Posted by SLS on January 23, 2013, at 0:20:34
In reply to Dr Ken Gillman on dual action antidepresants, posted by jono_in_adelaide on January 22, 2013, at 19:25:43
> Dr Ken Gilman on why he feels a combination of (say) nortriptyline or bupropion plus sertaline is a more effective antidepressant than Effexor or Cymbalta
Effexor and Cymbalta monotherapy have worked miracles for people who failed to respond to SSRI monotherapy, right or wrong?
There are also people who respond to SSRIs who don't respond to clomipramine, right or wrong?
The doctor would have to design a cross-over study to prove his theories. In other words, if he can produce evidence that an overwhelming majority of SNRI responders maintain their response once they are switched to a SSRI + NRI combination, his recommendations here would be more compelling.
About the only thing I agree with is this:
"2) There is not a simple or direct relationship between receptor affinity and effect"
A friend of mine responded only partially and inadequately to a combination of Lexapro 40 mg/day + Wellbutrin 300 mg/day, despite months and months of treatment. When Lexapro was switched out for Pristiq 100 mg/day, she achieved full remission quite rapidly.
I am not married to Effexor and Cymbalta. I only question the assertion that they ought to be abandoned in favor of a sertraline + nortriptyline combination.
By the way, sibutramine was a failed antidepressant. There was nothing to be rediscovered about it. The drug sucks, in my experience. Milnacipran appears to be a better antidepressant than sibutramine. However, Effexor seems to be a better antidepressant than either of these two drugs, despite its having a lower NRI / SRI ratio.
Polypharmacy using SSRIs and NRIs together is an appealing idea theoretically, but it should be substantiated clinically. Using clomipramine as an example of a "true" SNRI neglects the plethora of other things that this drug does and is, in my opinion, faulty logic.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1036144
URL: http://www.dr-bob.org/babble/20130112/msgs/1036177.html