Lexapro maintains status as first-line antidepressant therapy

Lexapro vs. Pristiq According to a Decision Resources (DR) press release, Lexapro (escitalopram), a SSRI, “retains leadership among first-line therapies in the treatment of major depression” despite the fact that physicians have increasingly moved toward the use of SNRIs, eg, Effexor (venlafaxine). However, the reason why SSRIs still retain their first-line status is due to

  • cost
  • efficacy
  • familiarity

SSRIs have been out on the market for much longer than SNRIs so it’s what physicians are more comfortable with. As far as I know, there currently aren’t any generic SNRIs in the U.S.

As a result, SNRIs are likely pricier.

DR’s survey of psychiatrists found that the majority believe SNRIs work better in treating clinical depression than SSRIs and about 44 percent believe they have fewer sexual side effects. PCPs were also included in this survey and it seems that the majority of them believed the opposite despite DR’s spin that a lot of PCPs are on board with psychiatrists. From personal experience, four SSRIs were prescribed to me before I was shifted to a SNRI.

In the up-and-coming SNRI department, DR forecasts a bright future for Pristiq (desvenlafaxine).

Physicians are expected to move patients from Effexor to Pristiq-a newly approved SNRI- over the next two years. … Pristiq will begin to replace Wyeth’s Effexor XR and Lilly’s Cymbalta, especially in
psychiatrists’ practices.

This is an interesting analysis from DR considering that psychiatrists, health insurers, and even some investors seem less than impressed with the slight advantages the “me-too” drug has over Effexor.

(logos from Forest Pharmaceuticals, Inc. and Wyeth)

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Pristiq receives approval from FDA

PristiqMore than a year ago, I promised to keep tabs on Wyeth’s new (renamed, rather) drug Pristiq. So I’m living up to it.

On February 29, 2008, the FDA granted Wyeth approval to move forward with putting the drug out on the market.

Wyeth said the company planned a big sales effort to introduce the product to psychiatrists and primary care doctors.

There’s a problem with that sentence. I’ll give you a second to figure out what’s wrong with it. Haven’t got it yet?

Primary care doctors. PCP should not be in the business of prescribing or providing psych meds. I’ve gone on and on about it at length before, but I’ll mention it again. PCPs are trained to treat overall conditions that have no need of referral to specialists. Think about it this way: If your psychiatrist prescribed anti-inflammatory medication because you mentioned that you’ve been having problems with your foot, you’d be taken aback, right? If a dermatologist prescribed heartburn medication after a patient mentioned he’d been having heartburn trouble, that would seem almost illogical, wouldn’t it?

(Pristiq logo from Pristiq.com)

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The "Black Dog," Part II

In February 2004, I tried to kill myself. I don’t remember how now. But he pleaded with me to go see a doctor and get some help. Since I was 21, I no longer qualified under my mother’s health insurance so I tried to avoid docs as much as I could. My pediatric (PCP) doctor continued to treat me despite my age. Dr. X diagnosed me with depression and said, "Since you don’t have medical insurance, I’ll give you some samples of Paxil that a drug rep gave me."

Welcome to the beginning of my first experience with psych drugs.

(Just an aside: Before this, I had never taken medication for depression. My parents wouldn’t let me growing up. In the psych hospital, I said no even though the psychiatrist there gave me a tough time about it.)

I remained on Paxil through July. I wasn’t accustomed to taking medication each day so I’d take it for a day or two on and off. But no more than that. If I didn’t take it for three days, I knew it was time to get back on it. I’d suffer from dizziness and "brain shivers." It was also the first time that I developed eyelid twitching.

I went back to Dr. X and told her that Paxil wasn’t working. She told me that she knew I wasn’t consistent in taking my meds. But she still switched me to another med.

Enter Lexapro in September.

A crucial year in college. I was attempting to graduate that semester, juggle responsibilities as a reporter and copy editor for the college paper, manage a long-distance relationship, and complete a 50+ page honors paper. After accidentally reporting incorrect data on an investigative piece that I thought I’d thoroughly researched, university directors came down HARD on me. The managing editor made it a bigger deal that it really was (according to my teacher and newspaper advisor), freaking me out and sending me into a tailspin. I adhered to my Lexapro regimen much more carefully, but my depression worsened. By the end of October, I’d quit my job at the paper and found myself unable to get out of bed except for late afternoon and night classes. In November, I had to cut back from 16-18 credits down to 12 – just enough to keep me a full-time student. Of course, I didn’t graduate that semester.

I’d went to a psychologist (recommended by my PCP) who gave me "tough love" advice for $75 per half-hour. The "tough love" approach wasn’t for me and actually made me feel worse about myself. I continued to worsen under his care. In February, I switched to a Christian-based counselor and dramatically improved. She listened to me for $75 an hour and at the end of the session, gave me helpful advice. The support of my counselor and boyfriend helped me to get through the trying time. Bob helped pull me through graduation the next semester despite occasional moments of relapsing (into bed).

Bob, not accustomed to the severe depression at first, immediately became frustrated and used the "pull yourself up by your bootstraps" mentality. After all, despite his depression, he was still going to work, still living. When he noticed that strategy wasn’t working, he did some research on depression and became a little more sympathetic.

However, our relationship began taking a turn for the worse: we began arguing about pretty important things – where we’d live and whether we’d have biological children. We took "breaks" on and off and after several attempts at discussing breaking up, we tried to do so. Of course, it didn’t last. His depression kept him from feeling confident in our relationship and his ability to handle my depression. He conveniently left out how he was worried that his depression would conflict with mine.

Antidepressants

Anti-depressants are a touchy subject for people who suffer from depression. Anti-depressants help some people, cause no change in others or, in some instances, can even harm. I went through Paxil and Lexapro before my doctor recommended Zoloft. None of those medications helped me with depression. Paxil didn’t hesitate to add weight, jittery nerves and increased anxiety; Lexapro helped to spin me deeper into depression and suicide — to a point where I couldn’t get out of bed. Once my doctor handed me a prescription for Zoloft, I realized that my end-all-be-all cure for depression could not depend on medicines. I received the argument, “Try all you can before stopping medication,” but I had done all I could on medication. My life was spinning out of control and it nearly cost me— I almost failed to graduate college and nearly lost my summer job at a prestigious magazine. While preparing for a wedding — one of the most stressful events in a person’s life — I quit taking the medication. Some people are better with anti-depressants than without them, but for others, anti-depressant just can’t and won’t do the trick.

UPDATE: Because of a recent bipolar diagnosis, I am currently on Lamictal (lamotrigine) and have been doing well on the medication. I recently came off of Effexor XR after having taken the medication and experience terrible withdrawal effects. More on that here.