Saturday, June 30, 2007

Dosage Adjustment in Special Populations

Special consideration may be necessary when prescribing pharmacologic therapy for depression and anxiety disorders in certain populations of patients. These populations are diverse in demographics and symptomatology. As a result, discussions of the special considerations their comorbid conditions require tend to be outside of the mainstream literature. This article discusses 3 special populations: patients with traumatic brain injury (TBI), patients with HIV or AIDS, and Asian Americans. When prescribing pharmacologic therapy for depression to patients in these special populations, clinicians must perform thorough patient assessments, maintain a high index of suspicion for comorbidities, and proceed with slow and gentle titration of medications.

READ MORE @ ABKHAZIA

Friday, June 29, 2007

Antidepressant studies find low birth-defect risk

Use of antidepressants by pregnant women doesn't significantly increase the risk of birth defects, with rare exceptions, two studies found.

The overall risk of having a child with a defect increased by less than 1 percent in women on the drugs, including Pfizer Inc.'s Zoloft, GlaxoSmithKline PLC's Paxil and Forest Laboratories Inc.'s Celexa, according to research published today in The New England Journal of Medicine.

READ MORE @ BALTIMORE SUN

Thursday, June 28, 2007

Approval of J&J's Antipsychotic Delayed for Teens

U.S. regulators delayed a request by Johnson & Johnson to expand use of its top-selling Risperdal to include schizophrenia and bipolar disorder in adolescents.

The FDA didn't request new studies on the treatment in a letter to the company, J&J said in a statement today. J&J said it would work with the agency to complete prescribing information on the drug, which is already approved for use in children with autism and adults with schizophrenia and bipolar disorder.

Use of antipsychotic drugs for younger patients has risen sharply in recent years, prompting concern among some doctors and parents about side effects including weight gain and diabetes. Risperdal, which generated $4.2 billion last year, is the second such drug delayed by U.S. regulators for teen use. Eli Lilly's Zyprexa was held up in April.

READ MORE @ REUTERS NEWS

Wednesday, June 27, 2007

Errors Drop 66% When Doctors Computerize Prescriptions

Medication errors such as prescribing or administering the wrong drugs to patients dropped 66% in hospitals used a computerized system to record doctors' orders.

Prescription errors costing each U.S. hospital as much as $5.6 million a year declined when doctors directly entered their instructions into an electronic system, rather than having staff transcribe handwritten notes, according to a review by the University of Minnesota of 12 separate studies.

"The problem is more complicated than bad handwriting or individual negligence," said Tatyana A. Shamliyan, a research associate at the University of Minnesota's School of Public Health. "There are several steps, and through all the steps errors can be introduced."

Switching from handwritten prescriptions to direct computer entry by doctors would reduce the medication errors that injure or kill half a million patients each year, the researchers said.

READ MORE @ BLOOMBERG NEWS

Tuesday, June 26, 2007

Psychiatrists Top in Drug Maker Gifts

As states begin to require drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

READ MORE @ NY TIMES

Monday, June 25, 2007

Anti-depressants weaken elderly bones

Two studies published add to growing evidence the most popular class of drugs taken to treat depression may contribute to fragile bones in elderly people.

The research focused on a class of antidepressant drugs called selective serotonin reuptake inhibitors. Millions of people, including many elderly, take these drugs, known as SSRIs, which include Eli Lilly's Prozac, known generically as fluoxetine.

Two teams of researchers found that older men and women taking SSRIs had more bone loss than those not taking the drugs, which account for more than 60 percent of U.S. antidepressant drug prescriptions. A drop in bone mass can lead to osteoporosis and bone fractures.

A team led by Dr. Susan Diem of the University of Minnesota tracked 2,722 women, average age 78, including 198 SSRI users. They measured their bone mineral density five years apart

READ MORE @ REUTERS

Sunday, June 24, 2007

Hospitalised Heart Patients Safer with Anti-depressants

According to the research findings, patients with “acute coronary syndrome” are less likely to have certain subsequent heart-related events if they are taking a selective serotonin reuptake inhibitor or SSRI. Primarily used for relieving depression, SSRI drugs also stop platelets from clumping together.

Led by Dr. Roy C. Ziegelstein, the research team based their study on the fact that SSRIs are often used for treating anxiety and depression in coronary heart disease patients. They wanted to ascertain if this has an effect on the patients’ outcome.

READ MORE @ HEARTZINE

Saturday, June 23, 2007

BEHAVIOUR DRUGS FOR CHILDREN 'UBIQUITOUS'

Canadian children are being widely prescribed antipsychotic drugs for behaviour and mood problems, with a significant proportion of the powerful drugs going to children under the age of nine, new research shows.

Ninety-four per cent of 176 child psychiatrists in Canada surveyed are prescribing drugs known as atypical antipsychotics for a variety of disorders and symptoms, including anxiety, attention-deficit hyperactivity disorder and "poor frustration tolerance."

While most prescriptions were for children 13 and older, researchers found that a "surprising" number were for the very young: Twelve per cent of all prescriptions were for children aged eight or under, including three-year-olds.

None of the drugs has been officially approved for use in children. All are in a different class from Ritalin, a stimulant used to treat attention deficit disorder in children.

READ MORE @ NATIONAL POST

Friday, June 22, 2007

FDA Delays Risperdal For Teenagers

Untold numbers 0f kids may be prescribed antipsychotics on an off-the-label basis every year, but the FDA held back from giving Johnson & Johnson its blessing to market the drug officially to teenagers suffering from schizophrenia.

The agency has issued an approvable letter in response to the drugmaker’s request to market Risperdal for schizophrenia in youngsters between 13 and 17, and for short-treatment of bipolar mania associated with bipolar I disorder in kids between 10 and 17. J&J was quick to note, however, that the FDA didn’t request new studies, according to its statement today.

READ MORE @ PHARMALOT

Thursday, June 21, 2007

Gates Vows to Fix Mental Health System

Defense Secretary Robert Gates promised Thursday to speed up changes to the military's much-criticized mental health system, declaring ''this is something that we can, must and will get fixed.''

A study released last week said more money and people are needed to care for troops suffering depression, anxiety, post-traumatic stress symptoms and other mental health problems because of their war experiences. It also said the Pentagon needs to build a culture of support throughout the military to help remove the stigma of asking for and getting psychological help.

READ MORE @ NY TIMES

Wednesday, June 20, 2007

On the Horizon, Personalized Depression Drugs

Imagine that you are depressed and see a psychiatrist who explains that you have clinical depression and would benefit from an antidepressant. So far, so good. But then the doctor tells you there is a 60 percent chance that you’ll feel better with this antidepressant and that it could take as long as four to six weeks to find out, during which time you’ll probably have some side effects from the drug.

With a simple blood test, the doctor will be able to characterize a patient’s unique genetic profile, determining what biological type of depression the patient has and which antidepressant is likely to work best.

Scientists have identified genetic variations that affect specific neurotransmitter functions, which could explain why some patients respond to some drugs but not to others. For example, some depressed patients who have abnormally low levels of serotonin respond to S.S.R.I.’s, which relieve depression, in part, by flooding the brain with serotonin. Other depressed patients may have an abnormality in other neurotransmitters that regulate mood, like norepinephrine or dopamine, and may not respond to S.S.R.I.’s.

READ MORE @ NY TIMES

Tuesday, June 19, 2007

Diagnosis, Treatment of Youth for Depression Fell After FDA Alert

Researchers are troubled by data indicating that large numbers of young people with depression are being left untreated after the FDA issued its first advisory about the antidepressants in 2003.

Rates of the diagnosis and pharmacological treatment of depression among children and adolescents dropped sharply after October 2003, when the U.S. Food and Drug Administration (FDA) issued its first public health advisory informing health care professionals of an increased risk of suicidality among youngsters taking antidepressants.

These findings, which appeared in the June American Journal of Psychiatry, have heightened the concerns of researchers and clinicians alike that suicide rates among untreated children and adolescents will rise unchecked. In fact, a study published in the February Pediatrics revealed an 18.2 percent increase in suicide from 2003 to 2004 among youngsters under the age of 20 (Psychiatric News, March 2).

READ MORE @ PSYCHIATRIC NEWS

Monday, June 18, 2007

Backlash on bipolar diagnoses in children

No one has done more to convince Americans that even small children can suffer the dangerous mood swings of bipolar disorder than Dr. Joseph Biederman of Massachusetts General Hospital.

From his perch as one of the world's most influential child psychiatrists, Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start "from the moment the child opened his eyes" at birth. Psychiatrists used to regard bipolar disorder as a disease that begins in young adulthood, but now some diagnose it in children scarcely out of diapers, treating them with powerful antipsychotic medications based on Biederman's work.

READ MORE @ BOSTON GLOBE

Sunday, June 17, 2007

F.D.A. Panel Rejects Drug for Obesity

A drug once viewed as a possible magic bullet against obesity was rejected yesterday by a federal advisory panel because of worries that it causes neurological and psychiatric problems and increases the risk of suicide.

Although the drug, rimonabant, is already marketed in 37 countries, it is now unlikely that the FDA will approve its sale in the US without additional safety data.

The advisory panel voted unanimously, 14 to 0, against recommending the drug, saying there was inadequate evidence of its safety. The FDA is not required to follow the advice of such panels, but it typically does.

READ MORE @ NY TIMES

Saturday, June 16, 2007

Eli Lilly: Drug ads influencing patients

Eli Lilly, which has faced thousands of lawsuits over its anti-psychotic Zyprexa, says lawyers' ads about the drug are prompting some patients to stop taking mental illness medications when they shouldn't.

The advertising blitz "presents yet another barrier for patients who suffer from severe mental illness" and increases the risks that people will not get the care they need, said Carole Puls, a spokeswoman for the Indianapolis-based drug maker.

Lilly released the results of a company-funded survey that asked 402 psychiatrists who treat patients with bipolar disorder or schizophrenia to complete an online questionnaire. More than half of the participating psychiatrists said they believed their patients who stopped medication or reduced the dosage did so after seeing lawyers' advertisements about anti-psychotic drugs.

READ MORE @ AP

Eli Lilly: Lawyers' Ads Are Hurting Patients - Law.com

Friday, June 15, 2007

Gabapentin (Neurontin) Eases Chronic Pain in Fibromyalgia

For treating the chronic pain and other symptoms of fibromyalgia, the anticonvulsant gabapentin (Neurontin) proved safe and effective, researchers here reported.

In a 12-week randomized, double-blind clinical trial, patients taking gabapentin displayed significantly less pain, better sleep, and less fatigue than placebo controls, Lesley M. Arnold, M.D., of the University of Cincinnati, and colleagues reported in the April issue of Arthritis and Rheumatism.

READ MORE @ MEDPAGE TODAY

Thursday, June 14, 2007

Drugs industry economics 'not sustainable' - report

The pharmaceutical industry business model is "economically unsustainable", according to a report by accountants PricewaterhouseCoopers. The study suggested drug companies' reliance on heavy marketing of a few drugs in the hope of huge sales meant they were "operationally incapable" of acting quickly enough to produce innovative treatments demanded by global markets.

According to Steve Arlington, the main author, drug companies spend twice as much on research and development than 10 years ago, yet produce half as many drugs: 40 to 45% of medicines in phase 3 clinical trials, the last stage, now failed.

READ MORE @ THE GUARDIAN

Wednesday, June 13, 2007

Young People, Mental Illness and The Pharmaceutical Industry

"As a practicing child and adolescent psychiatrist, I have been following with great interest the recent media attention being paid to young people, mental illness and the pharmaceutical industry."

"This is a topic that has been of continuing concern to the medical and non-medical communities. It raises a variety of important questions regarding the relationships between patients, physicians and drug companies; there are a variety of factors that have yet to be addressed."

READ MORE @ HUFFINGTON POST

Tuesday, June 12, 2007

Depression + osteoporosis link still unclear

Older women who take certain antidepressants are at increased risk of fracturing a bone, but it's not clear whether the association is due to the drugs, depression itself, or some other factor, according to a new report in the Harvard Women's Health Watch.

Nevertheless, while women shouldn't stop taking antidepressant drugs for the sole reason of protecting their bones, those who suffer from depression should get their bone mineral density checked out, the report's authors state.

READ MORE @ REUTERS

Monday, June 11, 2007

Big Headache for Big Pharma

For pharmaceutical giant Eli Lilly, death and injury are just a cost of doing business. When Zyprexa, Lilly’s drug to treat schizophrenia and bipolar disorder, hit the marketplace in 1996, it was hailed as an “atypical” – a “safe, gentle psychotropic,” more effective than older drugs like Thorazine and Trilafon, without the dangerous side effects. Sales skyrocketed. The hype soon gave way to reality, as Lilly faced waves of lawsuits by patients suffering from diabetes, massive weight gain, pancreatitis and cardiac problems. Lilly responded with the cozy arrangement that worked with Prozac, another blockbuster plagued with problems: quietly settle suits out of court, with proceedings sealed and secret under a gag order. Anything embarrassing – or illegal – that Lilly is doing behind closed doors would remain hidden from public view.

By - Will Hall co-founder of the Freedom Center, and a member of the Icarus Project.

READ MORE @ Adbusters

Sunday, June 10, 2007

Potentially Incompatible Goals at F.D.A.

Safety and speed are the yin and yang of drug regulation. Patients want immediate access to breakthrough medicines but also want to believe the drugs are safe.

These goals can be incompatible. Race a drug to market and much is likely to remain unknown when patients take it. Test a drug thoroughly to assess all possible risks and its release may be delayed by years.

A series of drug-safety scandals has led many on Capitol Hill to question whether the Food and Drug Administration has failed to strike the right balance between speed and safety. A clear sign of this imbalance, these critics say, is the increasing number of F.D.A. drug-safety officers who say they have been punished or ignored after uncovering dangers of popular medicines.

READ MORE @ NY TIMES

Saturday, June 9, 2007

Antidepressant Augmentation Can Be Useful in Treatment Resistant Elderly Patients

While the recovery rates of those receiving augmentation are not as high as in those who responded to first-line therapy, the recovery rates are still high enough to suggest that augmentation should be tried when older adults' depression is not improving

READ MORE @ RxPG NEWS

Friday, June 8, 2007

Swag from APA Conference

Psychiatrists attending the American Psychiatric Association conference in San Diego last month could stop by the exhibit hall, where reps from 160 companies doled out giveaways. The pharmas spent tens of thousands of dollars on booth space to tempt the docs to use their branded tchotchkes.

Above: The next time you reach for a tissue in the middle of a weepy therapy session, don't be surprised to see this reminder that depression is nothing to sneeze at. Effexor, an antidepressant, not only provides the tissue, but warns on the dispenser about rare side effects like life-threatening serotonin syndrome, sustained increases in blood pressure and "discontinuation symptoms" when people stop taking the drug.

READ MORE and see a slide show of more swag @ Wired News

Thursday, June 7, 2007

Depression with dysphoria may need two drug types

Findings from a small study suggest that combining an antidepressant with an anticonvulsive drug, a type of drug normally used to treat epilepsy, may be an effective treatment for patients with depression plus dysphoric mood, such as anger or hostility.

READ MORE @ REUTERS

Wednesday, June 6, 2007

Khat use linked to psychiatric disorders

British researchers are calling for improved research into the stimulant plant khat and its possible association with psychiatric disorders.

Investigating the potential link between the African plant and mental illness is the first systematic review of the topic.

READ MORE @ SCENTA

Tuesday, June 5, 2007

Genetic variations may predispose some men to suicidal thoughts

Genetic variations may help explain why some men with depression develop suicidal thoughts and behaviors after they begin taking antidepressant medications, while most do not, according to a report in the June issue of Archives of General Psychiatry.

Although most patients with depression respond favorably to antidepressant medications, a very small subgroup may experience worse symptoms after beginning treatment, according to background information in the article.

“Regardless of treatment specificity, nearly all antidepressant medication studies find that some patients experience suicidality after treatment initiation,” the authors write. “Identification of this subpopulation before treatment would have tremendous clinical utility.”

READ MORE @ EUREKALERT

Monday, June 4, 2007

Antipsychotic Medicine Inspires Tuberculosis Drug

The antipsychotic medication chlorpromazine (Thorazine) can be used to treat tuberculosis, but it causes terrible side effects. Scientists at SRI International are using this knowledge as a starting point to develop a new tuberculosis drug. Their challenge is to find a chemical that kills Mycobacterium tuberculosis, the bacteria that causes tuberculosis, without causing restlessness and uncontrollable jitters that are brought on by the antipsychotic medication.

READ MORE @ Wired News

Antipsychotic Drug Use in Older Adults with Dementia

Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety.

READ MORE @ Annals of Internal Medicine
READ MORE @ Science Daily

Sunday, June 3, 2007

SSRIs and Birth Defects: More Data Urgently Needed

There is a problem out there for prospective mothers and fathers. The problem is that instead of being able to find good information on the interplay between SSRIs (a group of antidepressants including Zoloft, Paxil and Prozac) and safe pregnancy, there is a big black void.

READ MORE @ LAWYERS & SETTLEMENTS

Saturday, June 2, 2007

Depression Risk Is Higher Among Battling Siblings

It could be that closeness with a sibling in childhood helps to develop skills in relating to peers that are taken into adult life or that lack of such closeness is an early sign of vulnerability to depression.

Poor sibling relationships in childhood may be an important and specific predictor of major depression in adulthood.

READ MORE @ Psychiatric News

Friday, June 1, 2007

Sildenafil Effective for SRI Associated Sexual Dysfunction

Depressed women with serotonin reuptake inhibitor (SRI) antidepressant-associated sexual dysfunction are able to continue taking effective antidepressant treatment with sildenafil while avoiding sexual side effects.

READ MORE @ DOCTOR'S GUIDE