Thursday, February 26, 2009

Paxil, anyone?

I ran a poll, not long ago, after reading Peter Kramer's blog post on the relative efficacy of the different SSRI's. Here's what we found:

Which SSRI is the most Effective?

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Lexapro 19% (28 votes)
Cymbalta (SNRI) 13% (20 votes)

Total Votes: 150

Which Medicine Causes the Most Side Effects
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Total Votes: 134

Okay, so let's start by talking about how this 'poll' is meaningless. We don't know who took it-- patients, docs, random plumbers surfing through. We don't know what experience these people have had with antidepressants-- so the question has different meaning if it's asked to a doc who has only ever prescribed Prozac and Zoloft, then if it's asked to a patient who has been on a long trial of every medication. There's no real head-to-head here, no measures of efficacy, no controls. And I didn't even specify what the efficacy was for: Depression? Anxiety? OCD? Panic? Halitosis? Slipping behind your ear to hold your glasses in place?

Still, we had a clear loser, and I was surprised: Paxil. Few people voted for it's efficacy, many for it's side effects.

I don't start people on Paxil so much anymore: the lore is that it causes more weight gain then the others, and when I do prescribe it, I tell people to get weighed. It may cause weight gain, as an overall risk to populations, but all I care about is if it causes weight gain to my particular patient, and clearly, some people do not gain weight on it. The more concerning thing about Paxil has been the withdrawal syndrome that some people experience and so far I've found that it's manageable, especially if people come off very slowly. Still, all things being equal, these days I may start with something else.

So why was I surprised: I guess I haven't heard a lot of patients complain about side effects, and I have patients who've been on this medicine for some time. It seems to work particularly well, at least that's my impression, for Anxiety, and it seems to be well tolerated, the 'polls' would say otherwise. And for the uninsured, the generic is on Walmart's $4 list (as is Celexa).
Just my thoughts.

And to those who've read yesterday's post about does Facebook wreck your brain: If you read either the original article or the comments to our post, you'll note that the original piece is simply theories that all this computer time may re-wire people; there were no studies, no proof. And as some of our readers pointed out, On-line interactions may well be a segway into the world of Real Life encounters for people who might otherwise hesitate. I often wonder if my college experience would have been broadened by the world of the internet---


Anonymous said...

i often wonder if my college experience would have been broadened if i had smoked pot.

Anonymous said...

My elementary school, high school, college and graduate school experiences were all broadened by smoking pot and many other things. We didn't have Facebook, but pot, that we had.

shrink on the couch said...

I wonder if my college experience would have been broadened by paxil. the lower libido might have done wonders for my GPA.

Anonymous said...

I thoroughly enjoyed my libido in college, phd, and that being the case, it's not the internet I wish I'd had in college, but the cellphone. From what I hear, kids today text for sex at a certain hour on a weekend night, and I think that would have had its appeal in the college years.

I think the internet would have interfered more than helped except for research papers. I remember beating around the stacks finding papers and then hauling them off for a primative thermal xerox or take notes in the library to save a dime. Now it's search the library website and hit "print".

tracy said...

i k n o w my college experience would have been much more enjoyable and productive if i had been on Paxil...or any anti-depressant, anti-anxiety agent (althought they probably weren't around in the old days). Dumb me, i waited waaaay too long to get help...!

Anonymous said...

Yes, I remember the stacks too. They were cold and musty and dusty and I probably inhaled more toxins from my years in the stacks than from the pot. I sometimes have cause to revisit the stacks even though I have internet access. I am glad I did not have a cellphone but I am glad I have one now.
Tracy: I cannot imagine you are so impossibly old that there were no anti-depressants or anxiolytics when you were in college. They sure had a long laundry list they used on me. I actually preferred some of that stuff to what they have today but I am told that the risks of TD are too high. Of course, in XX number of years they will be telling me that what they have been giving me is the cause of whatever I am dying from.Pass the pot.

Anonymous said...

What I think is really interesting is that this very small and unscientific poll replicates the results of the latest meta-analyses in the Annals of Internal Medicine (and I think the Lancet------something else prestigious and british, maybe it was the bmj).

Battle Weary said...

Hmm...I was one of the people that voted for paxil as the most effective really helped my depression. However...While on paxil I gained massive amounts of weight and was dx'd diabetic II. As I was also taking risperdol at the same time, I attributed the weight gain (and diabetes) to that...and not to the paxil. Perhaps it was both meds. :P

Dr. Pink Freud said...

To quote Benjamin Disraeli, "There are three type of lies; lies, damned lies, and statistics."

Anonymous said...

I loved Paxil, but stopped it because of excessive sweating. I was waking up in the middle of night soaking in sweat. It's a shame because other than that, it worked well for me.

Effexor on-the-other-hand, was good for mood, but crap in every other in life that makes one balanced. I gained loads of weight (craving carbs like nobody's business), made me anorgasmic thus rendering my libido to the crapper and to top it off, I ended up hypothyroid (no one in my family has a history of this) so thanks very much Effexor, I hate you and don't miss taking you much.

Neuroskeptic said...

Funny you say that Paxil is especially good for anxiety - in Britain (at least, with the British psych's I've spoken to) Celexa is regarded as especially good for anxiety.

I suspect the truth is that all SSRIs are pretty good for anxiety.

Anonymous said...

HOE DO I GET THE BACON OFF??? HELP I CANT EVEN SEE WHAT I"M TYPONG!!! GOD that's UGLY bacon. im scrofaphobac pleease heeellp meeeee pleeease.