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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by patc on October 10, 2002, at 17:24:13
Hi.
Are there any new treatments for atypical depression. I don't want to take Nardil.
I'm trying to get by on Neurontin and Klonopin,but the "major" depression is killing me. So I recently started taking Wellbutrin again, which really makes me anxious and almost panicky.Gepirone is getting pushed to 2004.
I'm bummed.
Posted by jrbecker on October 10, 2002, at 19:36:07
In reply to Atypical Depression - any new treatments?, posted by patc on October 10, 2002, at 17:24:13
I know, I just found that out as well about gepirone. I recently wrapped up participating in a gepirone study at Columbia in NYC, and after talking to the docs just last week, they thought it was on track for release in early to mid '03. Too bad. Other 5HT1a agonists are on the way though, although probably not til '04 or '05. We can be hopeful though, since there are a lot of pharmacological treatment avenues coming out soon. See link (a UK site from '99, but it pertains to current FDA approval process)…
http://www.abpi.org.uk/publications/publication_details/targetDepression/section6.asp
As for available treatments, I have had some success from Lamictal, helping with cravings, irritability, social avoidance, motivation, and a small effect for hypersomnia (does cause some daytime sleepiness though).
My least disliked of the SSRIs was Celexa, and of the atypicals, it was Effexor. Might use a NARI as an adjunct (reboxetine; tomexetine [early '03 release]. But don't discount the MAOIs as an option (e.g., desipramine, nardil, parnate) though. Side effects aside, they have a great track for our depressive type and it still might be a best-fit for some of us.
I will let you know if I can find out more from the researchers at Columbia about gepirone.
J
Posted by patc on October 10, 2002, at 21:38:55
In reply to Re: Atypical Depression - any new treatments?, posted by jrbecker on October 10, 2002, at 19:36:07
Did Gepirone help?
Or were on a placebo?
I took Lamactil, but it caused s/t memory loss. I would lose my train of thought too often.
I did Nardil for years and I stopped because it pooped out and the side effects sucked, especially the 60 pound weight gain.
Pat
Posted by jrbecker on October 10, 2002, at 23:44:20
In reply to Re: Atypical Depression - any new treatments?, posted by patc on October 10, 2002, at 21:38:55
> Did Gepirone help?
>
> Or were on a placebo?
>
> I took Lamactil, but it caused s/t memory loss. I would lose my train of thought too often.
>
> I did Nardil for years and I stopped because it pooped out and the side effects sucked, especially the 60 pound weight gain.
>
> PatUnfortunately, I got the placebo. It was a 3 variable study testing paxil and gepirone against placebo.
The recent news about the FDA hold up, as was reported on the Organon website as well as news sites like the NY Times, stated that the FDA was wary of the efficacy rates. This data referred to an earlier study that tested gepirone against prozac. I'm a little worried about what the efficacy problems were. But I think the FDA flagged two things: 1) there was a low # of subjects in the study, and 2) there is skepticism over whether gepirone is really equal to an SSRI treatment.
Here's the pro-con argument on the issue of gepirone as I see it:
Supposedly, the data has been fairly good. As one researcher put it to me: "too many people have been feeling better for it to be just Paxil's effect." But, in all honesty though, I don't believe gepirone will be the ultimate cure-all for us atypicals. I doubt it will pack the 'euphoric' punch that most of the SSRIs do. Here's why. First of all, it's been kickin around the research circuit for over 15 years now. And secondly, it is a close cousin to Buspar, which I think is a joke of a drug as a monotherapy for either depression or anxiety. However, this might be good news…since the SSRIs induce a subtle hypomania in many atypical sufferers, not to mention the emotional-numbing & apathy that pretty much anybody who takes them experiences. Of course, their sh*ity side effects speak for themselves as well. So gepirone might be a better treatment afterall.In theory, the 5HT1a drug family (Azaspirones) is ideal for depression treatment. More of the newer azaspirones in research right now are more highly selective to 5HT1a than buspar. In addition they are antagonists to 5HT2, and metabolizing to the potent alpha-2 receptor antagonist…all good news. Now, whether these drugs work as good in practice is a different story. There are a number of reasons why they just might not, but I won't ramble any further here. Anyhow, there are a plethora of published studies that prove gepirone's efficacy over placebo. Also, it has been shown that it attenuates hypersomnia and overeating, as well as improving sexual functioning….
www.pslgroup.com/dg/21710e.htm
www.pslgroup.com/dg/217266.htmLong story short, I think we'll have to wait and see. It's too easy to be overly eager about these new drugs without knowing how much of a treatment innovation it might be.
Of particular note: As I mentioned, one reason why the FDA has held it up is b/c there haven't been enough subjects recruited. So if anybody's interested in participating, please call Organon or any local research hospitals or university medical centers in your area to see if you can get in the study and hopefully, we can see this drug on the market sooner than we think. And if you know of anybody interested, please pass it on. HELP US GET THIS ON THE MARKET FOR ALL OF US TO TRY! The study is fairly short and if you end up getting gepirone, you will most likely be able to continue taking the drug.
Pat: as for your trial of Lamictal, I'm interested in knowing how long you were on it and what dosage you tried. For me, almost all of traces of the side effects, including the memory and speech impairments, dissipated with time.
J
Posted by jrbecker on October 11, 2002, at 0:17:54
In reply to Re: Atypical Depression - any new treatments? » patc, posted by jrbecker on October 10, 2002, at 23:44:20
Hah, ironically, my psychiatrist just emailed me saying she was at a meeting today where the Columbia researchers presented the Gepirone data. She said the presentation made the data look enticing.
Posted by patc on October 11, 2002, at 6:56:37
In reply to Re: gepirone..., posted by jrbecker on October 11, 2002, at 0:17:54
I pray that Gepirone works.
SSRIs never worked for me.
Only Nardil, Klonopin and to a lesser extant Neurontin. Wellbutrin helps, but it makes me too anxious.
I don't remember the level of Lamactil, but it was the starting dose.
Pat
Posted by Peter S. on October 11, 2002, at 21:00:52
In reply to Atypical Depression - any new treatments?, posted by patc on October 10, 2002, at 17:24:13
Have you tried Lamictal? I have had atypical depression practically all my life and it (with a combination of Neurontin and Prozac) is pretty much gone.
> Hi.
>
> Are there any new treatments for atypical depression. I don't want to take Nardil.
> I'm trying to get by on Neurontin and Klonopin,but the "major" depression is killing me. So I recently started taking Wellbutrin again, which really makes me anxious and almost panicky.
>
> Gepirone is getting pushed to 2004.
>
> I'm bummed.
>
>
Posted by chad_3 on October 13, 2002, at 11:38:35
In reply to Re: Atypical Depression - any new treatments?, posted by Peter S. on October 11, 2002, at 21:00:52
A study showed 90+ % of Dr's questioned believed Nardil was best for atypical depression.
Amazingly, the rate of Nardil as best for SP was relatively low - I think about 40%, but for atypical depression quite amazing to find so much agreement by Dr's on that one...
Chad
> > Hi.
> >
> > Are there any new treatments for atypical depression. I don't want to take Nardil.
> > I'm trying to get by on Neurontin and Klonopin,but the "major" depression is killing me. So I recently started taking Wellbutrin again, which really makes me anxious and almost panicky.
> >
> > Gepirone is getting pushed to 2004.
> >
> > I'm bummed.
> >
> >
>
>
This is the end of the thread.
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