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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Laney on October 15, 2011, at 11:15:09
doc said "Milnacipran is not approved for the treatment of depression in the US"
What can I say in response to this?
Laney
Posted by Chairman_MAO on October 15, 2011, at 11:23:03
In reply to I want to try milnacipran but doc said not approve, posted by Laney on October 15, 2011, at 11:15:09
My doctor asked me if I wanted to try that just a few days ago (for dysthymia/social phobia) before jumping to Marplan. It is obviously an antidepressant and you should find a doctor that knows what he's doing.
Who cares if it's not licensed in the US? It is obviously an antidepressant.
NOTE: I am in the US.
Posted by Phillipa on October 15, 2011, at 12:21:44
In reply to I want to try milnacipran but doc said not approve, posted by Laney on October 15, 2011, at 11:15:09
Laney true I guess what makes you feel this is a good one? I'm more than curious see new pdoc Wed old one retiring. Taking the desipramine? Love Phillipa
Posted by Laney on October 15, 2011, at 12:52:37
In reply to Re: I want to try milnacipran but doc said not approve » Laney, posted by Phillipa on October 15, 2011, at 12:21:44
Thanks guys! Yes, still taking desiprimine but Chairman's previous posts about combining TCA's and SSRI's made me think even though Scott has recomended this and so has bleuberry.
The worst thing about desiprimine is the constipation. So far nothing for mood.
I'm hoping someone will produce some information that I can show my Pdoc that it is being used for depression in the U.S.
Good luck with your new Pdoc on Wed.
Laney
Posted by Christ_empowered on October 15, 2011, at 14:12:20
In reply to Re: I want to try milnacipran but doc said not approve, posted by Laney on October 15, 2011, at 12:52:37
Hey Laney.
Its weird to me that your doc would say no just because its not approved in the US for depression. Is it a public health doctor? I go to one, and that sounds like something they might say. Then again, all shrinks use stuff "off label" all the time, so its strange that any psychiatrist would say something like that, especially when there's a pretty good track record of successful use in other countries.
If you're that interested, you can always order it from an online pharmacy w/o an Rx for relatively cheap. I mean, that's kind of going behind your shrink's back, but hey--you do what you gotta do, right? Plus, its not like its Xanax or something.
Good luck!
Posted by jono_in_adelaide on October 15, 2011, at 19:21:49
In reply to Re: I want to try milnacipran but doc said not approve, posted by Laney on October 15, 2011, at 12:52:37
You dont seem to have given the paroxetine/desipramine much of a chance..... a few days at subtheraputic doese is not a fair trial.
If you're looking for a drug that will totaly cure you in a week with no sde effects, you're going to be disapointed
Posted by Chairman_MAO on October 15, 2011, at 20:52:06
In reply to Re: I want to try milnacipran but doc said not approve, posted by jono_in_adelaide on October 15, 2011, at 19:21:49
Cure in one week? Try starting at 60mg/day of tranylcypromine from day one. ;-) That worked for me!
Now, sleeping was another matter. Don't try this at home.
Posted by Laney on October 15, 2011, at 21:44:55
In reply to Re: I want to try milnacipran but doc said not approve, posted by jono_in_adelaide on October 15, 2011, at 19:21:49
I have tried this combination before, for three weeks. I know it hasn't been long enough but just looking ahead! I
I don't expect anything to work that quick! Wouldn't that be nice though?
Laney
Posted by FrustratedMama on October 15, 2011, at 23:30:05
In reply to Re: I want to try milnacipran but doc said not approve, posted by jono_in_adelaide on October 15, 2011, at 19:21:49
Is milnacipran the same as Savella? If so ..... It was awful for my anxiety..... Just thought I would add my two cents cause it seems we have responded somewhat similar to meds.... But others love it !!!!
Posted by bleauberry on October 16, 2011, at 6:29:16
In reply to I want to try milnacipran but doc said not approve, posted by Laney on October 15, 2011, at 11:15:09
My guess is the most likely reason he said that is because he is protecting himself from any troubles with his Board or with insurance carriers. That's because if something goes wrong in the treatment, he could be scrutinized for prescribing an off label med when he should have prescribed firstline meds instead. Off label doesn't seem to be a problem after it has been done a while and a lot of doctors do it. With savella however it hasn't been on the market very long so I don't think it has built a following or a pattern yet.
The fact that it is new could be a factor as well. Maybe the doctor is just more comfortable sticking within his comfort zone?
The manufacturers of savella I think must have been very concerned about the risks of psychiatric prescriptions because they went out of their way to overemphasize in their label that savella is not an antidepressant and could have suicide risk or cause depression. That is actually true of all the psych meds equally, but they purposely put it right on the table so no one could miss it. That, I believe, in an attempt to protect themselves while entering the dangerous waters of the USA prescription market. I think they were perfectly happy going for the fibromialgia market and didn't want the risk of the depression market.
That said, savella has been approved as an antidepressant in other countries for many years. It's one of the few primary antidepressants in Japan. It has a large number of clinical studies on it including some with treatment resistant depression. Speaking only for myself, it put a significant dent in my ECT resistant depression rather quickly at a super low dose.
So I don't know what the fuss is all about. Some people are comfortable managing their own decisions. If that were the case, savella is easily ordered by mail without a prescription from overseas. Not recommending it, just sayin.
What you could do maybe is ask the doctor what he wants you to try. Go along with it and show some enthusiasm and interest in the idea. Then tell him you are even more excited than that with savella. Then strike a deal. Tell him you would like to try savella right now, and that the deal is if it goes badly then the doctor's idea is next up. The doctor/patient relationship really should be one of that kind of trust and give-n-take. If it's not, then it's not a good relationship and either needs to be nurtured or dissolved.
Posted by Laney on October 16, 2011, at 11:26:18
In reply to Re: I want to try milnacipran but doc said not approve, posted by bleauberry on October 16, 2011, at 6:29:16
Bleuberry,
Why did you stop taking it?
Also, there's lots of anxiety with just 15mg. of desiprimine. Will this ever abate as I'm supposed to shoot for 50mg?
I can't even imagine how I'd feel or even sleep.
Thanks!
Laney
This is the end of the thread.
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