Posted by Bill LL on September 7, 2004, at 10:12:06
I pasted the article below from Men's Health Magazine. As you can see, a doctor from the University of Washington thinks that the sexual side effects of Cymbalta will be a lot lower than that of SSRI's. HOPEFULLY, this will turn out to be true.
A Quicker Picker-Upper?
A new pill claims to squash depression, beat chronic pain, keep your sex life roaring--and work almost instantly. Read on to find out just how happy we should be
By: Jim Thornton
Photographs by: Joseph Rafferty
Surviving The Spin Factory
Since Prozac first landed in pharmacies nearly 17 years ago, the market for antidepressants has ballooned to nearly $14 billion in the United States, says stock analyst Scott Shevick, who follows the major-pharmaceuticals sector for the investment firm Bear, Stearns & Co. Last year, more than 213 million prescriptions for antidepressants were dispensed, mostly SSRIs in one form or another. Without a doubt, a new antidepressant could prove to be a windfall for its manufacturer.
"Forecasting individual drugs is incredibly hard to do," Shevick says. "But Lilly knows the psychopharmacology market better than anybody, and they'll be throwing 5,300 reps at physicians to sell the hell out of this drug."
Indeed, in coming months, Shevick says Lilly is likely to barrage doctors and would-be patients alike, pushing Cymbalta's supposed advantages over the competition. We're likely to be barraged, too, by cautionary words and horror stories from antidepressant critics, ranging from reputable researchers to "fringe groups" like the Church of Scientology, which, Shevick says, has been lobbying to have Prozac banned since it first came on the market.
Sorting through all the hype and nuttiness won't be easy, but here are a few of the questions likely to be raised.
Will Cymbalta have the same sexual side effects as the SSRIs?
"When the SSRIs first hit the market," says Joseph Glenmullen, M.D., a Harvard psychiatrist and the author of Prozac Backlash, "it was thought that incidence of sexual side effects was only 5 percent.
We now know that 60 percent of patients have some sexual problems." The rates of sexual dysfunction with Cymbalta, by comparison, have been extensively studied using rating scales, says David Dunner, M.D., director of the center for anxiety and depression at the University of Washington at Seattle. "It appears that only about 10 percent to 15 percent of men will have some kind of sexual dysfunction," he says.
Dysfunction is defined as anything from reduced sexual desire and/or trouble getting an erection to delayed orgasm, or even anorgasmia--the technical term for life without whoopee. For those men who develop erectile difficulties, Dr. Dunner adds, Viagra and its brothers can usually help. The only cure for anorgasmia, however, is lowering the antidepressant dosage or avoiding the drug entirely.
How does Cymbalta compare with Effexor?
Though Cymbalta has been shown to be 5 to 10 percent more likely than SSRIs to provide complete relief from depression, the same can also be said about Effexor (venlafaxine), the other SNRI available in the United States. Effexor, however, appears to affect norepinephrine only at high dosages, which, in 10 percent to 12 percent of patients, also cause dangerously elevated blood pressure. The data from Cymbalta's clinical trials are much more reassuring: Only 1.3 percent of patients experienced increases in blood pressure. Still, such a selling point may prove short-lived. "Since Effexor XR, the extended-release form, hit the market," says Shevick, "you rarely hear about high blood pressure being a problem."
Will Cymbalta act more quickly than other antidepressants?
Generally speaking, people have to take the currently available antidepressants for 2 to 6 weeks before they notice improvement. Eli Lilly claims that Cymbalta may act faster. Michael Detke, M.D., Ph.D., associate medical director for Lilly, argues that the drug's dual action allows it to simultaneously hit depression, anxiety, reduced concentration, low energy, and physical pain. Because it attacks on several fronts, he says, the patient may notice improvement faster. Anecdotally, at least, some patients corroborate this. "There's a possibility this could be true," says Dr. Thase. "But at this point, the studies that are needed to prove it have not been done."
Didn't a patient commit suicide during the testing of Cymbalta?
Early last February, a 19-year-old college student serving as a "normal control" in a Cymbalta trial hung herself from a shower rod at a Lilly research lab. Investigators determined that the young woman was actually on a placebo at the time of her death, though she had earlier been receiving relatively large doses of the active medication. Lilly claims its drug played no role in the woman's death, a conclusion with which many outside observers agree. "The FDA is very risk averse," says Dr. Goldstein. "If they believed that Cymbalta caused suicide, they would stop further development."
A Close Call
If Cymbalta gets a thumbs-up from the FDA, guys like me will be faced with a decision:
Stay the course with medication that's already working pretty well--or embrace the promise of a potentially better remedy?
When I ask for advice from Dr. Dunner, he tells me, "One of the first things I learned in psychiatry was not to rock the boat. Depression is a complex illness, and the reasons for switching from an effective medication ought to be compelling--a less-than-full response, for example, or a deeply troubling side effect."
But Prozac works for me, and I can tolerate the side effects. In fact, the only "problem" I've endured is slightly delayed ejaculation--a problem my wife doesn't seem to mind at all.
Cost also figures strongly on the "stay the course" side of the equation. As a self-insured man, I pay for most prescriptions out of pocket. Now that Prozac is available as generic fluoxetine, it's become nearly as cheap as aspirin--and I'm in no rush to go back to pills that Shevick forecasts could cost well over $3 a pop.
"Effective" and "cheap" are two adjectives that are hard to ignore. Regardless of Cymbalta's fate, I've decided to stay with the miracle drug that's helped me so much so far. For guys who've been let down by SSRIs, or for those newly diagnosed with depression, Cymbalta could prove to be a better option.
Who knows? I may even join them one day.
"Some patients have reported that over time, a given antidepressant doesn't work quite as well anymore," says Dr. Goldstein. Practitioners refer to this as "Prozac poop-out"--though anecdotal cases have been reported with all the antidepressants, not just fluoxetine. In such cases, says Dr. Goldstein, "it might be the time to try a dual-activity antidepressant like Cymbalta."
And that's why I follow all the advances in antidepressants. As another barrier between me and abject misery, Cymbalta is already a miracle drug--even if I never end up needing to take it.