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.

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Loose Screws Mental Health News

I need a new subject header for “Mental health news.” It’s so blah. I need something snazzy. Perhaps “Loose Screws News”? Okay, nevermind… That’s what I get for being a former copy editor. Renamed as of 2/16/2009.

A new study, published in the scientific journal of the American Academy of Neurology has found that women who experience chronic headaches, namely migraines, are four times as likely to report symptoms of major depressive disorder. Of the 1,000 women surveyed, “593 reported episodic headache (fewer than 15 headaches per month) and 439 had chronic headache (more than 15 headaches per month).” Migraines were diagnosed in 90 percent of the women. Author of the study Dr. Gretchen Tietjen said that more studies are being done to discover whether the a serotonin imbalance in the central nervous system is the cause of chronic headaches, severe physical problems, and major depressive disorder. (source: The Trouble With Spikol)

According to businesswire.com, the non-profit organization Stanley Medical Research Institute (SMRI) will provide up to $9 million to fund Omeros Corporation’s schizophrenia program, which will help the completion of
Phase 1 clinical trials. Business Wire basically listed SMRI’s press release so I’m curious to do some research on SMRI and how this non-profit was able to obtain $9 million. I don’t know much about this organization but a non-profit organization funding a biopharmaceutical company’s program seems out of the ordinary to me. (This may be something normal, but I’m not aware of this.) According to SMRI’s “about us” blurb at the bottom of the PR, they state:

“The Stanley Medical Research Institute (SMRI) is a nonprofit organization that supports research on the causes and treatment of schizophrenia and bipolar disorder (manic-depressive illness), both through work carried out in its own laboratories and through support of researchers worldwide who are working on these diseases. SMRI has provided over $200 million in funding since 1989.”

Whoa. $200 million since 1989 is not a whole lot. Where in the world did this $9 million come from? Do non-profit organizations actually save up money to blow on a worthy future project? (The cynical patient in me wonders if there’s a drug company like GSK or Wyeth slipping money through SMRI’s back door.)

Liz Spikol usually blogs headlines before I can even get to ‘em so I credit her with discovering the following three links:

According to the Delhi Newsline, yoga can help with cases of severe depression and schizophrenia. (Hm, interesting.) Patients who took yoga classes in addition to meds improved more rapidly than patients only on meds. The connection with yoga seems to be the relaxation component — outdoing counseling and “talk therapy,” which can aid treatment in a mentally ill individual.

Oy. UPI has reported that Swedish researchers have discovered that those who struggle with suicidal ideation have problems with nightmares and sleep problems. Of the 165 patients surveyed, 89 percent of them reported a sleep problem. Nightmares proved to be the highest indicators of those with a high suicide risk. However, lead author Nisse Sjostrom is quick to note,

“Our finding of an association between nightmares and suicidality does not imply causality.”

But

“Our findings should inspire clinicians to include questions concerning sleep disturbance and especially nightmares in the clinical assessment of suicidal patients.”

CPAPMy husband thinks I suffer from sleep apnea – he claims I stop breathing sometimes in the middle of the night. I’m going for a sleep assessment sometime in February so I’ll let you know if I come back with a CPAP (continuous positive airway pressure) machine.

I’ve had increased dreams (or nightmares, what have you) on these psych meds. I haven’t been excessively suicidal and I hope it’s no indication of more suicide attempts on the way. *sigh* Were any of the surveyed patients on meds like Effexor and Lamictal?

(ASIDE: Dang working in a medical industry! I’m becoming more familiar with unfamiliar medical acronyms.)

And finally, News 24 reports that children who suffered from neglect and abuse are more likely to develop severe depression as adults. The study, published in the Archives of General Psychiatry, says the data specifically shows that “depression is a consequence of… abuse.” Um, who wouldn’t be depressed after such a traumatic experience? How do physicians differentiate between major depressive disorder (DSM-IV term for clinical depression) and post-traumatic stress disorder? Ah, once we get the answer, we can use it as a Jeopardy! question.