Response (Ervin Varga)

Ervin Varga’s response to Samuel Gershon’s comment on Ildiko Miklya’s reply to Gershon’s comment on her essay on the History of Selegiline.

Last time we had a discussion on deprenyl (D) was in the company of George Simpson and Arthur Sugerman, while Don Gallant introduced his famous crepes. I appreciate your convincing comment concerning the destructive effect of marketing. As far as your negative comment on D’s antidepressive effect - the answer is more complicated. I am not aware of any blind comparative study on D. Even if so, an intriguing question in clinical psychopharmacology is how the same drug may produce a different outcome in different blinded studies.  An important meta-analysis of efficacy studies comparing new generation antidepressants in Lancet (2009; 373; 9665) showed clinically important differences among commonly prescribed antidepressants. The therapeutic value and the popularity of a drug does not go necessarily hand-in-hand. We clinician are relatively humble, when it comes to administering treatment. It is only occasionally that our first choice of drug lifts severe depression in our patients. And I have had patients who did not respond to any antidepressant but to D although that is not always the case.  I trust the drug because it has been tested by other psychiatrists as required by the FDA, but the ultimate judgment must be based upon actual clinical response in patients. I remember our discussion and I admired your logic and forthright expression of your opinion. I feel honored to be involved in scientific interaction with you.

Ervin Varga

January 29, 2015