Lexapro

[Aggie_Ama]

My doctor recently (as in Tuesday) started me on Lexapro for depression and generalized anxiety. Although I have struggled with it before this is the first time I have gone to the doctor. I was already have a awful time sleeping and now the insomnia is getting even worse. I read this is the most common side effect, does it eventually subside? Currently I am taking at night because it was easy to remember but I think I will switch to morning. I take Topamax at night which can increase drowsiness so maybe it will counter it if I don't have the Lexapro? I just want to be me again and I know the doc said it won't happen overnight with a pill. I am scared about the weight gain but hoping since I am not very hungry I will be okay. I will deal with that if it happens, right?

[skinimini]

I was already have a awful time sleeping and now the insomnia is getting even worse.

Aggie, just the opposite for me. I was on Lexapro for several years and initially had an easy time adjusting to it. It did help me get through a really tough time in my life when the depression was all-consuming. However, as time passed, I became more and more lethargic, sometimes taking 3 to 4 hour naps during the day as well as sleeping 9-10 hours per night. This is no exaggeration. I could not function this way. When I decided to get off the drug, it took me forever to titrate down.

My husband is an OB/Gyn and has found that many of his patients on Lexapro have reacted the same way as I did. He only prescribes it now as a last resort or when other medications are contraindicated. I also had significant weight gain during the time on this drug. We were talking about this just the other night. This is just my personal experience, but I wanted to share.
However, my older sister has taken it for years without complications.

[bmccasland]

Aggie_Ama - have you talked to your Pharmacist? I had a chat with mine when I was put on Topomax - or rather, she was waiting for me when I came to pick it up. Anyway, they'd be the ones to discuss the timing for taking meds, side effects and all that. Sometimes I think they know more about the meds than the Docs do.

[jobob]

When I first started taking Lexapro I had a bit of a problem getting to sleep as well. My doctor initially put me on Ambien and after a few weeks I switched to benadryl (an OTC antihistamine which is also the sleep aid ingredient in the "PM" versions of many pain relivers). Over the course of a couple of months I was gradually able to stop taking the benadryl to get to sleep. I've been on Lexapro for about 3 years now and it's improved my quality of life significantly. I gained some weight over that time but that could be due as much to my crummy eating habits and generally getting older. :p

You would of course have to check first with your MD or pharmacist to make sure there are no contraindications w/ the Topamax, but you might want to consider taking benadryl as a sleep aid for a little while until you've adjusted to the Lexapro.

[ny biker]

Aggie_Ama - have you talked to your Pharmacist? I had a chat with mine when I was put on Topomax - or rather, she was waiting for me when I came to pick it up. Anyway, they'd be the ones to discuss the timing for taking meds, side effects and all that. Sometimes I think they know more about the meds than the Docs do.

Pharmacists do know more about meds than doctors do. They are always the best people to ask when you have questions about when to take a dose, side effects, etc.

Good luck.

[Selkie]

Ama - Sorry, I can't help you with your meds question, but I hope you start feeling better. Try not to worry about the potential weight gain side effect. If the meds help you, it's well worth it.

[Crankin]

AA, I would talk to the pharmacist, but I also am leery of primary care docs prescribing psychotropic meds. PM'ing you.

[ASammy1]

I don't have any experience with Lexapro, but Zoloft has been a life saver for me. It has the anti-anxiety properties that Lexapro has. At first it made me sleepy so I just took it at night. I also lost 40 lbs in 2 months (I had it to lose) because it completely curbed my apetite. I pretty much lived off smoothies and Boost because the thought of food made my stomach turn.

I used to be one of those people who cringed at taking medication. My mom was the one who urged me to see my Dr after she started to really notice the symptoms of depression in me. Apparently it runs in my family, but I didn't know it because it was kept "hush hush." My depression was so gradual that I didn't realize just how bad I was feeling until I started to feel better. Anti-depressants have given me my life back :D

[channlluv]

...as time passed, I became more and more lethargic, sometimes taking 3 to 4 hour naps during the day as well as sleeping 9-10 hours per night. This is no exaggeration. I could not function this way. When I decided to get off the drug, it took me forever to titrate down.


I had the exact same reaction. I was falling asleep at stop lights and having to pull over after dropping my daughter off at school into a parking lot so I could take a nap, or I'd never had made the 20-minute drive back home. It was horrible.

I also found out that I was glucose intolerant during this period. I don't know if they're related. I can't eat white bread or rice without getting really sleepy. (I really miss Chinese food, and I only got to have one slice of my daughter's birthday cake because it knocked me out.)

I hope your doctor can help you find an alternative medication, Aggie. And good luck weaning off of this one.

Roxy

[Possegal]

There are quite a few drugs for depression and anxiety with varied responses that are quite individualized. It is unclear from your post, but I too have the feeling you are talking about a GP prescribing this. I would highly encourage a specialist. They work with these drugs every day and are far better informed to play around and find the one that works for you. And when you find the right one, it can be a real godsend!

And definitely talk to a pharmacist if you are worried about drug interactions or have any general drug questions.

Not that I'm biased or anything - Possegal, PhD (Dr of Pharmacology) ;)

[jobob]

I've read Ama's post a few times and I didn't see anything that suggested that she was being prescribed by a GP. (For what it's worth, in my own post I referred to my "doctor", but that doctor happens to be a specialist in psychiatric medicine)

And I just want to echo Possegal's sentiments - anti anxiety/depression treatments work differently for different people. It's kind of a crapshoot, unfortunately. Part of the reason why I put off getting treatment for so long was because I dreaded the potential trial and error involved. Now, as it turned out, I was very fortunate that after a short adjustment period (namely, the insomnia that I experienced, which responded very well to sleep medication and which went away entirely within couple of months) I adjusted very well to Lexapro, and I didn't have to try any other medication. And it really has greatly improved the quality of my life.

All I'm trying to say is that if it didn't work well for you, that doesn't necessarily mean it won't work well for someone else.

[Aggie_Ama]

I did get prescribed my GP but he did do a thorough 45 minute sit down and talk about what was really going on. He knows about my neurological factors (my tremor disease that is not under control) that could be coming into play. I felt very comfortable with talking to him about how I was feeling. And while I have had a friend who went to the gyno and said "I am such a b*tch when I pms" and was immediately given anti-depressants this was a lot more thorough. He did suggest I try other routes but we discovered working out didn't curb the anger and crying. He also wants to see me again in 3 weeks to see how I am doing. He refused to treat my tremors because he isn't a neurologist and they won't touch my husband's crohn's issues. I have a feeling he felt it was something he could handle addressing for me because he often refers us if he finds it is in our best interest.

I also have an appointment with my neurologist next week and I am going to discuss that the last time I felt like this for so long was when my tremors went haywire which they have started to do. It feels like my own fault because when they came out of remission I was hesistant to go back on anti-convulsants.

FWIW- The insomnia subsided thanks to a cold and nyquil. I have slept like a baby the last two nights but I would rather not be sick. But I will check with the pharmacist if it returns.

[salsabike]

I think there are quite a few GPs/family practitioners out there who are very well qualified to prescribe, follow, and change antidepressants. Sounds like yours is one of them.

[Dogmama]

I heard that GP's prescribe most antidepressants. If it's working, don't mess with it. I DO believe that if it isn't working, or if you need a combination of drugs or you are trying something "off label" (meaning that the primary intended action of the drug isn't for depression/anxiety, etc., but it's been shown to help those conditions) a good psychiatrist is worth his/her weight in gold. I've become a non-responder to most antidepressants, so I'm using another med off-label and it is incredible. Even DH remarked that he's seen a huge change in me.

Finally, don't forget talk therapy. Once your depression & anxiety abates, it may become easier to see where you get off-track. For me, my thoughts are not always my friend. Sometimes my brain wants to take me to a bad neighborhood where I worry about everything. :mad:

[Aggie_Ama]

I feel like a different person. At first I thought it was the placebo effect but I am back in control and "I don't know who is in my head" feeling. I go back to the doctor in two weeks, only bad thing is now no insomnia but I am tired now but we had upped my topamax so there is no telling what is the cause.

The pharmacist recommended playing around with when I take the meds since my doctor did not say to take it at a certain time. My neurologist took me off topamax and agreed my tremors aren't helping my depression, jeez you think?

That being said I am not opposed to therapy and my new insurance at my new job will allow for it at some level so once it kicks in I may consider it.

[polly4711]

Ama.... as being a former fellow lexapro taker... i COMPLETELY understand how you feel. You need to definately talk with your doctor. When I was on it, I didn't care about life or what was going on. I'm quite the snuggling/touchy feely person, and I didn't want to hold hands with my boyfriend. (So if you have a partner, talk with them and tell them how you feel on it and that you are trying to fix it.

Maybe you need to change the pill overall. Please keep my posted.... I'm here for you.

[Aggie_Ama]

Polly- I am actually feeling quite well on it so far but my doc wants to constantly monitor because this is my first try on anti-depressants. I am actually quite loving towards my husband which I hadn't been for months. He is so happy I am no longer shying away from his hugs.

I am trying to track my sleeping to see if it is abnormal because I have always enjoyed a good nap. :) I think I took a 3 hour one yesterday but then I went to bed at 11 and got up at 5:30 so really I am not sleeping that much, just should go to bed early so I don't need that nap.

I meant the "I don't know who is in my head feeling" has gone away finally. I feel so much better just a bit sleepy in the afternoon.

[chatterbox]

I took lexapro for about eight months. It definitely short-circuited the crying jags and really helped, but after six months my husband was concerned because not only had I stopped crying, I'd stopped laughing. I didn't have sleeping issues while on it, but when I came off of it I had terrible terrible vertigo. My doctor actually decided I could cold turkey because the draw down was just prolonging the dizziness. I think I was dizzy for about 6 - 8 weeks.

Glad you're getting help and beginning to feel better.

[polly4711]

, but after six months my husband was concerned because not only had I stopped crying, I'd stopped laughing. .


yes... i understand.

Ama... i'm glad that it's working out well for you and the hubby.... i don't know what to tell you.... but good luck.

[jobob]

Well, I'm a relatively long-time Lexapro user and I think my sense of humor and my ability to laugh is still intact.

In fact, I think I find it easier to laugh nowadays. But that's just me.

It's different for everyone. Looks like I'm in a minority here, as a satisfied Lexapro user, but, there you have it. I sympathize with those of you for whom it hasn't worked out, I guess my particular brain chemistry & what-have-you are compatible w it. I hope you've been able to find something else suitable, be it drug or talk therapy. I did talk therapy for a while but it didn't work well for me - maybe it was the therapist I was seeing, but this was before trying Lexapro. I'm not inclined right now to try talk thereapy again, but I'll never say never ...

(To be honest I was rather hesitant to talk about my experiences with the drug, but since the trend on this thread was somewhat negative, I thought I would add my own positive experience as a counterpoint. Who knows, maybe I'm the only satisfied Lexapro user out there ... :D )

[malaholic]

Aggie, I'm glad that the Lexapro is helping you. I hope that the insomnia is only a temporary adjustment thing and that you don't experience any other bad side effects.

FWIW, there is a website http://www.askapatient.com (http://www.askapatient.com/) where you can typically find a lot of anecdotal information on how well specific drugs have worked for people and what side effects they've experienced. I found it to be pretty helpful a few years ago when my then-doctor told me that there was absolutely no way that the headaches I was getting were due to the birth control I was on...I eventually stumbled upon that site and what do you know, there were a ton of people reporting killer headaches while on that pill.

Anyway, once again, best of luck with this treatment!

[Dogmama]

(To be honest I was rather hesitant to talk about my experiences with the drug, but since the trend on this thread was somewhat negative, I thought I would add my own positive experience as a counterpoint. Who knows, maybe I'm the only satisfied Lexapro user out there ... :D )

Well Jobob...I have to eat my words...chomp chomp, slurp, swallow...

My Pdoc tried to take me off Lexapro. Big mistake. I started to get p*ssy about everything. Even on my bike rides, I'd play the "conversation" game - You know, "I'll say this...then he'll say that...then I'll say this..." etc. Completely missed what a beautiful day it was because my head was in a very bad neighborhood. When I can't relax on my rides, I know I'm in trouble.

I'm on a super low dose, 5 mg, but it is just the dusting of SSRI I need to keep sane. My anxiety & depression just takes over my life. That's one reason why I started riding & working out. I don't think I need as much med as most people.

I do talk therapy too. Depression & suicides run in my family & I don't really want to continue the family tradition. My bike would cry & rust...so sad.:(

[jobob]

Well, I eat my words all the time. Everyone needs a hobby, I likes to say. :)

I might go for a lower dose at some point. I actually missed a few days during my current "adventure" (hospital etc after biking accident) and I didn't notice anything off ... altho I wasn't in much position to notice such stuff, heh.

Then again, at least for the moment anyhow, it ain't broke so why fix it ... (just a rhetorical question) .

[Aggie_Ama]

Everyone's experience with a drug can be mixed but usually people who have a very negative response remember it more. When my tremors first started I was on Neurontin. I was also extremely depressed. I thought it was the Neurontin and was convinced it was the devil's drug. Now that I have had the same depression feelings I had in 2004 and my tremors were coming out of remission I know it probably wasn't Neurontin. Although I felt like an idiot on it (many people say that), it gave me hot flashes and made me really loopy if I took anything else but the depression wasn't the Neurontin. Oh and quitting Neurontin made me feel really out of it, I would say wacko but that isn't the word. I was even more depressed, irritable and frustrated for the two week taper. Many people take Neurontin for tremors and are quite happy with the results, so there you go.

I appreciate everyone's stories and cautions about their experience. I go back to the doctor next week to see what he thinks but I feel less irritable, more in control and overall content. I guess for me, for now it is the right choice.

Oh and the sleeping? I realized I always take a lot of naps in the spring, have since I was 15 I guess it could be the time change and not a thing to do with the Lexapro. The insomnia has stopped. Sometimes we want to blame something when it probably has nothing to do with it. :rolleyes:

[Dogmama]

Sometimes we want to blame something when it probably has nothing to do with it. :rolleyes:

Jumping to conclusions is how I get my exercise when I can't ride. :D

Neurontin made me scrub my kitchen floor at 2AM. I just knew the grout had to be cleaned...or else. My ortho surgeon put me on it because I had neuropathy in my hands. I finally just had the cervical fusion & decided the grout would have to get dirty.

[crazycanuck]

I'm confused & hope a chemist/pharmacy expert might be able to answer this question. Why is it that all of the drugs that are supposedly supposed to help folks(the type of illness/disorder/etc etc does not matter as there are drugs to help each one) have so many side effects? It's the 21st century & I would assume there's the technology...

It doesn't seem fair to create more conundrums for folks when all they want is a solution to their illness/disorder/etc etc.

[limewave]

I'm confused & hope a chemist/pharmacy expert might be able to answer this question. Why is it that all of the drugs that are supposedly supposed to help folks(the type of illness/disorder/etc etc does not matter as there are drugs to help each one) have so many side effects? It's the 21st century & I would assume there's the technology...

It doesn't seem fair to create more conundrums for folks when all they want is a solution to their illness/disorder/etc etc.


My best friend is a chemist for a very large pharmaceutical company. I've asked her similar questions. Why aren't they trying to find cures? Why are there so many side-effects? Etc.

Basically, she said, that the money is in treating symptoms--not in curing them. If there's more symptoms to treat, there's more money to be had . . .

This is why I now see a Doctor who practices Functional Medicine. I was on Lexapro for YEARS. It was great in that it really gave me my life back, but I suffered from so many side-effects. I was told that I would be a lifer on Lexapro. Now, I'm off all SIX of the prescription drugs I started taking at 25. And I feel better than I've ever felt. My doctor manages my depression symptoms naturally through supplements and diet. I won't go back on prescriptions--I can't stand the thought of being under the influence of something that was designed to rip me off, not make me better.

[jobob]

Aw, come on, let's get real - don't you think that if BigPharmaCo came up with a cure (for anxiety, depression, hangnails, what-have-you) without any sort of side effects they'd market it out the wazoo and make a fortune?

The reality is, science is (still) imperfect, and hasn't yet progressed to the point that it can mimic and predict all of the outcomes of any particular agent on a person it is meant to treat.

That is why there are clinical trials for new drugs, and why trials are in (at least) three phases. The first phase is to determine the safety and tolerability of the drug, figure out a safe dosage range (not effective - safe) and to determine if any side effects are present. In Phase II the drug is given to a larger group of patients to figure out what the effective dose range is and to further monitor side effects and tolerability. In Phase III, the drug is given to an even larger group of patients to determine its effectiveness relative to currently used drugs for that condition (if there are any), and to further monitor safety & side effects. The length, size and the precise nature of the clinical trials depend in large part on the disease/disorder being treated by the drug. But in general, clinical trials involve lots of people, lots of trials, and lots of bucks spent to conduct those trials.

Now, that said, does BigPharma have a profit motive? Of course it does. That is why there are treatments out there to cure such life-threatening conditions such as baldness and erectile dysfunction. :D (OK, that was snarky of me, those are traumatic situations for those involved ... but you know what I mean ...)

And if the clinical trials for a certain disease are very lengthy and/or involve vast quantities of patients, some companies (especially smaller companies) might shy away from attempting to develop treatments for that disease, or at the very least try to partner with a Big(ger)PharmaCo with deeper pockets. Companies survive and fail based on the outcomes of these trials, so yes, it's big bizzness.

So, it's not as simple as it sounds. Like everything else. :rolleyes:

[limewave]

Aw, come on, let's get real - don't you think that if BigPharmaCo came up with a cure (for anxiety, depression, hangnails, what-have-you) without any sort of side effects they'd market it out the wazoo and make a fortune?
:rolleyes:

I'm just passing on what my friend told me--word for word. I wasn't trying to be cynical and if you knew me personally, you would know that I'm not into conspiracy theories, etc. Sadly, this has been my personal experience with commercial medicine. Its a cycle I see my parents going through--being prescribed prescription drug after prescription drug to satiate side-effects while no one bothers to investigate the origin of the problem.

You can roll your eyes, that's fine. I just want people to be aware that there are other options out there and they are worth being explored. Prescription drugs are NOT the only solution.

[Possegal]

Well I work in the field too and I would strongly disagree that companies prefer to have drugs with side-effects so that they can make more money.

The reason there are so many side effects is that the drug acts at many more places other than where you need it to act for its benefit. They aren't really "side effects" but are what we would call extensions of the pharmacology of the drug or exaggerated pharmacology. So you need a drug to act at point B in order to benefit you. Unfortunately, point B exists at more parts of the body than just the one you are looking for. Or point C and D are physiologically very similar to point B and so the drug has effects there too.

The body is a very complex thing and finding a drug that does one thing only at one point only in the body, is damn near impossible. But trust me when I say that companies are definitely trying to find more exact mechanisms.

[jobob]

I'm sorry you took offense to my comments, limewave, but to be honest I took a bit of offense to your friends'.
(Or I would have, were I still in the lab trying to work on such things.)

She says the money is in treating symptoms, not curing them. In one respect she's right. The bar is much higher for cures than for treatments. What defines a cure? Absence of symptoms or absence of the physiological marker for the disease - but, for how long? Forever? So if a patient has a relapse after 5 years, then it's not a cure? The devil is in the details.

Plus, how safe and tolerable is a "treatment" as opposed to a "cure"?

It's easy to be cynical about pharma - lawd knows I am, often!! - but sometimes when I boil it down to the basic problems and issues and realities, I can (grudgingly) realize that there are a lot of factors in play and it's not a big 'ol conspiracy.

I'm glad that you found an alternative that works for you.

And I'm sorry that your folks have had a difficult time with their prescriptions. It can get mind-boggling. But do you really know that no-one has bothered to investigate the origins of their problem(s)? That's painting with an awfully broad brush, isn't it?

Perhaps the dispensing physician or pharmacist are not giving you (or your folks) the kind of information you/they desire? Just wondering.

[alpinerabbit]

I'm in the industry too and can only back up what they said. Pharma bashing is convenient but not always backed by logical thinking.

If any of the big Pharmas *could* develop a miracle drug that with one dose or one course, could make depression go away, forever - they would go to FDA, NIH, and health insurance companies etc. and tell them look, we can save you tens of 1000s of bucks per person for doctors fees, chronic medication, psychotherapy, even institutionalization - we'll charge 20'000 (or insert any other, largish amount) a course and the patient is done.*
It would be fair, and it would be nice to have.
Unfortunately depression like many other chronic illnesses is poorly understood, possibly multifactorial and can't just be switched off by finding the right button. At least not yet. Therefore, this is an example for a disease where only symptoms can be treated.

Bacterial infection? Other issue entirely. As long as the strain is not resistant (which is an almost inevitable consequence of the development and use of these drugs, it is "directed evolution"), the course of antibiotics will cure the disease and not just gloss over the symptoms.

Or you vaccinate. Maybe, one day, there will be a vaccine against depression. Who knows.


*they cannot just give the drug away. It's a business to make profit.
A drug costs between 0.5-0.8 billion $ to develop. You have to recoup that, and a profit on top. And if it only takes one shot, that shot is gonna cost.

[limewave]

Jobob--sorry, I was in a defensive mood this morning. Didn't mean to come off harsh.

[Crankin]

I am not anti-medication, but I think we need to be very informed. There are other ways to treat depression, or at least use in conjunction with meds, until you can wean off of them, and I am not talking about quackery here. It's just that the development of these medications has changed the field of psychotherapy so much, that meds are the only thing many think of, in terms of treatment. It scares me when one of my close friends has been prescribed Lexapro by her gyn. She has a mess of issues and has not had any counseling. The medication does not seem to be effective (there was some good response in the beginning), but after 5-6 years, she just takes her dose and wonders why no one can stand to be around her. How is her case being monitored?
I know that Aggie is not in that position, but many people are.

[jobob]

No sweat, limewave! :cool: :)

And Crankin, you're making a very good point. Is your friend willing to look into counseling? When one is in that sort of position, it's very hard to take those kinds of steps (been there, avoided that) but sometimes one has to take the bull by the proverbial horn and be a bit self-reliant to get the kind of help one needs. Much easier said than done, unfortunately.

[alpinerabbit]

agree with jobob here - what is a gyn doing prescribing antidepressants?

[Jolt]

I am not anti-medication, but I think we need to be very informed. There are other ways to treat depression, or at least use in conjunction with meds, until you can wean off of them, and I am not talking about quackery here. It's just that the development of these medications has changed the field of psychotherapy so much, that meds are the only thing many think of, in terms of treatment. It scares me when one of my close friends has been prescribed Lexapro by her gyn. She has a mess of issues and has not had any counseling. The medication does not seem to be effective (there was some good response in the beginning), but after 5-6 years, she just takes her dose and wonders why no one can stand to be around her. How is her case being monitored?
I know that Aggie is not in that position, but many people are.

I agree with this. Yes, the meds have their place, but too often people look for the "quick fix" of a pill instead of trying other things (like counseling and lifestyle changes) as the first line of treatment. This really applies to a lot of things (weight loss, cholesterol, blood pressure) and not just depression. Sometimes the meds are still necessary, but in many cases I think things can be solved without them and that eliminates the possibility of side effects.

[skinimini]

agree with jobob here - what is a gyn doing prescribing antidepressants?

In defense of gynecologists--they are primary care physicians, just as internists and family practitioners. Most have done advanced work in psychopharmacology and are highly qualified to prescribe antidepressants. Reputable physicians of all sorts know when to refer to specialists and do so regularly--including to psychiatrists, psychologists, therapists, etc. It's true that I am married to a very well-respected gynecologist, so I suppose I'm a little biased.

[sundial]

Since depression occurs in more women than men, it is not unreasonable for a gyne to prescribe antidepressants. Depression can be triggered by hormonal imbalance, such as post-partum depression, and ob-gyne docs are trained to diagnose and treat this illness.

[Crankin]

I guess he prescribes it for her because he is her primary care physician. I know him socially (not a friend, but belongs to my temple) and he is a good doc, but I think it needs to be monitored.
Jobob, my friend has had counseling in the past, when things were really bad in her marriage and when there were kid issues. That was quite awhile ago. It is a long and complicated story. I truly think that she knows she has issues, but she is so rigid in her thinking that she just says, well, this is the way it is. Eventually, I may say something to her, but even as a therapist in training, I know I shouldn't be "counseling" a friend. For me, it's a situation of not being able to cut off ties all the way, for many reasons, but not being able to stand being around her, either. So, I limit my phone calls to 1-2x a month and we rarely get together socially as opposed to in the past. She also has ADD and can't remember anything. It's getting worse, or maybe I didn't notice it before. If something was a certain way, like 10-15 years ago, that's how she remembers it. Like, if when my son was 12, he liked something or did something, then she thinks thats how it is today, even though he's an adult. She thinks she has to do things the way "mommy and daddy (her words)" did them, even though, she overtly hostile to her mother and says how judgmental and demanding she is; guess what? She is exactly the same.
OK, enough of my example. I will end with this: She came to yoga with me one time last year. At the end, she said, "Oh, I never get this relaxed. This is really great." I told her that's a good reason to practice yoga and that it might help her in various ways. Her reply was, "Oh, I don't really believe in this stuff."

[Dogmama]

Crankin, I have several friends like that. They swear they can't afford counseling, even though their insurance probably covers it if they'd bother to look, but whine about the same stuff over & over. As a counselor-in-training too, I am learning to hold my tongue & let them "go through their process." Hopefully they'll get sick & tired of being sick & tired. In the meantime, I limit contact too.

BUT, back to the OP & meds - primary care docs prescribe most antidepressents. If it's working, don't fix it. If it isn't working, I'd see a Pdoc.
They know the latest about meds & sometimes can add something that tweaks things. Fact is - nobody knows what will work for any single person. A Pdoc just has more experience. After all, I'd NEVER let my Pdoc do a pelvic exam on me.:eek:

[jobob]

Well Crankin, you did what you could, and you're bound by ethics so that can be tricky.

Hopefully she'll eventually come to realize what she needs, and be willing & able to seek it out. :cool:

[ZenSojourner]

Well I work in the field too and I would strongly disagree that companies prefer to have drugs with side-effects so that they can make more money.


I don't think that's what's being said at all. Rather that side effects are not considered of primary importance by drug manufacturers, and doctors tend to prescribe more meds to deal with the side effects. This is very well documented in the medical literature and it's how many elderly patients end up on 20 or 30 meds. My dad was on a med that had the side effect of causing tremors; they put him on another med to control the tremors. That med had the side effect of causing stomach problems; they put him on a med for stomach problems; etc etc etc ad nauseum.


The reason there are so many side effects is that the drug acts at many more places other than where you need it to act for its benefit. They aren't really "side effects" but are what we would call extensions of the pharmacology of the drug or exaggerated pharmacology.

BULL. That's the very definition of side effect, an effect that you don't want coupled with the one that you do. Calling it "an extension of the pharmacology of the drug" is like calling a bug in a program a "feature".


But trust me when I say that companies are definitely trying to find more exact mechanisms.

I'm sure if they stumbled across a more exact mechanism they would happily exploit the hell out of it. However the truth of the matter is that drug studies are manipulated and massaged in order to minimize the impact and frequency of side effects. It's all about approval and marketing.

Another well documented fact is that once a drug is released, side effects in the general population are more frequent, broader in scope, and potentially more severe than were reported in the drug studies. A certain amount of this can't be helped - there are always going to be side effects that pop up when your sample size is millions that you would be unlikely to run across when your sample size is 100. But the truth is that side effects are routinely down-pedaled and soft-shoed in order to get through the approval process, and to make the drug more palatable and hence more marketable to the public. There is a mechanism in place for doctors to report side effects post-approval, but very few use it. A lot of docs seem to be unaware that the mechanism even exists, and even if they do know about it, they don't know how to access it.

Doctors have also been brain-washed into believing that side effects are always "rare" which they generally equate to "non-existent". As a person who has suffered from many many weird and bizarre side effects (drug sensitivity runs on BOTH sides of my family) I can attest to the fact that docs more often than not tend to discount patient reports of side effects.

Recently my father was having problems with low BP. We had moved recently and he didn't have new docs yet. During a hospitalization for an entirely different matter, the hospital doc took him off ALL his heart meds, citing the low BP as the reason. This doc did not review his med list, he just took him off ALL his heart meds, meds he has been on for 15 years and has always tolerated well. His low BP not only did not remit, his CHF got much, much worse (go figure, how could that happen?). It was left to ME to review his med list, discover that some doc had put him on Wellbutrin, find the literature listing low BP as a potential side effect, and then wrangle with the doc to drop the Wellbutrin and put him BACK on the heart meds. What was the doc's response when the side effect of low BP related to Wellbutrin was pointed out to him? "Side effects are very rare".

It has been documented that side effects among the general population post-marketing run 3x to 10x what is reported in the pre-approval testing. So they're not rare, but Big Pharma wants us to think they are. So they under report, massage the data, find reasons to drop people who have adverse reactions so they don't "dirty" the data for approval.

Take Prozac for instance. Upon review, FDA officials discovered that researchers had dropped 76 of 97 cases of reported suicidality from its post-marketing surveillance data submitted to the FDA. DURING pre-marketing drug testing, similar cases had been excluded based on the flimsiest of excuses. I loaned that report to a friend so I can't look up the exact circumstances, but incidents of activation (emotional stress that can lead to suicidality) and actual suicidality were dropped from the data set based on some self-serving double talk, sort of like calling a side effect "an extension of the pharmacology of the drug".

Furthermore, Prozac is almost 20 times more likely to result in a suicide attempt than other antidepressants. (Spontaneous Domestic Reports January 1982-July 1991. [PZ-1548, See pp. 5-14]). This was known before marketing and it was hidden via data manipulation and under reporting in order to get Prozac through the approval process.

Prozac was a bonanza for Eli Lilly, and in fact when their monopoly on it ran out, they repackaged it as a treatment for PMS so they could extend their monopoly on it. (http://web.mit.edu/newsoffice/1997/pms.html)

Serafem (Prozac repackaged for treatment of PMDD but often prescribed for PMS) is reported by Eli Lilly to have "similar side effects" to Prozac. This is more Big Pharma double-talk, since Serafem is the exact same drug in the exact same dosage, only tinted a pretty pink, it has the EXACT same side effects as Prozac.

The problem is that the way Prozac was foisted off on the American Public is par for the course.

So sorry, but trusting Big Pharma, and you indirectly as their mouthpiece, is not in the cards here.

*EDIT*

I did find some of the info on Prozac's approval process online

http://www.baumhedlundlaw.com/media/timeline.html

These are exerpts from ELI LILLY documents during testing phases, pre-approval, and post-marketing.

ELI LILLY KNEW there were major risks associated with Prozac. The only thing this spurred them to do was to find ways to double-talk it, downplay it, and hide it.

[Crankin]

I tend to agree with everything ZenSoujourner said (in a much more eloquent way than I could).
You are lucky if you can take SSRIs or any other medication with no side effects. I have side effects with everything. If I ever get heart disease or several other things that require medication, I will be in serious trouble because I can't take things that have the stuff that causes "serious digestive problems." It's in so many things that it seems crazy. I almost had to be hospitalized when I tried Fossomax about 7 or 8 years ago. Last year, when I was having all my medical issues, I tried two SSRIs... bad, bad, bad. I felt worse than the original problem that lead me to trying them. Let's see, oh yes, I am also allergic to iodine, hence IV contrast dye, so if i ever need a cardiac stress test, angiogram, etc who knows what they will do. Guess I'd better keep riding!

[ZenSojourner]

(Major snippage - about depression) Therefore, this is an example for a disease where only symptoms can be treated.

Depression isn't a disease. It's a process. It is, as you noted, multifactorial and includes developmental, emotional, environmental, and biological elements. The medical model of disease - alleopathic treatment (eg drugs or surgery) - cure doesn't fit because it isn't a disease.

As others have noted, taking the pill (whatever the flavor of the week happens to be) and then continuing to live in dysfunction isn't really helping anyone. If someone came into a doctor's office with a broken leg and he sent them home with morphine or oxycontin, it might reduce the pain of the broken leg, but the leg is STILL BROKEN. Or better yet, a bleeding wound. The patient may feel better, but he'll still bleed to death, even if happily, if you only treat the symptoms palliatively.

That's what is being done when people are given drugs for life-style/developmental issues like depression and anxiety. Not only that, but the research shows that drugs alone do not work as well as drugs plus therapy; and that drugs plus therapy does not work as well as therapy alone. The longer the followup time, the better therapy looks.

The people who have lasting effects are people who make lasting change in their lives, and drugs do not do that.

As for GPs and other non-specialists prescribing psychoactive meds, it should not be done. It IS done routinely, but it shouldn't be. The vast, VAST majority of cases of under, over, and mis-medication occur when a non psych MD hands out powerful psychotropics without the necessary evaluation, followup and monitoring. Anyone who thinks you can be fully trained to handle psychotropic medications in under 18 months to 2 years of full time study on just that subject alone is mistaken. Furthermore even most Psych MDs underestimate the importance of concurrent therapy or even therapy as a preferred treatment.

It's true that people tend to seek a solution in a capsule, but it's also true that the medical establishment by and large pushes pills, largely due to the history of the development of antibiotics. Penicillin was a wonder drug that could cure nearly anything that ailed you. It was a miracle back when people died of minor cuts and tooth aches with what we would now consider to be alarming frequency. Pills and surgery were miracles, and modern medicine has yet to move beyond the early flush of the success of mechanical intervention.

Drugs can have a dramatic effect on behavior and emotion; but take the drug away and the effect dissipates. Antibiotics "cure" because they kill off disease causing organisms; but depression and anxiety are not caused by killable critters. They are an outgrowth of the way we look at and interact with the world, and that doesn't come in a pill.

[jobob]

What's your educational background and what do you do for a living, ZenS?

I have a PhD in biochemistry and I used to work as a research scientist, until I went over to the dark side (as it were) and I now work on patents at a biotech company which is developing protein-based pharmaceuticals.

Possegal is also a PhD in the pharmacology field - I don't remember what she does exactly (and if she said on this thread, I'm too lazy to go back right now and look).

What I'm getting at is that we both work in the field. And I know (and I assume PG also knows) people who work in "the trenches" , as it were, working on the development of pharmaceuticals which, if all goes well (big if), will improve and possibly save some lives in the future. And no, the people I know and work with are not conniving manipulators trying to pull a fast one over unsuspecting patients in order to turn a buck.

ZenS, you've had some very unfortunate experiences with your father's meds. I'm not downplaying that in the least, and it sounds like the current state of drug dispensing for elder patients is disgraceful.

But wrapping this up into a big indictment of pharmaceutical companies?

I'm curious how you reached your conclusions. You do have some sort of background in the medical / pharmaceutical area?

Because to be honest, some of your comments are so off the wall that, to use your own term, they're bull.

[ZenSojourner]

Jobob, I don't doubt that you may be well-intentioned. But good intentions do not make up for facts.

I cited specific evidence. You reject the evidence out of hand. Heck, you flat out pretend it doesn't EXIST. Snagging the example of my father's med problems and waving it around like a red flag as if it were the main issue is just an attempt to distract from the facts presented. My views of the pharmaceutical industry have little to do with my dad's condition and med problems, or even my own, but with the way Big Pharma has typically handled marketing and testing of drugs, a subject which I have followed for over 20 years.

Trying to imply that only people who have chemistry degrees and work in the pharmaceutical industry are suited to evaluate that industry is disingenous. I have a brain, and I use it. And yes, I have the educational background to be able to evaluate the facts. I have a background in biology, medical research, computer and engineering technology, and psychology.

Telling people they can't have an informed opinion because they don't work for a pharmaceutical company is ludicrous. Using loaded terms like "off the wall" to describe the facts presented doesn't change those facts. Go read the memos Eli Lilly was passing around in their attempt to soft-pedal the problems with Prozac; THAT'S off the wall.

That said, there is a distinction to be drawn between chemists/biochemists working directly on the development of a drug and the marketing weenies who make the decisions about how to present the drug to the FDA and to the public. By your own lights, since you don't work in marketing, you must not be qualified to speak to issues of marketing and decisions made at the corporate level.

I'm not going to argue with you about it. I am not accusing you personally or anyone else who has posted here of malfeasance; the problem lies outside of the venue of research, and is more correctly to be attributed to corporate policies and marketing concerns.

[jobob]

Fair enough.

I didn't address the memos you quoted since I didn't have my back brace on yet and my husband was nagging me to either put it on or go lay down (heh, laziness won, I chose the latter).

And I know you have a brain. I just wanted to point out that some here work in the pharma industry. Now, that said, I don't work in marketing which might be where some of you're issues are coming from. And I don't know jack about marketing.

I work in patents, which has is own issues, some of which I've come to question. The exclusivity that comes from patents, for instance. Sometimes I wonder if that's such a great idea. Drugs under patent cost a bundle, as opposed to generic drugs (for which the patents have expired). But then, how will the company that develops the patented drug in the first place recoup its cost and make a profit to make it worth the company's while? Many drugs, theoretically promising ones, don't make it past clinical trials and its a very large investment for each one so the pharma co's need some way to make up for not only the cost of developing the drug that is actually marketed, but all of the other drugs that never got that far but that they still spent a bundle on. Oh yeah, and have a reason to exist in this day & age (i.e., make profits, at least eventually) .

So that's where the exclusivity from patents comes in. If the pharma co didn't have that exclusivity period (roughly 20 years starting from when the patent application was filed, give or take a few years for a number of reasons [Ed. to add - the exclusivity period is way less than 20 years once the patented drug finally reaches the market btw]), then another company would be able to make and sell that drug right away without having to do the background research & development work, so they'd be able to sell it for a much lower cost and the original pharma co would never make anything off of their original investment.

But that doesn't help the consumers' bottom line much. What's the answer? Gah. Corporations vs public funding? I suppose if it were all government funded then there would be no need to cover costs and no profit motive (and Yes I'm laughing at myself as I'm typing this). Of course then taxpayers would be funding the pharma industry (waaay more than it does now) which would probably mean an increase in taxes and I shall not go there. :cool:

Complicated stuff, unfortunately.

[Triskeliongirl]

I've avoid chiming in here, but at this point I can't help it. I don't work in big pharma, and I know nothing about marketing. What I do know about is biochemistry, pharmacology and neuroscience. I have a PhD in biochemistry and I teach and run a research lab at a major research university.

The goal of developing better therapeutics is always to make drugs that will do what we want them to without side effects. I don't believe for a minute that big pharma markets drugs with side effects in order to sell more drugs. I agree with the earlier comments that the human body is so complicated, that it is extremely difficult to develop a drug that just effects what we want it to without any side effects. It's because our bodies use common pathways/mechanisms, etc. to carry out many different functions, that to specially inhibit only one of those functions and not any others is nearly impossible.

With that being said, I also think big pharma over markets pharmacological interventions, as an observer seeing all the commercials we are inundated with on TV. But we all have a choice, and whether we do or don't choose pharmacological interventions depends on the problem. I am hypothyroid and would not for a minute consider doing anything other than taking thyroid meds. But, I am also hypoinsulinemic, and find that as long as I don't challenge my body with too much carbohydrate, exercise, and maintain a normal body weight, that I can avoid taking insulin, so I do that.

[Dogmama]

Depression isn't a disease. It's a process. It is, as you noted, multifactorial and includes developmental, emotional, environmental, and biological elements. The medical model of disease - alleopathic treatment (eg drugs or surgery) - cure doesn't fit because it isn't a disease.


I have to respectfully disagree. Insulin doesn't cure diabetes. Is diabetes, then, not a disease, just a process? People take a pill and, as you said, continue to live in dysfunction...

I hesitate to stigmatize people who need antidepressants. I would not stigmatize a person who takes insulin. Certainly, diabetes can be helped with exercise and diet. Depression can be helped by therapy. But cured? No. At least, not yet. Although, many years ago, we performed lobotomies, but there were definite side effects...:eek:

[Dogmama]

OK, gotta chime in here.

A chiropractor is not schooled in brain chemistry to the extent that a board certified psychiatrist is. Period.

Philln - depression goes on a continuum. We all have down times in life and we don't call it clinical depression. Some people have an actual medical condition that predisposes them to seriously suicidal thoughts. Depression can be fatal. If you've ever been clinically depressed, you'd know that keeping busy and finding the cause are futile. Depressed people often cannot sleep, no matter how much they change their schedule.

Let me be very clear - I do advocate for behavioral changes. Exercise, diet, meditation, yoga, etc., can all be great adjuncts to treatment. But a clinically depressed person needs treatment in the form of medical intervention. We stigmatize mental illness in this country as being a weakness. As a result, people do not seek help. It's not "going on drugs" any more than taking thyroid medication is "going on drugs" (but ask somebody with a hypoactive thyroid how they feel without their "drugs" and I bet you'd hear the word "depressed.") Ask a person who has experienced black depression. Medication brings them back to normal - it doesn't make them high. I'm talking about medication - prescribed by a board certified psychiatrist - with the admonition that it can take several tries to find the right medication/combination of medication, diet and lifestyle change.

I'm pretty adamant about this topic & apologize in advance for offending anyone. It's important that people understand so that they can seek help for themselves or their loved ones without feeling ashamed, weak or less-than.

[OakLeaf]

those last two posts are spam....

[tulip]

Yes, they are spam, but Right On, Dogmama!

[snapdragen]

Gee ASammy1, we could be related. I had the same "hush hush" experience with my family. I've been taking Zoloft for a few years now, but it wasn't until my nephew overdosed that we found out my dad had been hospitalized 40+ years ago for depression.

+ a million on getting your life back! In this case better living through chemistry was a lifesaver for me!


I used to be one of those people who cringed at taking medication. My mom was the one who urged me to see my Dr after she started to really notice the symptoms of depression in me. Apparently it runs in my family, but I didn't know it because it was kept "hush hush." My depression was so gradual that I didn't realize just how bad I was feeling until I started to feel better. Anti-depressants have given me my life back :D

[snapdragen]

those last two posts are spam....


Yes, they are spam, but Right On, Dogmama!

And now they're gone :D:D

[Dogmama]

those last two posts are spam....

I'm such a fish. Just hook me up & pull me in.