Cost of Antidepressants

Crispin

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There has been some discussion on the monetary cost of antidepressants. In general, cost varies on individual insurances. However, here is some information on antidepressants in general terms.

MAOIs (Monamine Oxidase Inhibitors): These are largely not used anymore because of the dietary restrictions. Foods that are high in tyramine can cause a hypertensive crisis. Fava beans, red wine, and aged cheeses are a few that must be avoided. EnSam is a transdermal patch. At the 6mg dose dietary restrictions are not mandated; however, it is not proven to be clinically effective until the 9mg dose. Selegiline is the generic name. It is frequently used to treat Parkinson's.

TCAs (tricyclic antidepressants): These are older medicines as well. They have side effects of weight gain, sedation, and arrthymias. They are lethal in overdose. In general, these are not prescribed much. Common generic names are imipramine, amitripyline, clompiramine, nortriptyline, and desipramine. They are relatively inex*****ve; however, there usage carries significant risk.

SSRIs (selective serotonin reputake inhibitors): These are the mainstay and safest treatment. The most common side effect is anorgasmia. In general, they are very safe. celexa - citalopram, prozac - fluoxetine, and paxil - paroxetine are four dollars a month or ten dollars for three months at Target or Wal-Mart. Paxil has higher side effects then the others and is probably not the best choice for a first line agent.
-zoloft (sertraline,) lexapo (escitalopram,) and luvox (fluovamine) are all generic. They should be relatively inexpensive. Lexapro is the most recent to go generic so probably the most expensive. Luvox is dosed twice a day and can be sedating, there is a CR (continual release) form available but that will be more expensive.

SNRIs (Selective norepinephrine reuptake inhibitors): These are the newest subclass. The name is a misnomer because they also work at serotonin. Effexor (venlafaxine,) cymbalta (duloxetine,) and pristiq (desvenlafaxine) are currently FDA approved. Effexor is generic and should be inexpensive. Cymbalta and pristiq are brand name only and will be very expensive. Cymbalta is FDA approved for peripheral neuropathy and very helpful for that. In general, the cost of cymbalta and pristiq may not outweigh the benefits. Savella is also an SNRI but does not have FDA approval for depression.

Wellbutrin (buproprion): This is a unique antidepressant that works at norepinephrine and dopamine. It is the only antidepressant that does not have the potential to cause sexual side effects. It can be used to reverse sexual side effects from other antidepressants. It is generic and inexpensive.

Remeron (Mirtazepine): This is an older antidepressant with known side effects of weight gain and sedation. It can also interact with cardiac medications. It is very inexpensive but probably not the best first line agent.

Trazodone: This is the generic name and what it is well known as. At higher doses it is extremely sedating and rarely used as an antidepressant. At lower doses it is an extremely effective medicine for insomnia. It is non-addictive! This is also on the target and Wal-Mart four dollar list.

Okay, there is Crispin's crash course on antidepressants and their costs. There are others out there, of course, but this is the basics.

Crispin
 

worldtalker

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I have ONE question,why do people need this crap to begin with,they weren't born that way. GodBless Chris
 

G.I.B.

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I couldn't get through the entire post... too depressing.

I'd rather go outside and play with my metal detector. So why the medical lesson? It relates somehow to the hobby by....?
 

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Crispin

Crispin

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I couldn't get through the entire post... too depressing.

I'd rather go outside and play with my metal detector. So why the medical lesson? It relates somehow to the hobby by....?

Gold Maven brought it up in a previous thread. I responded to it there but it got deleted for being off topic. So, I started a new thread. Also, this is the everything else section; be definition, that means not related to metal detecting.
 

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Crispin

Crispin

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I have ONE question,why do people need this crap to begin with,they weren't born that way. GodBless Chris

WorldTalker: Thank you for providing us with a spectacular example of the stigma against depression and psychiatry. It is comments like this that prevent people from getting the help they need. You are only hurting the ones you love. Depression is a GENETIC disease. In fact, people ARE born with it. I just figured out why you picked the name WorldTalker...it is because you never know what in the world you are talking about.

Let me add an element to the thread to help you out: The UN is coming for our guns!
 

G.I.B.

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The UN is coming for our guns!

...and next, a thread on paranoia.

Would love to chat, but heading outside to go metal detecting. Will post in the Beach and Shallow Water section later this afternoon.
 

worldtalker

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WorldTalker: Thank you for providing us with a spectacular example of the stigma against depression and psychiatry. It is comments like this that prevent people from getting the help they need. You are only hurting the ones you love. Depression is a GENETIC disease. In fact, people ARE born with it. I just figured out why you picked the name WorldTalker...it is because you never know what in the world you are talking about.

Let me add an element to the thread to help you out: The UN is coming for our guns!
Got a "pill" for it??
 

pong12211

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They should make a pill to cure stupidity and raise peoples common sense level.. Now that would be impressive.
 

worldtalker

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They should make a pill to cure stupidity and raise peoples common sense level.. Now that would be impressive.
Guess 'public school' has something to do with it,we are born with common sense,but,people can be,and,are taught out of it!
 

Frankn

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See the old days & theory thread. Frank

111-1 profile.jpg
 

worldtalker

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WorldTalker: . I just figured out why you picked the name WorldTalker...it is because you never know what in the world you are talking about.



Actually, I talk on my radio to people around the world! You don't figure to well.
 

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They should make a pill to cure stupidity and raise peoples common sense level.. Now that would be impressive.

I know a place where those kind of pills should be passed out like candy,actually two places:laughing7:
 

Rebel - KGC

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WorldTalker: Thank you for providing us with a spectacular example of the stigma against depression and psychiatry. It is comments like this that prevent people from getting the help they need. You are only hurting the ones you love. Depression is a GENETIC disease. In fact, people ARE born with it. I just figured out why you picked the name WorldTalker...it is because you never know what in the world you are talking about.

Let me add an element to the thread to help you out: The UN is coming for our guns!

LOL!
 

0121stockpicker

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I get that every winter. Of course it's brought on by my lack of metal detecting!!
 

packerbacker

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Cris...........I'm being serious here. Chantix, a stop smoking drug is said to cause agressive behavior in some people. Apparently Chantix is a mind-altering drug which can change moods in any range from agressive to suicidal. I took Chantix myself and actually quit smoking over 5 years ago. Didn't seem to effect mu moods; I hated the same people just as much as I did before I started taking it. :) My thing though is, isn't it HIGHLY possible that some of the drugs given to mental health patients capable of causing the same agressive behavior? Maybe they wouldn't go on killing sprees if they hadn't started these drugs in the first place? I guess I have the same stigma about mental health as some others do; I don't understand why folks can't get through their problems without using drugs and I feel the drugs just exacerbate the situation. My wife worked for mental health for many years so she understands a little more than I do but I just can't change my opinion and I've heard all sides. I just have my own theories.
 

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Crispin

Crispin

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Cris...........I'm being serious here. Chantix, a stop smoking drug is said to cause agressive behavior in some people. Apparently Chantix is a mind-altering drug which can change moods in any range from agressive to suicidal. I took Chantix myself and actually quit smoking over 5 years ago. Didn't seem to effect mu moods; I hated the same people just as much as I did before I started taking it. :) My thing though is, isn't it HIGHLY possible that some of the drugs given to mental health patients capable of causing the same agressive behavior? Maybe they wouldn't go on killing sprees if they hadn't started these drugs in the first place? I guess I have the same stigma about mental health as some others do; I don't understand why folks can't get through their problems without using drugs and I feel the drugs just exacerbate the situation. My wife worked for mental health for many years so she understands a little more than I do but I just can't change my opinion and I've heard all sides. I just have my own theories.

PackerBacker: We have had some good dicussions and I respect your opinion. Let me explain a little.
1. Chantix is a vicious drug. Anybody with any history of mood disorder should not take it. Physicians call me weekly to ask about specific patients taking it, I almost always say no. Chantix CAN and WILL make people aggressive and suicidal. Chantix works by blocking Dopamine receptors in the Nucleus Accumbens. The Nucleus Accumbens is the pleasure center of the brain. Nicotine binds to dopamine receptors in the NA to produce a feeling of euphoria. Chantix binds to those receptors so nicotine can't. Thus, the theory, is people stop smoking because they no longer get pleasure from the nicotine and experience all the bad tastes and feelings from the other things in cigs.
2. However, when chantix blocks dopamine receptors it is non-specific. Dopamine stimulation is a neccesary part of feeling happy. Without it...depression, violence, and aggression.

3. Some medicines given by mental health professionals can cause aggressive behavior. It all depends on which one we are talking about. Did you have a specific one in mind?
4. Antidepressants carry a black box warning on young adults and children because they have been associated with a higher rate of suicide attempt. This is a fact.
5. That does not mean that antidepressants cause this age group to commit suicide. When somebody is depressed they often have little energy and suicidal feelings. When treating depression, energy will improve BEFORE mood does. What happens when you take a depresssed, suicidal adolescent and improve their energy but not their mood? You guessed it...more suicide attempts.
6. The data for this black box warning was based on a meta-study of 8000 patients. 4000 patients given an antidepressant and 4000 patients given placebo. The group given placebo had a 2% suicide attempt rate. The group given antidepressants had a 4% suicide attempt rate. HOWEVER, nobody of all 8000 succusfully committed suicide. NO DEATHS.
7. You are absolutely right, antidepressant use must be closely monitored in this population.

8. You do have the stigma, but at least you can admit it. Let me click on this and I'll start another reply.
 

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Crispin

Crispin

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Part II:

1. Depression IS a chemical imbalance in the brain based on genetic sequencing. Look at it like diabetes. There are different causes of diabetes but some people are just born with it and can do nothing about it. Diabetes is genetic and it runs in families.
2. Depression is the same thing but with different chemicals. Diabetes is related to insulin, glucagon, and others. Depression is related to serotonin, norepinephrine, dopamine and others.
3. I can do a finger stick and show you your sugar is high or low.
4. I cannot stick a needle in your brain, draw off fluids, and show you your serotonin is low without causing significant damage or killing you.
5. That is why there is a big stigma against psychiatry. some people have to SEE things to believe them.

6. Not all forms of depression need medication. Biological symptoms of depression are decreased sleep, decreased appetite, decreased sex drive, decreased energy, decreased concentration, feelings of guilt/worthlessness/helplessness/ or hopelessness, anhedonia, and suicidal ideation (just thinking about it.) People with several of these symptoms will respond well to medication.
7. Social stressors can make people feel depressed. For example: I hate my job, I hate my freinds, I hate my family....blah, blah, blah. HOWEVER, social stressors DO NOT respond to medications. These people need therapy.
8. This contributes to STIGMA of psychiatry. You see all these people complaining and think...get over it. Well it is not that simple, but it is NOT the same as a GENETIC CHEMICAL IMBALANCE. However, I admit, these people can try anybody's patience quickly.

9. If I give somebody an antidepressant with a chemical imbalance they usually feel better in a week or two. If I give somebody an antidepressant with social stressors it does nothing.

10. any questions? It is a pleasure to help clear up some of the stigma.
 

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