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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1170 to 1194 of 8406. Go back in thread:
Posted by mills on November 7, 2002, at 11:08:27
In reply to Re: Thoughts and feelings, posted by emmalie on November 7, 2002, at 11:02:37
This is a fascinating topic, and I am glad to see I have so many outspoken allies on this subject. For years (and I mean YEARS), I struggled with the idea of trying to 'change my feelings' through changing my thoughts, and it wearied me and exhausted me; now I focus on processing feelings. For the record, I too am a "highly sensitive" person.
> Ann--
> Yes, I've read the book. I also like The Highly Sensitive Person In Love. It talks about the challenges of being a "sensitive" person in intimate relationships (this is actually what I do my research on--I'm in a PH.D. program for psychology).
>
> If anyone out there has been able to change their feelings by thinking about things differently, I'd love to hear your stories.
>
>
Posted by Alan on November 7, 2002, at 14:01:53
In reply to Re: Lexapro 'failed' trial?/bottom » dr. dave, posted by pharmrep on November 7, 2002, at 10:58:27
> > > > I too get a bit tired of the ad nauseum claims of Lex's lower incidence of SE 's and efficiacy over Celexa.
> > > >
> > > > We hear a lot about how 'the published studies' demonstrate both things clearly, even thou the data is contradictory at best.
> > > >
> > > > Know what I would like to see? The UNPUBLISHED studies that would have had to have been submitted to the FDA for the approval of Lexapro. They can be obtained thru the Freedom of Information Act for those brave enough to do so. I would NOT be surprised to see several studies that show NO greater effect than either placebo or Celexa for that matter.
> > > >
> > > > All we have so far are the studies done by paid Forrest consulants, which may not be all that objective.
> > > >
> > > > Perhaps I will take the time to learn how to submit a FOIA request for the unpublished studies submitted to FDA. I bet there are some real gems in there.
> > > >
> > > > Like Dr. Dave, I have yet to hear a remotely plausible explaination for the claims of less SE's with Lexapro.
> > > >
> > > >
> > > >
> > > ============================================
> > > Until the FDA has better oversight of the test results, the pharm. co.'s are allowed to cherry pick test results and throw out the undesired test results after having changed the test criteria until they get the result that they want - which the FDA never sees before adjudicating the drug's acceptance. Fox guarding the chicken coop.
> > >
> > > Alan
> > >
> >
> > ==================================================
> >
> > Maybe Pharmrep could help us out with this.
> >
> > To my knowledge, there have been four efficacy studies on escitalopram, two in the US and two in Europe and Canada.
> >
> > Both US studies compared Lexapro with Celexa. Study MD-02 has not been presented, but we know it was a 'failed' study in the sense that it showed no statistically significant difference between Lexapro, Celexa and placebo (see Cipralex product monograph at www.cipralex.com, page 22.)
> >
> > The other study (MD-01, published by Burke et al) showed no statistically significant difference between Celexa and Lexapro on the measure they had previously defined as the primary outcome measure.
> >
> > One of the European studies compared Lexapro with Celexa (study 99003, described in papers by Lepola et al, Montgomery et al and Reines et al. Note that these are not seperate trials but the same trial reported several times.) Again this showed no statistically significant difference between Lexapro and Celexa on the previously defined main outcome measure.
> >
> > If there have been other trials comparing the efficacy of Celexa and Lexapro I'm sure we'd all like to know about them.
>
> *** no failed trials...all are on the table...and all of the studies are LOCF (last observation carried forward)
======================================
And how is this distinguishable from the actual practice of the continual changing of critetia to finally get the desired results? LOCF? Last observation OR is it last *entire* test result carried forward including prior "side effects"? What happens to the old test results including side effects? Are they published? Or are they kept confidential?Most importantly, if they are internal documents, are the internal documents available to the FDA or other oversight for consideration of their methodology before the approval takes place?
Or does it take a court order as in Dr. Healy's case to view, at the last minute in a court case, to view evidence that Paxil representatives and lawyers covered up as to whether Paxil was addictive or not? (Which they still deny).
Just wondering if Forest is provably different from other companies about how they do tests in this regard?
Alan
Posted by dr dave on November 7, 2002, at 15:07:30
In reply to Re: Lexapro 'failed' trial?/bottom » dr. dave, posted by pharmrep on November 7, 2002, at 10:58:27
> > > > I too get a bit tired of the ad nauseum claims of Lex's lower incidence of SE 's and efficiacy over Celexa.
> > > >
> > > > We hear a lot about how 'the published studies' demonstrate both things clearly, even thou the data is contradictory at best.
> > > >
> > > > Know what I would like to see? The UNPUBLISHED studies that would have had to have been submitted to the FDA for the approval of Lexapro. They can be obtained thru the Freedom of Information Act for those brave enough to do so. I would NOT be surprised to see several studies that show NO greater effect than either placebo or Celexa for that matter.
> > > >
> > > > All we have so far are the studies done by paid Forrest consulants, which may not be all that objective.
> > > >
> > > > Perhaps I will take the time to learn how to submit a FOIA request for the unpublished studies submitted to FDA. I bet there are some real gems in there.
> > > >
> > > > Like Dr. Dave, I have yet to hear a remotely plausible explaination for the claims of less SE's with Lexapro.
> > > >
> > > >
> > > >
> > > ============================================
> > > Until the FDA has better oversight of the test results, the pharm. co.'s are allowed to cherry pick test results and throw out the undesired test results after having changed the test criteria until they get the result that they want - which the FDA never sees before adjudicating the drug's acceptance. Fox guarding the chicken coop.
> > >
> > > Alan
> > >
> >
> > ==================================================
> >
> > Maybe Pharmrep could help us out with this.
> >
> > To my knowledge, there have been four efficacy studies on escitalopram, two in the US and two in Europe and Canada.
> >
> > Both US studies compared Lexapro with Celexa. Study MD-02 has not been presented, but we know it was a 'failed' study in the sense that it showed no statistically significant difference between Lexapro, Celexa and placebo (see Cipralex product monograph at www.cipralex.com, page 22.)
> >
> > The other study (MD-01, published by Burke et al) showed no statistically significant difference between Celexa and Lexapro on the measure they had previously defined as the primary outcome measure.
> >
> > One of the European studies compared Lexapro with Celexa (study 99003, described in papers by Lepola et al, Montgomery et al and Reines et al. Note that these are not seperate trials but the same trial reported several times.) Again this showed no statistically significant difference between Lexapro and Celexa on the previously defined main outcome measure.
> >
> > If there have been other trials comparing the efficacy of Celexa and Lexapro I'm sure we'd all like to know about them.
>
> *** no failed trials...all are on the table...and all of the studies are LOCF (last observation carried forward)==================================================
OK.... so what were the results of study MD-02? I only describe it as a 'failed trial' because that's how Lundbeck describe it in the product monograph. Are you saying that they are wrong? And if so, we need to see the results. If they are all on the table.
I'm glad you brought up LOCF, because as you know on LOCF analysis no trial has shown greater efficacy for Lexapro over Celexa at end-point. Again, if you disagree, let us all know which study contradicts this and we can all look at the results.
Posted by wharfrat on November 7, 2002, at 16:40:40
In reply to Re: 5 weeks lexapro, posted by ANXIETY ANN on November 6, 2002, at 9:22:12
> > > > > > 5 weeks now on lex, increased sex drive, very very weird dreams, less headaches, have dizzy feeling in the morning which is relieved by 2 ibuprofen (can't figure that one out), seems to wear off around 7pm, start feeling slight anxiety. Eating like crazy..crave carbs/sweets, gained 4 lbs in 5 weeks. See doc on monday, will evaluate then.
> > > > >
> > > > > I have been on lexapro 2 months. My sex drive is good but no orgasms..My appetite is better and I do crave sweets more but I dont find myself eating 24/7 like I did with other antidpressants. I felt dizzy and zoned out only the first few days..Iam not noticing any real bad side effects and I feel great. Mari
> > > >
> > > > I know what Ya'll mean about the sweets. Reese's stocks should be going up. Plowed thru my kid's halloween candy after he went to bed (I ought to be ashamed! NOT!!)Never been a big guy, around 140 LBs. forever. Gained 5 in 5 weeks. Never really cared for candy before either. Sex drive of an 18 year old, but it's always been that way. Got to really relax to "complete the mission" wink, wink. Otherwise feeling great. Headaches went away after about a week. Did I say I'm feeling really great? This reality has woken me up to the fact that my job really sucks!! But I could care less - Wharf
> > >
> > > Wharf...lol..you crack me up...I could relate to the halloween candy story..soon as my kids hit the door Im telling them "mommy has to check that candy before I eat...I mean you eat it." Im allot happier to on lexapro but as you said..sex drive is there but mission not complete!...Its funny how easier it is too see things now too. Im easily amused anyway but to feel really happy again is wonderful..have a great day....Mari :-)
> > >
> > >That's great for you guys, good to hear that some folks still have sex drive! I'm usually quite (blush), in the mood. But I might as well enter the convent now. I do agree about the eating and the halloween candy (blush, again). Must have put on 5 pounds in the last 3 weeks....Kat :-\
> >
> >
> LoL, Its good to see humor again!(something I did'nt always do before Lex)I too feel dizzy in the mornings and evenings, it does seem as though the Lexapro wears off towards the evening. I went to the doc yesterday and he said that it takes some peoples systems longer to get adjusted than others. He also said that I could take 5mg of lex in the am and 5mg in the pm if I thought it was wearing off. I do feel better mentally though. I too crave sweets but have actually lost weight since taking the lex.(If I keep eating that chocolate, Im sure that will change) The lack of orgasms is still an issue but am hoping for one soon! Its good to be able to hear other peoples stories and know that there are others as kooky as me out there! thanks Ann
>Who are you calling a Kook???
Just kiddin' - Wharf
Posted by cannoli on November 7, 2002, at 17:49:10
In reply to HELP!!! drink with lexapro?, posted by THOV on November 6, 2002, at 11:50:42
> second question....
> do women face sex s/e .......or is it just men as far as ejaculation....?
> why why why
I can't help with the question about drinking, but I can answer about sexual side effects. Women (at least some women) DEFINITELY have sexual problems with SSRIs - mainly difficulty reaching orgasm and decrease in sex drive.
Posted by cannoli on November 7, 2002, at 17:57:53
In reply to Re: dr dave can you answer? » THOV, posted by dr. dave on November 7, 2002, at 3:58:57
> There is an incidence of anorgasmia (inability to achieve orgasm) of about 2% in women taking Lexapro according to the recent trials, compared to less than 1% with placebo. A low incidence, but there is some risk.
These numbers are hard to believe, but then all of the reported percentages for sexual side effects seem absurdly low to me. But maybe I'm wrong. Let's ask: Is there anyone out there who has taken SSRIs for an extended period of time (2 years or more) who has NOT experienced loss of sex drive and/or difficulty with orgasm or ejaculation?
Posted by Anyuser on November 7, 2002, at 18:53:02
In reply to Re: Lexapro 'failed' trial? » pharmrep, posted by Alan on November 7, 2002, at 14:01:53
How would you improve the FDA regulatory process, and what would be the practical consequence to patients of such improvement?
Posted by JLM on November 7, 2002, at 20:27:22
In reply to Re: Lexapro 'failed' trial?/bottom » dr. dave, posted by pharmrep on November 7, 2002, at 10:58:27
> > > > I too get a bit tired of the ad nauseum claims of Lex's lower incidence of SE 's and efficiacy over Celexa.
> > > >
> > > > We hear a lot about how 'the published studies' demonstrate both things clearly, even thou the data is contradictory at best.
> > > >
> > > > Know what I would like to see? The UNPUBLISHED studies that would have had to have been submitted to the FDA for the approval of Lexapro. They can be obtained thru the Freedom of Information Act for those brave enough to do so. I would NOT be surprised to see several studies that show NO greater effect than either placebo or Celexa for that matter.
> > > >
> > > > All we have so far are the studies done by paid Forrest consulants, which may not be all that objective.
> > > >
> > > > Perhaps I will take the time to learn how to submit a FOIA request for the unpublished studies submitted to FDA. I bet there are some real gems in there.
> > > >
> > > > Like Dr. Dave, I have yet to hear a remotely plausible explaination for the claims of less SE's with Lexapro.
> > > >
> > > >
> > > >
> > > ============================================
> > > Until the FDA has better oversight of the test results, the pharm. co.'s are allowed to cherry pick test results and throw out the undesired test results after having changed the test criteria until they get the result that they want - which the FDA never sees before adjudicating the drug's acceptance. Fox guarding the chicken coop.
> > >
> > > Alan
> > >
> >
> > ==================================================
> >
> > Maybe Pharmrep could help us out with this.
> >
> > To my knowledge, there have been four efficacy studies on escitalopram, two in the US and two in Europe and Canada.
> >
> > Both US studies compared Lexapro with Celexa. Study MD-02 has not been presented, but we know it was a 'failed' study in the sense that it showed no statistically significant difference between Lexapro, Celexa and placebo (see Cipralex product monograph at www.cipralex.com, page 22.)
> >
> > The other study (MD-01, published by Burke et al) showed no statistically significant difference between Celexa and Lexapro on the measure they had previously defined as the primary outcome measure.
> >
> > One of the European studies compared Lexapro with Celexa (study 99003, described in papers by Lepola et al, Montgomery et al and Reines et al. Note that these are not seperate trials but the same trial reported several times.) Again this showed no statistically significant difference between Lexapro and Celexa on the previously defined main outcome measure.
> >
> > If there have been other trials comparing the efficacy of Celexa and Lexapro I'm sure we'd all like to know about them.
>
> *** no failed trials...all are on the table...and all of the studies are LOCF (last observation carried forward)Pharmrep,
Just to be clear here: you are saying that ALL the trials sent to FDA as a part of the NDA process have been published in the public domain? In other words, there is no trial data sitting at FDA that the public hasn't seen, or has NOT been published in the medical literature.
Frankly, I find this hard to believe but...
Posted by Dr. Bob on November 7, 2002, at 22:27:15
In reply to Re: Thoughts and feelings, posted by emmalie on November 7, 2002, at 11:02:37
> I also like The Highly Sensitive Person In Love.
I'd just like to plug the new double double quotes feature:
http://www.dr-bob.org/babble/faq.html#amazon
But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at PBA:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks,
Bob
Posted by Alan on November 8, 2002, at 9:27:12
In reply to FDA » Alan, posted by Anyuser on November 7, 2002, at 18:53:02
> How would you improve the FDA regulatory process, and what would be the practical consequence to patients of such improvement?
===============================================
Take oversight of clinical trials away from the FDA and give it to the NIH. That is, accept as evidence only trials designed and supervised by the NIH.Failing that, ban cross-employment between the FDA and any company that it regulates for 10 or 15 years in either direction. Right now, there is a revolving door between the fox's house and the henhouse. It's bad enough that regulators are hired directly from the regulated companies. It's even worse that the FDA's "internal advocate" for a drug can and often does leave the FDA after approval of the drug to earn hundreds of thousands of dollars a year working for the maker of the drug.
Actually, we probably need both of the steps above.
And of course we need a law placing all directly or indirectly maker-funded research about a drug into the public domain when that drug receives FDA approval.
I also believe the "control groups" in the research should be better defined.
Alan
Posted by Anyuser on November 8, 2002, at 9:46:08
In reply to Re: FDA » Anyuser, posted by Alan on November 8, 2002, at 9:27:12
More drugs approved? Fewer drugs approved? Should Lexapro, for instance, have been approved?
Posted by Alan on November 8, 2002, at 13:33:06
In reply to What would the result be? » Alan, posted by Anyuser on November 8, 2002, at 9:46:08
> More drugs approved? Fewer drugs approved? Should Lexapro, for instance, have been approved?
============================================The result would be medications that have the proper kind and amount of oversight in a way that there would be, by comparison, no conflict of interest.
I think that it speaks for itself that the quality of drugs would increase substantially.
Lexapro research? Suffers from the same conflicts of interest as with any other newly introduced medication as of now...
Alan
Posted by Anyuser on November 8, 2002, at 14:10:37
In reply to Re: What would the result be? » Anyuser, posted by Alan on November 8, 2002, at 13:33:06
Posted by Alan on November 8, 2002, at 14:28:21
In reply to In other words, fewer drugs, less choice (nm) » Alan, posted by Anyuser on November 8, 2002, at 14:10:37
From the results of the current system of oversight one would have no problem whatsoever asserting that quantity does not equal quality...especially if one takes into consideration that doing the most amount of good for the most amount of people is paramount.
From what I see and read in credible media, bboards like these, and the research that is out there, much of the drugs and drug marketing is set up in such a cookie cutter, commercially driven fashion that there's any wonder the most and severe complaints are seen with the very drugs (modern AD's) that are a product of the present system. (see link in next post).
But if secrecy and quantitiy is what one's after instead of full disclosure and the least amount of harm being done to the least amount of patients, one can always stick with the present system.
The politics of medicine has shifted more to the "free market will solve everything" model at the patient's expense.
Alan
Posted by Alan on November 8, 2002, at 14:31:19
In reply to In other words, fewer drugs, less choice (nm) » Alan, posted by Anyuser on November 8, 2002, at 14:10:37
http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html
Special attention given to the World Health Organisation's two paragraph's worth about the newer AD's.
Alan
Posted by johnj on November 8, 2002, at 15:35:21
In reply to Re: In other words, fewer drugs, less choice » Anyuser, posted by Alan on November 8, 2002, at 14:31:19
"One of the main selling points of the SSRIs when they arrived in the early 1990s was that people did not become physically dependent on them as they had on older antidepressants - the benzodiazepines such as Valium and Librium."
Posted by dr. justin on November 8, 2002, at 17:01:49
In reply to Re: dr dave can you answer?, posted by wharfrat on November 7, 2002, at 9:27:00
wharf,
Totally off subject, but I had to thank you for the first good laugh I've had in a while. My best friend in college (Northern Arizona U.) was a Texan, and he had all sorts of sayings, including the classic, "I'm a Texan and it's my duty to drink." I can't count the times we were cut off at the bar and he'd loudly pronounce that one. Most of us here go too long without simply joys like a good laugh, plus your post forced some great memories to the surface. Thanks...
justin
Posted by Alan on November 8, 2002, at 18:13:07
In reply to In other words, fewer drugs, less choice (nm) » Alan, posted by Anyuser on November 8, 2002, at 14:10:37
PS. Such a question would imply that our choice consists of less effective drugs being dressed up to look better than they actually are!
Would anyone really do that? Surely not for trivial incentives like profit...
Posted by Anyuser on November 8, 2002, at 18:53:38
In reply to Re: In other words, fewer drugs, less choice » Anyuser, posted by Alan on November 8, 2002, at 18:13:07
I suppose it's just an eensy bit more complicated than that. I would be in favor of both the increased disclosure of information that you advocate, and also less FDA restriction. I would be opposed to making the perfect the enemy of the good. That is, approving only perfect drugs (there is no such thing). The possibility that a drug company might make a profit doesn't trouble me in the least. In fact, I'm looking for a good investment. Any recommendations?
Posted by Geezer on November 8, 2002, at 21:49:04
In reply to Re: In other words, fewer drugs, less choice, posted by Anyuser on November 8, 2002, at 18:53:38
Anyuser,
How very well said!! A little additional "freedom & incentive" to develope something more than another split isomer SSRI would be most welcome by those of us with TRD, as well.
I have completed my eighth ECT treatment as of this morning and will begin taking Parnate tomorrow morning. I don't look to the FDA to facilitate any drug benefits on my behalf regardless of maker, motive, or disclosure.
Thanks for the post,
Geezer
Posted by Alan on November 8, 2002, at 23:32:55
In reply to Re: In other words, fewer drugs, less choice, posted by Anyuser on November 8, 2002, at 18:53:38
> I suppose it's just an eensy bit more complicated than that. I would be in favor of both the increased disclosure of information that you advocate, and also less FDA restriction.
How is less FDA oversight going to improve the quality of testing that has been found to be inadequate? There are too many conflicts of interest as I mentioned before. NIH would be much more qualified and dispassionate to provide improved (not perfect) oversight.
>I would be opposed to making the perfect the enemy of the good. That is, approving only perfect drugs (there is no such thing).
Surely this is an exaggeration. Who said anything about perfect drugs?....only a process by which the testing is done with the betterment of *true* results being the motivating factor, not profits.
>The possibility that a drug company might make a profit doesn't trouble me in the least. In fact, I'm looking for a good investment. Any recommendations?
The most profitiable business on the planet today needs to make more profit? See paragraph directly above. Quantitiy does not equate with improvement in quality. The outcome of the "shotgun" effect is intrinsicically not for the betterment of the patient.
Posted by Alan on November 8, 2002, at 23:39:58
In reply to Re: In other words, fewer drugs, less choice » Anyuser, posted by Geezer on November 8, 2002, at 21:49:04
> Anyuser,
>
> How very well said!! A little additional "freedom & incentive" to develope something more than another split isomer SSRI would be most welcome by those of us with TRD, as well.A rather limited example to assert your point. The explosion of AD's in the last 10 years has been facilitated by the very process that has given us medications by the World Health Organisation's standards as being the top medications for patient's complaints, far ahead of anything else. If it isn't broke, don't fix it is what i hear being said?
>
> I have completed my eighth ECT treatment as of this morning and will begin taking Parnate tomorrow morning. I don't look to the FDA to facilitate any drug benefits on my behalf regardless of maker, motive, or disclosure.
>
> Thanks for the post,
>
> GeezerWho do and have you looked to may I ask then?
Alan
Posted by Dr. Bob on November 9, 2002, at 1:25:01
In reply to Re: In other words, fewer drugs, less choice » Anyuser, posted by Alan on November 8, 2002, at 23:32:55
> How is less FDA oversight going to improve the quality of testing that has been found to be inadequate?
I'd like discussion of FDA policies, etc., to be redirected to Psycho-Social-Babble. Thanks,
Bob
PS: And follow-ups regarding posting policies to be redirected to Psycho-Babble Administration.
Posted by charly on November 10, 2002, at 8:07:21
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
Hi,
I've been on 10mgs of Lexapro for over 3 weeks and am still getting daily headaches. From others experiences, how long before they go away?
My depression has gone away, which is great, but headaches aren't fun.
Thanks,
charly
Posted by wharfrat on November 10, 2002, at 10:55:13
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
Thanks Dr. Bob, I kind of would like people to get back on the subject "Anyone switched to Lexapro" and take their FDA complaints elsewhere.No offense to anyone, I'm just tired of conspiracy theories that's all. I for one am more interested in how this med is working for people, be it good or bad and how everybody is doing.
So, my question to anybody out there is this.
Has anyone been "newly" diagnosed and been put on lexapro without ever having been on an antidepressant before and how is it working for them?
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Dr. Bob is Robert Hsiung, MD,
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