Eli Lilly seems to be passing along its misfortune off to AstraZeneca, which now appears to be having issues with masking evidence of Seroquel side effects. From Furious Seasons:
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.
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).
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)
My 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.
I am officially joining the ranks of those who are facing the challenge of Lamictal withdrawal.
On Wednesday, I went to see my psychiatrist with a plan to come off of Lamictal:
- 150 mg for 3 months
- 100 mg for 3 months
- 75 mg for 3 months
- 50 mg for 3 months
- 25 mg for 3 months
- 12.5 mg (depending on whether my side effects on the 25 mg are bad)
I told him that my husband and I were looking to have a child sometime next year and that I’d like to taper off of Lamictal but was open to the possibility of getting back on it should I encounter severe suicidal ideation and mixed episodes. He warned me against it and thought it was a bad idea.
He proceeded to say that it’s a maintenance medication, I have a lifelong disorder, it won’t just go away, my symptoms would probably return, I have a higher risk of attempting suicide, blah blah blah — am I aware of all these risks?
He explained people with bipolar depression after coming off of meds can actually be worse, undergo severe depressive episodes, have more suicide attempts, and yadda yadda yadda. To sum it all up, I was risking my life just to get off of Lamictal.
My pdoc was trying to scare me into staying medicated.
He then added if I really wanted to come off of my meds, I could “just stop.”
WHAT?! My eyes flew open.
He stated he’d had patients who had stopped cold turkey without a problem. According to him, anticonvulsants don’t have severe withdrawal effects.
WHAT?! His advice just flies in the face of what most doctors recommend. In fact, quitting Lamictal immediately increases the risk of seizures, which is exactly what I’m afraid of.
Philip’s experience and Gianna’s experience along with the comments on each blog are proof that many people have experienced tremendous withdrawal effects from decreasing Lamictal’s dosage. In the past, I’ve quit Paxil and Lexapro cold turkey — both with not-so-good results to put it mildly.
I insisted that I wanted to come off of it slowly so he said I could just cut my 200 mg pills in half and jump down to 100 mg and stop after 2 weeks.
For real? Two weeks, doc? I had a plan that would take me over a year and you’re reducing it to a mere two weeks? On 100 mg dosage?
Again, I insisted that I wanted to take more time. He reluctantly wrote me a 30-day prescription for 100 mg and said since I was off the medication, I had no need to see him anymore. “Good luck,” he flatly told me.
When I came home after the appointment (and a bitching session to my husband), I remembered that I’d stashed a few 150 mg pills away sometime ago after I jumped back up to 200. So as of Wednesday, my arsenal included:
- A bottle of six 150 mg pills
- A bottle twenty-five 200 mg pills
- A prescription for thirty 100 mg pills
I dropped down to the 150 mg on Wednesday and have been doing all right so far. I intend to keep myself at 150 mg (cutting the 200 mg and the 100 mg in half) for at least 2 weeks, then drop down to 75 mg for 2 weeks and then 50 mg for 2 weeks. I’m most worried about coming off of the 25 mg. This is a way more accelerated plan that I hoped for but I’ve got to work with the cards that I’m dealt.
We’ll see what happens.
Funny the writers decided to add that. A year ago, that clause would have never been considered yet alone thought of.
Pfizer isn’t doing badly; in fact, despite the credit crunch, they’ve been able to snag $22.5 billion in loans since they also have $26 billion cash on hand. The NYTimes also reports that this merger would be the biggest since AT&T and BellSouth merged back in March 2006. But of course, with mergers always come layoffs. And what a time to have layoffs. Pfizer today announced that they’ll be cutting 8,000 jobs.
But as I said in a previous post, Pfizer’s biggest challenge is get some pipeline products out to market soon since some of the patents on their big names (ie, Lipitor) are expiring soon. Don’t hold me to this but I think Wyeth has a bit more sitting in their pipeline, hence why the merger would make sense. But I hope Wyeth can produce a new blockbuster drug for Pfizer otherwise Pfizer’s really going to be hurting for money. Especially since Wyeth’s best-selling drug, Effexor, is now generic and Pristiq isn’t completely cutting it.
justAna posted a comprehensive list of SSRI side/withdrawal effects that can be found on TheEffexorActivist.org. And it's freaking crazy. I've bolded the ones that I've experienced. (I've been pretty lucky, though.) Here we go:
1. Crying spells
2. Worsened mood
3. Low energy (fatigue, lethargy, malaise)
4. Trouble concentrating
5. Insomnia or trouble sleeping
6. Change in appetite
7. Suicidal thoughts
8. Suicide attempts
9. Anxious, nervous, tense
10. Panic attacks (racing heart, breathless)
11. Chest pain
12. Trembling, jittery,or shaking
14. Agitation (restlessness, hyperactivity)
18. Homicidal thoughts or urges
19. Confusion or cognitive difficulties
20. Memory problems or forgetfulness
21. Elevated mood (feeling high)
22. Mood swings
23. Manic-like reactions
24. Auditory hallucinations
25. Visual hallucinations
26. Feeling detached or unreal
27. Excessive or intense dreaming
29. Flu-like aches and pains
33. Runny nose
34. Sore eyes
38. Abdominal pain or cramps
39. Stomach bloating
41. Spinning, swaying, lightheaded
42. Hung over or waterlogged feeling
43. Unsteady gait, poor coordination
44. Motion sickness
47. Numbness, burning, or tingling
48. Electric zap-like sensations in the brain
49. Electric shock-like sensations in the body
50. Abnormal visual sensations
51. Ringing or other noises in the ears
52. Abnormal smells or tastes
53. Drooling or excessive saliva
54. Slurred speech
55. Blurred vision
56. Muscle cramps, stiffness, twitches
57. Feeling of restless legs
58. Uncontrollable twitching of mouth
I've also gotten rashes coming off of Effexor. I was also on Lamictal as well so I don't think it's common. Ana puts it best when she says:
Hoo boy, it sure doesn't.
The New York Times has reported that a recent study found atypical antipsychotics, which include the friendly family of Clozaril, Abilify, Risperdal, Zyprexa, and Seroquel (maybe Saphris soon), can increase a patient’s risk of dying from cardiac arrest twofold.
The study published in The New England Journal of Medicine also concluded that the risk of death from the psychotropic medications isn’t high. However, an editorial also published in the same issue “urged doctors to limit their prescribing of antipsychotic drugs, especially to children and elderly patients, who can be highly susceptible to the drugs’ side effects.”
A U.S. News & World Report article linked to the FDA’s atypical antipsychotics page for further patient information. If you’re on an atypical, I’d recommend reading each word in the patient safety info that applies to you. Proofreaders like me shouldn’t be the only ones tortured with reading all the fine print. *winks*
Last night, I spent some time on the phone with my husband’s friend’s sister (aka my former pastor’s sister). We’ll call her Natalie.
Natalie was very sweet and kind, really encouraging and strengthening me by sharing her testimony of faith in God. She suffers from anxiety and panic attacks, which has led her to take Paxil (on and off) for the past 7 years. She says the drug has helped her tremendously and who am I to knock the drug (knowing what I know about Paxil/Seroxat) when she has seen the wonders that it has worked in her life?
I briefly explained my story of depression, history of suicide, and diagnosis of bipolar disorder. Although she couldn’t fully relate, she was very sympathetic and understanding. In fact, our conversation was so fruitful, I ended up taking notes!
We briefly touched on the issue of Nouthetic counseling (NC). She has undergone the course and simply needs to be certified. The counselor I currently see is associated with the Christian Counseling Education Foundation (CCEF), which has roots in NC and was founded by the man—Jay Adams—who developed the method. However, CCEF is now known for what is called biblical counseling. The organization has since moved away from pure Nouthetic methods and become more a bit more varied, taking bits and pieces of psychology (and perhaps psychiatry) that line up with the Bible. Adams, disagreeing with the organization’s approach, founded the Institute for Nouthetic Studies and uses the Bible as the sole counseling textbook. According to the wiki entry on Nouthetic counseling, Adams developed the word Nouthetic based on the “New Testament Greek word noutheteō (νουθετέω), which can be variously translated as ‘admonish,’ ‘warn,’ ‘correct,’ ‘exhort,’ or ‘instruct.'”
NC was developed back in the ’70s as a response to the popularity of psychology/psychiatry. Many Christians reject some of the teachings of such popular psychologists as Freud, Jung, Adler, Maslow, etc. Adams’ highly successful book, Competent to Counsel, criticizes the psychology industry and counters its teaching with a Nouthetic approach.
But NC has its Christian critics.
My husband and I are talking about expanding our family. While that sounds all well and good, I just have one issue:
For most women, they think, “Well, I want a kid” and the most they have to do is probably get off birth control. Just finish off their contraceptives, maybe feel a little nauseous, and move forward with their plans.
(sigh) Not me. If I want to do this right, it might be a good 6 months or so before I can consider trying.
So much for Miss Up-on-Pharmaceuticals.
How did I find this out? It hit me where it hurt.
In the pockets, of course.
I went to CVS yesterday night for my Lamictal refill. Since I’ve been under my husband’s plan, we’ve been paying about $40 for the medication. So I nearly doubled over when the pharmacy cashier said $54.
I was in a bit of a foul mood about money anyway so the last thing I wanted to do was argue about the cost of my prescription that had jumped up by $14. (Which, in retrospect, I probably should have done because I could have saved $49 right there.)
I came home and made my husband’s day go from bad to worse. He flipped out and got on the phone with his insurance immediately. He said that the max he should pay on any medication is $50 so why was he paying $54 and why the cost rose so sharply.
“Well, sir, it’s because Lamictal has now gone generic and you’re paying the difference between the cost of the medication and the cost of the generic.”
Bob gets off the phone and goes straight to Google News to find out when Lamictal went generic.
According to MarketWatch.com, Teva Pharmaceuticals commenced shipment of lamotrigine tablets on July 22nd. So instead of either the pharmacist asking me if I wanted a generic version or the insurance company letting us know a generic version would be available (it would have saved them money), we ended up paying $49 more than necessary. It appears that Teva’s generic is AB-rated, which means that it has similar strength, bioequivalence, and efficacy. Overall, it likely shouldn’t be a problem if I go from Lamictal to lamotrigine. At least I hope not. We’ll see.
Mood rating: 5
- Postpartum Progress reports that the Melanie Blocker Stokes MOTHERS Act bill did not pass. Spreading lies like this did not help.
- The FDA recently approved Stavzor, a valproic acid delayed release capsule, for the treatment of bipolar disorder, seizures, and migraine headaches. Wow. That’s covering the gamut. The drug looks like it’ll be competing directly with the Depakote brand.
The mastermind behind Stavzor is Noven Pharmaceuticals (in conjunction with Banner Pharmacaps Inc.). The new “small, easy-to-swallow soft gel capsule” is available in three strengths: 125, 250, and 500 mgs. The pills are are “up to 40% smaller than han Depakote® and Depakote ER® tablets at the 500 mg dosage strength.” From Noven’s PR:
Stavzor is approved for the treatment of manic episodes associated with bipolar disorder, as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures, and for prophylaxis of migraine headaches.
The drug will hit the market in mid to late August.
- A recent AP article notes that more than 22,000 veterans contacted the veterans portion of The National Suicide Prevention Lifeline hotline since its inception last July. The government reports that the hotline support has helped to prevent more than 1200 people from committing suicide. The Veterans Administration (VA) estimates that 6500 veterans commit suicide annually. In light of recent news regarding the increase in Marine suicides, the effectiveness of the suicide hotline is offers significant promise.
The hotline receives an average 250 calls each day from veterans that have fought in Iraq, Vietnam, and Afghanistan.
The issue of soldiers with mental illness has recently come to light with studies showing that 1 in 5 soldiers returning from Iraq and Afghanistan have shown symptoms of post-traumatic stress disorder. The issue of the high suicides rate has been a high priority of the VA since mental health director Ira Katz tried to hide the significant number of suicides committed by veterans.
The National Suicide Prevention Lifeline is available 24 hours a day by calling 800-273-TALK (8255); veterans should press “1” after being connected.
- Psychologists are now saying that hitting and yelling at children is causing an increase in mental illness, which has manifested in ages as young as 3 years old. News.com.au reports that 1 in 7 children are affected by a mental disorder.
“We have seen a 60 per cent increase in demand for our child anxiety classes in the past six months,” said [Dr. Kimberley O’Brien, of the Quirky Kids Clinic at Woollahra in Sydney].
It sounds more like the article is speaking of children who are exposed to constant physical and emotional abuse. If that’s the case, shouldn’t there rather be an increase in parenting properly classes?
- Finally, a bit of sad news: police in Connecticut report than 10-year-old killed herself apparently by hanging. Police do not believe that foul play was involved. I can’t imagine being 10 and feeling suicidal. It was tough enough at 14.