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Re: that other thread Elizabeth

Posted by Cam W. on August 17, 2001, at 16:59:05

In reply to Re: that other thread Cam W., posted by Elizabeth on August 17, 2001, at 13:52:47

Elizabeth -
> I'm not sure that I agree with the idea that studies should necessarily be carried out in more diverse populations. (Maybe I'm just misunderstanding what you were getting at.) I'm all for specificity, since drugs have different effects on people depending on the nature of the condition being treated as well as patient characteristics such as age, sex, etc.
I believe that large scale naturalistic studies, using clinical situations, in the post-marketing surveillance stage of drug development is essential. If it were done more, we would have caught the delayed weight gain with Paxil, or the withdrawl syndrome of short-acting SRI-like drugs. The other, proper randomized, placebo-controlled clinical trials are necessary to produce a short-term therapy baseline, but these need to be extended to real world situations.
> > > I think that phenelzine can also contribute to type 2 diabetes, no?
> > >
> > Yeah, I think so, but not to the degree we are seeing it with Clozaril and Zyprexa.
> Really. That's surprising. I'm pretty sure I became insulin-resistant on Nardil; Zyprexa caused some cravings but it wasn't nearly as bad. Then again I was taking low-dose Zyprexa, and that might factor in.
Dose does not seem to be strongly related to the incidence of the diabetes, either. It is probably a numbers game we are looking at. When you see 5 people taking Nardil and 100 people taking Zyprexa, it is going to look like the Zyprexa is a worse offender, because you see more of them.
> > Even people who do not have risk factors (eg. not overweight or have not gained a lot of weight) are still becoming diabetic.
> That's interesting that people develop type 2 diabetes without having gained weight on the drug. Do these individuals experience appetite stimulation (if you know)?

On the whole, we usually see both weight gain and diabetes, but I have read articles where no weight gain and diabetes occurred. I do not know much more than that, and it would have been interesting to see his baseline triglyceride levels prior to the initiation of therapy, as well as his family Hx for diabetes (ie. the people could have been borderline diabetics, to start with. These were not mentioned in the two different articles (can't find them quickly, of course), but the articles did not go into much detail on them. I do not know about appetite stimulation in the non-weight gainers.

Back at ya ;^)
- Cam




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