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#351525 - 07/07/11 08:45 AM Re: J.P.'s office [Re: medic8r]
BobKay Offline
connoisseur

Registered: 03/23/10
Posts: 3113
Loc: Massachusetts Badlands
[quote=medic8rRight on. Interestingly, the conventional wisdom is that the tricyclic antidepressants of the 1960s and 1970s are just as effective, or maybe even slightly more effective, than the newer generation SSRIs and SNRIs. The main reasons that the newer generation supplanted them are (1) better overall tolerability and (2) next to zero chance of lethality in overdose. [/quote]

How much $$ was shelled out in grants for us to learn this? I want half! 'cause all they had ta do is call me, don't be afraid, they can call me, maybe it's late, but just call me.....

Gee, I hope velevet hammers make a come back.
_________________________
I never wanted to run in an election, but I always thought it'd be cool to die in office.

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#351682 - 07/12/11 06:14 AM Re: J.P.'s office [Re: medic8r]
fredk Offline
axiomite

Registered: 12/06/07
Posts: 7031
Loc: Canada
Originally Posted By: medic8r

Right on. Interestingly, the conventional wisdom is that the tricyclic antidepressants of the 1960s and 1970s are just as effective, or maybe even slightly more effective, than the newer generation SSRIs and SNRIs. The main reasons that the newer generation supplanted them are (1) better overall tolerability and (2) next to zero chance of lethality in overdose.


Now thats interesting. Unfortunately, the general effectiveness of antidepressants is much lower than drug companies would like you to believe. It shows how little we really know about how the brain works (or doesn't). I'm just glad I don't need those things any more. Depression is hell on earth...
_________________________
Fred

-------
Blujays1: Spending Fred's money one bottle at a time, no two... Oh crap!

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#351691 - 07/12/11 08:33 AM Re: J.P.'s office [Re: fredk]
BobKay Offline
connoisseur

Registered: 03/23/10
Posts: 3113
Loc: Massachusetts Badlands
Originally Posted By: fredk
Originally Posted By: medic8r

Right on. Interestingly, the conventional wisdom is that the tricyclic antidepressants of the 1960s and 1970s are just as effective, or maybe even slightly more effective, than the newer generation SSRIs and SNRIs. The main reasons that the newer generation supplanted them are (1) better overall tolerability and (2) next to zero chance of lethality in overdose.

Unfortunately, the general effectiveness of antidepressants is much lower than drug companies would like you to believe.


Then you're not taking enough.
_________________________
I never wanted to run in an election, but I always thought it'd be cool to die in office.

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#351731 - 07/12/11 01:44 PM Re: J.P.'s office [Re: BobKay]
tomtuttle Offline
axiomite

Registered: 06/20/03
Posts: 8268
Loc: Tacoma
Seriously. "Don't under-dose" was one of the first rules I learned in college.
_________________________
bibere usque ad hilaritatem

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#351739 - 07/12/11 04:17 PM Re: J.P.'s office [Re: tomtuttle]
BobKay Offline
connoisseur

Registered: 03/23/10
Posts: 3113
Loc: Massachusetts Badlands
Originally Posted By: tomtuttle
Seriously. "Don't under-dose" was one of the first rules I learned in college.


But you've broken it, haven't you? Admit it!
_________________________
I never wanted to run in an election, but I always thought it'd be cool to die in office.

Top
#351752 - 07/12/11 07:13 PM Re: J.P.'s office [Re: BobKay]
fredk Offline
axiomite

Registered: 12/06/07
Posts: 7031
Loc: Canada
Originally Posted By: BobKay
Originally Posted By: fredk
Originally Posted By: medic8r

Right on. Interestingly, the conventional wisdom is that the tricyclic antidepressants of the 1960s and 1970s are just as effective, or maybe even slightly more effective, than the newer generation SSRIs and SNRIs. The main reasons that the newer generation supplanted them are (1) better overall tolerability and (2) next to zero chance of lethality in overdose.

Unfortunately, the general effectiveness of antidepressants is much lower than drug companies would like you to believe.


Then you're not taking enough.

No. Wrong treatment. Divorce worked like a charm.
_________________________
Fred

-------
Blujays1: Spending Fred's money one bottle at a time, no two... Oh crap!

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#351762 - 07/12/11 08:33 PM Re: J.P.'s office [Re: fredk]
jakewash Offline
shareholder in the making

Registered: 12/26/03
Posts: 10398
Loc: Calgary, Alberta
laugh
_________________________
Jason
-----------------
TTTHHHPPPPPTTTT!

My HT

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#354159 - 09/06/11 01:56 PM Re: J.P.'s office [Re: jakewash]
BobKay Offline
connoisseur

Registered: 03/23/10
Posts: 3113
Loc: Massachusetts Badlands
Dear Doctor: Now that CGS (Complicated Grief Syndrome) is the hot new phsychosis, are there any neat drugs in the pipeline with cool side effects?

Inquiring junkies want to know.


Edited by BobKay (09/06/11 01:58 PM)
_________________________
I never wanted to run in an election, but I always thought it'd be cool to die in office.

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#354181 - 09/07/11 08:58 AM Re: J.P.'s office [Re: BobKay]
medic8r Offline
axiomite

Registered: 02/05/06
Posts: 6380
Loc: Fredericksburg, Virginia
Dear Bob,

Thanks for your missive. The sad fact is that the psychiatric drug pipeline is flowing at a trickle these days. There's not much that's novel; most new drugs are either tweaks on existing drugs or "me-too" drugs in the same family as existing drugs. As one commenter in one of my favorite blogs recently observed, most new psych meds introduced since 1987 have been a clone of either Prozac (SSRI class antidepressant) or Clozaril ("atypical" antipsychotic).

I've found the recent entries on said blog very interesting. I'm not sure that you guys will enjoy this discussion as much as I have, but for the curious, here's the back story.

Blog author Daniel Carlat is a psychiatrist in the Boston area who has taken up the noble cause of getting the pharmaceutical industry out of the continuing medical education (CME) business. Up until now, there's been a lot of CME programs that were sponsored by "Big Pharma", to use the somewhat pejorative term. Such programs, unsurprisingly, cast the product(s) of the sponsor in a positive light, making it hard to tell how much of the content was objective and how much was "spin" or bias.

Carlat is not alone in his quest. A lot of medical schools have done away with the old practice of industry-sponsored Grand Rounds, drug lunches, drug dinners, and, in some cases, visits from drug reps entirely. The AMA is starting to voice its concerns as well.

Carlat is, however, one of the more vocal critics of Big Pharma, leading to this recent response by Stephen Stahl. Dr. Stahl is a psychiatrist and educator. He is on the faculty at UC San Diego and has his own Neuroscience Education Institute, through which he offers CME at symposia around the country. He is also a paid consultant/speaker/researcher for just about every pharmaceutical company - over a dozen of them. So if anybody is qualified to be the opposition in this argument, it's him.

So Dr. Stahl has taken up the fight against the influence of Dr. Carlat and others, calling him a "Pharma-scold" and alleging that, because of people like him, the pipelines are drying up. It's quite a leap, to me, to draw that conclusion, and, I must say, Dr. Stahl's response seemed quite over-the-top, as did the later followup by his minion associate, Debbi Ann Morrissette, PhD.

My take on the whole thing is that Carlat has a legitimate concern. When I was in medical school and residency, one of the popular games at Grand Rounds was "Guess The Sponsor". It was an easy game, usually over within five minutes. That was about how long it took to introduce the subject matter and begin talking about the studies that showed how drug X was a good choice for the disease under discussion. Bipolar disorder with rapid cycling? Depakote is good for that. Hey, the guys in the back row are wearing Abbott Labs name tags. I win a free breakfast!

The other side of the coin is that, as far as the studies show, Depakote is really the best drug for that condition, so the drug companies have gotten out a message that will help me help patients. And they did disclose that they were the sponsors of the Grand Rounds. And, well, this is America, where capitalism encourages the companies to promote their products, generate sales, and generate profit. The hope is that the profit is married to real benefit for patients, not just the shareholders.
_________________________
"The Universe is the game of the self, which plays hide and seek forever and ever" - Alan Watts

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#354183 - 09/07/11 09:54 AM Re: J.P.'s office [Re: medic8r]
CatBrat Offline
axiomite

Registered: 08/05/09
Posts: 5797
Loc: Some random location
Got any Cialis?

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