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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by SalArmy4me on July 19, 2001, at 17:49:29
Is there any reason to believe that fluvoxamine has a chance of working when paroxetine and sertraline didn't work in 6-week trials?
Posted by Janelle on July 19, 2001, at 17:59:11
In reply to Paroxetine, Sertraline,....then Fluvoxamine?, posted by SalArmy4me on July 19, 2001, at 17:49:29
YES!! My pdoc was going to prescribe fluvoxamine for me fairly recently, after I tried sertraline, which did not work and paroxetine, which pooped out after many years (probably too many years on it). So, it sounds like it IS indeed possible for fluvoxamine to work even AFTER unsuccessful 6-week trials of sertraline and paroxetine, since my pdoc was contemplating that exact route!
However, given my mixed bag of symptoms/conditions, she decided to go with Zyprexa and then added in Lamictal instead; I'm on EffexorXR for a-d, but will be tapering off that (waaaaaay too activating) and onto one of the more sedating ones next appointment.
Posted by SalArmy4me on July 19, 2001, at 18:06:38
In reply to Re: Paroxetine, Sertraline,....then Fluvoxamine?, posted by Janelle on July 19, 2001, at 17:59:11
http://www.acnp.org/g4/gn401000105/
"Substituting One Serotonin Reuptake Inhibitor for Another
The proliferation of different SRIs begs the question of their interchangeability. Should patients nonresponsive to one SRI receive a trial of another or should they be routinely switched to another class of agents? As of yet, there are no controlled studies to address this important question. Clinical experience suggests that intolerance to one SRI does not necessarily convey intolerance to the whole class. A large prospective study by Brown and Harrison (11) found that 91% (85 of 93) patients intolerant to fluoxetine were able to complete an adequate trial of sertraline (50 to 200 mg/day), of which 69 (76%) responded. There are, as of yet, no controlled data to address the equally important question about the effectiveness of an alternate SRI when another member of this class is not effective..."
--My problem is not the intolerance of the SSRI's but unresponsiveness.
Posted by Janelle on July 19, 2001, at 18:39:26
In reply to Paroxetine, Sertraline,....then Fluvoxamine?, posted by SalArmy4me on July 19, 2001, at 17:49:29
For what it's worth, a psychologist (get that! not even a pdoc) told me that even though ALL these meds (e.g., Paxil, Prozac, Zoloft et al.) are SSRI's, the reason that for example, Person A WILL RESPOND to Paxil and not Zoloft, but Person B WILL NOT RESPOND to Paxil and WILL RESPOND to Zoloft is that each of the SSRI's act on DIFFERENT Serotonin receptors.
For the longest time, the ignorant one here didn't even know that there's more than one, that there are MANY, MANY different Serotonin receptors in the brain!!
Therefore, it's trial-and-error until the person and their pdoc "find"/discover the SSRI which "matches" and binds with that person's "weak" receptor(s).
So, it could be that YOUR particular receptor(s) MIGHT be "matched" to Prozac rather than the other two.
Hope this makes sense - I'm not nearly as good as you are in explaining this stuff.
-Janelle
Posted by pellmell on July 19, 2001, at 20:09:08
In reply to MORE about this subject: » SalArmy4me, posted by Janelle on July 19, 2001, at 18:39:26
As far as I understand, there's only one type of serotonin *reuptake pump*, which is what SSRIs act on. Some of them do act on serotonin receptors (for instance, fluoxetine agonizes...um, I forget which one, but it causes its activating effects), but this seems to have more (but not exclusively) to do with their differing side-effects than their differing theraputic effects. The article that Sal cited is evidence of this.
So the secondary actions of SSRIs definitely affect their tolerability in different people. It might even make one more effective than another in a person. But it doesn't seem likely that a *non*-responder to one SSRI would respond to a different one, since their primary actions are the same.
But I can't cite any studies and I don't know any antecdotes that would back this up. So we're right where we started.
I'd like to know the answer to Sal's question myself.
-pm
> For what it's worth, a psychologist (get that! not even a pdoc) told me that even though ALL these meds (e.g., Paxil, Prozac, Zoloft et al.) are SSRI's, the reason that for example, Person A WILL RESPOND to Paxil and not Zoloft, but Person B WILL NOT RESPOND to Paxil and WILL RESPOND to Zoloft is that each of the SSRI's act on DIFFERENT Serotonin receptors.
>
> For the longest time, the ignorant one here didn't even know that there's more than one, that there are MANY, MANY different Serotonin receptors in the brain!!
>
> Therefore, it's trial-and-error until the person and their pdoc "find"/discover the SSRI which "matches" and binds with that person's "weak" receptor(s).
>
> So, it could be that YOUR particular receptor(s) MIGHT be "matched" to Prozac rather than the other two.
>
> Hope this makes sense - I'm not nearly as good as you are in explaining this stuff.
> -Janelle
Posted by Janelle on July 19, 2001, at 21:44:12
In reply to Re: MORE about this subject: » Janelle, posted by pellmell on July 19, 2001, at 20:09:08
Woops! Well, now I'm confused, because I was under the impression that while there is only one type of serotonin *reuptake pump*, it pumps out the Serotonin to many receptors (I was told this by a doc and have also seen pictures wherein a bunch of little Serotonin circles being released from one set of receptors into the synapses, then starting to binding to a corresponding bunch of receptors on the other side so to speak).
Which article that Sal cited cites evidence of what you said about the differing side-effects vs. the differing therapeutic effects? I would like to double check that one.
As for what you said about how it doesn't seem likely that a *non*-responder to one SSRI would respond to a different one, since their primary actions are the same, I know, have read and heard of MANY people (myself being one!) who have been NON-responder to one SSRI but DID indeed respond to another.
In my case, I did NOT respond to Zoloft, but DID respond very well for many years (till poop-out) to Paxil!! I know several people (member of the same family for what that might be worth) who were NON-responders to Prozac and Paxil, but DID respond to Zoloft!! Go figure!!
Again, what article did Sal cite that cited evidence mentioned above? Thanks.
-Janelle
Posted by pellmell on July 20, 2001, at 12:00:12
In reply to Re: MORE about this subject: HELP! » pellmell, posted by Janelle on July 19, 2001, at 21:44:12
> Woops! Well, now I'm confused, because I was under the impression that while there is only one type of serotonin *reuptake pump*, it pumps out the Serotonin to many receptors (I was told this by a doc and have also seen pictures wherein a bunch of little Serotonin circles being released from one set of receptors into the synapses, then starting to binding to a corresponding bunch of receptors on the other side so to speak).
>Yep, but the SSRIs don't control which receptors serotonin binds to once it's released from the serotonergic nerve cell's axon. Some other antidepressants though, such as Remeron, do, via receptor blockade.
> Which article that Sal cited cites evidence of what you said about the differing side-effects vs. the differing therapeutic effects? I would like to double check that one.
>It's the article he cited in this thread, which describes a study that demonstrated that most of the patients in the study who couldn't tolerate Prozac had fewer problems tolerating Zoloft.
> As for what you said about how it doesn't seem likely that a *non*-responder to one SSRI would respond to a different one, since their primary actions are the same, I know, have read and heard of MANY people (myself being one!) who have been NON-responder to one SSRI but DID indeed respond to another.
>Okie. Like I said, *I* didn't have any antecdotes to tell to back up my guess. Now you've given me some negative evidence, which is very cool (you learn more when people disagree civilly with you. ;) ).
Cheers,
-pm
Posted by pellmell on July 20, 2001, at 12:10:56
In reply to Re: MORE about this subject: HELP! » Janelle, posted by pellmell on July 20, 2001, at 12:00:12
> > Woops! Well, now I'm confused, because I was under the impression that while there is only one type of serotonin *reuptake pump*, it pumps out the Serotonin to many receptors (I was told this by a doc and have also seen pictures wherein a bunch of little Serotonin circles being released from one set of receptors into the synapses, then starting to binding to a corresponding bunch of receptors on the other side so to speak).
>Oops, and I forgot...the 5HT reuptake pump only does what its name implies: it reclaims free serotonin from the synapse for the serotonergic neuron. Other mechanisms are responsible for releasing 5HT from the cell.
Oh, and the reuptake pump is on the presynaptic terminal, while the majority of the receptors live on the postynaptic terminal.
Until next time,
-pm
Posted by SalArmy4me on July 21, 2001, at 23:01:04
In reply to Re: MORE about this subject: HELP! » pellmell, posted by Janelle on July 19, 2001, at 21:44:12
After a consideration of the discussion, I have decided that a try of another SSRI for me would just lead to increased side-effects and no antidepressant efficacy--considering two previous SSRI's had failed.
This is the end of the thread.
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