Posted by jrbecker on March 2, 2003, at 10:40:26
In reply to Is Gepirone the magic bullet for Atypical Dep.?, posted by patc on March 1, 2003, at 16:28:17
I was in a gepirone trial but I received the placebo. I've heard fairly good things about Gepirone from the docs involved. In terms of comparing to the SSRIs based on mood effect alone, some believe it might be almost as equal in efficacy, and some have gone as far to say that it will be even better. But the real utility of the drug is that fact that it helps reduce the core atypical symptoms of eating, sleeping, and reduced sexual desire[somethin the SSRIs surely ain't helping with]. I always remain skeptical about new drugs myself. Every drug gets more hype than it should at first. Don't ever hold your breath on something that's not approved yet. If it turns out to be a wonderdrug, then great, but I've learned never to hold a candle for it in the meantime. Maybe the bigger question is whether gepirone will come close to Nardil as a treatment? For mood and anhedonia alone, I highly doubted.
And I guess that's your real question...what are the best treatments for anhedonic depression vs. just treating the atypical symptoms of hypersomnia, overeating, etc?
I don't think there's anything that comes close to the MAOIs but I think opioid therapy (e.g., buprenorphine) might have some promise. The TCAs might even rank a little higher than the SSRIs in terms of mood treatment for atypical depressives, but the real question is whether any of us can handle the side effects. In terms of the newer drugs, Effexor is probably the best new single drug treatment out there, but once again, it comes with a lot of side effects as well. And finally, if I had to choose an SSRI I favored for atypical, it would be celexa (better than lexapro in my opinion), which is the best pairing of tolerability with mood effects of its drug class. Augmentors like Klonopin (for anxious-types), hormonal options (e.g., Test., estrogen), as well as others such as NADH, selegiline, strattera, moclobemide, and even Buspar (I've found this one useless though); are all ones to experiment with.
But back to looking on the horizon...
Duloxetine is probably the best new drug to look out for in the near future (if you had any success with Effexor), which is probably available somewhere in the next 3-6 months. Further off, the selegiline patch seems to be making a lot of people cross their fingers (including myself). And sure, gepirone, might be something fairly useful as well.
Hope this helps,
JRB
> Has anybody tried Gepirone during the trials?
>
> Other than Nardil and Klonopin is there anything that helps w/ hard core Atypical Depression?
>
> Thx.
>
> Pat
poster:jrbecker
thread:205092
URL: http://www.dr-bob.org/babble/20030301/msgs/205261.html