eGADs. More Pills.
If you have Generalized Anxiety Disorder (GAD), you’ve probably tried all manner of addictive meds: Valium, Ativan, Klonopin, etc. I don’t have GAD, but I have Jewish Neurotic Disorder, so I take a wee bit of Ativan every night. I live in fear of becoming addicted, particularly after bad experiences with Klonopin.
But whatever your fears, there may be some good news: Some non-addictive, non SSRI anticonvulsants may be useful in treating GAD — at least according to a new article in Psychiatric Times.
The rationale for the use of anticonvulsants in anxiety disorders is supported by neurobiological underpinnings that make these compounds a likely alternative for short-term treatment in patients who do not respond to benzodiazepines or who have a contraindication (an addiction disorder, respiratory problems, or who are at risk for falls). However, data are limited, and current criteria for levels of evidence and lines of treatment recommendations suggest strong evidence only for pregabalin in patients with GAD with or without comorbidity (Table 2).
Pregabalin and gabapentin have been shown to be promising in social phobia. Data about gabapentin in panic disorder are somewhat mixed; they suggest a possible role only in patients who are moderately to severely affected. In any case, these compounds must still be considered second- or even third-line treatment.
Further studies are needed on the neurobiology of anxiety disorders and neuropharmacology of anticonvulsant drugs to develop pharmacological treatment strategies that target symptom patterns and patients’ needs.
The author of the study is Marco Mula, MD, PhD, a research associate and consultant in neurology and neuropsychiatry in the department of clinical and experimental medicine, section of neurology, The Neuropsychiatry Research Group at the Amedeo Avogadro University in Novara, Italy. At the top of the piece, it says, “Although he received no financial support for the preparation of this article, Dr Mula reports that through the years he has received travel support and speakers fees from various pharmaceutical companies who are involved in the manufacture of antiepilectic drugs, including Novartis, Pfizer, UCB-Pharma, Janssen-Cilag, and Sanofi-Aventis.” You can decide for yourself if that disqualifies him for offering objective evidence. I take no position one way or the other.
Can Anticonvulsants Help Patients With Anxiety Disorders?
liz | 1:18 PM | BIG PHARMA, meds
AstraZeneca, Are You Fucking Kidding Me?
Joe, who continues to make me look bad by knowing more than I do, sent me a link to an article about AstraZeneca from the St. Petersburg Times, which is (and this calls for all caps) ABSOLUTELY UNBELIEVABLE:
AstraZeneca, maker of the blockbuster antipsychotic Seroquel, is battling to keep information about the drug out of the public’s view … for the public’s own good.
This month in Orlando, lawyers for the drugmaker will argue that unsealing company documents, including unpublished clinical trial data and letters from the FDA, could harm “a vulnerable patient population.”
“This (disclosure) could jeopardize public safety by causing confusion and alarm in patients, who may then discontinue their medication without seeking the guidance of a medical professional,” lawyers for the drugmaker said in a recent filing in federal court.
This is utter and complete bullshit. AstraZeneca is running scared from revelations that could turn them into another Eli Lilly, so they’re inventing this ridiculous excuse to pretend they’re protecting People Like Us from learning the truth about their meds. To be clear: That’s the premise here—that I’m so mentally unstable that I can’t handle the truth.
So better to keep me in the dark about the dangers of my medication, otherwise I might run out and shoot people or jump off a building or something.
I am outraged by this. The article, by Times staff writer Kris Hundley, breaks it down further and examines all the issues. It also says, “The company said it is aware that the U.S. Attorney’s Office in Philadelphia is investigating Seroquel’s marketing practices, most likely based on whistle blower complaints.” I’ll try to get more information on that if I can.
Seroquel maker wants to seal info from you, “for” you
liz | 10:00 AM | BIG PHARMA, meds, side effects
Bad News, for a Couple Reasons
How’s this for a Big Pharma blowout:
NEW YORK (MarketWatch) — GlaxoSimthKline PLC could announce a near 6% reduction to its workforce as it cuts costs in the wake of greater generic-drug competition and fewer new products, according to London’s Sunday Telegraph on Sunday. The British pharmaceutical giant is expected to announce the 6,000 job cuts on Thursday when it reports its fourth-quarter results, the newspaper said on its website. Rival AstraZeneca said last week it would cut 15,000 jobs by 2013. U.S. traded hares of GlaxoSmithKline closed Friday at $35.26, up 1.4%.
Not just bad for people losing their jobs, but also bad for the future of drug development: The industry will be even more desperate to create new and wholly unnecessary products.
liz | 2:59 PM | BIG PHARMA
Metabolic Syndrome
For those who don’t know, metabolic syndrome is the name for the shitstorm of physical ailments that come from long-term use of antipsychotics. Well, that’s not exactly right. Let me quote a real authority, the American Heart Assn.:
The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:
* Abdominal obesity (excessive fat tissue in and around the abdomen)
* Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
* Elevated blood pressure
* Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
* Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
* Proinflammatory state (e.g., elevated C-reactive protein in the blood)People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.
So yes, it’s not just from psychotropics, but people with severe mental illnesses who take atypicals for more than 10 years are in an extremely high risk group. I’ve seen it too many times to count, and that doesn’t even begin to take into account what happens to a person psychologically when they’re not only overweight, but unable to be active in order to lose that weight.
Today Joe sent me this:
Metabolic monitoring in patients prescribed antipsychotics abysmal
Abysmal. That’s a serious word. From the piece:
Among insured patients newly prescribed second-generation antipsychotics, monitoring of blood glucose and lipid levels falls far short of 2004 American Diabetes Association (ADA) guidelines, researchers report [1].
The guidelines are based on substantial evidence that these drugs can increase risk for cardiovascular disease by affecting lipid and glucose metabolism and body weight.
However, this study showed that by 2006, just over 10% of patients newly prescribed second-generation antipsychotics received lipid monitoring and just over 20% received glucose monitoring.
“These numbers are unacceptably low, given that the ideal level of monitoring should be 100%,” lead author Dr Dan W Haupt (Washington University School of Medicine, St Louis, MO) said.
Joe suggests the following announcement:
Dear Psychiatrist,
You may not be aware that claims that SGAs are safer and more effective then FGAs turned out to be horse hooey. If not, you may have noticed that some of your patients just don’t come around anymore and when you attempt to call them threatening injectables to guarantee medication compliance, you find their phones are no longer in service. Well some of these folks are never coming back …. if you get what I mean. It may have something to do with Metabolic Syndrome.
First, it wasn’t your fault. Heck, you were just relying on what a pharma rep told you over the lunch brought from Panera. (Isn’t their Tomato & Mozzarella on Ciabatta Panini just great?)
liz | 6:19 PM | BIG PHARMA, meds
Irony Alert: “Did Pfizer Just Commit Suicide?”
That’s a headline on Motley Fool. Which is funny, ’cause, you know, Pfizer makes drugs that are supposed to make you happy.
For the post, go here.
liz | 5:11 PM | BIG PHARMA
What Else Don’t We Know?
For years I took Singulair for my asthma and it was a huge help. (You too, Joey, right?) Of course, it was more helpful to quit smokin
g cigarettes, but that’s another story.
At any rate, it seems Singulair has been under suspicion of causing suicidal ideation and impulses, but Merck’s top-selling drug has—at least in this regard—been given a clean bill of health. From Bloomberg.com:
Merck & Co.’s asthma medicine Singulair and related treatments weren’t associated with an increased risk of suicide or suicidal urges, U.S. regulators said after a review of clinical trials. …
Merck reported in 2007 that it has seen an unusual number of reports of suicidal behavior in Singulair users. Those cases weren’t enough to prove a definitive link and were based of voluntary reports from patients and doctors, Merck said. …
The FDA reviewed 41 Merck-funded studies involving 17,709 patients who received Singulair or a placebo. Of those patients, one person taking Singulair had a suicidal thought compared with none on placebo. No suicides were reported in either group.
Yet the FDA is still analyzing the drug for other side effects and says doctors need to monitor patients who are taking it. So did this drug have an impact on my psychological symptoms? I don’t know; I guess I’ll never know, in fact. But it would have been nice to understand at the time what the implications were for a person with psychiatric illness. Or hell, maybe I was misdiagnosed, and I really just have Singulairitis!
Merck’s Singulair Not Associated With Suicide Risk (Update2)
liz | 5:05 PM | BIG PHARMA, meds
