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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2219
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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How would you rank the following meds

Resolved Question:

How would you rank the following meds for effectiveness in treating major depression ?

Rank Compound
1 Clomipramine(desmethylclomipramine)
2 Imipramine(desimipramine)
3 Paroxetine
4 Fluoxetine
5 Escitalopram
? Trazodone
? Venlafaxine
? Bupropion
? Desvenlafaxine


From SERT and NET binding constants at http://en.wikipedia.org/wiki/Antidepressant and elsewhere, they kind of order as shown above ???

Is it a reasonable question to ask?

Thank you.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 1 year ago.

Elliott, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I believe that I can help.

Elliott, LPCC, NCC :

If there was such a possible ranking, then doctors would always prescribe the drug at the top of the list.

Elliott, LPCC, NCC :

Everyone is physiologically different and what works for some does not work for others.

Customer:

Good evening Elliot

Elliott, LPCC, NCC :

Hello my friend.

Elliott, LPCC, NCC :

Finding the best medication is usually a question of trial and error.

Customer:

How about a theoretical ranking then?

Elliott, LPCC, NCC :

It also depends on other side effects. Bupropion, for example, does not cause weight gain or drop in libido, whereas most of the others can and often do.

Elliott, LPCC, NCC :

Some are easier to quit than others.

Elliott, LPCC, NCC :

Some are effective for some patients whereas others have little effect.

Elliott, LPCC, NCC :

A theoretical ranking based on what critieria?

Customer:

How about a theoretical ranking where side-effects are not under consideration? A theoretical ranking is not the same as a clinical ranking.

Customer:

A theoretical ranking based on binding constants at SERT, NET, and DAT sites (maybe)

Elliott, LPCC, NCC :

I will look at this site. Please give me a moment:

Customer:

Sure

Elliott, LPCC, NCC :

To give you the best answer possible I will opt out and refer you to Dr. Vikas or Dr. Kaushik who would be the most competent to answer this question for you. I want you to have the best service from JustAnswer.

Customer:

Thanks Elliot

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I just sent in a second request to the JA moderators to send your question on to Vikas or Kaushik, our most knowledgable experts on psychotropic medications. Thank you so much for your patience.

Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7663
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Elliott, LPCC, NCC and other Mental Health Specialists are ready to help you
Expert:  Dr. Vikas replied 1 year ago.
Hello ! Thank you for your question, I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you today.

Honestly speaking, choosing an effective antidepressant is a hit and trial method in most cases. As such, all these medicines are more or less equal in relieving depressive symptoms. Some patients respond to one particular antidepressant while other may not respond to it at all.

Kindly go through the link given below to have more insight regarding the effectiveness of various antidepressants and then we can discuss further.

STAR*D study -

http://psychcentral.com/lib/2008/frequently-asked-questions-about-the-stard-study/

Please copy and paste the above mentioned link in your browser.
Customer: replied 1 year ago.

Thank you


that psychcentral reference has some invalid links


See www.star-d.org for complete study


I've got some reading to do...


 


 

Customer: replied 1 year ago.

Thank you


 


that psychcentral reference has some invalid links


 


See www.star-d.org for complete study


 


See


http://www.elsevier.com/about/press-releases/research-and-journals/a-calculator-to-estimate-the-likelihood-of-antidepressant-response for Roy Perlis treatment resistance calculator based on Star*d dataset; July 1, 2013


 


 


I've got some reading to do...


 


 

Customer: replied 1 year ago.

Thank you


 


that psychcentral reference has some invalid links


 


See www.star-d.org for complete study


 


See


http://www.elsevier.com/about/press-releases/research-and-journals/a-calculator-to-estimate-the-likelihood-of-antidepressant-response for Roy Perlis treatment resistance calculator based on Star*d dataset; July 1, 2013


 


 


Biomarkers are another approach to treatment resistant depression


See http://www.genomind.com/videos?vid=9 vidio from 2013 APA meetup.


 


I've got some reading to do...


 


 

Expert:  Dr. Vikas replied 1 year ago.
Sure, we can discuss further once you are ready.
Customer: replied 1 year ago.

Good morning

 

Thank you for the Star*d reference. Prescribing psychiatric meds is trial and error as you and the Star*d study pointed out.

 

Returning to the list of meds I have been prescribed over 30+ years:

 

  • All told, I show a good response to 3 medications: Clomipramine, Imipramine and Paxil. I would classify the other meds as low or no response
  • I have never quit a med because of side-effects
  • Currently, I am taking Clomipramine 75mg - that is day 4 at 75 mg and first trial of Clomipramine. Sleep and mood are improved. It's early days but I am counting this as a good response.

 

 

Q1: What does Clomipramine+, Imipramine+ and Paroxetine+ say about my anti-depressant response and the list of SERT, NET, DAT binding constants referenced at the top of this thread?

 

Q2: What might be added to Clomipramine (if anything) to increase energy and motivation and mood?

 

Thank you

 

 

Expert:  Dr. Vikas replied 1 year ago.


Hello

Clomipramine and Impramine are both older generation tricyclic antidepressant while Paxil is a newer generation SSRI antidepressant. Tricyclic antidepressant mainly act on two neurotransmitters that is Noradrenaline and Serotonin while SSRI antidepressants mainly act on a single neurotransmitter that is Serotonin.

So you can see that there is no specific pattern here. You responded well to both Tricyclic antidepressant and a SSRI antidepressant.No correlation can be made between the SERT, NET, DAT binding constants and your responding to two different class of antidepressant in my view.

The usual dose range of Clomipramine is from 100 -200 mg per day. You are currently on only 75 mg per day and since you are responding well to this medicine so an increase in the dose by your doctor to 100 mg should be the next step. Increasing the dose alone should help in lifting mood and controlling other symptoms.

Your doctor can consider the option of adding Buspirone later on if needed for augmenting the effect of Clomipramine.
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2219
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Dr. Vikas and other Mental Health Specialists are ready to help you
Customer: replied 1 year ago.

Thanks for answering my questions Dr Vikas.


 


I now appreciate that prescribing meds is a trial and error process.


 


Yesterday I returned a GOOD rating for this service. Did you receive that rating?


 


I agree to pay $29 for this GOOD service.


 


Kindest Regards,


Janice

Expert:  Dr. Vikas replied 1 year ago.
Hello Janice,

You are most welcome.


I really enjoyed working with you – please feel free to request me again when you come back to ask another question.

I have not yet received any rating yet. You have to rate my answer for this.

Kind regards

Vikas
Customer: replied 1 year ago.

Thank you Dr Vikas. The rating software requires another $29 payment. I paid $29 for Elliott's portion of the conversation. If possible, please ask the system administrator to close this question with a GOOD rating.


Thanks and have a great day, Janice

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