Anyway I thought I would send this to both of you, TAP and Drugmonkey to see if you had a rant to develop.
I know you both probably think Ambien is bad medicine…. If you don’t, I do.
Ambien for depression? Maybe if you are depressed because your brain cannot recharge its neurotransmitters during sleep. Even that is a stretch. If the patient is responding bad to an SSRI, why not just give him/her Remeron and kill two birds with one stone? Knocks him/her out, and has antidepressant effects. Some people have even resorted to abusing Artane just to get that amped up feeling. Treating the side effects of a medication with another medication (AKA PolyPharmacy) just leads down the road to trouble. Funny how you mention that Ambien vs Ambien CR. Its like Artane is way more activating than Cogentin is. Trazodone has been used for years for this, and even though one out of a million men will have an eternally hard pecker, its worked wonderful for the last bazillion years. As far as the SSRI’s go, last I checked Prozac was the most activating (which is why it was initially investigated as a weight loss drug, only to be found to improve mood. Plus its dirt cheap. People are beginning to realize that they can pay 10 bucks cash for 30 generic ambien vs a $50 copay for trade name Ambien CR. However one of the clinical side effects of depression is lethargy/sleeping a ton. Next think you know the patient is on 30 different meds, you cannot switch any of them without a cascading failure as they get out of equilibrium, and when they get hospitalized its a real pain in the ass to treat them. I think that people underestimate the power of a good solid 8+ hours of sleep. I think you’re on the right track here. Henceforth the SSRI craze was born) while Paxil (and its anticholinergic effects) was the most sedating. Sinofi must be crapping their pants and trying to come up with new indications.
Ok. zoloft) in the evening. paxil) in the morning. Last I checked, and granted its been awhile, but all SSRIs are not created equal. Yes, depression. Regardless, today a miniskirted, stilletto heeled prostirep came into my office and tried to l me that some Doc, which she desribed as a “sleep guru”, is now reccomending Ambien for depression. The premise of the argument is that SSRIs can be activating and that ambien CR (which is magical as opposed to regular ambien which is poison) should be used to combat the insomnia “common” to ALL SSRIs. some sedate, some activate, and those of us who prescribe with half a brain will l the patient to take the activating ones (i.e. and the occasionally sedating (i.e.
Obviously if the patient needs 30 a month in order to sleep there is something deep underlying that needs to be addressed. Eh, for occasional use its perfectly fine (especially if the patient just had a traumatic event/surgery/etc).
This was sent from an MD to both the DrugNazi and myself. Here is my take on it.
(in the bad sense). they just pop up with some “study” and pass them out like they are “educating” me. Am I off base here? It seems the reps have a new strategy for pushing off label uses. It seems that this is barely legal.
Giving a clinically depressed person (who doesn’t want to get out of bed, shows no sign of doing things that would normally make him/her happy, etc) a CNS depressant seems like pouring gasoline on the fire. Yeah, I think something is seriously retarded with this drug rep or some key information was not being relayed to you. Clearly the SSRI’s are tons more dangerous in high doses than Ambien (which is very Benzo like). Actually people don’t realize how hard it is to treat an aspirin overdose, and that kills more people than Rx medication does. Overdosage might or might not be an issue here.
Oh, and the advisability of giving a patient a clearly addicting medicine (I dont care what the prostirep says) especially when they are depressed and at high risk for overdose seems inadvisable at best, and possibly malpractice at worst.
More doc’s need to do this and show the drug companies (and the hot reps they employ) that doctors are not their little pawns in a money-making scheme. No, actually I’m thrilled that you are questioning what the talking heads are blabbing at you.Ambien depression