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#1
Old 07-05-2001, 04:23 AM
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What is the difference between these? I understand they are forms of SSRI but is the difference mainly chemical.

The sites all say the help rebalance seratonin (sp?) but that is about it.

Is it a difference like Asprin vs Ibuprofen vs Naproxen, where as they are all NSAIDS or a difference like Ibuprofen (or asprin) vs Acetomenephen, where as they both relieve pain but do it differently.
#2
Old 07-05-2001, 08:41 AM
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Quote:
Originally posted by Markxxx
Is it a difference like Asprin vs Ibuprofen vs Naproxen, where as they are all NSAIDS or a difference like Ibuprofen (or asprin) vs Acetomenephen, where as they both relieve pain but do it differently.
That sentence makes no sense to me. Aspirin (acetysalycylic acid) is a different chemical than ibuprofen (Advil, Motrin, etc.) But they are all NSAIDs. Whereas, acetominophen (Tylenol, etc.) is not an NSAID, but only an antalgesic. They all relieve pain but different chemicals do it differently. Acetominophen does not relieve inflammation, or if does, only slightly.

Anyway, to answer your question, Wellbutrin is not a SSRI. It is a weak blocker of the neuronal uptake of serotonin and norepinephrine. It inhibits the neuronal reuptake of dopamine to some extent.

Prozac, Zoloft, and Paxil are SSRI. As such, they all work the same way. However, IANAMD.
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#3
Old 07-05-2001, 08:52 AM
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The only difference I can see between the SSRI's you listed is that they all have different side-effects. They all do the same thing, but a person taking this type of anti-depressant might try all of them until they find one that doesn't do more harm than good with the side-effects.

And barbitu8 is correct, Wellbutrin works with the dopamine system and is used sometimes with an SSRI. It's also commonly prescribed to women who are, for lack of a better word, frigid. It's supposed to boost libido in women.

Hope I've helped.



BTW - You missed one in the main SSRI family. Celexa is also prescribed often for depression.
#4
Old 07-05-2001, 08:53 AM
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Some cost more than others. Some need a pill to be taken twice a day. Some cause drowsiness while others cause anxiety, Comprende?
Each of the medicines have subtle differences that might compell a doctor to choose one over the other to better meet the specific needs of each individual patient.

IANAMDE


I suggest you stand in front of a mirror in the dark and say "Quadgop the Mercotan" three times.
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#5
Old 07-05-2001, 08:59 AM
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Quote:
Originally posted by wishbone
say "Quadgop the Mercotan" three times.
"... and I can't even say Ticonderoga."
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#6
Old 07-05-2001, 09:28 AM
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Just a quick FYI:

SSRIs have a range of possible documented side effects, including:

Delayed ejaculation
Loss of libido
Nausea
Hypertension
Weight gain

Lest you feel that the SSRIs are too dangerous, remember that these side effects are rather less intrusive that those presented by, say, certain MAO-Inhibitors, or by depression itself. These effects are by no means experienced by all users of SSRIs. One SSRI will have one group of side effects, while others have will have different effects. Understanding the drugs and judging which will be efficacious without unacceptable side effects is a job for a physician.
#7
Old 07-05-2001, 10:08 AM
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This article is kinda creepy. Rewiring your brain with over proscribed drugs that lose efficacy over time? I think I'll take a pass. Not to mention the side effects.
#8
Old 07-05-2001, 10:15 AM
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Barbitu8 summed it up pretty well (as usual!) as did the other respondants, so I've nothing really useful to add other than it's a complex area of medicine. As a Family doc, a generalist, I'm comfortable prescribing about 3 different anti-depressants, and then only if the patient agrees to work with a therapist or psychiatrist. There are getting to be so many choices out there, each with its own variable advantages and disadvantages that I frankly can't keep up.
#9
Old 07-05-2001, 10:18 AM
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Quote:
Originally posted by adam yax
This article is kinda creepy. Rewiring your brain with over proscribed drugs that lose efficacy over time? I think I'll take a pass. Not to mention the side effects.
I agree. This is not candy, and not for normal reactions to life's stresses. It's serious medicine for people with serious depression, and here, the benefits can really outweigh the risks.
#10
Old 07-05-2001, 11:14 AM
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They're not candy, but once you find one that works, it can make an extraordinary difference.

The process of finding the correct drug can take a while, and ideally you should work with a psychiatrist for this. If you're seeing another kind of therapist (social worker, psychologist, etc., none of whom can give prescriptions), he or she will usually have the names of several psychiatrists just so you can deal with the drug issue.

My regular shrink's a social worker, and when we determined that a drug might help she gave me the name of a psychiatrist. At first, we tried Wellbutrin because it has the fewest sexual side effects. I found it made me too hyper, and worsened rather than lessened my anxiety. So then we tried Paxil, which is particularly indicated for panic. A low dose worked for me, so the much-feared sexual side effects are minimal.

I only had to see the psychiatrist three times, which was a Good Thing since those visits were out of pocket. My GP is perfectly happy to issue my renewals, although like Qagdop I don't think he'd have been comfortable prescribing in the first instance.

I have prescription coverage through my health plan, so it's not costing me too much. Prozac is coming off patent soon, so will be available in generic version (which is why its manufacturer is busy pushing a seven-day version, for which it will retain the patent).

Good luck - Oxy.
#11
Old 07-05-2001, 03:19 PM
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Re: Just a quick FYI:

Quote:
Originally posted by Tranquilis
SSRIs have a range of possible documented side effects, including:

Delayed ejaculation

<snip side effects I haven't experienced from Luvox, the SSRI I'm on for major depression>
Even the side effects can be of mixed benefit ... If I can just get in better shape, I can rock and roll all night, baby! Can be a bit frustrating, though, I have to admit.
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#12
Old 07-05-2001, 09:29 PM
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As a final year resident, I prescribe these drugs often.

Zoloft, Prozac and Paxil are all SSRIs and probably more similar than drug literature would have us believe. Paxil is the only one currently approved for treatment of social anxiety and is useful for depression with an element of anxiety. It also tends to make patients drowsy and can be useful if sleep is impaired. It causes lots of side effects, though, especially for the first couple weeks; mainly gastrointestinal and a drugged-drowsy sensation. Zoloft has fewer side effects and I tend to use it in more elderly patients. In this population, depression is often subtle and it is important to ask specifically about hobbies and activities. Prozac is cheap (generic), dependable and a good choice too. Wellbutrin is meant for "atypical" depressions, if other alternatives fail, if there is hypersomnolence (too much sleep) or I suppose if smoking is an issue, not that I use it personally for the last one.
#13
Old 07-05-2001, 11:51 PM
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If they are so similar why is Paxil the only one for anxiety,

I ask as we just got out new fomulary meds for our HMO and they have replaced Prozac with Paxil. In other words they won't pay for Prozac but only Paxil.

This has a few people I work with upset. It isn't so bad I just got my Azmacort replaced with Flovent but I don't use a steriod often so maybe twice a year and if this Flovent is bad I'll pay the extra for the Azmacort.

But at $100.00 a prescription it seems that isn't an option for many. I know there is an appeals process but it usually fails.

But it seems maybe even dangerous to arbitraily take someone off one antidepressent to another unless they are the same.
#14
Old 07-06-2001, 12:01 AM
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Quote:
Originally posted by Markxxx
This has a few people I work with upset. It isn't so bad I just got my Azmacort replaced with Flovent but I don't use a steriod often so maybe twice a year and if this Flovent is bad I'll pay the extra for the Azmacort.[/B]
Flovent is pretty good, I prescribe it a lot. But both flovent and azmacort are meant to be maintenance medications, used regularly, whether the asthma is acting up or not. Anyone who needs a rescue inhaler (like albuterol) more than once a week should be on a maintenance medication, to reduce lung inflammation. It's the lung inflammation, not the bronchospasm, that causes long-term lung damage.

You raise legitimate issues with the formulary comments, but I can't open that can of worms right now. It's late. I don't need to get angry, I want to sleep tonight.

Dr Pap has given a good description of the "fantastic four" of antidepressants, much more concisely than I could have.
#15
Old 07-06-2001, 09:08 AM
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I have a related question...how about Celexa? It is described as "a highly selective" SSRI. Can someone explain this?

Zoloft alone doesn't do much for me; combined with Celexa it works...also I take lithium. Wellbutrin made me manic, Prozac had no effect. Imipramine was the only single med I took that was fairly effective, but it has significant side effects. It seems there is a lot of trial & error in finding the correct combination & dosage.

Carina, who truly wishes she didn't have to spend so much of her life on meds but it's better than the alternative!
#16
Old 07-06-2001, 09:22 AM
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Quote:
Originally posted by Dr_Paprika
Wellbutrin is meant for "atypical" depressions, if other alternatives fail, if there is hypersomnolence (too much sleep) or I suppose if smoking is an issue, not that I use it personally for the last one.
Wellbutrin is that quit smoking pill? What if I were to use it to quit smoking, is there a chance that I could develop depression once the drug is stopped and my brain has to readjust to lower levels of serotonin?
#17
Old 07-06-2001, 09:44 AM
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[QUOTE]Originally posted by adam yax
Quote:
Wellbutrin is that quit smoking pill? What if I were to use it to quit smoking, is there a chance that I could develop depression once the drug is stopped and my brain has to readjust to lower levels of serotonin?
Not to be a big hijacker, but I have a question about withdrawal from these medications as well. The last time I tried to stop taking Prozac, I nearly ended up in the psych ward. Mind you, I started out with pretty bad depression, but nothing that came even CLOSE to what occurred when I stopped taking Prozac. I gradually lowered the dosage as my physician prescribed, but still had major problems getting off of it.

Yet, I frequently hear it's not "habit forming." Okay, maybe it's not habit forming in the sense that I need more and more to get an affect. But doesn't this kind of withdrawal mean...well, isn't it WITHDRAWAL? Or is it all in my head?

-L
#18
Old 07-06-2001, 10:12 AM
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Quote:
Originally posted by SexyWriter
Not to be a big hijacker, but I have a question about withdrawal from these medications as well. The last time I tried to stop taking Prozac, I nearly ended up in the psych ward. Mind you, I started out with pretty bad depression, but nothing that came even CLOSE to what occurred when I stopped taking Prozac. I gradually lowered the dosage as my physician prescribed, but still had major problems getting off of it.

Yet, I frequently hear it's not "habit forming." Okay, maybe it's not habit forming in the sense that I need more and more to get an affect. But doesn't this kind of withdrawal mean...well, isn't it WITHDRAWAL? Or is it all in my head?

-L [/B]
It's definitely not in your head. I ran out of Paxil at one point and after a couple of days I was not doing well. I had physical symptoms like a weird dizziness when I moved around, and heightened anxiety. I went on these drugs (now on Celexa) because they said they aren't habit-forming but now I feel stuck on them. They are worth the side effects to me but I dread having to get off them some day.

My brother was on Wellbutrin and the difference with those MAOIs is you can't take a lot of other things with them (OTC cold medicine, etc.) Drinking a lot of alcohol isn't a good idea with any of these.
#19
Old 07-06-2001, 10:33 AM
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[QUOTE]Originally posted by gigi
Quote:
I had physical symptoms like a weird dizziness when I moved around, and heightened anxiety.
A friend of mine caused an auto accident on his way to my house while trying to get off of Zoloft. The dizziness and "foggy" feeling when trying to get off of Prozac is horrible as well. I know now that if I want to stop taking this medication I have to take a week or so off of work and make sure I don't need to do anything besides drool.

What really bugs me about this is that it ends up making me feel truly CRAZY. Because the doc generally assures me, "no side affects, no addiction, no problem." Then when I show up at his office door crying, hysterical, unable to work, too dizzy to drive, he acts as if it can't possibly be the medication he prescribed because he's never seen such a thing before. I end up assuming that I'm either completly bonkers, or I'm the one unlucky person in eleventy million who has this problem.

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#20
Old 07-06-2001, 11:43 AM
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All antidepressants can cause rebound depression if stopped too suddenly. It usually takes a few days to a few weeks, just like the medications take a while to start working in the first place. That's why it's important to taper off the medication rather than stop cold turkey.

IMO, the differences between the SSRIs are minimal. I don't know how much better Paxil is for anxiety symptoms than the others, but I always suspected the SAD indication to be more the result of aggressive marketing and FDA lobbying than hard science. Celexa was late to the marketing party; it claims to be more selective and thus have fewer side effects, but again, I doubt that has been objectively backed up.

I can't really add much to what the other docs have said. I think these are great drugs, and they've helped bring psychiatric treatment to primary care; I plan to take some psych electives in my Internal Medicine residency for just that reason.

Dr. J
#21
Old 07-06-2001, 11:56 AM
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Re: Re: Just a quick FYI:

Quote:
Originally posted by SCSimmons

Posted by Tranquilis
Delayed ejaculation...

<snip>side effects I haven't experienced from Luvox, the SSRI I'm on for major depression

Even the side effects can be of mixed benefit ... If I can just get in better shape, I can rock and roll all night, baby! Can be a bit frustrating, though, I have to admit.
Zoloft had that effect on me, and my wife loved the delayed ejaculation part of it, but she hated that because of reduced libido, she wasn't getting it frequently enough. Fortunately I was only on it for a short time, and we just made up for the 'endurance' bit with more frequent sex, once my libido recovered.
#22
Old 07-06-2001, 12:03 PM
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Quote:
Originally posted by DoctorJ
Celexa was late to the marketing party; it claims to be more selective and thus have fewer side effects, but again, I doubt that has been objectively backed up.
If the makers of Celexa are claiming this publicly, either through physican information sheets or via any other public forum, then it has been backed-up by clinical study. The FDA is rabidly aggressive when it comes to Labelling and publishing of Drug Efficacy Claims. More than one pharmaceutical firm has had it weewee severely whacked in the last year for unsupported claims. The FDA takes a really dim view of unsubstantiated claims on the efficacy and attributes of ethical pharmaceuticals.
#23
Old 07-06-2001, 06:44 PM
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Quote:
Originally posted by Dr_Paprika
Wellbutrin is meant for "atypical" depressions...
I hadn't heard that.

Quote:
Originally posted by DoctorJ
I don't know how much better Paxil is for anxiety symptoms than the others, but I always suspected the SAD indication to be more the result of aggressive marketing and FDA lobbying than hard science.
Well yeah, it's not only lobbying, it's that it's the only SSRI that has been tested enough on SAD. But, AFAIK, there's no evidence to suggest that the other SSRIs don't work just as well.


Quote:
Originally posted by DoctorJ
Celexa was late to the marketing party; it claims to be more selective and thus have fewer side effects, but again, I doubt that has been objectively backed up.
Well, receptor selectivity is relatively easy to test, so I betcha that has been backed up objectively. IMO what's harder to prove is whether selectivity is a good thing. Espec. since they have only the dimmest notion of what slamming any particular receptor has on the brain in real life. Esp. long term.

IANAMD
#24
Old 07-06-2001, 07:14 PM
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Doesn't Prozac™ (fluoexetine) have a longer half-life than the other SSRIs? I was under the impression that this made forgetting the occasional dose less of an issue, but also created the potential for more liver problems than with the other SSRSs.

Generic fluoexetine has been available here for quite a while, so I'm guessing that there's no longer an exclusive license in existence for the manufacturers of Prozac™.
#25
Old 07-06-2001, 09:40 PM
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Paxil is the only SSRI approved by the government for social anxiety because the research was done on Paxil. Most likely, it is a class effect that applies to all SSRIs including Prozac. I'm sure all the drug companies are doing the research as I type this to get their SSRI approved for the same indication.

Drug side effects are determined by clinical trials and summarized statistically, e.g. "15% of people on Paxil report a drowsy-drugged feeling". Any SSRI can have side effects despite being fairly safe compared to other medications. Often it would be hard to tell if a drug is causing a common symptom and the best test is to see what happens when the dose is reduced or the drug is withheld.

Prozac does have a generic form. Withdrawal from any SSRI is certainly a possibility.

I think Celexa is very much overrated. I haven't seen much evidence the selectivity makes much of a difference. I do a month of psychiatry in September and will let you know if this changes my opinion.

Wellbutrin is the same drug as Zyban although the doses are different. I would not prescribe Wellbutrin as a substitute for the patch because of differences in drug distribution, but in theory you could and some doctors have. They might be on shaky legal ground, though. I don't play that game.

Taking an SSRI in conjunction with other SSRIs or antidepressants may be dangerous, leading to an overdose known as "serotonin syndrome". Wine and cheeses containing tyramine may be dangerous with older MAO inhibitors.
#26
Old 07-06-2001, 10:12 PM
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There have been a lot of horror stories associated with Prozac, which has been the trendy drug for years. GPs prescribe it rather loosely, I hear. Their patients say they feel depressed, and they are prescribed Prozac. I've also heard that some of these school rampages have been caused because those kids were on Prozac. This is just what I heard. I don't know.

My take on this is that if there really is not a serotonin problem in one's brain, and a person is prescribed Prozac, it could cause mania, resulting in all these horror stories. But IANAMD, and I don't know. The reason why it is Prozac and not the other SSRIs is because that's the trendy one that has been prescribed for years. Any of you medical doctors has an opinion on this?
#27
Old 07-06-2001, 10:27 PM
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Quote:
Originally posted by barbitu8
There have been a lot of horror stories associated with Prozac, which has been the trendy drug for years. GPs prescribe it rather loosely, I hear. Their patients say they feel depressed, and they are prescribed Prozac. I've also heard that some of these school rampages have been caused because those kids were on Prozac. This is just what I heard. I don't know.

My take on this is that if there really is not a serotonin problem in one's brain, and a person is prescribed Prozac, it could cause mania, resulting in all these horror stories. But IANAMD, and I don't know. The reason why it is Prozac and not the other SSRIs is because that's the trendy one that has been prescribed for years. Any of you medical doctors has an opinion on this?
Barbitu8, I'm just educated enough to realize how ignorant I really am when it comes to these meds (and so many other things). But I do believe they are a tremendous help to certain individuals, while they are overprescribed for many others. I'm not sure I buy into the theory that they are causing rampages or other such violence, and I haven't seen any data that makes me think they really can induce clinical mania in anyone that's not already having or heading for that disease. But I really think they're best reserved for those meeting the diagnostic criteria for depression, or other appropriate diagnosis, and in my practice, I generally leave that work to the shrinks.

BTW, just what is your background, Barb? You certainly demonstrate a wealth of good information on things medical and physiologic, and your comments are on target and insightful. What's up with that?
#28
Old 07-06-2001, 10:36 PM
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Quote:
Originally posted by Qadgop the Mercotan
BTW, just what is your background, Barb? You certainly demonstrate a wealth of good information on things medical and physiologic, and your comments are on target and insightful. What's up with that?
Thanks for the compliments, Qadgop. I'm a lawyer and worked for a title insurance company for years. I've been working for the Social Security Admn for 20 years now, and deal with disability cases. Hence, I get to know a lot about impairments, treatments, etc. from reading the medical records. In addition, I've been interested in physiology, esp. exercise physiology for about 20 years. Also, being a runner and former marathon runner I've been drawn to that field, as well as nutrition, etc.
#29
Old 07-06-2001, 10:49 PM
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I've been on both Seroxat and Zoloft: zip. Nothing. Zero. No effect. Candy to me.

Would I have any reason to believe any of the others would do anything, then, since they're all supposed to have the same effect (just different side effects)?

--- G. Raven
#30
Old 07-06-2001, 10:53 PM
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Quote:
Originally posted by Morrison's Lament
I've been on both Seroxat and Zoloft: zip. Nothing. Zero. No effect. Candy to me.

Would I have any reason to believe any of the others would do anything, then, since they're all supposed to have the same effect (just different side effects)?--- G. Raven
Maybe. Remember, they're supposed to work slowly, not with a single dose. They're not primarily mood altering. 6 to 8 weeks is, I think, the minimum time frame to start feeling an effect. Then it will hopefully be a lessening of the depressive (or whatever) symptoms it's been given for. And some meds work better than others for individuals, for reasons I at least don't understand at all.
#31
Old 07-06-2001, 11:36 PM
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Quote:
some meds work better than others for individuals, for reasons I at least don't understand at all.
You are not alone. It's remarkable how many psychoactive drugs seem to have changed their mechanism of action in the past few years. What used to regulate serotonin, dopamine or norepinephrine metabolism or uptake, now serves to induce the growth of new neurons in "underpopulated" regions of the brain. The science behind these meds is a lot more empirical than we have been led to believe. Which of course leaves lots of room for variation in the effectiveness of individual drugs within a class such as the SSRI's.
#32
Old 07-07-2001, 12:02 AM
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These drugs are very helpful. Qadcop is absolutely right when he points out we know very little about the way many psychoactive drugs work, but they do. The successful treatment of psychosis is one of the great medical advances of the century. Understanding neuropharmacology will be the great advance of next century.
#33
Old 07-07-2001, 12:36 AM
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Quote:
My brother was on Wellbutrin and the difference with those MAOIs is...[/B]
Since no one has commented on this yet, I'm beginning to doubt myself but Wellbutrin isn't an MAOI. (is it?)

Anyway, I interpreted the OP to be much more specific. Though, apparently, it wasn't intended as such, I'd like to go ahead and ask what I'd hoped would be answered in this thread: what are the differences between these drugs on the molecular level? Why the small differences in side effects? Why do some work better in some people than others? I realize a lot of this is probably still a mystery to science, but what do we know about this?
I've just always been fascinated with how a pill (particularly psychoactive ones) reacts physically with your body, and specifically with your CNS, to produce the effects it does.

Incidentally, I've been on Wellbutrin in the past and had some bizarre experiences from it, but that's for another time.
#34
Old 07-07-2001, 12:45 AM
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Oooops, sorry

I just noticed, on glancing back at the thread, that the 2 posts before mine actually addressed my question.
I read the whole thread, honest. Must be that darn ADHD (which, incidentally, was what I was prescribed wellbutrin for, though I haven't heard of anyone using it for that recently).
#35
Old 07-07-2001, 01:35 AM
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I know that I'm taking this conversation slightly OT here, but I have to say that quite literally SSRIs are the only reason I'm alive today. They are by no means "happy pills"; I recaptured the feeling of "normal" when I commenced SSRIs - I got back to being the competent, resourceful, loving, functional woman I was before I was engulfed by the hideous cloud of endogenous depression.

My personal belief - based upon my observations - is that some doctors do prescribe these drugs inappropriately. That doesn't make the drugs in and of themselves bad or useless. It might indicate that physicians have become as complacent about prescribing them as they were many years ago in repect of thalidomide, antibiotics, benzodiazepines, and a host of other classes of which can have profound impacts if they start being perceived as harmless "candy".

Zyban™ will probably untimately be banned in my country. An observed side effect of prescribing the original Wellbutrin™ was that it reduced the desire for nicotine - among other drugs. Perhaps it only reduces that desire in patients who have a pre-existing condition which responds to treatment with SSRIs. Perhaps it's only effective in patients who are using other drugs to self-medicate the symptoms of depression.

I take a generic version of a very well-known SSRI. I happen to have a great GP who went to great lengths to warn me about the potential side effects and make himself available 24/7 during my first two months on that medication. In short, as my prescribing physician, he really wanted to know about and take control of any problems which might have occurred in respect of the particular medication he'd given me. I wish every prescriber was so responsible. Clearly, some are not. There are certain psychotropic medications which can only be prescribed by specialist medical practitioners here - maybe SSRIs need to be put in that class if it can be proven that they are often prescribed without appropriate evaluation of a patient's medical history and without sufficient monitoring of their effects.
#36
Old 07-07-2001, 02:12 PM
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Quote:
Originally posted by Moe
..Wellbutrin isn't an MAOI. (is it?)
No it's not. It's a novel antidepressant.

Quote:
Originally posted by Moe
...what are the differences between these drugs on the molecular level? Why the small differences in side effects? Why do some work better in some people than others? I realize a lot of this is probably still a mystery to science, but what do we know about this?
I've just always been fascinated with how a pill (particularly psychoactive ones) reacts physically with your body, and specifically with your CNS, to produce the effects it does.
In the simplest terms it's because small changes in the the structure will change their ability to bind with different targets in the brain. There are many different sites that these molecules can bind, and in general they'll affect your serotonin, norepinephrine and dopamine levels to different degrees in different parts of the brain depending on their structure.

SSRI's that are "more selective" will bind much more strongly to the enzymes which reabsorb serotonin into the cell (thus decreasing the level of serotinin in your synapse) - compared to their binding to other receptors. "Dirtier" SSRIs will bind - shall we say "more promiscuously" - and will have broader affects in your CNS.

(That's just the SSRIs. Other antidepressants - MAOIs, Tricyclics, and novel antidepressants - target different combinations of enzymes/receptors/neurotransmitters.)

But even with the "cleanest" SSRIs, nothing's clean. The brain responds to changes in neurotransmitter activity complexly. Over the long term your brain could react to higher levels of serotonin by altering levels of dopamine, for example. These are called "downstream effects."

Also nobody's sure why antidepressants take several weeks to take effect - this is probably the result of a downstream effect of raising serotonin levels in the synapse - but nobody can say for sure what that effect is.
#37
Old 07-07-2001, 03:18 PM
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These NEW drugs help a few people and thats wonderful.

BUT, it seems to me the American public have become guinea pigs for these new drugs. Apparently NO ONE really knows ANYTHING about the anti-depressants PAXIL< ZYBAN> PROZAC etc. but they will be prescribed and sucked down by anyone without a lot of thought.
How and how long do these drug companies actually research
meds like these? What about longterm side effects??
Months? A few years?
These drugs scare the ever lovin' hell out of me!!!
If I ever needed to take them they'd have to dope me up with
old and proven anti anxiety meds first, just to take ANY of these new ones......
#38
Old 07-07-2001, 03:29 PM
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Quote:
Originally posted by anenquiringmind
These NEW drugs help a few people and thats wonderful.

BUT, it seems to me the American public have become guinea pigs for these new drugs. Apparently NO ONE really knows ANYTHING about the anti-depressants PAXIL< ZYBAN> PROZAC etc. but they will be prescribed and sucked down by anyone without a lot of thought.
How and how long do these drug companies actually research
meds like these? What about longterm side effects??
Months? A few years?
These drugs scare the ever lovin' hell out of me!!!
If I ever needed to take them they'd have to dope me up with
old and proven anti anxiety meds first, just to take ANY of these new ones......

Well, they know more about the new ones than they knew about the old ones when they first prescribed them. And the old ones have some proven long term effects.

Realize millions and millions of people have taken these drugs for the past 15 years. So that's a pretty grand experiment that has already taken place. So far there hasn't been any *proven* terrible side effect.

But you're right. There aren't any good long-term (longer than a year) clinical studies. Most are no more than a few months. There's also very poor monitoring of side effects in the "real world." That, IMO, is the FDA's fault. And the general wisdom is that people with recurrent depression should be on them "indefinitely." That does make me worry.
#39
Old 07-07-2001, 06:41 PM
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Re. marketing... fluoexetine (trade name Prozac) was tested and found to be effective treatment for severe PMS. So they gave it a different name, put it in a lavender (or some other feminine color) package and are marketing it specifically for that purpose. It is exactly the same as Prozac.

Interestingly, some literature I've seen suggests that a woman only needs to take it episodically (during second half of menstrual cycle or just that week before menses?) which is hard to believe as others say it takes some weeks before it's effects are felt at all.
#40
Old 07-07-2001, 07:02 PM
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Yeah, jillGat, and isn't there a bit of stink over the repackaging as being false advertisement or something? Like, "If its prozac they should call it prozac" etc.

Well, whether that's the case is a GD but it is interesting and shows how drugs can have very varied results when taken.

For a little background, drugs are made, initially, in the millions based on a family of molecules with varying degrees of different "add-ons" which make them similar but not the same. The most common example is the similarity between MDA and MDMA (ecstacy), where there is only one group changed but the results are different (or so testimony says, never tried MDA).

At any rate, these core structures are then tried on targets(in a lab, not people targets) to see if there is any effect in binding, destruction, whatever. AFAIK, there is only so much testing that can reasonably go on in seeing how a drug reacts. Even if a drug works reasonably well that is no guarantee it will ever make it to the market because of other chemical properties like permeability, solubility, pKa, dissolution, etc etc. Tack FDA approval onto this (and I have no idea what the FDA does for testing) and you're looking at (about) five years (a long 5 years? a measly five years?) from conception to pharmacist's shelf.

But for certain immediately dangerous side effects are the primary concern. Long term are not, AFAIK, actively tested for. Some primary concerns: is it physically addictive; is it mentally addictive, to the side effects outweigh the benefits (such as AIDS drugs being a bit different than, say, high blood pressure medicine).
A pharmaceutical company I recently visited has just made a drug which caused mice to lose weight rapidly with seemingly no side effects, apart from actually liking the drug and "frolicking" after taking. Turns out the drug had an opiate action; those suckers were getting high AND losing weight. they should keep that one on the back burner for the time when (if?) marijuana becomes legal.
#41
Old 07-07-2001, 07:16 PM
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Quote:
Originally posted by JillGat
Re. marketing... fluoexetine (trade name Prozac) was tested and found to be effective treatment for severe PMS. So they gave it a different name, put it in a lavender (or some other feminine color) package and are marketing it specifically for that purpose. It is exactly the same as Prozac.
Yeah, and equally irritating is the fact that they insist in the marketing that it's "not PMS." It IS PMS as any layman would understand it - or basically PMS that is bad enough to interfere with your functioning. Talk about marketing illness.

Quote:

Interestingly, some literature I've seen suggests that a woman only needs to take it episodically (during second half of menstrual cycle or just that week before menses?) which is hard to believe as others say it takes some weeks before it's effects are felt at all.
You got me on that. Good question.
#42
Old 07-07-2001, 08:14 PM
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Quote:
Originally posted by erislover
Tack FDA approval onto this (and I have no idea what the FDA does for testing) and you're looking at (about) five years (a long 5 years? a measly five years?) from conception to pharmacist's shelf.
FDA has several tiers before it approves a drug. I believe the first tier is to establish that it is safe. Next, they test it on animals for efficacy, and then on a select few experimental individuals for efficacy. Then there is broader testing before it is approved.
#43
Old 07-08-2001, 01:20 AM
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[[FDA has several tiers before it approves a drug. I believe the first tier is to establish that it is safe. Next, they test it on animals for efficacy, and then on a select few experimental individuals for efficacy. Then there is broader testing before it is approved.]]

I'm not sure at all if the FDA takes this into account, but many drugs are approved in other countries (with more liberal laws about drug testing, I guess)and used for many years, giving us the ability to see if there are any longterm effects. This does NOT mean the US is "testing drugs on third world countries," mind you (though I'm sure that's been done, too). The monthly injectable hormonal birth control is one example and there are many others. You will often see such evidence cited in studies here, "This drug/immunization has been used in Japan for 12 years and this is what we've seen there..."
#44
Old 07-08-2001, 01:58 AM
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Quote:
Originally posted by Dr_Paprika

Wellbutrin is the same drug as Zyban although the doses are different. I would not prescribe Wellbutrin as a substitute for the patch because of differences in drug distribution, but in theory you could and some doctors have.

Did you mean as a substitute for nicotine patches? Zyban comes in 150mg sustained release tablets, the same as one of the strengths of Wellbutrin SR. The problem is that many 3rd party plans will not pay for Zyban, but they will pay for the Wellbutrin. Most times, in order for the patient to get the drug my pharmacy winds up calling the Dr's office for a substitution even though it's the exact same drug.
#45
Old 07-08-2001, 02:05 AM
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Quote:
[i]Originally posted by uglybtch

Yeah, and equally irritating is the fact that they insist in the marketing that it's "not PMS." It IS PMS as any layman would understand it - or basically PMS that is bad enough to interfere with your functioning. Talk about marketing illness.
[/B]


I like how it is no longer PMS, but "Premenstrual Dysphoric Disorder".
#46
Old 07-08-2001, 04:11 AM
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Quote:
Originally posted by kspharm
I like how it is no longer PMS, but "Premenstrual Dysphoric Disorder". [/B]
They can't do that - PDD alread stands for Pervasive Developmental Disorder, a spectrum of syndromes including (among others) autism and Rett syndrome. Don't steal our acronym! (My son is autistic.)

To get back on topic, I've been on and off Serzone for about five years now. Only side effect I ever had was some slight headaches which never occur now. I only take them 'casually' now, i.e., when I feel myself heading for a depressive episode. Less than yearly now, which is very relieving. When I initially started taking them, it took about a month for the effects to kick in, but these days it seems that it's just a couple days after I start taking them that I'm functioning better. Is this psychosomatic or a result of my brain getting rewired? I have never had any withdrawal symptoms when I stop taking it. Am I just lucky, or is Serzone better for that sort of thing?
#47
Old 07-08-2001, 12:53 PM
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That was Mr. Death, posting at 3am.
#48
Old 07-08-2001, 02:15 PM
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In Canada, Wellbutrin comes in 100mg and 150mg tablets. Zyban comes in 150mg. "Dose" may have been the wrong word to use, but it is good to start anti-depressants at minimal doses. Also, there are definite legal implications of switching the drugs in Canada. FOrtunately, most insurance plans cover both here.
#49
Old 07-09-2001, 10:19 PM
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Posts: 214
here is afairly complete description of Fluoxetine. In addition there is wide spead discussion of a large number of withdrawal syptoms being reported, if anyone requires references searching under "Prozac Withdrawal" on Google will turn up many such reports as well as so support groups for people going through this.
The general advice is yes there can be withdrawal effects, these can be quite extreme in som cases, so you should always withdraw from such medications with medical support, if your phyisition does not understand th issues associated with these drugs find one that does.

Keep safe
Britt
#50
Old 07-10-2001, 12:02 AM
kiz kiz is offline
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Nope, you're not bonkers, Sexy and gigi...I've been on Zoloft for what seems like an eternity (I'm guessing 7 or 8 years), and I'd give anything to stop taking it, as that 1) I am no longer depressed, never mind not being in therapy, and 2)the thought that I may be on this little yellow pill for the rest of my life irks me to no end, like I'm a slave to it or something. The times when my doctor has attempted to taper me off it have been horribly unsuccessful -- pounding headaches, spontaneous sobbing for no apparent reason, and, what frightens me the most, a seething eruption of anger -- again, for no apparent reason.

You wouldn't mind, but I was originally put on Prozac because my doctor feared that I was becoming anorexic. I gained something like 10 lbs. in a month, and nearly became a babbling idiot in the meantime. Ergo, the switch to Zoloft...

[QUOTE]Originally posted by SexyWriter
Quote:
Originally posted by gigi
Quote:
I had physical symptoms like a weird dizziness when I moved around, and heightened anxiety.
A friend of mine caused an auto accident on his way to my house while trying to get off of Zoloft. The dizziness and "foggy" feeling when trying to get off of Prozac is horrible as well. I know now that if I want to stop taking this medication I have to take a week or so off of work and make sure I don't need to do anything besides drool.

What really bugs me about this is that it ends up making me feel truly CRAZY. Because the doc generally assures me, "no side affects, no addiction, no problem." Then when I show up at his office door crying, hysterical, unable to work, too dizzy to drive, he acts as if it can't possibly be the medication he prescribed because he's never seen such a thing before. I end up assuming that I'm either completly bonkers, or I'm the one unlucky person in eleventy million who has this problem.

-L
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