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
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
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.
