Posted by jono_in_adelaide on December 11, 2012, at 17:14:27
In reply to Re: Augment Effexor or TCS or MAOI or other? » jono_in_adelaide, posted by SLS on December 11, 2012, at 2:31:56
Different is different, however, most large scale studies have asserted that at standard doseages, there isnt a clinicaly significant difference between Effexor and the better of the SSRI's in terms of improvement of illness.
Of course there may be individuals where Effexor is far better, but they arnt common if the studies are to be beleived. if everybody was treated with the newest, most expensive drug as a first option because of supposed marginal improvements in response over standard drugs, costs would be vastly decreased while most patients would get no extra benifit.
Take a patient with high cholesterol for example, he could have generic simvastatin for $4 per month, or Crestor for $200 per month. For 99% of patients, there would be no difference, so it makes sense to start everybody on simvastatin, and only use Crestor for those where simvastatin fails. I am not saying "dont use effexor ever" just use it discriminatingly.
I am not saying "never use effexor", I'm saying start off with the sertaline because of its lower cost and equal efficiacy in blind controlled studies, if that doesnt work, move onto other things.
I also was basing my recomendations of those of Dr Ken Gillman, we well respected British/Australian psychiatrist who has shown that sertaline + nortriptyline is a superior antidepressant to effexor alone.
I understand your points SLS, but the point that ciast effectiveness matters is also valid
poster:jono_in_adelaide
thread:1032720
URL: http://www.dr-bob.org/babble/20121130/msgs/1032843.html