Generic Lamictal (lamotrigine)

I'm on "Day I-don't-know" of lamotrigine (generic Lamictal). It's been at least 2 weeks. I haven't had any significant side effects except for extreme fatigue. I am often tired. Some days, I can give myself a boost of energy by playing the Wii Fit (which I snagged Saturday afternoon) and other days, exercising just wears me to out to the point where I head to the shower and then to bed. I can have 3 cups of coffee, never become fully awake, and still go to sleep at a decent time.

I'm still not sleeping well. Haven't slept well since before I went into the hospital in October 2006. I can't remember the last time I had truly restful sleep.

My symptoms remain at bay. I haven't had many suicidal thoughts or impulses. In fact, some days, I can go without thinking about suicide at all. I can't say it's all the medicine — my counseling and faith play a much bigger role — but I'm sure the medicine helps.

I've recently noticed that I'm not suffering from as much social anxiety. Again, I don't know if this is due so much to the medication as it is to the resurgence of my spiritual life. I ventured out on Sunday to a meetup writers workshop group that I'd never been to before. It was extremely weird. Not the situation, but the fact that I walked into a room full of strangers, made myself comfortable on the couch at the coffeehouse and offered input quite freely without worrying about what the others thought of me. I even had the audacity to network with a woman who works at a trade magazine in the area. How strange. I don't have balls. This is not me.

What the heck has happened to me?

Generic drugs are not exactly like brand names

Gianna at Bipolar Blast stumbled upon an article at the LA Times that outlines the FDA’s standard for generics:

In almost all cases, the FDA permits a generic drug to release 80% to
125% of an active ingredient into the bloodstream, compared to that
released in a single dose of the original medication.

Gianna makes a good point for tapering down on brand-name meds then switching to generics:

And definately too broad when I’ve been cutting down my only 10% at a
time. If the drug is 80% of what I’m taking that is a 20% cut without
intending a reduction. It of course can work the other way and make
coming off the drug a longer task and more difficult if it’s actually
125% of the brand name.

eek – that’s something to think about.

Loose Screws Mental Health News

"Can an antipsychotic drug from the 1950s be paired with a 1980s antibiotic to shrink 21st-century tumors?"

That's the first line from the NYT's recent article on biotech companies mixing two unrelated generic drugs to treat medical problems. Alexis Borisy, the executive of CombinatoRx, is spearheading the movement to mix and match two different generic drugs in the hopes that the combo will cure or effectively treat a disease that may be unrelated to the drugs' initial purposes.

"Orexigen, in creating its obesity drug Contrave, took a treatment used for drug and alcohol addiction and combined it with an antidepressant sometimes used to help people quit smoking." (My guess is that the antid was Zyban.)

It's a nice concept, but I'd hate to see risk of side effects doubled. One med can be a doozy; coupled with another could turn out to be problematic.


More from the NYT: Pharmaceutical companies pay psychiatrists (to push their products) more than doctors in any other specialty.

"For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved."

The bipolar child paradigm.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

Doesn't the last sentence make you feel all warm and fuzzy inside? It's great to know that getting people to use drugs are more important to these companies than making sure these drugs are safe to use. Yeah, yeah, I know, it's a company and companies are only out to make profits. Whatever kind of optimist is in me wants to believe that maybe there's one doctor out there who is more motivated by helping others than by pharma-backing money. But I'm only a slight optimist.

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

Wow. I learned something new – “Women are over-represented in all cases of” depression, anxiety, dysthymia and panic attacks. Read more here.


An interesting observation from Gretchen Rubin, blogger of The Happiness Project.

“Studies showed that depressed people have as many nice experiences as non-depressed people, but they remember them less well.”


Graham’s Blog has linked to interesting fashion jewelry: Made with Molecules. For only $20, you can:

“Display your favorite neurotransmitters close to your brain!”

Erhm. The very thought of this disturbs me. Also feel free to purchase a serotonin-happiness card or a dopamine-heart card – just in time for Valentine’s Day.

dopamine heart card

Pfizer is cutting 10,000 from its workforce citing nothing other than loss of profits:

“The drug giant Pfizer said Monday that it would lay off 10,000 workers and close several manufacturing and research sites in an effort to bolster earnings hurt by the loss of patent protection on certain drugs and by setbacks in developing new products.”

I’ve mentioned patent protection before but it seems that Pfizer isn’t generating enough “structurally related” drugs to prevent the loss of its profits to generics. The two biggest losses: Zoloft and Zithromax.

“Pfizer said the moves would save $1.5 billion to $2 billion a year in pretax expenses.

Pharmaceutical industry analysts have generally been welcoming cutbacks by Pfizer but have said that while cost-cutting is beneficial, the company needs to resume growth by bringing new products to market.”

Pfizer’s a big company; I’m sure they’ll have no problems rebounding. However, I have no doubt that the failed torcetrapib factored into Pfizer’s decision to cut staffers.


A Philly plaintiff in the Vioxx suit against Merck has willingly withdrawn her suit. She cannot refile against Merck.

“Merck has consistently said it will fight each case on a one by one basis rather than submit to a large settlement.

In trials that have reached a jury verdict so far, Merck has won nine and lost four, including one Merck victory that since has been thrown out.”

The legal fees surrounding the Merck case must be astounding, but is it really worth it for Merck to drag these cases out against 27,000 other plaintiffs? I would assume on Merck’s part that it would be cheaper to settle. But then again, maybe it’s the whole “we need to clear our name” thing. That’s a fast way to lose profits for a pharma company.

Loose Screws Mental Health News

At least 2.9 million people either suffer from depression, know someone who has it, or want to know more about it. According to comScore Networks, a research firm, depression in the most researched medical condition online. Straggling behind in second place is bipolar disorder with insomnia coming in at third.

Whew! Am I glad I’m off Paxil! I’d rather be alive and not in a lawsuit than dead and have my family suing for a wrongful death.

Niiiice: Target goes head-to-head with Wal-Mart and launches its own $4 generic prescription drug program.

Target

Competition between the nation’s two largest retailers is REALLY beginning to heat up… In the good news category, psych meds such as fluoxetine (Prozac), citalopram (Celexa), and paroxetine (Paxil) are part of the deal. See the full list of generics Target offers for $4. IMPORTANT FINE PRINT:

“Due to state law in CA, CO, LA, MN, MT, PA, RI, TN, WI, and WY, pricing on these drugs is higher than $4.”

Dangit – sucks for me – I now live in Pennsylvania. Lucky New Yorkers!

Who needs antidepressants and antipsychotics? One blogger’s found the cure-all for mental illness.

Olfactory nerves have more than an ability to smell. Apparently, they can be used to determine whether someone can develop a mental illness, according to Australian researchers.  Researchers at the University of Melbourne have detected a connection between mental illness and the poor ability to identify smells. Looks like a scratch-and-sniff card is only a mental illness determination away.