Posted by zeugma on April 18, 2005, at 17:45:04
In reply to Re: What is the status of this drug ?? » zeugma, posted by scatterbrained on April 18, 2005, at 17:00:07
> Since it got the thumbs down from the FDA for depression, is it going to be marketed under any other context, for example anxiety,etc? If so, it seems logical to assume that it will be prescribed off label for depression as long as the drug is being produced.>
Anxiety, it seems, is being reconceptualized as part of bipolar disorder. For example, I have seen it asserted that Generalized Anxiety Disorder and BP II are co-extensive. What this will mean in practical terms is that meds such as Lyrica, which are GABAergic and anticonvulsant, will be increasingly used for anxiety disorders, due to suspicion that anxiety is a manifestation of a bipolar disorder. Drugs such as the azapirones, of which buspirone is the only representative in clinical use, will be shelved, and not used for any indication whatsoever. IMHO this is unfortunate for several reasons:
buspirone is probably the least-efficacious member of this class of drugs;
the pharmacokinetics of the azapirone class practically dictate that they be available in ER formulation, but while such a formulation has been prepared for buspirone, and would improve its therapeutic potential considerably, it will not see the light of day either because the drug has gone off patent;
the reconceptualization of GAD as a species of bipolar is another instance of psychiatry marching rapidly backwards. Since the azapirones, unlike the AC's, have proven, if modest, efficacy in depression, they are unlikely to be used for anxiety if this symptom is viewed as a manifestation of bipolarity. I agree that GAD is a dubious category, but I think that subsuming it under bipolarity compounds whatever error brought it into the DSM in the first place.
Please note that these are merely my opinions, and are likely to be hotly disputed by many others on this board. But you are unlikely to see geprirone prescribed anywhere for any reason.
-z
poster:zeugma
thread:485714
URL: http://www.dr-bob.org/babble/20050418/msgs/486117.html