Loose Screws Mental Health News

Ebselen, an experimental bipolar disorder drug, has been found by British researchers to work like lithium but without lithium’s side effects. In mice. In testing, mice that were somehow made manic with “small doses of amphetamine” were placated with ebselen. Researchers are now moving on to testing on healthy human volunteers before studying those suffering with bipolar disorder.


A study, published in JAMA Neurology, discovered that retired NFL players were more likely to suffer from depression and brain impairment. The study comes on the heels of the suicides of Dave Duerson, Ray Easterling, and Junior Seau. Researchers suspect a link between “hard hits to the head and depression.” These problems have also been noted in NHL players and combat soldiers who have suffered a brain injury. Many of the retired NFL players developed a type of brain damage called chronic traumatic encephalopathy (CTE). Duerson and Easterling were found to have CTE during autopsy. In related sports news, the UK’s Telegraph reports that depression is a problem for soccer players in England and Scotland.


According to Time magazine, ketamine—a drug that induces hallucinations and other trippy effects—may hold potential as an antidepressant.

And now scientists report on two formulations of drugs with ketamine’s benefits, but without its consciousness-altering risks, that could advance the drug even further toward a possible treatment for depression.

Ketamine is seen as a fast-acting antidepressant for those at high risk for suicide. GLYX-13, mentioned here previously, is a ketamine-like antidepressant currently in clinical trials. AstraZeneca has AZD6765, a “ketamine mimic” that does not appear to be as effective as actual ketamine.

New research has discovered that people with mental illness are more likely to be victims of domestic violence. Even though the study evaluated men and women, the results for women were overwhelmingly striking.

It finds that women with symptoms of depression were 2.5 times more likely to have experienced domestic violence over their lifetimes than those in the general population, while those with anxiety disorders were more than 3.5 times more likely to have suffered domestic abuse. The extra risk grew to seven times more likely among those with post-traumatic stress disorder.


An analysis of more than 1 million Scandinavian women has shown that taking SSRIs during pregnancy may not increase the risk of stillbirth. This study could help revolutionize treating depression in pregnant women.

“From our study, we don’t find any reason to stop taking your medication, because untreated depression may be harmful for the pregnancy and the baby,” [Dr. Olof Stephansson, the lead author of the new report] told Reuters Health.


Finally, “gender identity disorder” has been removed from the DSM-V and has been replaced by “gender dysphoria,” a condition in which people are concerned about their gender identity. “Gender identity disorder” seemed to stigmatize gays, lesbians, and transgender individuals. The continuing inclusion of “gender dysphoria,” however, ensures that people suffering with gender identity disorder still have access to health care treatment. (In my opinion, the renaming of “gender identity disorder” to “gender dysphoria” is really a politically correct change. Homosexuality was removed from the DSM back in 1973.)

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Loose Screws Mental Health News

According to an article in USA Today, researchers have found that siblings who argue could have negative effects on their mental health.

Researchers report that conflicts about personal space and property, such as borrowing items without asking and hanging around when older siblings have friends over, are associated with increased anxiety and lower self-esteem in teens a year later. And fights over issues of fairness and equality, such as whose turn it is to do chores, are associated with later depression in teens.

I’d like to tell these siblings to get over it, but I don’t have any siblings of my own to relate my experience to.


PBS’s Frontline reports that most soldiers who commit suicide have never seen combat or even been deployed. According to the Defense Department, the Army has the sharpest rate of suicides of all the military branches. About 53 percent of military personnel who took their lives in 2011 had no history of deployment to active combat zones such as Iraq or Afghanistan. Even more troubling is that 85 percent of those who committed suicide may have been deployed but not involved in direct combat. Even though the military has invested $50 million to study mental health and suicide, a stigma of getting help still remains. It seems as though military personnel would rather take their own lives than seek help.


An antidepressant called GLYX-13, currently under study, appears to work within hours and last for up to a week. The lead researcher reports little to no side effects on the drug, which is injected intravenously. The drug is in phase 2, which means that its effectiveness and safety are still being tested. I have my doubts about an intravenous drug. If doctors are not currently testing patients’ serotonin levels, how would they be able to prescribe an intravenous antidepressant?


Depression has passed asthma as the top disability among North American (U.S. and Canadian) teens.

Asthma had been the largest contributor to YLDs (years lived with disabilities) for youths in that age range in the US and Canada in 1990, but the study published in The Lancet on Thursday led by researchers at the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, Seattle showed that in this group depression surpassed asthma to claim the number one spot in 2010.

Back in the 1990s, depression was not widely regarded or evaluated among teens. It was still “suck it up” and “pull yourself up by your bootstraps.” My depression was viewed as laziness or “senioritis” among my teachers. I had no sympathy and very little leeway. Now, mental health is being taken more seriously for teens, and I think that’s a good thing.


See you if you can keep an elder person in mind during this holiday season. Senior depression is always on the rise during the holiday season due to problems with health, loneliness, or finances.

It’s Official: I’m on Abilify and Prozac

A cursory search on Google for Abilify + Prozac didn’t yield too many helpful results. I suppose it’s not a common drug combination. So far, I haven’t had any real side effects. I take Prozac in the morning and Abilify at night. I’ve also started taking my vitamins again after shirking them for quite a while: Fish Oil with Omega-3s, Iron (for slight anemia), Vitamin B-Complex with Vitamin C, and a women’s multivitamin.

I am a little nervous about taking an SSRI again because the last SSRI I was on (Effexor/venlafaxine) produced some nasty side effects (mania, night sweats, vivid dreams, brain shivers) along with the one I liked (significant weight loss). When I last blogged about Prozac, my only side effect was somnolence—a side effect I don’t appear to be experiencing this time around.

Are you on a drug combination? If so, what and is it working for you? If you used to be on a drug combination, what was it and did it help?

Christopher Pittman seeks new trial

Christopher PittmanFrom Furious Seasons:

I simply don’t know what to make of the case of Christopher Pittman who was convicted of shooting his grandparents to death when he was 12-years-old–except that it argues for how risky it is to put young children on anti-depressants. Pittman, sentenced to 30 years in prison, is seeking a new trial and a hearing on that matter is underway in South Carolina.

You can read more about the Zoloft-rage/violence connection is relation to Pittman’s case.

Should psych drugs be avoided at ALL costs?

My brain isn’t functioning today quite honestly so my apologies if the following makes no sense whatsoever. It’s long and I ended up rambling.


Lately, I’ve been thinking about whether there are any benefits to using pharmaceutical drugs. I have blogger friends who are very much anti-pharmaceuticals anything, try to avoid drugs as much as possible but take them if necessary, or think pharmaceutical drugs are a Godsend.

I’m still trying to figure out where I stand.

Pharmaceutical companies are in the business of making money. It is not to their advantage to put out completely shoddy products that do not work. I’m sure many of them bury negative data and findings that do not shed a positive light on their drugs but if something works overall, they’ll put it out there. I don’t believe the doctors who are involved in these trials are all dirty, rotten sell-outs. Some of them are very well-meaning and honest who work to make these drugs as effective as possible. Call me naïve if you like but I just can’t bring myself to believe there are more greedy docs who skew results than there are those who are concerned with advancement.

I don’t think twice about popping Excedrin Migraine when I’ve got a painful, debilitating migraine; I have no problem taking naproxen (aka Aleve) when I’ve got menstrual cramps, and taking ibuprofen isn’t an issue if I have severe muscle pain. I don’t question the safety of these drugs. I’ve used them for so long, they’ve proven to be relatively safe for me (not everyone can tolerate those drugs) and efficacious. The safety risk of taking Excedrin Migraine sometimes outweighs the benefits of not taking it. (Note: I only speak of adults in terms of ingesting this kind of medication.I don’t believe developing bodies, such as youngsters, are able to handle medication that can significantly affect mood.)

When it comes to psych meds, I am not anti-medication. Psych meds should be taken on a case-by-case basis. There are some people who consider these meds to be a life-saver while others complain that it has made them miserable and worsened their lives. This is the gamble people take when choosing to ingest a psych med—most people don’t know that. Trouble is, most people don’t know when the stakes are high enough to take that risk.

I shouldn’t be in a position to judge anyone but when I hear people taking antidepressants based on circumstances—a job loss, failed relationship, loss of a life—I worry that it’s unnecessary. We are becoming a nation that is more reliant on “quick fixes” rather than developing coping mechanisms. It’s easier to pop a pill and dull your emotions than it is to face problems, tackle issues head on, and learn to work your way through it. Case in point: rising unemployment hasn’t slowed sales of antidepressants or sleeping pills.

  • I have an aunt who was a violent paranoid-schizophrenic. She was placed in a mental institution and drugged up the wazoo. Now, she’s basically existing; the lights are on but no one’s home. The drugs have killed her. She’s alive but not really.
  • My father was a non-violent paranoid-schizophrenic. It got to the point where we needed to medicate him to get him on track. The medication helped him to function “normally” but his thought processes and physical ability was significantly slowed. He once told me that he felt useless because my mother was busting her butt at work to pay for my college and he was basically an invalid because his mental illness had prevented him from being able to work. He died 4 months later. A few days after the funeral, my mom began to find his psych meds hidden all around the house. I often wonder if the drugs killed him.
  • Another aunt (this is all on the paternal side of the family) also became a paranoid-schizophrenic. She was a brilliant woman who was basically reduced to moving from place to place to the point where she eventually became homeless and could not hold down a job. She disappeared for a while but during one cold winter, was found and brought into a homeless shelter. She was placed on meds and her cognitive functions returned despite the fact that her speech was sometimes garbled. She traveled the world, went on cruises and various excursions. The change was remarkable. Psych meds improved her life and saved her—the benefits of the drugs outweighed the side effects.

As I withdraw from Lamictal, I am curious to see who I am without this drug. Will my creative juices flow freely once again or are they now somewhat hindered? Will my cognitive functioning correct itself or will I forever suffer from problems? Will my short-term memory loss issues smooth out or will I still suffer from intermittent forgetfulness? I have some side effects that may remain with me for a while or perhaps forever (though I hope not) but seeing others fully recover after taking drugs for 10 times longer than I have gives me hope.

I feel the majority of my progress has come from intensive counseling and being infused with the truths as laid out in the Bible. I’d say 90% of my progress has been due to counseling. I give the meds 10%. You can tell I don’t place much stock in them. But they’ve helped to cut down on the mixed episodes.

So far, I haven’t had any suicidal thoughts are behaviors that are out of the ordinary. (Thank GOD.) I’ve been dealing with a mild depression but that stems from basing my worth based off of my career rather than any biological imbalances. The last time I suffered a severe depression, I was on Lexapro (if that tells you anything).

I’ve gotten a lot of resistance and concern from family members who question my decision to come off of the medication. They’ve seen a miraculous change in me and attribute it to being on meds. Meds aren’t a cure-all. They don’t see the counseling and shifting of thought processes going on that has helped me to develop coping mechanisms. Meds may help people “cope” but they don’t develop the tools needed to cope.

I’ve decided that I’ll probably give that Christian psychiatrist a call. My counselor recommended him and she said that he’s very neutral on meds and doesn’t shove them on anyone. I mentioned that I wasn’t sure if anyone would accept me as a patient only to lose me in the end—she insisted he wouldn’t mind. The intake cost is hefty but since I was able to temp a few days for my job this week—I’m not permanently returning, I can swing it.

Which brings me back to my position on psych meds: I said it earlier but I think it’s a case-by-case basis. In my personal life, I’ve seen the benefits outweigh the side effects and I’ve seen the side effects outweigh the benefits. And I’ve seen benefits (not necessarily beneficial) as a result of side effects. Psychiatry is the biggest medical guessing game of all medical specialties. There are no certainties, and there’s no one medication that works best for everyone. Pharmaceutical companies make it a point to put the disclaimer on the patient information sheet that they’re not exactly sure HOW these drugs work. All that stuff about serotonin, dopamine, and neurotransmitters is pure speculation when it comes to depression. You’ll have me convinced about chemical imbalances once I can get a MRI and blood test done. Until then, it’s all trial-and-error.

So if I do suffer from relapses while withdrawing from this medication and it gets to the point where I may need to be hospitalized, I’m not averse to remaining on the drug. Better to be alive and on a psych drug than dead because I was determined not to use it at risk to my safety. If I end up having to stay on the drug, the future of giving birth to children will seem a bit more uncertain.

Loose Screws Mental Health News

Portland, Oregon has been recently declared the most depressed city in the country. BusinessWeek determined this based on “antidepressant sales, suicide rates, unemployment, divorce, and crappy weather.” Philly didn’t make the top 20 list. That’s because we’re too busy enjoying the highest suicide rate in the country.


smokingA great way to avoid depression, however, is to simply stop breathing. Yes, that’s right. Just stop breathing. A new study presented at an American Psychological Society meeting shows people who are consistently exposed to secondhand smoke are twice as likely to suffer from depression. So that’s my recommendation to you: STOP BREATHING. I guarantee you won’t be depressed after a while. (By the way, that’s a joke so you can go ahead and take a deep breath now.)


Apparently all this talk of an economic depression is causing people to be depressed enough to buy more antidepressants. I don’t get how it works but it seems as though antidepressant prescriptions (along with sleeping aid prescriptions) are rising alongside the unemployment rate in this country. Big Pharma isn’t filing for bankruptcy anytime soon. And if they do, it’s their own freakin’ fault.


In what appears to be a landmark ruling (correct me if I’m wrong), the U.S. Supreme Court ruled that pharmaceutical companies are still liable for injuries cause by FDA-approved drugs and devices and juries can legitimately award damages. The buzzword I’ve learned for this case is preemption.

A woman who was injected with an antinausea drug (Phenergan, if you’re wondering) brought a damage suit against Wyeth after her arm had to be amputated. After a jury awarded her with $6.7 million, Wyeth took the case to the U.S. Supreme Court, expecting a cool victory after the court sided with Medtronic in last year’s Riegel v. Medtronic case. Wyeth, the defendant in the case, hoped the Supreme Court would rule in their favor since the FDA had already evaluated their product for safety—a preemptive act. However, this time the court ruled 6-3 in favor of allowing the woman to keep her award money. The decision also sets a precedent for pharmaceutical consumers to sue pharmaceutical companies for injuries despite FDA approval—striking down preemption. For further information, check out Doug Bremner’s and Philip Dawdy’s blogs that have already covered this. In the meantime, I leave you with this:

Ronald Rogers, a spokesman for Merck, said, “We believe state courts should not be second-guessing the doctors and scientists at the F.D.A.”Merck was hit with several huge damage awards over its painkiller Vioxx before agreeing to a $4.85 billion settlement in 2007. Allowing juries to make determinations about drug risks, Mr. Rogers said, would cause “mass confusion.”

Hm. Make of that what you will.

Loose Screws Mental Health News

I could’ve been a statistic right here in this area.

suicides in PhiladelphiaPhiladelphia now boasts the sharpest increase in suicides in the country. Despite all the homicides in Philadelphia making the news, the 196 people who killed themselves in 2008 were quietly buried in the obit pages (if they made it there at all).

In light of this news, I’ve decided to place a suicide hotline web banner in the upper right-hand corner of my right sidebar. Susan of If You’re Going Through Hell Keep Going has one in her sidebar and I think it’s a wonderful idea. I’ve had a couple of people comment or send me emails about how they feel they’re on the brink of losing it so hopefully the banner — one of the first things to be seen on this page — will draw some attention and prompt someone to call for help. When I was a teen, I called 1.800.SUICIDE. I can’t remember what happened exactly but I called the hotline and someone talked me into why life was still worth living. People who are suicidal don’t really want to die; they want an escape from the pain they’re feeling and they feel the only way to alleviate that pain is through inflicting death upon themselves. I hope someone who is suicidal would be willing to pick up the phone and come to the same realization that I did at the time.


Speaking of suicide, researchers from the World Health Organization and the University of Verona, Italy have discovered that SSRIs (a class of antidepressants) may significantly reduce the risk for suicide in adults. SSRIs — which include such medications as Prozac, Paxil, and Zoloft — are not be confused with SNRIs such as Effexor, Pristiq, and Cymbalta. PsychCentral notes:

SSRIPrevious studies, including a 2007 study by the U.S. Food and Drug Administration (FDA), found the risk of suicide in adults was neutral, elevated in those under 25 and reduced in people older than 65. A subsequent black box warning was added to all antidepressants regarding increased risk of suicidal symptoms in people under 25 years of age.

Basically, this study just means antidepressants help those who are 25 years and older and hurt those 24 years and younger. I’m sure a new study will come out within the next year or so that contradicts this one. Especially since numerous previous studies on SSRIs found the risk of suicide to be neutral in ages 25-65.


Young adultAccording to the Boston Globe, a (really pathetic) new study shows that nearly half of young adults between the ages of 19 to 25 “meet the criteria for at least one psychiatric disorder.”

Whether in college or not, almost half of this country’s 19-to-25-year-olds meet standard criteria for at least one psychiatric disorder, although some of the disorders, such as phobias, are relatively mild, according to a government-funded survey of more than 5,000 young adults, published in December in the Archives of General Psychiatry.

The study, done at Columbia University and called the National Epidemiologic Study on Alcohol and Related Conditions, found more alcohol use disorders among college students, while their noncollege peers were more likely to have a drug use disorder.

But, beyond that, misery is largely an equal-opportunity affliction: Across the social spectrum, young people in America are depressed. They’re anxious. They regularly break one another’s hearts. And, all too often, they don’t get the help they need as they face life’s questions…

According to the 2005-2007 American Community Survey, the population for adults ages 18-24 is gauged to be around 30 million. Therefore if we’re going to take the study at its word, let’s chop the number by half (even though the number is just under half). That will put us at about 15 million young adults. The NIMH, however, estimates 57.7 million adults in the U.S. “suffer from a diagnosable mental disorder.” If this is the case, those 15 million young adults make up nearly 26 percent of the NIMH’s “diagnosable mental disorder” statistic. The inclusion of alcohol and drug addictions might explain why this figure might be a little high.

Antidepressant rankings: Zoloft and Lexapro considered best overall

A number of antidepressants were recently ranked in different surveys:

Zoloft and Lexapro came in first for a combination of effectiveness and fewer side effects, followed by Prozac (fluoxetine), Paxil (paroxetine), Cymbalta, and Luvox among others.

The first was efficacy — or how likely patients were to experience the desired effects of the drug.

Efficacy:

1. Remeron (Mirtazapine)
2. Lexapro (Escitalopram)
3. Effexor (Venlafaxine)
4. Zoloft (Sertraline)
5. Celexa (Citalopram)
6. Wellbutrin (Buproprion)
7. Paxil (Paroxetine)
8. Savella (Milnacipran)
9. Prozac (Fluoxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

The second was acceptability — the likelihood that a patient would continue using a drug for the duration of the study (it is generally assumed that a high ratio of patients dropping out indicates the presence of undesirable side effects for a drug).

Acceptability:

1. Zoloft (Sertraline)
2. Lexapro (Escitalopram)
3. Wellbutrin (Buproprion)
4. Celexa (Citalopram)
5. Prozac (Fluoxetine)
6. Savella (Milnacipran)
7.
Remeron (Mirtazapine)
8. Effexor (Venlafaxine)
9. Paxil (Paroxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

antidepressantsMy experience with Lexapro was a disaster and I’ve written about Zoloft’s connection with irritability and rage. Paxil’s side effects are especially rough (see Bob Fiddaman’s Seroxat page) while Effexor’s withdrawal effects proved to be significantly challgenging. Although Prozac offset Effexor’s withdrawal symptoms, it causes severe somnolence that can impair cognitive functioning. And last but not least, Cymbalta contributed to the unfortunate death of Traci Johnson who had no history of depression.

These drugs may be effective for many people but it’s still a guessing game. Dr. Mark I. Levy, quoted in ABC News’s article on the rankings, mentioned that while psychiatrists may not have much use for the rankings, he sees them as beneficial for primary care physicians. And Dr. Harold G. Koenig, a professor at Duke University Medical Center, adds:

“I would be likely to start patients on either Zoloft [because it’s cheaper] or Lexapro … Unfortunately, that is almost none of my patients. By the time they get to me [a psychiatrist], the primary-care doctors have tried Zoloft and other antidepressants, so my patient are not the “new to medication” kind of patients,” he said.

I won’t rehash my thoughts on PCPs prescribing antidepressants and other psych meds. You can read about them here.

Chemical imbalances do not exist; dying brain cells do

Researchers have never been fully confident in the chemical imbalance theory, yet the media continue to purport it as fact. Dr. John Grohol over at PsychCentral recently wrote:

We’ve all heard the theory — a chemical imbalance in your brain causes depression.

Although researchers have known for years this not to be the case, some drug companies continue to repeat this simplistic and misleading claim in their marketing and advertising materials. Why the FTC or some other federal agency doesn’t crack down on this intentional misleading information is beyond me. Most researchers now believe depression is not caused by a chemical imbalance in the brain.

How did we come to this conclusion? Through years of additional research. But now some are jumping on the next brain bandwagon of belief — that depression is caused by a problem in the brain neuronal network.

Grohol cites Jonah Lehrer's article in the Boston Globe in which he posits that researchers now think depression comes from "brain cells shrinking and dying." Lehrer writes:

Read the rest of this entry »

Pristiq's side effects: Too close to Premarin and Prempro for comfort?

Back in January 2007, I’d mentioned that Wyeth was not only seeking to market Pristiq (desvenlafaxine) for depression but also for the use of vasomotor symptoms in menopausal women.

I just learned that Wyeth produces two major menopause drugs, Premarin and Prempro, that allegedly has produced hormones causing cancer in more than 5,000 women. This added up to a loss of 40 million users and $1 billion annually.

With Effexor going generic in 2 years and the introduction of Pristiq to the market, Wyeth hopes to lure some of those customers back and net an annual $2 billion. However, serious questions linger about Pristiq’s side effects in menopausal women.

Why did two women in the study group taking Pristiq have heart attacks
and three need procedures to repair clogged arteries compared with none
taking placebo? How can Wyeth assure long term safety when 604 of the
2,158 test subjects took Pristiq for only six months and 318 for a year
or more? And what about serious liver complications seen in the studies?

Martha Rosenberg, reporting on Pristiq’s use as a menopausal drug, culled comments from CafePharma’s message boards and found one thread rife with mixed comments on the new drug. From an Anonymous commenter:

Read the rest of this entry »

John Grohol interviews Wyeth's VP of Medical Affairs on Pristiq

Dr. Grohol interviewed Dr. Phil Ninan, Wyeth’s VP of Medical Affairs on Pristiq, its efficacy, and surrounding issues. It was quite an interesting interview (and long) but here are some highlights that I chose to comment on. I’ll be making some comments in between Dr. Ninan’s answers due to the extensive length. Some parts of the answers have been truncated.

Read the rest of this entry »

Lexapro maintains status as first-line antidepressant therapy

Lexapro vs. Pristiq According to a Decision Resources (DR) press release, Lexapro (escitalopram), a SSRI, “retains leadership among first-line therapies in the treatment of major depression” despite the fact that physicians have increasingly moved toward the use of SNRIs, eg, Effexor (venlafaxine). However, the reason why SSRIs still retain their first-line status is due to

  • cost
  • efficacy
  • familiarity

SSRIs have been out on the market for much longer than SNRIs so it’s what physicians are more comfortable with. As far as I know, there currently aren’t any generic SNRIs in the U.S.

As a result, SNRIs are likely pricier.

DR’s survey of psychiatrists found that the majority believe SNRIs work better in treating clinical depression than SSRIs and about 44 percent believe they have fewer sexual side effects. PCPs were also included in this survey and it seems that the majority of them believed the opposite despite DR’s spin that a lot of PCPs are on board with psychiatrists. From personal experience, four SSRIs were prescribed to me before I was shifted to a SNRI.

In the up-and-coming SNRI department, DR forecasts a bright future for Pristiq (desvenlafaxine).

Physicians are expected to move patients from Effexor to Pristiq-a newly approved SNRI- over the next two years. … Pristiq will begin to replace Wyeth’s Effexor XR and Lilly’s Cymbalta, especially in
psychiatrists’ practices.

This is an interesting analysis from DR considering that psychiatrists, health insurers, and even some investors seem less than impressed with the slight advantages the “me-too” drug has over Effexor.

(logos from Forest Pharmaceuticals, Inc. and Wyeth)

Loose Screws Mental Health News

John Grohol at PsychCentral reports that the fate of the mental health parity bill is uncertain as its main champion, Sen. Ted Kennedy, takes a leave of absence to focus on treatment of his brain tumor. I echo John’s thoughts in hoping to see that other senators are willing to carry the torch and pass this important piece of legislation.


I came across a post from Kalea Chapman at pasadena therapist in which she linked to a WSJ article on whether veterans suffering from PTSD should be awarded the Purple Heart.

Supporters of awarding the Purple Heart to veterans with PTSD believe the move would reduce the stigma that surrounds the disorder and spur more soldiers and Marines to seek help without fear of limiting their careers.

Opponents argue that the Purple Heart should be reserved for physical injuries, as has been the case since the medal was reinstituted by Congress in 1932.

I side with the opponents. The Purple Heart should be awarded to be people who have visible evidence of bravery. With the rising number of PTSD prevalence, I’m afraid that the award would be handed out like candy. The rising number of veterans with PTSD on disability has caused enough of an issue that a Texas VA facility wanted mental health officials to stop diagnosing veterans with the condition.


Jordan Burnham, an 18-year-old student who survived a nine-story jump from a building, plans on walking at his graduation with the assistance of two canes. A family who used to attend my church knows this family and put him on my church’s prayer list. It’s a small world, after all.


Finally, it looks like expecting moms should have no fear of causing birth defects in their baby while taking antidepressants, according to a study being published in the British Journal of Psychiatry.

A research team from Montreal University studied more than 2000 pregnant women on antidepressants and discovered the drugs did not present any adverse effects. However, it sounds like they only oversaw the women while they were pregnant in their first trimester. I haven’t seen the actual study but it doesn’t seem to mention whether the women discontinued the antidepressants after the first trimester.

Poor Wyeth — New drug delayed in FDA approval

From Forbes.com:

Wyeth Pharmaceuticals just can't seem to catch a break. The company is not only increasingly worried that it will lose a large chunk of its revenues to generic competition, it also faces the ongoing threat that its pipeline is starting to go dry. A further delay in the approval of its postmenopausal osteoporosis drug has become one more nail in the pharma company's coffin.

The drug, bazedoxifene, has had a hard time getting approval from the FDA since April 2007.  The FDA is concerned about bazedoxifene's effects on causing myocardial infarctions or blood clots.

This is some pretty disheartening (to say the least) news considering that Effexor will soon be going generic and Pristiq has received some less-than-stellar reviews.

Analysis of "Depression: Out of the Shadows"


The show is essentially Depression 101 – for those new to learning
about the illness.
As someone who struggles with depression (within
bipolar disorder), I found a lot of the two hours pretty boring (90
minutes on personal stories and about 22 minutes for "candid
conversation"). The "a lot" comes from the stuff that I've either heard before or flies over my head, eg, how depression affects the brain, prefrontal cortex, neurotransmitters, synapses, etc. The personal stories were powerful: depressingly heartwarming. (Yes, I mean that.)

My heart sank as I heard the stories of Emma and Hart, teenagers who were diagnosed with depression and bipolar disorder, respectively. Both were such extreme cases that they needed to be sent away for special psychiatric care. They are on medications for their disorders; the specific drugs are never mentioned.

While watching Deana's story of treatment-resistant depression, I instantly thought of Herb of VNSDepression.com whose wife suffers from the same malady.

I tried to listen attentively for the antidepressant that Ellie, who suffered from PPD after the birth of her first child, would be taking during her next pregnancy. It was never mentioned.

My jaw nearly dropped to the carpet as Andrew Solomon, carefully plucked brightly colored pills from his pillbox that he takes every morning for his unipolar depression: Remeron, Zoloft, Zyprexa, Wellbutrin, Namenda, Ranitidine, and two kinds of fish oil. He might have even mentioned Prozac. He takes Namenda, an Alzheimer's drug to combat the effects of an adverse interaction between Wellbutrin and one of the other drugs that I can't remember. Solomon says he's happy. I'm happy for him and I'm happy that his drug cocktail works for him but I couldn't help but sit there and wonder, "Isn't there a better way?"

While I thought the stories covered the gamut, in retrospect, I'm surprised they didn't interview a veteran or U.S. soldier to discuss PTSD. If the producers were able to fit in dysthymia, I'm sure they might have been able to throw in a story about a soldier who struggles with depression and suicidal thoughts stemming out of PTSD. Considering all the stories coming out of the VA, it's rather relevant. It would have been more interesting than the Jane Pauley segment. But I'll get to that in a minute.

As I listened to the narrator, I couldn't help but wonder what alternate perspectives could have popped up. For what it was, I fear none. This was a Depression 101 show — a program designed to either get people to fight against fear and stigma and get help or to open the eyes of loved ones to this debilitating disorder. I'm not sure how to slip in an opposing view on medication from a doctor without confusing or scaring people away. What would Healy or Breggin say that would encourage people to seek appropriate care?

Holistic or natural treatment was not mentioned. It's not mainstream and it's not recommended by most doctors as first-line therapy. I would have been surprised had something been said about it.

The depression portion of bipolar disorder was briefly discussed in Hart's story then Pauley added commentary about her personal experience in the remaining 22 minutes of the program.

Pauley appears at the end of the show promising a "candid conversation" on the topic. The three experts: Drs. Charney, Duckworth, and Primm sit and smile politely as Pauley rattles on occasionally about herself. Some people might find her exchange endearing and personal. After the first 3 minutes, I found it annoying. As a journalist, I wish she would have taken the impartial observer approach rather than the "intimate discussion" approach. In my opinion, she seemed to have dominated the "discussion."

It ended up being a Q&A with each doctor. Her questions were focused and direct. I expected a little bit of an exchange between doctors, talking not only about the pros of medication and treatment like ECT and VNS but also the cons. (Should I apologize for being optimistic?) Charney interjected into the conversation maybe once or twice but was only to offer an assenting opinion. Primm spoke least of everyone on the panel. I think she was placed on the show solely to represent diversity.

There were no "a recent study said…" or "critics say such-and-such, how do you address that?" It was a straightforward emphasis on encouraging people to get help or for those suffering to get treatment. Pauley's segment didn't discuss any negatives (not with the medical director of NAMI there!). The closest the entire 2 hours gets to any cons is with ECT shock treatment and giving medication to growing children. The childhood medication thing isn't dwelt on. The basic gist is: Doctors don't understand how medication works in children but are working on trying to understand it and improve its efficacy.

Forgive me for being negative. The point of the program was designed to give hope to those suffering. Instead, it just made me feel even worse. Thoughts raced through my head: "Well, if this doesn't work, then it's on to that. And if that medication doesn't work then I'll probably be prescribed this therapy, and if that doesn't work, then I'm treatment-resistant at which point, I'll have to do…"

I hope the program does what it's designed to do and that's to get those suffering with depression to seek appropriate care. The one upside is that talk therapy was stressed. I'm a huge proponent of talk therapy myself. Let me know what you thought of the show if you were able to catch it.

In the meantime, this depressed girl is going to cure herself for the night by going to bed.

P.S. Is it really fact that depression is a disease?

My official position on pharmaceutical companies and psychotropic meds

In previous posts, perhaps I’ve come off a little bit as “I hate Big Pharma.” I did. For a while.

I’m not in love with pharmaceutical companies either. I’ve quoted it before but “to whom much is given, much is required.” As a result of accumulating knowledge through reading and research, I know a whole lot more about pharmaceutical companies, the treatment options they put out there, and what lengths they go to get those treatments out there. Most of the things I read are negative. Much of what I’ve said is negative. Perhaps “ignorance is bliss.” My husband said this recently:

“The Internet is the great bitching ground. No one’s going to talk about how great medication is. Everyone’s going to go on and just bitch about side effects and bad experiences.”

I agree. “Effexor really helped me feel better today” doesn’t make for an interesting blog post. No one pays attention to medication when it’s working, however, everyone will complain if something is going wrong. The most “positive” drug comments I’ve seen are on my seemingly “negative” posts from people who are being helped by a drug.

Take, for instance, the following comment from Suffering:

Read the rest of this entry »

BJ Harroun left this comment for me on one of my posts Pristiq's FDA Chances: Depression – Yea; Menopause – Nay:

I have just completed my first two weeks on Pristiq. I have suffered from MDD for 35 years. I cannot take Effexor because it increases my appetite. Pristiq has really helped me. I have taken everything and I think I have finally found something that works for me. Don't dismiss this drug because it is an Effexor metabolite.

I didn't expect to see much of a difference between Pristiq and Effexor in terms of side effects since I figure since they're from the same class (SNRI). But I'm glad that Pristiq seems to be helping BJ. It would behoove me to take a look at the PIs for Effexor and Pristiq and check out the clinical trial data and see how they shaped out differently. But there's only so much time for me during the day.

Wyeth Pushing Pristiq Hard

PristiqThe Wall Street Journal reports that Wyeth, desperate to make money off of its Effexor XR-knockoff, Pristiq, says it will slash the antidepressant at a 20% discount compared to Effexor’s price. The price slash, CNN money reports, is a result of less-than-impressive clinical trial data on Pristiq’s “safety and effectiveness.”

Wyeth SVP Joe Mahady told analysts that Pristiq will sell for a flat $3.41 per tablet for both mid- and high-dose, Dow Jones Newswires’ Peter Loftus reports.

Wyeth, apparently, has done this in the past. Back when it was known as American Home Products, the company slashed its price on Protonix, its heartburn drug, to compete with AstraZeneca’s Prilosec. The drug generated $1.9 billion in profits for Wyeth last year. CNN Money reports that Teva Pharmaceuticals and Sun Pharmaceuticals began selling the generic version of the drug and handily cut into Wyeth’s profits: the company reported a 4.6% decline in profit and a 66% drop in sales for the drug for the first-quarter. What will happen with Pristiq remains to be seen. I’m not sure that doctors in 2010 will want to dole out prescriptions for Pristiq when they can save patients—and insurance companies—money by prescribing what will then be known as venlafaxine. WSJ also notes:

A month’s supply of sertraline (Pfizer’s old hit Zoloft) or fluoxetine (Lilly’s Prozac) goes for 50 cents a day at drugstore.com.

$3.41 or $0.50 per tablet. It wouldn’t surprise me if some insurance companies choose to exclude Pristiq from its list of covered drugs. Regardless, Wyeth expects sales of the drug to exceed $1 billion in its first year.

The drug will hit the shelves in May.

Wyeth reps no like Pristiq

Oof. I'm just starting to read The Carlat Psychiatry Blog and stumbled upon this post about Wyeth drug reps trashing Pristiq. Wow. Carlat pulled an excerpt of a Wyeth rep mocking Pristiq's new marketing slogan: "People, Passion, Performance… Pristiq!"

"PEOPLE – 1/2 of you will be gone in less than 27 days

PASSION – There is no passion now, but for those that remain with Wyeth, we will bribe the passion out of you by taking you to Vegas for 4 days.

PERFORMANCE – You thought it was hard to reach your performance incentive before? Wait until 2nd quarter

PRISTIQ – Good luck selling both Effexor XR and Pristiq at the same time. So Dr., would you like to hear about my antidepressant that has been around for 12 years, with proven efficacy with the ability to titrate the dose as need to better care for each patient's needs that will have generic competition in 4 months, or would you like to hear about my brand new antidepressant with one dose, less indications and less evidence of efficacy? You want me to choose, let me check with my bonus plan to see which one pays more."

Carlat:

If this is the typical attitude within the Pristiq sales force, Wyeth may end up a little shy of the blockbuster they were hoping for!

I couldn't have said it better myself.

Pittman, Zoloft, and akathisia revisited

Christopher PittmanI’ve written about Christopher Pittman, now 19, who confessed to shooting and killing his grandparents when he was on psych meds at the age of 12. He appealed for a Supreme Court hearing but was denied, CNN reported today. He — and his defenders — appealed on the grounds that his 30-year sentence was “excessive for someone that age” and that the dosage of his antidepressants at the time (200 mg) “sent his mind spinning out of control.” Pittman was tried as an adult and, his lawyers argue, “no other inmate in the United States is serving so severe a sentence for a crime committed at such an early age.”

In previous posts here and here, I’ve questioned the link between Zoloft and violence/rage. Pittman, in 2001, had been switched to Zoloft a few days before the murder of his grandparents. However, it sounds like there had been some emotional problems in Pittman’s life that may have given prosecutors a solid case:

At the time of the crime, the boy had bounced around homes for years, experiencing a half dozen family splits and divorces after his mother had twice abandoned him as a child. She has not been in Pittman’s life for years.

Joe Pittman, the boy’s father, raised Christopher Pittman and his sister for much of their lives, but the relationship between father and son deteriorated. A state psychologist later testified this was a “young man who’d had difficulty with the adults in his life.”

On November 28, 2001, Pittman was sent home early for fighting in school and sent to bed by the grandparents. The boy claimed his “Pop-Pop” also beat him with a belt as punishment.

South Carolina prosecutors may easily have set Pittman up as a disturbed young man, which he very well may have been. But there are indications that this disturbance transcended his emotional state into his mental health:

After threatening to harm himself and suffering other emotional incidents, the boy was diagnosed as clinically depressed. His lawyers said Pittman was then given Paxil, a mild antidepressant no longer recommended for those under 18.

Just days before [shooting his grandparents], a doctor had begun prescribing Zoloft, another antidepressant. The family contends the abrupt substitution of drugs caused a bad chemical reaction, triggering violent outbursts.

At trial, a parade of psychiatrists offered conflicting testimony on whether the boy’s emotional problems excused his criminal behavior. Prosecutors called the Zoloft defense a “smokescreen.”

Juror Steven Platt later told CNN the crime appeared deliberate. “It always seemed like the defense was grasping at straws,” he said. “Just because you take prescription medicine doesn’t mean you can’t be held accountable for your actions.”

Read the rest of this entry »

Blood test for efficacy of antidepressants in the future?

Scientists have found that a biomarker for depression could show whether a person's antidepressant is working. The discovery could lead to something everyone in the psych world has been waiting for: a blood test of some kind.

The researchers looked at the interaction of neurotransmitters and a protein called Gs alpha. In brain cells, the protein acts like a kind of butler, passing messages from neurotransmitters on the outside and amplifying their messages, [study co-author Mark] Rasenick explained.

When the protein is working properly, it's like a butler whose "hands are just flying, cooking and cleaning at the same time," he said. But when the brain is depressed, "it just sits there in the corner."

That's an interesting observation. This might finally explain the difference between "depressed" brain activity and normal brain activity on an MRI. (By the way, has anyone had an MRI performed for depression?)

Researchers compared the proteins in the brains of people who committed suicide as a result of depression to those who did not. "They found the protein would have worked less effectively in the brain cells of the suicide victims."

Dr. Gregory Simon conceded that doctors cannot determine which antidepressant will work for which person.

"There's a long history of research using patterns of symptoms or biological measures — chemicals measured in blood or spinal fluid — to predict response to a particular antidepressant. None of those hoped-for predictors have significant value.

[Genetic tests] would not eliminate trial-and-error, but it would reduce the waiting time with each trial. But it's a long way from a study like this one to a test that's useful to patients and doctors."

Good news for the skeptics about this research study: It was funded by the U.S. Public Health Service and the American Foundation for Suicide Prevention. But a test simply to see if an antidepressant is working has the smell of pharma somewhere on it.

(Hat tip: Ephphatha)

Bipolar & the Workplace

I was surprised to see an ABC News article on bipolar disorder. Bipolar disorder is the “hip” mental illness these days — especially when used to characterize someone with extreme mood swings. One section addressed admitting to bipolar disorder in a work environment:

One day, he let it slip.

“I just blurted it out. ‘I’m sorry I’m getting shock treatments. I can’t remember anything,'” Steve said. His colleagues’ reactions were less than encouraging, he recalled.

“I would say that they were afraid of me,” Steve said. “They stopped referring their clients to me.”

Steve said that eventually his colleagues’ attitudes forced him to leave his job.

I admitted my problem to three people at my job: my managing editor at my last job and three of my coworkers (one with whom I am still friendly).

  • The managing editor, who had picked on me mercilessly, finally backed off. As far as I know, she didn’t tell anyone which I appreciated.
  • One of my coworkers admitted she had depression to me first before I told her I had bipolar disorder. It’s understood between us that we won’t go around and talk about these things.
  • The other coworker also told me about her journey through depression and her treatment afterward. I then revealed my struggle with bipolar disorder. We are friends outside of work now.
  • I’d told the last coworker about this shortly after I received my diagnosis after being released from the psych hospital. As far as I know, she didn’t tell anyone. But in the end, she’s the one who said the hurtful things about me in the e-mail I inadvertently received. It’s anyone’s guess if she told other coworkers or if she completely forgot.

From Bipolar Journey:

My experience is: work is work.  Outside of work is where one gains support for any illness they struggle with.  Acknowledging my response is skewed on the basis of recent events, I can’t recommend telling anyone you work with about one’s illness.  I should have kept to my Psychology professor’s advice:  “Never tell anyone you work with about your illness, trust me when I tell you:  they will treat you differently.”

I attended an outpatient group in late October 2006 after my hospitalization. One lady said that one of her coworkers admitted she was bipolar; since then, the coworker was teased and verbally abused by her supervisor and other coworkers. I’m not positive but I think the person might have even gotten fired lest her disorder interfere with her ability to do her job. (She cleaned pools.)

People with the disorder often have trouble keeping a job and are 40 percent less likely to be employed than the average person, said Ronald Kessler, a public health researcher at Harvard University.

On the other hand, Kessler said, if treated properly, they can be creative and invaluable individuals. Many highly successful authors, artists and professionals have the disorder.

I’ve seen statistics like this before and they worry me. I constantly wonder whether I’ll ever be able to hold down a full-time job for a long period of time. I’m currently unemployed and – to my disbelief – enjoying it. I’m afraid I’ll get lazy and never go back to work. I’m afraid that I’ll start to go in and out of jobs like a revolving door. One of my psychotherapists in college flat out told me that I’d never be able to hold down a job.

As I try to venture into editorial freelancing, I’m afraid of a host of things: outdated skills, inexperience, lack of confidence, failure, libel, confrontation, socializing, networking, creating expectations (of myself) that I never live up to. My counselor told me to just jump in and do it first then worry about the details later. [deep breath]

failureI fear failure the most. Failure that I’ve forgotten my editorial skills because they haven’t been used daily since 2005. Failure that editors will write me off because I’m a 26-year-old with unimpressive clips like “Bees Infest Dorm Hall” (yawn), “Student Organization Rallies Youth to Vote” (so cliche), and “Penn State Strikes Deal with Napster on File-Sharing” (Nov. 2003 = old). Failure that I’ll write an article, misinterpret the facts, and then get the publication slapped with a lawsuit. Failure that I’ll have to be “pleasantly persistent” in calling up editors, asking for prompt payment of my freelance services. Failure that I will intentionally avoid things that would otherwise propel my career: attending social mixers, networking, doing all the social things that makes my blood run cold because I hate meeting new people (in person). Failure that I’ll look at past awards I’ve received and then never live up to the reason why I received them in the first place. I don’t want to blame bipolar disorder from holding me back but sometimes, I can’t help but think where I’d be in my professional career without it.

(Image from gobears.wordpress.com)

Loose Screws Mental Health News

An article in the NYTimes addresses the issue of diagnosing mental health in developing countries. A startling fact:

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

emoIn India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated. With a population of more than one billion, India has fewer than 4,000 psychiatrists, one-tenth the United States total. Because most psychiatrists are clustered in a few urban areas, the problem is much worse elsewhere.

Looks like depression is really more than just a whiny rich American kid who chooses to be upset because he’s got nothing better to do. That’s “emo” for those who aren’t hip-to-the-jive. 😉


On The Elite Agenda, Dr. Fred Baughman mentions Swedish writer Janne Larson who asserts that “over 80 percent of persons killing themselves were treated with psychiatric drugs.” Thank God for FOIA that provides the docs to back this up:

According to data received via a Freedom of Information Act request, more than 80 percent of the 367 suicides had been receiving psychiatric medications. More than half of these were receiving antidepressants, while more than 60 percent were receiving either antidepressants or antipsychotics. There is no mention of this either in the NBHW paper or in major Swedish media reports about the health care suicides.

I guess Sweden isn’t the only country in the world that wants to sweep unfavorable mental health coverage under the rug. By the way, Sweden also is considered to be the seventh happiest country in the world.

While the FDA has recognized that antidepressants can cause an increase in suicidal behavior (as indicated by the “black box warning”), antipsychotics seem to have fallen under the radar. In fact in 2002, Clozaril was approved to combat suicidal behavior in schizophrenic patients. Since then, research has shown that antipsychotics can increase suicidal behavior in schizophrenic patients twenty-fold.

Akathisia – a serious side effect that has occurred for nearly all psych drugs in clinical trials – has been found to be linked to suicidal behavior with not only antidepressants but also in conjunction with antipsychotics.

Finally, Baughman closes with this:

It is important to note that nearly every school shooting that has happened in the United States over the last decade has been conducted by young males who were taking antidepressant drugs. The drugs not only cause suicidal behavior, they also seem to promote extreme violence towards other individuals. In most school shooting cases, the young men committing the violence also committed suicide after killing classmates and teachers. These are classic signs of antidepressant use.

I don’t know if that’s wholly true but it’s a trend I’ve seen with Cho, Kazmierczak, and Eric Harris of Columbine. Since 1996, there have been 55 major school shootings all around the world; 43 of them occurred in the U.S. Makes you wonder how many of these gunmen were on a psychotropic drug – prescribed or not – of some kind.

(Image from Style Hair Magazine)

Today's lesson: Paxil and Lexapro are not great antidepressants

Dawdy at Furious Seasons wrote a post on an editorial in the LA Times by Summer Beretsky’s experience with Paxil. After reading her editorial, I’m reminded that my own experience with one antidepressant wasn’t all that unique. Her drug was Paxil for panic attacks; mine was Lexapro for depression following a 3-month (on-and-off) stint with Paxil. I’m struck by the similarity of our experiences; not only did the same thing happened to me but I was also a communications major in college as well.

Paxil had one pretty undesirable effect on me: I started to lose interest in just about everything. I stopped initiating social activities (who needs that sort of thing?) and was no longer motivated to perform well academically.

My emotions had flat-lined: I hadn’t cried in months, nor had I proverbially jumped for joy. I felt — nothing.

I can still remember sleeping in bed at home on a weekday when I should have been at class. It was 2 in the afternoon, around the time my copy editing class was to begin. My boyfriend at the time (now my husband) lived in Kentucky while I attended college in New York. He planned to visit me that weekend but was getting fed up with my depression and listlessness. He called from work to tell me to get up and go to class. I mumbled on the phone, half-confused, and said no. He demanded, “Why not?” I said quite plainly, “Because I don’t care.” He said, “If you don’t get up and go to class, I won’t visit you this weekend.”

I replied, “I don’t care.”

Read the rest of this entry »

I hate to brag, but…

I hate to brag, but…

February 28, 2007
Pristiq's FDA Chances: Depression – Yea; Menopause – Nay

It wouldn't surprise me if they said yea to antidepressant use and nay to vasomotor use because of lack of evidence in improved symptoms.

April 19, 2007
Wyeth looking for Pristiq's FDA approval in 2008

I'll follow Pristiq as the information continues to trickle out but don't expect to hear much about it until next year when Wyeth becomes the proud papa of a brand new (and approved) product.

This is one of the few times I can actually say I was right. (Teenage-like "squee!" goes here.)

More recent posts from:

Pristiq receives approval from FDA

PristiqMore than a year ago, I promised to keep tabs on Wyeth’s new (renamed, rather) drug Pristiq. So I’m living up to it.

On February 29, 2008, the FDA granted Wyeth approval to move forward with putting the drug out on the market.

Wyeth said the company planned a big sales effort to introduce the product to psychiatrists and primary care doctors.

There’s a problem with that sentence. I’ll give you a second to figure out what’s wrong with it. Haven’t got it yet?

Primary care doctors. PCP should not be in the business of prescribing or providing psych meds. I’ve gone on and on about it at length before, but I’ll mention it again. PCPs are trained to treat overall conditions that have no need of referral to specialists. Think about it this way: If your psychiatrist prescribed anti-inflammatory medication because you mentioned that you’ve been having problems with your foot, you’d be taken aback, right? If a dermatologist prescribed heartburn medication after a patient mentioned he’d been having heartburn trouble, that would seem almost illogical, wouldn’t it?

(Pristiq logo from Pristiq.com)

Read the rest of this entry »

Depression: Theory or fact?

UPI has an article on a study which finds that the media presents depression's "chemical imbalance" as a fact instead of a theory. According to Jeffrey Lacasse and Jonathan Leo, the DSM says "the cause of depression and anxiety is unknown." Lacasse and Leo asked members of the media to submit evidence that supports chemical imbalance as a fact but no one did. This finding comes after the near-damning U of Hull study that asserts antidepressants don't work much better than a placebo on the majority of depressed patients. If the efficacy of antidepressants are this dubious, how much more are antipsychotics?

This article gets me thinking about the idea of media responsibility. I feel like what we call "news" has reverted to the days of yellow journalism. Sometimes, even worse than that. While the majority of publications strive to adhere to ethical practices and accuracy, many major publications will resort to printing anything that sells — even if it's libelous. But I'm getting off track here.

I can't wholly blame the media for sensationalism on certain topics like depression.  Most of them aren't scientists or research experts – they only report what they're told. Take NIMH's explanation of the way medication works for depression:

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

NIMH isn't presenting the way antidepressants work as a theory. It's an authoritative paragraph that sounds as though it's fact. If the chemical imbalance that causes depression is only theory then one must conclude the way antidepressants work as a theory as well, no? The NIMH has a section that explains what causes depression:

There is no single known cause of depression. Rather, it likely
results from a combination of genetic, biochemical, environmental, and
psychological factors.

"Likely results" leaves the door open to interpret the sentence as "maybe it's a combination of…" However, most people aren't scrutinizing words that carefully. Most people see this: "Rather, it results from a combination of…" Yes, I'm being nitpicky but the word "likely" still strikes me with a more authoritative connotation than maybe or perhaps. Here's a quote from a recent report from a local news station News 8 Austin:

Depression is more than just a negative state of mind. There are physical changes that occur in the brain that disrupt that natural balance of chemicals called neurotransmitters. (emphasis mine)

There is no single factor that causes depression. In fact, many experts believe most cases
[sic] of depression are a result of several sources. (emphasis mine)  

Again, I'm being nitpicky. "There are" is an authoritative phrase. People are unlikely to argue with a statement that includes the verb "are." Take for example, "There are people outside" or "There are five cats at the door." There's no question in the speaker's mind about whether people exist outside or the number of cats at the door. With subjects like depression that involve psychiatry and neuroscience, the majority of people aren't going to question these assertions either. I'm surprised that second paragraph didn't read, "many experts say …" Unless you're an expert yourself, you'd be unlikely to argue on what an expert says versus what the expert believes.

While I appreciate Lacasse and Leo's study on the inaccurate way depression is presented in the media, the "authoritative" sources on the issue would be loathe to correct it. Right now,  the big picture of raising awareness about depression is more important than to correct a trivial thing about the chemical imbalance being a theory. Pharmaceutical companies don't like correcting minor nuisances like theories.

To sum it up, I think the idea of a chemical imbalance causing depression is a theory. That's not a dubious statement. Unless it depends on your definition of what is is. 

Follow up post to selective publishing

Also, check out a recent post by Kevin Drum over at The Washington Monthly who raises a very good point:

I have no particular opinion about the quality of this study, and not really any special interest in SSRIs either. In fact, what really drew my attention was the range of news outlets that reported this news. According to Google News, here they are: the Guardian, the Independent, the London Times, the Telegraph, the BBC, Sky News, the Evening Standard, the Herald, the Financial Times, and the Daily Mail. In fact, it's getting big play from most of these folks, including screaming front page treatment from some.

So what's the deal? Why is this huge news in Britain, where most of the stories are making great hay out of the amount of taxpayer money the NHS is squandering on these drugs, and completely ignored here in the U.S.? The conspiracy theory version of the answer is obvious, but what's the real version? Do American newspaper editors universally know something that I (and their British colleagues) don't?

Furious Seasons covers it as well and links to a variety of other blogs (toward the end of the post) that cover the topic.

Selective publication on antidepressant efficacy and data

After the release of the U of Hull study on Tuesday, the AFP has written an article about doctors who are urging patients on antidepressants to continue taking them.

Louis Appleby, national clinical director for Mental Health, told the Press Association: "… the message to patients and doctors remains the same — anti-depressants are an appropriate treatment for moderate or severe depression."

I agree that patients on antid's should not cease medication cold turkey. (Trust me on this one. Even with proper tapering, the side effects are not pretty.) I waver on the idea that antid's are "appropriate treatment" for moderate-to-severe depression rather than a "form of treatment." Antidepressants can help, but I'm not sure I like the term "appropriate." But I likely am arguing semantics.

Since the results of the study originate from Britain (despite the fact that it also includes data from the FDA), I can only assume that news reports on this are more widespread over there. In my Philadelphia, USA-world, it seems a little bit off the radar to me. Let me know if I'm wrong.

To Mr. Appleby's credit, he has acknowledged that the British government plans to rigorously pursue routes of alternative treatment in light of the study.

The government has plans to expand the availability of psychological therapies as an alternative to drugs, Appleby explained, with extra investment and more psychological therapists.

"The evidence shows that these therapies are effective and often preferred by patients."

WebMD also covered the recent study.  Dr. Nada Stotland of the American Psychiatric Association insists that the study is not reflective of real psychiatry.

"We know that many people who are depressed do not respond to the first antidepressant they try," she says. "It can take up to an average of three different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve."

Stotland has a point. Patients usually do not respond to the first antidepressant that is prescribed to them. About 30 percent of patients do not respond to antidepressants or experience no improvement until several weeks later.  Even then, patients who are on antidepressants for long-term maintenance, experience the return of depressive symptoms. An article from The New England Journal of Medicine evaluated the selective publishing of antidepressant trials with a positive efficacy:

Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

The authors' conclusion: "Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients." It's an obvious statement; so obvious, it can be easily overlooked.

While it's important to shed light on the issue of treating depression with antidepressants, it seems as though many authors are cherry-picking favorable results to publish. Considering that much of these research studies are backed by drug companies, it's no surprise. Also, I can't fault the authors only. I recently freelanced for a medical publication and learned that many of the submitted articles are heavily rewritten by the editors. Editors are hard-pressed (and probably loath) to publish a piece that criticizes antidepressants when their biggest advertisers include such big names as Wyeth, Eli Lilly, and GlaxoSmithKline. Run enough of those pieces and a publication is quickly on its way to folding.

That's why it's stunning to read the U of Hull study that has somewhat of a negative slant toward antidepressants' effectiveness. While doctors are wisely advising patients to continue any antidepressants they may be on, currently drug makers have launched into damage-control mode.

In a statement, GlaxoSmithKline (GSK) representatives express "disappointment" at how the study was being reported by the media, suggesting that news reports may have caused "unnecessary alarm and concern for patients."

Of course these news reports are "unnecessary" to GSK. Letting patients know that their antidepressants might not work better than sugar pills isn't good for business. However, GSK's reps were kind enough to balance out their statement, adding "counseling and lifestyle changes" also are important aspects of treating depression. Then, the company accuses the researchers of selectively reporting their data:

"GSK fully endorses public disclosure of clinical trial results for its medicines and is actively committed to communicating data relevant to patient care," the statement reads. "All the data related to GSK's clinical trial results of [Paxil], regardless of study outcome, are available at the company's clinical trials register at 20 www.gsk.com."

Tell that to the estimated 5,000 Americans who have filed a lawsuit against GSK regarding Paxil. Still, Kirsch, who has received consulting fees from Squibb and Pfizer, insists "the [drug companies] certainly do publish selectively."

I'm inclined to agree.

Do antidepressants provide psychosomatic improvement?

Despite all the hype surrounding antidepressants and their effectiveness, the AP has reported on a new study from the University of Hull in Britain that says antidepressants only help severely depressed people and “work no better than placebos in many patients.”

The drugs used in the study: Prozac (fluoxetine), Effexor (venlafaxine), Paxil/Seroxat (paroxetine), and Serzone (nefazodone).

Irving Kirsch, who headed the study, said: “Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great. This means that depressed people can improve without chemical treatments.” (AP)

This is a pretty controversial finding considering the widespread use of antidepressants among those who have been diagnosed with clinical depression and other forms of mental illness, i.e. anxiety.

According the NIH, depression (the clinical term is major depressive disorder) affects an estimated 14.8 million American adults. CNN cites a study from the U.S. Centers for Disease Control and Prevention that says 2.4 billion drugs were prescribed in 2005; of those, 118 million were antidepressants. I can only imagine as “awareness” of depression increases, the number of prescribed antid’s has increased as well.

Adult use of antidepressants almost tripled between the periods 1988-1994 and 1999-2000.

Between 1995 and 2002, the most recent year for which statistics are available, the use of these drugs rose 48 percent, the CDC reported.

Many psychiatrists see this statistic as good news — a sign that finally Americans feel comfortable asking for help with psychiatric problems. (CNN)

CNN quoted Dr. Kelly Posner, an assistant professor at Columbia University College of Physicians and Surgeons in New York City, who said that “25 percent of adults will have a major depressive episode sometime in their life, as will 8 percent of adolescents.” If 25 percent of adults have a “major depressive episode,” does that mean that those 25 percent will require antidepressants as well? I’m concerned about the relatively high number for adolescents. I’m not a fan of throwing pills at growing children.

In light of the U of Hull study, the first course of treatment regarding depression should be non-medicated therapy of some kind. Whether it be “talk” therapy or cognitive behavior therapy, tackling depression really should first be treated with psychologic therapy. Posner says “25 percent of adults will have a major depressive episode.” Major depressive episode does not equal clinical depression or major depressive disorder, for that matter. A major depressive episode could mean anything: bereavement, loss of employment, or a difficult situation without an immediate resolution. I am strongly against prescribing antidepressants to help people cope with “normal” life events. People feel as though that their grief is too much to bear so they go to the doctor in the hopes that an antidepressant will help “dull” their emotions. I can only hope that a doctor will be able to differentiate between true clinical depression and a difficult situation that could be helped without the use of psychiatric medication.

P.S. I looked up Dr. Posner’s conflicts of interest and they were “TBD.” I would feel better had it listed “no conflicts of interest to disclose.”

Loose Screws Mental Health News

Note: I’m manually typing HTML through my e-mail so if any of the formatting is funky, I apologize in advance.

1) It seems that FDA black box warnings on antidepressants targeted for teen use have led to a decrease in adults being diagnosed with depression. In all honesty, I’m not sure how a black box warning leads to a significant decrease in diagnoses, but I’m not a researcher from the study.

2) Doctors at McGill University in Canada are holding out hope for a faster-acting antidepressant. Most antidepressants take up to six weeks to finally kick in while the seemingly promising compounds, RS 67333 and prucalopride, appear to act “four to seven times faster” than regular antid’s.

3) Sad news: While American suicide rates overall have dropped, the rate of suicide among teenage girls have increased. The preferred method of dying? Hanging.

4) Recent reports have been released that Owen Wilson’s Aug. 26 suicide attempt wasn’t his first – in fact, it was his third.

Official reports confirm Wilson attempted suicide, and now a family friend has told The National Enquirer that the recent incident wasn’t Wilson’s first cry for help.

The unnamed source tells the publication, “A good portion of his (Wilson’s) life has been dedicated to fighting depression and addiction… This is the third time he’s tried killing himself.”

When I hear of celebrities who openly admit to being depressed, I immediately get skeptical. Mandy Moore… Zach Braff… Paris Hilton… Depression is the “hawt” mental illness of choice. Everyone can have it and remain normal! Bipolar’s too crazy and schizophrenia is too psycho. Being bipolar means that you’re spontaneously moody and being schizophrenic means that you’re, well, just not all there. No one wants to be the last two. You can be “sad” and “suffer” from depression — that is, sad about your goldfish of 2 days dying. Mr. Wilson appears to genuinely suffer from depression (among other problems) and my heart goes out to him. As for Britney Spears: I’m fully convinced that the woman has a mental illness. No joke.

The Zoloft-rage/violence connection

[This post is quite lengthy so I suggest you grab a cup of coffee or tea and sit down and read it. The following is not for the faint of heart (or those with a lack of time).]

It’s been amazing to me that I’ve received numerous comments on Zoloft inducing rage. I’m humbled by having a Pittman supporter visit my site and post some comments from the ChristopherPittman.org forums. Read the following:

In my senior year in high school I was diagnosed as being severely depressed and put on medication. The first medication that I was on I took for 5 months and it made me really aggressive. My friends and family noticed the change and I told my doctor about it and she changed my meds. After that I was fine. I am normally a very passive person and will let just about anything fly. But the medication made me really aggravated and aggressive toward my friends and family and it seemed that I wasn’t overcoming my depression. I just got done watching the 48 hours investigation on the Discovery Times Channel and felt a connection with Chris. I felt that I had to write this to let you know that Chris is not the only one out there that had these side effects. I think there should be a study done to see how many people that take antidepressants have increased aggression. The problem is that the pharmaceutical industry has deep pockets and many lobbyists. I hope this helps in some way.

And another:

I remember the case when it happened.

At the time I thought, “Zoloft right”.

Let me tell you my physician put me on Zoloft and it took about three weeks for my to become psychotic and I’m a 50 year old woman.

I have three children and I don’t make a lot of money but please let me know if I can do anything for the Pittman boy.

The jury should have been placed on Zoloft before they made they decision. Unless you’ve experience it you simply cannot believe its’ effect.

Brynn and Phil HartmanI did a bit of quick reading/research into Zoloft triggering violence in people who otherwise would have never been violent and it seems that are a few stories out there to support the assertion. I found a few comments on depressionblog.com that mentioned a link between Zoloft and rage fits. A Salon.com article published a story antidepressants inducing rage in 1999. Apparently, Brynn Hartman, the wife of famous comedian Phil Hartman, killed herself and her husband while taking Zoloft. While close friends attribute the sudden behavior on the antidepressant, others attribute it to a combination of the medication with cocaine and alcohol in her system. (Zoloft does have a warning against alcohol use in conjunction with the drug.)

One interesting thing I learned from the article is that this kind of behavior is often labeled under the name akathisia on patient safety guides. Most – if not all – of the major antidepressants list akathisia as a side effect. Here’s the initial description of this condition from Wikipedia:

Akathisia, or acathisia, is an unpleasant subjective sensation of “inner” restlessness that manifests itself with an inability to sit still or remain motionless… Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), and rarely, antidepressants.

Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still, accompanied by overwhelming anxiety, malaise, and severe dysphoria (manifesting as an almost indescribable sense of terror and doom).

No real mention of extreme anger or irritability mentioned there. But if you read on…

The 2006 U.K. study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as “agitation, emotional lability, and hyperkinesis (overactivity)”. The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia. Healy, et. al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can “exacerbate psychopathology.” The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebos showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).

Read the rest of this entry »

Can Zoloft induce rage?

Furious Seasons has a post on WWE wrestler Chris Benoit, who possibly may have taken Zoloft shortly before he committed the murder of his wife and child. The article on pwtorch.com that FS linked to refers to the possibility that Benoit's friend and doctor, Phillippe Astin III, may have prescribed the drug to Benoit on Friday, the day before he killed his wife.

There are definitely some funky mental issues behind Benoit's motives for killing his family, but it wouldn't surprise me if the Zoloft played a part in influencing him to do so. I recently mentioned Christopher Pittman who killed his grandparents in 2001 then proceeded to set their house on fire when he was on an adult dosage of 200 mg of Zoloft. He was 12. Stephany of soulful sepulcher commented that her daughter suffered from a similar problem while on 150 mg Zoloft:

Pittman was about the same age my daughter was then, and she was on 150mg of Zoloft a day, and that med changed her personality into a full blown all day raging person. She had to go inpatient to get off of it, and once off of it, she's never raged like that again. The Pittman story is very sad, as are all of the others associated with antidepressant use and teen violence. Columbine had Luvox, there's Accutane–it's beyond me how this can be overlooked in connection.

I wonder if there are other stories floating out there now about how Zoloft – an antidepressant – has caused similar behaviors. It'd be interesting to observe whether Zoloft causes hallucinations, delusions, and psychosis.

Take two pills and call me if there's a birth defect

A recent article in the NYT reported that two studies released in The New England Journal of Medicine claim that an antidepressant could potentially increase the risk of a baby being born with a birth defect, but, uh,  it's unlikely and "confined to a few rare defects."

Benedict Carey, author of the article, points out that the studies didn't have a good sampling to really prove that assertion:

"In both studies, researchers interviewed mothers of more than 9,500 infants with birth defects, including cleft palate and heart valve problems. They found that mothers who remember being on antidepressants like Zoloft, Paxil, or Prozac while pregnant were at no higher risk for most defects than a control group of women who said they had not taken antidepressants."

So what's it's sounding like for me is that researchers got a group of expecting moms together, basically said, "Hey, have you taken an antidepressant?" and the ones who said yes were placed in one control group and the ones who said no were placed in another. How reliable.

Having been part of a clinical trial for bipolar disorder, I know it's likely these women got paid for their participation in this study. (Most people do, from what I understand.) So some could essentially have lied in the hopes they could snag $100. It doesn't sound like these women agreed to have their past medical history released to researchers that could prove they've been on antidepressant medication, they could have just been like:

"Uh, yeah. I took the antidepressant with the happy little egg sad face thingy."

Doctor: "Zoloft?"

"Yeah, yeah! That one. It maketed me alllll better."

Remember – it's mothers who "remembered" being on antidepressants while pregnant, not medical histories that proved that they've at least been prescribed the medication.

One doctor, not involved in the research, had reservations about the so-called findings:

"These are important papers, but they don't close the questions of whether there are major effects" of these drugs on developing babies, said Dr. Timothy Oberlander, a developmental pediatrician at the University of British Columbia, who was not involved in the studies.

Despite the seemingly positive outcomes that "support doctors' assurances that antidepressants are not a major cause of serious physical problems in newborns," both studies uncovered some pretty serious – but considered rare – conditions.

"One of the studies, led by Carol Louik of Boston University and financed in part by the drug makers GlaxoSmithKline and Sanofi-Aventis, found that use of Paxil was associated with an increased risk of a rare heart defect, which the company had previously reported.

The other study, led by Sura Alwan of the University of British Columbia, found that use of antidepressants increased the risk of craniosynostosis, a condition in which the bones in the skull fuse prematurely. Rare gastric and neural tube defects may also be more common in babies exposed to the medication, the studies suggested."

But don't worry, pregnant moms – the risks are low, "appear remote, and confined to a few rare defects." So, hey, even if your baby DID develop a rare defect, at least it's rare! [sarcasm]

I'd take the chance of depression if it meant my baby had a better chance of being born healthy. I'm lucky – I couldn't take Lamictal if I got pregnant. I wish antidepressants would have the same instruction.

NICS the anti-depressants

In my Google alerts, I came upon a link to The Center for Science Writings at the Stevens Institute of Technology. John Horgan, a professor on the blog, received an e-mail from a former student commenting on the future of anti-depressant therapy:

Introducing “pharmacogenomics,” the latest and greatest addition to the ever-growing collection of pseudoscientific portmanteaus. According to a recent article in the New York Times written by Richard A. Friedman, M.D., there will soon be psychological medication that is custom-tailored to a patient’s DNA and genetic structure to ensure maximum effectiveness.

He makes his case with an example: his patient Laura. Laura was depressed, so Friedman gave her Lexapro, a common selective seratonin reuptake inhibitor (SSRI) anti-depressant. But Laura was still depressed, so he switched her to Zoloft, another SSRI. Still depressed, Laura switched to Wellbutrin, a non-SSRI anti-depressant. No dice. Dr. Friedman was frustrated; after three months he still couldn’t find an effective treatment for Laura. Then, Laura decided that since Prozac (also an SSRI) had helped her father with depression, she wanted to give it a shot. And voila, it worked!

If only Laura’s genes were able to reveal that Dr. Friedman should have prescribed Prozac, arguably the most well-known anti-depressant in America, from the very beginning, that would have saved a lot of hard, aggravating diagnosis work on everybody’s part.

But wait! There might be salvation on the horizon; according to Friedman it will soon be possible for doctors to analyze a patient’s unique genetic profile and prescribe the appropriate medicine so that time and money would no longer be wasted on the circuitous trial-and-error process of expert diagnoses.

No, what “melted away” Laura’s depression was good, old fashioned SSRI Prozac. But Friedman doesn’t see the contradiction. Instead, he claims that this new process of genetic-based medical treatments, “pharmacogenomics” will revolutionize the medicine, allow doctors to enhance their already astute diagnosing skills, and reduce the pharmaceutical industry to a withering dinosaur.

But what about Laura? What about the Prozac? Could it be that she was genetically predisposed to a specific brand of medicine? Are we all designed to respond to one drug label instead of another? If indeed that’s the case, there is only one logical conclusion to draw: God exists and He’s a Big Pharma shareholder.

Somehow, I’m not so convinced. — Suhas Sreedhar

I'm with Suhas. I skimmed Dr. Friedman's article and the whole process sounds weird. I think Laura probably – haha – psyched herself into thinking that Prozac would work since it worked for her dad.

While genes play a role in generational and familial health, I'm not completely convinced that psych meds would affect a father in the same way as it would affect his son or daughter across the board. Even if it really did work for Laura, I am skeptical that the method could be applied to any psychiatric patient. If a patient doesn't have any family, there we go with trial-and-error. Or we could just search our future FBI DNA mental health database and see if the patient matches up with anyone currently on meds.


Last week, Attorney General Alberto Gonzales called upon the remaining 27 states who don't report mental health files to the  NICS to do so. (That was an awful sentence.)

Speaking during a meeting of the nation's state attorneys general, Gonzales urged [states] to participate in the National Instant Criminal Background Check System, more popularly known as "NICS."

Then the article (linked to above) jumped to protecting the public from sex offenders:.

Gonzales also called for ideas on how to protect the public from convicted sex offenders.

Mental health experts, however, say Gonzales is overreacting. Sex offenders are less likely to repeat the same type of crime than other criminals, only about 13 percent within the first five years, said Dr. James Stark, former president of the Georgia Psychological Association.

"The whole country is in a predator panic. They've gone crazy," said Stark, who treats sexual disorders at the Marietta and Ellijay clinics of Psychological Forensic Associates.

"There are very few sex offenders who are actually dangerous," he said, adding that most of the 13,000 people on Georgia's registry of sex offenders are there for flashing, being a peeping Tom or having consensual sex with an underage girlfriend.

Maybe I'm overreacting. If a sex offender isn't dangerous, why is he or she a sex offender to begin with? Yup, peeping Toms don't ever turn into psychos. On that matter, try watching Alfred Hitchcock's movie, Psycho. (Please don't watch the remake. You'll be better off for it.)

Loose Screws Mental Health News

Let’s start off small and build up, shall we?

A blog I came upon, Providentia, has a post on the suicide rate in Kentucky over a 10-year period. Male schizophrenics have the highest rate of suicide. The leading methods of suicide in the state are firearm use, overdose, and hanging.


Mary WinklerMary Winkler, the preacher’s wife who killed her husband, has been moved from jail to a mental health facility, where she will serve the remainder of her three-year sentence.


East meadow, a poster on the drugs.com message board, asks about Lexapro’s correlation to suicide. Her sister committed suicide while on Lexapro and questions whether the Lexapro might have affected her in that way. As a former Lexapro user, I can empathize with the change in her sister’s behavior.


The Depression Calculator: see how much depression is costing your company and see if treatment is worth your while. I went through it for kicks and basically, I walked away feeling like it cost too much to hire someone with depression, especially if I were running a small business. Blah.


Apparently, bipolar disorder is covered under the Americans with Disabilities Act (ADA). Starbucks is settling an $85,000 lawsuit with Christine Drake, a former Starbucks employee who suffers from bipolar disorder. It seems that Drake’s first manager was willing to work with her “psychiatric impairment” and allow her to gain “extra training and support.” Then, get this:

“But, during her third year, new management told her she was “not Starbucks material,” refused to continue the accommodation and ultimately fired her for discriminatory reasons, the agency alleged.”

Starbucks probably put up one helluva fight, but in the end, they’ve tried to put a good face and good spin on the situation:

Starbucks agreed to pay Drake $75,000 and donate another $10,000 to the Disability Rights Legal Center, which provides legal representation for low-income people with disabilities facing discrimination, as part of the settlement.

“The facts of this case illustrate how relatively minor accommodations are often all that disabled people need to be productive members of the work force,” said the EEOC’s San Francisco district office director, Joan Ehrlich. “It is important that all of Starbucks’ managers understand their legal duties regarding disabled employees and provide them with the tools necessary to succeed. This is in everyone’s best interest.”

Ms. Drake, who seems to be more than capable of handling a job well, has probably eeked out several years of a barista’s salary from the Starbucks suit.


I’m amused, but it’s not necessarily a good thing.

RisperdalJohnson & Johnson is gearing up to put Risperdal for children on the market. I’m sure other blogs have beat me to the punch on this, but I just came across this info and found it absolutely retarded. (But what do drug companies care?)

The FDA has approved “expanded use” for Risperdal in teenagers who suffer from schizophrenia and the short-term treatment of bipolar mania in kids ages 10-17. I’m leery enough about antidepressants in kids let alone antipsychotics.

“J&J said the agency has not requested the company perform any additional studies, implying that it need only agree with the FDA on acceptable labeling for the expanded uses in order to gain final approval.”

I wasn’t sure what “expanded use” was so I looked it up. This was the best I could come up with:

“Applications for a new or expanded use, often representing important new treatment options, are formally called “efficacy supplements” to the original new drug application.”

Well, I didn’t know what efficacy supplements were so I looked that up too:

“The legislative history indicates that this provision was directed at certain types of efficacy supplements (i.e., supplemental applications proposing to add a new use of an approved drug to the product labeling).”

So – correct me if I’m wrong – it sounds like the studies performed that led up to this “expanded use” are not as rigorously evaluated by the FDA as the initial studies that allowed the drug to be released on the market in the first place. It just seems like a company and the FDA simply need to agree on “acceptable labeling.” So if we’re following the theory that I’m still correct, the FDA doesn’t follow up on the clinical trials performed on these children, they just agree with J&J on the “acceptable labeling.” Doesn’t that thought make you feel all warm and fuzzy inside about your health?


Christopher PittmanOn the subject of children and psychotropic medications, 12-year-old Christopher Pittman shot and killed his grandparents and then set their house on fire in November 2001 all while on an adult dosage of Zoloft. It looks like the drama is still playing out in June 2007.

According to CourtTV.com, Pittman suffered from hallucinations while on the 200 mg dose and while in jail, displayed symptoms of mania.

“Three years after the killings, Pittman was tried in adult court and convicted of murder. He was sentenced to 30 years in prison. He was then 15 years of age.”

No doubt Pittman should be held responsible for what occurred, especially if he admitted to the killings (which he did). However, the situation raises a few questions. First of all, why was he on 200 mg of Zoloft when he was TWELVE? Why wasn’t he considered mentally ill and placed in a mental health facility? I could go on and on. While Pittman “did the crime and needs to do the time,” why isn’t the doctor who prescribed this not present in any of the reported stories? If this incident was 2001, it can only be worse for antidepressants and other psych meds today.

Women & Antidepressants

Pink, a magazine for business women, has an article in its April/May 2007 issue titled, “The Magic Pill.” (The only way to read this article is to get a hard-copy of the mag.) No, this isn’t about birth control. The subhead: “Antidepressants are now used for everything from migraines to menopause. But are women getting an overdose?”

Good question. The article, well-written by Mary Anne Dunkin, does a nice job of trying to present both sides of the coin. One subject, Pam Gilchrist, takes tricyclic antidepressants to relieve her fibromyalgia symptoms. “One of the [antidepressants] that allows her to keep going” is Effexor (venlafaxine). God forbid the woman should ever have to come off of that one. (It works well when you’re on it, but withdrawal is sheer hell.)

The other subject mentioned in the article, Billie Wickstrom, suffers from bipolar disorder, but had a therapist who diagnosed her with obsessive-compulsive disorder. The psychiatrist she was referred to promptly put her on Anafranil (clomipramine). We all know what antidepressants tend to do for those with bipolar disorder. Wickstrom blanked out at an interview that she says she normally would have aced. In another incident, she veered off-course after leaving town and spent the night on the side of the road with her daughter. “Search parties in three states” were out looking for them.

“Three years and three hospitalizations later, Wickstrom is finally free of clomipramine and has a job she loves as PR director for a $300 million family of companies. She says she’s happy, she’s focused and she feels great – consistently.”

Dunkin’s article uncovers a large, problematic use – by my standards, anyway – of off-label usage by doctors.

“Gilchrist… is one of the estimated one in 10 American women taking some type of antidepressant medication. And a considerable percentage of these prescriptions, particularly those for tricyclic antidepressants, are not used to treat depression at all.

A growing number of doctors today prescribe antidepressants for a wide range of problems, including anxiety, chronic pain, insomnia, migraines, high blood pressure, irritable bowel syndrome, premenstrual syndrome, menopausal hot flashes and smoking cessation.”

I’m sure the list goes on, but magazines have but oh so much space.

Melissa McNeilDr. Melissa McNeil at the University of Pittsburgh points out three things:

  1. Since depression is a prevalent (see common) condition, doctors are better detecting it.
  2. Since antidepressants have proven their safety and efficacy, primary care physicians have no reservations prescribing them.
  3. Clinical studies are finding that antidepressants can aid a number of medical issues apart from depression.

My take on McNeil’s points (I’ll try to keep them brief):

  • Depression is way too common to be abnormal. If a woman has a rough patch in life for 2 weeks or more, she’s got depression. As for doctors being better at detecting depression? Studies consistently show that doctors are great at overlooking depression in men.
  • Antidepressants haven’t proven jack squat. Placebos have proven more safety and efficacy than antidepressants. PCPs have no reservations prescribing them because they only know about the positive facts that pharma reps tell them instead of researching the potential side effects.
  • Clinical studies aren’t finding all those things out. Seroquel has FDA-approval to treat psychiatric symptoms (psychosis, for one). As far as I know, Seroquel is not FDA-approved to treat insomnia or crappy sleeping patterns. There are no specific clinical studies to see if Seroquel can treat insomnia. Seroquel is prescribed to treat insomnia/restless sleep because doctors have found that a major side effect of the drug is somnolence. If this is the case, Effexor should be prescribed for weight loss. It’d be the new Fen-Phen.

Dunkin cites two widely used antidepressants for nonpsychiatric uses: Wellbutrin (bupropion) and Prozac (fluoxetine). Zyban, used for smoking cessation is, well, bupropion. Sarafem, used to treat PMS symptoms is – you guessed it – fluoxetine.

Viktor BouquetteDr. Viktor Bouquette of Progressive Medical Group thankfully takes a more cautious approach:

“The widespread use – mostly misuse – by physicians of antidepressants to treat women for far-ranging symptoms from insomnia, chronic fatigue and irritability to PMS and menopause is merely another unfortunate example of the pharmaceutical industry’s tremendous influence on the practice of modern medicine. Take enough antidepressants and you may likely still have the symptoms, but you won’t care.”

Kudos to Dunkin for landing that quote. Since Bouquette is part of an alternative medicine group, he’s got a good motive for slamming pharma companies.

McNeil goes on to sound anti-d happy in the article. Not that it matters, but she is also a section editor for the Journal of Women’s Health, which has several corporate associates representing pharmaceutical companies. (She is also the only source in the article who sings anti-d’s praises.) Dunkin tracked down Dr. Scott Haltzman, a clinical professor at the Brown University Department of Psychiatry, who advocated patient responsibility.

“Just because antidepressants work for depression does not mean they should always be used. People need to learn skills to manage their depressive symptoms instead of depending on medication. When you take medicine for every complaint, you lose the opportunity to learn how to regulate your mood on your own.”

Oh, for more doctors like Haltzman and Bouquette.

UPDATE: Uh, alleged fraud suit pending against Progressive Medical Group. Bouquette is now part of Progressive Medical Centers of America.

Nothing you didn't already know

Paxil's great for kids

An Associated Press article has reported on how antidepressants have a positive effect on children and adolescents. The upside? No suicides.

Antidepressants used: Paxil, Celexa, Zoloft, Lexapro, Prozac, Serzone, Remeron.

Dr. David Brent from the University Of Pittsburgh School Of Medicine is a flat-out idiot:

‘‘The medications are safe and effective and should be considered as an important part of treatment. The benefits seem favorable compared to the small risk of suicidal thoughts and behavior.’’

Screw you, Dr. Brent for not taking meds and taking money from drug companies (probably to fund research studies). All meds listed above – Paxil, namely – have side/withdrawal effects strong enough to fuck an adult up, let alone a developing child. Sure, I recommend alcohol for kids: It’s safe, effective, and the benefits are favorable compared to the small risk of alcoholism and drunk driving.

The prestigious Duke University has a smarter and cautious doctor, Dr. John March, chief of child and adolescent psychiatry at Duke University Medical Center.

“He said the suicidal behavior risk, although lower than found by the FDA, demands that doctors and families watch for warning signs.

‘You can’t treat kids with these drugs without taking this information into account,’ said March, who was not involved in the study, but does similar research. ‘You can’t say, ‘Take these and call me in six weeks.’ You have to monitor carefully the benefits and adverse events.’

An addendum: “The study was supported by grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation.”

Talk amongst yourselves.

Wyeth looking for Pristiq's FDA approval in 2008

Depressed Americans will be spared of Pristiq for 1 year. According to an article from Reuters, "positive" data has raised investors’ hopes in Wyeth’s future star drug.

"The trial data showed low doses of Pristiq were effective against both depression and hot flashes and caused less nausea than was seen in prior studies of higher doses. Although the new data will take more time for regulators to analyze, it could bolster prospects for eventual approval and commercial success of the drug."

My best guess? Pharma reps will push Pristiq at higher dosages and doctors will prescribe it at higher dosages with a minimal warning of nausea. I’d like to know the highest dosage tolerated with the least amount of nausea. And really, what is considered a low dosage anyway? The difference between 37.5 mg of Effexor and 300 mg of Effexor is significant despite the fact people told me that the dosages didn’t compare to that of Lexapro’s. (It was supposedly less powerful than Lexapro.)

Anyway, I’ll stop my rants. I’ll follow Pristiq as the information continues to trickle out but don’t expect to hear much about it until next year when Wyeth becomes the proud papa of a brand new (and approved) product.

Pristiq's under-the-radar clinical trials

News stories on Wyeth’s Pristiq, Effexor’s “knockoff”, have focused on the drug’s uses that are pending FDA-approval: vasomotor symptoms accompanying menopause (see hot flashes) and depression. (“Knockoff” term courtesy of CLPsych.) The major media has failed to pick up on Wyeth’s Phase III clinical trials to use Pristiq for fibromyalgia and neuropathic pain (injured tissue or damaged nerve fibers) in diabetics. A search for Pristiq on Wyeth’s Web site yields no results. Desvenlafaxine yields two very meager results.

In related matters, bifeprunox is pending FDA-approval for the use of schizophrenia and is still in Phase III for use of bipolar disorder. They are also in Phase III of testing Lybrex (levonorgestrel) for use for Premenstrual Dysmorphic Disorder in addition to the drug functioning as an oral contraceptive. (I’ll be honest; I had NO clue that diagnosis existed.) In any event, I’ve been misdiagnosed because according to the symptoms, I qualify. I think I also qualify for OOPS – Overdiagnosed and Overmedicated Patient Syndrome.

I’d like expound on Wyeth’s Learn and Confirm phase that’s supposed to replace Phase I and II of clinical trials. It sounds like a speedier way to just get drugs to Phase III of clin. trials, but it’s late and I’m working on something else, so I’ll save that for another day.

Also something to tackle in the future: All these interesting clinical trial results for Effexor XR involving depression and GAD. We’ll see…

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Mood: 6.5

Blogs: Tracking Effexor Withdrawal

I really should have posted on this a LONG time ago, but Graham’s Blog has done an unbelievable job of tracking his Effexor withdrawal symptoms. Something I learned today:

"| Night Sweats – I had this very bad, constantly wake up drenched in sweat,
literally soaked to the skin and to the mattress. But Have just realised I have
not had these severity of symptoms for some weeks, which is helping with the
consistency of sleep."

Ohh, so that’s why I wake up drenched in sweat in the middle of the night regardless of whether it’s warm or cold in my room. To quote Dawdy over at Furious Seasons, like Paxil, it truly is the "gift that keeps on giving." Hooray for long-lasting effects from psych meds! [sarcasm] Now, I’ve got this occasional twitch in my cheek. I took Paxil for about 3 months in 2003 and I still get eye twitches that I never had previous to the medication.

Check out Graham’s Blog and see the hell that Effexor can cause. Stephany at soulful sepulcher tracks some helpful tips for withdrawing from a psych med.

Pristiq's FDA Chances: Depression – Yea; Menopause – Nay

As more info on Pristiq continues to roll out, I'll do my best to track them quite closely.

While Wyeth scrambles to resolve issues in its Puerto Rico plant to meet FDA standards, Ms. Kathleen Kerr of Newsday recently reported on Pristiq's potential to be approved for use in depression and hot flashes resulting from menopause. I was so excited to see some decent reporting on a mental health issue in a paper other than the NYT. It was also nice to see that it didn't end with "Shares of Wyeth fell 38 cents Friday to close at $51.50 on the New York Stock Exchange."

"If Pristiq wins Food and Drug Administration approval, it will be the first antidepressant and only non-hormonal remedy marketed specifically for hot flashes. But Pristiq isn't without problems – it poses rare suicide risks in young people."

Read the rest of this entry »

A final update on my Effexor withdrawal

I failed to update on my Effexor withdrawal because, well, you know why.

After three to four weeks, my Effexor symptoms – well, most of them anyway – have dissipated. The brain shocks were gone by early February. The vertigo as of now has completely resolved. (Although I’ll probably still have occasional instances where it may linger.) The dizziness also has lightened up. I can confidently say that I’m pretty much back-to-normal. All cases will differ, but for me, it took about five weeks total to have a complete recovery.

But don’t do headstands after Effexor – whoo, boy, can that throw you for a loop.

Also – it took about four weeks to get the drowsy effect of fluoxetine (Prozac) out of my system. January was an extremely rough month for meds, let me tell you.

Blog worth checking out

Holly Finch’s blog “Am I Still Me?” is worth taking a look at. She was a survivor in the London bombing that occurred on July 7, 2005 and as a result, blogs about her daily life while suffering from PTSD.

She recently blogged about coming off citalopram (U.S. trademark name: Celexa) and is experiencing some awful withdrawal effects. This makes me glad that I skipped Celexa in the hospital before I met my doctor. He recommended Effexor instead.

Not that it makes a difference really. I just had the privilege of not having two withdrawal symptoms in succession.

Loose Screws Mental Health News

As much as I hate to admit it, the Scientologists have a point.

A group linked to Scientology staged a protest near a school after a student on psychiatric drugs stabbed a classmate to death. The point of the protest was to highlight “the dangers of antidepressants.”

“Several Scientologists held signs that mentioned by name John Odgren, the teen accused in the fatal stabbing. Signs included slogans such as “What psychiatric drugs was John Odgren prescribed?” and “Stop combining drugs to make walking time bombs.”

Odgren, 16, has been diagnosed with Asperger’s syndrome, a mild form of autism, and according to his attorney was taking several prescription medications at the time of the stabbing. Odgren lived in Princeton but attended a special education program at L-S.”

I didn’t know that psychiatric drugs made people homicidal. I guess if they can make people suicidal then homicidal isn’t that far off.

“’There’s a lot of concern around the country when kids are becoming violent on psychiatric drugs,’ said Kevin Hall, the Scientology group’s New England director.”

Concern from who? This is probably something I should look into. See my favorite quote below:

“This is not a serious request by a serious group,” said School Committee Chairman Mark Collins on the demand that Odgren’s medical records be made public.”

Ouch. Scientology dismissed in one sentence.

UPDATE: Psychiatry drugs supposedly have no violent effect on children. But there are two sides to the debate.

Version 1 —

“Though the Food and Drug Administration currently includes a warning, called a ‘black box warning,’ on SSRIs stating studies have shown increased risk of suicide, particularly among teens and children, [John Fromson, chair of the psychiatry department at MetroWest Medical Center] said there are no studies which show the drugs cause violence toward others.

‘Violence is a social issue here,’ he said. ‘Illicit street drugs can do that…but to make a connection between medication that’s prescribed for legitimate reasons and at appropriate doses and violence – the scientific evidence just isn’t there.'” [emphasis mine]

Version 2 —

“Advocates like Lisa Van Syckel, however, insist the drugs can lead to violence, because they’ve seen it firsthand.

Van Syckel’s anti-depressant ordeal began seven years ago, when her then- 15-year-old daughter Michelle was prescribed the SSRI Paxil for depression and anorexia.

Over the next year, Van Syckel said, she attacked her brother, she viciously attacked three police officers, she went after another student with a baseball bat and she cut the word ‘die’ into her abdomen.

After nearly a year on the medication, doctors changed Michelle’s diagnosis to Lyme disease, and gradually weaned the teen off the drugs, and Van Syckel said Michelle has been herself ever since.”

Perhaps the scientific evidence isn’t there because clinical studies don’t track adolescents long enough to determine whether a propensity toward violence to others significantly increases.


A Mexican man who tried to commit suicide became a victim of police homicide. (Weird.) He threw himself on the train tracks in the Mexico City subway and was eventually rescued by station employees. After two policemen took him into custody, they allegedly beat him to death inside their patrol car. It’s so sad that this man had a second chance at life and two stupid policemen took it away.


I didn’t know this was possible:

“A 23-year-old man who sold a lethal cocktail of drugs as “suicide pills” on the Internet was sentenced by a court in Germany on Wednesday to three years and nine months in prison. The man pleaded guilty to 16 counts of the illegal sale of pharmaceuticals, a spokesman for the court in Wuppertal said.”

Wow. Who does a Google search for “suicide cocktail” or “lethal drug cocktails”? Isn’t it easier (and cheaper) to do it the old-fashioned ways: crash a car, hanging, jumping off a bridge…? Not advocating suicide, but I don’t understand why people need to pay for suicide. Maybe they’re wussies like me. But that’s what overdosing on pills is for.  The Captain Obvious quote of the day:

“Suicide and assisting suicide are not illegal in Germany.”

Maybe I should move to Germany. (KIDDING. Just kidding. Sort of.)


50 Cent’s producer Disco D (Dave Shayman) killed himself on January 23. Although not much is known about his death, there is speculation that Disco D had bipolar disorder.

“DJ Vlad, a good friend of D, was shocked upon hearing the news.

‘Disco D was a good friend of mine. I lived with him in Brazil for a couple weeks. He was a real artist,’ Vlad revealed. ‘I just talked to him a few days ago, and he told me things were hard. I tried to cheer him up. I didn’t realize how hard it really was. I’m devastated right now.’”

No one really knows how difficult it is for someone struggling with depression and suicidal thoughts unless you’ve been there.


An article from IHT details interesting research that Harvard’s McLean Hospital is conducting to find out more about genetic schizophrenia.

“Consider, said Deborah Levy, the lab’s director: ‘The incidence of schizophrenia is stable at about 1 percent, and schizophrenics have very low reproductive rates. So what is keeping those genes going? One hypothesis is that most of the people carrying the schizophrenia genes are not the patients. Rather, they are some of the well parents and well siblings, most of whom never show signs of the illness.’”

Hmm. Is that why I’m an only child?

“The effects of such genes may show up in a variety of subtle ways, they say – including faulty eye-tracking and asymmetry in facial features so hard to detect that it is best measured by highly specialized 3-D cameras.

At Levy’s lab, people with schizophrenia and their relatives undergo 10 to 12 hours of tests. … The faces are measured in minute detail by Curtis Deutsch, a genetics expert who focuses on facial variations and their links to various diseases. … So, subtle abnormalities in the shape and layout of a face may reflect specific abnormalities in brain structure, he said. Thus far, he said, he has found that some schizophrenics do have certain minor facial anomalies – none of them visible to the naked eye – as do some of their healthy relatives.”

So it’s possible that facial features and movements could provide a clue to schizophrenic genes or perhaps increased risk for schizophrenia. The article’s pretty interesting. Go read the rest of it.

Pessimists get heart disease while Lexapro's "better" than Cymbalta

If view the glass as half-empty, you may be at increased risk for heart disease. An essay, published via the NYT, explains the findings of a study.

"A study by researchers in the Netherlands has found that people who are temperamentally pessimistic are more likely to die of heart disease and other causes than those who are by nature optimistic."

While people with depression are at a higher risk for poor health, pessimists apparently are too.

"Dr. [Eric J.] Giltay and his colleagues found that subjects with the highest level of optimism were 45 percent less likely than those with the highest level of pessimism to die of all causes during the study.

For people who already have well-documented heart disease, depression increases the risk of death about threefold."

Dr. Richard A. Friedman, author of the essay, get to the heart (npi) of the matter: screen pessimists for depression.


CL Psych wrote about how Lexapro’s data beat Cymbalta’s data but in a semi-shady manner. My mind can’t comprehend all the scientific math and data behind this so feel free to read his post and ask him your questions.

2nd-generation Celexa, or TC-2216

Targacept is in the process of developing a “new class of [oral] drugs known as NNR (neuronal nicotinic receptor) Therapeutics.” They’re starting the first phase of a clinical trial called TC-2216 that targets depression and anxiety treatment.

“The trial is designed to evaluate the safety and tolerability of TC-2216 and to assess its pharmacokinetic profile. The trial is a double-blind, placebo-controlled crossover study, with sequential ascending single oral doses administered to healthy male volunteers.”

The next paragraph in the press release (basically) that I got this from goes on to explain that the new compound focuses in on the central nervous system and mood-regulating neurotransmitters, blah, blah, blah.

“In preclinical studies, TC-2216 showed greater potency than and anti-depressant effects comparable to selective serotonin reuptake inhibitors and tricyclics, which are commonly used treatments for depression, as well as anxiety-relieving effects.”

Because every new product in the clinical trial phase and has yet to receive FDA approval is better than everything currently out on the market. Of course.

“In November, the company announced positive top line results from a Phase II clinical trial of TRIDMAC, a treatment combination comprised of mecamylamine hydrochloride as an augmentation therapy to citalopram hydrobromide, in patients who did not respond adequately to citalopram alone. Mecamylamine hydrochloride binds non-selectively to various NNR subtypes, but there is a body of scientific evidence that suggests that its anti-depressant activity is derived through its antagonism at the alpha4beta2 NNR.”

What’s that mean? They’re basically working on Celexa II if people were treatment-resistant to the original Celexa. Like many other drug companies, they’re patenting a similar version of Celexa once Celexa’s eligible to become a generic brand.

“‘The results of our TRIDMAC trial not only substantiate the promise of the NNR mechanism in the treatment of depression and other mood disorders, but also further bolster our enthusiasm for the potential of TC-2216 said J. Donald deBethizy, Ph.D., Targacept’s President and Chief Executive Officer.’”

That’s a pretty bold statement for a company that’s just in Phase I of a clinical trial.

Pristiq gains ground with FDA

FDA approval for Pristiq (I'll refer to it as Pq occasionally) is contingent upon Wyeth's handling of "quality control problems… made to the satisfaction of federal inspectors." As I'd previously mentioned before, Wyeth has built an amazingly similar medication based on Effexor. Wyeth is trying to market Pristiq as an antidepressant and treatment for vasomotor symptoms (hot flashes during menopause). Wyeth is significantly banking on Pristiq since their $3.5 billion Effexor XR will lose its patent in a few years, allowing other companies to make venlafaxine generics.

Some of the "quality control" problems Wyeth is experiencing:

  • unclear whether Pq keeps depressive episodes at bay
  • efficacy at low doses and in young kids
  • severe nausea in 50 percent of patients in the clinical trials

Reuters' article notes this, though:

"But the studies do not need to be completed prior to approval of the new depression pill."

While Wyeth has admitted that Pq is "structurally related" to Effexor, it "has not yet disclosed if Pristiq has any advantages over Effexor XR, other than to say it would be an alternative to existing treatments."

But it has acknowledged the newer drug caused nausea in about one-half of patients in clinical trials.

Wyeth is banking on patients sticking out the nausea for one week (it supposedly subsides after that) or a 50 mg pill that would be more effective than the whopping 400 mg they used in earlier phases of the clinical trials.

"The company said it will not launch Pristiq until it obtains results from the low-dose trials. Moreover, Wyeth said the timing of the launch also will depend on progress of the FDA's ongoing review of Pristiq as a possible non-hormonal treatment for hot flashes. The FDA is scheduled to decide on the hot flashes indication in April."

Wyeth wants to be absolutely sure they can cover all of their bases in an effort not to lose a single portion on their market share — from those who can tolerate low doses at 50 mg to those who need to go 400 mg and up.

"A G Edwards analyst Joseph Tooley has predicted Pristiq will garner annual sales of $1.4 billion by 2011 — about $1 billion from use against depression and the remainder for menopausal symptoms."

Getting not only psychiatrists to prescribe the drug, but also OB/GYNs is a clever move on their part.

Loose Screws Mental Health News

Since I was born on Groundhog Day (Google it if you don’t know when it is), I found this story about a groundhog so endearing. (And I make sure to turn around on my birthday to see my shadow.)

Cate BlanchettIf you’re over 50 and on antidepressants, look out – you might be doubling your risk for osteoporosis. Fracture risks seem to be unrelated to falls caused by dizziness and low blood pressure. CLPsych’s analysis is also worth a read. (Many thanks to Bob Thompson for the link.)

People has an article on Cate Blanchett talking about marriage:

“Getting married is insanity; I mean, it’s a risk – who knows if you’re going to be together forever? But you both say, ‘’We’re going to take this chance, in the same spirit.’”

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