![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by MRM1666 on August 10, 2015, at 18:29:12
Can anyone say if Vyvanse is addicting?
Thank you.
Posted by rjlockhart37 on August 10, 2015, at 23:47:02
In reply to Is the antidepressant Fetzima 'energizing'?, posted by MRM1666 on August 10, 2015, at 18:29:12
i've never taken it, it's a newbie drug.....but it looks like it does improve mood associated with low energy.....
here's just quick research:
https://en.wikipedia.org/wiki/Levomilnacipran
https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Levomilnacipran-(Fetzima)
http://www.medscape.com/viewarticle/839274_____
vyvanse can be addicting, yet it's not as a fast hit drug like adderall and yes it does release dopamine but adderall is known as the wake up coffee drug, alot of people in the US take adderall in the mornings......and it's hard to get going if your used to being waked up by it, without it......
r
Posted by rjlockhart37 on August 10, 2015, at 23:50:21
In reply to Is the antidepressant Fetzima 'energizing'?, posted by MRM1666 on August 10, 2015, at 18:29:12
copy and paste the links if they don't directly take you there.....
r
Posted by rjlockhart37 on August 11, 2015, at 0:06:22
In reply to Re: Is the antidepressant Fetzima 'energizing'?, posted by rjlockhart37 on August 10, 2015, at 23:47:02
Vilazodone, Levomilnacipran and Vortioxetine for Major Depressive Disorder: The 15-min Challenge to Sort These Agents Out
In a prior 15-min challenge, we tackled the three new oral anorectic agents.[1] This time, we will sort out three new agents that have been approved for the treatment of major depressive disorder. Major depressive disorder is common. Estimated lifetime prevalence rates for major depressive disorder in epidemiological studies have ranged from approximately 1316% of the USA population, with 12-month prevalence rates of 5.36.6%, and with rates that are higher in women than in men.[2] Major depressive disorder is associated with significant functional disability and increased morbidity and mortality, and can be unremitting in 15% of patients and recurrent in 35%.[2] Despite the plethora of available antidepressant medications, both generic and branded, response and remission remains often elusive, and new treatments that may offer something different are eagerly sought. Within the past 4 years, three new antidepressant medications have become available in the USA: vilazodone,[3] levomilnacipran[4] and vortioxetine.[5] How are they similar? How are they different?
Table 1 is a list of pertinent information regarding indications, contraindications, bolded boxed warnings, dosage recommendations, drug interactions and most commonly encountered adverse effects (incidence ≥ 5%), taken directly from the product labels for each of these agents.[68]
All three of these agents have the identical indication (treatment of major depressive disorder), but each have their own nuances regarding potential mechanisms of action. Vilazodone is a selective serotonin reuptake inhibitor and a partial agonist at the serotonin 5-HT1A receptor. Levomilnacipran is a serotonin and norepinephrine reuptake inhibitor (i.e. a SNRI). Vortioxetine is a serotonin reuptake inhibitor as well as an antagonist at the serotonin 5-HT3 receptor and an agonist at the serotonin 5-HT1A receptor. The serotonin 5-HT1A and 5-HT3 receptors have been hypothesised as being potentially useful targets for the treatment of MDD.[9,10]
Contraindications are similar, as are the bolded boxed warnings as generally found in all antidepressant drug labels. Although all three agents are dosed once daily, they all require initial dose titration (a disadvantage compared with some existing antidepressants). Vilazodone needs to be administered with a meal to ensure adequate bioavailability, whereas levomilnacipran and vortioxetine can be taken without regard to meals. Nausea is the most frequently encountered adverse event for levomilnacipran and vortioxetine. Diarrhoea is the most commonly encountered adverse event for vilazodone, followed by nausea.
Table 2 outlines the efficacy information from the pivotal acute short-term trials as extracted from prior reviews.[35] Response is defined as a ≥50% reduction from baseline on the Montgomery-Asberg Depression Rating Scale (MADRS). Remission is defined by the achievement of an end-point MADRS score no greater than 10. Number needed to treat (NNT) vs. placebo for each of these outcomes is provided.
Although the NNT vs. placebo for response or remission is more robust with vortioxetine, the 95% confidence intervals of the NNT estimates overlap for all three of these agents. Head to head studies will be required to detect if there are any clinically relevant differences in response or remission rates. Newly published clinical trials can help refine the NNT values that were originally calculated based on the pivotal trials available at the time of drug approval. For example, a postregistration randomised controlled trial of vilazodone yielded a NNT for response vs. placebo of 6, and that for remission of 9.[11]
Table 3 summarises the safety and tolerability information regarding the proportion of patients who discontinued the clinical trial(s) because of an adverse event and the number needed to harm (NNH) vs. placebo is provided. The incidence of the most common adverse event and the NNH is also listed.
Vortioxetine appears to be the best tolerated based on the NNH vs. placebo for patients discontinuing because of an adverse event, but again the 95% confidence intervals of the NNH estimates overlap for all three antidepressants. Nausea is a prominent adverse event for all three medications with robust NNH values of 610.
As we compare and contrast, the concept of likelihood to be helped or harmed (LHH) can be helpful, provided that you select a relevant harm to contrast with the expected benefit.[12] Table 4 provides the NNT for response or remission, NNH for discontinuation because of an adverse event, and the resultant LHH.
Response or remission is more likely to be encountered than a discontinuation because of an adverse event. The LHH ratio for this comparison is largest for vortioxetine. However, the LHH is not as favourable when contrasting the likelihood of response or remission vs. the likelihood of encountering nausea ( Table 5 ). When the LHH is less than 1.0, one would expect to encounter nausea more often response or remission. However, this does not necessarily eliminate any of these choices from further consideration if the nausea is mild, temporary and easily managed. Moreover, nausea and response/remission are not mutually exclusive.
Differentiating these three new antidepressants from those already available include a more benign weight gain profile for all three,[35] fewer problems related to sexual functioning for vilazodone and vortioxetine,[3,5] and potential relief of the cognitive dysfunction that can be associated with depression as demonstrated with vortioxetine.[13] In addition, levomilnacipran's profile of approximately twofold greater potency for norepinephrine than serotonin reuptake inhibition differs substantially from that for the other available SNRIs. Because the modulation of energy, vigilance and arousal can be directly linked to the noradrenergic system, it has been suggested that antidepressants with a prominent noradrenergic component, may be particularly effective in addressing functional impairment.[14,15] The product label for levomilnacipran notes that the medication demonstrated superiority over placebo as measured by improvement in the Sheehan Disability Scale functional impairment total score.[7]
There are several important caveats. The data presented are from carefully conducted registration trials that enrolled subjects who fulfilled restrictive inclusion/exclusion criteria. Such patients may differ from persons encountered in routine clinical practice. Thus, pragmatic clinical trials that are more generalisable will help place these antidepressant medications into clinical perspective for their use in the 'real world'. However, depression is a hetergenous disorder and antidepressant response (and tolerability) in an individual patient can vary. Having additional choices offers greater opportunities for success.
-MedscapeL. Citrome
Disclosures
Int J Clin Pract. 2015;69(2):151-155.
Posted by phidippus on August 11, 2015, at 18:29:43
In reply to Is the antidepressant Fetzima 'energizing'?, posted by MRM1666 on August 10, 2015, at 18:29:12
I don't find it addicting
Eric
Posted by Chris O on August 30, 2015, at 4:50:07
In reply to Is the antidepressant Fetzima 'energizing'?, posted by MRM1666 on August 10, 2015, at 18:29:12
I've got several sample packs in my bathroom. In my brief trials, I did find it energizing, almost immediately so. That would suggest withdrawals, I guess, though I didn't take it long enough (only a few days at a time) to experience that side effect.
Chris
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.