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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 linkadge on January 30, 2007, at 16:27:03
Are we in a psychiatric drug development ressession?
A few reasons I see this.
1) Drug Backlash. 20 years ago doctors would say
that antidepressants were correcting the
problem. But, now we are seeing backashes of
side effects, poop out, paradoxical
reactions etc.2) Awareness of lack of efficacy. More and more
statistics are being revealed that show
antidepressants are not much better than
placebo.3) Drug company scandal. Faith in drug developemnt
is at an all time low. It seems now that
the case for the antidepressant was more about
money than about helping people.4) Dead ends. A lot of drugs are just the
same old drugs as we had 30 years ago.
Some promising drugs like gepirone, and
valdoxine were shunned for proably because
they did not fit the mold of older drugs.
Other new drugs are not showing efficacy,
probably because they are not the essentially
short acting pep pills that are the monoamine
active drugs.
Are we in a drug development ressions? How long do you think it will last?Linkadge
Posted by dbc on January 30, 2007, at 19:31:33
In reply to Are we in a psychiatric drug development resesion?, posted by linkadge on January 30, 2007, at 16:27:03
EMSAM was our first real new hope. A dopamine centric MAO is just what some people needed.
What happened?
-The price was insane.
-The wrong people got it for the wrong reasons.
-Theres not enough information going around both to patients and doctors about it.I realize selegline is infact an old drug but EMSAM and its application is new.
Posted by linkadge on January 30, 2007, at 20:24:37
In reply to Re: Are we in a psychiatric drug development reses, posted by dbc on January 30, 2007, at 19:31:33
Supposedly after the addictive potential of the amphetamines was uncovered, some researchers put the whole concept of an antidepressant in the garbage can.
I think we are seeing some enthusiasm taper off.
You are right, drugs can be prohibitivly expesive.
Apparently, you can put a price on happiness.
Linkadge
Posted by Phillipa on January 30, 2007, at 20:27:54
In reply to Re: Are we in a psychiatric drug development reses, posted by dbc on January 30, 2007, at 19:31:33
Boy do I agree about the EMSAM someone needs to find a med so the worst side effects of anxiety and insomnia are not there. And an agent for those who get raised red rashes where the patch goes and I do not believe the docs were ever properly educated on who the best candidates were and are. Or why are there so many failures. Wish more poitive posts of EMSAM would appear. Love Phillipa ps I wanted to try that med so much the patch where you can see it and take it off empowered the user too.
Posted by shadowplayers721 on January 31, 2007, at 0:51:26
In reply to Are we in a psychiatric drug development resesion?, posted by linkadge on January 30, 2007, at 16:27:03
We may be Link. I know there is a lot of skeptical views on psychiatry now - all the points you have are valid.
I have to say for myself that I have seen a great difference in me with and without any medication. I guess that I will have to juggle the meds back and forth, but it is well worth it. Shadows not being able to drive vs. Shadows being able to drive. It's an easy choice.
I think there needs to be way more research. I hope there will be more choses on the horizon. But, even with the disappointment, there has been growth of knowledge about meds, chemistry, and the goal of helping mental suffering. We all have to hang in there with each other and not give up. It 's not easy. I have been at the brink many times the past few years. If I didn't have a wisp of inner strength to think about how it would affect a loved one, I would have been long gone.
Posted by stargazer on January 31, 2007, at 1:26:56
In reply to Re: Are we in a psychiatric drug development reses, posted by shadowplayers721 on January 31, 2007, at 0:51:26
A friend of mine told me today she knows someone who buys patents for older medications and then hangs onto them because they eventually are coming back into popularity as the "newer, more improved" meds fail to live up to their advertised promises.
This happened with the MAO's...Marplan was discontinued due to "lack of market share" just as the SSRI's were taking off. I was supposed to just stop a drug that was working great(Marplan) switch to a new improved drug (Prozac) and live happily ever after. Well, the newer drugs pooped out, and Marplan returned again but was not the same formula and nver worked the same.
So before the older drugs are buried forever, we should give the newer drugs more than a few years to prove their worth. I have not had good luck with many of the newer AD's and as I can see here, MAO's continue to offer good results even with their SE profile. But they actually work for difficult cases of depression, they don't just make you an emotionless zombie, like so many of the "Super AD's" that tout all kinds of promises but seem to fall short in many ways.
Time will tell where the pendelum will swing with AD's but in my opinion, there are too many drugs and not enough studies to prove anything about efficacy until at least 5 years has elapsed.
I see the greatest hope in biological testing and identifying physiological and neurological deficiencies, rather than the shotgun approach that exists today.
Posted by bulldog2 on January 31, 2007, at 9:49:15
In reply to Re: Are we in a psychiatric drug development reses, posted by stargazer on January 31, 2007, at 1:26:56
I agree we need to develope more accurate diagnostics. There are a number of effective ad's out there that effect one or more neurotransmitter groups. We need testing to determine which ones we may be low in and therefore get the correct ad prescribed. If you go to a primary for depression you will get one of the newer ssris prescibed. But in fact your depression may not be do to an ssri deficiancy!
I have heard that there are some newer ads being developed that work on cortisol as that has been implicated in depression.We also may see more maois being prescribed again as doctors realize their efficacy. Doctors have to educate themselves about the drug and dietary restrictions.
Posted by NYCguy on January 31, 2007, at 12:17:49
In reply to Re: Are we in a psychiatric drug development reses, posted by bulldog2 on January 31, 2007, at 9:49:15
> We also may see more maois being prescribed again as doctors realize their efficacy. Doctors have to educate themselves about the drug and dietary restrictions.
I'm down for this. I think that Parnate is great. Of course it's only been one week @ 20mg for me. I'm hopeful that it continues to get better. :)
Posted by med_empowered on January 31, 2007, at 12:50:02
In reply to Re: Are we in a psychiatric drug development reses, posted by NYCguy on January 31, 2007, at 12:17:49
yup. Its kind of like how, for 20 years or so, nobody came out with anything new for schizophrenia. There was Thorazine, a bunch of phenothiazines behind it, Haldol, and then the late-comers--moban and loxitane--and then nothing, not until interest in clozapine gave up risperdal and zyprexa, followed by the others. Now that they're making drugs for most psychiatric problems, I think we'll see more stop-and-go periods, where new drugs are developed and docs badmouth the old drugs, then start "re-assessing" the old drugs and prescribing both, and then development slows down for a while.
Plus, lets be honest: a lot of the skepticism people have about psychiatry is well-deserved. A lot of these drugs are grossly overpriced, overmarketed, overprescribed, and seem to lack the effectiveness expected from such expen$ive therapies. On the plus side, it seems like there's a renewed interest in using orthomolecular approaches and other less toxic approaches, so that should be interesting...I think that sort of an approach could be quite worthwhile.
Posted by halcyondaze on January 31, 2007, at 14:44:24
In reply to Re: Are we in a psychiatric drug development reses, posted by stargazer on January 31, 2007, at 1:26:56
They are marketing EMSAM like crazy to psychiatrists - there's an ad in every Am J Psychiatry and every psychiatrist has samples. They have not, however, been marketing to the public and that's a shame.
Posted by laima on February 1, 2007, at 1:45:59
In reply to Re: Are we in a psychiatric drug development reses, posted by halcyondaze on January 31, 2007, at 14:44:24
New, novel drug shortage= polypharmacy up? Just a speculation.The thing about Emsam is, it's one antidepressent, and not the one for everyone. Breakthrough delivery process does not equal miraculous universally effective drug- these are two different issues. What Emsam did was make one particular MAOI more accessable to a wider pool of patients. A technological breakthrough. Fortunately, I swore I heard at least one other MAOI was being slowly developed into a patch. MAOIs are known, I understand, to be particularly effective for atypical depression- the oversleeping, understimulated, overeating kind. So of course it might not be the best choice for someone with an undereating, undersleeping problem. And a drug which made me sleepier and hungrier would make me miserable. In short, to consider it a panacea I think is an error.
Meanwhile, quite recently it seems as though we've seen a lot of new non-drug treatments become available. I'm not so well versed on these- there's the implant, (Vagus Nerve Stimulator?), there's the magnets, and is there not something else similar?
I also have seen ads recently for research studies looking for volunteers- they are looking to figure out ways to predict which patients will repond to which antidepressents by testing their emzymes, or something along those lines. This would take a lot of educated guesswork out of prescribing.
So research IS being done. Meanwhile, maybe we have to wait for the fda scandals to blow over. There was a New York Times article yesterday about how drug companies will be facing far more scrutiny due to public outcry about approved drugs which turn out to be dangerous- the article cited Vioxx, but I have a few other suspects in mind. I would imagine drug companies would want to hedge their money and bets on something they believe would be a sure and easy approval, relatively safe from costly mass lawsuits, and a guarenteed money maker-as opposed to money sinker. Cut their losses while ahead, if a drug starts looking iffy. I wonder if we will see reprocussions and fallout from the zyprexa fiasco. (A great drug for many- but not always so great for the many people who were prescribed it for inappropriate off-label uses, in part due to a notoriously aggressive and arguably deceptive sales campaign, and developed obesity or diabetes as a result. Lilly paid out millions, if not billions, in lawsuit settlements just this winter.) (As per New York Times articles, all available under "zyprexa" on wikipedia, and on various babble threads.) I suspect Lilly stock isn't at its best at the moment. That was their top seller.
So- potential LAWSUITS- that may be a monetary deterrent to trying out daring new powerful pharmaceuticals.
A shame it's not easier to pool the world's research together, and make drug importation/exportation easier for everyone's benefit. Ie, if France developes and approves a great atypical antipsychotic, why not speed up approval for legal importation into the US? Why no RIMAS in US? Or that drug which is a cousin of provigel? Why not pull MDMA back out of the closet and clean it up? There might be lots of important substances already sitting in closets in laboratories, banished for being bad, when all they might need is some tweaking to be more realistic for functioning well with daily use.
I also wonder lately if nutrition, ie, EFAs, might not be one crucial factor for many of us. Ie, a brain enjoying top nutrition surely would be more responsive than one gasping along, short on antioxidants, vitamins, essential fatty acids? Just a pet theory I am entertaining and experimenting with. And look at some of the possible novel alternative/pharmaceutical combos, like Emsam/dlpa. How much research has been done in this sort of area?
Posted by deniseuk190466 on February 1, 2007, at 15:10:52
In reply to Are we in a psychiatric drug development resesion?, posted by linkadge on January 30, 2007, at 16:27:03
I've had this illness now for five years and five years ago I was searching for new up and coming drugs and they were talking about CRF Antagonists and other drugs.
Now five years later when I'm starting to despair again, I search the net and come up with the same old articles, nothing seems to have moved forward, nothing has changed.
And yet they say that Depression is going to become the second leading illness behind heart disease (I think anyway) yet they don't seem to be coming up with anything new.
Infact, there seems to be a trend now to push people more toward Cognitive Behaviour Therapy and get them off medication completely which I find scarey because I can't see how Cognitive Behavioural Therapy would help me (negative thinking I know). When I'm really down, it doesn't matter who I'm with, where I am, what I'm doing etc, nothing makes a difference.
Denise
Denise
Posted by jealibeanz on February 1, 2007, at 15:31:00
In reply to Re: Are we in a psychiatric drug development reses, posted by halcyondaze on January 31, 2007, at 14:44:24
> They are marketing EMSAM like crazy to psychiatrists - there's an ad in every Am J Psychiatry and every psychiatrist has samples. They have not, however, been marketing to the public and that's a shame.
Are they marketing to GP's as well?I know most people say the only pdoc's will prescribe an MAOI, but it's not like it a controlled drug. It's not even that dangerous, just has some very easy to follow dietary restrictions.
GP's don't tend to be risk takers though, and I respect that. I'm just wondering if the drug reps have now made their way in their offices.
Posted by rina on February 3, 2007, at 19:08:04
In reply to I find it depressing, posted by deniseuk190466 on February 1, 2007, at 15:10:52
> I've had this illness now for five years and five years ago I was searching for new up and coming drugs and they were talking about CRF Antagonists and other drugs.
>
> Now five years later when I'm starting to despair again, I search the net and come up with the same old articles, nothing seems to have moved forward, nothing has changed.
>
> And yet they say that Depression is going to become the second leading illness behind heart disease (I think anyway) yet they don't seem to be coming up with anything new.
>
> Infact, there seems to be a trend now to push people more toward Cognitive Behaviour Therapy and get them off medication completely which I find scarey because I can't see how Cognitive Behavioural Therapy would help me (negative thinking I know). When I'm really down, it doesn't matter who I'm with, where I am, what I'm doing etc, nothing makes a difference.
>
>
>
> Denise
>
> DeniseHi Denise,
My pdoc is doing the Cognitive Behavioral therapy with me. I'm about to go manic on her because it doesn't work for me at all. While in her office I imagine myself putting tape over her mouth to stop the madness.
Posted by Sebastian on February 4, 2007, at 15:21:54
In reply to Re: I find it depressing, posted by rina on February 3, 2007, at 19:08:04
It does not work for me very well either. Especialy when there are no answerers they can give you. I tried it twice(cognitive therapy). Found myself getting upset at doctor because they had no answers to my pain, except drugs. How do you justify being treated badly and there is nothing anyone can do to make it right.
This is the end of the thread.
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