The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G-BA) to investigate whether patients with depression benefit from taking drugs belonging to the selective serotonin and norepinephrine reuptake inhibitor (SNRI) drug class. Up till now, 2 of these drugs have been approved as antidepressants in Germany: venlafaxine and duloxetine. The Institute published its final report on 18 August. According to this report, the benefit of both drugs has been proven compared to a sham drug (placebo): patients respond better to the therapy and suffer less from the symptoms of depression. Moreover, there are indications that both drugs protect against relapse in addition to alleviating symptoms.
Interplay of biological and psycho-social factors
There are various assumptions about when and how depression occurs. The possible causes and influencing factors are manifold. What is not disputed is that the complete clinical picture of depression is the result of a complex interplay of biological and psycho-social factors. There are indications that a modification or reduction in the transfer of certain messenger substances in the central nervous system plays a part. This is where most drug therapies start their effect. The comparatively new SNRI drug class is intended to influence two of these messenger substances (neurotransmitters) by inhibiting the reuptake of serotonin and norepinephrine.
READ MORE @ SCIENCE DAILY
Showing posts with label drug effectiveness. Show all posts
Showing posts with label drug effectiveness. Show all posts
Thursday, August 27, 2009
Monday, June 1, 2009
Common autism medication is ineffective for repetitive behaviors, study finds
New information may change treatment protocols for children with autism spectrum disorders
Citalopram (Celexa), a medication commonly prescribed to children with autism spectrum disorders (ASD), was no more effective than a placebo at reducing repetitive behaviors, according to a multi-site clinical trial guided by lead author Bryan H. King, MD, director of child and adolescent psychiatry at Seattle Children's Hospital and professor and vice chair of psychiatry at the University of Washington School of Medicine. Because citalopram is also prescribed for patients with obsessive compulsive disorders (OCD), these study results may challenge the widely held premise that repetitive behaviors in children with ASD are similar to repetitive behaviors often found in cases of OCD. The study "Lack of Efficacy of Citalopram in Children with Autism Spectrum Disorders and High Levels of Repetitive Behavior" was published in the June 2009 issue of Archives of General Psychiatry.
"We're continuing to learn new information about the multiple variables that may cause or contribute to autism spectrum disorders, as well as how to treat them," said King. "Even as our understanding of autism grows, so much still remains a mystery. While our study's findings may be frustrating news for hopeful families and clinicians, each new finding helps us to re-examine and revise treatment plans, refine future studies and build upon what we know as we search for effective treatments and eventually cures for this complex group of disorders."
"When prescribing any medication we must always weigh the possible benefits against possible risks," added King. "Because citalopram showed no more benefit than placebo and it may produce side effects, providers need to carefully examine whether it is appropriately prescribed for repetitive behaviors in children with an ASD."
Citalopram is in a class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), which are sometimes prescribed for children with ASD to reduce repetitive behaviors. These behaviors include hand flapping or wringing, repetitive complex body movements like spinning, swaying, or rocking back and forth, repetitive play, and inflexible daily routines.
"Parents of children with autism spectrum disorders face an enormous number of treatment options, not all of which are research-based," said Thomas R. Insel, MD, director of the National Institute of Mental Health (NIMH). "Studies like this help us to better understand which treatments are likely to be beneficial and safe."
Previous research has suggested that some children with ASD may have abnormalities in their serotonin, a brain chemical that, among many other functions, plays an important role in early brain development. Children with OCD may also have abnormal serotonin function, as well as repetitive or inflexible behaviors. OCD is effectively treated with SSRIs, which leads many doctors to prescribe SSRIs to reduce repetitive behaviors in children with ASD. Even though studies have shown mixed results for use in ASD, SSRIs remain among the most frequently prescribed medications for children with ASD.
READ MORE @ EURFEKALERT
Citalopram (Celexa), a medication commonly prescribed to children with autism spectrum disorders (ASD), was no more effective than a placebo at reducing repetitive behaviors, according to a multi-site clinical trial guided by lead author Bryan H. King, MD, director of child and adolescent psychiatry at Seattle Children's Hospital and professor and vice chair of psychiatry at the University of Washington School of Medicine. Because citalopram is also prescribed for patients with obsessive compulsive disorders (OCD), these study results may challenge the widely held premise that repetitive behaviors in children with ASD are similar to repetitive behaviors often found in cases of OCD. The study "Lack of Efficacy of Citalopram in Children with Autism Spectrum Disorders and High Levels of Repetitive Behavior" was published in the June 2009 issue of Archives of General Psychiatry.
"We're continuing to learn new information about the multiple variables that may cause or contribute to autism spectrum disorders, as well as how to treat them," said King. "Even as our understanding of autism grows, so much still remains a mystery. While our study's findings may be frustrating news for hopeful families and clinicians, each new finding helps us to re-examine and revise treatment plans, refine future studies and build upon what we know as we search for effective treatments and eventually cures for this complex group of disorders."
"When prescribing any medication we must always weigh the possible benefits against possible risks," added King. "Because citalopram showed no more benefit than placebo and it may produce side effects, providers need to carefully examine whether it is appropriately prescribed for repetitive behaviors in children with an ASD."
Citalopram is in a class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), which are sometimes prescribed for children with ASD to reduce repetitive behaviors. These behaviors include hand flapping or wringing, repetitive complex body movements like spinning, swaying, or rocking back and forth, repetitive play, and inflexible daily routines.
"Parents of children with autism spectrum disorders face an enormous number of treatment options, not all of which are research-based," said Thomas R. Insel, MD, director of the National Institute of Mental Health (NIMH). "Studies like this help us to better understand which treatments are likely to be beneficial and safe."
Previous research has suggested that some children with ASD may have abnormalities in their serotonin, a brain chemical that, among many other functions, plays an important role in early brain development. Children with OCD may also have abnormal serotonin function, as well as repetitive or inflexible behaviors. OCD is effectively treated with SSRIs, which leads many doctors to prescribe SSRIs to reduce repetitive behaviors in children with ASD. Even though studies have shown mixed results for use in ASD, SSRIs remain among the most frequently prescribed medications for children with ASD.
READ MORE @ EURFEKALERT
Wednesday, January 21, 2009
Antidepressant Has Modest Benefits in Anxious Older Patients
Treating generalized anxiety disorder in patients 60 and older with a selective serotinin reuptake inhibitor (SSRI) significantly improved their symptoms as long as they took the drug, researchers here said.
The response rate among patients taking escitalopram (Lexapro) for up to 12 weeks was 69%, compared with 51% assigned to placebo in a randomized trial (P=0.03), reported Eric J. Lenze, M.D., of Washington University, and colleagues in the Jan. 21 issue of the Journal of the American Medical Association.
There were significantly greater improvements with the active drug versus placebo for activity limitations, social function, worry questionnaire scores, and overall anxiety symptoms and role functioning, the researchers said.
But the researchers characterized the improvements in the 179-patient trial as "modest," and diminished further by nonadherence.
READ MORE @ MEDPAGE TODAY
The response rate among patients taking escitalopram (Lexapro) for up to 12 weeks was 69%, compared with 51% assigned to placebo in a randomized trial (P=0.03), reported Eric J. Lenze, M.D., of Washington University, and colleagues in the Jan. 21 issue of the Journal of the American Medical Association.
There were significantly greater improvements with the active drug versus placebo for activity limitations, social function, worry questionnaire scores, and overall anxiety symptoms and role functioning, the researchers said.
But the researchers characterized the improvements in the 179-patient trial as "modest," and diminished further by nonadherence.
READ MORE @ MEDPAGE TODAY
Sunday, December 7, 2008
No Reason to Prefer Atypical Antipsychotics over Older Drugs
The common distinction between first- and second-generation antipsychotic drugs has no scientific basis and should be dropped, said researchers here.
A meta-analysis of 150 double-blind studies found little evidence that newer, so-called atypical antipsychotic drugs are more effective than older drugs for symptoms of schizophrenia, reported Stefan Leucht, M.D., of Munich Technical University, and colleagues online in The Lancet.
The researchers also found that although newer drugs induced fewer extrapyramidal effects than haloperidol (Haldol) that was not the case when compared with low-potency first-generation agents.
"Second-generation antipsychotic drugs differ in many properties" -- including structure and mode of action as well as clinical effects -- "and are not a homogeneous class," the researchers concluded.
"Improper generalization creates confusion and, as a result, the classification [of first- versus second-generation agents] might be abandoned," they said.
READ MORE @ MEDPAGE TODAY
A meta-analysis of 150 double-blind studies found little evidence that newer, so-called atypical antipsychotic drugs are more effective than older drugs for symptoms of schizophrenia, reported Stefan Leucht, M.D., of Munich Technical University, and colleagues online in The Lancet.
The researchers also found that although newer drugs induced fewer extrapyramidal effects than haloperidol (Haldol) that was not the case when compared with low-potency first-generation agents.
"Second-generation antipsychotic drugs differ in many properties" -- including structure and mode of action as well as clinical effects -- "and are not a homogeneous class," the researchers concluded.
"Improper generalization creates confusion and, as a result, the classification [of first- versus second-generation agents] might be abandoned," they said.
READ MORE @ MEDPAGE TODAY
Monday, August 25, 2008
Looking beyond the drug receptor for clues to drug effectiveness
Antipsychotic drugs that are widely used to treat schizophrenia and other problems may not work as scientists have assumed, according to findings from Duke University Medical Center researchers that could lead to changes in how these drugs are developed and prescribed.
Scientists have known that all antipsychotic drugs target the D2 receptor inside cells. New tests developed at Duke reveal that the biochemical pathways linked to this receptor – the pathways along which the drugs deliver their therapeutic effects – may function differently than previously understood.
The Duke team developed specialized tests and studied two main pathways that stem from the receptor. The first is the G-protein-dependent signaling pathway, and the other is the beta arrestin pathway.
Most antipsychotic drugs in use today were developed to target the G-protein signaling that occurs at the receptor. Only recently, beta-arrestin, a protein known as an "off-switch" for G-protein receptors, has been shown to also play a role in directing other cellular activities.
The tests uncovered surprising results. "Our work showed that all nine antipsychotic drugs we examined uniformly and more potently block the beta-arrestin pathway downstream of the D2 dopamine receptor," said Bernard Masri, Ph.D., lead author and postdoctoral researcher in the Duke Department of Cell Biology.
READ MORE @ EUREKALERT
Scientists have known that all antipsychotic drugs target the D2 receptor inside cells. New tests developed at Duke reveal that the biochemical pathways linked to this receptor – the pathways along which the drugs deliver their therapeutic effects – may function differently than previously understood.
The Duke team developed specialized tests and studied two main pathways that stem from the receptor. The first is the G-protein-dependent signaling pathway, and the other is the beta arrestin pathway.
Most antipsychotic drugs in use today were developed to target the G-protein signaling that occurs at the receptor. Only recently, beta-arrestin, a protein known as an "off-switch" for G-protein receptors, has been shown to also play a role in directing other cellular activities.
The tests uncovered surprising results. "Our work showed that all nine antipsychotic drugs we examined uniformly and more potently block the beta-arrestin pathway downstream of the D2 dopamine receptor," said Bernard Masri, Ph.D., lead author and postdoctoral researcher in the Duke Department of Cell Biology.
READ MORE @ EUREKALERT
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