ANTI DEPRESSANT DRUG BLOG

Antidepressant drug raises new hopes

October 30, 2006

The news that Dallas Cowboys football player Terrell Owens had attempted to commit suicide because of depression alarmed sports fans worldwide, for whom he is one of the game’s biggest stars. However, recent information on the uses of a drug with positive effects on depressed patients raises hopes that the problem may be successfully confronted in a not too distant future.

It is estimated that almost 15 million people in the United States are affected by depression in any given year. Worldwide, the World Health Organization estimates that over 120 million people meet the criteria for clinical depression.

Depression is a democratic disease, since it affects people from all social strata. Even presidents suffer from it, the most notable example in the past being Abraham Lincoln, who suffered from prolonged bouts of depression while he was president of the country. In spite of that, he is one of the most admired presidents in U.S. history.

Now come the news that ketamine, a drug that was first synthesized in 1962, had an almost immediate effect in relieving depression from some patients. Although the drug is unlikely to be used in patients because of some serious side effects such as hallucinations and other unwanted psychological side effects, it can point the way toward developing a new class of faster and longer-acting medications. The results of a study involving the drug called ketamine were published in the Archives of General Psychiatry.

A show if its efficacy is that people with treatment-resistant depression experienced significant relief as quickly as two hours after a single dose of ketamine in amounts lower than what is normally used as an anesthetic in humans and animals. As a contrast, antidepressants usually take eight weeks or more to exert their effect in the same kind of patients.

For this study 18 treatment-resistant depressed patients were randomly assigned to receive either a single dose of ketamine or a placebo, an inactive compound. Depression improved in 71 percent of all those who received ketamine while those receiving a placebo didn’t show any effect. In 35 percent of patients who showed improvement, that improvement lasted for over seven days after receiving a single dose of the medication.

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According to Dr. Thomas R. Insel, Director of the National Institute of Mental Health in the United States, “This is the first report of any medication or other treatment that results in such pronounced, rapid and prolonged response with a single dose.”

Scientists involved in the study believe that current antidepressant medications take a much longer time to work because they act on targets close to the beginning of a series of reactions that regulate mood. Ketamine may act by skipping many of these intermediate steps and thus may reach its target much faster than other medications.

In this regard, as Dr. Carlos A. Zarate Jr., lead researcher of the NIMH Mood and Anxiety Disorders Program stated, “This may be a key to developing medications that eliminate the weeks and months patients have to wait for antidepressant treatments to kick in.”

Further analysis of the way ketamine acts may help scientists understand how and why depression occurs, and develop new and more specific medications to treat this disease, as well as find specific markers to aid in early diagnosis.

The potential of ketamine to deal with other problems is also significant. Research is being carried out in France, Russia and the U.S. into the drug’s usefulness in pain therapy and for the treatment of alcohol and heroin addiction. Because of its potential for illicit use, however, it cannot be used by the general public without prescription.

Because it acts in different ways than previous medications, it opens the way to research of new antidepressants that are not just variations of existing ones. Ketamine efficacy in the treatment of depression has enormous public health implications, given the significant amount of people who suffer from it. For many of them, it can mean the difference between life and death.
Cesar Chelala, M.D., Ph.D., is an international public health consultant for several international agencies.

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ANTIDEPRESSANTS REDUCE SPERM COUNT

October 25, 2006

Antidepressant drug use could severely lower men’s sperm counts, according to a case report presented at yesterday’s American Society for Reproductive Medicine conference in New Orleans. Dr. Peter Schlegel of the Cornell Medical Center in New York, along with a colleague, recently treated two men for infertility and found when both patients stopped taking their prescription antidepressant medications - selective serotonin reuptake inhibitors (SSRIs) - their sperm counts dramatically increased.

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Schlegel then observed that when both men re-started their antidepressants, their fertility problems returned. - News Target

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Prozac is linked to low sperm count

October 24, 2006

ANTIDEPRESSANT drugs could lower men’s sperm count, the first investigation of their effect on male fertility has found.

A case report on two patients taking the most common class of antidepressants, which includes the market leaders Seroxat and Prozac, has revealed a possible adverse effect on both the concentration and swimming ability of sperm.

Doctors at the Cornell Medical Centre, in New York, who were treating the two men for infertility, found that when the patients stopped taking selective serotonin reuptake inhibitors (SSRIs), their fertility problems disappeared, only to resume when they restarted antidepressants.

The first patient was taking citalopram, known as Cipramil in Britain. The second was on sertraline, which is sold as Lustral in Britain. The second patient then switched to a different SSRI, venlafaxine or Effexor. Again, his sperm count dipped, only to climb again when he came off the drug.

The implications of the study are limited by the very small number of patients, but similar effects have been reported in a another dozen patients. A clinical trial has begun of 30 men taking sertraline.

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Peter Schlegel, who presented the research yesterday at the American Society for Reproductive Medicine conference, in New Orleans, said: “The patients had normal sperm counts and motility before medication. On the medication they have severe deterioration of both. The same patients going on and off medication had the same pattern. It shows a strong association.�

Impotence and delayed ejaculation are common side-effects of the drugs, and Dr Schlegel believes that the drugs may be preventing sperm from getting into semen.

Allan Pacey, senior lecturer in andrology at the University of Sheffield, said: “There does seem to be a major correlation. Maybe this is an unknown side effect of these drugs that is only just coming to light.�

The researchers warned patients taking SSRIs not to abandon their use of the drugs over concerns for their sperm count, as sudden changes in treatment may worsen psychiatric conditions.

SSRIs are the most commonly prescribed antidepressants in Britain, and are taken by between two and three million people.

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Antidepressants linked to ‘adolescent’ aggression

October 18, 2006

Prozac can make “adolescent� hamsters more aggressive towards their cage-mates, despite the antidepressant drug producing the opposite effect in adult hamsters, making them calmer.

The new findings may help explain why certain antidepressants appear to cause irritability and other abnormal behaviours in teenagers.

Kereshmeh Taravosh-Lahn at the University of Texas at Austin, US, and colleagues gave injections of the drug fluoxetine (sold in pill form as Prozac) to pubescent and mature hamsters. They injected either a low dose (10 milligrams per kilo of body weight) or a high dose (20 milligrams per kilo body weight), while other hamsters received a placebo.

The researchers then introduced a smaller, same-sex hamster into the cage of each experimental hamster and filmed all the fights between the two rodents that were initiated by the subject animals. None of the fights resulted in the skin-breaks or injury to the animals, the researchers stress.

As expected, the pubescent hamsters on a higher dose of drug appeared calmer, initiating about 65% fewer attacks than those on placebo. But surprisingly, those on the lower dose of antidepressant became more aggressive, initiating 40% more fights than those on placebo. Watch a short movie of the aggression in action.

Adult hamsters on either dose of the drug initiated fewer fights than those on placebo.
Binding on

Taravosh-Lahn speculates that different receptors in the brain may be activated by the different dosages in the younger animals. Fluoxetine, like all selective serotonin reuptake inhibitors (SSRIs), works by increasing the amounts of a mood-altering brain chemical called serotonin.

At low doses, serotonin might bind more readily to serotonin-3 receptors, which promote aggression in the hamsters, she says. But at higher doses of antidepressant, the extra serotonin could bind to serotonin-1a receptors, which inhibit aggressive behaviour, she says.

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Mature hamsters may have a fewer serotonin-3 receptors in their brains than “adolescent� hamsters, Taravosh-Lahn suggests.

Some young people with depression receive lower doses of antidepressant drugs because of their relatively small weight and size. But Taravosh-Lahn says the findings of the hamster study should prompt a closer look at the effects of this practice.

“We underestimate the differences between the juvenile brain and the adult brain,� says Taravosh-Lahn. “It seems there needs to be more research on the effects of antidepressants on kids.�
Suicidal thoughts

Previous studies have also indicated a link between SSRIs and violent behaviour. Aggression was the most common reason children discontinued taking the drug Zoloft in two clinical trials conducted by pharmaceutical giant Pfizer (PLoS Medicine, DOI: 10.1371/journal.pmed.0030372), for example.

One high-profile case is that of Christopher Pittman, who in 2001 at the age of 12 shot and killed his grandparents before setting their house on fire. Lawyers defending the boy argued the murders were influenced by the antidepressant Zoloft, but a jury disagreed and sentenced him to 30 years in prison in February 2005.

Following a decision by the US Food and Drug Administration in late 2004, all antidepressants in the US now carry strong “black box” warnings, which state that the drugs may cause abnormal behaviours or suicidal thoughts in teenagers.

However, experts stress that antidepressants can dramatically improve the lives of some children. “By in large, children do not become aggressive on Prozac,� says child psychiatrist Stuart Goldman, at the Harvard Medical School in Boston, US.

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Some antidepressants may cause adolescent aggression

October 16, 2006

New York, Oct 16 (IANS) Some antidepressant drugs could cause irritability and other abnormal behaviour in teenagers and more research is required to study their effect on children, say scientists.

Kereshmeh Taravosh-Lahn of the University of Texas at Austin, US, and colleagues gave injections of the drug fluoxetine (sold in pill form as Prozac) to pubescent and mature hamsters.

They injected either a low dose (10 milligrams per kilo of body weight) or a high dose (20 milligrams per kilo body weight), while other hamsters received a placebo.

The researchers then introduced a smaller, same-sex hamster into the cage of each experimental hamster and filmed all the fights between the two rodents that were initiated by the subject animals, reported the online edition of New Scientist.

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The pubescent hamsters on a higher dose of drug appeared calmer, initiating about 65 percent fewer attacks than those on placebo. But surprisingly, those on lower dose of antidepressant became more aggressive, initiating 40 percent more fights than those on a placebo.

Adult hamsters on either dose of the drug initiated fewer fights than those on placebo.

Prozac can make “adolescent” hamsters more aggressive towards their cage-mates, despite the antidepressant drug producing the opposite effect in adult hamsters, making them calmer, the researchers said.

Some young people with depression receive lower doses of antidepressant drugs because of their relatively small weight and size. But Taravosh-Lahn says the findings of the hamster study should prompt a closer look at the effects of this practice.

“We underestimate the differences between the juvenile brain and the adult brain,” he said. “It seems there is more research needed on the effects of antidepressants on kids.”

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Consumer group: Medicare drugs in coverage gap can cost more than retail

October 11, 2006

Medicare’s prescription drug program was supposed to cost less than buying retail, but a new analysis of South Florida drug prices shows seniors who fall into the “doughnut hole” coverage gap often pay more than they would at the drugstore.

The regular retail price at the lowest-priced drugstore beat doughnut hole prices charged by Medicare drug plans 80 percent of the time, according to a report released Tuesday by Consumers Union, the nonprofit group that publishes Consumer Reports. In some cases, the drugstore price was 10 percent less.

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“We were surprised,” said Peter Sikora, a co-author of the report. “The Medicare drug plan is not working, because of the doughnut hole. It’s not delivering the right prices for the consumers.”

At a news conference outside a Costco in Pompano Beach, consumer activists said the report strengthened the argument that Congress should change the law in order to allow Medicare to bargain directly with manufacturers, to keep prices down for consumers. Democrats in Congress agree, saying the Republican-drafted program boosts profits for drug makers.

The Department of Veterans Affairs can negotiate with manufacturers, and its prices were 54 percent less than prices charged by Medicare plans in the doughnut hole, the report said.

“It’s absolutely appalling,” said Bill Newton, director of the Florida Consumer Action Network. “The Medicare plan needs to be done over.”

But spokesmen for Medicare and insurers offering the drug coverage said the report focuses on one aspect of the first-year program, which the government says saves $1,500 a year on average for each person on it.

A study by Medicare last month found Medicare drug plans saved consumers 27 percent on average — as much as 56 percent at best — compared with retail prices. Surveys show 80 percent of seniors are satisfied with the drug program.

“Overall, people will continue to save money. It’s a no-brainer,” said Mohit Ghose, a spokesman for America’s Health Insurance Plans.

But Consumers Union focused on the most controversial piece of program, the doughnut hole, a period when most plans offer no coverage. After a recipient obtains $2,250 worth of drugs, most plans halt coverage until the person has spent a total of $3,600 out of pocket on drugs. At that point, the person comes out of the gap and the plan covers 95 percent of costs. An estimated 3 million to 7 million people are expected to reach the gap this year.

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For its report, Consumers Union called all 261 retail drug outlets in Broward County to get regular retail prices for six commonly used medicines, including cholesterol drug Lipitor, antidepressant Zoloft and blood pressure drug Norvasc.

Then researchers compared doughnut hole prices charged by more than 40 Medicare drug plans available in Broward. Sikora said the comparison would have come out the same anywhere in South Florida, and applies nationwide.

The results: The lowest price retail store had lower prices 80 percent of the time. For example, a Wal-Mart charged $62.85 for a one-month supply of Lipitor, but the lowest price for Lipitor for those in the doughnut hole was $67.46, in SilverScript Plus plan.

Sikora said researchers were not sure why the drug plan prices were so high for recipients in the gap. Plans were supposed to have bargaining power to extract lower prices. “The plans failed to do what they were supposed to do,” he said.

Sikora said he could not recommend that seniors in Medicare stop buying drugs through their plans when they reach the gap. Those who buy enough drugs to emerge from the gap should stay with their plans, because if they don’t, they will never reach the 95 percent coverage.

But for those who will not emerge from the gap, it’s worth shopping for lower prices once they reach the $2,250 threshold, he said.

“In many cases, individuals will be want to make their own decisions based on what’s best for them,” Sikora said.

The gap hit hard for Rita and Abe Levine of Delray Beach. Their drug bill soared by $500 a month after they hit the gap.

“We’re not poor from this but it’s affecting our monthly budget. Whoever came up with this plan, it’s a terrible plan,” Rita Levine said. “I better start shopping around now.”

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Light therapy and antidepressant equally effective treatments for seasonal affective disorde

October 10, 2006

Bright artificial light therapy is as effective as antidepressant medication in the treatment of winter depression, say Canadian psychiatry researchers in a new study published in the May 2006 issue of the American Journal of Psychiatry.

The study compared the use of the antidepressant drug fluoxetine and light therapy as treatment for trial patients in four Canadian cities over three winters.

“Both treatment options produced positive results - an improvement in the patient’s condition in 67 per cent of the cases - however the light therapy showed some advantages over the antidepressant fluoxetine,” says Dr. Anthony Levitt, co-author of the study and Chief of Psychiatry at Sunnybrook Health Sciences Centre. “The light therapy worked faster, having a greater effect at one week’s time, and it also produced less agitation, less sleep disturbance and less palpitations. The overall dropout rate however, including those due to side effects, did not differ between treatments,” says Dr. Levitt, who is also a Professor at the University of Toronto.

Although light therapy and antidepressants are each known to be more effective than placebo, there have been few direct comparisons of the two treatment options until now. “This study gives patients more information about their options, providing further evidence that both light treatment and medication can help with the sub-type of major depression,” says Dr. Robert Levitan, also a co-author of the study and a Psychiatrist at the Centre for Addiction and Mental Health.

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Study participants received light therapy and a capsule each day. One group received low-intensity “placebo” light in addition to the drug fluoxetine. The other group received a placebo capsule and was exposed to 10,000-lux white fluorescent light for 30 minutes a day. Patients who were identified as high risk for suicide were excluded from the study.

Winter depression is the most common type of seasonal mood disorder. “We have studied the population of Ontario and consistently find prevalence rates of seasonal depression of approximately 2.7 per cent,” says Dr Levitt. The symptoms may begin in the fall and include depressed mood, profound lack of energy, excessive sleeping, and overeating, in addition to reduced interest or motivation. Impaired occupational or social functioning is common.

The CAN-SAD Study was a randomized controlled double-blinded trial conducted by researchers at Sunnybrook Health Sciences Centre, the Centre for Addiction and Mental Health, the University of Toronto, the Vancouver Coastal Health Research Institute, the University of British Columbia, the University of Manitoba, Winnipeg Health Sciences Centre, and Dalhousie University.

The study was funded by the Canadian Institutes of Health Research (CIHR) and a CIHR/Wyeth Postdoctoral Fellowship Award. Light boxes were supplied by Uplift Technologies.

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