Antidepressants In Thailand ?

[lovebangkok]

Anyone use antidepressants here ?

I asked for the price of Prozac at farmacy. It was 1100 bt 14 pills. This is nearly twice the price in my homecountry

[chemist]

You can easily buy standard antidepressants, such as Prozac (fluoxetine), Cipram/Cipramil/Celexa (citalopram), Lexapro/Cipralex (escitalopram), Zoloft (sertraline), Paxil/Seroxat (paroxetine), Effexor (venlafaxine), etc, without prescription in Thailand.

The problem in Thailand is that in almost all cases only the original brand (see above) is available, which means that the price will be (very) high for these medications. There are however exceptions, and one of those is a generic formulation of fluoxetine (brand name Prozac, as above). I don't remember the trade name of this particular generic pill, but I know that for example the Watson pharmacies sell it at a very reasonable price level (if I remember correctly, we are talking about around 10 baht per 20 mg pill, compared with the price of around 75-100 baht per 20 mg pill for the brand Prozac).

Good luck!

chemist

PS I forgot to mention that some of the old tricyclic antidepressants (such as amitriptyline, brand names Elavil/Tryptizol/Tryptanon) are very cheap even in Thailand (around 3 baht per 25 mg amitriptyline pill for the original brands; maybe even cheaper when it comes to the generic versions). These older antidepressants are very effective (sometimes more so than the newer ones), but the side effects are often more harsh and you have to be careful not to take too much (risk of severe heart problems, etc in case of an overdose). However, if you "start low and go slow" with these older medications the result can often be very good.

Edited January 19, 2008 by chemist

[NALAK]

Anyone use antidepressants here ?

I asked for the price of Prozac at farmacy. It was 1100 bt 14 pills. This is nearly twice the price in my homecountry

fluoxetine is available at most chemist i pay 120Bt for 10. prozac brand name from lilley very expensive generics much cheaper

[AlexLah]

If I may add my two cents.

Is it not better to first find out why you are depressed?

Popping a pill will not take away the root cause.

I have extensive experience watching and trying to help my ex that was for some hidden reason always looking at the negative side of life.

She went to doctors, had therapy, stayed for a few months in group therapy and took all kinds of medication.

Nothing helped.

This whole thing was already going on for 8 years and yes I always tried to support but was not easy.

Next to her depression she also had panic attaqcks at the weirdest moments.

So I decided to lock us up and told her she and me would not be able to leave the room before we found the root cause.

It was like me doing a hard interogating session for 3 days but in the end it all came out (I will not go into the details here).

Went back to the clinic and we talked with the shrink so he could build a strategy.

Please do not take those medicine, it will not help you.

Find the root cause of why you are depressed.

[Maestro]

...generic formulation of fluoxetine (brand name Prozac, as above). I don't remember the trade name of this particular generic pill

MIMS gives this information, on this web page:

http://www.mims.com/Page.aspx?menuid=mimss...%2c&CTRY=TH

--

Maestro

[chemist]

Please do not take those medicine, it will not help you.

Excuse me, but how do you know that? Are you a licensed psychiatrist? Have you met the OP? I have said something similar like this before on this forum (in that case during a discussion about benzodiazepines) and I will say it again: The fact that you personally (or your ex) had a negative experience with medications doesn't necessarily mean that everybody will have the same response.

People suffering from depression, anxiety, schizophrenia or whatever of course browse sites like this, just like you and me, and there is a likelihood that sweeping generalizations like the one above will persuade individuals with psychiatric conditions not to try treatments that potentially could help them considerably and even save their lives. Why not try to write something like "I and my ex had a bad experience with medications, but that doesn't mean that nobody will benefit from medical interventions".

The causes of depression are many, and on many occasions (but not all) medication gives the patient a possibility to develop new ways of coping with life. The medicine can then often be phased out without a return of the depressive symptoms.

However, in many cases a very long treatment period is needed (perhaps life-long for some patients). That is especially true for people with so called endogenous depression (that is, the depression comes "from within", and is not caused by external factors like a divorce, the death of a loved one, etc).

Cheers

chemist

PS I am not endorsing self-medicating here. If the OP feels depressed and hasn't got a diagnose from a doctor I recommend him/her to seek professional advice. Then it is possibly time to buy the antidepressant(s), and as we all know it is much cheaper in Thailand to buy medicines outside of the hospitals.

Edited January 19, 2008 by chemist

[TommyGun]

If I may add my two cents.

Is it not better to first find out why you are depressed?

Popping a pill will not take away the root cause.

I have extensive experience watching and trying to help my ex that was for some hidden reason always looking at the negative side of life.

She went to doctors, had therapy, stayed for a few months in group therapy and took all kinds of medication.

Nothing helped.

This whole thing was already going on for 8 years and yes I always tried to support but was not easy.

Next to her depression she also had panic attaqcks at the weirdest moments.

So I decided to lock us up and told her she and me would not be able to leave the room before we found the root cause.

It was like me doing a hard interogating session for 3 days but in the end it all came out (I will not go into the details here).

Went back to the clinic and we talked with the shrink so he could build a strategy.

Please do not take those medicine, it will not help you.

Find the root cause of why you are depressed.

Good advice. AD's are not the answer. If you do decide to take them, look into the risks first, there is pleanty of info on the net. AD's can actually make you more depressed and even suicidal. My best friends GF died at only 23. She was on AD's for 2 years.

[AlexLah]

Chemist,

All depression is caused by either surpressed memories of bad things that happened in the persons life or are caused by recent traumatic experiences.

Lock me up in a room with Nalak and I am sure I will find out the reason why.

Stop prescribing your medicine it does not help it only make people addicted.

And you know it, why you do that?

You get some kind of bonus when you sell those medication?

Please prepare yourself as I have a few very nice documents that proof it.

[chemist]

Chemist,

All depression is caused by either surpressed memories of bad things that happened in the persons life or are caused by recent traumatic experiences.

Absolute rubbish. It has been known for a long time that genetic discrepancies increase the risks of getting depression, bipolar depression, schizofrenia, etc. As always, we are dealing with a mixture of genetics/heritage and the environment here (this means that SOME psychiatric problems can start due to environmental factors, such as the death of one's child, for example; but genetics ALSO play a very important role). Google Pubmed and check out som REAL science instead of guesswork. Simply referring to "my ex" or "my girlfriend" (see earlier posts; I prefer scientific investigations instead of hearsay and/or experience from one or two individuals) is not good enough here. "But my grandfather smoked two packs of John Silver without filter all of his life and he died when he was 96, so smoking can't be dangerous blah blah blah."

Lock me up in a room with Nalak and I am sure I will find out the reason why.

Stop prescribing your medicine it does not help it only make people addicted.

And you know it, why you do that?

You get some kind of bonus when you sell those medication?

I am not prescribing anything, since I am not a medical doctor. I do have a Ph D degree in medicinal chemistry though, and my speciality is psychiatric drugs. Like you, I don't hesitate for a second when it comes to bribery in the pharmaceutical industry. That IS a problem. However, that doesn't mean that the medications that are sold are no good. Far from it. Also, it is a well known fact that some antidepressants (especially Paxil (paroxetine) and Effexor (venlafaxine)) can give rise to discontinuation symptoms when they are phased out. BUT, the general rule is that antidepressants are NOT, I repeat NOT, addictive. None of them is a controlled substance ANYWHERE (including the US and the European Union).

Please prepare yourself as I have a few very nice documents that proof it.

I'm sure you do, and as I said before I agree with you regarding the bonuses and bribery.

Finally, what is it with some people and psychiatric medications? Why do they almost HATE these drugs? Some individuals almost explode when this subject is brought up. As I have already mentioned, genetic factors play a big role here, so why is it so WRONG to be on a medication if you have a psychiatric illness? Nobody tells a diabetic to "get a grip" or try some fancy "natural healing" treatment instead of using insuline. Is it because having a psychiatric disorder is still so stigmatized in our society? Probably. Sad but true...

Best regards

chemist

[moldy]

Depression for most of us is a transitory but sometimes excruciatingly painful process. It has many hues and it helps if you can roughly define what it is you are struggling with without concern for analysis, or judgement, or indeed quick fix rationalisations, eg, I should have known better or that's life. Drugs can and do help, and indeed may give us the buffer we need to integrate our thoughts and gradually feel those feelings and fears we might not ordinarily want to feel. At other times, depression simply is tiredness, pain, illness, or plain existential angst. Sometimes my depression is just about my football team not qualifying and nothing else, at others due to long lasting emotional wounds, horse for courses in the way we deal with these things.

There's no one cause of depression and no one way of dealing with it. But to be sure it is part of human existence, and struggle is more a natural occurrence than ease. Most cousellors will probably caution against dogmatic strategies and quick fix solutions. Sure effort of will is required, but so is giving in- to the grief, loss, anger or just plain disappointment that often is masked by depressive urges.

When it's not too serious, I can usually cope with bad spells by simply recognising that I am sad, or anxious, or a bit manic, and this can be peculiarly relieving. As time passes I may even begin to enjoy it in rather the bizarre way one can enjoy a luke warm bath where the water gets progressively cooler. Hopefully, then the insights come along, and the creativity, so I guess I try to harvest it.

[AlexLah]

Hi chemist,

Thanks for your reply, it is very much appreciated.

The experience I had during almost 8 years living with my ex I did a lot of research into those medicine and talked with a lot of doctors.

You mention schizofrenia and depression in one sentence and you know those two are not comparable.

I had a friend in my homecountry and he has schizofrenia and indeed the only way to stop that is with taking his medicines but he told me he feels like a robot when he takes it.

I am just saying to the OP not to take a quick fix and try to find out the root cause first.

If no reason can be found it might indeed be genetic and perhaps some kind of drugs will help but then I guess that person should take it for the rest of life.

From my experience with about ten people I knew at that time that suffered from some kind of depression nine of them were depressed because of their struglle with life. One even tried to commit suicide but made sure he was found while still alive so it was actually a scream for attention and he admitted that later.

Some people just cannot see the positive sides of life as I cannot feel the negative side of life.

Anyway it is good that we can have an open discussion about it here and I hope the OP will feel happy in the near future with or without medicine.

And thanks Moldy for your reply, try taking a nice 2 hour Thai massage when you feel sad, very refreshing!

Cheers all!

Alex

[chemist]

And thanks to you, AlexLah.

Like you said, it is always refreshing with an open discussion about sensitive things. I feel that I have to apologize a little bit for my aggressive style in my post above. I wrote it late last night, and I wass tired as h_ell.

Anyway, good luck to the OP and moldy (a nice post there, moldy).

Cheers

chemist

[Nienke]

Chemist wrote: The causes of depression are many, and on many occasions (but not all) medication gives the patient a possibility to develop new ways of coping with life. The medicine can then often be phased out without a return of the depressive symptoms.

However, in many cases a very long treatment period is needed (perhaps life-long for some patients). That is especially true for people with so called endogenous depression (that is, the depression comes "from within", and is not caused by external factors like a divorce, the death of a loved one, etc).

Interesting discussion! IMO, there are more ways to Rome than only allopathic medicines, and I always want to know: what really causes it.

I have a question, though:

Depression has (can have) many causes. From what I understand is that often the real root of these causes are actually unknown. One can say external depression caused by: traumatic experience, death of loved one, divorce, and also downright PMS (GAWD, that makes you REALLY depressed :D) Internal (endogenous with a beautiful word) causes and even genetic.

But what does actually really happen in your body, when you feel a certain feeling. What happens when you feel happy, joy, sadness, grieve, anger, etc etc. Normally the body will balance with all sorts of chemical/hormonal processes, when something becomes in excess. But what if due to whatever, this process becomes out of balance?

(I hope you understand what I'm getting at )

Example: best friend of my sister had with her future husband her last big trip before they would start his practice. Of they went to Indonesia. They were robbed in the night. Both were stabbed, he died in her arms. She was a full-time nurse for many years and he was a medical doctor. Talking about traumatic here.

From what I (sort of) understood from her was that during the horrible incident her adrenaline went up so sky-rocketing high, that her body wasn't capable of stabalizing it anymore, while that normally is the case when someone is frightened, has a sudden fright etc. Her body never recovered, and although a lot better now (more than 10 years later!), this imbalance in her body still has lots of influence on her behavior.

PMS, also has an endogenous cause (if I use that word well). But what exactly? If it's only estrogen and progesteron, why do some women benefit from vitamin B (1, I think)?

I've heard more about vitamin B benefitting depressed people, as are other vitamin/minerals/trace elements.

And what causes the genetic defect, more so where is this a defect gene in the body.

Always on the learning curve and this chemical/hormonal imbalance really interests me.

Your thoughts are highly appreciated, especially from the experts such as Sheryl, geriatrickid, chemist.

Nienke

[geriatrickid]

Chemist,

I though you wrote a succint and balanced explanation. Certainly better than what I would have tossed up. It is unfortunate that the words were read but not understood within the context which they were written.

[AlexLah]

Hi Chemist,

No need to apologise lah.

I did not feel you reply was agressive at all.

No worry.

[tim armstrong]

Anyone use antidepressants here ?

I asked for the price of Prozac at farmacy. It was 1100 bt 14 pills. This is nearly twice the price in my homecountry

Hi Love Bangkok,

There are some good and spirited responses to your question. As others have said and you no doubt know already, the causes of depression can be both internal or external. Symptoms may last a few months or a lifetime. In my 30yrs experience of treating and counselling depressed people, I would say that many people also develop significant anxieties that interfere with their recovery. Choosing drug treatments alone may control your depressive symptoms, but may not necessarily help you to be less anxious or productive, or relate to other people as you would like.

Much current research both in the psychiatric and psychological literature suggests that drug treatments, and psychological therapies have similar success rates in the long term. In other words, behaviour and lifestyle changes are as effective as altering your brain chemistry. There are now some really effective evidence based psych. therapies for depression, both conventional and alternative.

Of course drug companies don't really want to bring attention to this research, because depression in terms of the burden of disease on the community (ie Western countries) will be the number 2 health problem behind heart disease by 2020. Incidentally it was Eli Lilly the manufacturers of Zoloft who sponsored this widely quoted Harvard study. But the new SSRI anti depressants work very well with few side effects.

Amongst health professionals of all disciplines, there are many of us who think that depression is widely over diagnosed, because its a big, money earner. Someone who is going to use antidepressants twice a day for at least 2 years is a good customer. I recently worked in a very poor war torn country, where despite the huge loss of life over many years, the incidence of depression was much less than in advanced western countries. As health services were minimal most people found other non clinical ways of coping with their problems, and dealing with traumas that the rest of us could hardly imagine.

So, sorry for the rave, but do think carefully about the treatments you've already had, and whether or not they really have allowed you to function well, rather than just cope with life. Because many depressive conditions can be cured, with a combination of therapies, not just treated with drugs alone. Tim

[Sheryl]

Agree with bioth Chemist and Tim, and what they have each said is not incompatible.

I would add tho that while anti-depressents are indeed overprescribed they are also under-utilized by many of the people who do in fact need them. In other words there are both many people taking them who don't need them -- and in some cases have problems which these drugs will actually make worse --and many people who aren't taking them but would benefit by doing so. In the last instance it is often because the fact that the person is seriously depressed has not been recognized for what it is or the person is hesitant to use the drugs, and this is where I get concerned with the effect the anti-AD spiels may have. I have a close friend who lost her husband to suicide because he held off on taking drugs until it was too late (shot himself a few days into having finally started treatment...and yes, he was already in therapy). I myself had years of therapy, on and off, and finally "gave in" and reluctantly took SSRIs (while still in therapy) and it made a world of difference in my progress. I realized I should have "given in"and taken them years sooner. Sometimes, especially in depressions of very long-standing, the psychic energy which work in therapy requires is just not there.

Few other points:

Depression in the clinical sense and the depressed moods everyone gets from time to time should not be confused, they are utterly different. It's unfortunate that the same word is used as I think it leads both to unnecessary treatment (i.e. taking of anti-depressents by people who are simply experiencing a normal emotion) and to under-use/stigmatization of those who need to take them because others incorrectly assume that they are doing so to avoid the normal deprerssive moods they themselves experience.

Anyone who has not experiewnced true clinical depression has no idea of what it is like. It is in no way the same as the natural emotion of sadness or depression.

Clinical depression may be caused or (more likely) triggered/exacerbated by past trauma but it is by no means always the case. Not all clinically depressed people have such trauma in their past and not all people who have such traumas develop depression (altho most will develop some type of psychological problem)

Which brings me to my nextpoint : there are a wide range of pyschological or pyschiatric problems a person can have and the same person may have more than one type; in fact every disturbed person's disturbance is a blend unique to them. There are a wide range of pyschotropic drugs with different actions and indications. Hence the danger of self-prescribing or, for that matter, prescription by doctors who are not mental health specialists and/or do not know the patient well. Much harm can be done by giving a perfectly useful drug for one condition to someone whose particular blend of problems differs. Obviously the chances of having an accurate handle on what the problem is/what if any medicatiions are likely to be necessary or helpful is greater if the person is in therapy. Even a qualified physchiatrist can go wrong if prescribing on the basis of a one time consultation.

Lastly, don't forget the very valuable role SSRIs can play in menstrual dysphasic disorder (formerly called PMS). Mild sufferers can usually manage without them but for the not inconsiderable number of women with more severe forms it makes a world of difference. This particular condition has nothing to do with past traumas etc. and does not necessarily indicate a need for therapy. It is a hormone-mediated disturbance of neurotransmitters for which at present SSRIs are the most effective treatment.

So please don't stigmatize or condemn all anti-depressent use...but also don't rush inti self-medication or recommend same to others without being sure there is first a thorough understanding of their specific, individual problems.

[moldy]

Wow! how do you follow a posting like that ?. BANG ON.

So I'd like to talk about the subjective angle. I honestly think when talking about depression it's important to talk from your own depression so to speak. It may be rambling even a little pointless, and not immediately resolve the poster's pain, but we're more likely to be genuine and there are dangers when we assume the alternative position of playing rescuer/ false mystic without qualification.

Quick fix solutions don't work to be sure.

[chemist]

An excellent post, Sheryl!

The importance of one of the issues you brought up can't be stressed enough: Many people who would benefit greatly from antidepressant medical treatment never seek help, but instead they suffer for years and years. (In many cases this suffering ultimately ends in suicide.) Sure, many of these people would get better if they went into some psychological treatment like CBT (cognitive behaviour therapy), but in many cases something has to be done quickly to get the person motivated to start psychotherapy. As Sheryl so elegantly explained, clinical depression is not a state where you feel a little blue or temporarily sad. Most people suffering from major depressive disorder (MDD) have lost interest in EVERYTHING. Almost nothing feels good anymore, and life in general seems more or less pointless. (There are of course different levels here, from mild to severe, but MDD is still easily distinguishable from normal ups and downs.) Many many of these persons simply NEED to be on an antidepressant longterm, but that doesn't mean that they can't attend some kind of psychotherapy at the same time. As a matter of fact, and here Sheryl talked about her own experience, there is often a synergy between different treatment methods.

It has been shown over and over again that since the more modern antidepressants (the SSRIs (Selective Serotonin Reuptake Inhibitors), the modern SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors), etc) hit the market the suicide rate has gone down in most Western countries. So, we are talking about very important life-saving drugs here. At the same time some kind of paranoia regarding these drugs has grown exponentially (please look at some of the internet forums dealing with depression; in many of them some people seem to "know" that antidepressants are evil...). I think we are talking about a "moral" issue here. A lot of people believe firmly that taking ANY medication to improve psychiatric problems is somehow "wrong". Where does this attitude come from? I don't know, but probably it has something to do with the (in my view illogical) separation of mind and body in Western medicine. To treat the body with drugs is fine, but if you treat the mind medically...well, then many people think that you are somehow "erasing" or "changing" or "drugging" the patient's personality and what constitutes what he or she "is". This is a very sensitive issue, and I am sure much more can be said about it (especially WHY it is so sensitive).

Another misconception is that a patient taking for example an SSRI like Prozac (a "happy pill") will somehow live in a drug-induced worry-free bliss. While that can actually be true in rare cases, the vast majority of patients on SSRIs report that they now at least are able to live a somewhat normal life, and that they now have the strength to deal with life more confidently. Now, what is wrong with that, as long as the medicine doesn't hurt them? And what is the alternative for many people? Living in a black hole from which you see no escape? Furthermore, depression (and anxiety) has been linked to an increased risk of getting heart problems, cancer, diabetes etc due to the fact that depression and anxiety wear the body down.

The reason I myself studied chemistry and pharmacology at university is that I too have suffered from the illnesses we are talking about here. I simply wanted to know more, and felt that I was drawn to psychiatry and psychiatric drugs (and also psychology). So have I tried these medicines myself? Yes, I have, and the only thing I regret about that is that I should have started the pharmacological treatment much sooner.

By the way, depression and anxiety run in my family, so in my case I am certain that genetic factors are involved. Every day I feel thankful for living in an era when problems like these can be efficiently treated. That was not the case only about 50 years ago...

A little rambling there, I know, but it is late and I am tired. Time to hit the bed!

Cheers

chemist

[endure]

Few other points:

Depression in the clinical sense and the depressed moods everyone gets from time to time should not be confused, they are utterly different. It's unfortunate that the same word is used as I think it leads both to unnecessary treatment (i.e. taking of anti-depressents by people who are simply experiencing a normal emotion) and to under-use/stigmatization of those who need to take them because others incorrectly assume that they are doing so to avoid the normal deprerssive moods they themselves experience.

Anyone who has not experiewnced true clinical depression has no idea of what it is like. It is in no way the same as the natural emotion of sadness or depression.

Too true! I wish SSRIs had been available 20 years ago.

[tim armstrong]

An excellent post, Sheryl!

The importance of one of the issues you brought up can't be stressed enough: Many people who would benefit greatly from antidepressant medical treatment never seek help, but instead they suffer for years and years. (In many cases this suffering ultimately ends in suicide.) Sure, many of these people would get better if they went into some psychological treatment like CBT (cognitive behaviour therapy), but in many cases something has to be done quickly to get the person motivated to start psychotherapy. As Sheryl so elegantly explained, clinical depression is not a state where you feel a little blue or temporarily sad. Most people suffering from major depressive disorder (MDD) have lost interest in EVERYTHING. Almost nothing feels good anymore, and life in general seems more or less pointless. (There are of course different levels here, from mild to severe, but MDD is still easily distinguishable from normal ups and downs.) Many many of these persons simply NEED to be on an antidepressant longterm, but that doesn't mean that they can't attend some kind of psychotherapy at the same time. As a matter of fact, and here Sheryl talked about her own experience, there is often a synergy between different treatment methods.

It has been shown over and over again that since the more modern antidepressants (the SSRIs (Selective Serotonin Reuptake Inhibitors), the modern SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors), etc) hit the market the suicide rate has gone down in most Western countries. So, we are talking about very important life-saving drugs here. At the same time some kind of paranoia regarding these drugs has grown exponentially (please look at some of the internet forums dealing with depression; in many of them some people seem to "know" that antidepressants are evil...). I think we are talking about a "moral" issue here. A lot of people believe firmly that taking ANY medication to improve psychiatric problems is somehow "wrong". Where does this attitude come from? I don't know, but probably it has something to do with the (in my view illogical) separation of mind and body in Western medicine. To treat the body with drugs is fine, but if you treat the mind medically...well, then many people think that you are somehow "erasing" or "changing" or "drugging" the patient's personality and what constitutes what he or she "is". This is a very sensitive issue, and I am sure much more can be said about it (especially WHY it is so sensitive).

Another misconception is that a patient taking for example an SSRI like Prozac (a "happy pill") will somehow live in a drug-induced worry-free bliss. While that can actually be true in rare cases, the vast majority of patients on SSRIs report that they now at least are able to live a somewhat normal life, and that they now have the strength to deal with life more confidently. Now, what is wrong with that, as long as the medicine doesn't hurt them? And what is the alternative for many people? Living in a black hole from which you see no escape? Furthermore, depression (and anxiety) has been linked to an increased risk of getting heart problems, cancer, diabetes etc due to the fact that depression and anxiety wear the body down.

The reason I myself studied chemistry and pharmacology at university is that I too have suffered from the illnesses we are talking about here. I simply wanted to know more, and felt that I was drawn to psychiatry and psychiatric drugs (and also psychology). So have I tried these medicines myself? Yes, I have, and the only thing I regret about that is that I should have started the pharmacological treatment much sooner.

By the way, depression and anxiety run in my family, so in my case I am certain that genetic factors are involved. Every day I feel thankful for living in an era when problems like these can be efficiently treated. That was not the case only about 50 years ago...

A little rambling there, I know, but it is late and I am tired. Time to hit the bed!

Cheers

chemist

Good discussion. And indeed one person's experience is not the same as another. But I just wish there was not the lemming like rush to find a quick fix for every ailment. Tim

[bkkperson]

Like you said, it is always refreshing with an open discussion about sensitive things. I feel that I have to apologize a little bit for my aggressive style in my post above. I wrote it late last night, and I wass tired as h_ell.

Hmm....a chemist getting ratty as he was up to late and tired as hel_l maybe he should be staying off the pills and applying a bit of group anger managment theropy.....hmm very interesting..will take note

[chemist]

Like you said, it is always refreshing with an open discussion about sensitive things. I feel that I have to apologize a little bit for my aggressive style in my post above. I wrote it late last night, and I wass tired as h_ell.

Hmm....a chemist getting ratty as he was up to late and tired as hel_l maybe he should be staying off the pills and applying a bit of group anger managment theropy.....hmm very interesting..will take note

bkkperson, I don't recall saying that I was on any medication right now. But I will of course follow your advice about anger management.

Tim, I agree that sometimes people are looking for a quick fix. In many of these cases I can understand that, if the persons in question have been suffering for years. I mean, who can blame them?

At the same time, and perhaps I have not been so clear on this point, I think that for longterm solutions of these problems (for example depression) multiple approaches are necessary. These approaches naturally have to be tailored to fit each individual case, as we all are different. What is good for person A is not necessarily good for person B, and vice versa. In MY case, medication offered the best solution for a couple of years until I felt ready and mature enough to start a psychotherapeutic intervention. The psychological method(s) simply didn't give me anything of value (yes, I tried several) until I had put my life in reasonable order with the help of antidepressants and anxiolytics.

What is important here is to avoid sweeping generalizations like "psychiatric drugs don't work" or "psychotherapy is a load of BS" (I don't mean that you used generalizations like those, Tim).

Best regards

chemist

Edited January 23, 2008 by chemist

[tim armstrong]

Like you said, it is always refreshing with an open discussion about sensitive things. I feel that I have to apologize a little bit for my aggressive style in my post above. I wrote it late last night, and I wass tired as h_ell.

Hmm....a chemist getting ratty as he was up to late and tired as hel_l maybe he should be staying off the pills and applying a bit of group anger managment theropy.....hmm very interesting..will take note

bkkperson, I don't recall saying that I was on any medication right now. But I will of course follow your advice about anger management.

Tim, I agree that sometimes people are looking for a quick fix. In many of these cases I can understand that, if the persons in question have been suffering for years. I mean, who can blame them?

At the same time, and perhaps I have not been so clear on this point, I think that for longterm solutions of these problems (for example depression) multiple approaches are necessary. These approaches naturally have to be tailored to fit each individual case, as we all are different. What is good for person A is not necessarily good for person B, and vice versa. In MY case, medication offered the best solution for a couple of years until I felt ready and mature enough to start a psychotherapeutic intervention. The psychological method(s) simply didn't give me anything of value (yes, I tried several) until I had put my life in reasonable order with the help of antidepressants and anxiolytics.

What is important here is to avoid sweeping generalizations like "psychiatric drugs don't work" or "psychotherapy is a load of BS" (I don't mean that you used generalizations like those, Tim).

Best regards

chemist

Thanks chemist. I think we are in agreement, but from different angles. In recent years its been good for me to work in 'developing' countries where many people simply don't have time for depression because they are just trying to survive the day. So I do get concerned about the over diagnosis of this problem, which for sure does cause long term dysfunction for some,- and the current meds do help a lot. Incidentally, Amitryptiline seems to work really well in small doses in these countries, but not so in more developed ones. Any thoughts ? Cheers, Tim

[chemist]

Thanks chemist. I think we are in agreement, but from different angles. In recent years its been good for me to work in 'developing' countries where many people simply don't have time for depression because they are just trying to survive the day. So I do get concerned about the over diagnosis of this problem, which for sure does cause long term dysfunction for some,- and the current meds do help a lot. Incidentally, Amitryptiline seems to work really well in small doses in these countries, but not so in more developed ones. Any thoughts ? Cheers, Tim

Yes, amitriptyline (brand names Elavil, Tryptizol, etc) is a very interesting substance. As you probably know it is one of the old tricyclic antidepressants, and it is rarely used for depression anymore in developed countries. So what makes it interesting? One reason it that amitriptyline targets a lot of neurotransmittors in the brain (it is by no means "selective", like the SSRIs for example). It is a serotonin (5-HT, 5-hydroxytryptamine) reuptake inhibitor, a noradrenaline reuptake inhibitor, a strong 5-HT2 receptor antagonist (blocker), a histamine 1 (H1) receptor antagonist, and it also displays fairly strong anticholinergic properties, etc. Now, almost all of those modes of action (including the anticholinergic one) are in one way or another linked with antidepressant response (the H1 antagonism results in sedation, anxiolysis and sleep pattern improvements), and this means that this drug can be regarded as "polypharmacy" in one pill. What most people are not aware of is that amitriptyline is one of the most effective antidepressants known.

You have probably heard the phrase "selective" being touted as something good when it comes to antidepressants. However, during the last decade the pharmaceutical companies have changed strategy because they have "rediscovered" that it is actually good to influence more than one transmittor substance if you want to treat depression pharmacologically. So, the recent hype is to combine for example an SSRI (like Prozac, etc) or a modern SNRI (Serotonin and Noradrenaline Reuptake Inhibitor) like Effexor (venlafaxine) or Cymbalta (duloxetine) with low doses of an atypical antipsychotic like Seroquel (quetiapine) or Zyprexa (olanzapine) in hard-to-treat cases of depression. So what do those combinations give us pharamacology-wise? Well, we get serotonin reuptake inhibition, noradrenaline reuptake inhibition, 5-HT2 receptor antagonism, histamine 1 receptor antagonism and some anticholinergic effects (plus some dopamine receptor modulation)... Sounds familiar? In other words we have now almost come full circle back to the pharmacodynamics of the old tricyclics, like amitriptyline and clomipramine. Interesting, in my view.

So why isn't for example amitriptyline used so much anymore in the West? One reason is that the side effects tend to be a little harsh in higher doses (>75 mg per day), and also that amitriptyline can cause death by heart failure when overdosed (suicide attemts). AND, of course, the patent for amitriptyline ran out decades ago, which means that especially the generics are dirt cheap (not much money to make here).

But I think the most important reason as to why amitriptyline "doesn't work" in the West is that Western people simply don't accept bothersome side effects (even if transient), while people in poorer countries are more "tough" in that regard (they are simply glad that something works). (Ok, that was a theory of mine, but I think that it makes sense.)

However, small doses of amitriptyline (10-50 mg per day) ARE being used in the West to help with fibromyalgia and various pain syndromes (and the drug is really helpful here). Many doctors have also noticed that their patients taking amitriptyline for some pain disorder also often report that they feel more positive and calm, i e they experience an antidepressive effect even when using those low doses (even if the amitriptyline wasn't prescribed for that in the first place).

What I am trying to say here is that often older is better (and definitely cheaper).

Best regards

chemist

Edited January 27, 2008 by chemist

[tim armstrong]

Thanks chemist. I think we are in agreement, but from different angles. In recent years its been good for me to work in 'developing' countries where many people simply don't have time for depression because they are just trying to survive the day. So I do get concerned about the over diagnosis of this problem, which for sure does cause long term dysfunction for some,- and the current meds do help a lot. Incidentally, Amitryptiline seems to work really well in small doses in these countries, but not so in more developed ones. Any thoughts ? Cheers, Tim

Yes, amitriptyline (brand names Elavil, Tryptizol, etc) is a very interesting substance. As you probably know it is one of the old tricyclic antidepressants, and it is rarely used for depression anymore in developed countries. So what makes it interesting? One reason it that amitriptyline targets a lot of neurotransmittors in the brain (it is by no means "selective", like the SSRIs for example). It is a serotonin (5-HT, 5-hydroxytryptamine) reuptake inhibitor, a noradrenaline reuptake inhibitor, a strong 5-HT2 receptor antagonist (blocker), a histamine 1 (H1) receptor antagonist, and it also displays fairly strong anticholinergic properties, etc. Now, almost all of those modes of action (including the anticholinergic one) are in one way or another linked with antidepressant response (the H1 antagonism results in sedation, anxiolysis and sleep pattern improvements), and this means that this drug can be regarded as "polypharmacy" in one pill. What most people are not aware of is that amitriptyline is one of the most effective antidepressants known.

You have probably heard the phrase "selective" being touted as something good when it comes to antidepressants. However, during the last decade the pharmaceutical companies have changed strategy because they have "rediscovered" that it is actually good to influence more than one transmittor substance if you want to treat depression pharmacologically. So, the recent hype is to combine for example an SSRI (like Prozac, etc) or a modern SNRI (Serotonin and Noradrenaline Reuptake Inhibitor) like Effexor (venlafaxine) or Cymbalta (duloxetine) with low doses of an atypical antipsychotic like Seroquel (quetiapine) or Zyprexa (olanzapine) in hard-to-treat cases of depression. So what do those combinations give us pharamacology-wise? Well, we get serotonin reuptake inhibition, noradrenaline reuptake inhibition, 5-HT2 receptor antagonism, histamine 1 receptor antagonism and some anticholinergic effects (plus some dopamine receptor modulation)... Sounds familiar? In other words we have now almost come full circle back to the pharmacodynamics of the old tricyclics, like amitriptyline and clomipramine. Interesting, in my view.

So why isn't for example amitriptyline used so much anymore in the West? One reason is that the side effects tend to be a little harsh in higher doses (>75 mg per day), and also that amitriptyline can cause death by heart failure when overdosed (suicide attemts). AND, of course, the patent for amitriptyline ran out decades ago, which means that especially the generics are dirt cheap (not much money to make here).

But I think the most important reason as to why amitriptyline "doesn't work" in the West is that Western people simply don't accept bothersome side effects (even if transient), while people in poorer countries are more "tough" in that regard (they are simply glad that something works). (Ok, that was a theory of mine, but I think that it makes sense.)

However, small doses of amitriptyline (10-50 mg per day) ARE being used in the West to help with fibromyalgia and various pain syndromes (and the drug is really helpful here). Many doctors have also noticed that their patients taking amitriptyline for some pain disorder also often report that they feel more positive and calm, i e they experience an antidepressive effect even when using those low doses (even if the amitriptyline wasn't prescribed for that in the first place).

What I am trying to say here is that often older is better (and definitely cheaper).

Best regards

chemist

Thanks for that very informative reply. I think your theory is right - about side effects. Indeed, its interesting how things have come full circle. Funny what happens when patents run out.

Cheers, Tim

[Sheryl]

Tim and Chemist,

I don't think it as much a question of toughing out side effects as it may be of different neurochemical problems responding differently to drugs that affect them.

I have been struck by how differently Thais and Westerners respond to drugs that act on the CNS. Thais are very easily sedated (understatement!) and doses of sedatives and pain killers that are technically sub-clinical seem to work on them. (Not to mention the "instantly falling asleep sitting upright in an all night bus" pehenomena!). Depressing the CNS of a westerner enough to produce sedation or pain relief takes a good deal more.

In addition, drug abuse in Thailand is heavily focused on stimulents. In the west, there is stimulent abuse but alrguably more abuse of depressents (heroin, benzos etc).

Cambodians are yet another different group...as hard to sedate as westerners but likewise inclined to seek out stimulents rather than depressents as drug of choice among substance abusers.

I have both directly observed, and been told by mental health professionals working in Cambodia, that Cambodians do not respond very well to SSRIs and do better on drugs that affect a wider range of neurotransmitters, such as amitriptyline. Many westerners, on the other hand, do better with an SSRI for simple depression.

I recently tried Sibutramide for weight loss, a preperation that apparently works very well for many Thais. Knowing it had SRI effects I went off my Zoloft first to avoid serotonin syndrome then started. Did nothing for me in the way of appetite control but made me feel awful bordering on crazy, which I attribute to the noradrenaline effects...which I clearly did not need. Gave it up, back on the Zoloft, and all is well again (except of course still unresolved over-healthy appetite!)

My point being that individuals with depression and other mood disorders do not all necessarily have the same neurotransmitters affected to the same degree, and there may be general tendencies in that regard by culture (perhaps both from social/environmental and genetic factors) but of course there will always be exceptions to the norm within particular ethnic groups.

[TCA]

PS I forgot to mention that some of the old tricyclic antidepressants (such as amitriptyline, brand names Elavil/Tryptizol/Tryptanon) are very cheap even in Thailand (around 3 baht per 25 mg amitriptyline pill for the original brands; maybe even cheaper when it comes to the generic versions). These older antidepressants are very effective (sometimes more so than the newer ones), but the side effects are often more harsh and you have to be careful not to take too much (risk of severe heart problems, etc in case of an overdose). However, if you "start low and go slow" with these older medications the result can often be very good.

Does anyone know if Amitriptyline is available in Thailand in 10mg pills? Either brand names or generic.

Thanks.

[Sheryl]

Widely available under many brand names, both local and imported.

If you want inexpensive local brand of reliable quality I suggest amitriptyline GPO. Comes in 10mg dose.

I assume you already know about contraindications and adverse effects, but if not then obviously should read up on it.

[ArranP]

is the fluoxetine here in thailand the same as the fluoxetine from the UK, I've been taking this drug for over 2 years in the UK but now I'm living here in Thailand.

In the UK the drug comes in a white and green capsule, here in thailand I just got my first batch, these are white and pink and I do not feel the same after taking them..... I have switched back onto what is left of my white and green ones from the UK batch, hoping to find a solution soon..... any advice much appreciated,

thank you.