Antidepressant improves recovery from spine injury

A common antidepressant combined with an intensive treadmill training program helped people with partial spinal cord injuries walk better and faster, U.S. researchers said on Sunday.

They said Forest Laboratories' antidepressant Lexapro or escitalopram, which affects a message-carrying brain chemical called serotonin, helps strengthen remaining nerve connections along the spine, giving patients with spinal cord injuries more ability to control their muscles during training.

"The drug is enhancing the effects of the therapy," said George Hornby, a research scientist at the Rehabilitation Institute of Chicago, who is presenting his findings at the Society for Neuroscience's meeting in Chicago.

"The drug on its own isn't a miracle drug. What you need is the drug plus the training," Hornby said in a telephone interview.

The findings are the first in humans and builds on studies in animals that found giving serotonin-like drugs after spinal cord injuries can promote recovery of walking when paired with an intensive training program.

READ MORE @ REUTERS

CORRECTED - US family doctors prescribe most mental health drugs

(Corrects final paragraph to show the FDA did not approve Seoquel's use in children, but an FDA advisory panel)

* Most mental health drugs prescribed by family doctors

* Doctors' role raises concerns about quality of care

Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, not psychiatrists, raising concerns about the quality of some treatments, according to a study released on Wednesday.

Researchers from Thomson Reuters (TRI.TO) and the U.S. Substance Abuse and Mental Health Services Administration examined 472 million prescriptions written for psychotropic drugs from August 2006 and July 2007.

They found that general practitioners prescribed the bulk of prescriptions in two main categories -- 62 percent of antidepressants and 52 percent of stimulants.

The stimulants were mainly drugs for treating attention deficit hyperactivity disorder, or ADHD. About 25 percent of all stimulant prescriptions examined were written by pediatricians, they reported in the journal Psychiatric Services.

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Prescriptions now biggest cause of fatal drug overdoses

Debra Jones didn't begin taking painkillers to get high.
Jones, 50, was trying to relieve chronic pain caused by rheumatoid arthritis.

Yet after taking the painkiller Percocet safely for 10 years, the stay-at-home mother of three became addicted after a friend suggested that crushing her pills could bring faster relief. It worked. The rush of medication also gave her more energy. Over time, she began to rely on that energy boost to get through the day. She began taking six or seven pills a day instead of the three to four a day as prescribed.

"I wasn't trying to abuse it," says Jones, from Holly Springs, N.C., who has since recovered from her battle with addiction. "But after 10 years, I couldn't help what it did to my body or my brain. It was hard to work without it."

Addiction to prescription painkillers — which kill thousands of Americans a year — has become a largely unrecognized epidemic, experts say. In fact, prescription drugs cause most of the more than 26,000 fatal overdoses each year, says Leonard Paulozzi of the Centers for Disease Control and Prevention.

READ MORE @ USA TODAY

Drug Combo May Offer Best Relief for Nerve Pain

People with nerve pain respond better to a combination treatment using the anticonvulsant gabapentin and antidepressant nortriptyline than to treatment with either drug alone, according to Canadian researchers.

The study findings suggest that combination treatment could be used to help people who only partially respond to one drug or the other.

Nerve, or neuropathic, pain -- which affects 2 to 3 percent of the population -- is "initiated or caused by a primary lesion or dysfunction in the nervous system," according to a news release from The Lancet, which is publishing the study online Sept. 29. Conditions that cause neuropathic pain include nerve problems in the spine, diabetes-related nerve damage and postherpetic neuralgia (PHN), which is nerve pain caused by the varicella zoster virus that can follow an outbreak of shingles.

ATLANTA JOURNAL CONSTITUTION

Many Kids Suffer Medication Side Effects: Study

More than half a million kids a year are treated for medication side effects in American outpatient clinics and emergency rooms, according to new data.

Researchers at Children's Hospital Boston analyzed National Center for Health Statistics outpatient data between 1995 and 2005. Among children up to age 18, there were 585,922 visits a year for adverse drug events (ADEs). Most visits were to outpatient clinics, but 22 percent were to hospital emergency departments.

"We found that there are as many as 13 outpatient visits for adverse drug events per 1,000 children, indicating that they are a common complication of pediatric care," study leader Dr. Florence Bourgeois, of Children's division of emergency medicine, said in a news release.

The majority of visits were by children 4 and younger (43 percent), followed by youngsters aged 15 to 18 (23 percent). Skin-related (45 percent) and gastrointestinal (16.5 percent) were the most common types of side effects, and 52 percent of the children had symptoms that suggested an allergic reaction.

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Lilly Reaches Zyprexa Agreement With Seven States (Update2)

Eli Lilly & Co. agreed to settle, on confidential terms, lawsuits filed by seven states alleging the company improperly marketed its antipsychotic drug Zyprexa, a court-appointed official said.

“All of the states have essentially settled for the same” non-monetary arrangements, said Michael Rozen, special master appointed by the court to help settlement negotiations. The money terms, which weren’t disclosed, “have fallen roughly in line,” he said at a hearing today in federal court in Brooklyn, New York.

Lawyers told U.S. District Judge Jack B. Weinstein, who is overseeing the cases, that finishing the settlements may be delayed while the parties determine how much money the U.S. government plans to claim in compensation for federal dollars spent on Zyprexa through state Medicaid programs.

If completed and approved in court, the settlements would leave four suits filed by states pending against Lilly.

READ MORE @ BLOOMBERG

Can depression cause osteoporosis?

[Studies indicate that a link exists and that the risk of bone disease is further increased by behaviour and medication, "One theory is that stress hormones released during depression may play a role ... The other theory is that if you suffer a bone fracture, your quality of life goes down. The question is, is it causal?" ]

In the feel-good French movie Amélie, audiences are introduced to an eccentric old character held hostage by his home and his own body. He's dubbed "The Glass Man."

Raymond Dufayel was born with bones as brittle as crystal. All the furniture in his Parisian apartment is padded, explains the narrator, and a simple handshake could crush his fingers. He's been trapped inside his home for 20 years and leads a small, lonely life.

In the 2000 thriller Unbreakable, a comic book specialist played by Samuel L. Jackson, nicknamed "Mr. Glass," is convinced he's found a real-life superhero in an unremarkable security guard played by Bruce Willis. His obsession is fuelled by his own crystalline skeleton and a villainous drive to find purpose for his lonesome, handicapped life.

Tall tales from cinematic imaginations? Of course. Entirely without foundation? Not so for those suffering from osteoporosis.

When Debbie Howe suffered a spinal fracture after bending over to pick up her baby, she was housebound for six months, and told she had the bones of 75-year-old woman. Six weeks later, she broke another vertebra from raising her arms over her head to shampoo her hair. She was 36 at the time.

"Those were some pretty grey days," Howe, now 57, said in her King City home.

Over the last decade or so, the relationship between depression, the use of antidepressants and osteoporosis has been the subject of a growing body of research.

READ MORE @ TORONTO STAR

Drugmaker Glaxo cuts back on seminars for doctors

* Company cuts out commercial medical education companies

* Only about 20 accredited providers will get grants

Drugmaker GlaxoSmithKline (GSK.L) said on Monday it will pare back funding for continuing medical education seminars.

While the company did not link its decision to political developments, pressure has been mounting in Congress and among some medical journal editors to limit the drug industry's influence over doctors.

Deirdre Connelly, president of Glaxo's operations in North America, said in a statement that starting in 2010, the company will limit its support for medical education programs, funding only independent programs with "the greatest potential to improve patient health."

The company said it will cut out education programs put on by commercial providers, and will only pay for programs from about 20 medical education providers with a track record of quality.

READ MORE @ REUTERS

Bipolar Disorder Amongst Children And Adolescents Receive Late Diagnosis

A new study finds that 75% of the cases of paediatric bipolar disorder are diagnosed late – up to 18 months – due to the symptoms manifesting themselves in a different manner depending on whether the patient is a child or adult. Moreover, 25% of sufferers have a delay in their medical diagnoses of up to three years and four months, according to a study by the Department of Psychiatry and Medical Psychology at the University Hospital of Navarra, in collaboration with the Paediatric Psychopharmacology Unit at the Massachusetts General Hospital at Harvard University (Boston, United States).

As Dr. Inmaculada Escamilla Canales, specialist at the Madrid-based Child and Adolescent Psychiatry Unit of the University Hospital of Navarra explained, the research was based on an article previously published by her department in 2005 in which the perspectives of bipolar disorder amongst children outside the USA were reviewed. A very low incidence was observed in Europe compared to the North American samples, especially amongst certain countries. Also, in Great Britain, a study undertaken with a sufficiently representative sample concluded that the rate for this illness was non-existent.

READ MORE @ SCIENCE DAILY

EEOC Sees Mental Health Stereotypes at Work

The federal government is suing a North Carolina employer for what it calls a pervasive problem in the workplace: discrimination against employees with mental illness.

In the federal suit filed Sept. 21 in the Eastern District of North Carolina, the Equal Employment Opportunity Commission contends that the Smith International Truck Center relied upon "myths, fears and stereotypes about mental impairments" when it unlawfully terminated an employee who took leave for a mental health issue.

According to the suit, the employee, Stephen Kerns, took one week off from work to obtain medical treatment and get his dosage adjusted for medicine he took for what the complaint calls a mental impairment. The man then returned to work with no restrictions, but was fired shortly thereafter, according to the EEOC.

The agency asserts that his employer fired Kerns because of his perceived disability -- in violation of the Americans With Disabilities Act. "The employer just assumed, acting on stereotypes, that if he's getting treatment for any kind of mental impairment, that he must not be able to work, and that's the problem. They didn't look at his abilities," said Carol Miaskoff, assistant legal counsel to the EEOC.

READ MOLRE @ THE AMERICAN LAWYER

Brain Scans Link ADHD to Biological Flaw Tied to Motivation

For decades, attention-deficit hyperactivity disorder has sparked debate. Is it a biological illness, the dangerous legacy of genes or environmental toxins, or a mere alibi for bratty kids, incompetent parents and a fraying social fabric?

With 4.5 million U.S. children having received a diagnosis of the disorder -- and more than half of them taking prescription drugs to control it -- the question has divided doctors and patients, parents and teachers, and mothers and fathers.

Scientists maintain that they've been narrowing in on the origins and mechanics of disabling distraction, while gathering increasing evidence that ADHD is as real as such less controversial disorders as Down syndrome and schizophrenia. Their most recent progress is described in a Sept. 9 report in the Journal of the American Medical Association, based on a new study that indicates a striking difference in the brain's motivational machinery in people with ADHD symptoms.

READ MORE @ WASHINGTON POST

Dueling Intimidation Allegations Filed in Neurontin Litigation

The continuing litigation about whether Pfizer’s anti-seizure medication Neurontin is linked to suicidal behavior in some patients has been marred by allegations filed by attorneys on both sides accusing the other of using intimidation and strong-arm tactics.


Neurontin, known chemically as gabapentin, is an anti-epileptic medication (also called an anticonvulsant) taken by patients to reduce or eliminate seizures in adults and children as young as 12. The drug has been associated with serious side effects, most notably suicide.
Pfizer
Attorneys representing victims of Neurontin recently accused Pfizer’s counsel of trying to intimidate a potential key witness in the case. Pfizer’s attorneys then returned fire with a similar complaint against David Egilman, an expert witness for the plaintiffs.

READ MORE AT ATTORNEYATLAW.COM

British doctor faces action over claims of 'ghost writing' for US drug company

Doctors have been agreeing to be named as authors on studies written by employees of the pharmaceutical industry, giving greater credibility to medical research, according to new evidence.

The Guardian has learned that one of Britain's leading bone specialists is facing disciplinary action over accusations that he was involved in "ghost writing".

The wider phenomenon has come to light through documents disclosed in the US courts which have revealed a culture in which doctors agree to "author" studies written by employees of drug firms. The doctors may have some input but do not have access to all the evidence from the drug trial on which the paper's conclusions are based, the documents showed.

The General Medical Council will call Professor Richard Eastell in front of a fitness to practice committee. Eastell, a bone expert at Sheffield University, has admitted he allowed his name to go forward as first author of a study on an osteoporosis drug even though he did not have access to all the data on which the study's conclusions were based. An employee of Proctor and Gamble, the US company making Actonel, was the only author who had all the figures.

Ziprasidone Plus Lithium or Divalproex Is More Effective Than Monotherapy in Bipolar Disorder: Presented at ECNP

Ziprasidone as adjunctive treatment of bipolar disorder yields better efficacy than monotherapy and does not have the side effect of weight gain, according to researchers here at the 22nd European College of Neuropsychopharmacology (ECNP) Congress.

Eduard Vieta, MD, Bipolar Disorders Program, Clinical Institute of Neuroscience, Barcelona, Spain, and colleagues investigated the efficacy of combining ziprasidone with standard mood stabilisers. Because few bipolar patients experience adequate symptom control with long-term lithium or divalproex therapy, the use of adjunctive treatment with atypical antipsychotics is being investigated.

READ MORE @ DOCTOR'S GUIDE

Drug-Drug Interactions, Other Factors Can Affect Antipsychotic Treatment Regimens: Presented at ECNP

Inhibitors or inducers of the cytochrome (CY) P450 system may affect the metabolism and activity of antipsychotic drugs, according to a study presented September 13 at the 22nd European College of Neuropsychopharmacology (ECNP) Congress.

Pierre Chue, MD, Department of Psychiatry, University of Alberta, Edmonton, Alberta, and colleagues performed an evidence-based review of all relevant literature to identify and define possible drug-drug interactions (DDIs) and other factors that may influence patient response to drug treatment.

Comorbidities such as smoking, alcohol, other substance-abuse disorders, infections, and metabolic disorders complicate the pharmacological management of psychotic patients. Additional factors such as genetic polymorphisms and environmental interactions (eg, DDIs and drug-food interactions) also influence drug efficacy. The researchers noted that clinicians need to consider these factors and others, along with patients' unique characteristics, when determining treatment.

EWAD MORE @ DOCTOR'S GUUIDE

Treatment guidelines issued on depression during pregnancy

For women with serious conditions, medication may be the best route, but 'talk therapy' may alleviate suffering for others, according to a document prepared by two national physicians groups.

For the nearly one in four women who experience symptoms of depression during pregnancy, physicians on the front lines have long had little more than a prescription for antidepressants and a massive dose of uncertainty to offer.

The result: At last count, roughly 13% of pregnant women in the United States took antidepressant medications at some point in their pregnancy -- often with little to guide them in weighing the risks the drugs may pose to their fetus against the misery and dangers of untreated depression.

In a bid to resolve that conundrum, two of the nation's leading physicians groups have issued the first guidelines for the treatment of depression during pregnancy.

READ MORE @ LOS ANGELES TIMES

Metabolic Side Effects, Cardiovascular Risk Differs Among Antipsychotic Treatments for Schizophrenia: Presented at ECNP

The differences in metabolic side effects and cardiovascular risk resulting from antipsychotics make the initial choice of medication important in controlling long-term effects from treatments used for schizophrenia, researchers said here at the 22nd European College of Neuropsychopharmacology (ECNP) Congress.

W. Wolfgang Fleischhacker, MD, Biological Psychiatry Department, Medical University Innsbruck, Innsbruck, Austria, and colleagues analysed data from the European First Episode Schizophrenia Trial (EUFEST) study to determine the effects of several first- and second-generation antipsychotics on cardiovascular risk factors in patients with or without metabolic syndrome (MS) risk. Results of the study were presented on September 14.

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Glaxo Executive’s Memo Suggested Burying Drug Studies (Update4)

An executive of GlaxoSmithKline Plc, the world’s second-biggest drugmaker, talked about burying negative studies linking its antidepressant drug Paxil to birth defects, according to a company memo introduced at a trial.

“If neg, results can bury,” Glaxo executive Bonnie Rossello wrote in a 1997 memo on what the company would do if forced to conduct animal studies on the drug. The memo was read during opening statements in the trial of a lawsuit brought by the family of a child born with heart defects.

The Philadelphia trial is the first of more than 600 cases alleging that London-based Glaxo knew Paxil caused birth defects and hid those risks to pump up profits. The drug, approved for U.S. use in 1992, generated about $942 million in sales last year, 2.1 percent of Glaxo’s total revenue.

The family of Lyam Kilker claims Glaxo withheld information from consumers and regulators about the risk of birth defects and failed to properly test Paxil. Kilker’s mother, Michelle David, blames Paxil for causing life-threatening heart defects in her 3-year-old son.

Glaxo officials urged scientists to withhold information about Paxil’s risks from a paper laying out the company’s “core safety philosophy” for the drug, said Sean Tracey, a lawyer for Kilker and David, in his opening statement in the trial.

READ MORE @ BLOOMBERG

The future of schizophrenia

Press conference at the 22nd Congress of the European College of Neuropsychopharmacology, Sept. 14, 2009, Istanbul, Turkey

Schizophrenia is a major public health problem. Affecting almost 1% of the world's population, it takes an enormous economic and social toll in addition to the distress, dysfunction, disability and mortality for those afflicted with this disease. Elements of the disease are present from birth, other aspects emerge during developmental years, and the illness becomes fully expressed in early adulthood with long-lasting implications for most patients.

Schizophrenia, which is seen as the paradigmatic psychiatric illness, presents different symptoms in multiple domains, whereby positive and negative phenomena can be separated (Falkai et al., 2005): Positive (psychotic) symptoms in a broader sense include delusions or delusional ideation, hallucinations, disturbance of association, catatonic symptoms, agitations as well as feelings of alien influence and suspiciousness. Negative symptoms include restricted range and intensity of emotional expression, limited thought and speech productivity, social withdrawal, and reduced initiation of goal-directed behaviour. These negative components are typically characterised as affective flattening, alogia, diminished drive, anhedonia and avolition. Furthermore, schizophrenia is associated with cognitive impairment, disorganised speech and behaviour, as well as poor attention. The primary advance in pharmacological treatment of schizophrenia was in 1952 with the introduction of dopamine antagonist antipsychotic drugs.

Paradigm shift in schizophrenia research: from single-disease entity to the paradigm of multiple domains

A century of work has been based on designs that conceptualise schizophrenia as a single disease entity, despite recognition that schizophrenia must have scientific status of a syndrome in the absence of proof of a single disease process (Carpenter et al., 1999). The implications are profound. Research based on the presumption that a single disease is present has produced weak findings that frequently fail confirmation in replication studies. The heterogeneity of patients receiving this diagnosis is substantial. Causal and neuropathological findings valid for some patients will not be found in others. Illness manifestations vary substantially between patients, and symptomatic components of illness are only weakly related to each other within individuals.

READ MORE @ EUREKALERT

SSRI Use May Correlate With Lower Bone Mineral Density in Middle-Aged Women: Presented at ASBMR

A study presented at the 31st Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) found that use of some antidepressants may have a correlation with reduced bone mineral density (BMD) in women.

While data have been circulated since the late 1990s associating the use of selective serotonin reuptake inhibitors (SSRIs) with an increased risk of hip fractures, the studies have been in elderly women.

"They were based on database studies and were not able to control for important variables such as bone density and other health conditions," said Susan Diem, MD, University of Minnesota, Minneapolis, Minnesota, on September 12. "Basic science data in the last few years have also found that serotonin transcriptors may exist on bone cells. SSRIs, which block serotonin transcription, might then have an effect on bone density."
READ MORE @ DOCTOR'S GUIDE