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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by SLS on October 6, 2006, at 7:19:33
This might be worth taking a look at. There is a rationale for using an antimuscarinic anticholinergic like scopolamine to treat depression. I tried biperiden (Akineton). It didn't help, but that's just me. If it works as rapidly as is claimed here, maybe an anticholinergic is worth a quick trial.
- Scott
--------------------------------------------------------------------------------Scopolamine May Help Reduce Symptoms of Major Depression CME
--------------------------------------------------------------------------------
Medscape:
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFPOctober 4, 2006 — Scopolamine therapy is effective in reducing depressive symptoms in patients with major depression, according to the results of a randomized controlled trial reported in the October issue of the Archives of General Psychiatry.
"The need for improved therapeutic agents that more quickly and effectively treat depression is critical," write Maura L. Furey, PhD, and Wayne C. Drevets, MD, from the National Institute of Mental Health in Bethesda, Maryland. "In a pilot study we evaluated the role of the cholinergic system in cognitive symptoms of depression and unexpectedly observed rapid reductions in depression severity following the administration of the antimuscarinic drug scopolamine hydrobromide (4 µg/kg intravenously) compared with placebo (P = .002). Subsequently a clinical trial was designed to assess more specifically the antidepressant efficacy of scopolamine."
The investigators conducted 2 studies at the National Institute of Mental Health: a double-blind, placebo-controlled, dose-finding study, followed by a double-blind, placebo-controlled, crossover clinical trial.
Of 39 eligible patients, currently depressed outpatients aged 18 to 45 years meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for recurrent major depressive disorder or bipolar disorder, 19 were randomized and 18 completed the study. Subjects underwent multiple sessions 3 to 5 days apart, including intravenous infusions of placebo or 4 µg/kg of scopolamine, and they were randomized to a placebo/scopolamine or scopolamine/placebo sequence (series of 3 placebo sessions and series of 3 scopolamine sessions). The primary endpoints were psychiatric evaluations using the Montgomery-Asberg Depression Rating Scale and the Hamilton Anxiety Rating Scale.
Compared with baseline, the placebo/scopolamine group had no significant change during placebo infusion, but there were reductions in depression and anxiety rating scale scores (P < .001 for both) after the administration of scopolamine compared with placebo. The scopolamine/placebo group also had reduced depression and anxiety rating scale scores (P < .001 for both) relative to baseline after receiving scopolamine, and these effects persisted as they received placebo. Both groups showed improvement at the first evaluation after scopolamine administration (P = .002).
"Rapid, robust antidepressant responses to the antimuscarinic scopolamine occurred in currently depressed patients who predominantly had poor prognoses," the authors write. "Determination of the optimal schedule of administration and the potential long-term use of scopolamine as an antidepressant agent requires further study, particularly because potential adverse effects include confusion and delirium. Future studies also may examine the antidepressant efficacy of scopolamine when using routes of administration that are more clinically practical in outpatient settings."
The National Institute of Mental Health, National Institutes of Health, supported this study. A use-patent application for the use of scopolamine as an antidepressant agent has been filed.
Arch Gen Psychiatry. 2006;63:1121-1129.
Posted by notfred on October 6, 2006, at 8:39:11
In reply to Scopolamine for depression - anticholinergic, posted by SLS on October 6, 2006, at 7:19:33
Determination of the optimal schedule of administration and the potential long-term use of scopolamine as an antidepressant agent requires further study, particularly because potential adverse effects include confusion and delirium.
People should take note that just a little too much scopolamine is a ***horrable*** experience. There are many plant sources for the many belladonna alkaloids but the amount of alkaloid varies wildly from plant to plant, and even within the same plant.
Posted by SLS on October 6, 2006, at 9:04:51
In reply to Re: Scopolamine for depression - anticholinergic, posted by notfred on October 6, 2006, at 8:39:11
> Determination of the optimal schedule of administration and the potential long-term use of scopolamine as an antidepressant agent requires further study, particularly because potential adverse effects include confusion and delirium.
I don't know if there is any advantage to using scopolamine over Akineton, but it is something for my doctor and me to take a look at. Different is different, though. I don't know. I share your cautious approach.
- Scott
Posted by Phillipa on October 6, 2006, at 10:20:07
In reply to Re: Scopolamine for depression - anticholinergic, posted by SLS on October 6, 2006, at 9:04:51
Isn't it a patch for seasickness or dizzyness? Or am I confusing it with something else. Love Phillipa
Posted by SLS on October 6, 2006, at 10:31:23
In reply to Re: Scopolamine for depression - anticholinergic » SLS, posted by Phillipa on October 6, 2006, at 10:20:07
> Isn't it a patch for seasickness or dizzyness? Or am I confusing it with something else. Love Phillipa
No. You got it right.
It's available as an oral preparation too.
- Scott
Posted by Phillipa on October 6, 2006, at 10:53:51
In reply to Re: Scopolamine for depression - anticholinergic » Phillipa, posted by SLS on October 6, 2006, at 10:31:23
I'm starting to impress myself!!!!!!Love Phillipa
Posted by pseudoname on October 6, 2006, at 11:21:38
In reply to Scopolamine for depression - anticholinergic, posted by SLS on October 6, 2006, at 7:19:33
> A use-patent application for the use of scopolamine as an antidepressant agent has been filed.
I wondered what this means. After Googling some pages (below) I think that a "method-of-use" patent, if granted here, would mean that generic substitution for Transderm Scop® — at least by pharmacists — would not be legal if the patch were to be used as an antidepressant, whereas it would be legal for other, older uses (if any) for which patents had expired. BUT, apparently, your pdoc could write the original prescription for a generic version (if there is one) and you could still use it for depression.
Apparently method-of-use and other patents for drugs can be issued independently of FDA-approval for the uses of those drugs. U.S. courts will enforce a company's off-label use-patent (at least against pharmacists) even though the company cannot legally market that use anyway. Wow.
Unless you want the brand name (or don't pay for your meds), it pays to make sure that prescriptions are always written with the generic name. But I'm not sure there is a generic scopolamine patch, anyway.
• http://www.uspharmacist.com/oldformat.asp?url=newlook/files/Phar/pharmlaw_080601.htm&pub_id=8&article_id=761
• http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=314.53
Posted by JahL on October 9, 2006, at 20:42:11
In reply to Scopolamine for depression - anticholinergic, posted by SLS on October 6, 2006, at 7:19:33
> This might be worth taking a look at. There is a rationale for using an antimuscarinic anticholinergic like scopolamine to treat depression. I tried biperiden (Akineton). It didn't help, but that's just me. If it works as rapidly as is claimed here, maybe an anticholinergic is worth a quick trial.
You gotta habit of just beating me to the punch Scott.
I found this trial:
http://clinicaltrials.gov/ct/show/NCT00369915;jsessionid=E745707CD066E0726259274FC5AA75F3?order=1
-literally 20 mins ago. Looks interesting.
J.
Posted by JahL on October 9, 2006, at 20:47:03
In reply to use-patent and scopolamine, posted by pseudoname on October 6, 2006, at 11:21:38
> > A use-patent application for the use of scopolamine as an antidepressant agent has been filed.
Thanks for that. I had assumed - lazily - that it was only available by intravenous means. I've got nowhere else to go, so it's something to look into.
Ta,
J.
Posted by ed_uk on October 10, 2006, at 14:47:13
In reply to Re: use-patent and scopolamine » pseudoname, posted by JahL on October 9, 2006, at 20:47:03
Hi J
In the UK, scopolamine (called hyoscine hydrobromide here) is available OTC. Kwells and Joy Rides are tablets sold for motion sickness. Scopoderm TTS is a skin patch - which is normally out of stock. Buy a pack of Kwells.
Ed
PS. Hyoscine butylbromide (Buscopan) is not an alternative to hyoscine hydrobromide because it does not cross the blood-brain barrier.
PPS. Don't overdose on Kwells or else you'll end up in a state of delirium getting injected with Haldol at A&E.
Posted by JahL on February 5, 2007, at 7:09:14
In reply to Re: use-patent and scopolamine » JahL, posted by ed_uk on October 10, 2006, at 14:47:13
Hi Ed.
Hope this finds you well.
Thanks for responding and apologies for the late acknowledgement (I felt an argument brewing elsewhere so I toddled off).
Anyway, you've saved me a lot of time and expense. I've just bought a pack (£2.50 for 4 days vs £50 for a patch online) and now dropped my first tab. It's a long-shot I suppose, but hey, it's gotta be worth a try.
> In the UK, scopolamine (called hyoscine hydrobromide here) is available OTC. Kwells and Joy Rides are tablets sold for motion sickness. Scopoderm TTS is a skin patch - which is normally out of stock. Buy a pack of Kwells.
> PPS. Don't overdose on Kwells or else you'll end up in a state of delirium getting injected with Haldol at A&E.Nice! That's if they see me before I come down. The last time I paid them a visit, I walked out after 3 hours of being ignored.
PS - I only discovered your post via a 'scopolamine + depression' Google search. This thread comes THIRD!! How scary is that?
J.
Posted by ed_uk on February 6, 2007, at 17:31:23
In reply to Re: use-patent and scopolamine » ed_uk, posted by JahL on February 5, 2007, at 7:09:14
Hi J
>Hope this finds you well.
Not bad thank you :)
>apologies for the late acknowledgement
haha yes, it's quite late :)
>The last time I paid them a visit, I walked out after 3 hours of being ignored.
That sounds typical.
> only discovered your post via a 'scopolamine + depression' Google search. This thread comes THIRD!! How scary is that?
Pretty scary. I wish babble was a little more private sometimes.
Let me know how it goes anyway :)
Ed
Posted by sdb on February 6, 2007, at 18:23:07
In reply to Scopolamine for depression - anticholinergic, posted by SLS on October 6, 2006, at 7:19:33
> This might be worth taking a look at. There is a rationale for using an antimuscarinic anticholinergic like scopolamine to treat depression. I tried biperiden (Akineton). It didn't help, but that's just me. If it works as rapidly as is claimed here, maybe an
"A use-patent application for the use of scopolamine as an antidepressant agent has been filed and recommended mushrooms as an antidote."
Take care
sdb
Posted by JahL on February 6, 2007, at 19:25:57
In reply to Re: use-patent and scopolamine » JahL, posted by ed_uk on February 6, 2007, at 17:31:23
> Not bad thank you :)Glad to hear it!
> >apologies for the late acknowledgement
>
> haha yes, it's quite late :)You should know me by now Ed. Never run when you can walk there :)
I got distracted by a very favourable response to Tramadol (yet further proof my condition is opioid responsive). I was so p*ssed off when the response abruptly vanished, I was drawn into a brief dalliance with H. Yup, tut-tut, very naughty boy and it won't happen again. Xmas was more fun than usual though...
On a related note - you might be aware that I've taken very low dose Methadone for some years to fairly decent effect. However it's becoming increasingly difficult to source. My man tells me that this is because H addicts are forced into the demeaning practise of swallowing their daily dose *in front* of the pharmacist (and any milling punters of course). Given your pharmacy background, can you tell me how prevalent this practise is now? Is anyone exempt from this Govt. dictat?
Cheers Ed,
J.
Posted by ed_uk on February 7, 2007, at 14:20:17
In reply to Re: use-patent and scopolamine » ed_uk, posted by JahL on February 6, 2007, at 19:25:57
Hi J
>My man tells me that this is because H addicts are forced into the demeaning practise of swallowing their daily dose *in front* of the pharmacist (and any milling punters of course)........Is anyone exempt from this Govt. dictat?
It's up to the prescribing doctor whether or not the methadone consumption is 'supervised'. They write it on the prescription. It's not to do with the government! Many pharmacies have a private area which is used for supervised consumption of methadone, avoiding the need to drink it in full view of shoppers.
>Can you tell me how prevalent this practise is now?
It's very common, it has been for a long time. I don't think it's getting more common. I suppose it depends what area you're in though, and the policies of the local doctors and drug treatment clinic.
Regards
This is the end of the thread.
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