Why is there No antidepressant with same makeup of Tramadol

[tacogirl]

Hello,

I used to take Aramadol, no more, but it did improve my mood. My doctor started me on Cymbalta (Duloxetint} a month ago, felt nothing, and he just added Abilify. Why are they No antidepressant with the exact qualities?...or a combination of drugs. I've herd this many times and there just not seem to be a dupe...does anyone know why??

 

[JeffRX]

I find ODSMT, which is main active metabolite in Tramadol, to have incredible anti-depressant properties and not to lead to crippling opiate addiction as long as you maintain on low doses.  It's sold as an RC, although it has been studied for ages and is likely to receive FDA approval as a prescription drug soon, and is much more affordable than Tramadol. Your doctor won't  be able to prescribe it but it's something that has really helped me and is fairly easy to locate online.

 

[7ohmbro]

I find ODSMT, which is main active metabolite in Tramadol, to have incredible anti-depressant properties and not to lead to crippling opiate addiction as long as you maintain on low doses.

lol... easier said than done

 

[JeffRX]

lol... easier said than done

You're not wrong there  but at least it's cheap. And I find that capsuling my intended daily dosages up as soon as the powder arrives helps me to stick to my planned dosing schedule vs. just having a big baggy of powder sitting around.

 

[vs322]

I've studied quite a bit of psychopharmacology, so I think I can shed some light on the OP's question.  Until pretty recently, antidepressant discovery was largely trial-and-error, or random luck/observation.  Only rather recently have chemists begun designing antidepressants by first figuring out what the molecule should look like, and then make and test it.  ("Rather recently" = ~20+ years, but recent compared to other medical advances).  Even now the bulk of new-drug development in this form entails things like selecting a particular optical isomer of a known drug, or modifying like one moiety not thought to be the main driver of the drugs effects.

You'll notice that new antidepressants kind of come in waves—like prozac came out, the shortly(ish) thereafter, a bunch of other SSRIs came out.  Same thing, more or less with MAOIs and tricyclics.  Developing from scratch a drug that has certain desirable clinical effects is really, really hard, and usually requires some luck.

As for combinations of drugs achieving a desired therapeutic outcome, this is really hard for researchers to study, for statistical reasons that I'll spare you unless you're interested.  When psychopharmacologists start down the polypharmacy road with a patient, there's a lot of guesswork and trial-and-error.  The good ones can often develop a successful polypharmacy course of treatment for a given patient, but it's a bumpy process that often takes years of experimentation and evaluation.

But getting back to the thing you (the OP) actually care about, ask your doctor about switching to Effexor (venlafaxine) instead of cymbalta.  If s/he chose Cymbalta because it has some efficacy against chronic pain and neuropathy, ask about accomplishing that with perhaps gabapentin instead, so that you'd be swapping out Cymbalta for Effexor and gabapentin.

As for the Abilify, I urge you to stop that (ask your doctor first, of course...), especially if you are young-ish, i.e., if you expect to live more than another 5-10 years.  My understanding, informed by three expert doctors, is that for someone taking abilify, the question is not *if* they'll develop tardive dyskinesia, but rather *when* they'll develop it.  And TD is largely irreversible, I think.  At a minimum, you should seek a second opinion.  Also, I don't know your insurance or financial situation, and I'm not sure whether it's still on-patent, but back when I briefly took it, only the brand-name was available, and the cash price was like $700/month.  I had pretty decent insurance, but I still had a $60 copay each month.  

But I digress...  Best of luck and G*d bless!

 

[JeffRX]

I've studied quite a bit of psychopharmacology, so I think I can shed some light on the OP's question.  Until pretty recently, antidepressant discovery was largely trial-and-error, or random luck/observation.  Only rather recently have chemists begun designing antidepressants by first figuring out what the molecule should look like, and then make and test it.  ("Rather recently" = ~20+ years, but recent compared to other medical advances).  Even now the bulk of new-drug development in this form entails things like selecting a particular optical isomer of a known drug, or modifying like one moiety not thought to be the main driver of the drugs effects.

You'll notice that new antidepressants kind of come in waves—like prozac came out, the shortly(ish) thereafter, a bunch of other SSRIs came out.  Same thing, more or less with MAOIs and tricyclics.  Developing from scratch a drug that has certain desirable clinical effects is really, really hard, and usually requires some luck.

As for combinations of drugs achieving a desired therapeutic outcome, this is really hard for researchers to study, for statistical reasons that I'll spare you unless you're interested.  When psychopharmacologists start down the polypharmacy road with a patient, there's a lot of guesswork and trial-and-error.  The good ones can often develop a successful polypharmacy course of treatment for a given patient, but it's a bumpy process that often takes years of experimentation and evaluation.

But getting back to the thing you (the OP) actually care about, ask your doctor about switching to Effexor (venlafaxine) instead of cymbalta.  If s/he chose Cymbalta because it has some efficacy against chronic pain and neuropathy, ask about accomplishing that with perhaps gabapentin instead, so that you'd be swapping out Cymbalta for Effexor and gabapentin.

As for the Abilify, I urge you to stop that (ask your doctor first, of course...), especially if you are young-ish, i.e., if you expect to live more than another 5-10 years.  My understanding, informed by three expert doctors, is that for someone taking abilify, the question is not *if* they'll develop tardive dyskinesia, but rather *when* they'll develop it.  And TD is largely irreversible, I think.  At a minimum, you should seek a second opinion.  Also, I don't know your insurance or financial situation, and I'm not sure whether it's still on-patent, but back when I briefly took it, only the brand-name was available, and the cash price was like $700/month.  I had pretty decent insurance, but I still had a $60 copay each month.  

But I digress...  Best of luck and G*d bless!

Effexor is hands down the worst thing I've ever been prescribed. It made my life a nightmare, and this was before I ever "self-prescribed" myself other drugs or took recreational drugs at all.

Of course, everything affects everyone differently, so who knows how it will affect you. But just sharing my experience.

 

[vs322]

@JeffRX  Useful input (seriously!)  Even though drugs affect different people in different ways, I think it's valuable to share our experiences so that if someone else notices the same thing, they'll know it's not just in their head.

For me, Abilify was absolute hell.  I won't even write down the lengths to which I would be willing to go to avoid taking that stuff again.  But for some people, under some circumstances, it's a miracle drug.  Go figure...

Likewise, citalopram gave me disabling vertigo (I couldn't go up or down stairs), and apparently that's a relatively rare side effect, but you never adapt to it, so citalopram is off the table for me.  But my doctor switched me to escitalopram (the "S" enantiomer of racemic citalopram), and it worked pretty well with no trace of vertigo.

To end on a lighter note (kind of), when my brother got his wisdom teeth removed, he was prescribed tylenol with codeine, and he complained to the doctors that it was doing anything at all.  The doctors thought he was just trying to score some stronger opioids, so they blew him off.  He took a lot of recreational drugs at that point, so the doctors seemed to be making a responsible call.  But flash forward several years, and my brother discovers that he has some abnormality with one of his CYP450 enzymes, and he literally can't metabolize codeine!