Pristiq (desvenlafaxine) information

Here’s a list of compiled links providing information on Pristiq. These links include info from my blog and others.

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Effexor (venlafaxine) Withdrawal

I’ve compiled a list of my posts on Effexor (venlafaxine) withdrawal in chronological order. Do NOT take any of the information from these posts as official medical advice. This is based on my own experience; experiences may vary.

Done deal: Pfizer buys Wyeth for $68 billion

Pfizer-Wyeth merger

The New York Times puts it this way:

The deal, if completed, would not only create a pharmaceutical behemoth but would be a rarity in the current financial tumult: a big acquisition that is not a desperate merger of two banks orchestrated by the government. [emphasis mine]

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.

Emotional eating, Part 2

Seeing the scale at 180 scared me into action somehow. I thought of my father who died of a heart attack and remembered that I had a history of high cholesterol running through my family. I decided I had to do something so I didn’t drop dead of a myocardial infarction at 23.

  • gymBob and I joined a gym. We went 1-2 times a week for about 30 minutes, which — for a variety of reasons — was a disaster so this consistency didn’t last long. But it helped short-term. We mostly did circuit training and about 20 minutes of cardio. We also had a
    personal trainer for a while. It’s expensive and we haven’t been able to afford one since, but it was definitely worth the money. I dropped 5 lbs.
  • I stopped drinking soda. Everyone in my family will tell you that I was ADDICTED to soda. However, I knew the carbonation made me bloated.
    • I slowly weaned myself off of regular soda, forcing myself to like the significantly inferior diet products.
    • Crystal Light On-the-GoIn due time, I tired of diet drinks and became hooked on Crystal Light On-the-Go packets and forced myself to drink water regularly. This change resulted in an additional loss of 5 lbs. For whatever reason, the CL packets soon became too sweet for my sweet tooth and I stopped using them.
    • While I drink mostly water, I somehow picked up a daily habit of drinking coffee and lattés along the way. I usually make my own coffee but often order my lattés at coffee shops or cafés. I initially didn’t care about drinking whole milk but I soon learned that the calories can quickly add up between the vanilla shots and 16 oz. of milk.
    • Now, I ask for sugar-free vanilla lattés with skim milk. (These are called “skinny lattés” at Starbucks.) I always hated skim milk but forced myself to get used to it if I really wanted the pounds
      to continue to peel off. I still get my caffeine fix but for significantly less calories. Depending on the size I get, my latté can vary from 90-175 calories. Not bad when a regular vanilla latté is easily 300.
  • I began eating Lean Cuisine or Healthy Choice for lunch. This is something that’s since dropped out of my diet but I need to reincorporate because it’s offered me the most results. I limited myself to LC or HC only and fought off any other hunger urges if I could. These pre-made frozen meals led to another 5-lb weight loss. (NOTE: The sodium counts on some of these meals are ridiculous, negating the healthy benefits of the low-calorie count, and causing increased hunger. Check the Nutritional Information for products that contain — on average — 600 mg or less of sodium. I’ve found that more than that can be counterproductive. Healthy Choice is pretty good about keeping the sodium milligrams around 500 or less.)
  • walkingI began commuting to the city and walked from the train station to work for a total of 20-30 minutes round-trip. I skipped walking during severe heatwaves and rain. The bus to the train station from my job wasn’t very reliable so I often ended up walking for at least 10 minutes during the day. Or more if I walked somewhere (usually by myself at a faster pace) for lunch. I lost 5 more pounds.
  • I ended up in the psych hospital. This is NOT recommended. I didn’t like much of the food so I hardly ate anything. I was also started on Effexor XR, of which weight loss was a side effect. I dropped a good 10 lbs in 7 days as a result of this. By this point, I was down to 150 — my “Freshman 15” weight.
  • Since my body was getting used to the 20-30 minute work walks, I began working out at the gym at least 2-3 days a week for at least 30 minutes. I attempted to do a minimum of 20 minutes of cardio and 10 minutes of strength training or vice versa. I maintained a weight between 140-145 lbs for more than a year.

I haven’t been able to crack 139 on the scale for whatever reason and my goal is for a weight maintenance of 130-135 lbs. The BMI scale recommends that I weigh 110-125 lbs for my height.  Considering that my 26-year-old body is significantly different than my 16-year-old body, I’m not going to shoot for anything less than 130. I think to do so at this point in my life would be unrealistic. Besides, I wouldn’t want to be that skinny again anyway. 110 lbs on a 16-year-old looks vastly different on a 26-year-old  or a 36-year-old or a… you get the point. I’ve made 130 my minimum — a goal I’m sure I’ll be happy with if I’m able to attain it. Even if I bounced between 130 and 140 lbs, I wouldn’t mind as long as I didn’t regain my Freshman 15 weight. But I’m a work in progress.

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 »

2-Year Anniversary: The Long and Winding Road

I’m aware that my blog has taken a significantly dark turn.  This may alienate some of my readers who seek happier, brighter topics. I don’t think my posts have been negative; on the contrary, I think they’ve been positive. Positive and educational.

I’ve been exploring the topic of suicide recently because it’s a subject that’s quite near and dear to me, now more than ever before.

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)

Pharma's "me-too" drugs face skeptical docs and health insurers

As patents expire on a variety of drugmakers’ moneymakers, pharma companies have gone to great lengths to structurally reinvent the successful drugs then tout the benefits that differ from their predecessors.

InvegaCase in point — Johnson & Johnson’s Invega. Invega is the successor to the popular antipsychotic drug, Risperdal, and competitor to AstraZeneca’s widely used antipsychotic Seroquel. Scott Hensley at The Wall Street Journal’s Health Blog (WSJ) reports that Risperdal is going generic in June. Gianna at Beyond Meds recently said it will not. According to the Dow Jones Newswires (DJN), these “junior” drugs face skepticism from health insurers and doctors. California-based Kaiser Permanente and Minneapolis-based UnitedHealth Group Inc. (UNH) are example of companies that have somewhat discouraged use of the drug. Kaiser doesn’t cover Invega at all, and members of UNH are required to pay higher copays for the brand name. The wire reports New York-based psychiatrist Jeffrey Lieberman wasn’t “buying it” the difference between Invega and Risperdal.

Invega is “basically a me-too drug, and the company hasn’t done the studies that would be required to really distinguish it,” Lieberman, chairman of the psychiatry department at Columbia University’s medical school told Peter Loftus of Dow Jones Newswires.

Ouch.

The blog also quotes Daniel Carlat from the The Carlat Psychiatry Report.

Dan Carlat, a psychiatrist and a tough critic of Invega, wrote that J&J’s “marketing team apparently missed the fact that the word in the English language that sounds most like “Invega” is “inveigle,” meaning “to entice, lure, or ensnare by flattery or artful talk or inducements.’ ” He asked doctors: “Will you be doing your patients a favor by taking the plunge? Or will you simply be giving them the same wine in a fancier bottle?”

Even J&J’s Group Chairman of Pharmaceuticals, David Norton, admitted that Invega is a tough sell.

“We need to do a better job at drawing a differentiation in a difficult-to-treat population.

So far, Invega sales have been incredibly disappointing compared to the Risperdal blockbuster.

Wyeth (antidepressant Effexor XR cum Pristiq) and Shire (ADHD drug Adderall XR cum Vyvanse) face the same uphill battle. Wyeth’s Effexor faces generic competition from Teva Pharmaceuticals despite efforts to halt generic sales of the drug and the patent on Shire’s Adderall is set to expire next year.

Hensley, in his analysis, raises a question in which the answer remains to be seen:

Cheap generics abound to treat a broad assortment of illnesses these days. What’s the point, the critics ask, of paying more for drugs that are at best only slight improvements over tried and true medicines available at bargain prices?

It’s something that I’ve questioned myself.

In an attempt to have the “me-too” drugs compete with its derivative, both Wyeth and Shire are slashing their prices, or as the DJN reported, “emphasizing improved dosing for the newer drugs.” Although Pristiq’s efficacy comes at higher doses, it’s being priced 20 percent lower than Effexor.

[Deutsche Bank pharmaceutical analyst Barbara Ryan] thinks the odds of
Pristiq’s success are slim because it appears to offer few benefits
beyond those of Effexor.

That remains to be seen. So far, a few patients have commented on my blog that Pristiq has already begun to help them. I haven’t seen any DTC ads for Pristiq so I can only assume that drug reps are doing a fine marketing job at selling the different benefits of the drug to doctors.

Vyvanse, on the other hand, is looking promising for Shire, already having 7 percent of U.S. ADHD drug prescriptions. Chief Executive Matthew Emmens says the drug is chemically different from Adderall (aren’t they all?) and has better pricing. Shire expects to beat Adderall’s 26 percent peak market share. Seems like a lofty goal to me.

As for Invega, J&J is currently seeking FDA approval to use the drug for bipolar disorder and not just treatment for schizophrenia. It is also l0oking to get approval for an injectable Invega XR.

(Invega logo from Janssen.com)

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.

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.

The Effexor Chronicles: Lucky Her

One woman had a near trouble-free time getting off of Effexor.

I was taking effexor for about 4 months due to having a anxiaty attack one day.

One day I just felt like I was ready to get off of them.

I started by slowly bringing down my dosage. Did that for 2 weeks. The 3rd week I stopped taking them all together.

The worst sympton I felt was the dizzy feeling, I think they call it vertigo. That lasted for up to 2 weeks after stopping the medication.

I am proud to say I am now completly effexer free, with no side affects any longer. It can be done. Just go slow !

Good luck.

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.

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 »

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.

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.

Tips for proper self-withdrawal from medication(s)

Gianna, a reader of this site, has a great and informative blog, Bipolar Blast. In a recent post, she gives some tips for proper psych drug withdrawal. This is particularly helpful for those dealing with severe antidepressant withdrawal effects. For me, Effexor comes to mind. I also think about "Honey’s" experience with Zoloft. Not only does Gianna emphasize diet and nutrition as an important part of the process, but she also delves into proper titration. (Many people think that the diet and nutrition thing is obvious, but many people overlook that important piece of recovery.)

I understand that many people – especially in the psych world – think Peter Breggin’s a wack job, but he can have some good points. Gianna refers to Breggin’s 10% rule:

"Breggin suggests what has come to be known the 10% rule. Any given drug should not be reduced anymore than 10% at a time. Once a taper is complete the next taper should not exceed 10% of the new dose. Therefore, the milligram, then fraction of milligram amount decreases with each new taper. I’ve found that I have to sometimes go in even smaller amounts. As low as 5% and sometimes people go as small as 2.5%–for people on benzodiazepines it is not unusual to go in even smaller amounts. Cutting pills is not always enough. Sometimes liquid titration is necessary. This may involve dissolving the smallest dose pill in water, club soda or even alcohol, which can then be diluted with water, then using a syringe to cut down milliliters at a time. Medications also sometimes come in liquid form and can be gotten by prescription. It should be noted that some medications should not be dissolved. Especially time released medications. This would be extremely dangerous."

Gianna clearly knows what she’s talking about. Head on over to her site to read the rest of the post.

Drug Interactions

soulful sepulcher has a post up on drug interactions. You can find nearly all meds and find out the interactions as drugdigest.org. I did a search for lamotrigine (Lamictal) and venlafaxine (Effexor), which included interactions with food and alcohol and there were none. (That was a relief.) I’d encourage anyone on medication to do this search to make sure that multiple psych drugs are not interfering with each other.

The "Black Dog," Part III

By the end of March, we decided to get engaged and work out our differences. (I’d move to Kentucky and he’d be open to not having biological kids.) In early July, I quit Lexapro cold turkey. (This, folks, is a NO-NO.) Two weeks later, I had a relapse and attempted to commit suicide. Bob freaked out and called the cops and I nearly lost my job at a prestigious magazine. It wasn’t Bob’s fault; it was mine for quitting a med cold turkey and it was Dr. X’s for not warning me about the potential for suicide attempts on the drug. Perhaps she didn’t know. After all, she kept doling out Lexapro samples to me via the drug rep. When I told her in August that Lexapro wasn’t working, she became skeptical, assumed that I was still being noncompliant and wrote out a prescription for Zoloft. By that point, I was tired of meds. I’d gained 40-50 lbs between Paxil and Lexapro (after being skinny all my life) and still had a difficult time functioning normally. I never filled my prescription.

I moved to Kentucky in September and started a new job in October. After things became a little hectic and overwhelming at work in December, I became suicidal once again. I never saw Bob during the day (I worked second shift into third shift sometimes) so he was able to be depressed during the night and hide it apart from me since I rarely saw him. Bob, fearful of a failing marriage and I’d make good on my promise to kill myself, made the decision for us to move back to his hometown in Pennsylvania in April 2006.

As of January 2006, I knew I needed to be hospitalized and talked about it frequently. However, I felt like I couldn’t: "My job needs me," I said. "We’re understaffed. My job needs me." Even the anxiety of handing in my resignation at a job I hadn’t been employed at for a year gripped me.

We began our job search in the metro Philly area in April and both landed jobs in May. He in the suburbs; I in Philadelphia. My suicidal attempts and thoughts remained with me, but began to increase in August. My sick days became frequent. After a honeymoon at the end of August, I came back in September to a hostile co-worker and a micromanaging, picky boss. Those factors – in addition to whatever I was already dealing with – contributed to taking a disability leave from my job and admitting myself to a psych hospital. I’d been unwilling to do it because I was so busy, but if not, my husband would have been forced to do it for me.

I stayed in the hospital for 7-8 days. The doctor who initially admitted me asked me what meds I’d been on. I said Lexapro and Paxil. I mentioned I didn’t like them. He suggested that I try Celexa in the meantime and that it wasn’t the same as those two. Before I began this blog, I had no idea that Lexapro (escitalopram) and Celexa (citalopram) are virtually the same thing. I passed on Celexa at med times, knowing that my case doctor would be switching me to something different. My case doctor, Dr. S, recommended Effexor XR after I told him that I’d had trouble with Lexapro and Paxil. He said, "Well, it’s an SNRI and functions differently than an SSRI. Let’s try you on that. We’ll start you off at 37.5 mg and get you up to 150 mg by the time you leave."

On the first day of Effexor, I developed severe somnolence that lasted an hour. Later that day and the next three days, I developed severe dry mouth. I’d never known what dry mouth was until then. So I chugged several Snapple Iced Teas a day since water wasn’t available through their vending machines. (Weird, I know.) When I began at my intensive outpatient treatment afterward, a nurse told me that drinking too much sugar can cause the liver to overproduce sugar – if I remember correctly – which can lead to diabetes. *sigh*

Because of a (somewhat) sexual assault incident at the hospital, my release was hastened and I left at 75 mg of Effexor. My psychiatrist at the outpatient clinic titrated me up to 150 mg, which according to him, "is standard. Some patients do better at 300 mg." (!) By the time my outpatient treatment was over, I was steady at 150 mg of Effexor.

In the meantime, my husband was overtaken by all the events that had been occuring since August. (You’d be freaked out too if you woke up to see your spouse trying to hang him/herself.)

In November, he finally admitted to me that he struggle with depression. He began crying all the time over nearly everything. As a computer programmer for seven years, he felt inadequate and insecure at his new job. He cried over my depression. He cried about worsening my depression with his depression. He became anxious over everything. He couldn’t sleep in the event that he’d wake up to see another suicide attempt. He became wracked with anxiety. After much provoking and nagging, he finally agreed to seek treatment in the evening at the outpatient clinic I’d been to. He found it somewhat helpful but admitted that it was difficult to act on what he’d learned.

November threw another curveball at us when my outpatient psychiatrist diagnosed me with bipolar disorder. That finally explained my hostile, irritable, and angry episodes (which normally occurred at night) in addition to my depression. Now, Bob became anxious over the next manic episode that might occur.

Just as he had involved my mother of my situation, I sat down with his parents and spoke with them about Bob’s. His parents seemed taken aback. The quiet, shy kid had all these problems that they’d never known about? His parents and I thought that Bob was freaking out over me and the recent events. Little did we all know that it was simply a trigger. Since I was around Bob all the time now, he wasn’t able to hide it from me any longer.

Despite weekly counseling that we began in August, he still suffers from extreme anxiety. He still suffers from depression with passing suicidal thoughts. He still cries and gets angry over, well, insignificant things. But he’s been brave to admit that he struggles with depression. He’s taken a leap of faith to talk to his parents, his brother, and me about what he deals with and some of what he’s been thinking. Bob has a long way to go, but he’s finally taken the steps forward to recovery.

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.

Fun with ICD-9 codes

I came across a situation recently in which a woman was described having mania in bipolar disorder, but was “diagnosed” with 296.2. And the recommended treatment? Venlafaxine (Effexor).

I swear, sometimes doctors themselves don’t even know what to prescribe.

UPDATE:
Okay, maybe I was wrong?

2007 ICD-9-CM Diagnosis 296.2
    Major depressive disorder single episode
        * 296.2 is a non-specific code that cannot be used to specify a diagnosis
        * 296.2 contains 72 index entries
        * View the ICD-9-CM Volume 1 296.* hierarchy

    Alternate Terminology
        * Depressive psychosis, single episode or unspecified
        * Endogenous depression, single episode or unspecified
        * Involutional melancholia, single episode or unspecified
        * Manic-depressive psychosis or reaction, depressed type, single episode or unspecified
        * Monopolar depression, single episode or unspecified
        * Psychotic depression, single episode or unspecified

So it’s totally possible to have a bipolar episode and be depressed? WTF? Am I depressed with bipolar symptoms or am I bipolar with depressive episodes? Ugh, none of this diagnosis stuff makes sense. Glad I’m not a doctor now.

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.

UPDATE: Venlafaxine withdrawal symptoms

I previously wrote about how fluoxetine helped smooth out my withdrawal from venlafaxine. I’m doing much better and am able to function.

What’s the update then?

I’ve got lingering side effects from either the fluoxetine or the venlafaxine – I’m not sure which.

somnolenceThe lingering somnolence/grogginess for about a week or so can definitely be attributed to fluoxetine. I’d never struggled with somnolence on any med except when I first started Effexor in the hospital. Grogginess has never been a problem except for my antihistamine medication hydroxyzine.

The brain shocks still linger. They’re not as bad nor are they frequent. I can walk around, turn, spin – no problem. But if I’m in the middle of walking  down the street and turn my neck slightly to see if a car is coming before I cross – *zap!* – brain shock. That’s all I get for the rest of my 15-minute walk. I’d say that’s pretty good (considering what I’d previously endured).

Dizziness, vertigo, and light-headedness: those are much more frequent. As I sit here and type, my entire field of vision can swirl clockwise and return to normal via counter-clockwise. It happens for about 3 seconds or less, but it’s long enough for me to notice and go, “Whoa.” (Who needs recreational drugs when you’ve got withdrawals from psych meds?) These side effects are not as frequent as they used to be with the direct venlafaxine withdrawal, but they can occur about 30 times or less throughout a 17-hour day (7 a.m.-12 a.m.) for me.

I’ve read that people can use fluoxetine to offset venlafaxine withdrawal symptoms with relatively uneventful side effects. Somnolence was not a fun side effect. Just a warning.

Seroquel abuse and medication weight gain

SeroquelFurious Seasons has blogged about Seroquel (quetiapine) in the past and he recently posted on Seroquel abuse in an Ohio prison. Apparently, inmates have been snorting the atypical antipsychotic, also known in slang terms as “quell” or “Susie-Q.” Excerpt from Furious Seasons:

“Second, we all know that Seroquel is regularly handed out to bipolars and depressives and people with anxiety in order to address insomnia, as opposed to the kind of underlying psychosis/mania issues you’d expect it to be used for. PCPs hand it out this way and so do psychiatrists. What I have noticed among friends who’ve been given Seroquel for sleep issues is that they end up, over a few months time, needing more and more of the drug in order to get an effect. Or, put another way, people keep complaining of problems with sleep despite taking, say, 300 mgs. of Seroquel and their doctor will keep upping the dose to get the desired effect. As a result, I have seen people with very mild bipolar disorder wind up taking 800 mgs. of Seroquel a day–that’s roughly the same that a schizophrenic in a state hospital would get–and still they get no results, aside from putting on tons of weight. I have heard this from other readers of this blog as well.”

My aunt, who works in the psych wing of a hospital, warned me that she’s seen patients on Seroquel gain weight. A man I met at my Bipolar and Depression Alliance Group last night gained 60 lbs since taking Seroquel. I can’t image that everyone who takes Seroquel overeats to a point of obesity and leads a sedentary lifestyle. I have a random theory that Seroquel signficantly slows a person’s metabolism down to the point where it is difficult for a person to lose weight.

Read the rest of this entry »

Fluoxetine helps offset Effexor withdrawal

ProzacGreat news: I upped my dosage took 20 mg of fluoxetine last night and the Effexor brain shivers have completely worn off. My cognitive functioning has completely returned and I’m no longer afraid of passing out when walking or turning to talk to someone. I’ll probably take another 20 mg tonight and call it a day for fluoxetine. (Thank you Dr. Ivan!)

So it’s true: If you’re experiencing Effexor withdrawal, ask your doctor or psychiatrist (whomever you’re seeing for mental illness) for 20 mg of fluoxetine and take it for about 2-3 days.  This may not work for everyone (especially those who may be treatment-resistant) but I’m confident it can work for the vast majority of sufferers. I’ll tell you later if I have a suicidal relapse; I’ll be on the alert for the next two weeks. That’s how long it took me to have a relapse when I quit Lexapro cold turkey.

Many thanks to Furious Seasons for the shout-out.

UPDATE: An old post from a blog detailing an Effexor withdrawal experience. I was on Effexor for about 3 months and the withdrawal effects were essentially the same.

Patient Responsibility

“An article on brain shocks from about.com linked to a statement at socialaudit.org.uk on venlafaxine withdrawal. It seems that when coming off of venlafaxine, it is best to use fluoxetine (Prozac) in conjunction with it. Somehow, Prozac’s effects can minimize or negate the side effects of Effexor allowing for an uneventful withdrawal. I’m seeing my psychiatrist later today and I might bring up the idea with him. He might think one of two things: a) I’m crazy (pun not intended) or b) I don’t know what I’m talking about. My guess is he’ll choose the latter of the two.

Unlike most patients, I know more about meds than ‘the average bear.’”

UPDATE: I asked my doctor about going on fluoxetine to offset the effect of venlafaxine withdrawal. He looked up, somewhat shocked, and said, “Yeah.” So then I pushed and said, “Well, I’d like 10 mg then.” lol. He wrote out a prescription for 10 mg of Prozac in addition to bumping me up from 150 mg to 200 mg of Lamictal. I took the fluoxetine (Prozac is now a generic drug) last night and it has offset the intensity of the brain shocks. I experience them but they are much more mild compared to yesterday when they were moderate to severe. Yesterday, I was barely able to drive; today, I drove nearly an hour to work on a somewhat urban road with good reflexes and almost normal cognitive functioning. I can only hope that the Prozac continues to aid my withdrawal issues. And I was happy to wake up this morning without wondering why I dreamt that I was in a department store with parrots singing Gwen Stefani’s “Wind It Up” and swinging like moneys instead of flying.

You get the idea: Effexor causes some strange dreams.

Read the rest of this entry »

Venlafaxine withdrawal symptoms

Work has got me busy, folks, so posts may drop significantly in the next coming days/months. Possibly through April or May. (I’ll probably have one of those work days when I end up doing more blogging than working. It happens every now and then.) But don’t be surprised if Saturday quotes, Wednesday puppies, and Sunday stats are what pops up each week. I’ve got many of those backlogged through April. I’ll try to backlog some other posts on bipolar disorder and depression for the coming weeks and quickly blog on anything that’s timely.

electric shockIn the meantime, I had to take a sick day today. It’s my third day off of the Effexor and I’m having some weird side effects (see Case 1: Standard Dose under the link). Whenever I turn or move too quickly (consider your “natural” body turn), I “kind of” see stars and the whole world slightly spins beyond my field of vision for about 3 seconds before coming back into focus. After doing some light research on the side effects of venlafaxine (Effexor’s generic name), I’ve found out that side effects can incude vertigo, dizziness, light-headedness (associated with dizziness), and something called “brain shivers,” which are a form of electric shock sensations. You know that feeling when you get an electric shock from somebody? Yeah, imagine feeling that throughout your whole body. Precisely; not a good feeling. Nancy Schimelpfening, blogger for depression.about.com, found a newsgroup posting on the brain shiver effect, mainly associated with venlafaxine:

It happens to me if I turn my head quickly, or if I stop suddenly, or in general with sudden motion. They’re worse if I’m nervous.

i’ve seen them described as feeling as though your brain keeps going when you turn your head. that doesn’t seem quite adequate to me. it’s more like this:

you turn your head (or your whole body — this happens to me if i whirl around too quickly as i’m taking the stairs. what. doesn’t everyone whirl on the stairs…?), but your brain *stays put* for a micro second, then tries to catch up but only in a stuttering, stopstart motion, accompanied by a staccato ‘zzt zzt zzt’ with each stop. the ‘zzt’ you can feel in your head, an electric sort of vertigo, and it often reverberates in your hands and fingers. some folks feel it in their toes; i haven’t yet.

sometimes your brain overshoots and comes strobing back, then overshoots again.. this all unfolds in just a second or two.

these days i endeavor to go around corners all smooth slow and steadylike. helps to reduce the number of brain shivers per day

Yeah, that’s me. It’s hard to explain to someone who’s never felt it. I got this feeling after not taking Paxil for three days too. The effects eventually wore off, but it was such a weird feeling.

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Loose Screws Mental Health News

Surprise, surprise — the likelihood of suicide attempts increases with antidepressants.

     “Suicidal patients taking antidepressants have a ‘markedly increased’ risk of additional suicide attempts but a "markedly decreased" risk of dying from suicide, a large Finnish study has found.
     “The research into nearly 15,400 patients hospitalized for suicide attempts between 1997 and 2003 showed that ‘current antidepressant use was associated with a 39 percent increase in risk of attempted suicide, but a 32 percent decrease in risk of completed suicide and a 49 percent reduced risk of death from any cause,’ the authors wrote in a report published in the Dec. 4 issue of Archives of General Psychiatry.
      “The Finnish study analyzed 15,390 suicidal patients of all ages for an average of 3.4 years. The authors said they did this ‘because previous suicide attempts are the most important risk factor for predicting suicide.’”

I think 15,390 patients is a sizeable, significant study that could probably yield semi-accurate statistics.

      “Among the 7,466 males and 7,924 females examined, there were 602 suicides, 7,136 suicide attempts requiring hospitalization and 1,583 deaths recorded during follow-up. The risk of completed suicide was 9 percent lower among those taking any antidepressants than among those not taking antidepressants.
     “But the picture was not so bright for all those who took SSRIs. It was for those taking fluoxetine (Prozac), who had a 48 percent lower risk of suicide than those not taking medication. But the study found that those taking another SSRI, venlafaxine hydrochloride (Effexor XR), had a 61 percent increased risk.”

So Prozac is better than Effexor XR in terms of suicidal risk. Nice, considering that I've had a 10-year history of suicidal attempts and this study seems to show that venlafaxine increases the risk of suicide attempts. Perhaps Effexor should be prescribed to those who aren't/have never been suicidal?

Read the rest of this entry »

PCPs Don't Know Jack From Zyprexa

Eli Lilly’s actions continue to be appalling.

LillyApart from trying to hide the fact that Zyprexa induces weight gain, diabetes, and hyperglycemia, they also had sales reps encourage primary care physicians to prescribe Zyprexa for patients who did not have schizophrenia or bipolar disorder (basically off-label usage).

It seems that Lilly told marketing reps to suggest Zyprexa for dementia in the elderly. Lilly denies this, of course, since olanzapine (Zyprexa’s generic name) is not approved for that kind of use since it increases the risk of death in seniors with psychosis associated with dementia. Lilly also attempted to market olanzapine to patients with mild bipolar disorder who suffer mainly from depression. (In actuality, Zyprexa is approved to treat those who suffer from mania.)

This issue with Eli Lilly delves into precisely why I am against PCPs prescribing psychiatric medicines. Primary care physicians don’t know enough about the various psychiatric conditions to prescribe the appropriate kind of medication. This type of prescription should be left to specialists like psychiatrists. PCPs should focus on the things they deal with on a daily basis that no one else can take care of: the common cold, the flu, annual physical, etc. It should be the job of the PCP to refer a patient to a psychiatrist should they present symptoms of mental illness (depression, schizophrenia, etc.). I have been burned by having a PCP prescribe antidepressants for me and as a result, attributed my horrible experience with drugs to that.

Read the rest of this entry »

Antidepressants rake in billions

The following is data I found at USAToday.com. Shouldn’t be shocking but I can’t help but think of pharmaceutical execs rolling around in dough, laughing happily at medicating those who find nothing but hopelessness and sadness.

Top-selling antidepressant drugs in 2005:

  • Zoloft: $3.1 billion
  • Effexor XR: $2.6 billion
  • Lexapro: $2.1 billion
  • Wellbutrin XL: $1.5 billion
  • Cymbalta: $667 million

Source: IMS Health
Give Cymbalta time since it’s relatively new to the market. It’ll catch up. I also can’t help but think that the friendly Zoloft ads have helped push its profit margin to first place. The ads are nearly everywhere. Come antidepressant time, it’s the first med that patients think of and probably ask their doctor for.