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Dr. Bob is Robert Hsiung, MD,
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Posted by mr.scott on February 1, 2002, at 21:28:01
In reply to Re: Forest Labs gets US conditional approval for Lexa., posted by SLS on January 31, 2002, at 16:44:49
Posted by Ritch on February 1, 2002, at 22:48:21
In reply to Will try it, but not impressed! (nm), posted by mr.scott on February 1, 2002, at 21:28:01
I have always wondered about the "mechanism" of SSRI's being responsible for their antidepressant effects AND the side effects you get from sertonin reuptake inhibition versus the medicine itself that "happens" to be an SSRI.
In other words, if the "R" isomer of citalopram is a therapeutic dud (depression, etc.-wise) and the "S" isomer is responsible for the therapeutic effects. Could it also mean that the dud isomer causes *less* side effects than the active one because it doesn't do much to block 5-HT reuptake? In that case, there shouldn't be much therapeutic or side-effect advantage to taking escitalopram. The only advantage would be less medication for your liver to get rid of. I will try it and see as well and post the results.
Mitch
Posted by ben on February 2, 2002, at 10:10:56
In reply to Re: Will try it, but not impressed! » mr.scott, posted by Ritch on February 1, 2002, at 22:48:21
No. r-citalopram is supposed to responsible for the side-effects, at least for more side effects than s-citalopram. Thats why they leave the r-isomere away. Lilly is planning this with Prozac (fluoxetine) too.
> I have always wondered about the "mechanism" of SSRI's being responsible for their antidepressant effects AND the side effects you get from sertonin reuptake inhibition versus the medicine itself that "happens" to be an SSRI.
>
> In other words, if the "R" isomer of citalopram is a therapeutic dud (depression, etc.-wise) and the "S" isomer is responsible for the therapeutic effects. Could it also mean that the dud isomer causes *less* side effects than the active one because it doesn't do much to block 5-HT reuptake? In that case, there shouldn't be much therapeutic or side-effect advantage to taking escitalopram. The only advantage would be less medication for your liver to get rid of. I will try it and see as well and post the results.
>
> Mitch
Posted by ben on February 2, 2002, at 10:19:36
In reply to Re: Reason For Release of New Drugs » OldSchool, posted by Mr. Scott on January 31, 2002, at 21:31:39
The new Celexa is in fact not a breakthrough but if it were more easy to develop new antidepressants (they have to be better than placebo !) the companys would do it - believe me ! This comes from a lack of knowledge in the pathology of depression. Sometimes I am also angry about companys because I do not responde to ADs like 2/3 of the people are doing (or should theoretically do).
> > > The development of the new Celexa is meant to be an improvement in its effectiveness - it's meant to have fewer side-effects. Most of the side-effects experienced comes from the ineffective isomer of Celexa. Take that away & you'll still get the same response as you did to the old Celexa but without as many troubling side-effects.
> > >
> > > There are teams of earnest young scientists working together to come up with new ADs but drugs can only be chemically engineered & carefully tailored for each specific need as more is learned about how our body's many functions interact. That's why one class is called "Selective" serotonin reuptake inhibitors. There's many sites throughout the body where serotonin has its effects, these try to target slective sites. If drugs could be even more tailored to just fit the ones that need to be targeted - result is more effective meds with fewer side-effects.
> > >
> > > Drug engineering is really only in its infancy. We're only at the "leeches & blood-letting" stage, so to speak, but at this point in time, it's the best we've got. Would it be more cruel to hold back simply because we haven't progressed enough? Or to provide treatment such as we have now?
> > >
> > > (Not to say I don't think pharmaceutical firms don't push their products forcefully on the market - but that's another story.)
> >
> > A "new and improved" Celexa is silly. Celexa already has a reputation as being one of the antidepressants with the fewest side effects. In fact thats one of the reasons Celexa was originally marketed. Its marketed as the "SSRI with the favorable side effect profile." We dont need a new and improved Celexa.
> >
> > The amount of money spent on developing this new and improved Celexa could have been spent on something else...something better than a new SSRI. The real reason this new and improved Celexa is being developed is one reason. Money. $$$$$$ Its so the company that sells Celexa can continue to make a big profit on it. Thats all. Seems like someone on here mentioned that the current Celexa patent is about to run out. Thus the financial incentive to develop this "new and improved" Celexa. Give me a break.
> >
> > SSRIs are big money and drug companies love them because these drugs are very safe. Nobody seems to want to develop better drugs or drugs oriented for treatment resistant depressives. Just plug along doing the same old crap. SSRIs and serotonin drugs. Yawn. SSRIs do not work for 20% to 30% of those who take them.
> >
> > I also do not believe this new Celexa will be more effective than the original Celexa. It probably has a better side effect profile, but more effective? I SERIOUSLY doubt it!
> >
> > I have one word to describe this "new and improved" Celexa. Bullshit.
> >
> > Old School
>
> I couldn't agree more... Remember "The Purple Pill" called Prilosec for GERD. They tweaked the molecule just in time for the patent to expire and create "The New Purple Pill" Nexium.
Posted by dave40252 on February 2, 2002, at 12:14:51
In reply to Re: Reason For Release of New Drugs, posted by OldSchool on January 31, 2002, at 19:19:29
What a crock! I have been prescribed seven different ADs in the last couuple of years. MSome are effective for me - some are not. Trouble is that all those that have been effective have had unacceptable side effects too - I am currently on Celexa and it is the best for me so far in terms of effectivness and side effect profile. Still I have sexual side effects from it - bad ewnough that i often wan to tstop taking it. If i could get something that works as well without the side effects i would be one happy camper. I bet there are a lot of others like me. Saying that they shouldnt bother with this because it is "good enough" is silly. Yes they should work on novel approaches. But why shouldnt thet also make something we already have better?
> > The development of the new Celexa is meant to be an improvement in its effectiveness - it's meant to have fewer side-effects. Most of the side-effects experienced comes from the ineffective isomer of Celexa. Take that away & you'll still get the same response as you did to the old Celexa but without as many troubling side-effects.
> >
> > There are teams of earnest young scientists working together to come up with new ADs but drugs can only be chemically engineered & carefully tailored for each specific need as more is learned about how our body's many functions interact. That's why one class is called "Selective" serotonin reuptake inhibitors. There's many sites throughout the body where serotonin has its effects, these try to target slective sites. If drugs could be even more tailored to just fit the ones that need to be targeted - result is more effective meds with fewer side-effects.
> >
> > Drug engineering is really only in its infancy. We're only at the "leeches & blood-letting" stage, so to speak, but at this point in time, it's the best we've got. Would it be more cruel to hold back simply because we haven't progressed enough? Or to provide treatment such as we have now?
> >
> > (Not to say I don't think pharmaceutical firms don't push their products forcefully on the market - but that's another story.)
>
> A "new and improved" Celexa is silly. Celexa already has a reputation as being one of the antidepressants with the fewest side effects. In fact thats one of the reasons Celexa was originally marketed. Its marketed as the "SSRI with the favorable side effect profile." We dont need a new and improved Celexa.
>
> The amount of money spent on developing this new and improved Celexa could have been spent on something else...something better than a new SSRI. The real reason this new and improved Celexa is being developed is one reason. Money. $$$$$$ Its so the company that sells Celexa can continue to make a big profit on it. Thats all. Seems like someone on here mentioned that the current Celexa patent is about to run out. Thus the financial incentive to develop this "new and improved" Celexa. Give me a break.
>
> SSRIs are big money and drug companies love them because these drugs are very safe. Nobody seems to want to develop better drugs or drugs oriented for treatment resistant depressives. Just plug along doing the same old crap. SSRIs and serotonin drugs. Yawn. SSRIs do not work for 20% to 30% of those who take them.
>
> I also do not believe this new Celexa will be more effective than the original Celexa. It probably has a better side effect profile, but more effective? I SERIOUSLY doubt it!
>
> I have one word to describe this "new and improved" Celexa. Bullshit.
>
> Old School
Posted by dave40252 on February 2, 2002, at 12:20:08
In reply to Re: about the new Celexa » OldSchool, posted by IsoM on February 1, 2002, at 1:23:14
You are surely right about the timing, but i guess i feel "so what?" The old will still come off patent won't it? I for one will be happy to pay more for the "new" version if it works for me without the side effects than i would have to for the generic old version.
> Old School, we're both on the same side, even if our comments seem not to be. I thoroughly do agree with you about putting money into developing truly new drugs & that they're already tested long enough in Europe without the FDA needing to spend years more.
>
> The point I was trying to make was that the new Celexa ISN'T more effective than the old. Just that side-effects that bother a few will be much less. I'd also like to explain a little about chemistry, if you wouldn't mind.
>
> Compounds that consist of two different isomers are called racemic mixtures. One of the isomers is effective & the other often isn't. But it still can have an effect on the body. Thalidomide that was prescribed for morning sickness in pregnant women a few decades ago was a racemic compound. The birth defects that were caused by thalidomide (seal flipper-like limbs) was a result of the ineffective isomer of thalidomide.
>
> Research has come a long ways & has now developed a relatively simple method to separate a racemic mixture. This has being done with thalidomide & it's now used in treating leprosy. Millions of dollars were not poured into developing a new Celexa - instead new developments are being applied to different areas & one of them is in the separation of the two isomers of Celexa. Plain & simple.
>
> And yes, I do believe that the original patent running out on Celexa has a lot to do with the timing of the release of the new compound. I just like to separate the truth from the accusations. If information isn't accurate & has too much rhetoric to it, fewer people will be convinced.
Posted by Simcha on February 2, 2002, at 13:18:23
In reply to Re: Reason For Release of New Drugs, posted by OldSchool on February 1, 2002, at 10:08:16
> > I couldn't agree more... Remember "The Purple Pill" called Prilosec for GERD. They tweaked the molecule just in time for the patent to expire and create "The New Purple Pill" Nexium.
>
> I havent read or heard that before, but it sounds logical. It doesnt surprise me at all. Pure bullshit is what it is.
Here is an exerpt from a news release regarding Lexapro:"In the trials, Lexapro was shown to be well tolerated and to significantly improve symptoms of depression in the first or second week of treatment. 'The most frequent adverse events observed in these trials were nausea, insomnia and ejaculation disorder.' In fixed dose studies, the overall incidence rates of adverse events in patients treated with Lexapro 10 mg daily was similar to that in placebo treated patients."
So it seems that the s-isomer is responsible for some of the more infamous side-effects too. Efficacy and drugs usually equal side-effects. The whole question comes down to whether or not you can tolerate the side-effects for having the benefits.
I for one shall remain sceptical until this drug has been out for about a year. I will not beg my p-doc to be switched for something that has not been tested by the general depressive population. I await all of your comments, those of you who will switch, eagerly.
Simcha
Posted by OldSchool on February 2, 2002, at 14:31:12
In reply to Re: Reason For Release of New Drugs, posted by dave40252 on February 2, 2002, at 12:14:51
> What a crock! I have been prescribed seven different ADs in the last couuple of years. MSome are effective for me - some are not. Trouble is that all those that have been effective have had unacceptable side effects too - I am currently on Celexa and it is the best for me so far in terms of effectivness and side effect profile. Still I have sexual side effects from it - bad ewnough that i often wan to tstop taking it. If i could get something that works as well without the side effects i would be one happy camper. I bet there are a lot of others like me. Saying that they shouldnt bother with this because it is "good enough" is silly. Yes they should work on novel approaches. But why shouldnt thet also make something we already have better?
>
Dave I could care less about SSRI side effects like sexual dysfunction. Severe depression already has destroyed my sexual functioning, no drugs involved. Id be glad just to be able to get out of depression fully and go back to work and not be disabled and be able to earn a living and be independent again. Screw SSRI side effects...Id gladly put up with some "SSRI sexual dysfunction" in order to get out of depression and go back to work. Of course SSRIs dont work very good for me, so its a non issue.SSRIs cause some sexual dysfunction in me. I could care less. I take them anyway. At least I can sleep on them and have some appetite on SSRIs.
Old School
Posted by Ritch on February 2, 2002, at 15:13:43
In reply to Re: Mitch: r versus s!, posted by ben on February 2, 2002, at 10:10:56
> No. r-citalopram is supposed to responsible for the side-effects, at least for more side effects than s-citalopram. Thats why they leave the r-isomere away. Lilly is planning this with Prozac (fluoxetine) too.
>
>
> > I have always wondered about the "mechanism" of SSRI's being responsible for their antidepressant effects AND the side effects you get from sertonin reuptake inhibition versus the medicine itself that "happens" to be an SSRI.
> >
> > In other words, if the "R" isomer of citalopram is a therapeutic dud (depression, etc.-wise) and the "S" isomer is responsible for the therapeutic effects. Could it also mean that the dud isomer causes *less* side effects than the active one because it doesn't do much to block 5-HT reuptake? In that case, there shouldn't be much therapeutic or side-effect advantage to taking escitalopram. The only advantage would be less medication for your liver to get rid of. I will try it and see as well and post the results.
> >
> > Mitch
Thanks, Ben. The proof will be in the pudding, so to speak. It would be interesting to see the results of twin trials (one with the R-isomer and the other with the S). It would be interesting to see what the discontinuation rates are...I just brought this up because I get the same side effects from *all* the SSri's for the most part. Some are worse for one side effect more than another-but they are fairly similar.
Mitch
Posted by Mr. Scott on February 2, 2002, at 17:53:24
In reply to Re: Mitch: r versus s!, posted by ben on February 2, 2002, at 10:10:56
> No. r-citalopram is supposed to responsible for the side-effects, at least for more side effects than s-citalopram. Thats why they leave the r-isomere away. Lilly is planning this with Prozac (fluoxetine) too.
The Prozac one didn't work out for Lilly because at higher doses R-Fluoxetine caused cardiac side effects. That has been ditched... The next big hope out of Lilly is Duloxetine. Another dual acting pump inhibitor.Scott
Posted by Mr. Scott on February 2, 2002, at 17:57:52
In reply to Forest Labs gets US conditional approval for Lexa., posted by bonnie_ann on January 28, 2002, at 20:01:34
They have begun running "coming Soon" ads in the professional journals so what I can say is that the company expects FDA approval within 3-6 months. However predicting the FDA approval process is impossible unless you're actually the one paying them off.
Scott
Posted by OldSchool on February 2, 2002, at 18:12:13
In reply to Prozac one went south! » ben, posted by Mr. Scott on February 2, 2002, at 17:53:24
> > No. r-citalopram is supposed to responsible for the side-effects, at least for more side effects than s-citalopram. Thats why they leave the r-isomere away. Lilly is planning this with Prozac (fluoxetine) too.
>
>
> The Prozac one didn't work out for Lilly because at higher doses R-Fluoxetine caused cardiac side effects. That has been ditched... The next big hope out of Lilly is Duloxetine. Another dual acting pump inhibitor.What a waste of time. We already have Effexor...same exact thing as Duloxetine.
Old School
>
> Scott
Posted by djmmm on February 2, 2002, at 23:52:59
In reply to Re: Prozac one went south!, posted by OldSchool on February 2, 2002, at 18:12:13
> > > No. r-citalopram is supposed to responsible for the side-effects, at least for more side effects than s-citalopram. Thats why they leave the r-isomere away. Lilly is planning this with Prozac (fluoxetine) too.
> >
> >
> > The Prozac one didn't work out for Lilly because at higher doses R-Fluoxetine caused cardiac side effects. That has been ditched... The next big hope out of Lilly is Duloxetine. Another dual acting pump inhibitor.
>
> What a waste of time. We already have Effexor...same exact thing as Duloxetine.
>
> Old School
> >
> > Scottoldschool,
Here's something, it's the (R) isomer of sibutramine (meridia)..it will be marketed for depression and ADHD...this may be interesting because it seems to be more selective to norepinephrine and dopamine than serotonin.
http://www.sepracor.com/pharm/
Posted by likewater on February 3, 2002, at 0:22:37
In reply to Re: Prozac one went south!, posted by djmmm on February 2, 2002, at 23:52:59
Everyone is aying that this will be barely better except for side effects.
Assuming this study is correct in addition to less side effects lexpro shows a quicker esponse time.An excert from Yahoo business:
A pooled analysis of two earlier randomized, double-blind, flexible-dose, placebo-controlled studies with a total of 844 patients showed that patients with major depressive disorder who were treated with either escitalopram or Celexa showed significantly greater improvement than depressed patients receiving placebo. Dosing of escitalopram and Celexa was adjusted as needed at specified intervals during the eight-week studies. Escitalopram was dosed at 10 mg or 20 mg per day, with a mean daily dose of 12.6 mg throughout the studies; Celexa was dosed at either 20 mg or 40 mg per day with a mean daily dose of 25.5 mg throughout the studies. The analysis showed that escitalopram and Celexa were both statistically superior to placebo on all efficacy measures. However, this superiority was demonstrated by escitalopram in the first week of treatment and later in the study by Celexa.
Posted by Cecilia on February 3, 2002, at 2:44:38
In reply to Re: Prozac one went south!, posted by OldSchool on February 2, 2002, at 18:12:13
Anyone have any info on duloxetine-when it`s coming out, side effects, how it differs from Effexor(which was pure poison for me even at half a 25 mg tablet)? Cecilia
Posted by IsoM on February 3, 2002, at 3:31:45
In reply to I disagree, posted by likewater on February 3, 2002, at 0:22:37
It may very well be that anyone taking escitalopram shows a faster response than on Celexa, but my son & I were both very surprised to find that we initially responded to Celexa in just under a week, though it took longer for full benefits to be felt. I've never responded to any ADs in such a short time frame. Most took around 3 weeks before I noticed anything.
I can't see why escitalopram would be quicker unless side-effects felt 'muffled' the initial response for many.
Posted by Ritch on February 3, 2002, at 10:29:48
In reply to Re: Duloxetine, posted by Cecilia on February 3, 2002, at 2:44:38
> Anyone have any info on duloxetine-when it`s coming out, side effects, how it differs from Effexor(which was pure poison for me even at half a 25 mg tablet)? Cecilia
Hi Cecilia,From what I found it appears that it will be sometime this year. Here are a couple of links, one discusses duloxetine, and I have thrown in another one for atomoxetine for ADHD, for anybody else who is interested. Interesting that these two are both being marketed by Lilly. Fluoxetine appears to have some interesting chemical cousins...
Mitch
http://www.additudemag.com/medical.asp?DEPT_NO=505&SUB_NO=9
http://www.mhsource.com/pt/mhe18-hourglass.html
Posted by Geezer on February 3, 2002, at 11:29:57
In reply to Re: Duloxetine Atomoxetine » Cecilia, posted by Ritch on February 3, 2002, at 10:29:48
> > Anyone have any info on duloxetine-when it`s coming out, side effects, how it differs from Effexor(which was pure poison for me even at half a 25 mg tablet)? Cecilia
>
>
> Hi Cecilia,
>
> From what I found it appears that it will be sometime this year. Here are a couple of links, one discusses duloxetine, and I have thrown in another one for atomoxetine for ADHD, for anybody else who is interested. Interesting that these two are both being marketed by Lilly. Fluoxetine appears to have some interesting chemical cousins...
>
> Mitch
>
> http://www.additudemag.com/medical.asp?DEPT_NO=505&SUB_NO=9
> http://www.mhsource.com/pt/mhe18-hourglass.htmlHi Cecilia,
For what its worth, I contacted Lilly by phone RE: Duloxetine. Customer service informs me they expect release late 2002. You still have to factor in the strong possibility the FDA will screw-up the whole business so there could be further delays. Seems like you had a typical response to "Side-Effexor".
Mitch - thanks for the article, it helps.
Geezer
Posted by Mr. Scott on February 3, 2002, at 12:43:59
In reply to I disagree, posted by likewater on February 3, 2002, at 0:22:37
My understanding is that these are currently in Phase II and III for ADHD.
Posted by Mr. Scott on February 3, 2002, at 12:47:28
In reply to I disagree, posted by likewater on February 3, 2002, at 0:22:37
My logic here is flawed, but if Lilly can produce a longer acting Effexor that has tolerability improvements over Effexor, that would be a very good thing for A LOT OF PEOPLE...
Posted by OldSchool on February 3, 2002, at 15:00:31
In reply to Re: Prozac one went south!, posted by djmmm on February 2, 2002, at 23:52:59
"New and improved" Celexa. Meridia for depression. < yawn > < roll eyes >
When is the Selegiline MAOI patch coming out? IS the MAOI patch going to be FDA approved? Now THERE is a real antidepressant!!
Old School
Posted by spike4848 on February 3, 2002, at 15:12:49
In reply to Re: New Celexa...BORING!, posted by OldSchool on February 3, 2002, at 15:00:31
> "New and improved" Celexa. Meridia for depression. < yawn > < roll eyes >
> Old School
I have to agree with Old School. I am not to excited about the new Celexa.
Alot of this is marketing by the drug companies .... businesses must alway have a product in the pipeline to stay afloat. Like the Nexium scam ....
Spike
Posted by djmmm on February 3, 2002, at 22:38:35
In reply to Meridia, Atomoxetine, posted by Mr. Scott on February 3, 2002, at 12:43:59
> My understanding is that these are currently in Phase II and III for ADHD.
Meridias r-isomer is in phase 2 for depression and ADHD
Posted by djmmm on February 3, 2002, at 23:43:33
In reply to Re: New Celexa...BORING!, posted by OldSchool on February 3, 2002, at 15:00:31
> "New and improved" Celexa. Meridia for depression. < yawn > < roll eyes >
>
> When is the Selegiline MAOI patch coming out? IS the MAOI patch going to be FDA approved? Now THERE is a real antidepressant!!
>
> Old SchoolMerida sounds interesting to me because the R-isomer has two metabolites r-desmethylsibutramine and r-didesmethylsibutramine which are both potent norepinephrine and dopamine reuptake inhibitors (stimulant qualities).
Posted by Denise528 on February 4, 2002, at 9:02:36
In reply to Re: New Celexa...BORING!, posted by djmmm on February 3, 2002, at 23:43:33
> > Hi,
This Selegiline MAOI patch sounds really good on going by the previous posts. Can somebody explain why?
Thx....Denise
>
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Dr. Bob is Robert Hsiung, MD,
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