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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by desolationrower on November 19, 2009, at 21:37:08
since methylphenidate felt like nothing, i'm going to try nortriptaline
only thing wondering about, i had trouble taking it everyday (same problem as w/ amphetamine). since it was part of the 'being productive' ritual/set of activities, where as an antidepressant you don't need to take in association with doing something
anyone have any ideas why NRIs take 2 weeks to reach effect? maybe not taking the stimulants nregularly hampered their effectiviness
also while filling Rx, the pharmacist came over to warn me about the interaction with the tranylcypromine (i use 3 pharmacies, whatever is cheapest for any drug, hadn't been there since i stopped the maoi). i started to argue with him, but decided not to bother.
saw this paper come out too, comparing w/ s-citalopram response trajectory
***********************************
Trajectories of change in depression severity during treatment with antidepressants
AbstractBackground Response and remission defined by cut-off values on the last observed depression severity score are commonly used as outcome criteria in clinical trials, but ignore the time course of symptomatic change and may lead to inefficient analyses. We explore alternative categorization of outcome by naturally occurring trajectories of symptom change.
Method Growth mixture models were applied to repeated measurements of depression severity in 807 participants with major depression treated for 12 weeks with escitalopram or nortriptyline in the part-randomized Genome-based Therapeutic Drugs for Depression study. Latent trajectory classes were validated as outcomes in drug efficacy comparison and pharmacogenetic analyses.
Results The final two-piece growth mixture model categorized participants into a majority (75%) following a gradual improvement trajectory and the remainder following a trajectory with rapid initial improvement. The rapid improvement trajectory was over-represented among nortriptyline-treated participants and showed an antidepressant-specific pattern of pharmacogenetic associations. In contrast, conventional response and remission favoured escitalopram and produced chance results in pharmacogenetic analyses. Controlling for drop-out reduced drug differences on response and remission but did not affect latent trajectory results.
Conclusions Latent trajectory mixture models capture heterogeneity in the development of clinical response after the initiation of antidepressants and provide an outcome that is distinct from traditional endpoint measures. It differentiates between antidepressants with different modes of action and is robust against bias due to differential discontinuation.
(Received April 21 2009)
(Revised July 20 2009)
(Accepted September 10 2009)
*******************************-d/r
Posted by ColoradoSnowflake on November 20, 2009, at 0:21:06
In reply to nortriptaline, posted by desolationrower on November 19, 2009, at 21:37:08
Hi d/r!
You've sure been quiet!
You mention stopping Parnate. Is that right? If so, why?
Just curious, if you don't mind telling me.
Also, what is your take on Nortrip with Parnate. It seems to be working really well for me, and I'm not dead yet, thank goodness!
Thanks,
Gayle
Posted by Phillipa on November 20, 2009, at 0:34:04
In reply to Re: nortriptaline, posted by ColoradoSnowflake on November 20, 2009, at 0:21:06
Gayle also need to write you. And D/R you also where you been stranger? Love Phillipa
Posted by SLS on November 20, 2009, at 5:27:26
In reply to nortriptaline, posted by desolationrower on November 19, 2009, at 21:37:08
Hi D/R.
How do you interpret the results of this investigation?
If it helps you put some pieces of the puzzle together, know that it takes approximately two weeks for receptor turnover. It might take less time to effect changes in gene activity before it is expressed as a reduction in receptor numbers. I really don't know.
- Scott
Posted by SLS on November 20, 2009, at 5:30:50
In reply to Re: nortriptaline, posted by SLS on November 20, 2009, at 5:27:26
I forgot to mention that, for me, at the onset of an antidepressant response, the effect is more robust with tricyclics than with SSRIs.
- Scott
Posted by desolationrower on November 20, 2009, at 16:38:13
In reply to Re: nortriptaline, posted by SLS on November 20, 2009, at 5:27:26
> Hi D/R.
>
> How do you interpret the results of this investigation?i guess the cynical interpretation is nort. is an antidepressant the same way stimulants are: hte energy to fix the things you're doing that are making you unhappy, + a good sleep drug.
or, ssris suck at first, while nris work faster.
> If it helps you put some pieces of the puzzle together, know that it takes approximately two weeks for receptor turnover. It might take less time to effect changes in gene activity before it is expressed as a reduction in receptor numbers. I really don't know.
>
>
> - Scottyeah, i'm just wondering if there was any evidence for the 'nris take two weeks, stimulants work from the starting gun' thing, which i haven't been able to trace back to any research.
And D/R you also where you been stranger? Love Phillipa
i find it hard to stop in for 5 minutes, and somehow i don't have time for more: my prioritization really is that bad. i get overwhelled seeing all the threads i guess.
> Hi d/r!
>
> You've sure been quiet!hey. i saw snow again last week :)
> You mention stopping Parnate. Is that right? If so, why?
>
> Just curious, if you don't mind telling me.hadn't felt depressed for a while, and wanted to try other things for ADHD. signed up for bar exam again, and hope to pass this time, so i wanted to be able to study this time. pdoc didn't want to add any of the things you can use for adhd to the MAOI, and after calling 2 or 3 others, didn't have any more energy to keep trying. actually, since i've been back, he said 'oh, well i talked to some people, and if you add the maoi to the tca, you can do it' argh! but at least i might have that as an option. i don't think i've been depressed, but i do have to work harder to avoid thinking of things that i dislike about my life. i also have more problem oversleeping than when i was taking parnate.
> Also, what is your take on Nortrip with Parnate. It seems to be working really well for me, and I'm not dead yet, thank goodness!
hey, that is great. i had tried to get that, before. what did it help you that wasn't there with either? i probably won't try to get the parnate again if i don't need it, but its possible depending on how things go.
-d/r
Posted by SLS on November 20, 2009, at 17:02:46
In reply to Re: nortriptaline, posted by desolationrower on November 20, 2009, at 16:38:13
> signed up for bar exam again, and hope to pass this time
Good luck with that.
Be well.
- Scott
Posted by Phillipa on November 20, 2009, at 19:29:17
In reply to Re: nortriptaline, posted by desolationrower on November 20, 2009, at 16:38:13
d/r the snow already there wow. Seriously you will pass the bar exam have a lot of confidence in you. You'll woop them!!!! Love Phillipa
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