![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 231 to 255 of 8406. Go back in thread:
Posted by pharmrep on September 1, 2002, at 16:59:45
In reply to Cheap, Generic Celexa Won't Happen: Here's Why: » moxy1000, posted by Simcha on September 1, 2002, at 15:33:19
> I'm concerned by the growing debate over Lexapro. I am not saying that we should not allow Drug Reps to provide information on this new drug.
>
> However..... I think that Pharmrep is more than zealous about Lexapro. Of course he would be. His job depends on it. I think we need to remind ourselves that drug reps and drug companies in general are for profit institutions and as such the profit is the ONLY GOAL of said institutions.
>
> Remember Enron, Worldcom, and all the rest of the corporate scandals lately. These big companies really have so much control over our lives.
>
> As they make Celexa impossible to get because it will be knocked off of the formulary of most insurance companies due to the pricing of their new drug Lexapro, Forest introduces "New and Improved Celexa" in the form of Lexapro. Now, those of us who do just fine on Celexa may not do as well on Lexapro. I see no convincing evidence that Lexapro will be better for me than Celexa. Most med changes have been very difficult for me.
>
> Knocking the waning Celexa off of insurance formularies by making Lexapro cheaper Forest has made certain that no one but Forest will make profit off of Citalopram. The old drug "citalopram" will die an early death at the hands of the insurance companies so that by the time Forest loses its patent no one will bother marketing generic citalopram because there would be no profit. Thus Forest retains its patent on Lexapro and remains the sole provider of this allegedly superior form of its most successful drug (removing the r-isomer of course).
>
> I do not buy into their claims that this is not a profit driven plan for the reasons above. It will insure a continued monopoly on the s-isomer at the very least and it will kill any incentive for any other company to make a generic citalopram thus keeping Lexapro on top of the market.
>
> Just My Opinion,
> Simcha*** where do you get your info on Celexa being "knocked off" formulary? I dont think that will happen...Forest is not trying to have "happy" Celexa patients switch to Lexapro...just those who "need" to for adverse event reasons. And to concur..generic Celexa not in US til late 2005....
PS Will somebody tell Simcha about Howard Soloman and his story (and his son) so maybe this way Simcha might see Forest in a different light. (PPS...the above point about waiting til patent out is what GlaxoSmithKline did with Paxil...Paxil CR was approved by FDA 3 years ago, but only came out this year...when the original Paxil expires...the public and Dr's are learning this and are not happy....sorry it happens Simcha...but really...Forest isnt a bad cookie and is trying to do the right thing...by promoting the better med.)
Posted by LostBoyinNC1 on September 1, 2002, at 17:31:47
In reply to Cheap, Generic Celexa, posted by moxy1000 on September 1, 2002, at 14:14:07
Generic Celexa will be better, cheaper than Lexapro. Why shell out your hard earned cash to Forest Labs for Lexapro and make yourself poorer and Forest Labs richer, when you can just buy generic Celexa?
Somethings make absolutely no logic whatsoever. This Lexapro thing is one of them.
LostBoyinNC
Posted by Winger on September 1, 2002, at 17:37:42
In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48
Posted by Winger on September 1, 2002, at 17:38:13
In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48
Posted by Winger on September 1, 2002, at 17:43:10
In reply to Re: sex. s/e, posted by pharmrep on August 1, 2002, at 10:54:11
I have read that small doses of Buspar seem to negate the side effects of SSRI's.
I have GAD and took Buspar. It worked great for a while, then it started giving me panic attacks, something I never had... and because of it's short half life, if I missed a does, it was bad... anxiety, chest pain, etc....
I got the buspar from my internest, but finally found a psych doc for help.. she put me on a very small does of zoloft to help me get off the Buspar.. I have to admit, while I was taking a low dose of BOTH, I felt the best I have ever felt.. I slowly stopped the buspar, then the Zoloft started making me edgy and giving me stomach problems.. and so I slowly stopped that as well... I am now trying a low 37.5 mg does of effexor XR.. not bad, fewer side effects, but not as good at the anxiety.. I want to try lexapro... and I may try a small single daily dose of Buspar to get rid of SSRI side effects...
I found a great web site for this kind of research
http://www.biopsychiatry.com/venbus.html
follow the links at the bottom... they're great...
anyone else heard of this buspar/SSRI thing?
Good luck and Thanks!
Posted by dr. dave on September 1, 2002, at 17:52:45
In reply to Cheap, Generic Celexa, posted by moxy1000 on September 1, 2002, at 14:14:07
Let's look at the 'patent emergency' question. It is undeniable that Lundbeck, who developed Celexa, are facing a patent emergency - 81% of their revenue in 2001 was from citalopram, the patent ran out in January of this year, and generic citalopram is available in many European countries. They have had no choice but to launch something new, and escitalopram was all they realistically had. Forest are not in the same position - but what would have happened had they not launched escitalopram when it has been launched in Europe? A 'new, improved' citalopram is being heavily marketed in Europe and they don't launch it too? There would have been uproar in the US, not least on this website. People would believe they were being denied a better drug. So Forest have really had no choice.
I think moxy1000 hasn't quite got the pharmacology here - Celexa is a combination of s-citalopram and r-citalopram, and lexapro is s-citalopram alone. So the active molecules are, in fact, exactly the same molecules, thereby having exactly identical effects on the body. In vitro data show Lexapro to be about twice, not 100 times, the potency of Celexa (Sanchez et al, at http://www.cipralex.ch/pdf/poster/sanch19_500.pdf ). If you think about it, this is only logical. Only half of Celexa is active, so you need twice the weight of it to get the same amount of s-citalopram as you do Lexapro, so half the potency. What does this potency mean? Potency is not related to rate of increase of serotonin levels. It merely describes the relative doses of two substances required to get the same effect. If being more potent means a drug works better, this would mean haloperidol would be a much much more effective drug than quetiapine, as it is tens of times more potent.If there is data to support the claim that escitalopram causes a higher rate of increase of serotonin levels I would be glad to see it.
I don't know what to say further about the claim of a cleaner 'side-effect profile' for Lexapro than Celexa. I've given the research data in detail in a previous post and no-one has provided anything new to contradict what that data says, which is that no difference in rates of side-effects has been found. Again, any data to back up the claim, I'd be glad to see it.
At the risk of being repetitive, we have to look closely at the data here and see what it is saying. It's important to make our own minds up from an informed perspective.
> Seems there is a lot of talk about generic Celexa again, and I think there a couple of things to think about. One, no Celexa generic will be available in the U.S. until approx mid 2005. I think Celexa's patent/exclusivity runs through the end of 2004 and they just received another 6 month patent extension for some studies they did in pediatrics. (I assume generic Celexa/Cipralex formulations are available now in Europe?) Second, Lexapro will be priced Cheaper then Celexa, and thus all other SSRI's. Therefore, if you think about the fact that the folks that run HMOs and formularies usually choose the least expensive agents to make available to their customers, it's probably safe to assume that Lexapro will replace Celexa/or other AD's on a lot of formularies. (Another thing to think about is that very soon the company that makes both drugs will no longer be making much $ on Celexa anymore.) In the case of Lexapro being introduced to the states, one thing is clear - this was Not an invention/product release that came about due to a "patent emergency."
>
> So why is Lexapro being released here? It has been said that it is "basically the same as Celexa." Why would a company introduce a drug that is effectively the same as a drug they have three years left to make money off of? Yes, the two drugs are the same in regards to their mechanism of action - both are SSRI's. But saying they are the same is effectively like saying Lexapro is the same as Prozac. It's like saying an apple is the same as an orange. They are two different molecules, thus having different effects on the body. A couple of things to consider - in vitro data shows Lexapro as being 100 times more potent then Celexa for the inhibition of serotonin reuptake - this means simply that Lexapro will increase serotonin levels at a much higher rate then Celexa. (Does anyone want to hear a disertation about receptor binding of Celexa, the R-enantiomer, and the S-enantiomer? I didn't think so - but I can give the sources and further data if necessary.) However, That is one important difference. The second difference is that in every study I've seen to date - authored by many different physicians - the onset of Lexapro in improving depression occured in 1-2 weeks. This is also a difference, as Celexa and all the other SSRI's claim onset at 4-6 weeks. Also, Lexapro's high life is a bit shorter, and protein binding is less. The side effect profile is cleaner, and Lexapro has the less potential for drug interactions then even Celexa does. I wont go into detail here about the significance of those things, however, it furthers the argument that Lexapro is NOT the same as Celexa.
>
> How does one pose an argument based on this: The authors of a study give their findings on Lexapro. The data looks encouraging. The only argument against the data is that the authors cannot be trusted because the studies were sponsored by a drug company. Funny, when Prozac was introduced, all of their studies were sponsored by the parent drug company, yet physicians through "caution to the wind" and began prescribing it anyway. Thankfully, this brought about a revolution in AD treatment and the patients that finally ditched their irritating Tricyclic meds gave a round of applause for a better tolerated medication.
>
>
> I still don't think anyone has explained successfully why the company that makes celexa would abandon it's marketing and sampling of Celexa in the U.S. when the patent is good for three more years. And why they would introduce the "same drug under a different name" as some claim requires an explanation also. There seems to be only one school of thought that makes sense - they looked at both Celexa and Lexapro, examined all the relevant studies for both agents, and decided to introduce a superior agent, rather then sit on Celexa until it's patent ran out in a few years. (Can you imagine the backlash against the company if they said, "Yeah, we knew about Lexapro back in 2002, but gee, we had Celexa and were making money hand over fist, so we just tucked Lexapro away for a rainy day." People would be furious if they then tried to market Lexapro as being superior.) Heck, they probably even did some research and believe in the long haul they'll make even more money on Lexapro, if we stick with the "drug companies are fundamentally concerned only with their bottom line and really don't care about patients" approach.
>
> What other feasible explanation could there be for Lexapro's release in the U.S.? I'd love to hear any feedback on this...as I have been noodling this concept for several weeks and have been unable to arrive at any other conclusion. If there's another explanation that factually makes sense, I'd probably change my mind completely on Lexapro. But so far, the only argument against Lexapro that I've heard is one based on the authors of every study being dishonest. Is it a conspiracy?
>
> Sorry about the long post. I was banned for a week (apologies Dr. Dave) so I had a lot of thoughts to share.
>
>
Posted by pharmrep on September 1, 2002, at 18:01:10
In reply to Re: Generic Celexa will be better than Lexapro, posted by LostBoyinNC1 on September 1, 2002, at 17:31:47
> Generic Celexa will be better, cheaper than Lexapro. Why shell out your hard earned cash to Forest Labs for Lexapro and make yourself poorer and Forest Labs richer, when you can just buy generic Celexa?
>
> Somethings make absolutely no logic whatsoever. This Lexapro thing is one of them.
>
> LostBoyinNC*** First of all, no generic available til 2005, 2nd...what do you base this on? Nothing...I didnt think so. If there werent advances in treatment...everybody would still be taking tricyclics...would you rather have that?
Posted by dr. dave on September 1, 2002, at 18:10:49
In reply to other findings, posted by pharmrep on September 1, 2002, at 10:42:58
I'm sorry if what I am saying is annoying you. I don't disagree with the findings, which are that switching from citalopram to escitalopram does not cause an increase in side-effects, and that escitalopram (like citalopram) is superior to placebo in treating GAD and as maintenance treatment in depression. None of these papers contribute any evidence to support any claim that escitalopram is superior to citalopram; no comparisons have been made.
Please let's stick to a careful analysis of the data. To reiterate my position - I believe escitalopram is effectively identical to citalopram (a good antidepressant which I continue to prescribe widely). There's nothing wrong with it particularly; but I cannot see convincing evidence that it contributes anything new, nor can I see how it could even hypothetically be better given the pharmacology.
> Here are other findings from Dr Dave's recommended website from another author(globaly) since Dr Dave "feels" Dr Gorman is "biased."
> http://www.docguide.com/news/content.nsf/news/DD86D17DF771760785256A80004D4D42?OpenDocument&id=48DDE4A73E09A969852568880078C249&c=Depression&count=10&highlight=0,
>
> http://www.docguide.com/news/content.nsf/news/7F27EF97B338460A852569B400610AE8?OpenDocument&id=48DDE4A73E09A969852568880078C249&c=Depression&count=10&highlight=0,
>
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>
>
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>
Posted by pharmrep on September 1, 2002, at 18:19:09
In reply to Re: sex. s/e (let's try this one more time -newby) » pharmrep, posted by Winger on September 1, 2002, at 17:43:10
> I have read that small doses of Buspar seem to negate the side effects of SSRI's.
> I have GAD and took Buspar. It worked great for a while, then it started giving me panic attacks, something I never had... and because of it's short half life, if I missed a does, it was bad... anxiety, chest pain, etc....
> I got the buspar from my internest, but finally found a psych doc for help.. she put me on a very small does of zoloft to help me get off the Buspar.. I have to admit, while I was taking a low dose of BOTH, I felt the best I have ever felt.. I slowly stopped the buspar, then the Zoloft started making me edgy and giving me stomach problems.. and so I slowly stopped that as well... I am now trying a low 37.5 mg does of effexor XR.. not bad, fewer side effects, but not as good at the anxiety.. I want to try lexapro... and I may try a small single daily dose of Buspar to get rid of SSRI side effects...
> I found a great web site for this kind of research
> http://www.biopsychiatry.com/venbus.html
> follow the links at the bottom... they're great...
> anyone else heard of this buspar/SSRI thing?
> Good luck and Thanks!** No joke...sexual s/e can be tough with SSRI's...I know it is a tough trade for some...treating the depressive componants vs sex s/e. I have heard of the buspar..and others like wellbutrin added on to SSRI's. It seems that your dose can be low enough for you and that the AD still works. Effexor is usually an SNRI, but at doses below 150 it is still an SSRI. How are you doing with the s/e? Are you experiencing increased sweating, increased blood pressure (you have to check your blood pressure with Effexor), dizziness, nausea, somnolence, insomnia, ejac disorder, or anything else? Most of all...like Paxil, you need to be aware of discontinuation s/e with Effexor...this is an AD you cant just stop and switch with..if you do...you might experience agitation, anorexia, anxiety, confusion, impaired coordination, fatigue, vertigo, vomiting,dry mouth, nervousness, and the earlier mentioned s/e. If you do try Lexapro...try it without the Buspar 1st to see if you even need it...you might not.
Posted by LostBoyinNC1 on September 1, 2002, at 18:20:45
In reply to what? » LostBoyinNC1, posted by pharmrep on September 1, 2002, at 18:01:10
> > Generic Celexa will be better, cheaper than Lexapro. Why shell out your hard earned cash to Forest Labs for Lexapro and make yourself poorer and Forest Labs richer, when you can just buy generic Celexa?
> >
> > Somethings make absolutely no logic whatsoever. This Lexapro thing is one of them.
> >
> > LostBoyinNC
>
> *** First of all, no generic available til >2005, 2nd...what do you base this on? >Nothing...I didnt think so.WRONG. I base what I say upon solid and basic pharmacology knowledge. Its a hard fact Lexapro is just another SSRI. Its no better than Prozac, Zoloft, Paxil, Luvox or the currently available Celexa. You know it...I know it. So do most psychiatrists and most of the posters on this board. One SSRI is as good as another SSRI.
Dont let your salesman mentality get in the way of logical thinkng Pharmrep. I realize you want to sell as much Lexapro as poosible...thats your job. You work for Forest Labs. When I read your posts, I think "who is this person who is writing this?" And I realize you are a DRUG SALESMAN for the company that makes Lexapro. DUH. Thus you are going to brag about your drug in order to try to sell more of it.
Lexapro is no more effective than currently available antidepressants, pharmrep.
It comes down to this one, basic simple fact pharmrep. Lexapro is nothing but another "me too" selective serotonin type antidepressant. Thus it is no better than anything else. In fact, its not AS EFFECTIVE as some antidepressants which hit multiple neurotransmitters like high dosage Effexor or the MAOIs.
And actually, yeah tricyclics hit more neurotransmitters than Lexapro.
> If there werent advances in treatment...everybody would still be taking tricyclics...would you rather have that?
Dont try to use emotion to sway people pharmrep. Stick to the hard facts when you make claims about your beloved Lexapro. Lexapro is just another SSRI. Id rather take generic Prozac, Zoloft or Paxil than make your company richer.
Generic Celexa will be here soon enough. 2005 is not that far off...just a few years. Once that happens no insurance company will want to pay for Lexapro, they will want to pay for the generic Celexa. As soon as a drug becomes generic, many insurance companies will ONLY pay for the generic version of the drug.
LostBoyinNC
PS: dont argue with me, you will never win.
Posted by Dinah on September 1, 2002, at 18:28:22
In reply to Re: what?, posted by LostBoyinNC1 on September 1, 2002, at 18:20:45
> Dont let your salesman mentality get in the way of logical thinkng Pharmrep. I realize you want to sell as much Lexapro as poosible...thats your job. You work for Forest Labs. When I read your posts, I think "who is this person who is writing this?" And I realize you are a DRUG SALESMAN for the company that makes Lexapro. DUH. Thus you are going to brag about your drug in order to try to sell more of it.
>
> LostBoyinNC
>
> PS: dont argue with me, you will never win.
>
Lost Boy,
Dinah here again, filling in for Dr. Bob.
Please see my civility warning on the thread below.
I'd like to keep this discussion focused on issues rather than on other posters.
Thank you,
Dinah
Posted by pharmrep on September 1, 2002, at 18:30:40
In reply to Re: Cheap, Generic Celexa » moxy1000, posted by dr. dave on September 1, 2002, at 17:52:45
You site the same studies that have opposite conclusions from what you are saying. The Sanchez study showed that s-citalopram is acutally being inhibited from r-citalopram in the microdialysis study. that 2mg of s-cit/Lexapro was more effective than 4mg of Celexa (2mg of s-cit + 2mg of r-cit). Therefore indicating that the r-cit does not help the racemic mixture at all.....and you said "s-citalopram is all that they realistically had." Did you know that the technology used to separate the isomers is so new that the scientists that invented it won the Nobel prize for chemistry for 2001? Lundbeck and Forest are not sitting and waiting, but being proactive and trying to develop better medicine....why dont you try it instead of being Dr. Theory all the time. Afterall, you are in Europe and have had the opportunity where we in the US have not.
Posted by LostBoyinNC1 on September 1, 2002, at 18:31:37
In reply to what? » LostBoyinNC1, posted by pharmrep on September 1, 2002, at 18:01:10
Once generic Celexa is available, many insurance companies wont want to pay for Lexapro anymore. In fact, my insurance company wont even pay for Celexa right now. Its not formulary on my coverage. Besides, Id prefer to use Prozac, Zoloft or Paxil anyway.
Generics are almost always better. They are cheaper, just as good, just as effective. And furthermore you have the satisfaction of knowing you are not making some asshole drug company richer, while making yourself poorer. We already have generic Prozac, generic Paxil and generic Zoloft are not far off. Then we will have generic Effexor XR. Wellbutrin is already generic.
We dont need anymore SSRIs, the USA already has plenty of them on the market. Before Lexapro we had five SSRIs...Prozac, Zoloft, Paxil, Luvox and Celexa. Now Lexapro. Thats stupid. Five was plenty. Its time to develop something truly new, novel and improved than more SSRIs.
Furthermore, 2005 will be here before you know it. Generic Celexa is right around the corner.
LostBoyinNC
Posted by LostBoyinNC1 on September 1, 2002, at 18:37:12
In reply to Re: Please be civil » LostBoyinNC1, posted by Dinah on September 1, 2002, at 18:28:22
> > Dont let your salesman mentality get in the way of logical thinkng Pharmrep. I realize you want to sell as much Lexapro as poosible...thats your job. You work for Forest Labs. When I read your posts, I think "who is this person who is writing this?" And I realize you are a DRUG SALESMAN for the company that makes Lexapro. DUH. Thus you are going to brag about your drug in order to try to sell more of it.
> >
> > LostBoyinNC
> >
> > PS: dont argue with me, you will never win.
> >
>
>
> Lost Boy,
>
> Dinah here again, filling in for Dr. Bob.
>
> Please see my civility warning on the thread below.
>
> I'd like to keep this discussion focused on issues rather than on other posters.
>
> Thank you,
> Dinah
I am keeping the discussion on the issues. If you cant see that, you need to learn logic. We have a poster here who is bragging about "Lexapro" making it sound like its God's gift to psychiatry or something. When if you investigate you will find that all it is is another stupid serotonin SSRI antidepressant. I was just pointing out to pharmrep (reminding him) who he is, that when he writes things people should keep in mind who he works for, etc. Thats basic argumentative writing 101 Dinah, it has nothing to do with "being civil."When pharmrep brags about Lexapro, it should be taken with a big grain of salt based upon the fact that its just another SSRI. And the other basic fact that pharmrep works for Forest Labs.
There are many treatment resistant depressives out there who Lexapro wont help them worth squat. The amount of resources that was spent bringing Lexapro to market could have been better spent, in ways that would truly benefit more people.
LostBoyinNC
Posted by pharmrep on September 1, 2002, at 18:39:00
In reply to Re: what?, posted by LostBoyinNC1 on September 1, 2002, at 18:20:45
** I have hard facts....9 positive studies..have you read any of them? I have not "sold" in this forum at all...if you look closely, I am only correcting any misstatements I see, and back them up with studies. If you like one med over another, thats your decision, but Lexapro is hardly a "me too." Get your facts and sources on the table and not just your opinions, then your "arguements" will have more validity.
Posted by Dinah on September 1, 2002, at 18:40:44
In reply to Re: bad logic from Dr. Dave » dr. dave, posted by pharmrep on September 1, 2002, at 18:30:40
> why dont you try it instead of being Dr. Theory all the time. Afterall, you are in Europe and have had the opportunity where we in the US have not.
Dinah here.
Pharmrep, please don't post anything that could lead others to feel accused or put down.
I'd like to keep this discussion about ideas rather than about fellow posters.
Here is a link to Dr. Bob's civility guidelines:
http://www.dr-bob.org/babble/faq.html#civil
This is a volatile thread with feelings running high on all sides. Please remember to be careful how you phrase your posts (and your subject headings).
I appreciate your cooperation while Dr. Bob is away.
Dinah
Posted by dr. dave on September 1, 2002, at 18:47:56
In reply to Re: bad logic from Dr. Dave » dr. dave, posted by pharmrep on September 1, 2002, at 18:30:40
Just a couple of things. Firstly, I have a duty to be 'Dr Theory'. I need to know and understand research on new drugs and to be able to make out what the results mean. I would expect my doctor to do this. I would want my doctor to think for him- or herself, and I would not appreciate it if they tried new drugs out on me just because they were new, if they weren't convinced they were any better than the established drugs.
Secondly, I deal with the realities of prescribing antidepressants to people every working day, and have done for years. I would like to ask you to please refrain from sarcasm directed towards me - please can we stick to discussing the facts.
> You site the same studies that have opposite conclusions from what you are saying. The Sanchez study showed that s-citalopram is acutally being inhibited from r-citalopram in the microdialysis study. that 2mg of s-cit/Lexapro was more effective than 4mg of Celexa (2mg of s-cit + 2mg of r-cit). Therefore indicating that the r-cit does not help the racemic mixture at all.....and you said "s-citalopram is all that they realistically had." Did you know that the technology used to separate the isomers is so new that the scientists that invented it won the Nobel prize for chemistry for 2001? Lundbeck and Forest are not sitting and waiting, but being proactive and trying to develop better medicine....why dont you try it instead of being Dr. Theory all the time. Afterall, you are in Europe and have had the opportunity where we in the US have not.
Posted by pharmrep on September 1, 2002, at 18:49:08
In reply to Re: Please be civil » pharmrep, posted by Dinah on September 1, 2002, at 18:40:44
> > why dont you try it instead of being Dr. Theory all the time. Afterall, you are in Europe and have had the opportunity where we in the US have not.
>
> Dinah here.
>
> Pharmrep, please don't post anything that could lead others to feel accused or put down.
>
> I'd like to keep this discussion about ideas rather than about fellow posters.
>
> Here is a link to Dr. Bob's civility guidelines:
>
> http://www.dr-bob.org/babble/faq.html#civil
>
> This is a volatile thread with feelings running high on all sides. Please remember to be careful how you phrase your posts (and your subject headings).
>
> I appreciate your cooperation while Dr. Bob is away.
>
> Dinah*** My bad. I guess I am getting steamed. I have been in PB awhile now...and I was upfront on my "Pharmrep" to be open with everybody. I have the same right as anyone else to be here, and I take extra precautions to be sensitive and not "saleslike" in my posts, and site studies as often as I can. I have received mostly fair posts from others, and although topics get heated, I know we are entitled to our opinions (hopefully that can be based on facts and studies). So I agree...lets turn it down a notch and try to be a little more conscious of our posts and keep it fact-based.
Posted by LostBoyinNC1 on September 1, 2002, at 18:52:08
In reply to Re: Lexapro side-effects » dr dave, posted by pharmrep on August 31, 2002, at 22:13:49
.
>Stop trying to find a reason why you disagree >with the studies...and be a little more >objective, or better yet...let the folks >here in the US have the chance to decide for >themselves if they want to try Lexapro...since >you arent willing to and have had the chance for >some time now.How about if you try to be more objective pharmrep, instead of telling other depressives who have personally "been there, done that" what the real deal is with SSRIs? You can improve your objectivity by simply publicly admitting that:
1) Lexapro is just another "me too" serotonin SSRI. This is a hard fact, anyone who reads about it can see this for themselves. Its been proven that one SSRI is as good as another SSRI. No SSRI is any better than another.
2) By admitting to yourself and others on here that you are a Forest Labs drug salesman whose job is to sell Lexapro. Its difficult, if not impossible for you to be truly objective because of who you are. You have a conflict of interest. Do you know what a conflict of interest is, pharmrep? Because youve got one.
You have a lot of gaul telling people on here, sick people who have serious medical problems that they should "be objective" when you yourself are about as biased as a person can be. Youre a Lexapro drug salesman for Forest Labs.
LostBoyinNC
Posted by Simcha on September 1, 2002, at 18:53:32
In reply to Re: Generic Celexa Won't Happen: see bottom » Simcha, posted by pharmrep on September 1, 2002, at 16:59:45
>*** where do you get your info on Celexa being "knocked off" formulary?
Logic my man. Pure logic. Since Lexapro is supposed to be the "New and Improved Celexa" and it will be priced cheaper than Celexa, insurance companies *WILL* notice and dump Celexa from the formulary. It's simple economics.
>I dont think that will happen...Forest is not trying to have "happy" Celexa patients switch to Lexapro...just those who "need" to for adverse event reasons. And to concur..generic Celexa not in US til late 2005....
Um, I beg to differ. I still see no research that tells me that Lexapro is anything more than just another SSRI. Lexapro is 1/2 of what Celexa is and yes it still would take 20mg of Lexapro to equal 40mg of Celexa. This is my effective dose. The side effect profile for 20mg of Lexapro and 40mg of Celexa are not statistically significant.
>PS Will somebody tell Simcha about Howard Soloman and his story (and his son) so maybe this way Simcha might see Forest in a different light.
Um Forest Labs is soooo very far away from its early days. Now it is no more than any other Drug Giant.
If Forest were really so benificent then they would give up their patent for an allegedly inferior drug (Celexa) so that more patients might at least be able to afford it while introducing the lower-priced Lexapro. Instead we will see insurance companies drop the more expensive version of Forest's drug, Celexa, from their formularies. No, this is a marketing strategy to force Lexapro into market dominance.
>PPS...the above point about waiting til patent out is what GlaxoSmithKline did with Paxil...Paxil CR was approved by FDA 3 years ago, but only came out this year...when the original Paxil expires...the public and Dr's are learning this and are not happy....sorry it happens Simcha...but really...Forest isnt a bad cookie and is trying to do the right thing...by promoting the better med.)Forest is just doing it differently. Please use common sense, economics, and marketing savvy then tell me if their plan is not about forcing Celexa out so that Lexapro will rise to the top.
Posted by pharmrep on September 1, 2002, at 18:55:07
In reply to Re: 'Dr Theory' » pharmrep, posted by dr. dave on September 1, 2002, at 18:47:56
OK Dr Dave...lets just say we agree to disagree...you have one intrepretation to the studies and their conclusions you have read and I tend to agree with the studies. I will say this...I dont like the extra hype on Lexapro...I would rather just be able to give the Dr's I see the studies and samples like all pharmreps do, and let the Dr's decide for themselves...is there a place for this med, will it be able to help some of my patients where other meds dont, and once comfortable maybe new patients can try it as well.
Posted by Dinah on September 1, 2002, at 18:57:55
In reply to Re: Please be civil, posted by LostBoyinNC1 on September 1, 2002, at 18:37:12
> I am keeping the discussion on the issues. If you cant see that, you need to learn logic.
>Thats basic argumentative writing 101 Dinah, it has nothing to do with "being civil."
>Lost Boy, I should have added that further discussion of posting policies should take place at PB Administration. However, I will offer this.
This site is not the place for argumentative writing, Lost Boy. It is designed for support and education. Education can be offered in ways that are not argumentative, and on this site it must be offered in non-argumentative ways, or the site cannot fulfill its supportive function.
As I said below, I hope you choose to stay and follow the civility guidelines so that you will be able to continue to offer education.
Also, for future reference, the civility guidelines also apply to comments addressed to me.
Any further discussion of posting policies or administrative matters should be directed to PB Administration.
Dinah
Posted by Dinah on September 1, 2002, at 19:03:28
In reply to Re: Lexapro side-effects, posted by LostBoyinNC1 on September 1, 2002, at 18:52:08
>
> You have a lot of gaul telling people on here, sick people who have serious medical problems that they should "be objective" when you yourself are about as biased as a person can be. Youre a Lexapro drug salesman for Forest Labs.
>
> LostBoyinNC
Sorry, Lost Boy. I asked you before to be civil, so I have had to block you from posting for one week.
Posted by pharmrep on September 1, 2002, at 19:08:40
In reply to Re: Generic Celexa Won't Happen: Simple Economics » pharmrep, posted by Simcha on September 1, 2002, at 18:53:32
> >*** where do you get your info on Celexa being "knocked off" formulary?
>
> Logic my man. Pure logic. Since Lexapro is supposed to be the "New and Improved Celexa" and it will be priced cheaper than Celexa, insurance companies *WILL* notice and dump Celexa from the formulary. It's simple economics.
>
> >I dont think that will happen...Forest is not trying to have "happy" Celexa patients switch to Lexapro...just those who "need" to for adverse event reasons. And to concur..generic Celexa not in US til late 2005....
>
> Um, I beg to differ. I still see no research that tells me that Lexapro is anything more than just another SSRI. Lexapro is 1/2 of what Celexa is and yes it still would take 20mg of Lexapro to equal 40mg of Celexa. This is my effective dose. The side effect profile for 20mg of Lexapro and 40mg of Celexa are not statistically significant.
>
> >PS Will somebody tell Simcha about Howard Soloman and his story (and his son) so maybe this way Simcha might see Forest in a different light.
>
> Um Forest Labs is soooo very far away from its early days. Now it is no more than any other Drug Giant.
>
> If Forest were really so benificent then they would give up their patent for an allegedly inferior drug (Celexa) so that more patients might at least be able to afford it while introducing the lower-priced Lexapro. Instead we will see insurance companies drop the more expensive version of Forest's drug, Celexa, from their formularies. No, this is a marketing strategy to force Lexapro into market dominance.
>
>
> >PPS...the above point about waiting til patent out is what GlaxoSmithKline did with Paxil...Paxil CR was approved by FDA 3 years ago, but only came out this year...when the original Paxil expires...the public and Dr's are learning this and are not happy....sorry it happens Simcha...but really...Forest isnt a bad cookie and is trying to do the right thing...by promoting the better med.)
>
> Forest is just doing it differently. Please use common sense, economics, and marketing savvy then tell me if their plan is not about forcing Celexa out so that Lexapro will rise to the top.****Do you know how managed care works? Just because Lexapro is less than Celexa, doesnt mean Celexa will get bumped off formulary. They will both be high on the formularies ahead of other AD's. Forest is not trying to "remove" Celexa. And there is a lot more to Lexapro than being "1/2 of Celexa" in fact if you are on 40mg of Celexa...then 10mg of Lexapro would be the equivalent..not 20mg. Do you have access to any of the studies? If not...keep checking the posts (or web)...they are out there. And "doing it differently" is the right thing to do...bring the better med to the public if thats what it is.
Posted by winger on September 1, 2002, at 19:34:32
In reply to Re: sex. s/e (let's try this one more time -newby) » Winger, posted by pharmrep on September 1, 2002, at 18:19:09
I have had some side effects with the effexor.. flushing, some sexual side effects although nothing major - thougth at higher doses I got the jitters and lots of physical side effects like shakes and spasams much like what you read about with the serotonin syndrome... BP seems fine so far though that is a concern of mine as high BP runs in my familly. As to withdrawal.. I tried Paxil a long time ago, when I first started having anxiety problems, and had terrible agitation and nervousness from it.. I didn't have a psych doctor then, and decided to just stop it.. The funny thing is, I felt Terrific for a week or two.. the most relaxed and in control I have been in years... I guess I was still getting the serotonin effects of the medication without the side effects, and had absolutely no withdrawal other than that.. my doctor was amazed.. same for the zoloft..
the Buspar was bad though... I lost about thirty pounds and years off my life getting off that medication!! But it wasn't as bad with the zoloft...And I would definitely try the Lexapro sans Buspar first..! it's just something I read in a study and was curious about.. I definitely will avoid that drug if possible.. It's also funny, the Buspar is supposed to take a long time to start working, but it helped me almost immediately..
I also know about the fact that at the dose I'm taking, Effexor really just an SSRI, that's one reason I want to try another SSRi .. at higher doses of Effexor, I can't take it... it's like speed to me....
Just goes to show how different all of us are!!
This is really all just one big experiment on all of us.. but it's one of the only shots we have short of doping up on the benzo drugs... or joining a tibetin monastery!!! :)
You sound like you know your stuff... at least you are giving reasonable info to people...!
It's all about what works for the individual, and about taking it slow and getting a doctor that will work with you and help you along...
no quick fix for any of this sad to say!!
I really think our modern lifestyle is the ultimate culprit - especially in our formative years.. but I'm not ready to chuck it all just yet
Ciao!!
Dave
> ** No joke...sexual s/e can be tough with SSRI's...I know it is a tough trade for some...treating the depressive componants vs sex s/e. I have heard of the buspar..and others like wellbutrin added on to SSRI's. It seems that your dose can be low enough for you and that the AD still works. Effexor is usually an SNRI, but at doses below 150 it is still an SSRI. How are you doing with the s/e? Are you experiencing increased sweating, increased blood pressure (you have to check your blood pressure with Effexor), dizziness, nausea, somnolence, insomnia, ejac disorder, or anything else? Most of all...like Paxil, you need to be aware of discontinuation s/e with Effexor...this is an AD you cant just stop and switch with..if you do...you might experience agitation, anorexia, anxiety, confusion, impaired coordination, fatigue, vertigo, vomiting,dry mouth, nervousness, and the earlier mentioned s/e. If you do try Lexapro...try it without the Buspar 1st to see if you even need it...you might not.
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