![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 8406. Go back in thread:
Posted by Phil on August 1, 2002, at 6:15:48
In reply to Re: slug-fest (get it..like a snail) » pharmrep, posted by Ritch on August 1, 2002, at 0:26:06
pharmrep, Are you saying Celexa is around 20% sexual dysfunction, mostly delayed ejaculation?
Or are you saying only 20% will talk about it?
I would think in the real world that it's 50-70%.
And from personal experience, the sexual problems are more varied. I'm taking 40mg, down from 60mg and don't even think about getting as far as ejaculation. I take Wellbutrin and Adderall and Viagra occasionally and I've still written off sex. It's so frustrating, it's not worth the effort.
I cannot believe the numbers that companies get away with putting on package inserts.
Do you, as a rep, encourage doctors to bring the subject up with patients or does every rep say, well, patients just don't want to talk about it.
If you know that's true, why don't $200.00 an hour psychiatrists bring the subject up? I think that nobody, including drug companies and doctors, want to bring it up. It's difficult to say anything in a 15 minute med check.Is Forest aggressively trying to overCOME this problem? The first company that makes an effective AD without this SE will never have cash flow problems again. I'm sure pharm co. are aware that they could make a fortune.
What's the figure going to be on Lexapro..2%?
Have you ever been on meds? Does your company realize that the choice we are given is semi-normalcy at the expense of sex? Semi-normalcy at the expense of 100% apathy?
Not trying to blame you for the world's depression problems but after 20 of my best years spent on meds, it's all getting a bit tiresome.Phil
Posted by pharmrep on August 1, 2002, at 10:54:11
In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48
Hi Phil...yes, I am saying Celexa at around 20%, mostly ejac delay. This has been said nationally. Although I account for a small pool (300 dr's or so) I do talk about it to learn more from my dr's. They say the same 20% for Celexa, and 30-40% for other ad's. I am seeing more of the combo Celexa and Wellbutrin...its called cel-well (its big on the East coast...and moving West. 20-40mg Celexa/100mg Wellbutrin, maybe higher on Celexa, but not Wellbutrin (due to seizure risks). I agree that sex s/e are not aggessively addressed, but I wouldnt say it's being ignored. 5-10 years is all that co's know of it..remember only 6% of patients reported it for Celexa back then. But
now that it's a more open topic, maybe co's will cater to it more. (yes, it would be a $-maker). On a personal note, no..I've not taken any ad's, I do have experience through some family& friends.
And I do hear the semi-normalcy vs sex s/e a lot from my Dr's. They are more concerned with treating the depression and other components 1st, before worrying about weight gain, any s/e,p450
inhibitions (liver metabolization) etc only secondary. I wouldnt say Forest or myself for that matter is apathetic on the matter. It's just not easy to have 1 drug do everything. I'm sure it's on the way some day. As for Lexapro...no it's not it. I believe it will have the least sex s/e, but again 9% voluteered the info (last year). With todays heightened awareness, I believe that's good...maybe in low to mid teens in reality. But only large volume experience and time will tell.
PS 15 med check? That's funny...when I go into an office, I get on average 1-2 minutes with the Dr's. (and thats more than most reps) They see 10+ reps a day, and 5-10 seconds just to sign for samples is not uncommon. I try to be concise with Dr's (90% of time, there are patients waiting). Any questions I can ask to learn about their practice or prescribing habits usually take 4-5 visits or so to develop. I focus more on the Dr's and patients as topics...not the samples.
Posted by Phil on August 1, 2002, at 11:21:26
In reply to Re: sex. s/e, posted by pharmrep on August 1, 2002, at 10:54:11
SSRI sexual problems are about 70% according to people in your field. I'll try to find the info.
Read the archives on this board. I think Celexa is better but it's not to me.Anyway, I like Forest Labs for what I know about them. Lilly strikes me as operating from Billy Bob Gates book of ruthless business practice. Sarafem, please.
Here's my combo, give me your thoughts, if you will.
Celexa 60mg
Wellbutrin 400mg
Clonazepam 3mg
Adderall XR 60-90mgIn the last few days, I dropped Celexa to 40mg to see if: a. My unit would work...no. b. See if I could wake up. I've talked to others on this board about Celexa sleepiness which is horrendous.
I went to 90mg of Adderall and have been guzzling coffee! I've taken Clonazepam with a lot of drugs and it's not the culprit. When I dropped Celexa to 40mg the first day, while at 90mg Adderall, I stayed up till 3 a.m.
A lady here, can't remember who, took Dex for years. After starting Celexa, her once steady dose had to be escalated several times to no avail. What up? It has been the worst for me in that area.I know you aren't a shrink but appreciate your input. How long have you been in that business?
Posted by pharmrep on August 1, 2002, at 11:50:17
In reply to Re: Another question and statement, posted by Phil on August 1, 2002, at 11:21:26
You know what..I just printed your combo, and will take it with me to see what my PD'rs think. As for sleepyness, I know Cx can do that for some, do you take it at night or morning? My Dr's say if you feel to relaxed...take it at night, you will sleep well, and my morning, it isnt as "relaxing" for your day . As for the rest of the combo, I will get back to you.
Posted by Phil on August 1, 2002, at 12:12:38
In reply to Re: Phil combo, posted by pharmrep on August 1, 2002, at 11:50:17
That's very generous of you. I took Celexa in the a.m. when I started it but when I realized what was happening, went to p.m.
Your docs will probably say I'm too maxed out on too many meds but it will be interesting.
Don't forget the pens. *wink*Oh, when I started AD's 20 years ago, I took Amitriptyline 250mg. Fast metabolizer, I guess.
Thanks again
Posted by inertia on August 1, 2002, at 18:50:33
In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48
> pharmrep, Are you saying Celexa is around 20% sexual dysfunction, mostly delayed ejaculation?
> Or are you saying only 20% will talk about it?
> I would think in the real world that it's 50-70%.
> And from personal experience, the sexual problems are more varied. I'm taking 40mg, down from 60mg and don't even think about getting as far as ejaculation. I take Wellbutrin and Adderall and Viagra occasionally and I've still written off sex. It's so frustrating, it's not worth the effort.
> I cannot believe the numbers that companies get away with putting on package inserts.
> Do you, as a rep, encourage doctors to bring the subject up with patients or does every rep say, well, patients just don't want to talk about it.
> If you know that's true, why don't $200.00 an hour psychiatrists bring the subject up? I think that nobody, including drug companies and doctors, want to bring it up. It's difficult to say anything in a 15 minute med check.
>
> Is Forest aggressively trying to overCOME this problem? The first company that makes an effective AD without this SE will never have cash flow problems again. I'm sure pharm co. are aware that they could make a fortune.
>
> What's the figure going to be on Lexapro..2%?
> Have you ever been on meds? Does your company realize that the choice we are given is semi-normalcy at the expense of sex? Semi-normalcy at the expense of 100% apathy?
> Not trying to blame you for the world's depression problems but after 20 of my best years spent on meds, it's all getting a bit tiresome.
>
> PhilPhil, I think your guess-timate of sexual s/e in 50%-70% of SSRI users is right on target.
I hope this isn't overkill, but I looked for all the GOOD studies on sexual dysfunction from different antidepressants and the 50%-70% is just about what they found.
I included one abstract on the TYPE OF QUESTIONAIRE the Salamanca group used to get their data so you could see that they have a pretty valid measuring instrument.
Study design is EVERYTHING. Generally I think you should be skeptical of any study sponsored by a pharmaceutical company (unless, maybe, the researchers are known to be of top-notch caliber) and you want to see a result replicated by other researchers.
The German study below is interesting because it shows that when MDs used their (presumably sensitive) questionaire to ask about sexual s/e they came up with a vastly greater incidence than if they left it to the patients to mention it (61.5% vs 21.6% for SSRIs).
1) Authors .Ferguson JM. Shrivastava RK. Stahl SM. Hartford JT. Borian F. Ieni J. McQuade RD. Jody D.
Institution Pharmacology Research Corporation, Salt Lake City, Utah, USA.
Title Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline.
Source Journal of Clinical Psychiatry. 62(1):24-9, 2001 Jan.Abstract BACKGROUND: Several different classes of antidepressants have been associated with sexual adverse effects. This double-blind, randomized trial compared the effects of nefazodone and sertraline on reemergence of sexual dysfunction in depressed patients who had experienced sexual dysfunction as a result of sertraline treatment. Depressive symptoms were also monitored. METHOD: One hundred five patients with DSM-III-R major depressive episode who were experiencing sexual dysfunction attributable to sertraline (100 mg/day) were screened for entry. Eligible patients entered a 1-week washout period that was followed by a 7- to 10-day single-blind placebo phase. Patients without symptoms of sexual dysfunction at the end of the single-blind placebo phase were randomly assigned to receive double-blind treatment with either nefazodone (400 mg/day) or sertraline (100 mg/day) for 8 weeks. RESULTS: Nearly 3 times more sertraline-treated patients (76%; 25/33) experienced reemergence of sexual dysfunction (ejaculatory and/or orgasmic difficulty) than did nefazodone-treated patients (26%; 10/39) (p < .001). In addition, patients treated with nefazodone were more satisfied with their sexual functioning than were patients treated with sertraline. Both treatment groups demonstrated a similar and sustained improvement in depressive symptoms. Both drugs were well tolerated, and the overall incidence of adverse reactions was similar for both treatment groups; however, 9 sertraline-treated patients (26%) discontinued because of adverse events compared with 5 nefazodone-treated patients (12%). Of the patients discontinuing therapy for adverse events, 5 of the sertraline-treated patients did so because of sexual dysfunction reported as an adverse event, whereas only 1 of the nefazodone-treated patients discontinued therapy secondary to sexual dysfunction. CONCLUSION: In this sample of patients with major depression who had recovered from sexual dysfunction induced by treatment with sertraline, nefazodone treatment resulted in significantly less reemergence of sexual dysfunction than did renewed treatment with sertraline and provided continued antidepressant activity.
2) Authors .Montejo AL. Llorca G. Izquierdo JA. Rico-Villademoros F.
Institution University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain. angelluis.montejo@globalmed.es
Title Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.
Source Journal of Clinical Psychiatry. 62 Suppl 3:10-21, 2001.Abstract BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
3) Authors Montejo AL. Garcia M. Espada M. Rico-Villademoros F. Llorca G. Izquierdo JA.
Institution Hospital Universitario de Salamanca, Facultad de Medicina, Universidad de Salamanca. angelluis.montejo@globalmed.es
Title [Psychometric characteristics of the psychotropic-related sexual dysfunction questionnaire. Spanish work group for the study of psychotropic-related sexual dysfunctions]. [Spanish]
Source Actas Espanolas de Psiquiatria. 28(3):141-50, 2000 May-Jun.Abstract BACKGROUND: The presence of sexual function impairment in patients with psychiatric disorders is very common and could be an effect of the medication (mainly antidepressant and neuroleptics). The patient frequently has difficulties to communicate this adverse effect and the assessment of these changes by the physician should be encouraged. The real SD incidence is underestimated and the use of a specific questionnaire is needed. METHODS: The authors analyse psychometric characteristics of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ) that includes questions about libido, orgasm, ejaculation, erectile function and general sexual satisfaction. The questionnaire was applied to 62 patients who were taking nefazodone "de novo" (n = 18) or were switched to nefazodone (n = 44) due to bad tolerated sexual dysfunction secondary to other antidepressant. RESULTS: The PRSexDQ has shown an excellent feasibility with nil percentage of patients with missing responses on all items except on items 1 and 2 (1.7% and 15.5% of patients with missing response). Cronbach's alpha value was 0.93, which indicates adequate reliability. The PRSexDQ also showed adequate construct validity. As it may be expected, the PRSexDQ showed a high correlation with a Clinical Global Impression scores on Sexual Dysfunction (r = 0.79) and moderate correlation with Hamilton Depression scores (r = 0.63). PRSexDQ also showed good discrimination between naive and pretreated depressed or dysthymic patients, with statistically significant differences between those groups of patients. Finally, the instrument showed adequate sensitivity for detecting clinical changes on sexual dysfunction with greater changes in the patients treated previously with antidepressants and who were switched to nefazodone than in naive patients (SES = -3.77 in patients switching to nefazodone; SES = -0.64 in naive patients).
4) Authors Arias F. Padin JJ. Rivas MT. Sanchez A.
Institution Unidad de Psiqiatria, Fundacion Hospital de Alcorcon, Madrid. farias@fhalcorcon.es
Title [Sexual dysfunctions induced by serotonin reuptake inhibitors]. [Spanish]
Source Atencion Primaria. 26(6):389-94, 2000 Oct 15.Abstract OBJECTIVE: To assess the incidence of serotonin reuptake inhibitor (SRI) antidepressant-induced sexual dysfunction (SD) and to compare the sexual side effects of SRI. DESIGN: Naturalistic, prospective, observational study. SETTING: Two urban health centers. PATIENTS: 235 outpatients (164 women, 71 males) who began treatment with some of the following SRI: fluoxetine, sertraline, paroxetine, citalopram and venlafaxine, who had engaged in regular sexual practices with stable partner, who were suffering from different mental disorders who were being treated with SRI. The assignment to each group was according to clinical criteria. INTERVENTIONS: Patients completed questionnaires that allowed reporting of both SD induced by the illness and the treatment, evaluating changes in libido, arousal, and orgasm. The patients were observed over 6 months of treatment. RESULTS: 147 patients (62.6%) reported one or more SD related to SRI treatment. There were differences in the incidence between the different SRI: 39% with fluoxetine, 75.5% with paroxetine, 78.8% with sertraline, 28.9% with citalopram and 80% with venlafaxine. In 78.2% of patients the SD showed no improvement by the end of this period. In a predictive logistical regression model of the presence of SD induced by the SRI, the female category and the presence of previous sexual problems were favourable predictors and the treatment with paroxetine, sertraline or venlafaxine were increased the risk of SD. CONCLUSIONS: SD is one of the most frequent and persistent SRI adverse effect. We recommended to inquiry about SD in patients who were treated with SRI. Significant differences were found in the occurrence of SD between the different SRI. Such data would be particularly valuable to physicians when choosing a specific antidepressant from this therapeutic group.
5) Authors Philipp M. Tiller JW. Baier D. Kohnen R.
Institution Bezirkskrankenhaus Landshut, Klinik fur Psychiatrie/Psychotherapie, D-84034, Landshut, Germany. phillip-landshut@t-online.de
Title Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults. The Australian and German Study Groups.
Source European Neuropsychopharmacology. 10(5):305-14, 2000 Sep.Abstract OBJECTIVE: To compare the emergent sexual effects of moclobemide and selective serotonin reuptake inhibitors (SSRIs) during acute and maintenance therapy in routine practice. METHOD: 268 patients were evaluated for sexual function at baseline, 6 weeks, 3 and 6 months of treatment using physician ratings and self-rating questionnaires. Patients received moclobemide, an reversible monoamine oxidase A inhibitor (RIMA), or a SSRI (fluoxetine, fluvoxamine, paroxetine, sertraline). RESULTS: Baseline values were similar in all groups. Incidences of impairments of sexual functioning with treatment, whether clinically relevant or not, were 24.3% with moclobemide and 61.5% with SSRIs (physician ratings), with no significant tolerance to these effects. There was a suggestion of differences between the SSRIs in their specific dysfunctions they cause. SSRIs (21.6% of patients) had about ten times the moclobemide rate (1.9%) of sexual dysfunction reported as adverse events. Antidepressant efficacy was comparable between treatments. CONCLUSION: In patients for whom sexual function is important or sexual dysfunction is present, moclobemide should be considered a first line antidepressant.
Posted by pharmrep on August 3, 2002, at 0:20:36
In reply to Re: Another question and statement, posted by Phil on August 1, 2002, at 11:21:26
Well, I got some general answers since they dont know you. But the one commonality I heard was you have some pretty high doses, and the feeling sleepy yet not able to fall to asleep til 3am.
Everyone thought 400mg Wellbutrin was too high (going to 1/2 was something I heard a couple of times) Adderall at 40 came up too (2x 20mg's). The Dr's thought this was your insomnia problem. I asked specifically if Celexa could be the "relaxed/tired" culprit...they didnt think so...they often go to 80+ without the "tired" effect, but everyone is different. There was the strong belief that more likely that there are both activating and relaxing meds in you at the same time...at the higher dosing, you could be getting adverse events as well. Your Dr. may have more experience with these meds at the higher doses than the pool I spoke with, but one thing I would recommend is to see how each one of these meds metabolizes in to make sure they are in fact doing that rather that fighting for the same pathway in you body and just floating around...this causes s/e and adverse events as well...I'll give you Celexa...it's a very mild inhibitor of the 2D6 and 1A2 pathways in the liver.
Posted by .tabi.T.ha. on August 3, 2002, at 3:28:08
In reply to Re: phil's combo, posted by pharmrep on August 3, 2002, at 0:20:36
Hi pharmrep,
Saw the note about Phil's combo, can't resist asking a question. For me Celexa is activating and causes insomnia. I take 10mg in the morning, and can't sleep at all unless I take something sedating at night. For now the sedating med is neurontin, but even with that I'm awake til 3am. Do you know of any better way to deal with the insomnia side effect from celexa?
Also, how does lexapro compare on insomnia? Sorry if you've answered this elsewhere, I didn't read the entire thread.
-Tabitha
Posted by Phil on August 3, 2002, at 7:21:23
In reply to Re: phil's combo, posted by pharmrep on August 3, 2002, at 0:20:36
Insomnia was a problem only when dropping the Celexa dose. In the monograph, Celexa rates high in somnolence. If you search 'celexa sleepy' on this site, it's not uncommon.
Thanks for checking. I'll do some science stuff and seek an interpretation.
Posted by pharmrep on August 3, 2002, at 11:00:24
In reply to Re: phil's combo, posted by pharmrep on August 3, 2002, at 0:20:36
> Well, I got some general answers since they dont know you. But the one commonality I heard was you have some pretty high doses, and the feeling sleepy yet not able to fall to asleep til 3am.
> Everyone thought 400mg Wellbutrin was too high (going to 1/2 was something I heard a couple of times) Adderall at 40 came up too (2x 20mg's). The Dr's thought this was your insomnia problem. I asked specifically if Celexa could be the "relaxed/tired" culprit...they didnt think so...they often go to 80+ without the "tired" effect, but everyone is different. There was the strong belief that more likely that there are both activating and relaxing meds in you at the same time...at the higher dosing, you could be getting adverse events as well. Your Dr. may have more experience with these meds at the higher doses than the pool I spoke with, but one thing I would recommend is to see how each one of these meds metabolizes in to make sure they are in fact doing that rather that fighting for the same pathway in you body and just floating around...this causes s/e and adverse events as well...I'll give you Celexa...it's a very mild inhibitor of the 2D6 and 1A2 pathways in the liver.These are the adverse events incidence in the clinical trials (listed in the package insert) for Celexa vs placebo. I'm only listing those at 10% or greater or interesting #'s. (this is 8wk study) celexa (1063 patients) placebo (446)
dry mouth 20%/ 14
increased sweating 11 / 9
nausea 21 / 14
fatigue 5 / 3
somnolence 18 / 10
insomnia 15 / 14
yawning 2 / 0
**in the 6mo-24mo trial the numbers stayed about the same. except for nausea..cx=6% and placebo=10%.So Phil, you seem to have somnolence with Cx, and .tabi, you get insomnia. I hate that the same drug
can contradict itself in different people. I will get you some ideas to help next week. (I cant remember
the Lexapro #, but I think it was about 5 or so...FDA is saying "similar to placebo")
Posted by allisonm on August 3, 2002, at 16:10:16
In reply to contradictions, posted by pharmrep on August 3, 2002, at 11:00:24
The FDA makes drug companies test their drugs for only 8 weeks. But most literature says a depressive ought to take an AD for about a year to make sure the depression is gone. Many of us here take these drugs for years and will do so for the rest of our lives (I'm one of those). It gives many of us pause when we think about that and the possible future ramifications of longterm use. I for one don't like being a guinea pig, but figure the only other choice is death. The chance of getting cancer or some other malady later on because of these chemicals seems like an unfair but necessary (not to mention expensive) alternative to ending my life now. Do drug companies ever go back and study longterm use? Will there ever be any reassurance that these drugs are "safe" save for the lack of reports and warnings if nothing bad turns up?
Posted by pharmrep on August 4, 2002, at 22:20:13
In reply to pharmrep trial question, posted by allisonm on August 3, 2002, at 16:10:16
> The FDA makes drug companies test their drugs for only 8 weeks. But most literature says a depressive ought to take an AD for about a year to make sure the depression is gone. Many of us here take these drugs for years and will do so for the rest of our lives (I'm one of those). It gives many of us pause when we think about that and the possible future ramifications of longterm use. I for one don't like being a guinea pig, but figure the only other choice is death. The chance of getting cancer or some other malady later on because of these chemicals seems like an unfair but necessary (not to mention expensive) alternative to ending my life now. Do drug companies ever go back and study longterm use? Will there ever be any reassurance that these drugs are "safe" save for the lack of reports and warnings if nothing bad turns up?
*** Responsible companies do long term studies as well...there are such studies for Celexa, and I know that Lexapro studies are being done as we speak. The good news about Lexapro is that it is not a foreign matter in the human body. It is half of the Celexa molecule, and has been used by over 30 million people for over 15 years in Europe and the US. As far as the "FDA 8-weeks", you're right, unless there is something obviously wrong, or no separation from placebo, it usually passes.
Posted by Fuscia on August 5, 2002, at 13:09:14
In reply to Re: Lexapro update, posted by pharmrep on July 31, 2002, at 2:04:24
Hello pharmrep,
Do you know what the transport system(s) is for citalopram? The following was posted by James Ferrell, but does not include information about citalopram.
Thanks in advance for any information you can share! Fuscia
Dr. Bob's Psychopharmacology Tips
http://www.dr-bob.org/tips/"Date: Wed, 2 Apr 1997 15:05:51 -0800 (PST)
From: ferrell@cmgm.stanford.edu (James Ferrell)
Subject: Transport systems and antidepressantsHere are some data to give you an idea of what transport systems are
likely to be tweaked by the different antidepressants.From: Bolden-Watson C, Richelson E. Blockade by
newly-developed antidepressants of biogenic amine uptake into rat
brain synaptosomes. Life Sciences. 52 (12): 1023-9, 1993.------------------------------------------------------
Ki (nM)
Drug ------------ Selectivity for 5HT
5HT NE (Ki NE / Ki 5HT)
------------------------------------------------------
desipramine 180 0.6 0.003
doxepin 220 18 0.08
amitriptyline 84 14 0.2
imipramine 41 14 0.3venlafaxine 39 210 5.4
fluoxetine 14 143 10
norfluoxetine 25 410 17
paroxetine 0.7 33 45
sertraline 3 220 64
------------------------------------------------------From: Hyttel J. Pharmacological characterization of selective
serotonin reuptake inhibitors (SSRIs). International Clinical
Psychopharmacology. 9 Suppl 1: 19-26, 1994 Mar.------------------------------------
Drug Selectivity for 5HT
(IC50 NE / IC50 5HT)
------------------------------------
clomiprimine 14
fluoxetine 54
fluvoxamine 160
paroxetine 280
sertraline 840
------------------------------------"
Posted by allisonm on August 5, 2002, at 14:36:29
In reply to Re: trial question, posted by pharmrep on August 4, 2002, at 22:20:13
Sorry. I tend to disagee. A drug is a chemical. There are lots of things that are not foreign matter to the body but which cause disease just the same. Also, I appreciate your enthusiasm about what you sell, but I was not referring to Celexa specifically. I was referring to antidepressants in general. Witness the recent black box warning on Serzone and liver damage, for example. How many years has Serzone been on the market and how many millions of people have used it? That's my point. I remember when red dye #3 (or was it #5?) was withdrawn from the market and there were all kinds of things we couldn't have for awhile until they came up with a healthier shade of red. My memory is vague, but I think Kool-Aid had red dye #3 in it... Certainly, Wellbutrin, Remeron, Effexor, Celexa, Serzone, Prozac, Zoloft etc. have chemicals much less benign than what one would presume to be harmless food coloring...
Thanks.
Posted by pharmrep on August 5, 2002, at 21:39:41
In reply to Re: trial question » pharmrep, posted by allisonm on August 5, 2002, at 14:36:29
Maybe I missed your point. Your original question was regarding long-term studies...I am saying yes, they exist for Celexa as well as other ad's. I am not selling here, so please stop saying that. I was making the observation that Lex is not entirely a foreign substance to the body, as perhaps other new drugs might be "new." Paxil is another one that is not new (just a lowered dose with a different release mechanism)
Posted by pharmrep on August 5, 2002, at 22:37:56
In reply to Re: trial question, posted by pharmrep on August 5, 2002, at 21:39:41
Hey Phil...got a new one today, you heard of this. 250-500 mg of testoserone given once per month. This is supposed to help "speed up" the process...if you know what I mean. I have also heard of the Wellbutrin add-on (called CEL-WELL) to help too.
Posted by allisonm on August 6, 2002, at 10:34:07
In reply to Re: trial question, posted by pharmrep on August 5, 2002, at 21:39:41
>> Maybe I missed your point. Your original question was regarding long-term studies...I am saying yes, they exist for Celexa as well as other ad's. I am not selling here, so please stop saying that. I was making the observation that Lex is not entirely a foreign substance to the body, as perhaps other new drugs might be "new." Paxil is another one that is not new (just a lowered dose with a different release mechanism)<<
Thanks for the information. You did answer my question re' whether there were longterm studies going on. That is good to know.
I understand what you are saying about Lexapro and foreign substances, although I still tend to disagree that because something may not be "foreign" it is safer or less dangerous. They still are chemicals we are adding to our systems that cause desired and undesired effects. We just hope that the desired effects outweigh the undesired ones.
I don't care to get into picking nits, but was is your phrasing re' Lexapro that prompted my comment about your connection with the company that produces the drug. You said: "The good news about Lexapro is that it is not a foreign matter in the human body. It is half of
the Celexa molecule, and has been used by over 30 million people for over 15 years in Europe and the US."I hope you will excuse me: I have worked as newspaper editor and as a PR rep for many years and am sensitive -- or perhaps overly sensitive -- to how things are said, phrased, spun. Phrases such as "the good news about..." and even "which has been used by over 30 million people in Europe and the U.S." strike me as a bit promotional, especially coming from someone in your line of work. If it had been some computer programmer or grocery store clerk who'd been taking it and liked it a lot, I probably would have read past it or chalked it up to enthusiasm or perhaps overzealousness. Trying to talk about a drug from a company that you represent without sounding as though you are promoting it puts you in a difficult situation in that whatever you say is apt to be scrutinized very closely here -- even though your intent is to help and not to sell.
Thanks again for the information.
Posted by pharmrep on August 6, 2002, at 10:52:14
In reply to Re: trial question » pharmrep, posted by allisonm on August 6, 2002, at 10:34:07
No joke...it doesnt matter what I say...some will see it as info, as some will see it as a sales pitch. You aren't the first, but hopefully you will get to know me and see I am trying to be objective with my posts. (not overzealous)
Posted by Anyuser on August 6, 2002, at 17:58:28
In reply to Re: credibility » allisonm, posted by pharmrep on August 6, 2002, at 10:52:14
Here is a link to an article in BusinessWeek about Forrest Laboratories, the makers of Celexa and Lexapro. The founder of Forrest Labs is the father of Andrew Solomon, the author of The Noonday Demon.
http://www.businessweek.com/magazine/content/02_21/b3784001.htm
Posted by Ritch on August 7, 2002, at 9:39:50
In reply to Interesting article, posted by Anyuser on August 6, 2002, at 17:58:28
> Here is a link to an article in BusinessWeek about Forrest Laboratories, the makers of Celexa and Lexapro. The founder of Forrest Labs is the father of Andrew Solomon, the author of The Noonday Demon.
>
> http://www.businessweek.com/magazine/content/02_21/b3784001.htm
Yes, that was indeed very interesting. It would be nice if more pharm. companies would be interested in attempting to market meds that are already available in other countries that could be helpful here. I am thinking of moclobemide for one (why doesn't Roche try to get FDA approval here?). Also, the active metabolite of nortriptyline (I think E-10 OH-nortriptyline), has good anxiolytic properties, downregulates 5-HT receptors, and has nil side effects (that TCA's typically have). Why can't that be developed? Marketing active metabolits of older drugs is becoming more common (fexofenadine and cetirizine, ie.).Mitch
Posted by Geezer on August 7, 2002, at 11:15:45
In reply to Interesting article, posted by Anyuser on August 6, 2002, at 17:58:28
> Here is a link to an article in BusinessWeek about Forrest Laboratories, the makers of Celexa and Lexapro. The founder of Forrest Labs is the father of Andrew Solomon, the author of The Noonday Demon.
>
> http://www.businessweek.com/magazine/content/02_21/b3784001.htmGood article - gives a little balance to the "evil greedy drug company" argument, doesn't it. I wish I had an answer to Mitch's question as to why the FDA won't allow new and better drugs here in the US., after all, the US drug companies do their testing in Europe. I thought it was interesting the FDA "reached out" to Europe and killed the use of Amineptine for Europeans (now it's only available in South America - at a high cost I believe). My only thought would be to "privatize" the FDA (there might be a lot more to the solution than that)- nothing could be worse than the current FDA mess.
Geezer
Posted by SLS on August 10, 2002, at 9:37:13
In reply to Re: Interesting article » Anyuser, posted by Ritch on August 7, 2002, at 9:39:50
Hi Mitch.
How have you been doing?
> It would be nice if more pharm. companies would be interested in attempting to market meds that are already available in other countries that could be helpful here. I am thinking of moclobemide for one (why doesn't Roche try to get FDA approval here?).
First of all, it is my impression that moclobemide is really not a terribly effective drug - either for depression or social-phobia. Of course, some people respond well to it, but the non-selective irreversible MAOIs generally demonstrate superior efficacy. It is certainly worth a try, though. You never know, right?
- Don't give up on moclobemide until you reach 1200mg.
- Do not eat any more than 50mg of tyramine at any one meal.I would be very interested to know what drugs you would combine with moclobemide. Zyprexa would be interesting.
I tried moclobemide in December, 1996. I reacted very, very badly to it. It exacerbated my depression to a degree worse than I have ever experienced. I was curled up in a fetal position on the couch for days, wimpering in pain. No thoughts. Just mental pain.
Roche conducted trials of moclobemide in the US for the indication of social-phobia. I guess they figured they had a better chance of getting the FDA to approve a drug for an indication for which few drugs had yet been approved. The results were poor. I spoke to the head of the US moclobemide project just before it was discontinued. He told me that it was dead and that the trials had been terminated. I doubt they will revisit it.
> Also, the active metabolite of nortriptyline (I think E-10 OH-nortriptyline),
Isn't the parent compound active? What are the differences between them? What other drugs downregulate 5-HT receptors? In what ways does this help with depression? Is it simply an observed association or is there a hypothesis as to how it contributes to producing a remission?
Thanks.
> Why can't that be developed? Marketing active metabolits of older drugs is becoming more common (fexofenadine and cetirizine, ie.).
For every 1 drug brought to market, 100 are synthesized, researched, and discarded for various reasons, including projected profitability. It costs 800 million dollars and 12 years to get a drug approved by the FDA. I imagine there are a few miracle drugs that have ended up in landfills.
- Scott
Posted by Ritch on August 10, 2002, at 11:08:40
In reply to Re: Interesting article » Ritch, posted by SLS on August 10, 2002, at 9:37:13
> Hi Mitch.
>
> How have you been doing?
I have been doing better this summer than I have in *many* summers. I think the L-tyrosine and low-dose Depakote+Effexor+Wellbutrin is making a big difference this time. I am sleeping Ok, and I feel almost normal for a time of year I typically am very depressed. Of course, I am forcing myself to exercise a lot more-so that is contributing too.>
> > It would be nice if more pharm. companies would be interested in attempting to market meds that are already available in other countries that could be helpful here. I am thinking of moclobemide for one (why doesn't Roche try to get FDA approval here?).
>
> First of all, it is my impression that moclobemide is really not a terribly effective drug - either for depression or social-phobia. Of course, some people respond well to it, but the non-selective irreversible MAOIs generally demonstrate superior efficacy. It is certainly worth a try, though. You never know, right?
>
> - Don't give up on moclobemide until you reach 1200mg.
> - Do not eat any more than 50mg of tyramine at any one meal.
>
> I would be very interested to know what drugs you would combine with moclobemide. Zyprexa would be interesting.
>
> I tried moclobemide in December, 1996. I reacted very, very badly to it. It exacerbated my depression to a degree worse than I have ever experienced. I was curled up in a fetal position on the couch for days, wimpering in pain. No thoughts. Just mental pain.
>
> Roche conducted trials of moclobemide in the US for the indication of social-phobia. I guess they figured they had a better chance of getting the FDA to approve a drug for an indication for which few drugs had yet been approved. The results were poor. I spoke to the head of the US moclobemide project just before it was discontinued. He told me that it was dead and that the trials had been terminated. I doubt they will revisit it.I was considering moclobemide precisely because it *is* weak. I hyper-respond to antidepressants, due to bipolar and to general med sensitivities. It wouldn't surprise me at all if I responded well to 75mg twice daily! You see I am only taking 12.5mg of Effexor and 18.75mg of Wellbutrin right now. Any more of either one of those disrupts my sleep too much, or makes me too tired or too wired during the day. The trouble I have with antidepressants isn't really response, it is tolerance and hypomania. Also, stimulants and short half-life AD's like Effexor seem to work better than longer-half life AD's. The longer half-life ones seem to cause a lot of early morning awakenings and resultant daytime drowsiness. When that happens a lot, my cycling tends to worsen.
>
> > Also, the active metabolite of nortriptyline (I think E-10 OH-nortriptyline),
>
> Isn't the parent compound active? What are the differences between them? What other drugs downregulate 5-HT receptors? In what ways does this help with depression? Is it simply an observed association or is there a hypothesis as to how it contributes to producing a remission?OH, I was just thinking out loud about a medline abstract I read regarding E-10 OH-NT a long time ago. They recommended looking into developing it as a possible antidepressant. The 5-HT downregulation is common with many antidepressants-I think they were primarily looking at the anxiolytic effects. Nortripytline (the parent compound) *is* active. NT just happens to be the only tricyclic that I have had any success with. Amitriptyline is it's parent. Another study was done where they gave AMI to a group of people and measured the relative balance of AMI and NT in their blood. The people that had the highest remission rates had the highest NT blood levels. How active E-10 OH-NT compared to *it's* parent we probably will never know.
>
> Thanks.
>
> > Why can't that be developed? Marketing active metabolits of older drugs is becoming more common (fexofenadine and cetirizine, ie.).
>
> For every 1 drug brought to market, 100 are synthesized, researched, and discarded for various reasons, including projected profitability. It costs 800 million dollars and 12 years to get a drug approved by the FDA. I imagine there are a few miracle drugs that have ended up in landfills.
>
>
> - Scott
>
>
Posted by pharmrep on August 15, 2002, at 13:19:25
In reply to Re: Interesting article » SLS, posted by Ritch on August 10, 2002, at 11:08:40
Hi all, check your news sites, Lexapro was approved today. There are plenty of studies and clinical information posted as well if you havent already found some. (should be in pharmacies 1st week of September)
Posted by Anyuser on August 15, 2002, at 18:45:44
In reply to Lexapro approved » Ritch, posted by pharmrep on August 15, 2002, at 13:19:25
> There are plenty of studies and clinical information posted as well if you havent already found some.
Any new studies and clinical info posted? By that I mean very recent. Could you provide links? Thanks.
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