Posted by sjb on November 4, 2002, at 8:10:53
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McMAN'S DEPRESSION AND BIPOLAR WEEKLY (Nov 1, 2002 Vol 4 No 36)
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PAX-ILLS
The media is obviously far braver over in the UK than they are in the US.
Despite very stringent defamation laws there, the BBC aired on its flagship
current affairs program, Panorama, a no-holds barred documentary on Paxil
(marketed as Seroxat in the UK). Right off, with reporter Shelley Joffre's
allusion to the medication's "darker side," you knew this was no
industry-sponsored symposium:In quick succession, we hear from two patients, one who cannot get off the
drug and the other who mutilated himself while on the drug, followed by
David Healy MD who testified in a successful wrongful death suit brought
against the drug's manufacturer, and attorney Andrew Vickery who brought
that wrongful death suit. Then Joffre cuts to the chase:"The Maudsley Hospital in London runs a national information service for
people taking psychiatric medicines. Trouble coming off Seroxat is the
number one complaint from callers. Doctors too report far more withdrawal
problems from patients on Seroxat than on any other drug."According to Davis Taylor, Chief Pharmacist at the Maudsley Hospital: "If a
patient is to stop taking Seroxat suddenly, then usually they would quite
soon become quite anxious. They may feel very dizzy and unsteady on their
feet. Often people experience electric shock sensations. They may also have
a fever and feel generally unwell and they also may experience mood changes
or very vivid nightmares for example."Thanks to the wrongful death suit brought against manufacturer
GlaxoSmithKline, Dr Healy gained access to some quarter million documents in
the company's archives. He told Panorama that according to GSK's own
studies, often on healthy volunteers, that one in four experienced mental
agitation while on the drug, and in some instances up to 85 percent had
withdrawal problems when they halted.The wrongful death suit involved a retired man, Donald Schell, who
tragically shot his wife, daughter, nine-month-old granddaughter, and
himself two days after taking the drug. Due in part to Dr Healy's expert
testimony, a Wyoming jury last year concluded Paxil was to blame and awarded
$6.4 million to son-in-law Tim Tobin, the first successful suit brought
against a drug company involving an SSRI.Two weeks later, GSK added this warning to patient leaflets in Britain:
"Occasionally the symptoms of depression may include thoughts of harming
yourself or committing suicide. Until the full antidepressant effect of your
medicine becomes apparent, these symptoms may increase in the first few
weeks of treatment."Dr Alastair Benbow, head of GSK's European Clinical Psychiatry told Panorama
that:"There is no reliable clinical evidence that Seroxat causes violence,
aggression or homicide. This tragic, tragic case is something that does
occur from time to time in patients who are depressed."Meanwhile Panorama was saving its best for last: A "successful" US trial
involving 93 children found five experienced suicidal thoughts and gestures,
and five experienced severe psychiatric side effects.One may ask, what happened to fairness? Nowhere in the program did Panorama
talk to a single patient who had been restored to good health thanks to
Paxil, nor did the documentary seek the opinion of any experts who might
have testified to the drug's benefits across large populations. Then again,
GSK doesn't exactly use its $90 million US advertising budget to present a
balanced picture, either. Quite the opposite, in fact. Recently, the company
won a court case allowing it to keep airing adds in the US claiming the drug
is not habit-forming. The TV viewing public here, needless to say, has no
BBC to turn to for a competing view.http://news.bbc.co.uk/1/shared/spl/hi/programmes/panorama/transcripts/seroxa
t.txt<a
href="http://news.bbc.co.uk/1/shared/spl/hi/programmes/panorama/transcripts/
seroxat.txt">click here</a>MORE
At about the same time the documentary aired, the Prescription Medicines
Code of Practice Authority in the UK ruled that GSK had breached the
industry's of the code of practice by playing down Paxil's side effects.
Meanwhile, in the US, Paxil's most recent TV ad leaves out its previous
claim about the drug not being habit-forming.NUMBER ONE
According to the World Health Organization reported in The Guardian, Paxil
tops the list for drugs in terms of difficulty to quit followed by Effexor
at number two, Zoloft at number four, and Prozac at number seven. The
benzodiazepines Ativan and Valium come 11th and 13th.http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html
<a
href="http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html">clic
k here</a>WALK, DON'T RUN
If you are on Paxil, please do not panic. Mental agitation or anxiety from
SSRIs usually occurs in the first few days, if at all, then recedes. If the
agitation or anxiety persists, it is advisable to notify your doctor or
psychiatrist. If the drug is working for you, it is sensible to stay on it.
If the drug is being prescribed to you for the first time, it is advisable,
as with any medication, to express any concerns to your doctor or
psychiatrist. Should you no longer need to stay on the drug, following is a
"reprint" from a recent Newsletter:Last December, GSK changed Paxil's label, encouraging physicians to
recommend "a gradual reduction in the dose rather than abrupt cessation."
Paxil washes out of the system more quickly than other SSRIs when stopped.
In recent clinical trials, GSK decreased the daily dose by 10 mgs a week
(doses can range from 10 to 60 mg a day), then stopped treatment after
reducing the dose to 20 mgs. The Washington Post reports Frederick Goodwin
MD, former head of the NIMH, as in favor of an even more gradual taper,
"dropping the dose every four or five days by as little as possible, even if
that means cutting pills in half."ON THE LABEL
According to the manufacturer's product information, of patients who
gradually weaned off Paxil 2.3 percent experienced abnormal dreams, two
percent experienced a tingling sensation (paresthesia), and 7.1 percent
experienced dizziness. According to GSK, the majority of cases were mild and
did not require medical intervention.MORE ON SSRI WITHDRAWAL
Abstracts from PubMed:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=9219493&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=9219490&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=9476026&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=10855379&dopt=AbstractPAXIL LAWSUITS
Not since the tobacco lawsuits have law firms been so eagerly licking their
litigious chops. A Google search turns up dozens of law firms in the US,
Canada, and the UK that have already been filed on behalf of individuals or
classes of individuals or are touting for business. The claims generally
allege withdrawal symptoms or suicidal gestures and the failure of GSK to
issue appropriate warnings.DAVID HEALY
David Healy, the psychiatrist featured on Panorama, is the director of the
North Wales Department of Psychological Medicine at the University of Wales,
and author of "The Antidepressant Era" and numerous articles, several
alleging a Prozac-suicidality link. In small studies of SSRIs on healthy
patients, he found up to 20 percent lost their inhibitions. Dr Healy
testified as an expert witness in a wrongful death case concerning Prozac,
which failed, and in the Tobin case, which succeeded.In 2000, Dr Healy was offered a post at the Centre for Addiction and Mental
Health and in the department of psychiatry at the University of Toronto.
Prior to taking up his position, he delivered a guest lecture at the
university. Highlights from that talk include:"If our drugs really worked, we shouldn't have three times the number of
patients detained now compared with before, 15 times the number of
admissions and lengthier service bed stays for mood and other disorders that
we have now. This isn't what happened in the case of a treatment that works,
such as penicillin for GPI.""A significant proportion of the scientific literature is now ghost written.
A large number of clinical trials done are not reported if the results don't
suit the companies' sponsoring study ... Within the studies that are
reported, data such as quality of life scale results on antidepressants have
been almost uniformly suppressed. To call this science is misleading."But Dr Healy also said that antidepressants do work, notwithstanding the
shortcomings of drug trials, and he expressed concern that SSRIs might be
abandoned as the dependence factor became known, the fate of other classes
of drugs. The lecture had its origins in a talk he gave at an AstraZeneca
seminar, which led to further invitations to appear at AZ forums. The
University of Toronto, however, responded by rescinding its job offer with
no explanation. Dr Healy sued, and the two parties subsequently settled out
of court.http://www.nature.com/nm/voting/lecture.html
<a href="http://www.nature.com/nm/voting/lecture.html">click here</a>
SEGUE
And now back to normal programming ...
DEPRESSION GENE?
University of Pittsburgh researchers have narrowed their search the for
first susceptibility gene for unipolar depression to an eight-gene region of
chromosome 2q33-35 in women, but not in men. According to lead researcher
George S. Zubenko MD, PhD, the finding may indicate why women suffer from
depression in twice the numbers as men. An excellent candidate gene is
CREB1, which encodes a protein CREB that affects other genes that play
important roles in the brain. Postmortem brain studies of depressed patients
and animal studies have found alterations in CREB1 expression.<a href="http://www.eurekalert.org/">click here</a>
STAYING ON MEDS
A University of Texas Southwestern Medical Center at Dallas/Pfizer study of
Zoloft responders who remained on the drug through the last 18-month phase
of a three-phase trial found six percent relapsed compared to 23 percent on
the placebo. The Zoloft patients also recorded higher scores on functioning,
attitude, and quality of life.<a href="http://www.eurekalert.org/">click here</a>
ALL THAT IT'S CRACKED UP TO BE?
One of my readers, Carter, saw the media release of the above study before I
did, and did the math, namely:Out of an initial cohort of 635 patients completing a 12-week trial (we have
to assume a lot of patients dropped out during this stage, but we'll
overlook this), only 209 responded favorably to go into the four-month phase
of the trial, and ninety-five percent (199) qualified to go into the
18-month phase, of which 94 percent remained well (had everyone remained on
Zoloft, we can extrapolate a number of 187). Carter notes, "in this
projection only 29 percent would have experienced long-term alleviation of
symptoms - hardly 'most' patients alluded to in the release." Moreover,
assigning the placebo results in the same fashion, 153 would have
experienced relief. "So basically," concludes Carter, "only 34 patients out
of 635 experienced relief of symptoms at a higher level than the placebo."PAIN-BUSTERS
"Similarly, antidepressants have been used to help prevent migraines. 'If
antidepressants were discovered today and we didn't know they were
antidepressants, we'd call them analgesics,' says Dr. Seymour Diamond,
director of the Diamond Headache Clinic in Chicago. Intriguingly, the
pain-fighting effect of antidepressants takes just three to 10 days to kick
in, less than half the time needed to alleviate depression. This suggests
that depression and migraine are triggered by different, though related,
neural pathways."From a Time Magazine article on headaches.
http://www.time.com/time/health/article/0,8599,356029,00.html
<a
href="http://www.time.com/time/health/article/0,8599,356029,00.html">click
here</a>THE PAIN CONNECTION
For more on the connection between pain and mood, please check out the
article I wrote for the Depression and Bipolar Support Alliance at:http://www.ndmda.org/Research/ResearchUpdate22.html
<a href="http://www.ndmda.org/Research/ResearchUpdate22.html">click here</a>
INOSITOL
Safe Harbor's Alternative Mental Health News reports that Dr James
Greenblatt of McLean Hospital, affiliated with Harvard, is using inositol
supplementation to treat patients for depression and related ills. Inositol
is made in the body and "is shuttled around to various tissues as needed."
The substance is reputed to be efficacious without the usual meds side
effects.A Medline search turned up a small 2000 University of Pittsburgh study that
found six of the 11 patients on inositol plus their meds improved their
Hamilton depression scores by at least 50 percent. Eight patients achieved
success using the MADRS depression scale. A 2001 Israeli study, on the other
hand, found that inositol combined with SSRIs in treatment-resistant
patients did not produce an added benefit.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=11254020&dopt=Abstract<a
href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l
ist_uids=11254020&dopt=Abstract">click here</a>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=12404596&dopt=Abstract<a
href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l
ist_uids=12404596&dopt=Abstract">click here</a>PSYCH WARS
A Janssen survey of 4,308 patients on antipsychotics has found those taking
Clozaril, Zyprexa, Haldol, and Thorazine ran a higher risk of diabetes
compared to those not on antipsychotics while those on Risperdal (no
surprise) did not display a higher risk. The study represents the latest
salvo in the high-stakes war for the multi-billion antipsychotics market,
featuring gloves-off negative campaigning. Don't be surprised to find Eli
Lilly retaliating with its own study, this time involving prolactin levels
affecting guess which drug.<a href="http://www.psycport.com/">click here</a>
JAVA
This week coffee is good for you. A University of California, San Diego,
study has found that women at least 80 years-old who were lifetime coffee
drinkers had a slight edge over infrequent coffee drinkers on 11 of 12
mental acuity tests such as counting backward from 100 by sevens. The same
effect did not occur in men.http://www.reuters.com/news_article.jhtml;jsessionid=MRCZH3WI5PDXICRBAE0CFEY
?type=healthnews&StoryID=1662532<a
href="http://www.reuters.com/news_article.jhtml;jsessionid=MRCZH3WI5PDXICRBA
E0CFEY?type=healthnews&StoryID=1662532">click here</a>RECESSION BLUES
USA Today reports that the economic downturn has many struggling with
depression, anxiety, substance abuse, and marriage woes. Calls to employee
assistance programs are up 10 percent, 25 states report an increase in
requests for drug and alcohol treatment, and the use of antidepressants grew
12.8 percent in 2001 (180 million prescriptions last year). According to the
University of Western Ontario, 30 percent of husbands who experienced
unemployment suffered from significant mental health problems vs 16 percent
in stable employment, with unemployed and employed women at 36 percent and
23 percent, respectively.Says Joanne McCall, who was laid off for eight months in 1993 to USA Today:
"It took a number of years to really get over it. It's such a blow to your
self-esteem and who you are, and it takes a long time to repair that. It's
like a grief process ... Your work is like family, and all of a sudden you
feel cut off and ostracized. It's huge. There's a period of loss."http://www.usatoday.com/money/economy/employment/2002-10-28-stress_x.htm
<a
href="http://www.usatoday.com/money/economy/employment/2002-10-28-stress_x.h
tm">click here</a>HIV
A Columbia University survey of 235 HIV-positive individuals has found 72
percent reported symptoms of depression and 65 percent reported anxiety.
According to HealthScout, although more than 80 percent of US doctors say
mental health is a top priority when they make decisions about treatment, 62
percent of patients say physicians never ask about their mental state.http://www.healthscout.com/template.asp?page=newsdetail&ap=1&id=509872
<a
href="http://www.healthscout.com/template.asp?page=newsdetail&ap=1&id=509872
">click here</a>KIDS
A University of Michigan survey of 1,958 adolescents aged 15-19 has found
7.4 percent met the criteria for severe major depression, but only 11 to 15
percent of them sought help for it.<a href="http://www.docguide.com/">click here</a>
MEANWHILE ...
"More teenagers and young adults died from suicide than from cancer, heart
disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung
disease combined."David Fassler MD of the University of Vermont and author of "Help Me, I'm
Sad: Recognizing, Treating, and Preventing Childhood and Adolescent
Depression," on NPR's Talk of the Nation, hosted by Neal Conan.MEN ARE FROM MARS
"Well, most of our diagnostic criteria talk about what you said earlier,
that you're weepy, although sadness can start to go away if the depression
gets worse, but you're hopeless and you express that kind of hopelessness or
that sadness, while a lot of men get angry, irritable, mean, impulsive, and
we say they're - well, what language shall I use on NPR? - they're SOBs and
they're a pain, and let's get rid of them, let's fire them, let's divorce
them, when, in fact, behind that mask of masculinity is actually the same
sadness, hurt and pain expressed in a male-based fashion."William Pollack PhD of Harvard and author of "New Psychotherapy for Men" on
why men suffer from depression in equal numbers to women, though in
unrecognized ways, on NPR's Talk of the Nation, hosted by Neal Conan.rTMS
A University of Washington review of 12 studies comparing rTMS (repetitive
transcranial magnetic stimulation) to sham treatment found the number of
responders (ie a 50 percent or greater reduction in depression scores) was
only 13.7 percent vs 7.9 percent for sham treatment. No study showed at
least a 50 percent reduction.rTMS involves passing a magnetic coil over the scalp of a patient.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=12397863&dopt=Abstract<a
href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l
ist_uids=12397863&dopt=Abstract">click here</a>UK PRISONS
According to the Financial Times, Prison Service figures in the UK reveal
"as many as 90 per cent of prisoners show evidence of mental distress, a
psychiatric disorder, or drug or alcohol addiction," with more than 5,000
suffering from severe mental illness. Forty percent of women prisoners and
20 percent of men have admitted to trying to kill themselves.MAIL BAG
Carol writes:
"Related to the Rocky Mountain Low article, I was an insurance agent for
many years and you'll find this interesting: ALL life insurance policies
state that if the insured commits suicide within a specific time frame
following policy issue, the beneficiary will only receive the cash value -
not the death benefit. That time frame is two years in every state BUT
Colorado. Colorado is only one year. In theory, you can buy a policy and
kill yourself 366 days later, leaving your death benefit to loved ones.
Personally, if you're in that frame of mind, I think even one year is a long
time."IN MEMORIAM: PAUL WELLSTONE, 1944 - 2002
From NAMI's President, Jim McNulty:
"Our members have loved and admired Senator Wellstone for his tireless
advocacy on behalf of people with mental illnesses. Whether fighting for
passage of mental health insurance parity legislation or conducting an
unannounced visit to a juvenile justice facility, he brought a rare passion
and energy to fighting discrimination against people with mental illnesses
as part of a broader commitment to individual dignity, freedom, and bonds of
justice that bring our nation together as a community."From the Depression and Bipolar Support Alliance:
"Senator Wellstone was a good friend and advocate for those working in
mental health and a leader of the mental health parity movement. DBSA is
saddened by this loss and expresses its condolences to family and friends."From the Mental Health Association's President Michael Faenza:
"Not only was the Senator a committed, concerned and passionate individual,
he was also one of the finest elected officials I have ever met."VOTE
For US readers, you can make it a habit starting Tuesday, Nov 5.
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poster:sjb
thread:126380
URL: http://www.dr-bob.org/babble/20021101/msgs/126380.html