Can someone clear something up about SSRI pharmacology?

[JackiesBabyy]

SSRIs generally work by inhibiting the SERT so less serotonin is transported out, leaving more in the synapse, therefore increasing the level of serotonin and helping depression

Well, I read about the opposite of SSRIs, SSREs. http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_enhancer

The one SSRE drug is also an antidepressant, even though it does the opposite of what SSRIs do and increase binding to the SERT and decreasing the level of serotonin in the synapse.

How do these both work for depression if they do opposite things?

 

[sekio]

Who knows, depression is a very complex issue, ant tianeptine is the only drug of its class. No other drugs have ever been classed as a SSRE, and even then tianeptine's mechanism of action remains unknown.

SSRIs in general have only proven to work in major depression anyway.

 

[P A]

SSRIs in general have only proven to work in major depression anyway.

Actually, IIRC, the one indication for which SRIs have proven to be minimal in effect size is, ironically enough, MDD itself. For severe depression, SRIs appear to be of some benefit, but their efficacy in mild-moderate cases remains unclear.

Also, for your reading pleasure: Fluvoxamine: An Updated Review of its Use in the Management of Adults with Anxiety Disorders

 

[endotropic]

Well SSRI's take weeks before any antidepressant effect is noticed. One theory for why this might be is when you start SSRI treatment serotonin autoreceptors in some parts of the brain are activated, and this activation causes a decrease in serotonin release in other parts of the brain (most importantly the hippocampus). After weeks of treatment the autoreceptors stop responding, serotonin levels in the hippocampus rise and the drug becomes effective.

Tianeptine on the other hand gives antidepressant effects instantly, at least according to one study from 1988 gleaned from a wikipedia page. So it's possible that when serotonin reuptake is enhanced, the autoreceptors are less active, serotonin levels in the hippocampus rise right away, and voila antidepression.

Really that's just a guess though. The real reason is probably much more complex or completely unrelated to serotonin.

 

[P A]

The real reason is probably much more complex or completely unrelated to serotonin

And this is not to mention the less-than-stellar quality of the research backing such unorthodox drugs as tianeptine in the first place.

I'd be willing to bet that it exerts similar therapeutic effects as mild stimulant-like compounds such as modafinil, and that it likely produces a similarly meager, though statistically significant, effect size in psychiatric patients.

It's MOA, however, is probably slightly different. I'm thinking dopaminerigc disinhibition in the accumbens and subsequent postsynaptic stimulation of opioid receptors might be to blame for its (supposed) efficacy and mild rewarding properties, but it really is a guessing game at this point.

 

[Epsilon Alpha]

I smell zoklet lol
Tianeptine's main known mechanism actually seems to be modulation of AMPA glutamate receptors, and the whole SSRE bit was controversial from the get go even from the primary research.

 

[Dysphoric]

I've heard nothing but good from Tianeptine. I'm really curious as to why it still isn't here in America.

 

[P A]

I'm really curious as to why it still isn't here in America.

Better (i.e. more stringent) regulatory standards and a deeply entrenched preference for and confidence in variations on existing treatments (SRIs, tricyclics, MAOIs, etc.), to put it simply. This is a big part of the reason why drug relabeling (e.g. Wellbutrin-Zyban, Provigil-Nuvigil) is so rampant in these parts.

 

[alkap555]

For certain ADs--venlafaxine in particular--the antidepressant mechanism may involve downstream modulation of opioidergic tone. The following study demonstrates the abolishment of venlfaxine's antidepressant action in mu opioid receptor KO mice. The putative involvement of the endogenous opioid system may help explain the severity of the withdrawal symptoms associated with abrupt discontinuation of venlafaxine, relative to other SSRI/SNRIs.

http://www.ncbi.nlm.nih.gov/pubmed/20703010

This paper also demonstrates the abolishment of venlafaxine-mediated analgesia with naloxone administration:

http://www.ncbi.nlm.nih.gov/pubmed?term=16462101

*Both papers can be accessed for free*

 

[Dysphoric]

Better (i.e. more stringent) regulatory standards and a deeply entrenched preference for and confidence in variations on existing treatments (SRIs, tricyclics, MAOIs, etc.), to put it simply. This is a big part of the reason why drug relabeling (e.g. Wellbutrin-Zyban, Provigil-Nuvigil) is so rampant in these parts.

Disgusting!

 

[P A]

Disgusting!

I agree, but with some reservations. The quality and quantity of the research demonstrating tianeptine's clinical efficacy is disproportionate to the glowing accolades it has received on internet fora such as these. This fact alone should raise a skeptical eyebrow or two, especially when one considers the amount of money there is to be made selling 'bootleg' prescription drugs overseas. The shady quality of those markets and the paucity of long-term safety data for the drug(s) that they sell are more than enough to give me pause. As someone who could really use something along the lines of what tianeptine users claim to obtain from the drug, I elect not to search high and low for this drug because, at the end of the day, anecdotal reports and overseas merchants do not pass my personal evaluation for drug safety and efficacy. I may not be happy with the many of the DEA/FDA's tightwad policies re. experimental drug therapies in principle, but I don't look forward to the day that anti-FDA sentiment returns us to an era of technologically upgraded, retrofitted patent medicines and cure-all tinctures, in which I suspect that drugs like tianeptine would find a happy home.

 

[JackiesBabyy]

Better (i.e. more stringent) regulatory standards and a deeply entrenched preference for and confidence in variations on existing treatments (SRIs, tricyclics, MAOIs, etc.), to put it simply. This is a big part of the reason why drug relabeling (e.g. Wellbutrin-Zyban, Provigil-Nuvigil) is so rampant in these parts.

The reason relabeling is so common is because Pharma companies like money and they like to have a drug to themself for as long as they can. Look at vyvanse-adderall too. (yeah, one is d-amp and one is d-amp/l-amp, but provigil nuvigil is modafinil and armodafinil, which is for all intents and purposes modafinil)

IIRC, their excuse for the wellbutrin-zyban one is the former is supposed to be the antidepressant and the latter is supposed to be for quitting smoking, but I see people using the former for quitting smoking all the time.

 

[P A]

The reason relabeling is so common is because Pharma companies like money and they like to have a drug to themself for as long as they can.

Yesyes, those evil greedy corporations sure are evil and greedy.

I regret to inform you that the reality of the pharmaceutical industry is slightly more complicated than that. Drug companies do indeed love (and often financially need) to procure patent extensions for their blockbuster drug of the week, but greed isn't always the primary issue. The sheer amount of research that must conducted on a new drug candidate before its safety and efficacy data is submitted to the FDA for review (all of which is bankrolled by the pharm company, by the way) is so costly that many drug companies must use such underhanded, money-grubbing tactics simply to recoup losses, break even, or, if they're lucky, turn a profit, which would allow them to work on the development of a new new drug for later submission to the FDA, and so on ad infinitum. The hackneyed, hobbled trend of forced (non-)innovation is intrinsic and unique to Big Pharma for precisely this reason, and not necessarily because the Big Bad Men at the Top hate the little guy and love their ten-thousand-dollar suits. It is the nature of the beast that is the regulated market - not the all-consuming greed of a few faceless corporations - that ultimately underpins our current psychotropic stagnation.

The fact of the matter is that the FDA and Big Pharma love the familiar, tried-and-true successes of yesterday because that is what pays the bills and allows the entire biomedical industry to tread water whilst awaiting the next 'big discovery' to show up in the beaker of some mad scientist who is fully willing to take the risks that the company men are not. It is very telling that most major drug discoveries were accidental and, at least to begin with, were not even funded as such.

 

[JackiesBabyy]

Yesyes, those evil greedy corporations sure are evil and greedy.

I regret to inform you that the reality of the pharmaceutical industry is slightly more complicated than that. Drug companies do indeed love (and often financially need) to procure patent extensions for their blockbuster drug of the week, but greed isn't always the primary issue. The sheer amount of research that must conducted on a new drug candidate before its safety and efficacy data is submitted to the FDA for review (all of which is bankrolled by the pharm company, by the way) is so costly that many drug companies must use such underhanded, money-grubbing tactics simply to recoup losses, break even, or, if they're lucky, turn a profit, which would allow them to work on the development of a new new drug for later submission to the FDA, and so on ad infinitum. The hackneyed, hobbled trend of forced (non-)innovation is intrinsic and unique to Big Pharma for precisely this reason, and not necessarily because the Big Bad Men at the Top hate the little guy and love their ten-thousand-dollar suits. It is the nature of the beast that is the regulated market - not the all-consuming greed of a few faceless corporations - that ultimately underpins our current psychotropic stagnation.

The fact of the matter is that the FDA and Big Pharma love the familiar, tried-and-true successes of yesterday because that is what pays the bills and allows the entire biomedical industry to tread water whilst awaiting the next 'big discovery' to show up in the beaker of some mad scientist who is fully willing to take the risks that the company men are not. It is very telling that most major drug discoveries were accidental and, at least to begin with, were not even funded as such.

I didn't say pharma companies and the FDA are evil, greedy bastards who hate sick people. I don't think that. I'm just stating that they do, in fact, like money, just like every other human being on earth, and are in it for the money. Doesn't make them evil, it makes them human. Similar to how I don't think politicians are evil, evil is hurting others for fun. They're just in it for personal gain. Sure, they're struggling NOW, but there was a time when they weren't.

BUT, there's plenty of PROVEN TO BE SAFE drugs out there that could help lots of people that will never see the light of day because it's not profitable. Curing AIDS isn't nearly as profitable as giving them a pill to control it every day. Simple business.

 

[P A]

BUT, there's plenty of PROVEN TO BE SAFE drugs out there that could help lots of people that will never see the light of day because it's not profitable. Curing AIDS isn't nearly as profitable as giving them a pill to control it every day. Simple business.

But this is just the kind of conspiratorial thinking that I intended to address in my post...

Consider what exactly it is that you're suggesting, which I will attempt to summarize in the following: Big Pharma, in close collusion with the U.S. State Department, government-sponsored research organizations, and/or the FDA, is currently engaged in an incredibly costly and unprecedentedly aggressive campaign of global suppression of ongoing scientific research, the consequences of which amount to the horrific suffering and inevitable deaths of millions of people (many of which are children) per year...because of what, again? Money, or power, or...? And the awareness of this unseen campaign of corruption is a unique intellectual privilege of a small handful of concerned citizens who can do nothing to change the circumstances as they currently exist other than to protest its numerous injustices on the internet? And let me guess, the evidence is all around me, I need to open my eyes, etc., right?

I strongly suggest that you look up 'conspiracy theory' on Wikipedia, and decide for yourself whether your views on the pharmaceutical industry veer dangerously into tin-foil territory or not. It's one thing to view current biomedical issues though the lens of political economy, and quite another to make subtle, but nevertheless wild implications regarding the role of Big Pharma in determining how and when we receive our healthcare. Can you honestly entertain for a fraction of a second the notion that a corporation like Pfizer would look at a successful HIV vaccine, shrug it off, and shut it down its production because it doesn't fit their current business model? Give me a break. A drug like that would be a long-term, high-risk, extremely high-profit investment, possibly the most profitable biomedical investment ever made. Governments around the globe would be lining up to pay whatever price Pfizer chose to offer. The corporation would make international headlines and cement its reputation as the greatest biotech innovator of this century. Are you seriously suggesting that Pfizer would pass all that up to market some off-patent anti-viral for the next 100 years, and simply wait to exit stage left when some independently-funded genius patents his vaccine or sells it on the black market, stealing all the profit and glory in the process? What a joke.

Simple business indeed.

 

[JackiesBabyy]

But this is just the kind of conspiratorial thinking that I intended to address in my post...

Consider what exactly it is that you're suggesting, which I will attempt to summarize in the following: Big Pharma, in close collusion with the U.S. State Department, government-sponsored research organizations, and/or the FDA, is currently engaged in an incredibly costly and unprecedentedly aggressive campaign of global suppression of ongoing scientific research, the consequences of which amount to the horrific suffering and inevitable deaths of millions of people (many of which are children) per year...because of what, again? Money, or power, or...? And the awareness of this unseen campaign of corruption is a unique intellectual privilege of a small handful of concerned citizens who can do nothing to change the circumstances as they currently exist other than to protest its numerous injustices on the internet? And let me guess, the evidence is all around me, I need to open my eyes, etc., right?

I strongly suggest that you look up 'conspiracy theory' on Wikipedia, and decide for yourself whether your views on the pharmaceutical industry veer dangerously into tin-foil territory or not. It's one thing to view current biomedical issues though the lens of political economy, and quite another to make subtle, but nevertheless wild implications regarding the role of Big Pharma in determining how and when we receive our healthcare. Can you honestly entertain for a fraction of a second the notion that a corporation like Pfizer would look at a successful HIV vaccine, shrug it off, and shut it down its production because it doesn't fit their current business model? Give me a break. A drug like that would be a long-term, high-risk, extremely high-profit investment, possibly the most profitable biomedical investment ever made. Governments around the globe would be lining up to pay whatever price Pfizer chose to offer. The corporation would make international headlines and cement its reputation as the greatest biotech innovator of this century. Are you seriously suggesting that Pfizer would pass all that up to market some off-patent anti-viral for the next 100 years, and simply wait to exit stage left when some independently-funded genius patents his vaccine or sells it on the black market, stealing all the profit and glory in the process? What a joke.

Simple business indeed.

No, I'm not saying they've discovered a cure for AIDS, it was an example. There are chemicals out there that have been proven safe by clinical trials but were stopped due to simple lack of interest by Big Pharma. I remember seeing a paper about one 5-HT receptor agonist (Forgot which 5-HT receptor) that was proven to be safe, non-recreational, and almost if not AS good as opiates at treating pain. But a non-addictive pain killer that works just as good as opiates do? Big Pharma would lose so much money if that came out, because people wouldn't continue taking them once the pain went away like they do with opiates, because there's no euphoria, physical dependence, or withdrawals. That's the sad part. So many people who can't get or afford opiates have to live in pain, many others get addicted to them after surgery and end up miserable when their tolerance goes up and they have a choice between sticking through the WDs or chasing the nice euphoric high. But on the other hand, if they did come out with a non-addictive pain killer that wasn't an NSAID or hepatitis-in-a-pill (acetaminophen. ruining your liver as well as alcohol does without the nice drunk middleman to enjoy!), well, they'd probably end up in much worse shape than they are now.

I'm not a conspiracy theory believer normally, but sometimes, these "conspiracy theories" turn out to be true. I can link you to an article about a few "insane" 9/11-was-done-by-bush-esque conspiracy theories turned out to be true. I'm NOT saying BIG PHARMA IS EVIL AND HATES SICK PEOPLE AND IS BUILT ON GREED, I'm simply saying that it's a fact people DO get hurt for the sake of keeping their business afloat, it's not evil intentionally, but the result can appear pretty evil to the person suffering because of it.

The article if you're interested. http://www.cracked.com/article_19884_6-insane-conspiracy-theories-that-actually-happened.html

Pretty good read and proof fucked up things can and do happen.

Edit: I'll also try to find that painkiller chemical's name. I remember seeing it when reading random pharmacology articles and papers one night. (Because that's what cool people like me do when we're bored on a saturday night.)

 

[sekio]

I remember seeing a paper about one 5-HT receptor agonist (Forgot which 5-HT receptor) that was proven to be safe, non-recreational, and almost if not AS good as opiates at treating pain. But a non-addictive pain killer that works just as good as opiates do? Big Pharma would lose so much money if that came out,

You really think so? I think being the only company in the market that produces a non-addictive painkiller would be a cash cow.

Sometimes medications are developed that seem like miracle drugs (NMDA anagonists for stroke, dopamine transporter ligands for cocaine addiction, those freaky drugs that keep you breathing on opioids) just don't reach the market because of other issues, like toxicology, problems in synthesis, or even plain old efficacy. Rodent models don't always produce 1:1 results that humans can use, and pharma companies don't want to market drugs thay know won't work very well.

 

[JackiesBabyy]

You really think so? I think being the only company in the market that produces a non-addictive painkiller would be a cash cow.

Sometimes medications are developed that seem like miracle drugs (NMDA anagonists for stroke, dopamine transporter ligands for cocaine addiction, those freaky drugs that keep you breathing on opioids) just don't reach the market because of other issues, like toxicology, problems in synthesis, or even plain old efficacy. Rodent models don't always produce 1:1 results that humans can use, and pharma companies don't want to market drugs thay know won't work very well.

Sure, there'd be an initial gain for them, but once it became affordable to everyone, doctors would stop prescribing opiates and start prescribing that. They're not addictive physically OR euphoric, so their use would drop to actual pain reasons, and most opiate use in the US (Not counting morphine drips in hospitals and street heroin, I'm talking at home pill opiates like Roxi and vicodin) is recreational or to fend off WDs. The paper said, if I recall correctly, it wasn't dropped due to side effects, toxicology, etc. It was simply "lack of interest".

 

[P A]

No, I'm not saying they've discovered a cure for AIDS, it was an example...I remember seeing a paper about one 5-HT receptor agonist...Big Pharma would lose so much money if that came out, because people wouldn't continue taking them once the pain went away

Well, yes, but your previous example and the one you just mentioned are shades of the same color and a case in point. The same critique holds, but this time with a highly nuanced vengeance, given the fact that we're talking about controlled substances here. I will repeat the summary I attempted above, with an edit or two for context: Big Pharma, in close collusion with the U.S. State Department, government-sponsored research organizations, and/or the FDA, is currently engaged in an incredibly costly and unprecedentedly aggressive campaign of global suppression of ongoing scientific research, the consequences of which amount to the horrific pain and suffering of millions of people (many of which are children) per year...because of what, again? Money, or power, or...? And the awareness of this unseen campaign of corruption is a unique intellectual privilege of a small handful of concerned citizens who can do nothing to change the circumstances as they currently exist other than to protest its numerous injustices on the internet? And let me guess, the evidence is all around me, I need to open my eyes, etc., right?

If a drug company were to discover a non-addictive, highly effective treatment for chronic pain, what makes this dilemma any different in essence from the 'HIV vaccine' problem above? The revenue incurred by the sale of currently-approved opioids for chronic/postoperative for the next 100 years will only scratch the surface of the fortune that is to be made in the development of a genuinely innovative analgesic. Again, do you sincerely believe that any drug company would prefer shilling out maintenance dosages of off-label opioids whose patents have long since expired to launching an entirely new form of revolutionary pain treatment, strong-arming the competition out of the market in the process? You seem to be operating under a profound ignorance of pharmaceutical companies' principle sources of revenue - or perhaps of the entire industry as a whole. It behooves me to remind you that all drug patents eventually expire, necessitating the development of new, often ripoff drugs just to maintain solvency in a dangerous, highly speculative market. The patents on almost all commonly-prescribed opioids currently on the market are either expired or on their way out, and most doctors know better than to prescribe their patients a relabeled drug that they can't afford in lieu of an equivalent generic that they can. Insurance companies are no different. Where exactly do they fit into your grand conspiracy?

I'm not a conspiracy theory believer normally, but sometimes, these "conspiracy theories" turn out to be true. I can link you to an article about a few "insane" 9/11-was-done-by-bush-esque conspiracy theories turned out to be true.

But you've just betrayed yourself here as possessing all the hallmark features of a bug-eyed conspiracy theorist:

1) The woeful misconception that complex social problems must have relatively simple explanations and historical origins (the desire for money, power, etc.);
2) The bizarre, but nevertheless heartfelt, conviction that large, faceless organizations possess far greater powers of secrecy and manipulation than the sum of the (often stupid and talkative) individuals that comprise them, combined with the self-contradictory notion that despite their near-superhuman powers of secrecy, the corrupt actions of these organizations can be easily sniffed out by a quick Google search and a single viewing of a Peter Joseph 'documentary';
3) A reliance upon tertiary sources of information regarding such issues, and the propensity to wildly extrapolate from small amounts of historical data;
4) Severe deficiencies of actual scholarly and/or real-world knowledge regarding the complex issues they mean to address, leading to poor interpretations of data and the mistaken recognition of non-existent patterns; and,
5) An overemphasis on simplistic power relations to expound upon multidimensional issues worthy of deeper treatment.

Conspiracy theories are so attractive to the substantial minorities of people that propound them, because, in short, they provide a simple and convenient means by which to diagnose and explicate the world's many social ills, and do not demand creative solutions. They are circular, self-confirming, unfalsifiable ideologies that wax and wane in their popularity and influence in a manner similar to underground fashion trends. Conspiracy theories are intellectually cheap, a dime a dozen, a fact which easily explains the profusion of such ideologies on the internet, and especially in wealthy Western republics in which citizens enjoy the greatest amount of verbal and intellectual liberty. This curious relationship between conspiratorial thinking and political freedom is not as not as paradoxical as it may at first seem - what is freedom, after all, if not the capacity to make your own (intellectual) mistakes?


TL;DR - No matter how intellectually easy and comfortable it would be for you to believe otherwise, Big Pharma is not in the business of dealing cheap generic drugs and lame knockoffs to addicts nor are they particularly interested in suppression of scientific literature as such. They are in the highly volatile business of necessary risk and innovation, a market that simply cannot afford to sit on addictive generic drugs and launch vicious political campaigns in the long run.

 

[JackiesBabyy]

Well, yes, but your previous example and the one you just mentioned are shades of the same color and a case in point. The same critique holds, but this time with a highly nuanced vengeance, given the fact that we're talking about controlled substances here. I will repeat the summary I attempted above, with an edit or two for context: Big Pharma, in close collusion with the U.S. State Department, government-sponsored research organizations, and/or the FDA, is currently engaged in an incredibly costly and unprecedentedly aggressive campaign of global suppression of ongoing scientific research, the consequences of which amount to the horrific pain and suffering of millions of people (many of which are children) per year...because of what, again? Money, or power, or...? And the awareness of this unseen campaign of corruption is a unique intellectual privilege of a small handful of concerned citizens who can do nothing to change the circumstances as they currently exist other than to protest its numerous injustices on the internet? And let me guess, the evidence is all around me, I need to open my eyes, etc., right?

If a drug company were to discover a non-addictive, highly effective treatment for chronic pain, what makes this dilemma any different in essence from the 'HIV vaccine' problem above? The revenue incurred by the sale of currently-approved opioids for chronic/postoperative for the next 100 years will only scratch the surface of the fortune that is to be made in the development of a genuinely innovative analgesic. Again, do you sincerely believe that any drug company would prefer shilling out maintenance dosages of off-label opioids whose patents have long since expired to launching an entirely new form of revolutionary pain treatment, strong-arming the competition out of the market in the process? You seem to be operating under a profound ignorance of pharmaceutical companies' principle sources of revenue - or perhaps of the entire industry as a whole. It behooves me to remind you that all drug patents eventually expire, necessitating the development of new, often ripoff drugs just to maintain solvency in a dangerous, highly speculative market. The patents on almost all commonly-prescribed opioids currently on the market are either expired or on their way out, and most doctors know better than to prescribe their patients a relabeled drug that they can't afford in lieu of an equivalent generic that they can. Insurance companies are no different. Where exactly do they fit into your grand conspiracy?



But you've just betrayed yourself here as possessing all the hallmark features of a bug-eyed conspiracy theorist:

1) The woeful misconception that complex social problems must have relatively simple explanations and historical origins (the desire for money, power, etc.);
2) The bizarre, but nevertheless heartfelt, conviction that large, faceless organizations possess far greater powers of secrecy and manipulation than the sum of the (often stupid and talkative) individuals that comprise them, combined with the self-contradictory notion that despite their near-superhuman powers of secrecy, the corrupt actions of these organizations can be easily sniffed out by a quick Google search and a single viewing of a Peter Joseph 'documentary';
3) A reliance upon tertiary sources of information regarding such issues, and the propensity to wildly extrapolate from small amounts of historical data;
4) Severe deficiencies of actual scholarly and/or real-world knowledge regarding the complex issues they mean to address, leading to poor interpretations of data and the mistaken recognition of non-existent patterns; and,
5) An overemphasis on simplistic power relations to expound upon multidimensional issues worthy of deeper treatment.

Conspiracy theories are so attractive to the substantial minority that propounds them, because, in short, they provide a simple and convenient means by which to diagnose and explicate the world's many social ills, and do not demand creative solutions. They are circular, self-confirming, unfalsifiable ideologies that wax and wane in their popularity and influence in a manner similar to underground fashion trends. Conspiracy theories are intellectually cheap, a dime a dozen, a fact which easily explains the profusion of such ideologies on the internet, and especially in wealthy Western republics in which citizens enjoy the greatest amount of verbal liberty. This curious relationship between conspiratorial thinking and political freedom is not as not as paradoxical as it may at first seem - what is freedom, after all, if not the capacity to make your own (intellectual) mistakes?


TL;DR - No matter how intellectually easy and comfortable it would be for you to believe otherwise, Big Pharma is not in the business of dealing cheap generic drugs and lame knockoffs to addicts nor are they particularly interested in suppression of scientific literature as such. They are in the highly volatile business of necessary risk and innovation, a market that simply cannot afford to sit on addictive generic drugs and launch vicious political campaigns in the long run.

It seems like you're completely dismissing my idea (As a whole. I'm not entirely right and I don't know everything about the inner workings of Big Pharma) because it sounds like a 'conspiracy theory", which is a stigma-carrying term. I'm not saying there's evil business men in a dark room discussing how to suppress scientific discoveries and keep valuble drugs away from sick people. But look, there's PLENTY of very effective very safe drugs in use in Europe (first-world countries) that aren't availiable here, even if they are safer and/or more effective. Look at Moclobemide, an MAOI antidepressant that isn't available here despite it being better than SSRIs in efficacy and having FAR less side effects than the irreversible MAOIs available here which can kill you if you eat certain foods with them. Give me one good reason it shouldn't be availiable here despite going through europe's just as thorough testing. Stop pointing fingers and yelling "CONSPIRACY THEORIST" and grouping me with the people who do think big pharma is the real life equivalent to a super villain club of rich people. I don't. I just think the system could use a lot of changes, as does pretty much everyone who has knowledge about the subject.