![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by adams on March 3, 2001, at 21:32:06
What do you think is the most effective antidepressant drug there is on average? Which drug do the most people respond to? I would like a answer from someone who has a lot of knowledge of different drugs and has been reading this website for a long time and has some idea of what drugs work better than others, knowledge just from reading peoples personal experiences on this website. I know what you are going to say, you are going to say that there is no best antidepressant but I am just saying if you were a doctor and you had to pick just one drug to use for all your patients and you were only allowed to prescribe that one drug which one would you pick.
Posted by dj on March 4, 2001, at 2:59:07
In reply to What do you think?, posted by adams on March 3, 2001, at 21:32:06
> What do you think is the most effective
> antidepressant drug there is on average?CamW or Sunnely are the best overall to answer this, however it would doubtless help them if you were to outline what your symptoms are as that is part of determining what may work best as everyone's package of symptoms is somewhat unique... and hence the need to tailor the precrisption to the individual...
Posted by JohnL on March 4, 2001, at 4:42:43
In reply to What do you think?, posted by adams on March 3, 2001, at 21:32:06
> What do you think is the most effective antidepressant drug there is on average? Which drug do the most people respond to? I would like a answer from someone who has a lot of knowledge of different drugs and has been reading this website for a long time and has some idea of what drugs work better than others, knowledge just from reading peoples personal experiences on this website. I know what you are going to say, you are going to say that there is no best antidepressant but I am just saying if you were a doctor and you had to pick just one drug to use for all your patients and you were only allowed to prescribe that one drug which one would you pick.
Funny, I've posed this very question to each doctor I've had. Four responses were:
Doc1=Zoloft
Doc2=Prozac
Doc3=Effexor
Doc4=Each patient has unique chemistry, unique personality, and unique circumstances, and therefore there are no favorites. Each case is unique and different. What actually ends up working could be anything, even drugs totally unrelated to the assumed diagnosis.If I were a doctor, I would tend to agree with all four of the above docs to some degree, but I would hold a favoritism for Prozac+Zyprexa. There is something unique and special about this combo that addresses a wide range of symptoms in a wide range of people. Prozac is the tried and true workhorse of the SSRIs. While the other SSRIs are fairly similar to each other, Prozac stands out as being the most unique. And it has the longest track record. There is some kind of special synergy between Prozac and Zyprexa. So if I was forced to choose just one treatment that increased my odds for success, it would be that.
But of course the disclaimer always applies...your mileage may vary...what works for someone might not work for someone else. We just happen to see a lot of success with Zyprexa, and it goes especially well with Prozac.
John
Posted by Cam W. on March 4, 2001, at 8:18:50
In reply to What do you think?, posted by adams on March 3, 2001, at 21:32:06
Adams - The choice of which antidepressant (or any drug) for a patient depends upon many factors, starting with a diagnostic questionaire to determine if the person is indeed ddepressed; next a full history (medical and life) including past and present meds and lab tests to rule to drug out drug &/or medical condition-induced depressions. Next you factor in a patient's personality to get a feel for what type of treatments they would prefer (to try to maximize compliance). Sometimes medication is not needed and the depression can be treated with psychotherapy; sometimes both are indicated. Some people aren't able to tolerate certain side effects of treatment (eg nausea & drowsiness with antidepressants or ability to understand and the willingness work on lifestyle changes with psychotherapy). Cost of treatmetns also factors in to whether a person will keep taking therapy (sometimes you have to consider using a cheaper generic TCA,if a person canoot afford newer antidepresssants, with fewer side effects). Patients have to "want" to get better and have to work at it. The patient's role in the treatment of depression is not a passive one, nor is it easy.
Symptom presentation is begininning to guide some docs is choosing certain antidepressants (ie. would this person be helped with a medication that increases serotonin or norepinephrine). The are probably other obvious factors that enter into this equation, but I am a pharmacist, not a diagnostician.
Deciding on a medication or other therapy for the treatment of depression is where a doctors scientific skills and his/her experience come into play. This is a good instance of how the "art" of medicine plays a big role in the selection of a particular therapy for a particular person.
I am sorry that the answer is not as straight forward as you ewould like, but in reality (and in "real" medicine), it isn't. - Cam
Posted by JahL on March 5, 2001, at 10:13:53
In reply to What do you think?, posted by adams on March 3, 2001, at 21:32:06
> What do you think is the most effective antidepressant drug there is on average? Which drug do the most people respond to? I would like a answer from someone who has a lot of knowledge of different drugs and has been reading this website for a long time and has some idea of what drugs work better than others, knowledge just from reading peoples personal experiences on this website. I know what you are going to say, you are going to say that there is no best antidepressant but I am just saying if you were a doctor and you had to pick just one drug to use for all your patients and you were only allowed to prescribe that one drug which one would you pick.
To give a real-world example of the point Cam & John make (ie heterogeneity rules), the majority of pdocs I have seen have suggested Paxil or psychotherapy for my *apparent* presentation (dysthymia/social phobia). In fact, of some 20+ meds I've tried, seemingly only Lamotrigine-an anti-convulsant-helps. There is no history of epilepsy in my family.
How do you define best? MAOIs are generally considered more efficacious than SSRIs, but carry more serious risks. Which is best? All you can hope to do is match the appropriate drug to the patient's needs.
J.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.