Zoloft had that effect on me, and my wife loved the delayed ejaculation part of it, but she hated that because of reduced libido, she wasn’t getting it frequently enough. Fortunately I was only on it for a short time, and we just made up for the ‘endurance’ bit with more frequent sex, once my libido recovered.
If the makers of Celexa are claiming this publicly, either through physican information sheets or via any other public forum, then it has been backed-up by clinical study. The FDA is rabidly aggressive when it comes to Labelling and publishing of Drug Efficacy Claims. More than one pharmaceutical firm has had it weewee severely whacked in the last year for unsupported claims. The FDA takes a really dim view of unsubstantiated claims on the efficacy and attributes of ethical pharmaceuticals.
I hadn’t heard that.
Well yeah, it’s not only lobbying, it’s that it’s the only SSRI that has been tested enough on SAD. But, AFAIK, there’s no evidence to suggest that the other SSRIs don’t work just as well.
Well, receptor selectivity is relatively easy to test, so I betcha that has been backed up objectively. IMO what’s harder to prove is whether selectivity is a good thing. Espec. since they have only the dimmest notion of what slamming any particular receptor has on the brain in real life. Esp. long term.
IANAMD
Doesn’t Prozac™ (fluoexetine) have a longer half-life than the other SSRIs? I was under the impression that this made forgetting the occasional dose less of an issue, but also created the potential for more liver problems than with the other SSRSs.
Generic fluoexetine has been available here for quite a while, so I’m guessing that there’s no longer an exclusive license in existence for the manufacturers of Prozac™.
Paxil is the only SSRI approved by the government for social anxiety because the research was done on Paxil. Most likely, it is a class effect that applies to all SSRIs including Prozac. I’m sure all the drug companies are doing the research as I type this to get their SSRI approved for the same indication.
Drug side effects are determined by clinical trials and summarized statistically, e.g. “15% of people on Paxil report a drowsy-drugged feeling”. Any SSRI can have side effects despite being fairly safe compared to other medications. Often it would be hard to tell if a drug is causing a common symptom and the best test is to see what happens when the dose is reduced or the drug is withheld.
Prozac does have a generic form. Withdrawal from any SSRI is certainly a possibility.
I think Celexa is very much overrated. I haven’t seen much evidence the selectivity makes much of a difference. I do a month of psychiatry in September and will let you know if this changes my opinion.
Wellbutrin is the same drug as Zyban although the doses are different. I would not prescribe Wellbutrin as a substitute for the patch because of differences in drug distribution, but in theory you could and some doctors have. They might be on shaky legal ground, though. I don’t play that game.
Taking an SSRI in conjunction with other SSRIs or antidepressants may be dangerous, leading to an overdose known as “serotonin syndrome”. Wine and cheeses containing tyramine may be dangerous with older MAO inhibitors.
There have been a lot of horror stories associated with Prozac, which has been the trendy drug for years. GPs prescribe it rather loosely, I hear. Their patients say they feel depressed, and they are prescribed Prozac. I’ve also heard that some of these school rampages have been caused because those kids were on Prozac. This is just what I heard. I don’t know.
My take on this is that if there really is not a serotonin problem in one’s brain, and a person is prescribed Prozac, it could cause mania, resulting in all these horror stories. But IANAMD, and I don’t know. The reason why it is Prozac and not the other SSRIs is because that’s the trendy one that has been prescribed for years. Any of you medical doctors has an opinion on this?
Barbitu8, I’m just educated enough to realize how ignorant I really am when it comes to these meds (and so many other things). But I do believe they are a tremendous help to certain individuals, while they are overprescribed for many others. I’m not sure I buy into the theory that they are causing rampages or other such violence, and I haven’t seen any data that makes me think they really can induce clinical mania in anyone that’s not already having or heading for that disease. But I really think they’re best reserved for those meeting the diagnostic criteria for depression, or other appropriate diagnosis, and in my practice, I generally leave that work to the shrinks.
BTW, just what is your background, Barb? You certainly demonstrate a wealth of good information on things medical and physiologic, and your comments are on target and insightful. What’s up with that?
Thanks for the compliments, Qadgop. I’m a lawyer and worked for a title insurance company for years. I’ve been working for the Social Security Admn for 20 years now, and deal with disability cases. Hence, I get to know a lot about impairments, treatments, etc. from reading the medical records. In addition, I’ve been interested in physiology, esp. exercise physiology for about 20 years. Also, being a runner and former marathon runner I’ve been drawn to that field, as well as nutrition, etc.
I’ve been on both Seroxat and Zoloft: zip. Nothing. Zero. No effect. Candy to me.
Would I have any reason to believe any of the others would do anything, then, since they’re all supposed to have the same effect (just different side effects)?
— G. Raven
Maybe. Remember, they’re supposed to work slowly, not with a single dose. They’re not primarily mood altering. 6 to 8 weeks is, I think, the minimum time frame to start feeling an effect. Then it will hopefully be a lessening of the depressive (or whatever) symptoms it’s been given for. And some meds work better than others for individuals, for reasons I at least don’t understand at all.
You are not alone. It’s remarkable how many psychoactive drugs seem to have changed their mechanism of action :eek: in the past few years. What used to regulate serotonin, dopamine or norepinephrine metabolism or uptake, now serves to induce the growth of new neurons in “underpopulated” regions of the brain. The science behind these meds is a lot more empirical than we have been led to believe. Which of course leaves lots of room for variation in the effectiveness of individual drugs within a class such as the SSRI’s.
These drugs are very helpful. Qadcop is absolutely right when he points out we know very little about the way many psychoactive drugs work, but they do. The successful treatment of psychosis is one of the great medical advances of the century. Understanding neuropharmacology will be the great advance of next century.
Since no one has commented on this yet, I’m beginning to doubt myself but Wellbutrin isn’t an MAOI. (is it?)
Anyway, I interpreted the OP to be much more specific. Though, apparently, it wasn’t intended as such, I’d like to go ahead and ask what I’d hoped would be answered in this thread: what are the differences between these drugs on the molecular level? Why the small differences in side effects? Why do some work better in some people than others? I realize a lot of this is probably still a mystery to science, but what do we know about this?
I’ve just always been fascinated with how a pill (particularly psychoactive ones) reacts physically with your body, and specifically with your CNS, to produce the effects it does.
Incidentally, I’ve been on Wellbutrin in the past and had some bizarre experiences from it, but that’s for another time.
I just noticed, on glancing back at the thread, that the 2 posts before mine actually addressed my question.
I read the whole thread, honest. Must be that darn ADHD (which, incidentally, was what I was prescribed wellbutrin for, though I haven’t heard of anyone using it for that recently).
I know that I’m taking this conversation slightly OT here, but I have to say that quite literally SSRIs are the only reason I’m alive today. They are by no means “happy pills”; I recaptured the feeling of “normal” when I commenced SSRIs - I got back to being the competent, resourceful, loving, functional woman I was before I was engulfed by the hideous cloud of endogenous depression.
My personal belief - based upon my observations - is that some doctors do prescribe these drugs inappropriately. That doesn’t make the drugs in and of themselves bad or useless. It might indicate that physicians have become as complacent about prescribing them as they were many years ago in repect of thalidomide, antibiotics, benzodiazepines, and a host of other classes of which can have profound impacts if they start being perceived as harmless “candy”.
Zyban™ will probably untimately be banned in my country. An observed side effect of prescribing the original Wellbutrin™ was that it reduced the desire for nicotine - among other drugs. Perhaps it only reduces that desire in patients who have a pre-existing condition which responds to treatment with SSRIs. Perhaps it’s only effective in patients who are using other drugs to self-medicate the symptoms of depression.
I take a generic version of a very well-known SSRI. I happen to have a great GP who went to great lengths to warn me about the potential side effects and make himself available 24/7 during my first two months on that medication. In short, as my prescribing physician, he really wanted to know about and take control of any problems which might have occurred in respect of the particular medication he’d given me. I wish every prescriber was so responsible. Clearly, some are not. There are certain psychotropic medications which can only be prescribed by specialist medical practitioners here - maybe SSRIs need to be put in that class if it can be proven that they are often prescribed without appropriate evaluation of a patient’s medical history and without sufficient monitoring of their effects.
No it’s not. It’s a novel antidepressant.
In the simplest terms it’s because small changes in the the structure will change their ability to bind with different targets in the brain. There are many different sites that these molecules can bind, and in general they’ll affect your serotonin, norepinephrine and dopamine levels to different degrees in different parts of the brain depending on their structure.
SSRI’s that are “more selective” will bind much more strongly to the enzymes which reabsorb serotonin into the cell (thus decreasing the level of serotinin in your synapse) - compared to their binding to other receptors. “Dirtier” SSRIs will bind - shall we say “more promiscuously” - and will have broader affects in your CNS.
(That’s just the SSRIs. Other antidepressants - MAOIs, Tricyclics, and novel antidepressants - target different combinations of enzymes/receptors/neurotransmitters.)
But even with the “cleanest” SSRIs, nothing’s clean. The brain responds to changes in neurotransmitter activity complexly. Over the long term your brain could react to higher levels of serotonin by altering levels of dopamine, for example. These are called “downstream effects.”
Also nobody’s sure why antidepressants take several weeks to take effect - this is probably the result of a downstream effect of raising serotonin levels in the synapse - but nobody can say for sure what that effect is.
These NEW drugs help a few people and thats wonderful.
BUT, it seems to me the American public have become guinea pigs for these new drugs. Apparently NO ONE really knows ANYTHING about the anti-depressants PAXIL< ZYBAN> PROZAC etc. but they will be prescribed and sucked down by anyone without a lot of thought.
How and how long do these drug companies actually research
meds like these? What about longterm side effects??
Months? A few years?
These drugs scare the ever lovin’ hell out of me!!!
If I ever needed to take them they’d have to dope me up with
old and proven anti anxiety meds first, just to take ANY of these new ones…
Well, they know more about the new ones than they knew about the old ones when they first prescribed them. And the old ones have some proven long term effects.
Realize millions and millions of people have taken these drugs for the past 15 years. So that’s a pretty grand experiment that has already taken place. So far there hasn’t been any proven terrible side effect.
But you’re right. There aren’t any good long-term (longer than a year) clinical studies. Most are no more than a few months. There’s also very poor monitoring of side effects in the “real world.” That, IMO, is the FDA’s fault. And the general wisdom is that people with recurrent depression should be on them “indefinitely.” That does make me worry.
Re. marketing… fluoexetine (trade name Prozac) was tested and found to be effective treatment for severe PMS. So they gave it a different name, put it in a lavender (or some other feminine color) package and are marketing it specifically for that purpose. It is exactly the same as Prozac.
Interestingly, some literature I’ve seen suggests that a woman only needs to take it episodically (during second half of menstrual cycle or just that week before menses?) which is hard to believe as others say it takes some weeks before it’s effects are felt at all.
Yeah, jillGat, and isn’t there a bit of stink over the repackaging as being false advertisement or something? Like, “If its prozac they should call it prozac” etc.
Well, whether that’s the case is a GD but it is interesting and shows how drugs can have very varied results when taken.
For a little background, drugs are made, initially, in the millions based on a family of molecules with varying degrees of different “add-ons” which make them similar but not the same. The most common example is the similarity between MDA and MDMA (ecstacy), where there is only one group changed but the results are different (or so testimony says, never tried MDA).
At any rate, these core structures are then tried on targets(in a lab, not people targets) to see if there is any effect in binding, destruction, whatever. AFAIK, there is only so much testing that can reasonably go on in seeing how a drug reacts. Even if a drug works reasonably well that is no guarantee it will ever make it to the market because of other chemical properties like permeability, solubility, pKa, dissolution, etc etc. Tack FDA approval onto this (and I have no idea what the FDA does for testing) and you’re looking at (about) five years (a long 5 years? a measly five years?) from conception to pharmacist’s shelf.
But for certain immediately dangerous side effects are the primary concern. Long term are not, AFAIK, actively tested for. Some primary concerns: is it physically addictive; is it mentally addictive, to the side effects outweigh the benefits (such as AIDS drugs being a bit different than, say, high blood pressure medicine).
A pharmaceutical company I recently visited has just made a drug which caused mice to lose weight rapidly with seemingly no side effects, apart from actually liking the drug and “frolicking” after taking. Turns out the drug had an opiate action; those suckers were getting high AND losing weight. they should keep that one on the back burner for the time when (if?) marijuana becomes legal. 