Posted by jay on June 8, 2003, at 19:17:51
"Too much serotonin soup..not enough science! We aren't exactly organizing serotonin appreciation day around here anytime soon!" (One of my fav quote from "Noonday Demon"Yet another popular newspaper article (below) on medications, depression and bipolar disorder. This one is a bit more interesting than the usual, though, because it mentions things we still don't hear much about, like many can and do get weight gain from *all* antidepressants; (a fact that still seems to be in the dark in psychiatric offices); the "real" effective vs. ineffectiveness, and how individual that is; and one of my biggest concerns, the *lack* of develoment of completely new, novel medications for depression. (Not just the usual hype about the next SRI/SNRI. i.e. From Lexapro to Cymbalta..or whatever the heck it is called..) Not to mention sexual side-effects, which if you are on medication for life, *is* a big deal.
If I could find a drug that would help me lose the ton of weight put on since being on meds (my choice..of course..), and could turn me into a super-stud, that may just lift my depression. :-)
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from The Toronto Star June 8/03 www.thestar.com
Jagged little pills
ROBIN HARVEY
FEATURE WRITERTreating depression is an inexact balance of art and science.
Since you can't study live brains to see how any treatment really works, tackling the disease is somewhat like nailing jelly to the wall, says a leading expert.
Add that to the fact that more than half of depressive episodes eventually go away without treatment, and it's even harder to understand the disease, says Dr. Robert Cooke, of the mood disorders clinic at the Centre for Addiction and Mental Health in Toronto.
The resulting reality is that each day, millions of North Americans take pills to fight depression even though no one really knows exactly how they work.
"The brain is incredibly complicated (and) the mind is incredibly complicated," Cooke says. "There are still no simple answers or magic cures. We have treatments worked out on a trial-and-error basis and they are imperfect."
A mainstay of treatment has been antidepressant medication. But the earliest pills developed in the 1950s had significant side effects and could be highly toxic. By the late 1980s, with the advent of the new "designer" antidepressants, doctors thought they'd found a better answer.
The new drugs specifically target and change levels of the brain's chemical messengers — neurotransmitters. They were touted as "cleaner" drugs with fewer side effects and less toxic if taken in overdose.
They became so popular that sales of the drug Prozac — the first of the new class — hit $2.81 billion (U.S.) worldwide in 1998, and it became the fourth pharmaceutical product ever to eclipse $2.5 billion (U.S.) in global sales.
In Canada, from 1993 until 2002 the number of prescriptions for this class of drugs increased 768 per cent to 13.8 million, according to IMS Health Canada, a medical research firm.
Yet today, though millions of people are prescribed the new class of drugs, the new pills have not lived up to initial expectations.
"We need a major breakthrough in medications," Cooke says. "Most (used today) are copycats of older ones changed somewhat so they have fewer side effects. But the fact is, when it comes to effectiveness, the new drugs are no more effective than the ones we used in 1950s."
There is no doubt that changing neurotransmitter levels can affect mood, easing depression and mood swings, Cooke says.
Toronto's Glenn Hardcastle who has had bouts of depression all his adult life says he could never have fought the "molasses on the mind" without medication.
"It would be cruel to expect people to talk their way out when they are really down," he says. "For me, it was just not possible."
And Phil Upshall, spokesperson for the Mood Disorders Society of Canada, says the drugs help people out of their immediate crises so they can engage in talk therapy. Upshall, who has bipolar disorder, says medication was key to his getting his life back on track.
Though people on the medicine paint a glowing portrait of the drugs' benefits, the scientific evidence is not as clear-cut.
Studies show antidepressants help only 20 per cent of people who take them. That's based on controlled, double-blind trials which show that although 60 per cent of people respond to antidepressants, 40 per cent respond to a sugar pill, Cooke says.
But Dr. Barry Martin, another expert at the centre who runs its electro-convulsive therapy service, says that picture is incomplete because it only deals with patients who report improvement.
If you look at the number of people who completely recover on medication and compare it to people who take a sugar pill who report the same recovery, both are equally effective — about 40 per cent, he says.
However, Dr. Anthony Levitt, psychiatrist-in-chief at Sunnybrook and Women's Health Sciences Centre, says neither statistic is relevant. He says if you just look at depressed people left on waiting lists who are not involved in any studies, only 20 per cent improve on their own.
Besides the hazy picture of the drugs' effectiveness, other problems have emerged over the past 15 years as the newer medications have grown more popular.
Their side effects can be significant. The major ones are weight gain, sleep disturbance and sexual dysfunction, Cooke says.
Up to 30 per cent of patients using the neurotransmitter reuptake inhibitors report some sexual problem — either loss of desire, inability to have an orgasm, impotence or delayed orgasm. Hardcastle says he has experienced headaches, sexual dysfunction, agitation, sleeplessness and frequent urination as side effects in his search for a suitable medication.
Another concern has been the reports of physical withdrawal when people stop taking antidepressants — a problem Cooke says was "really underestimated."
In April, Health Canada warned doctors that "withdrawal reactions or discontinuation symptoms" occur with all the newer antidepressant drugs. It "may be misdiagnosed, leading to inappropriate treatment."
Cooke says people who stop antidepressants don't crave them for a high. But they can experience nausea and diarrhea. They may also have nightmares and can get a disturbing feeling like electrical sparks shooting through parts of their body, he says.
Bonnie North says she went through "agonizing withdrawal" when she tried to stop an antidepressant in 2001.
She had been on the treatment for three years to fend off depression after childbirth.
North suffered headaches, extreme nausea, vomiting and diarrhea. Most maddening, she says, was a constant sense of an electrical "zap" in her head that lasted for months. She has launched a lawsuit against the drug manufacturer.
The manufacturer will not comment on the court case but says its drug is safe and causes no severe withdrawal symptoms if discontinued properly under a doctor's supervision.
North also worries because there have been no studies of long-term side effects.
People like herself, who are put on the drugs for years, are "guinea pigs" she says.
Most of the pre-market studies of the drugs before they were approved for sale lasted six weeks. But many patients stay on the drugs much longer. That's because, unless the drugs are taken for a year, a patient is likely to have a relapse, Cooke says.
He acknowledges that information about long-term side effects is not available. But since the drugs are monitored after they hit the market, serious adverse reactions would be reported, he says.
Karen Liberman says she doesn't care about the lack of evidence from long-term studies.
The spokesperson for the Mood Disorders Association of Ontario says she went through "a decade of hell" trying 27 different medications as well as ECT before she found a drug that worked. But since she has been on it, she says, life is totally different.
"If it comes down to the risk of some long-term side effect that they don't know about, versus me having the quality of life I now have, I'd pick this good quality of life — even if (a side effect) made my life shorter," she says.
poster:jay
thread:232478
URL: http://www.dr-bob.org/babble/20030604/msgs/232478.html