Posted by Alan on November 24, 2002, at 2:18:43
In reply to Re: AD withdrawal » Alan, posted by pharmrep on November 23, 2002, at 19:40:26
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> > > *** SCOTT...have you ever heard of "discontinuation syndrome" or "withdrawal side effects?" Ask any Dr. who has had patients on Paxil or Effexor, and had them switch to something else...they will undoubtedly say it exists..particularly for these 2 drugs....In fact, GSK is in court right now regarding the "addictiveness" of Paxil because it is so difficult for a person to stop taking it due to the side effects. Not everybody will experience it, but a majority of the people do. As for Prozac, Celexa, Lexapro...you can stop without a taper, and start another without the "withdrawal" problem.
> > ================================================
> > http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html
> >
> > I will try to find the other AD's on this list but besides the two mwntioned ALONG with Prozac, it seems, according to the World Health Organisation, there are more problems with the euphemistically termed "discontinuation syndrome" (withdrawal) than one might perhaps be aware of.
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> > Alan
> >
> >***** euphemistic? Do you think I made this topic up? This is a big deal these days...maybe more of a hot topic than sexual side effects.
++++++++++++++++++++++++++++++++++++++++++++++Gee I didn't think that would be taken personally - but here goes anyway....
Regarding the use of AD's in the treatment of anxiety disorders - and significantly, depression that's commonly being driven by a primary evaluation of anxiety disorder (if the evaluating doc has the skill to recognise the difference):
The pharmecutical co's have "wordsmithed" this phenomenon into the medicaleese lexicon since the test results that showed that these withdrawals were in truth actual withdrawals (and were not presented to the FDA as such since the results of those test results were thrown out) the companies had to come up with something to call it instead of "withdrawal". If you're going to compete with drugs that are off patent and that produce the dependence/withdrawal phenomenon (bzds) then you're going to have to come up with some pretty newwords to describe essentially the same thing so marketing will not be by definition, legally contradictory.
"Poop out" - another euhpemism for "tolerance" is similarly being dressed up to be something other than tolerance.
Most AD's have a worse complaint rate about "discontinuation syndrome" than any of the bzds (bzds being the boogey man drug that the pharmecuticals are trying to take the market share away from in the treatment of anxiety disorders), claiming to be non-habit forming or non-addictive.
People need to choose their meds according to what works best in their own case. SSRIs and benzodiazepines are both serious medicine. Both types of medication can cause the user to develop tolerance, requiring periodic increases in dosage to maintain effect, although that is certainly a minority experience. Both types commonly require weeks or months of gradual tapering to discontinue comfortably. Both types can (rarely) make someone so dependent that discontinuation feels next to impossible.
The success rate in anxiety disorders is higher for benzodiazepines, but a number like that has only predictive and statistical value. It is pretty much irrelevant in any individual case, since what works is what works.
The complaint rate for dependence is currently much higher for SSRIs (in fact, globally the absolute numbers are unprecedented in recorded medical history), but that's probably the result of overoptimistic expectations created by misleading marketing. The manufacturers' unpublished rates of withdrawal in trials with healthy volunteers were equivalent to those for benzodiazepines.
Bottom line: dependence is a wash. Neither type of drug can claim dependence doesn't happen. If a case is serious enough or sufficiently biological in manifestation to require medication, the medication should be chosen according to individual response.
In regards to drug-seeking behaivor:
As long as doctors are pushing an SSRI at every patient who even looks at 'em cross-eyed, there's not going to be any opportunity to observe drug-seeking behavior. In fact, what they see right now is SSRI-avoidant behavior in anxiety disorders.
But let the doctors start withholding SSRIs and doing all they can to get people off of them (a day that may well come), and then we will see drug-seeking behavior from people who might even prefer to be off but can't possibly quit over the two week period now recommended as a taper.
Of course it is always important to remember that differences in individuals' reactions to antidepressants are so big that it is difficult to state meaningful generalizations about the statistical difference between one anti-depressant and another.
I guess "Lexapro" sounds better for sales of the drug than "CelexaMinus," which would more accurately describe its chemical relationship to Celexa. It's just Celexa with the less active molecular isomers purified out.
Of course now they're trying to say all the side effects resided in the removed components and all the therapeutic effects reside in the remaining component. (As though all effects could be absolutely categorized as either "therapeutic" or "side," but that's another issue.) Such a convenient coincidence is highly unlikely from a biochemist's perspective, since most of the biological activity of any kind resides only in the component that remains in Lexapro. A lot of the putative difference between the two drugs is carefully orchestrated statistical noise.
Finally, in order to keep revenues up, Lexapro doesn't give you anything you weren't already getting in Celexa, it's just sort of "purified". By doing that, they can get a new patent for what is essentially the same medication. And by investing many times as much money in marketing as they do in development, the drug companies can convince an amazing number of naive doctors that Lexapro actually IS newer, better, and amazingly free of most of the others' side effects and withdrawal phenomena that have emerged with all previous miracle drugs for the mind.
And speaking of side effects, get a load of the statistics cited on for instance sexual dysfunction. You wonder how a doctor can cite numbers like that without smirking all the way to the bank. He HAS to know they're fictitious. He can't be that blind to his own patients. Can he?
The whole thing is pretty close to putting new paint on an old pill and selling it again. The makers of Prozac tried to do the same thing but had to abandon it before getting to market because the "purified" Prozac turned out to cause dangerous heart arrhythmias.
The patent on Prozac was close to expiring and its manufacturer was scrambling to hold on to revenues and came out with a "new" prozac to treat PMS.
It makes you think. If they can get a patent on Prozac Weekly, the same active ingredient as normal Prozac in a different delivery matrix, they're not patenting medications -- they're patenting the physical pills!!!
So why don't they just patent something like a 2 mg (or whatever size) pill of every med to begin with? Then when that patent is about to expire, they can "invent" a 1 mg pill and patent that as a new medication that needs only half the dosage of the old one. Hell, with enough money spent on marketing, they can probably persuade tens of thousands of doctors that the 1 mg pill has less than half the side effects of the old, obsolete, addictive 2 mg pill.
It's a good thing for the drug companies that the FDA exists to keep a short leash on the patent office and other arms of government. Otherwise all kinds of rational thinking might break loose.
To make a profit these days, the co's have to differentiate. The best way to do that within a single class of drugs is to claim to have fewer side effects. Because of a serious loophole in our laws about drug research, they just keep doing trial after trial until they figure out how to get some of them to come out as desired. Then they negotiate with the FDA about what trials to include and how to summarize them in the prescribing info.We need to change our laws so that as part of the price for approval of a drug, *ALL* studies on its use in humans (at the least) get placed into the public domain...no matter what you hear information here to the contrary. That way it won't be as easy to make distorted claims. For instance, the public and the FDA have seen only a small fraction of SKB/GSK's studies on Paxil. In the majority of them it worked worse than placebo to a statistically significant degree*. At least that's what plaintiffs in one of the class-actions suits alleged, promising to provide supporting evidence. It just shouldn't be legal to hide things like that. And now that scandals like the HRT and cox-2 inhibitor surprises are emerging (i.e. it affects more than just us "head cases") I think there's some chance the regulatory environment may change.
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* Still, that's an average response. It doesn't negate the fact that some people respond and some of those respond extremely well. Statistical truth and statistical inference, important as they are, have considerable limits. The closer you narrow it down to an individual case, the fuzzier the picture gets until there is no statistical picture at all when dealing with a sample of one. Just because the number of people doing well on a drug is less than the number doing well on placebo does not prove that all those people are experiencing a placebo effect or spontaneous remission. Some of them may very well be experiencing a bona fide pharmacologically therapeutic effect. It's just that one can't prove it statistically. With the right tools, one could hypothetically prove it chemically or by doing repeated double-blind crossover trials on one or more individuals.Alan
poster:Alan
thread:109458
URL: http://www.dr-bob.org/babble/20021122/msgs/129020.html