Modern meds 2019

[bigmo]

I came off citralopram about 6 months ago having been on them for about 7 to 10 years. If I was to need anti depressants / anxiety treatment again, what would the doctor likely give me? Have there been any advancements in medications over that time or would it be the same meds?

[keta]

My GP is so bad they didn’t even look at my history from past 2 years ago. When I mentioned I was on Citalopram before, that’s exactly what he prescribed me.
in a way I m glad as I know with what I m dealing here ie. side effects.
I m not sure if there is anything better available these days , I think it also depends how people react to different meds.
Lets hope you won’t need to go back on meds.

[bigmo]

I recall when first going on citralopram feeling really ill with the side effects and reading some great posts on here which helped me get day to day. With medical advances I thought things may have moved on but not by the sounds of it. I've recently had a blip (health anxiety) but today I felt better than yesterday so hopefully I'm heading back to being well again without meds. I downloaded about 20 apps on my phone, plenty to choose from these days and even paid about £170 for 'the linden method' whilst in panic (what a devasting waste of money.) Apps are great and loads of free ones. I've found a free app which has helped me massively using the Dare method. With mental health issues increasing in China and the USA I thought they'd be more medicine help available.

[HalfJack]

They are making some progress recently in regards to new medications but they won't be available for a long time in all likelihood.
I've got a few friends who have found CBD oil helpful but I've never tried it myself and am not really familiar with its benefits.

[panic_down_under]

I came off citralopram about 6 months ago having been on them for about 7 to 10 years. If I was to need anti depressants / anxiety treatment again, what would the doctor likely give me?

Probably citalopram again, or escitalopram which has the same active drug.


Have there been any advancements in medications over that time or would it be the same meds?

There have been a few new ADs released in the last decade, but none have proved to be superior to the older meds and are not prescribed that often.


Have there been any advancements in medications over that time

Most of the major drug companies stopped developing new ADs about a 10-15 years ago, partly because some took a big hit financially when drugs under development failed at the final human drug trials hurdle, and because of litigation in the U.S. resulting in huge payouts for a while.

[lebonvin]

Hey Ian Panic

What yous take on these new ADs being tested rite now using fetanyl? Is there ketamine one too?

[panic_down_under]

What yous take on these new ADs being tested rite now using fetanyl?

There are fentanyl based ADs under development? Do you have any links?


Is there ketamine one too?

That's a wait and see. When it works ketamine seems to produce a rapid anti depressive response, but I think there is a long way to go as a viable alternative to current ADs and will be mostly be used for severe treatment resistant depression in an in-clinic/hospital setting which significantly increases the cost (the nasal-spray version seems to be very hit and miss, mostly miss, in its effectiveness). At this stage I see it more as an alternative to ECT than to ADs.

[lebonvin]

Hey Ian

I don't got links but some lady on another forum I was perusing a few month back said she was on clinical trial in UK sorry can't remember more than that

[AntsyVee]

Wow...I would think the fentanyl would be one powerful punch...even a tiny bit can be toxic to those who use opioids. Also, don’t ADs lower the stuff the body needs to process opioids?

[lebonvin]

2year back I was put on this real new AD it was a SSRI and something else at same time took 6 week it did pig shit all I remember is made in Denmark

[panic_down_under]

2year back I was put on this real new AD it was a SSRI and something else at same time took 6 week it did pig shit all I remember is made in Denmark

Probably vortioxetine (Trintellix, originally Brintellix) developed by Lundbeck. It seems to be okay for depression, but hit and miss for anxiety. Plus 6 weeks isn't really long enough to draw any conclusions.

[lebonvin]

Es corretto. I wasn't improving so trashed it

[bigmo]

Crazy when you Consider the amount of lost 'work days' to economies around the world that it isn't a massive priority.

[Try 2relax]

I was on mood stabilizers well they used to be anti psycho tics but they helped me and put me on the Right path

[panic_down_under]

Crazy when you Consider the amount of lost 'work days' to economies around the world that it isn't a massive priority.

The big pharmaceutical companies walked away from psyche drugs more than a decade ago, a combination of questionable expensive law suites and even more expensive drug trial failures of what had promised to be more effective drugs with fewer side-effects, Merck's MK-869 being the most spectacular demise (although it was later found to be a fairly good anti nausea med (aprepitant (Emend)) which has helped recoup some of the money).

There hasn't really been anything new this century. Newish ADs such as agomelatine (Melitor), levomilnacipran (Fetzima), vilazodone (Viibryd) and vortioxetine (Trintellix) have not been that successful and the latter three are simply variations on the SSRI/SNRI theme. A number of novel AD candidates have been spruiked as the next new thing for quite a while, but the promise seems to be taking a long time to materialise.

The older ADs, the MAOIs and TCAs developed back in the 1950s are still arguably the most effective anxiety and depression meds. The only real advantage SSRIs and SNRIs have is being safer in overdose, and even that isn't true of all of them. There popularity mostly rests on past marketing and doctor ignorance with many having little experience of the older meds.

[bigmo]

I've been reading about srni's which seem to be newer than ssris.. Any improvement, I'm guessing not otherwise we'd all be in them?

[panic_down_under]

I've been reading about srni's which seem to be newer than ssris.. Any improvement, I'm guessing not otherwise we'd all be in them?

Venlafaxine (Effexor), duloxetine (Cymbalta) and milnacipran (Savella) have been around nearly as long as the SSRIs, with desvenlafaxine (Pristiq), which is the active metabolite of venlafaxine, a little more recent and the most recent is levomilnacipran (Fetzima), which is the active isomer of milnacipran (the same patent extending tactic first applied with citalopram and escitalopram). Levomilnacipran is still in patent so may be more expensive than the others in some countries.

Venlafaxine is really only a SSRI having only a modest affect on noradrenaline (NA), aka norepinephrine, reuptake even at the maximum dose. Desvenlafaxine is more potent than its parent in NA inhibition, but not by much. The SSRIs fluoxetine (Prozac), sertraline (Zoloft) and especially paroxetine (Paxil) are all more potent NA reuptake inhibitors, albeit still only weak ones, than either venlafaxine versions.

All SNRIs suffer from having short half-lives which can increase initial side-effects severity, duloxetine seems to be the worst in that regard, and can make stopping them hard too, especially venlafaxine which vies with paroxetine for withdrawal symptom severity.

Imho, the serotonin+NA reuptake inhibiting TCA class meds are the better option, but if they are off the table for some reason then I think milnacipran and levomilnacipran are the pick of the bunch if available. Milnacipran inhibits serotonin and NA almost equally, whereas levomilnacipran is a more potent NA than serotonin inhibitor.

[pulisa]

But at the end of the day it's all guesswork and similar to prescribing a broad spectrum antibiotic to cover all bases.

[Benjammin69]

But at the end of the day it's all guesswork and similar to prescribing a broad spectrum antibiotic to cover all bases.

Recently I’ve become very intrigued with Russian nootropics especially selank and also stresam.

I can personally vouch for stresam as I gave it a trial for 30 days - got rid of anxiety, only side effects was a headache for 4 first days and no withdrawals. These meds are not controlled here in the UK as they are classed as nootropics but in some countries they are strong enough to be prescription only - stresam comes from France and is a prescription anxiolytic.

Just make sure you don’t start ordering Russian novel benzos like tofisopam or phenazepam as these have different legal statuses and is a slippery slope

[pulisa]

Recently I’ve become very intrigued with Russian nootropics especially selank and also stresam.

I can personally vouch for stresam as I gave it a trial for 30 days - got rid of anxiety, only side effects was a headache for 4 first days and no withdrawals. These meds are not controlled here in the UK as they are classed as nootropics but in some countries they are strong enough to be prescription only - stresam comes from France and is a prescription anxiolytic.

Just make sure you don’t start ordering Russian novel benzos like tofisopam or phenazepam as these have different legal statuses and is a slippery slope

I'd be very wary of any drug which came from Russia!:)

[bigmo]

Interesting. I have wondered what anxiety/depression levels are like in other counyries like China / Russia and the treatments available there to see if they have better success rates or not.

[panic_down_under]

Interesting. I have wondered what anxiety/depression levels are like in other counyries like China / Russia and the treatments available there to see if they have better success rates or not.

Anxiety and depression rates are probably about the same everywhere. Some countries claim lower rates, but this probably has more than to do with stigma, than actual differences in prevalence. For example, Japan claims to have far lower psych disorder rates, but the high prevalence of Hikikomori (https://www.tofugu.com/japan/taijin-kyofusho/), aka taijin-kyofusho, a cultural form of social anxiety with agoraphobia, and suicide suggest the figures are rubbery. Similarly, Russia claims more moderate rates of depression than most western countries, yet is number one in suicidality and ranks fourth in alcohol consumption.

[bigmo]

Just wonder since I last replied to this threat if there has been any major changes in modern medicines to help with anxiety/depression?

[panic_down_under]

No, and there isn't anything in the pipeline afaik. It takes about a decade to get new meds approved and anxiety and depression are well down the list of disorders attracting research and development funding. Antidepressants, some dating back to the 1950s, are effective, as are the cognitive, behavioural (CBT, REBT, etc) or mindfulness therapies.

[newb1234]

Late coming to this but what an interesting thread. I’ve been really intrigued by the newer postpartum depression medication. First it was just avail via IV but now there is an oral version. Zuranolone was approved by the FDA last year.

Brexanolone was approved first and is administered via IV.

[panic_down_under]

Zuranolone may be effective for postpartum depression but it's too early to assess its effectiveness for clinical depression, or anxiety. My guess is it won't become a long-term treatment, but because, at least for postpartum depression, it begins working within a couple of weeks may be co administrated with another AD to provide a quicker response. It targets the GABA-A receptors which may limit its usefulness due to dependency concerns. This is the same receptors activated by benzodiazepines and the 'Z' class insomnia meds.

[newb1234]

Yeah, it’s super interesting that there’s an option that works quickly. From what I’ve heard so far the effects of treatment seem to last as well. Time will tell as it’s been studied and been around longer, but cool to see something like that. I imagine when you have PPD you are already tired and feeling terrible anyway so waiting 6 weeks for a regular AD to help is not the best option.