SEROXAT AND OTHER SSRIs

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Posts Tagged ‘Antidepressants’

Crusader’s highly deserved recognition

Posted by shutah on February 19, 2011

Surely, one of the proudest moment’s in Bob Fiddaman’s quest for justice in the eternal fight against SSRI’s .

As Bob writes in his blog “What could piss off GlaxoSmithKline more than Bob Fiddaman getting an award for basically highlighting their dark history?”

Way to go Fiddy!!!!!!

[Click the pic to read the full story]

Posted in Blogroll, Depression, GlaxoSmithKline, GSK, Health, Paroxetine, Paxil, Seroxat, SSRIs | Tagged: , , , , , , | 1 Comment »

SSRI Comparison Facts

Posted by shutah on February 14, 2011

Comparison of Selective Serotonin Reuptake Inhibitors (SSRIs)

Efficacy and effectiveness

Clinical trials comparing one SSRI with another indicate that drugs in this class are equally efficacious. Each antidepressant produces approximately a 60% overall response rate (ie, at least a 50% reduction in symptoms as a result of treatment). However, some differences in the SSRIs efficacy exist.

Escitalopram may be superior in efficacy compared with other SSRIs in the treatment of major depressive disorder2. Also escitalopram has better efficacy in the treatment of severe depression than citalopram4.  A major consideration with escitalopram is that it is not yet available in lower-cost generic form. The drug is still under patent. In 2006 Forest Laboratories was granted an 828 day (2 years and 3 months) extension on its patent for escitalopram31. This pushed the patent expiry from December 7, 2009 to March 14, 2012.

Paroxetine, fluoxetine, and sertraline are similar in effectiveness for major depression and depression with high levels of anxiety3,5.

Paroxetine is the only SSRI indicated for all five anxiety disorders in addition to major depressive disorder.

Fluoxetine has a slower onset of antidepressants effect than other SSRIs4. Also, fluoxetine appears to be somewhat less effective, than other drugs in this class24,25.

Sertraline may have a slightly higher rate of response than fluoxetine and paroxetine26. Sertraline has advantages over paroxetine in the treatment of panic disorder27.

Interesting and important fact is that SSRI antidepressants are not interchangeable. Persons who discontinue one SSRI for lack of tolerability or response can be effectively treated with another19.

Discontinuation symptoms (withdrawal)

SSRIs aren’t considered addictive.  YET !! However, stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, including nausea, headache, dizziness, lethargy and flu-like symptoms. This is sometimes called discontinuation syndrome.

All antidepressants do not have the same type or severity of withdrawal symptoms. Discontinuation syndrome is more common with the SSRIs with shorter half lives and inactive metabolites, such as paroxetine, sertraline, and fluvoxamine. The incidence of discontinuation syndrome is highest with paroxetine followed by fluvoxamine and sertraline. Citalopram and fluoxetine have a lower occurrence of withdrawal symptoms10.

Abrupt interruption of antidepressant therapy for 5-8 days was associated with the emergence of new somatic and psychological symptoms in patients treated with paroxetine and to a lesser degree sertraline, with few symptoms seen with fluoxetine12.

Pregnancy category

All SSRIs (except paroxetine) are classified as pregnancy Category C, meaning that they may not be safe for use during pregnancy.

Paroxetine (Paxil, Paxil CR) is pregnancy Category D medication. Paroxetine may cause heart defects or serious, life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy.

Pharmacology

Selective serotonin reuptake inhibitors differ in their potency and selectivity in inhibiting serotonin reuptake and there may be important effects on other transporters and receptors, indicating that they are not as selective as their manufacturers suggest. It has been proposed, for example, that fluoxetine’s effects on 5-HT2C receptors may underlie a propensity to cause agitation; paroxetine’s affinity for muscarinic receptors causes its increased tendency to produce discontinuation effects; sertraline’s affinity for the dopamine transporter results in a greater efficacy in severe depression; and sertraline’s and fluvoxamine’s affinity for sigma1 opioid receptors is responsible for their efficacy in psychotic depression (Goodnick & Goldstein, 1998a).

Half-life

The half-life of a drug is the time required to achieve steady-state plasma concentrations (i.e., to metabolize half the dose and lower blood concentrations by 50%). Half-life can be used to estimate how long it will take to clear a drug from the body after treatment is discontinued.

Fluoxetine is unique because of its long half-life and the long half-life of its active metabolite norfluoxetine. Fluoxetine has a half-life of 2-4 days and its active metabolite, norfluoxetine, has a half-life of 4-16 days.

In comparison, citalopram, escitalopram, paroxetine, and sertraline have shorter half-lives in the range of 20-35 hours, and steady-state concentrations (and therapeutic effect) are reached much more rapidly. The long half-life of fluoxetine may blunt the effects of missed doses or treatment discontinuation and makes it easier to discontinue than any of the other SSRIs. On the other hand, fluoxetine requires a much longer washout period than the other SSRIs (several weeks), particularly when switching to monoamine oxidase inhibitors (MAOIs) or TCA.

Antidepressants with relatively short half-lives are desirable for people with multiple comorbidities and complex, multiple-drug regimens because they allow for once-daily dosing. A short half-life enables physicians to switch more rapidly and safely to an alternative antidepressant if treatment fails or if unfavorable drug reactions occur.

Paroxetine and fluvoxamine are more quickly cleared from the body than the other SSRIs.

The possible slower onset of antidepressant action of fluoxetine may be owing to a longer time taken to achieve therapeutic plasma concentrations. In situations where the speed of onset of therapeutic effect is particularly important, such as in severe depression, fluoxetine may not be the SSRI of choice. Patients in whom the long half-life may have advantages (and therefore for whom fluoxetine should be considered) include those who are poorly compliant and those in whom administration less frequent than daily is contemplated.

Sertraline exhibits a sex- and age-dependent half-life. In men, the half-life is approximately 30% shorter (22.4 hr) than in females or the elderly (32.1-36.7 hr).

References
  • Celexa Prescribing Information Celexa.com, Forest Pharmaceuticals, Inc.
  • Lexapro Prescribing Information Lexapro.com, Forest Pharmaceuticals, Inc.
  • Paxil Prescribing Information – Paxil.com, GlaxoSmithKline
  • Prozac Prescribing Information Prozac.com, Eli Lilly and Company
  • Zoloft Prescribing Information – Zoloft.com, Pfizer Inc.
  • 1. Side-effect profile of fluoxetine in comparison with other SSRIs, tricyclic and newer antidepressants: a meta-analysis of clinical trial data. Pharmacopsychiatry. 2005 Mar;38(2):69-77 MedLine
  • 2. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. J Psychiatry Neurosci. 2006 Mar;31(2):122-31. MedLine
  • 3. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA. 2001 Dec 19;286(23):2947-55
  • 4. Escitalopram is more effective than citalopram for the treatment of severe major depressive disorder Encephale. 2004 Mar-Apr;30(2):158-66. MedLine
  • 5. Fluoxetine versus sertraline and paroxetine in major depression: tolerability and efficacy in anxious depression. J Affect Disord. 2000 Aug;59(2):119-26.
  • 6. Labbate LA. Sex and serotonin reuptake inhibitor antidepressants. Psychiatr Ann. 1999;29:571–9.
  • 7. Meijer WE, Heerdink ER, van Eijk JT, Leufkens HG. Adverse events in users of sertraline: results from an observational study in psychiatric practice in The Netherlands. Pharmacoepidemiol Drug Saf. 2002;11:655–62. PubMed
  • 8. Fava M. Weight gain and antidepressants. J Clin Psychiatry. 2000;61(Suppl.):37–41. PubMed
  • 9. Fergunson JM. SSRI antidepressant medications: adverse effects and tolerability. Primary Care Companion. J Clin Pschiatry. 2001;3:22–7.
  • 10. Schatzberg AF, Haddad P, Kaplan EM, Lejoyeux M, Rosenbaum JF, Young AH, Zajecka J. Serotonin reuptake inhibitor discontinuation syndrome: a hypothetical definition. Discontinuation Consensus panel. J Clin Psychiatry. 1997;58
  • 11. Westenberg HG, Sandner C. Tolerability and safety of fluvoxamine and other antidepressants. Int J Clin Pract. 2006 Apr;60(4):482-91. PubMed
  • 12. Rosenbaum JF, Fava M, Hoog SL, Ascroft RC, Krebs WB. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biol Psychiatry. 1998 Jul 15;44(2):77-87. PubMed
  • 14. Ian M. Anderson and J. Guy Edwards. Guidelines for choice of selective serotonin reuptake inhibitor in depressive illness Advances in Psychiatric Treatment (2001) 7: 170-180
  • 15. Fava M, Judge R, Hoog SL, Nilsson ME, Koke SC. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry. 2000 Nov;61(11):863-7.PubMed
  • 16. Montejo-Gonzalez AL, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A, Carrasco JL, Ciudad J, Daniel E, De la Gandara J, Derecho J, Franco M, Gomez MJ, Macias JA, Martin T, Perez V, Sanchez JM, Sanchez S, Vicens E. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 1997 Fall;23(3):176-94.PubMed
  • 17. Maina G, Albert U, Salvi V, Bogetto F. Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors. J Clin Psychiatry. 2004 Oct;65(10):1365-71.PubMed
  • 18. Bymaster FP, Zhang W, Carter PA, Shaw J, Chernet E, Phebus L, Wong DT, Perry KW. Fluoxetine, but not other selective serotonin uptake inhibitors, increases norepinephrine and dopamine extracellular levels in prefrontal cortex. Psychopharmacology (Berl). 2002 Apr;160(4):353-61.
  • 19. Nurnberg HG, Thompson PM, Hensley PL. Antidepressant medication change in a clinical treatment setting: a comparison of the effectiveness of selective serotonin reuptake inhibitors. J Clin Psychiatry. 1999 Sep;60(9):574-9.
  • 20. Stahl SM. Not so selective serotonin reuptake inhibitors. J Clin Psychiatry 1998;59:343-4. Psychiatrist
  • 21. Owens JM, Knight DL, Nemeroff CB. Second generation SSRIS: human monoamine transporter binding profile of escitalopram and R-fluoxetine. Encephale. 2002 Jul-Aug;28(4):350-5. PubMed
  • 22. Bolden-Watson C, Richelson E. Blockade by newly-developed antidepressants of biogenic amine uptake into rat brain synaptosomes. Life Sci. 1993;52(12):1023-9. PubMed
  • 23. Edwards JG, Anderson I. Systematic review and guide to selection of selective serotonin reuptake inhibitors. Drugs. 1999 Apr;57(4):507-33. PubMed
  • 24. Geretsegger C, Bo”hmer F, Ludwig M. Paroxetine in the elderly depressed patient: randomized comparison with fluoxetine of efficacy, cognitive and behavioural effects. Int Clin Psychopharmacol. 1994 Spring;9(1):25-9. PubMed
  • 25. Flament MF, Lane RM, Zhu R, Ying Z. Predictors of an acute antidepressant response to fluoxetine and sertraline. PubMed
  • 26. Clinical Pharmacology of SSRI’s. How SSRIs as a Group Are Similar.Sheldon H. Preskorn, M.D.
  • 27. Bandelow B, Behnke K, Lenoir S, Hendriks GJ, Alkin T, Goebel C, Clary CM. Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison. J Clin Psychiatry. 2004 Mar;65(3):405-13 PubMed
  • 28. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001;62 Suppl 3:10-21. PubMed
  • 29. Winokur A, Lexon N, Allen K, and et al. Sertraline administered for 8 weeks to depressed patients did not alter sleep architecture: a preliminary report. New Research Program and Abstracts of the 147th Annual Meeting of the American Psychiatric Association; May 24, 1994
  • 30. Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009 Feb 28;373(9665):746-58.
  • 31. “Forest Laboratories Receives Patent Term Extension for Lexapro” Press release

Published: May 05, 2007
Last updated: August, 2009

Posted in Paroxetine, SSRIs | Tagged: , , , , , | 1 Comment »

GSK gives in – Last-minute deal in Avandia suit

Posted by shutah on January 31, 2011

A federal court in Philadelphia was all set to hear a liability lawsuit against GlaxoSmithKline today, but an 11th-hour settlement took that case right off the docket. GSK made a deal with the family of Avandia patient James Burford to resolve claims that the diabetes drug caused his fatal heart attack. GSK recently took a $3.5 billion charge for legal expenses, including new Avandia litigation filed in the U.S.

The settlement lets GSK avoid the risk of a jury trial, Matrix Corporate Capital analyst Navid Malik told Bloomberg. Investors had worried that a trial “could lead to substantial punitive damages,” Malik said. “GSK needs to successfully settle as many of these cases as possible.”

Two other suits brought by the same plaintiff attorneys were also settled. “GSK has resolved the Burford case scheduled for trial today in the U.S. District Court in Philadelphia, and all cases represented by attorneys Joseph Zonies and Thomas Cartmell,” GSK said in a statement, which also emphasizes that, “GSK continues to stand behind the safety and efficacy of Avandia when used appropriately and according to its label.”

Avandia’s safety, particularly its potential link to heart attack risks, has been under debate for several years, and GSK has already resolved some 10,000 liability suits with a $460 million settlement. In September, European regulators banned Avandia, saying its risks outweighed its benefits. The FDA stopped short of withdrawing the drug, but sharply restricted its use, and GSK agreed to stop promoting it. About 2,000 more lawsuits remain outstanding.

This SUCKS!!!  Not for the Claimants, I’m thrilled for them.  But GSK have ‘settled’ the case, thereby allowing them to walk away from their responsibilities by not having to testify in Court.

Their statement … “GSK continues to stand behind the safety and efficacy of Avandia ….” shows them to be lily-livered, cold-hearted bureaucrats with a seemingly bottomless well of money to throw about.  I’ll bet GSK doesn’t have the balls to ‘fess up to their errors when it comes to the SSRI drugs they ‘peddle’ around the World!!!  Boo, Hiss GSK!!!!

Posted in GlaxoSmithKline | Tagged: , , , , , , , | Leave a Comment »

NICE updates six year old guidance on chronic anxiety

Posted by shutah on January 28, 2011

26th January 2011

Guidance on managing generalised anxiety disorder (GAD) in adults is being updated for the first time since 2004.

GAD is a common condition with chronic, excessive worry about a number of different events associated with heightened tension. It can vary in its severity and complexity for each person. The National Institute for Health and Clinical Excellence (NICE) says it is important to consider how each patient should be treated individually.

In a statement, Christine Carson, Programme Director for the Centre for Clinical Practice at NICE, says: “Since NICE published guidance on the condition in December 2004, new evidence has emerged about how to manage GAD in adults. Therefore this particular section of the guideline was prioritised for updating. The new recommendations include health professionals considering a diagnosis of GAD in patients presenting with anxiety or significant worry, and in those frequently attending primary care who have a chronic physical health problem, or do not have a physical health problem but are seeking re-assurance about somatic symptoms or are repeatedly worrying about a range of different issues.”

Updated recommendations include:

  • Recognition and communication of the diagnosis of GAD should occur as early as possible to help people understand the disorder and start effective treatment promptly
  • People with GAD, whose symptoms do not improve with education and active monitoring, should be offered one or more of the following as a first-line intervention, guided by the person’s preference: individual non-facilitated self-help, individual guided self-help or psycho-educational groups
  • Patients should not be offered an antipsychotic for the treatment of GAD in primary care
  • People with GAD with marked functional impairment or those whose symptoms have not adequately responded to low-intensity psychological interventions such as pure self-help, guided self-help and psycho-educational groups should be offered an individual high-intensity psychological intervention or a pharmacological intervention

An under-recognised condition

Dr Tim Kendall, Director of the National Collaborating Centre for Mental Health, Medical Director and Consultant Psychiatrist, Sheffield Health and Social Care NHS Foundation Trust says: “Generalised anxiety disorder is a very common but under-recognised condition characterised by endless worrying, which results in substantial disability for many sufferers, affecting their capacity to work and to live fulfilled and meaningful lives. Many develop secondary disorders, such as panic and depression, and it’s much more common in people with chronic physical ill-health.”

He continued, “People with GAD will be able to choose from a range of self help interventions, including two psychological treatments and some antidepressants. The guideline emphasises choice and patient preference, and is much clearer that there are some old treatments that just don’t work. This is a really excellent and new piece of work produced with some of our top national clinical experts and really committed service users.”

Reaction

Reacting to the new guidance, Catherine O’Neill, Services Manager at Anxiety UK tells us by email: “GAD is a particularly difficult disorder to live with as it is constantly on the sufferer’s mind, providing no respite for the sufferer. Anxiety UK is pleased that NICE has revised their guidance on GAD so people can be diagnosed more quickly and receive the help they need.”

She explained, “Anxiety UK knows that currently GAD sufferers often do not receive a formal diagnosis for many years and are often misdiagnosed, leading to a prolonged period of uncertainty. It is hoped that focusing on early detection will reduce this.

“We also approve NICE’s recognition of the importance of self-help in treating GAD. Peer support is extremely beneficial, not least because it reduces the social isolation that many sufferers experience, and our members’ feedback shows that self-help can be vital in managing GAD long term. Anxiety UK is pleased to see more robust guidance overall with an emphasis on patient choice at the centre.”

 

Posted in SSRIs | Tagged: , , , | 1 Comment »

Troops can’t heal what they can’t feel !!!

Posted by shutah on January 27, 2011

Troops can’t heal what they can’t feel

Paxil, Zoloft, Fluoxetine, Sertaline ……

Each medication comes with warnings but no one seems to be paying attention to them anymore than they paid attention to the fact that most of these medications include instructions that a doctor monitor the patients. In other words, sending them back into combat on these medications offering warnings against driving or operating machinery is not a good idea considering they are doing a lot more than just driving.

PTSD is a wound but it is a wound causing emotional pain. They need to be able to feel something so they can heal it.

 

 

 

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