17, 2002, at 7:16:31
In reply to wy do people prefer ssri's over serzone/remeron??, posted by borderliner21 on March 16, 2002, at 19:27:54
> I just don't get it, serzone and remeron do not have the serious side effects that ssri's do(restlessness, sexual dysfunction, dystonia, insomnia etc etc. ) and ssri's are still the first line treatment for depression! ssri side effects ruined a year of my life (no sex, serous dystonia) and I still suffer sexual dysfunction after 8 months after paxil. Is it because ssri;s work better?
The question should be why do *psychiatrists* prefer SSRIs. They dish out SSRI like water because SSRIs are have a low side effect profile for *themselves*. That is, they don't have to worry about patients overdosing on SSRIs, minimal drug interactions and dosing the meds are easy. Unforunately, we as patients have to suffer through the physiological side effects of the SSRIs like sexual dysfunction, apathy, insomnia, nausea, diarrhea, etc.
Most patients have better responses to TCAs or MAOIs and often with less side effects. But psychiatrists are reluctant to prescribe these more effective drug because they have to spent more time titrating the drugs, worry about a patient overdosing on the med and don't receive perks from the drug companies who make the generic TCA/MAOIs.
So many pdocs prescribe for whats in there interest, not the patients!
Hal
PS to be fare, the parents of Libby Zion are to blame as well. They sued a group of doctors in New York for the death of there daughter. She was on Nardil and received Demerol at an Emergency Room and from complications of either hypertensive crisis or pulmonary hemorrhage. But she also took massive amounts of cocaine, which was more likely the cause of her death rather then the demerol. So doctors are reluctant to prescibe MAOI because of "lawsuit happy Americans."
Posted by Anyuser on March 17, 2002, at 10:45:31
In reply to wy do people prefer ssri's over serzone/remeron??, posted by borderliner21 on March 16, 2002, at 19:27:54
Here is a link to an article that offers a possible answer: http://www.salon.com/sex/feature/2000/09/26/wellbutrin/index.html
Posted by OldSchool on March 17, 2002, at 12:06:17
In reply to Re: only a follow-up post, posted by borderliner21 on March 16, 2002, at 21:38:48
> I would conside serzone much safer because some people get EPS / permanent tardive dyskenesia from ssri's
Do people get EPS rarely from SSRIs? The answer is yes. Do people get tardive dyskinesia from SSRIs? The answer is NO. I never heard of anybody getting TD from SSRIs. The SSRI caused TD thing is stretching things quite a bit.
EPS...sure. TD? Nah thats a neuroleptic thing.
Old School
Posted by OldSchool on March 17, 2002, at 12:20:52
In reply to Why do people prefer ssri's over Wellbutrin?, posted by Anyuser on March 17, 2002, at 10:45:31
> Here is a link to an article that offers a possible answer: http://www.salon.com/sex/feature/2000/09/26/wellbutrin/index.html
Thats an excellent article about Wellbutrin. Wellbutrin is a great antidepressant and it is very often underestimated. Ive had one or two psychiatrists who thought Wellbutrin is a "weak" antidepressant and I totally disagree with them. I personally found Wellbutrin SR to be a good AD and in fact I made my very first recovery on high dosage Wellbutrin SR years ago. SSRIs and Remeron hadnt worked for me, Wellbutrin SR worked fairly good however. I didnt get the "poopout" as bad with Wellbutrin SR as I did with serotonergic ADs. Weird huh?
As far as the seizure risk of Wellbutrin, yes its true Wellbutrin got a bad name early on because of that. Yet the seizure risk with Wellbutrin SR is EXTREMELY LOW. So low, I totally do not worry about it. In fact, my family doctor told me once that the reason Wellbutrin is associated with seizures is simply because the company that makes it was actually honest in its reports to the FDA back in the eighties. More honest than other drug companies concerning their antidepressants. My family doctor also told me that Effexor actually has a higher risk of seizures than Wellbutrin! Yet you never hear about any seizure connection to Effexor. Of course, even with Effexor the seizure risk is still ridiculously low and I have taken the max PDR dose of it.
I am totally unconcerned with seizure risk from antidepressants. I believe the only people who should be concerned with seizures from ADs are those who have a prior history of seizures.
Old School
Posted by djmmm on March 18, 2002, at 19:37:22
In reply to Re: Why do people prefer ssri's over Wellbutrin?, posted by OldSchool on March 17, 2002, at 12:20:52
Eric...Wellbutrin is weak in terms of potency; it's efficacy is similar to the SSRIs....I'm assuming that's what your Pdocs were trying to say...
Wellbutrin has less incidences of poop-out because it doesn't increase serotonin as much as the ssris...check out this link I found, it's in another post
Posted by OldSchool on March 18, 2002, at 20:14:11
In reply to Re: Why do people prefer ssri's over Wellbutrin?, posted by djmmm on March 18, 2002, at 19:37:22
> Eric...Wellbutrin is weak in terms of potency; it's efficacy is similar to the SSRIs....I'm assuming that's what your Pdocs were trying to say...
>
> Wellbutrin has less incidences of poop-out because it doesn't increase serotonin as much as the ssris...check out this link I found, it's in another post
>
> http://dr-bob.org/babble/20020318/msgs/98652.html
Hmmmm excess serotonin causes AD poopout? I never heard of that one before. That is an interesting website, Ive seen that one before. Those Neuropsychiatry guys seem to like high dose Buspar a lot, I saw on there those guys say super high dose buspar can be used for TD.As for antidepressant poopout, I dont really know what to believe in the end. Most of the stuff Ive read has said its gradual dopamine depletion that causes much of the SSRI poopout. But nobody really knows I have gotten the impression. It seems to be heavily guesswork and hypothesis stuff...nothing concrete. Arent you a pharmacy student? What do you learn in pharmacy school about the mechanism(s) of SSRI poopout?
I did find Wellbutrin pooped out much less than serotonergic drugs. Its been years since I have taken it though. I did make my first semi-recovery on it strangely...its supposed to be this "weak" antidepressant I didnt find it was weak at all. I was also taking a lot of benadryl for insomnia when I made my first semi-recovery on Wellbutrin. It was more steady, it had a mild stimulant effect that just kept going and going. It wasnt any stronger than the SSRIs, just more steady and not the fadeout. With the problems I have now, I should probably switch back to Wellbutrin SR as my AD. It doesnt really have any real side effects.
Old School
Posted by Hal on March 18, 2002, at 21:10:44
In reply to Re: Why do people prefer ssri's over Wellbutrin?, posted by OldSchool on March 18, 2002, at 20:14:11
Hey Everyone,
My take on poop out is it has nothing to do with the medication. The med, whether an SSRI or even an antibiotic does not change over time, the drug molecule is the same. What does change is the metabolism of the medication or the disease itself. If your body starts to metabolize the med quicker, just increase the dose and the efficacy will return. If the disease changes, that is the bacteria mutates or the depression changes, the medication may become less effective and increasing the dose will do nothing. You need a new medication.
There is no reason to think depression is different from other diseases, it probably changes and evolves over time. I think it is a minority of patients which find a the same med is effective over their entire life. Most need to shuffle meds occassional throughout their life. Be that as it may, my mother has been on the same med for 25 years, yet my father has needed to periodically change meds when the depression breaks through on particular medication.
This is pure theory and conjecture on my part!
Hal
Posted by chiaratara on March 19, 2002, at 2:03:59
In reply to Actually, why do *PSYCHIATRISTS* prefer SSRIs, posted by Hal on March 17, 2002, at 7:16:31
i will have to disagree with you on this one. SSRIs have worked for a whole lot of people. i think it should be what is tried first. when someone has weeds in their yard, do they immediately go for the napalm? SSRIs don't have dangerous side effects and interactions and once again, they work for a lot of people. unfortunately, most pdocs don't see their patients every day and cannot monitor what their client is doing. pdocs know that their clients aren't always totally honest with them. "no, i'm not doing any drugs." or, in the case of MAOIs, "no i don't eat tofu or cheese." these drugs that you are refering to should be used when other, safer methods are not working. would you want to give a freshman in college an MAOI and hope that she doesn't go out drinking the next weekend? Have you ever read the package insert on some of those drugs? in this day and age when people are on all sorts of perscription medication and self medicate, they don't need to be worrying if their patient is going to have heart problems from eating a hotdog with sauerkraut that interacts with their MAOI. have you looked at the dietary restrictions for people on MAOIs? i will eat paxil like candy before i would consider taking an MAOI.
i do think that for people like you, who know a lot about psychiatric drugs, MAOIs wouldn't be as much of a risk. however, for the 90% of the people that walk into a pdoc's office looking for an antidepressant, i would suggest a goody bag filled with prozac. SSRI side effects are nothing compared to other medications.
Posted by Hal on March 19, 2002, at 6:28:33
In reply to Re: Actually, why do *PSYCHIATRISTS* prefer SSRIs, posted by chiaratara on March 19, 2002, at 2:03:59
Hey Chiaratara,
I agree with you for the most part. I don't advocate MAOIs as a first med and probably not as a second med for most patients. I do think secondary amine TCA are first line meds, desipramine and nortriptyline. I find many patient report that they have a lower side effect profile that the SSRIs. They prefer dry mouth and mild constipation of the TCAs to insomnia, sexual dysfunction and anxiety of the SSRIs. It may take and extra week or two to taper the med correctly or even a blood level on my part, but it is worth it when you see the patient have a much better response to a TCA rather than SSRI. I see people who have been on years of various SSRIs and still depressed, and then on desipramine/nortriptyline final feel normal again.
Take care.
Hal
Posted by chiaratara on March 19, 2002, at 10:47:32
In reply to Re: Actually, why do *PSYCHIATRISTS* prefer SSRIs, posted by Hal on March 19, 2002, at 6:28:33
hi hal,
thank you for the response. i need to go and brush up on my reading about pharmaceuticals. i do not know much about TCAs, and from what you are saying, i should know more. it could be of use someday
thanks again.
take care,
tara
Posted by djmmm on March 19, 2002, at 14:54:05
In reply to Re: Actually, why do *PSYCHIATRISTS* prefer SSRIs, posted by chiaratara on March 19, 2002, at 2:03:59
> i will have to disagree with you on this one. SSRIs have worked for a whole lot of people. i think it should be what is tried first. when someone has weeds in their yard, do they immediately go for the napalm? SSRIs don't have dangerous side effects and interactions and once again, they work for a lot of people. unfortunately, most pdocs don't see their patients every day and cannot monitor what their client is doing. pdocs know that their clients aren't always totally honest with them. "no, i'm not doing any drugs." or, in the case of MAOIs, "no i don't eat tofu or cheese." these drugs that you are refering to should be used when other, safer methods are not working. would you want to give a freshman in college an MAOI and hope that she doesn't go out drinking the next weekend? Have you ever read the package insert on some of those drugs? in this day and age when people are on all sorts of perscription medication and self medicate, they don't need to be worrying if their patient is going to have heart problems from eating a hotdog with sauerkraut that interacts with their MAOI. have you looked at the dietary restrictions for people on MAOIs? i will eat paxil like candy before i would consider taking an MAOI.
>
> i do think that for people like you, who know a lot about psychiatric drugs, MAOIs wouldn't be as much of a risk. however, for the 90% of the people that walk into a pdoc's office looking for an antidepressant, i would suggest a goody bag filled with prozac. SSRI side effects are nothing compared to other medications.I was an emotionless, libidoless, zombie on every ssri I took...Wellbutrin gave me hives, a combo of Prozac and Effexor led to and "episode" and a seizure and now epilepsy...I take the MAOI Nardil now so avoiding sauerkraut is the least of my worries.
This is the end of the thread.
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