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Selective serotonin reuptake inhibitors

admin — Wed, 30 Nov 2011 21:58:56 +0000

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants considered the current standard of drug treatment. A possible cause of depression is an inadequate amount of serotonin, a chemical used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reuptake of serotonin (also known as 5-hydroxytryptamine, or 5-HT) by the presynaptic neuron, thus maintaining higher levels of 5-HT in the synapse. Chemists Klaus Schmiegel and Bryan Molloy of Eli Lilly discovered the first SSRI, fluoxetine. This class of drugs includes:
Citalopram (Celexa, Cipramil)
Escitalopram (Lexapro, Cipralex, Seroplex, Lexamil)
Fluoxetine (Prozac, Sarafem, Symbyax)
Fluvoxamine (Luvox)
Paroxetine (Paxil, Aropax)
Sertraline (Zoloft)
Vilazodone (Viibryd)

These antidepressants typically have fewer adverse effects than the tricyclics or the MAOIs, although such effects as drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, long-term weight gain and decreased ability to function sexually may occur. Some side effects may decrease as a person adjusts to the drug, but other side effects may be persistent.

Work by two researchers has called into question the link between serotonin deficiency and symptoms of depression, noting that the efficacy of SSRIs as treatment does not in itself prove the link. Research indicates that these drugs may interact with transcription factors known as “clock genes”, which may play a role in the addictive properties of drugs (drug abuse), and possibly in obesity.

A systematic review of randomized controlled trials published in the Archives of General Psychiatry showed that up to one-third of the 6-week effect of SSRI Treatment can be seen in the first week. The same study also found that patients treated with SSRIs were 64% more likely to achieve a 50% absolute reduction in HRSD than patients given a placebo.[1]

Citalopram (Celexa): usual dosing is 20 mg initially; maintenance 40 mg per day; maximum dose 60 mg per day.
Escitalopram (Lexapro, Cipralex): usual dosing is 10 mg and shown to be as effective as 20 mg in most cases. Maximum dose 20 mg. Also helps with anxiety.
Paroxetine (Paxil, Seroxat): Also used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder and PTSD. Usual dose 25 mg per day; may be increased to 40 mg per day. Available in controlled release 12.5 to 37.5 mg per day; controlled release dose maximum 50 mg per day. Less cycling in patients who are bipolar.
Fluoxetine (Prozac): Also used to treat OCD, bulimia, and panic disorder. Long half-life; less withdrawal when medication is stopped. Dosing is 20 mg to a maximum of 80 mg.
Fluvoxamine (Luvox): Although primarily used in the treatment of OCD, a doctor may prescribe it for depression. Initial dose is 50 mg, increasing by 50 mg every 4-7 days. If daily dose is greater than 100 mg give in equally divided doses or give larger dose at bedtime not to exceed 300 mg per day.
Sertraline (Zoloft, Lustral): Also used to treat panic disorder, OCD, PTSD, social anxiety disorder, premenstrual dysphoric disorder. Dosing is 50-200 mg per day and should be titrated upward.

Be aware of drug interactions. Dextromethorphan (found in many brands of over-the-counter cough syrup) as well as the opioids tramadol (Tramal, Ultram), and pethidine/meperidine are contraindicated with all SSRIs as they are serotonin reuptake inhibitors (SRIs) themselves and the combination could cause the potentially fatal serotonin syndrome. Many SSRIs inhibit the metabolism of dextromethorphan as well, further adding to the risk.

Drug interactions may also occur when concurrently taking phenytoin (Dilantin) and warfarin (Coumadin) (phenytoin and warfarin levels are increased).

Always check with pharmacy regarding potential drug interactions.[2]

Source:

[1]http://en.wikipedia.org/wiki/Antidepressant

[2]http://en.wikipedia.org/wiki/List_of_antidepressants

Tags: Aropax, Celexa, Cipralex, Cipramil, Citalopram, Coumadin, Dextromethorphan, Dilantin, Escitalopram, fluoxetine, fluvoxamine), Lexamil, Lexapro, Luvox, Paroxetine, Paxil, phenytoin, Prozac, Sarafem, selective serotonin reuptake inhibitors, Seroplex, Sertraline, SSRI, Symbyax, Tramal, Ultram, Viibryd, Vilazodone, warfarin, zoloft

The Most Prescribed Psychiatric Drugs

admin — Sat, 20 Nov 2010 21:11:25 +0000

When Xanax hit the U.S. market in 1981, it wasn’t clear it would be a hit. It was a me-too successor to Valium, the anxiety drug that was the most popular drug in America for most of the 1970s. Maker Upjohn figured out a clever way to market its drug: by testing it to treat panic attacks as well as anxiety.

Panic attacks had just been defined as a diagnosis and were assumed to be resistant to Valium-like drugs. But Upjohn ran studies showing Xanax reduced panic attacks; it was the first drug to get an approval for this claim. Xanax sold like hotcakes and became part of the popular lexicon. Panic attacks were popularized too; an affliction once thought to be rare became something nervous mothers joked about.

The Most Prescribed Psychiatric Drugs

Almost three decades later, America is still a Xanax nation. It remains the most popular psychiatric drug, topping more recently introduced medicines like the sleeping pill Ambien (No. 2) and the antidepressant Lexapro (No. 3). Doctors write nearly 50 million prescriptions for Xanax or alprazolam (the cheap, generic equivalent) every year–that’s more than one Xanax prescription every second. Upjohn vanished in a series of mergers–it’s buried somewhere inside Pfizer ( PFE – news – people ) now–but the decision its executives made still echoes through our culture, and through the bodies of psychiatric patients…Click here to read more

Source: http://www.forbes.com

Tags: anxiety, anxiety drug, Ativan, Cymbalta, Desyrel, diazepam, duloxetine, Effexor XR, Escitalopram, fluoxetine, generic equivalent, Lexapro, lorazepam, panic attacks, Prozac, quetiapine, Seroquel, Sertraline, the most popular psychiatric drug, The Most Prescribed Psychiatric Drugs, trazodone, Valium, Valium-like drugs, venlafaxine, Xanax or alprazolam, zoloft

What You Should Know About Psychiatry and Psychiatric Drugs

admin — Wed, 03 Dec 2008 19:36:27 +0000

Prozac: PANACEA OR PANDORA?, by Ann Blake Tracy, Ph.D.
Prozac: PANACEA OR PANDORA?, by Ann Blake Tracy, Ph.D., is the product of five years of research, and the study of the cases of approximately 1,000 patients on a long-term basis. The author holds a Doctorate in Biological Psychology, and heads the only support group in the state of Utah for those who have suffered adverse reactions to the SSRI drugs such as prozac, paxil, zoloft, luvox, effexor, serzone, anafranil & the diet pills – fenfluramine, fen-phen & redux.
“Brain wave patterns indicate patients [taking psychiatric drugs such as prozac, paxil, zoloft, luvox, effexor, serzone, anafranil & the diet pills - fenfluramine, fen-phen & redux] are in a total anesthetic sleep state while appearing awake and functioning. Increasing serotonin – exactly what these drugs are designed to do – induces both nightmares and sleepwalk. Patients report over and over again that they have lived out their worst nightmare. And as with sleepwalk episodes, many have no recall or little recall of what they have done. Often someone must prove to them what they have done while they where under the influence of these drugs before they will believe it to be true. One patient stated that he could not detect during his two year use of Prozac what was real or what was a dream.”
“Although initially increasing concentration and energy, patients [on drugs such as prozac, paxil, zoloft, luvox, effexor, serzone, anafranil & the diet pills - fenfluramine, fen-phen & redux] report long-term effects of impaired memory and concentration and mental disability. Learn the reasons why large numbers of Prozac patients report FALSE memories of ABUSE. As disruption of serotonin alters perception, reality and dreams SEEM one and the same, creating a STRONGER hypersuggestable state than hypnotism.”
“Elevated levels of serotonin (5HT) – exactly the chemical these [SSRI] drugs do increase – is the same chemical that LSD, PCP and other psychedelic drugs mimic in order to produce their hallucinogenic effects. Have these drugs turned the 90′s upside down for us to relive the 60′s? Learn that elevated levels of serotonin are found in schizophrenia, mood disorders, organic brain disease, Alzheimer’s, anorexia, autism, bronchial constriction, etc.”
“As our latest panacea, Prozac and its analogues [such as paxil, zoloft, luvox, effexor, serzone, anafranil & the diet pills - fenfluramine, fen-phen & redux] are being prescribed for everything from headaches and flu to acne and home sickness. Yet, according to FDA spokespersons, there have been more adverse reaction reports on Prozac than any other medical product. As of October, 1993, a total of 28,623 complaints of adverse side effects had been filed with the FDA, including 1,885 suicide attempts and 1,349 deaths. The FDA’s general rule of thumb for estimating the true figures is that these reports represent only one to ten percent of the actual figures. This would indicate the staggering amount of 286,230 – 2,862,300 actual adverse reactions, 18,850 – 188,500 actual suicide attempts and 13,490 – 134,900 actual deaths attributed to Prozac by the end of 1993.”
The Myth of Mental Illness, By Thomas S. Szasz, M.D.
Thomas S. Szasz, M.D. demonstrates that what is nowadays accepted as mental illness is whatever psychiatrists say it is-and that psychiatry has-with increasing zeal, defined more and more kinds of behavior as “mental illness.” What is termed “mental illness” is in fact behavior disapproved of by the speaker. This is a stigmatizing moral judgment, not a medical diagnosis.
If there is no mental illness, there can be no “treatment” or “cure” for it. When personal problems are seen for what they are-helplessness and fear, envy and rage, and the many other miseries that beset man-and are not masked under the guise of illness, being “mentally ill” ceases to be a refuge from personal accountability, and the individual’s responsibility for his own conduct can then be faced.
“It is customary to define psychiatry as a medical specialty concerned with the study, diagnosis, and treatment of mental illness. This is a worthless and misleading definition. Mental illness is a myth. Psychiatrists are not concerned with mental illnesses and their treatments. In actual practice they deal with personal, social, and ethical problems in living.”
A Dose of Sanity, by Sydney Walker III, M.D.
If you are currently being treated for depression, anxiety or panic disorder, attention deficit disorder, a sleeping disorder, or any of a wide array of common behavioral disorders, this book could save your life. If you are being given psychiatric SSRI drugs such as prozac, paxil, zoloft, luvox, effexor, serzone, anafranil, fenfluramine, fen-phen & redux, you must read this book.
In A Dose of Sanity, Sydney Walker III, M.D. takes us inside the big business of contemporary psychiatry and reveals how, by sacrificing sound medical principals in favor of labeling-by-convenience and brain-damaging quick-fixes like prozac, paxil, zoloft, luvox, effexor, serzone, anafranil, fenfluramine, fen-phen, redux, and ritalin, psychiatrists cause untold suffering and destroy the physical and mental health of millions of people.
Reading like a detective novel, A Dose of Sanity, tells the story of dozens of men and women, many of whom suffered needlessly for years, simply for lack of a sound medical diagnosis. You’ll meet the concert musician whose lifelong bouts with “psychosis” were actually due to undiagnosed typhus; the widow who was treated for “panic attacks” that turned out to be a thyroid dysfunction; the “hyperactive” boy whose symptoms were caused by exposure to carbon monoxide; and many others saved by the intervention of Dr. Walker and like-minded colleagues.
They Say You’re Crazy, By Paula J. Caplan, Ph.D.
A shocking expose of the process by which the mental-health elite judges us all.
How are decisions made about who is normal? Why are people being given psychiatric drugs such as ssri’s, prozac, paxil, zoloft, luvox, effexor, serzone, anafranil, fenfluramine, fen-phen and redux? As a former consultant to those who construct the “bible of the mental health professions,” the DSM (Diagnostic and Statistical Manual of Mental Disorders), Paula Caplan, Ph.D., offers an insider’s look at the process by which decisions about abnormality are made. A longtime specialist in teaching and writing about research methods, Caplan assesses the astonishing extent to which scientific methods and evidence are disregarded as the DSM is developed and revised.
The DSM is the guide that most psychiatrists, therapists, and social workers use to determine not only what care will be covered by insurers, but who will be hospitalized against their will and who may be judged incompetent or too disturbed to rear their own children. On a more day-to-day level, the DSM determines how millions of people feel about themselves once they are labeled psychologically “abnormal.” And yet this powerful manual, recently released in its fourth edition, is constructed by a tiny clique in the powerful psychiatric establishment, dominated by conservative white males.
In They Say You’re Crazy, Paula Caplan demonstrated that much of what are labeled “mental disorders” are actually common life problems or the effects of social injustice-and not signs of illness.
“Paula Caplan has written a lively, marvelous insider’s story of how psychiatric diagnoses are invented-how subjective, political, and personal agendas are dressed up in the lab coats of science and offered to the public as ‘truth’. Mental health professionals need to read this book to cure themselves of Delusional Scientific Diagnosing Disorder, and the public needs to read it for self protection.”, Carol Tavris, Ph.D.
Cruel Compassion, By Thomas Szasz, M.D.
“The truth is that after treatment with neuroleptic drugs, mental patients tend to be sicker and more disabled than before. Many exhibit the toxic effects of the drugs, suffering from a disfiguring neurological disturbance called ‘tardive dyskinesia.’”
Millions of Americans, diagnosed as mentally ill, are drugged with ssri’s, prozac, paxil, zoloft, luvox, effexor, serzone, anafranil, fenfluramine, fen-phen and redux and are confined by doctors for noncriminal conduct, go legally unpunished for the crimes they commit, and are supported by the state-not because they are sick, but because they are unproductive, unwanted, and “mentally ill”. While psychiatrists are obsessed with the false ideas that misbehavior is a medical disorder and that the duty of the state is to protect adults from themselves, we have replaced criminal-punitive sentences with civil-therapeutic “programs.” The result is the relentless loss of individual liberty, erosion of personal responsibility, and destruction of the security or persons and property.
Few contemporary thinkers have done more than Dr. Szasz to expose the myths and misconceptions surrounding insanity and the practice of psychiatry.
Thomas Szasz: Primary Values and Major Contentions, By Thomas S. Szasz, M.D.
In the Myth of Mental Illness Thomas S. Szasz, M.D. exposed and critically evaluated the cherished assumptions and misconceptions at the heart of psychiatry. In Thomas Szasz: Primary Values and Major Contentions he successfully isolates his basic claims and the arguments he offers in their behalf.
“By historical and traditional criteria, ‘mental illness’ is not an illness but a bogus invention that allows behavior, any behavior, to be categorized as ‘disease.’ Psychiatry is conventionally defined as a medical specialty concerned with the diagnosis and treatment of mental diseases. I submit that this definition, which is widely accepted, places psychiatry in the company of alchemy and astronomy and commits to the category of pseudoscience. The reason for this is that there is no such thing as ‘mental illness’.”
“In the history of science, thinking in terms of entities has always tended to precede thinking in terms of processes. Alchemists and astrologers thus spoke of mysterious substances and concealed their methods from public scrutiny. Psychiatrists have similarly persisted in speaking of mysterious maladies and have continued to refrain from disclosing fully and frankly what they do.” – Thomas Szasz M.D., Primary Values and Major Contentions
Beyond Bedlam, By Jeanine Grobe
In Beyond Bedlam, more than two dozen contemporary women write about their experiences with psychiatry: how they were mistreated, how they escaped, how they live now, and what can be done to change the system that abused them. Their voices rise above the clamor of psychiatric jargon, “treatment”, and “therapy.”
“Society blindly regards psychiatry as safe medicine. I found out that the psychiatric institution was not about healing but about the oppression of the human spirit. It taught me to accept being terrorized, tortured, and traumatized because these were ‘medicine’ and I was ‘sick’.”
The Tranquilizing of America: Pill Popping and the American Way of Life, By Richard Hughes and Robert Brewin
Dr. Louis Gottschalk states, “We have enough data here that certain of the benzodiazepines [sedatives and tranquilizers] are capable, after a single dose, of significantly disrupting certain kinds of cognitive and/or intellectual functions. Furthermore, this phenomenon outlasts the antianxiety effect of these drugs.
“..People are seeking an easy way out, looking for shortcuts on a path of life that has none; in the end not only will they be disappointed but they will end up by diminishing their humanness, the essence that separates man from animals.”
The Myth of the Hyperactive Child & Other Means of Child Control, By Peter Schrag and Diane Divoky
Millions of children have been “diagnosed” as “hyperactive” or having “attention deficit disorder” and millions are now taking amphetamine-type medication, in many cases by order of school officials. Millions of other children have been labeled predelinquent, found to have “deviant” tendencies, or said to exhibit “maladaptive behavior.” Can these illnesses be in fact so widespread, or is this a new way the schools have found to deal with healthy children who seem, to parents or teachers, to present some form of difficulty?
This shocking and meticulously documented book covers all aspects of the rapidly spreading ideology of “early intervention,” demonstrates how common problems become medical ones, and exposes the shoddy research that underlies those practices. Examining the “scientific” literature as well as searching out the underlying causes of this new and frightening trend, Peter Schrag and Diane Divoky document in telling detail the ways in which old-fashioned punishment and control are being replaced by new forms of medical and social treatment, teaching the younger generation that it must trust the state and its new “science” to define and manage the ways it grows up. The information and ideas they examine are critically important and profoundly disturbing.
The Myth of the A.D.D. Child, by Thomas Armstrong, Ph.D.
The Myth of the A.D.D. Child squarely challenges the mislabeling of millions of children as A.D.D., and questions the overuse of powerful mind-altering drugs in treating children’s hyperactivity. Not long ago, children who behaved in certain ways were called “bundles of energy”, “daydreamers,” or “fireballs.” Now they’re considered “hyperactive,” “distractible,” or “impulsive”-victims of the ubiquitous Attention Deficit Disorder. Tragically, such labeling can follow a child through life. Worse, the mind-altering drugs prescribed for A.D.D. are unnecessary-and they are harmful.
And They Call It Help, By Louise Armstong
From the best-selling author of Kiss Daddy Goodnight, comes this investigative journey into a multibillion-dollar industry that imprisons America’s children-for profit. Here and now, every year, thousands of kids are transported to a locked world where strange rules prevail and language is without meaning. Those in authority are empowered to administer brain-damaging drugs to children, forcibly restrain them, and lock them in isolation. Yet it is the children who are told over and over that they are the weird ones, the psychiatrically incorrect.
Important note: When trying to withdraw from many psychiatric drugs, patients can develop serious and even life-threatening emotional and physical reactions. It is dangerous not only to start taking psychiatric drugs, but also it can be dangerous to stop taking them. Withdrawal from psychiatric drugs should be done gradually and under medical and clinical supervision.
Source: http://outlookcities.com/psych/

Tags: mental illness, Prozac, Psychiatry and Psychiatric Drugs, Sanity, You're Crazy

Psychiatric Drugs’ Use Drops for Children

admin — Thu, 09 Oct 2008 17:57:55 +0000

Suicide Warnings Raise Bigger Fears On Testing Process
Warnings that drugs such as Prozac, Paxil and Effexor can increase suicidal behavior in some children have resulted in a nearly 20 percent drop in U.S. pediatric prescriptions of the widely used antidepressants and have triggered deep concerns about the quality of current data on psychiatric drugs, doctors and regulators said.
The unprecedented fall of what were once considered wonder drugs comes as a series of taxpayer-funded analyses have systematically undermined the claims of industry-funded drug trials, raising thorny questions about the ways in which psychiatric drugs are being tested, marketed and used.
No one knows the consequences of such a steep decline in children’s drug prescriptions: Critics of the drugs say regulators ought to crack down further, as British health authorities did last month, but many American psychiatrists are worried that reduced access to medications could cause an increase in suicide as a result of untreated depression.
As with many disputes over these and other psychiatric drugs, opinions are more readily available than definitive data. The fundamental problem, many experts said, is that there are not enough systematic long-term studies about psychiatric drugs.
“The problem is we don’t have enough good data,” said Thomas Laughren, director of the division of psychiatry products at the Food and Drug Administration. “All of our data are focused on the short term.”
As a result, he and others said, a consensus is growing that the system of approving psychiatric drugs based on industry-run trials that sometimes last just 12 weeks is not providing doctors with the information they need — many physicians place patients on the drugs for years. Senior FDA officials say they are weighing whether companies should be required to conduct longer trials to reveal the true risks and benefits of the drugs.
Pharmaceutical makers say that profound change would increase the time and expense of bringing new medications to market.
Although the agency does ask that companies pursue long-term trials after drugs are approved, few do. At a meeting this month, Laughren said, regulators will debate whether long-term trials “should be asked for at initial approval.”
Alan Goldhammer, associate vice president for regulatory affairs at the Pharmaceutical Research and Manufacturers of America, said long-term studies should be conducted by public health agencies at taxpayer expense.
“I don’t think they fall within the province of the pharmaceutical industry because they are so costly and time-consuming that it would probably bring drug development to a halt,” he said. “There would not be the funds to develop new drugs if one focused on one drug and tried to know everything about it.”
In the absence of long-term data, however, doctors, parents and patients have been confused by a steady stream of concerns that have recently emerged:
• An FDA review last year found that newer antidepressants increase suicidal behavior among some children, and the agency ordered that a “black box” warning be placed on them.
• British authorities last month went even further, telling doctors there never to prescribe medications to depressed children without first trying multiple alternatives, and never to prescribe drugs without also providing psychotherapy. Doctors were also warned not to prescribe the antidepressants Paxil and Effexor to depressed children under any circumstances.
• On Sept. 28, the FDA announced that the drug Strattera, prescribed widely to children with attention deficit disorder, had also been found to increase the risk of suicidal behavior in some, and told manufacturer Eli Lilly and Co. to add a black-box warning.
• Also last month, a major government analysis of antipsychotic medications found newer, expensive drugs were neither safer nor more effective than an older generic medication that doctors rarely use. The drugs had never been systematically compared in a long-term trial. Another study in older patients, paid for by Canadian health authorities, found the newer drugs “are not necessarily safer” when it came to causing uncontrolled movements; for years, doctors have believed the newer drugs were significantly less likely to cause that side effect.
Reflecting the confusion caused by the lack of good data, FDA regulators have drawn the ire both of critics who say the agency has not gone far enough to protect patients who take the drugs and of many psychiatrists who say the agency is going too far.
Antidepressant prescriptions for children fell nearly 20 percent in the last year, according to a recent report by the American Psychiatric Association and data from NDCHealth, a health care information company. Experts at the association worry that patients have been scared into thinking the drugs are dangerous, when the bigger danger of suicide lies in untreated depression.
Again, the FDA’s Laughren said there is little data on whether the drop in prescriptions is a good thing or a bad thing.
“It could mean that physicians are prescribing more rationally and that explains the drop, or it could mean there is a decreased access of medications,” he said. “Ultimately, systematic controlled trials are the best way to figure out the risks and benefits.”
Many experts said without long-term studies, doctors are left to rely on trial and error — and drug company marketing. Millions of dollars have been spent to boost the profile of newer antipsychotic drugs, for example. Although some patients clearly benefit, the study paid for by the federal government suggests doctors have embraced the new products without clear evidence that they are superior.
Many psychiatrists, in fact, were so certain the new drugs were better that they questioned the need to pit the new medications against an older drug, said Yale psychiatrist Robert Rosenheck, who helped conduct the study that found all of them did about as well.
Such misjudgments cannot be corrected when doctors are so dependent on short industry-sponsored trials, said Columbia University psychiatrist Jeffrey Lieberman, who led the antipsychotics study. Short-term studies do not tell clinicians which drug to try first or which is more cost-effective.
Many industry trials also carefully select the patients being studied in order not to muddy the results, whereas doctors routinely deal with patients with multiple conditions and complex problems. And companies have been legally allowed to keep short-term trials with inconvenient results out of public view. Studies that showed antidepressants were ineffective in children, for example, were systematically excluded from the medical literature. The result was that the data available to doctors painted a rosy picture of the drugs.
“If we only had the public evidence, we would have recommended the use of all the [drugs],” said Tim Kendall, a British psychiatrist who led a two-year analysis of both the public and secret data.
When the unpublished trials were taken into account, the evidence, he said, led them to rule out the use of Paxil and Effexor for children and to severely curtail the use of the other antidepressants.
Children with milder forms of major depression — who are persistently teary, emotionally flat, or uninterested in activities for several weeks — ought not to be candidates for the drugs at all, he said. Instead, the new British guidelines call for watchful waiting.
Children with severe forms of major depression — losing weight, not sleeping, and showing suicidal behavior — should get talk therapy for at least three months, Kendall said, before doctors consider adding a medication.
But Thomas Insel, director of the National Institute of Mental Health in Bethesda, said requiring three months of talk therapy before giving medication is unrealistic, because talk therapy is not widely available.
“It is not clear to me that most 16-year-olds would get any treatments at all,” he said. “It is hard to imagine that is an improvement.”
Depriving doctors of antidepressants could also prompt clinicians to venture into uncharted territory with even less data, Insel said. He is concerned that physicians are already switching children from antidepressants to antipsychotic drugs, none of which have been approved for children. The federal government’s top mental health researcher said it “was amazing” that nearly a quarter of all antipsychotic prescriptions for children are going to those younger than 9, the vast majority of them boys.
“I am concerned we are going to see an increase in . . . antipsychotics in this population,” said Insel. “Have we gone from one set of medications of known benefit and of questionable risks to a group of medications with unknown benefits and well-known risks?”

By Shankar Vedantam
Washington Post Staff Writer
Saturday, October 8, 2005; A01

washingtonpost.com

Source: j.b5z.net/i/u/2043019/i/washingtonpost.doc

Tags: Children, drug prescriptions, Effexor, Paxil, Prozac, Psychiatric Drugs' Use, Suicide Warnings

Antidepressants Hardly Help

admin — Thu, 18 Sep 2008 08:39:35 +0000

Popular antidepressants including Prozac and Paxil have little impact on most patients, according to a comprehensive review of newly released data from trials that were conducted before the drugs were approved in the U.S.
Researchers from the U.K., U.S. and Canada analyzed results for fluoxetine (better known by the brand name Prozac), venlafaxine (Effexor), nefazodone (Serzone) and paroxetine (Paxil or Seroxat) — all members of a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). The researchers’ paper, published this week in the journal PLoS Medicine, claims that only patients who are diagnosed “at the upper end of the very severely depressed category” get any meaningful benefit from the widely prescribed drugs. For the others, the paper says, antidepressants are barely more effective than a placebo (although patients suffering from depression, like those suffering from chronic pain, generally do see a substantial placebo benefit).
There are plenty of studies about antidepressants. What makes this one so important — the results were front-page news across the U.K. on Tuesday — is that the researchers were able to track down comprehensive unpublished trial results from the drug makers themselves before the drugs were authorized for sale in the U.S., and include them in their review of the literature. The U.S. Food and Drug Administration (FDA) must receive records of all relevant pharmaceutical-company trials, both published and unpublished, before it will approve a drug. Under the Freedom of Information Act, the researchers writing in PLoS Medicine were recently able to obtain those FDA records of industry-sponsored clinical trials. They yield data, they believe, that lets them avoid a bias that often plagues reviews of previous research: the tendency for conclusive positive results to be published, sometimes more than once, and thus over-represented, while mediocre results can be ignored or even swept under the rug.
Drug companies claim the review is still flawed, however. One massive problem: there are many more recent studies than those surveyed in the article, which looked only at pre-approval trials conducted before 1999. Nicholas Francis, a U.K. spokesman for Eli Lilly and Company, which produces Prozac, says that the new study “does not take into account that today more than 12,000 patients have participated in Prozac clinical trials and thousands of scientific papers have referenced Prozac, supporting its use in the treatment of depression.” Some 50 million people worldwide have taken Prozac, and in a company statement Lilly said it “is proud of the difference Prozac has made to millions of people living with depression.” Similarly, paroxetine producer GlaxoSmithKline warns, “This analysis has only examined a small subset of the total data available … and this one study should not be used to cause unnecessary alarm and concern for patients.” As a spokeswoman for Wyeth, Effexor’s maker, points out, these were, after all, the same data the FDA reviewed before approving the drugs for public use.
There are really two issues at the heart of the controversy. One is the difference between “statistical significance” — a measure of whether the drug’s effects are reliable, and that patient improvement is not just due to chance — and “clinical significance,” whether those effects actually are big enough to make a difference in the life of a patient. The researchers behind this new paper did find that SSRI drugs have a statistically significant impact for most groups of patients: that is, there was some measurable impact on depression compared to the placebo effect. “But a very tiny effect may not have a meaningful difference in a person’s life,” says Irving Kirsch, lead author on the paper and a professor of psychology at the University of Hull in England. As it happens, only for the most severely depressed patients did that measurable difference meet a U.K. standard for clinical relevance — and that was mostly because the very depressed did not respond as much to placebos. The drug trials showed SSRI patients improved, on average, by 1.8 points on the Hamilton Depression Rating Scale, a common tool to rate symptoms such as low mood, insomnia, and lack of appetite. The U.K. authorities use a drug-placebo difference of three points to determine clinical significance.
The more troubling question concerns what kind of data is appropriate for analyzing a drug’s efficacy. The companies are correct in claiming there is far more data available on SSRI drugs now than there was 10 or 20 years ago. But Kirsch maintains that the results he and colleagues reviewed make up “the only data set we have that is not biased.” He points out that currently, researchers are not compelled to produce all results to an independent body once the drugs have been approved; but until they are, they must hand over all data. For that reason, while the PLoS Medicine paper data may not be perfect, it may still be among the best we’ve got.

By LAURA BLUE/LONDON Tuesday, Feb. 26, 2008
Source: http://www.time.com/time/health/article/0,8599,1717306,00.html?iid=sphere-inline-bottom

Tags: Antidepressants, Food and Drug Administration, Hardly Help, Paxil, pharmaceutical, Popular antidepressants, Prozac, SSRI drugs

Psychiatric Drugs »» Antidepressants | Antipsychotics | Antianxiety | Antimanic Agents | Stimulants | Prescription Drugs » Tag: Prozac

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