Antidepressants
ddobbs | February 1, 2010PTSD, pharma, adjuvants, bad movies -- these are a few of my favorite things, and readers' too.
What's Neil doing here? He wasn't on Neuron Culture; I posted his clip on my catch-all, David Dobbs's Somatic Marker, because I love him. So he comes first. From 1986. Looks as if he's having a particularly good time here.
Neuron Culture's Top Five from Jan 2010
NEJM study finds post-event morphine cuts combat PTSD rates in half
"This is a pretty big deal if it holds up in future trials. One caveat I've not had time to check out is whether the morphine was often applied as part of an more…
ddobbs | December 7, 20091. Maybe it was just the headline ... but the runaway winner was "No pity party, no macho man." Psychologist Dave Grossman on surviving killing. Actually I think it was the remarkable photo, which looks like a painting. Check it out.
2. I'm not vulnerable, just especially plastic. Risk genes, environment, and evolution, in the Atlantic. The blog post about the article that led to the book.
3. Senator Asks Pentagon To Review Antidepressants
4. Gorgeous thing of the day: Sky's-eye view of the Maldives & other islands
5. The Weird History of Vaccine Adjuvants, even though it was from Oct 1…
j7uy5 | January 15, 2009There is a thought-provoking editorial in the openly-accessible Journal of Psychiatry of Neuroscience (JPN): Has the time come for clinical trials on the antidepressant effect of vitamin D?
(45 KB PDF). In it, the editor of the the Journal, Simon N.
Young, PhD, argues that there is enough evidence to justify increased
research efforts.
He points to a recent article in the Archives of General Psychiatry to support this view:
Depression Is Associated With Decreased 25-Hydroxyvitamin D and Increased Parathyroid Hormone Levels in Older Adults
Witte J. G. Hoogendijk, MD, PhD; Paul Lips, MD,…
amillikan | January 6, 2009Recently, a discussion has sparked on ScienceBlogs over how the word "addiction," could be used to describe some substances that aren't necessarily harmful such as antidepressants. Scicurious from Neurotopia points out that if a substance changes one's physical self, there will be physical effects if that drug is discontinued—a property of addiction. Likewise, PalMD from Denialism Blog suspects the negative nature of the word "addiction" may make drug companies hesitant to describe their products as such, even though it's accurate.
ddobbs | March 12, 2008The Kirsch study published a few weeks ago has stirred much discussion of the placebo power of antidepressants (or is it the antidepressant power of placebos?); it's clear that the act of taking a pill that you expect to help you often does help you.
But can the availability of a pill meant for depression make you feel (or think of yourself as) depressed? That's the question behind another part of the drug debate, regarding whether the drug industry encourages us to medicalize ordinary experience.
In pondering these things I ran across this fascinating New York Times >article from 2004…
ddobbs | March 6, 2008With so much written here lately about placebos and drug effectiveness, I would not want to leave out this remarkable study: Placebo effect is stronger, apparently, if you pay more for the placebo.
This is a fascinating study described in a letter to the Journal of the American Medical Association. A crudely shortened version: Some researchers at MIT (none of them Bill Murray, as far as I can tell) gave light shocks to volunteers, then gave them some placebos that were costly and some that were cheap. The costly ones worked better.
It sounds like a bit of a stunt, but as Respectful…
ddobbs | February 29, 2008The ripples from the PLOS Medicine antidepressants-don't-work study by Kirsch et alia, which I covered below, just keep spreading. Those who want to follow it can do well by visiting or bookmarking this search I did (an ingenious Google News search for "Kirsch SSRI"). It seems to be tracking the press coverage pretty well. Note that the heavier and higher-profile coverage comes mainly from UK. As far as I can tell, none of the top 3 or 4 US papers have yet covered it.
This blog search should help as well.
Some of the more notable responses since yesterday:
Science weighs in. The Times…
ddobbs | February 25, 2008I've not had time to thoroughly read this yet. But on the heels of another study published a few weeks ago (I blogged on it here) showing that SSRIs have little therapeutic effect if you include the (unflattering) clinical trials the industry had previously hidden, PLOS Medicine now publishes a larger study -- a meta-analysis of all available data on clinical trials of SSRIs -- that shows that "compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression" --…
ddobbs | January 17, 2008
I've written before, both here and in print, about how FDA policy and drug company practices have allowed drug makers to publish (and the FDA to base approval on) only the most flattering drug-trial results while keeping less-flattering studies in the drawer. Today a New England Journal of Medicine report shows how things change when you include the results from the drawer: The effectiveness of many SSRIs dives to near placebo-level. This despite that the companies design and conduct most of these trials in a way calculated to produce positive results.
When I wrote on this for Scientific…
j7uy5 | December 12, 2007 I haven't gotten
back to
the "selection of antidepressants" series. Mostly that is
because, alphabetically, the next one is supposed to be citalopram.
While
href="http://en.wikipedia.org/wiki/Citalopram">citalopram
(Celexa™)
is a perfectly fine antidepressant, it is kind of boring.
So to spice things up a little bit, I'm going to jump ahead to
href="http://en.wikipedia.org/wiki/Desvenlafaxine" rel="tag">desvenlafaxine.
This is a drug that is in development by
href="http://www.wyeth.com/" rel="tag">Wyeth.
They plan to market it with the brand name,
href="http://www.wyeth…
grrlscientist | September 6, 2007tags: researchblogging.org, mental health, suicide, depression, bipolar disorder, SSRIs, selective serotonin reuptake inhibitors, antidepressants, FDA black-box warning
Prozac.
Image: Tom Varco
After a 2003 report linking selective serotonin reuptake inhibitors, or SSRIs, with increased suicide rates among children and teen agers was published, the use of this class of antidepressants in these age groups has decreased dramatically. This led to a change in labeling in 2003 that warned that use of the medications could increase suicidal thoughts and behavior among youths. Sadly, this 'black…
neurontic | August 10, 2007My gut response after reading this question was: Well, duh--obviously, summer is more conducive to happiness. I mean, you can make a good case for the virtues of spring and fall, but they're really less seasons than they are opening acts. And apart from Christmas and skiing, winter doesn't have a whole lot to recommend it. Nope. If you're ranking seasons, summertime is the clear winner. Summer=hot sun, slow, quiet afternoons, and water-logged family vacations. What more does a human being need to be happy, apart from an air-conditioner and an ample supply of snacks?
Proving my theory seemed…
j7uy5 | July 3, 2007T
face="Helvetica, Arial, sans-serif">his
is another post in a series detailing the selection of antidepressant
medication. Use the "Antidepressants" link in the
"Categories"
part of the sidebar to find the other posts in the series.
In this post, I am sort of assuming that the reader has read the
previous posts, or has an adequate fund of general knowledge on the
subject.
href="http://en.wikipedia.org/wiki/Bupropion" rel="tag">Bupropion
is not a member of a family. Most antidepressants can be
placed
in a family of drugs that share similar properties, but there is no
other drug…
j7uy5 | June 3, 2007
face="Helvetica, Arial, sans-serif">This is
an interesting drug. Rarely prescribed, but interesting.
It is older than what we typically give today. It
is an antidepressant with a twist.
face="Helvetica, Arial, sans-serif">In
order to understand why it is interesting, you need to know a little
bit about the pharmacology of the drug.
rel="tag" href="http://en.wikipedia.org/wiki/Amoxapine">Amoxapine
is a tricyclic antidepressant, in my book, or at least in my
head; but I have seen it referred to as a tetracyclic. It
depends on whether you think all the rings have to have…
j7uy5 | May 30, 2007
href="http://en.wikipedia.org/wiki/Image:Amitriptyline-2D-skeletal.png">
face="Helvetica, Arial, sans-serif">This post is
about amitriptyline, one of the oldest
antidepressants on the market in the USA. It also used to be
the
most widely-prescribed antidepressant.
I've decided to not attempt an encyclopedic style of description of the
pharmacological action of the individual antidepressants.
That is
readily available already at Wikipedia, among others. But in
order to fully understand the topic, those who are not familiar with
the pharmacology should probably go to the general…
j7uy5 | March 30, 2007
A while back I started a series about the science and logic (and other
factors) involved in the selection of antidepressant medication.
I suppose I could put in the pinks to the first four parts,
but anyone can use the search box in the left-hand sidebar to search
for "selection of antidepressants" to find them. I suppose
when I am done I will go back to the first one and put in a list of
links to all the posts in the series.
style="font-family: Helvetica,Arial,sans-serif;">
The first four posts presented a top-down view, looking at the concepts
and principles used when choosing an…
j7uy5 | February 19, 2007Joltvolta (great name, by the way), asked a good question after I
posted part 3.
When you say proceed methodically, employ good data
collection, etc. How does the individual do that for themselves? If
they don't have the availability to see a specialist multiple times a
week, or even in a month, what options do they have?
I will get to that, eventually, but there are a few more things I have
to cover first. After all, part of my agenda in writing this
series is to enable patients to do more for themselves. There is
a shortage of specialists, and so long as that is the case, it will be…
j7uy5 | February 14, 2007It occurs to me that in order to go any farther explaining how to
choose an antidepressant, I should take a moment to explain the concept
of an adequate trial. Earlier, I mentioned that the
patient's history of response to previous antidepressant trials is one
of the most important factors to consider. Having said that, it
is important to realize that there are problems with that, both
practical and theoretical.
In order to derive valid conclusions from the outcome of any prior
trial on an antidepressant, it is necessary to have the right
information.
Having the right information means…
j7uy5 | February 12, 2007(Part One is
href="http://scienceblogs.com/corpuscallosum/2007/02/basic_concepts_selection_of_an.php">here)
Now we get to the heart of the matter: how does one decide what
antidepressant to prescribe?
First, let's take a look at the factors that are considered relevant to
the choice. If you understand what factors are relevant, and why
they are relevant, then you will start to see how the decision is
made.
In the process of deciding which drug to prescribe, there
are two bodies of information. Well, actually there are more, but
to
keep things simple, I am going to artificially…
j7uy5 | February 10, 2007Many ScienceBloggers, and some science bloggers, are writing posts
about basic concepts. I thought that was a good idea, but could
not think of one that would be interesting and that I felt like writing
about and that I was particularly well-suited to write.
Psychiatry is not a basic science. It is a medical practice that
is derived from several basic sciences: psychology, pharmacology,
physiology, anatomy, epidemiology, and so forth. So this is not
really a basic concept, in the sense of explaining something
fundamental about nature. Rather, it explains something that is
fundamental in…