Our expert says:
All this talk of neurochemicals does get confusing, doesn't it. Frankly, it confuses many doctors and experts, too. Every time it seems to be becoming clearer, someone discovers a newer chemical, or receptor, and it all gets muddy again.
Serotonin-active agents are not at all necessarily stimulating or anxiety proviking - many people find them very handy in managing anxiety disorders. And there are now also many different recognized sub-types of serotonin receptor which explains some of the complexity of how individuals respond differently to the same drug.
Coffee contains caffeine which usually stimulates a faster pulse rate - but most people dont check their pulse before and after a cappucino, an of course if you get anxious about the drug, or the coffee, or anything, that in itself puts the pulse rate up.
Whenever possible I would ALWAYS use the generic form of any drug where a generic is available ; there is no true advantage to taking the more expensive option, except for the drug company.
Two things I don't understand.
I don't understand at all what your doc says about no evidence that agomalatine works in panic disorder. There's loads of evidence, and a simple google search reveals dozens of scientific papers on the topic and the drug company could provide her with more. Its a bizarre opinion for her to hold. And I dont understand how any drug that is effective in anxiety generally, wouldn't be useful in panic dsorder.
And I don't understand your "electrophysiologist";s comment ( maybe as a physiologist not a psychiatrist or pharmacologist, he's not really familiar with drugs ) - but ALL drugs circulate around the body and are widely available to its parts. Maybe he's thinking about whether the drug is available to the synapses ( nerve endings / junctions ) in the brain, rather than in the heart. But this doesn't make sense either. Some drugs dont cross what we call the blood-brain barrier, that is, they can be swallowed or injected, and will be available all round the body, but won't get into the brain itself ; there is no drug which someone miraculously gets into the brain and its synapses, but not into the rest of the body.
Maybe I've had a bad day, and need to sit down with a cup of coffee, and tickle my synapses.
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