Posted by LostBoyinNC1 on July 11, 2002, at 1:32:18
In reply to Some antidepressant theory, posted by Shawn. T. on July 10, 2002, at 17:16:30
I personally think Remeron is a fine antidepressant...one of the best actually particularly for agitated depression. It has a good side effect profile for severe depression accompanied by severe insomnia and agitation, which is a very dangerous form of depression BTW. However, overall I dont believe Remeron is any better of an antidepressant than plain old Prozac. Pretty much all antidepressants are equally effective, with the exception of the MAOIs and high dose Effexor, which are stronger.
Remeron does have a good side effect profile though. Because it antagonizes the 5HT2A receptor, its great for anxiety, agitation and possibly even mild psychosis. Its also a good drug for someone suffering from anti-psychotic drug induced EPS. Remeron doesnt cause the initial akathisia that the SSRIs often cause, again due to the fact it antagonizes 5HT2A receptor.
In my opinion, Organon took the good things about atypical anti-psychotic drugs (antagonism of the serotonin 2A receptor) and applied it to an antidepressant. But left out the bad thing about atypical anti-psychotics...dopamine receptor blockade. Very few depressives need any dopamine receptor blockade. For the few who do have real psychotic symptoms to their depression, bilateral ECT would be safer better choice than taking atypical anti-psychotics.
Thus, Remeron is the perfect antidepressant for the agitated depressive with severe insomnia. It has some of the properties of the atypical anti-psychotics, but without the potential dangers of the atypical anti-psychotics. Remeron reduces agitation, but without creating any dangerous dopamine receptor blockade.
Also, Remeron doesnt cause sexual dysfunction like the SSRIs cause.
But I disagree with you that Remeron is a "wonder drug" its not any better than the SSRIs in the end. Maybe more tolerable for some, but more effective? Nope. Remeron is definitely not any kind of CRF-Antagonist antidepressant either. I wouldnt try to make it look like one.
Currently, the only drugs on the market I know of that might work directly on cortisol to improve depression is that abortion drug pill RU-486. There was a drug in development for AIDS called "Anti-Cort" which was supposedly going to be used for depression as well. I dont know if this drug has been FDA approved or whether its been rejected or the company gave up on it or what. Drugs which improve depression and anxiety by cortisol are still ten years away, if they are ever actually marketed at all. Im personally skeptical we will ever see cortisol blocking antidepressants.
Improvements run extremely slowly in psychiatry.
poster:LostBoyinNC1
thread:111957
URL: http://www.dr-bob.org/babble/20020709/msgs/112011.html