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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 Janelle on July 11, 2001, at 20:32:23
Pellmell, I hope you read this because you posted something above that has me confused - you wrote that from your experience with antidepressants, and I'll quote the rest: "I think you can tell whether a drug might be doing you good by the end of an eight week trial after having taken it for only two."
What do you mean by this or did you do a typo? Do you mean that you can tell after about 2 weeks if a drug might be starting to do some good? Or do you mean you need at least 8 weeks to tell?
HELP! I know these drugs take awhile to kick in, but I would think(?) that you'd FEEL at least a little something good after a couple of weeks or on the other hand, bad stuff after a few days or weeks? HOW LONG SHOULD ONE GIVE THESE MEDS?????? (I get impatient because I cannot stand being this way; in this condition)
Posted by SalArmy4me on July 11, 2001, at 21:00:21
In reply to How LONG should one try med for (ATTN:pellmell), posted by Janelle on July 11, 2001, at 20:32:23
http://www.vh.org/Providers/Conferences/CPS/11.html
A more recent placebo-controlled study by Quitkin et al (1996) reported on 693 patients treated prospectively with a variety of antidepressant regimens. A response criterion was a sustained score on the CGI of much improved or very much improved. All patients were rated weekly. They concluded that those patients with some improvement in depressive signs/symptoms by week 4 should have their antidepressant regimen continued until week 6. This was based on the observation that 39% (versus 8% of placebo) of patients at week 4 that had minimal improvement were responders at week 6. However, if at week 4 the patient has had no improvement, then the treatment should be changed. This was based on the observation that for drug and placebo only 13% and 6%, respectively went on to respond at week 6.
Posted by susan C on July 12, 2001, at 10:46:09
In reply to How LONG should one try med for (ATTN:pellmell), posted by Janelle on July 11, 2001, at 20:32:23
Once again Salarmy4me has great information. I can only add my experience, which is the same. With one comment...If I am taking a med and the side effects are so overwhelmingly bad, I get a consult to reduce or stop. I have generally found it to be the case that a med starts to work with in 2 to 4 weeks, at the earliest.
> Pellmell, I hope you read this because you posted something above that has me confused - you wrote that from your experience with antidepressants, and I'll quote the rest: "I think you can tell whether a drug might be doing you good by the end of an eight week trial after having taken it for only two."
>
> What do you mean by this or did you do a typo? Do you mean that you can tell after about 2 weeks if a drug might be starting to do some good? Or do you mean you need at least 8 weeks to tell?
>
> HELP! I know these drugs take awhile to kick in, but I would think(?) that you'd FEEL at least a little something good after a couple of weeks or on the other hand, bad stuff after a few days or weeks? HOW LONG SHOULD ONE GIVE THESE MEDS?????? (I get impatient because I cannot stand being this way; in this condition)
Posted by pellmell on July 12, 2001, at 13:30:29
In reply to How LONG should one try med for (ATTN:pellmell), posted by Janelle on July 11, 2001, at 20:32:23
> Pellmell, I hope you read this because you posted something above that has me confused - you wrote that from your experience with antidepressants, and I'll quote the rest: "I think you can tell whether a drug might be doing you good by the end of an eight week trial after having taken it for only two."
>
> What do you mean by this or did you do a typo? Do you mean that you can tell after about 2 weeks if a drug might be starting to do some good? Or do you mean you need at least 8 weeks to tell?
>Janelle,
I'm sorry about that grammatical sleight-of-hand. < g > Yes, I did mean that I think you can tell after two weeks whether you should stay on an antidepressant. That is, at the end of two weeks if the side-effects are still hard to tolerate *and* you're not feeling at least slightly better, you should strongly consider calling your pdoc. Listen to your body and brain; it'll tell you whether it's willing to play nice with any new biochemical buddy.
For instance, I felt my body accept Effexor almost immediately. Within a week I was feeling less anxious and able to enjoy life a little more. On the other hand, I stuck it out with Wellbutrin for a whole month in spite of the fact that it seriously exacerbated my symptoms of anxiety, made me irritable and fidgety, and did nothing for my depression. If I'd've listened to what my body and brain were telling me, I would've quit sooner and had a much better quality of life for those two weeks.
I'll write more soon.
My advice, though, is to call your doctor and ask to start on samples of something else.
-pm
Posted by pellmell on July 12, 2001, at 15:34:55
In reply to Re: How LONG should one try med for (ATTN:pellmell), posted by pellmell on July 12, 2001, at 13:30:29
Janelle,
Okay, here's the "more later" I promised. I have more time to think about what I'm writing now.
So think back to when you started Paxil and Celexa. Were the start-up side-effects then anywhere near as bad as they are now with Effexor? You've probably had enough experience with antidepressants to know how you feel in that space between start-up side effects and theraputic response.
That said, these meds DO need TIME to work. It's not simply the increase in concentration of 5HT and/or NE around the neurons in your brain that these drugs cause that makes them effective. If that were all it took, monoaminergic drugs would take effect very quickly (and in fact, this sudden increase in the concentration of available neurotransmitters is what causes the *side*-effects to kick in right away). It's the *chronic* increase in 5HT/NE levels that causes changes in *gene expression* in monoaminergic neurons, and, to be willfully redundant, this takes time.
So anyway, good luck. Let us know where you go from here.
-pm
This is the end of the thread.
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