TCM-Prozac / anti-cholinergic effects

[Guest guest]

This is according to Papolos and Papolos, 1997.

Yes, that was a few years ago now, though SSRI's

were already in use.

 

 

--- <alonmarcus wrote:

 

> the most anti-depressant meds with

> the most anticholinergic effects were also the

> most effective a-d meds.

> >>>>>

> That is not true. The first generation TCAs had

> the most anticholinergic effects and were not

> and not more or less effective than second

> generation TCAs or SSRIs. They tend to be more

> sedative so better for sleep problems. The only

> antidepressants that MAY be slightly more

> effective are the new atypical.

>

>

>

>

> Oakland, CA 94609

>

>

> -

> J. Lynn Detamore

> To:

> Chinese Medicine

> Saturday, November 26, 2005 7:11 PM

> Re: Prozac

>

>

> ...refine 5 e pattern

> this can be largely ST offending Water yin

> Dr. Holmes Keikobad...

>

> In fact, Holmes, I recall reading that

> historically, the most anti-depressant meds

> with

> the most anticholinergic effects were also

> the

> most effective a-d meds. I had forgotten

> that,

> thank you for the reminder. In other words,

> if

> effective, they are going to be drying. If

> someone is on continued a-d tx, I would think

> ongoing attention acu/herbs to moisten, and

> plenty of po fluids would be a necessary tx

> focus.

>

> Lynn

>

>

>

>

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>

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[Guest guest]

This is according to Papolos and Papolos, 1997.

Yes, that was a few years ago now, though SSRI's

were already in use.

>>>>>>>

There have been many comprehensive reviews of antidepressants. One was just

published (last month) which clearly stated that none of them work better than

any other. Effexor and other newer mixed effect may be slightly more effective

but not quite statistically significant, although many clinicians will tell you

they work on patients that failed on others. They do work best for pain. In

general antidepressants are chosen based on their sideeffect profile and trial

and error.

 

 

 

 

Oakland, CA 94609

 

 

-

J. Lynn Detamore

Chinese Medicine

Saturday, November 26, 2005 10:39 PM

Re: TCM-Prozac / anti-cholinergic effects

 

 

This is according to Papolos and Papolos, 1997.

Yes, that was a few years ago now, though SSRI's

were already in use.

 

 

--- <alonmarcus wrote:

 

> the most anti-depressant meds with

> the most anticholinergic effects were also the

> most effective a-d meds.

> >>>>>

> That is not true. The first generation TCAs had

> the most anticholinergic effects and were not

> and not more or less effective than second

> generation TCAs or SSRIs. They tend to be more

> sedative so better for sleep problems. The only

> antidepressants that MAY be slightly more

> effective are the new atypical.

>

>

>

>

> Oakland, CA 94609

>

>

> -

> J. Lynn Detamore

> To:

> Chinese Medicine

> Saturday, November 26, 2005 7:11 PM

> Re: Prozac

>

>

> ...refine 5 e pattern

> this can be largely ST offending Water yin

> Dr. Holmes Keikobad...

>

> In fact, Holmes, I recall reading that

> historically, the most anti-depressant meds

> with

> the most anticholinergic effects were also

> the

> most effective a-d meds. I had forgotten

> that,

> thank you for the reminder. In other words,

> if

> effective, they are going to be drying. If

> someone is on continued a-d tx, I would think

> ongoing attention acu/herbs to moisten, and

> plenty of po fluids would be a necessary tx

> focus.

>

> Lynn

>

>

>

>

> Music Unlimited

> Access over 1 million songs. Try it free.

> http://music./unlimited/

>

>

> Download the all new TCM Forum Toolbar,

> click,

>

http://toolbar.thebizplace.com/LandingPage.aspx/CT145145

>

> To change your email delivery settings,

> click,

>

> and adjust accordingly.

>

> Messages are the property of the author. Any

> duplication outside the group requires prior

> permission from the author.

>

>

>

>

[Guest guest]

Alon,

 

Can you share with us which publication (last month) you are referring to?

 

Thanks,

 

Mike L.

 

<alonmarcus wrote:

This is according to Papolos and Papolos, 1997.

Yes, that was a few years ago now, though SSRI's

were already in use.

>>>>>>>

There have been many comprehensive reviews of antidepressants. One was just

published (last month) which clearly stated that none of them work better than

any other. Effexor and other newer mixed effect may be slightly more effective

but not quite statistically significant, although many clinicians will tell you

they work on patients that failed on others. They do work best for pain. In

general antidepressants are chosen based on their sideeffect profile and trial

and error.

 

 

 

 

Oakland, CA 94609

 

 

-

J. Lynn Detamore

Chinese Medicine

Saturday, November 26, 2005 10:39 PM

Re: TCM-Prozac / anti-cholinergic effects

 

 

This is according to Papolos and Papolos, 1997.

Yes, that was a few years ago now, though SSRI's

were already in use.

 

 

--- <alonmarcus wrote:

 

> the most anti-depressant meds with

> the most anticholinergic effects were also the

> most effective a-d meds.

> >>>>>

> That is not true. The first generation TCAs had

> the most anticholinergic effects and were not

> and not more or less effective than second

> generation TCAs or SSRIs. They tend to be more

> sedative so better for sleep problems. The only

> antidepressants that MAY be slightly more

> effective are the new atypical.

>

>

>

>

> Oakland, CA 94609

>

>

> -

> J. Lynn Detamore

> To:

> Chinese Medicine

> Saturday, November 26, 2005 7:11 PM

> Re: Prozac

>

>

> ...refine 5 e pattern

> this can be largely ST offending Water yin

> Dr. Holmes Keikobad...

>

> In fact, Holmes, I recall reading that

> historically, the most anti-depressant meds

> with

> the most anticholinergic effects were also

> the

> most effective a-d meds. I had forgotten

> that,

> thank you for the reminder. In other words,

> if

> effective, they are going to be drying. If

> someone is on continued a-d tx, I would think

> ongoing attention acu/herbs to moisten, and

> plenty of po fluids would be a necessary tx

> focus.

>

> Lynn

>

>

>

>

> Music Unlimited

> Access over 1 million songs. Try it free.

> http://music./unlimited/

>

>

> Download the all new TCM Forum Toolbar,

> click,

>

http://toolbar.thebizplace.com/LandingPage.aspx/CT145145

>

> To change your email delivery settings,

> click,

>

> and adjust accordingly.

>

> Messages are the property of the author. Any

> duplication outside the group requires prior

> permission from the author.

>

>

>

>

[Guest guest]

Mike here are a couple of studies i pulled out as they were still in my

computer. There are several more you could do a search.

 

Purpose: Depression is common in primary care. There are no systematic reviews

of depression treatment comparing antidepressants with placebo; hence, we do not

know whether these medications are effective in primary care.

Methods: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis

Group register of controlled trials, MEDLINE, International Pharmaceutical

abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed

independently by 2 authors. Studies needed to include randomized controlled

trials of either a tricyclic antidepressant (TCA) or selective serotonin

reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The

data and quality of the studies were extracted and assessed by 2 authors blind

to the other's choice. Disagreements were resolved by Discussion. The main

outcome measures were the standardized mean difference and weighted mean

difference of the final mean depression scores, the relative risk of

improvement, and the number withdrawing because of side effects. Pooling of

Results was done using Review Manager 4.2.2.

Results: There were 10 studies in which TCAs were compared with placebo, 3 in

which SSRIs were compared with placebo, and 2 with both compared with placebo.

One half of the studies were of low methodological quality, and nearly all

studies were of short duration, typically 6 to 8 weeks. Pooled estimates of

efficacy data showed a relative risk of 1.26 (95% CI, 1.12-1.42) for improvement

with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI,

1.21-1.55). Most patients, 56% to 60%, responded well to active treatment

compared with 42% to 47% for placebo. The number needed to treat for TCAs was

about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal

caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs.

Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective.

Conclusion: This systematic review is the first comparing antidepressants with

placebo for treatment of depression in primary care. Both TCAs and SSRIs are

effective. This review is also the first to show that low-dose TCAs are

effective in primary care. Prescribing antidepressants in primary care is a more

effective clinical activity than prescribing placebo.

 

Introduction

Date of Most Recent Substantive Amendment: 2005 08 23

 

Background

Depression is common in primary care and it is associated with marked

personal, social and economic morbidity, and creates significant demands on

service providers in terms of workload. Treatment is predominantly

pharmaceutical or psychological. Fluoxetine, the first of a group of

antidepressant (AD) agents known as selective serotonin reuptake inhibitors

(SSRIs), has been studied in many randomised controlled trials (RCTs) in

comparison with tricyclic (TCA), heterocyclic and related ADs, and other SSRIs.

These comparative studies provided contrasting findings. In addition, systematic

reviews of RCTs have always considered the SSRIs as a group, and evidence

applicable to this group of drugs might not be applicable to fluoxetine alone.

The present systematic review assessed the efficacy and tolerability profile of

fluoxetine in comparison with TCAs, SSRIs and newer agents.

 

Objectives

To determine the efficacy of fluoxetine, compared with other ADs, in

alleviating the acute symptoms of depression, and to review its acceptability.

 

Search strategy

Relevant studies were located by searching the Cochrane Collaboration

Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), the

Cochrane Central Register of Controlled Trials (CENTRAL), Medline (1966 - 2004)

and Embase (1974 - 2004). Non - English language articles were included.

 

Selection criteria

Only RCTs were included. For trials which have a crossover design only

results from the first randomisation period were considered.

 

Data collection and analysis

Data were independently extracted by two reviewers using a standard form.

Responders to treatment were calculated on an intention - to - treat basis: drop

- outs were always included in this analysis. When data on drop - outs were

carried forward and included in the efficacy evaluation, they were analysed

according to the primary studies; when dropouts were excluded from any

assessment in the primary studies, they were considered as treatment failures.

Scores from continuous outcomes were analysed including patients with a final

assessment or with the last observation carried forward. Tolerability data were

analysed by calculating the proportion of patients who failed to complete the

study and who experienced adverse reactions out of the total number of

randomised patients. The primary analyses used a fixed effects approach, and

presented Peto Odds Ratio (PetoOR) and Standardised Mean Difference (SMD).

 

Main results

On a dichotomous outcome fluoxetine was less effective than dothiepin

(PetoOR: 2.09, 95% CI 1.08 to 4.05), sertraline (PetoOR: 1.40, 95% CI 1.11 to

1.76), mirtazapine (PetoOR: 1.64, 95% CI 1.01 to 2.65) and venlafaxine (Peto OR:

1.40, 95% CI 1.15 to 1.70). On a continuous outcome, fluoxetine was more

effective than ABT - 200 (Standardised Mean Difference (SMD) random effects: -

1.85, 95% CI - 2.25 to - 1.45) and milnacipran (SMD random effects: - 0.38, 95%

CI - 0.71 to - 0.06); conversely, it was less effective than venlafaxine (SMD

random effect: 0.11, 95% CI 0.00 to 0.23), however these figures were of

borderline statistical significance. Fluoxetine was better tolerated than TCAs

considered as a group (PetoOR: 0.78, 95% CI 0.68 to 0.89), and was better

tolerated in comparison with individual ADs, in particular than amitriptyline

(PetoOR: 0.64, 95% CI 0.47 to 0.85) and imipramine (PetoOR: 0.79, 95% CI 0.63 to

0.99), and among newer ADs than ABT - 200 (PetoOR: 0.21, 95% CI 0.10 to 0.41),

pramipexole (PetoOR: 0.20, 95% CI 0.08 to 0.47) and reboxetine (PetoOR: 0.61,

95% CI 0.40 to 0.94).

 

Authors' conclusions

There are statistically significant differences in terms of efficacy and

tolerability between fluoxetine and certain ADs, but the clinical meaning of

these differences is uncertain, and no definitive implications for clinical

practice can be drawn. From a clinical point of view the analysis of

antidepressants' safety profile (adverse effect and suicide risk) remains of

crucial importance and more reliable data about these outcomes are needed.

Waiting for more robust evidence, treatment decisions should be based on

considerations of clinical history, drug toxicity, patient acceptability, and

cost. We need for large, pragmatic trials, enrolling heterogeneous populations

of patients with depression to generate clinically relevant information on the

benefits and harms of competitive pharmacological options. A meta - analysis of

individual patient data from the randomised trials is clearly necessary.

 

 

 

Introduction

Date of Most Recent Substantive Amendment: 2003 02 21

 

Background

For many years amitriptyline has been considered one of the

reference compounds for the pharmacological treatment of depression. However,

new tricyclic drugs, heterocyclic compounds and the selective serotonin reuptake

inhibitors have been introduced on the market with the claim of a more

favourable tolerability/efficacy profile.

 

Objectives

The aim of the present systematic review was to investigate the

tolerability and efficacy of amitriptyline in comparison with the other

tricyclic/heterocyclic antidepressants and with the selective serotonin reuptake

inhibitors.

 

Search strategy

The Cochrane Collaboration Depression, Anxiety and Neurosis

Controlled Trials Register (CCDANCTR - Studies). Reference lists of all included

studies were checked.

 

Selection criteria

Only randomised controlled trials were included. Study participants

were of either sex and any age with a primary diagnosis of depression. Included

trials compared amitriptyline with another tricyclic/heterocyclic antidepressant

or with one of the selective serotonin reuptake inhibitors.

 

Data collection and analysis

Data were extracted using a standardised form. The number of

patients undergoing the randomisation procedure, the number of patients who

completed the study and the number of improved patients were extracted. In

addition, group mean scores at the end of the trial on Hamilton Depression Scale

or any other depression scale were extracted. In the tolerability analysis, the

number of patients failing to complete the study and the number of patients

complaining of side - effects was extracted.

 

Main results

The estimate of the overall odds ratio for responders showed that

more subjects responded to amitriptyline in comparison with the control

antidepressant group (odds ratio 1.12, 95% confidence interval 1.01, 1.23,

number needed to treat 50). The estimate of the efficacy of amitriptyline and

control agents on a continuous outcome revealed an effect size which also

significantly favoured amitriptyline (Standardised Mean Difference 0.13, 95%

confidence interval 0.04, 0.23). Whilst these differences are statistically

significant, their clinical significance is less clear. When the efficacy

analysis was stratified by drug class, no difference in outcome emerged between

amitriptyline and either tricyclic or selective serotonin reuptake inhibitor

comparators. The dropout rate in patients taking amitriptyline and control

agents was similar; however, the estimate of the proportion of patients who

experienced side - effects significantly favoured control agents in comparison

with amitriptyline (odds ratio 0.63, 95% confidence interval 0.56, 0.71). When

the tolerability analysis was stratified by drug class, the dropout rate in

patients taking amitriptyline and the selective serotonin reuptake inhibitors

significantly favoured the latter (odds ratio 0.84, 95% confidence interval

0.75,0.95, number needed to harm 40). When the responder analysis was stratified

by study setting amitriptyline was more effective than control ADs in inpatients

(odds ratio 1.22, 95% confidence interval 1.04, 1.42, number needed to treat

24), but not in outpatients (odds ratio 1.01, 95% confidence interval 0.88,

1.17, number needed to treat = 200).

 

Authors' conclusions

This present systematic review indicates that amitriptyline is at

least as efficacious as other tricyclics or newer compounds. However, the burden

of side - effects in patients receiving it was greater. In comparison with the

selective serotonin reuptake inhibitors amitriptyline was less well tolerated,

and although counterbalanced by a higher proportion of responders, the

difference was not statistically significant.

 

 

 

 

 

 

 

 

 

 

 

Oakland, CA 94609

 

 

-

Mike Liaw

Chinese Medicine

Sunday, November 27, 2005 2:54 PM

Re: Re: TCM-Prozac / anti-cholinergic effects

 

 

Alon,

 

Can you share with us which publication (last month) you are referring to?

 

Thanks,

 

Mike L.

 

<alonmarcus wrote:

This is according to Papolos and Papolos, 1997.

Yes, that was a few years ago now, though SSRI's

were already in use.

>>>>>>>

There have been many comprehensive reviews of antidepressants. One was just

published (last month) which clearly stated that none of them work better than

any other. Effexor and other newer mixed effect may be slightly more effective

but not quite statistically significant, although many clinicians will tell you

they work on patients that failed on others. They do work best for pain. In

general antidepressants are chosen based on their sideeffect profile and trial

and error.

 

 

Oakland, CA 94609

-

J. Lynn Detamore

Chinese Medicine

Saturday, November 26, 2005 10:39 PM

Re: TCM-Prozac / anti-cholinergic effects

 

 

This is according to Papolos and Papolos, 1997.

Yes, that was a few years ago now, though SSRI's

were already in use.

 

 

--- <alonmarcus wrote:

 

> the most anti-depressant meds with

> the most anticholinergic effects were also the

> most effective a-d meds.

> >>>>>

> That is not true. The first generation TCAs had

> the most anticholinergic effects and were not

> and not more or less effective than second

> generation TCAs or SSRIs. They tend to be more

> sedative so better for sleep problems. The only

> antidepressants that MAY be slightly more

> effective are the new atypical.

>

>

>

>

> Oakland, CA 94609

>

>

> -

> J. Lynn Detamore

> To:

> Chinese Medicine

> Saturday, November 26, 2005 7:11 PM

> Re: Prozac

>

>

> ...refine 5 e pattern

> this can be largely ST offending Water yin

> Dr. Holmes Keikobad...

>

> In fact, Holmes, I recall reading that

> historically, the most anti-depressant meds

> with

> the most anticholinergic effects were also

> the

> most effective a-d meds. I had forgotten

> that,

> thank you for the reminder. In other words,

> if

> effective, they are going to be drying. If

> someone is on continued a-d tx, I would think

> ongoing attention acu/herbs to moisten, and

> plenty of po fluids would be a necessary tx

> focus.

>

> Lynn

>

>

>

>

> Music Unlimited

> Access over 1 million songs. Try it free.

> http://music./unlimited/

>

>

> Download the all new TCM Forum Toolbar,

> click,

>

http://toolbar.thebizplace.com/LandingPage.aspx/CT145145

>

> To change your email delivery settings,

> click,

>

> and adjust accordingly.

>

> Messages are the property of the author. Any

> duplication outside the group requires prior

> permission from the author.

>

>

>

>

[Guest guest]

Thanks, Alon!

 

Mike L.

 

<alonmarcus wrote:

Mike here are a couple of studies i pulled out as they were still in my

computer. There are several more you could do a search.

 

 

 

 

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