Posted by moxy1000 on September 23, 2002, at 18:11:42
In reply to Txment Refract. Maj.Unipolar Depressive Seeks Same, posted by Alice Anne on September 23, 2002, at 15:44:55
I think one reason a lot of drug companies don't market/test drugs for "atypical" patients (i.e. treatment refractory, unipolar, manic, etc.) is because your average, run of the mill type depression is where the money is at. (And pardon my terminology - I say "average" meaning patients that meet the criteria for major depression and nothing else. Nothing about a depressive episode or any mental illness is "average.") Anyway, atypical patients are called "atypical" for a reason - they are in some way different from the standard depressed patient. They may be depressed, yes, but then they may also bring some other illnesses to the table along with the depression that makes them especially hard to treat. Being bi-polar, or manic, or refractory makes treatment much more difficult, as many already know.
I think the reason drug companies are not knocking themselves out to find cures for these different illness combinations is because the population suffering them is too small (in relative terms) for the manufacturers to make a profit on. Depression is suffered by millions and millions of people each year, and yes, there are many who suffer from some variation of depression along with another illness. But if you were going to invent a drug, would you try to invent one that could benefit millions or a medicine that would help a much smaller segment of the population? Just from a financial standpoint, it makes more sense for the drug companies profit margins to try to market drugs that will help as many people as possible.
This is just my theory. I think it makes sense to some extent that atypical patients are excluded from certain studies - Number one, SSRI's are not marketed or promoted for bipolar individuals or manic depressives. This is probably over simplifying things a bit, but if a drug has never claimed to work for those particular illnesses, why should the drug be tested in individuals suffering from those illnesses? Maybe they are tested in those specific patient populations, the drug doesn't work, and it's just never published...who knows. My assumption is always this: SSRI's generally work for the same types of illnesses - if two have been proven to work for G.A.D., I can usually safely assume that all will work for that condition. I think it's interesting to note that NOT ONE ssri has ever claimed to be beneficial for manic or bipolar patients. I think the expectation by many of us is simply to high for a single agent to live up to. Maybe in a few years something will become available that is a "cure all," but as many of us know, that day has not yet arrived.
Perhaps we should just expect SSRI's to be effective for the illnesses they are indicated for. I guess I'm suggesting that we take the indications of SSRI's at face value. If a certain agent (or similar agent) is not indicated for what ails you, it probably isn't going to work. I realize "off label" prescribing goes on all the time, but I wouldn't point a finger at a drug that never claimed it would be able to help me in the first place.
poster:moxy1000
thread:109458
URL: http://www.dr-bob.org/babble/20020922/msgs/120856.html