Lexapro

[jobob]

I'm sorry you took offense to my comments, limewave, but to be honest I took a bit of offense to your friends'.
(Or I would have, were I still in the lab trying to work on such things.)

She says the money is in treating symptoms, not curing them. In one respect she's right. The bar is much higher for cures than for treatments. What defines a cure? Absence of symptoms or absence of the physiological marker for the disease - but, for how long? Forever? So if a patient has a relapse after 5 years, then it's not a cure? The devil is in the details.

Plus, how safe and tolerable is a "treatment" as opposed to a "cure"?

It's easy to be cynical about pharma - lawd knows I am, often!! - but sometimes when I boil it down to the basic problems and issues and realities, I can (grudgingly) realize that there are a lot of factors in play and it's not a big 'ol conspiracy.

I'm glad that you found an alternative that works for you.

And I'm sorry that your folks have had a difficult time with their prescriptions. It can get mind-boggling. But do you really know that no-one has bothered to investigate the origins of their problem(s)? That's painting with an awfully broad brush, isn't it?

Perhaps the dispensing physician or pharmacist are not giving you (or your folks) the kind of information you/they desire? Just wondering.

[alpinerabbit]

I'm in the industry too and can only back up what they said. Pharma bashing is convenient but not always backed by logical thinking.

If any of the big Pharmas *could* develop a miracle drug that with one dose or one course, could make depression go away, forever - they would go to FDA, NIH, and health insurance companies etc. and tell them look, we can save you tens of 1000s of bucks per person for doctors fees, chronic medication, psychotherapy, even institutionalization - we'll charge 20'000 (or insert any other, largish amount) a course and the patient is done.*
It would be fair, and it would be nice to have.
Unfortunately depression like many other chronic illnesses is poorly understood, possibly multifactorial and can't just be switched off by finding the right button. At least not yet. Therefore, this is an example for a disease where only symptoms can be treated.

Bacterial infection? Other issue entirely. As long as the strain is not resistant (which is an almost inevitable consequence of the development and use of these drugs, it is "directed evolution"), the course of antibiotics will cure the disease and not just gloss over the symptoms.

Or you vaccinate. Maybe, one day, there will be a vaccine against depression. Who knows.


*they cannot just give the drug away. It's a business to make profit.
A drug costs between 0.5-0.8 billion $ to develop. You have to recoup that, and a profit on top. And if it only takes one shot, that shot is gonna cost.

[limewave]

Jobob--sorry, I was in a defensive mood this morning. Didn't mean to come off harsh.

[Crankin]

I am not anti-medication, but I think we need to be very informed. There are other ways to treat depression, or at least use in conjunction with meds, until you can wean off of them, and I am not talking about quackery here. It's just that the development of these medications has changed the field of psychotherapy so much, that meds are the only thing many think of, in terms of treatment. It scares me when one of my close friends has been prescribed Lexapro by her gyn. She has a mess of issues and has not had any counseling. The medication does not seem to be effective (there was some good response in the beginning), but after 5-6 years, she just takes her dose and wonders why no one can stand to be around her. How is her case being monitored?
I know that Aggie is not in that position, but many people are.

[jobob]

No sweat, limewave!

And Crankin, you're making a very good point. Is your friend willing to look into counseling? When one is in that sort of position, it's very hard to take those kinds of steps (been there, avoided that) but sometimes one has to take the bull by the proverbial horn and be a bit self-reliant to get the kind of help one needs. Much easier said than done, unfortunately.

[alpinerabbit]

agree with jobob here - what is a gyn doing prescribing antidepressants?

[Jolt]

I am not anti-medication, but I think we need to be very informed. There are other ways to treat depression, or at least use in conjunction with meds, until you can wean off of them, and I am not talking about quackery here. It's just that the development of these medications has changed the field of psychotherapy so much, that meds are the only thing many think of, in terms of treatment. It scares me when one of my close friends has been prescribed Lexapro by her gyn. She has a mess of issues and has not had any counseling. The medication does not seem to be effective (there was some good response in the beginning), but after 5-6 years, she just takes her dose and wonders why no one can stand to be around her. How is her case being monitored?
I know that Aggie is not in that position, but many people are.

I agree with this. Yes, the meds have their place, but too often people look for the "quick fix" of a pill instead of trying other things (like counseling and lifestyle changes) as the first line of treatment. This really applies to a lot of things (weight loss, cholesterol, blood pressure) and not just depression. Sometimes the meds are still necessary, but in many cases I think things can be solved without them and that eliminates the possibility of side effects.

[skinimini]

agree with jobob here - what is a gyn doing prescribing antidepressants?

In defense of gynecologists--they are primary care physicians, just as internists and family practitioners. Most have done advanced work in psychopharmacology and are highly qualified to prescribe antidepressants. Reputable physicians of all sorts know when to refer to specialists and do so regularly--including to psychiatrists, psychologists, therapists, etc. It's true that I am married to a very well-respected gynecologist, so I suppose I'm a little biased.

[sundial]

Since depression occurs in more women than men, it is not unreasonable for a gyne to prescribe antidepressants. Depression can be triggered by hormonal imbalance, such as post-partum depression, and ob-gyne docs are trained to diagnose and treat this illness.

[Crankin]

I guess he prescribes it for her because he is her primary care physician. I know him socially (not a friend, but belongs to my temple) and he is a good doc, but I think it needs to be monitored.
Jobob, my friend has had counseling in the past, when things were really bad in her marriage and when there were kid issues. That was quite awhile ago. It is a long and complicated story. I truly think that she knows she has issues, but she is so rigid in her thinking that she just says, well, this is the way it is. Eventually, I may say something to her, but even as a therapist in training, I know I shouldn't be "counseling" a friend. For me, it's a situation of not being able to cut off ties all the way, for many reasons, but not being able to stand being around her, either. So, I limit my phone calls to 1-2x a month and we rarely get together socially as opposed to in the past. She also has ADD and can't remember anything. It's getting worse, or maybe I didn't notice it before. If something was a certain way, like 10-15 years ago, that's how she remembers it. Like, if when my son was 12, he liked something or did something, then she thinks thats how it is today, even though he's an adult. She thinks she has to do things the way "mommy and daddy (her words)" did them, even though, she overtly hostile to her mother and says how judgmental and demanding she is; guess what? She is exactly the same.
OK, enough of my example. I will end with this: She came to yoga with me one time last year. At the end, she said, "Oh, I never get this relaxed. This is really great." I told her that's a good reason to practice yoga and that it might help her in various ways. Her reply was, "Oh, I don't really believe in this stuff."

[Dogmama]

Crankin, I have several friends like that. They swear they can't afford counseling, even though their insurance probably covers it if they'd bother to look, but whine about the same stuff over & over. As a counselor-in-training too, I am learning to hold my tongue & let them "go through their process." Hopefully they'll get sick & tired of being sick & tired. In the meantime, I limit contact too.

BUT, back to the OP & meds - primary care docs prescribe most antidepressents. If it's working, don't fix it. If it isn't working, I'd see a Pdoc.
They know the latest about meds & sometimes can add something that tweaks things. Fact is - nobody knows what will work for any single person. A Pdoc just has more experience. After all, I'd NEVER let my Pdoc do a pelvic exam on me.

[jobob]

Well Crankin, you did what you could, and you're bound by ethics so that can be tricky.

Hopefully she'll eventually come to realize what she needs, and be willing & able to seek it out.

[ZenSojourner]

Well I work in the field too and I would strongly disagree that companies prefer to have drugs with side-effects so that they can make more money.

I don't think that's what's being said at all. Rather that side effects are not considered of primary importance by drug manufacturers, and doctors tend to prescribe more meds to deal with the side effects. This is very well documented in the medical literature and it's how many elderly patients end up on 20 or 30 meds. My dad was on a med that had the side effect of causing tremors; they put him on another med to control the tremors. That med had the side effect of causing stomach problems; they put him on a med for stomach problems; etc etc etc ad nauseum.

The reason there are so many side effects is that the drug acts at many more places other than where you need it to act for its benefit. They aren't really "side effects" but are what we would call extensions of the pharmacology of the drug or exaggerated pharmacology.

BULL. That's the very definition of side effect, an effect that you don't want coupled with the one that you do. Calling it "an extension of the pharmacology of the drug" is like calling a bug in a program a "feature".

But trust me when I say that companies are definitely trying to find more exact mechanisms.

I'm sure if they stumbled across a more exact mechanism they would happily exploit the hell out of it. However the truth of the matter is that drug studies are manipulated and massaged in order to minimize the impact and frequency of side effects. It's all about approval and marketing.

Another well documented fact is that once a drug is released, side effects in the general population are more frequent, broader in scope, and potentially more severe than were reported in the drug studies. A certain amount of this can't be helped - there are always going to be side effects that pop up when your sample size is millions that you would be unlikely to run across when your sample size is 100. But the truth is that side effects are routinely down-pedaled and soft-shoed in order to get through the approval process, and to make the drug more palatable and hence more marketable to the public. There is a mechanism in place for doctors to report side effects post-approval, but very few use it. A lot of docs seem to be unaware that the mechanism even exists, and even if they do know about it, they don't know how to access it.

Doctors have also been brain-washed into believing that side effects are always "rare" which they generally equate to "non-existent". As a person who has suffered from many many weird and bizarre side effects (drug sensitivity runs on BOTH sides of my family) I can attest to the fact that docs more often than not tend to discount patient reports of side effects.

Recently my father was having problems with low BP. We had moved recently and he didn't have new docs yet. During a hospitalization for an entirely different matter, the hospital doc took him off ALL his heart meds, citing the low BP as the reason. This doc did not review his med list, he just took him off ALL his heart meds, meds he has been on for 15 years and has always tolerated well. His low BP not only did not remit, his CHF got much, much worse (go figure, how could that happen?). It was left to ME to review his med list, discover that some doc had put him on Wellbutrin, find the literature listing low BP as a potential side effect, and then wrangle with the doc to drop the Wellbutrin and put him BACK on the heart meds. What was the doc's response when the side effect of low BP related to Wellbutrin was pointed out to him? "Side effects are very rare".

It has been documented that side effects among the general population post-marketing run 3x to 10x what is reported in the pre-approval testing. So they're not rare, but Big Pharma wants us to think they are. So they under report, massage the data, find reasons to drop people who have adverse reactions so they don't "dirty" the data for approval.

Take Prozac for instance. Upon review, FDA officials discovered that researchers had dropped 76 of 97 cases of reported suicidality from its post-marketing surveillance data submitted to the FDA. DURING pre-marketing drug testing, similar cases had been excluded based on the flimsiest of excuses. I loaned that report to a friend so I can't look up the exact circumstances, but incidents of activation (emotional stress that can lead to suicidality) and actual suicidality were dropped from the data set based on some self-serving double talk, sort of like calling a side effect "an extension of the pharmacology of the drug".

Furthermore, Prozac is almost 20 times more likely to result in a suicide attempt than other antidepressants. (Spontaneous Domestic Reports January 1982-July 1991. [PZ-1548, See pp. 5-14]). This was known before marketing and it was hidden via data manipulation and under reporting in order to get Prozac through the approval process.

Prozac was a bonanza for Eli Lilly, and in fact when their monopoly on it ran out, they repackaged it as a treatment for PMS so they could extend their monopoly on it. (http://web.mit.edu/newsoffice/1997/pms.html)

Serafem (Prozac repackaged for treatment of PMDD but often prescribed for PMS) is reported by Eli Lilly to have "similar side effects" to Prozac. This is more Big Pharma double-talk, since Serafem is the exact same drug in the exact same dosage, only tinted a pretty pink, it has the EXACT same side effects as Prozac.

The problem is that the way Prozac was foisted off on the American Public is par for the course.

So sorry, but trusting Big Pharma, and you indirectly as their mouthpiece, is not in the cards here.

*EDIT*

I did find some of the info on Prozac's approval process online

http://www.baumhedlundlaw.com/media/timeline.html

These are exerpts from ELI LILLY documents during testing phases, pre-approval, and post-marketing.

ELI LILLY KNEW there were major risks associated with Prozac. The only thing this spurred them to do was to find ways to double-talk it, downplay it, and hide it.

[Crankin]

I tend to agree with everything ZenSoujourner said (in a much more eloquent way than I could).
You are lucky if you can take SSRIs or any other medication with no side effects. I have side effects with everything. If I ever get heart disease or several other things that require medication, I will be in serious trouble because I can't take things that have the stuff that causes "serious digestive problems." It's in so many things that it seems crazy. I almost had to be hospitalized when I tried Fossomax about 7 or 8 years ago. Last year, when I was having all my medical issues, I tried two SSRIs... bad, bad, bad. I felt worse than the original problem that lead me to trying them. Let's see, oh yes, I am also allergic to iodine, hence IV contrast dye, so if i ever need a cardiac stress test, angiogram, etc who knows what they will do. Guess I'd better keep riding!

[ZenSojourner]

(Major snippage - about depression) Therefore, this is an example for a disease where only symptoms can be treated.

Depression isn't a disease. It's a process. It is, as you noted, multifactorial and includes developmental, emotional, environmental, and biological elements. The medical model of disease - alleopathic treatment (eg drugs or surgery) - cure doesn't fit because it isn't a disease.

As others have noted, taking the pill (whatever the flavor of the week happens to be) and then continuing to live in dysfunction isn't really helping anyone. If someone came into a doctor's office with a broken leg and he sent them home with morphine or oxycontin, it might reduce the pain of the broken leg, but the leg is STILL BROKEN. Or better yet, a bleeding wound. The patient may feel better, but he'll still bleed to death, even if happily, if you only treat the symptoms palliatively.

That's what is being done when people are given drugs for life-style/developmental issues like depression and anxiety. Not only that, but the research shows that drugs alone do not work as well as drugs plus therapy; and that drugs plus therapy does not work as well as therapy alone. The longer the followup time, the better therapy looks.

The people who have lasting effects are people who make lasting change in their lives, and drugs do not do that.

As for GPs and other non-specialists prescribing psychoactive meds, it should not be done. It IS done routinely, but it shouldn't be. The vast, VAST majority of cases of under, over, and mis-medication occur when a non psych MD hands out powerful psychotropics without the necessary evaluation, followup and monitoring. Anyone who thinks you can be fully trained to handle psychotropic medications in under 18 months to 2 years of full time study on just that subject alone is mistaken. Furthermore even most Psych MDs underestimate the importance of concurrent therapy or even therapy as a preferred treatment.

It's true that people tend to seek a solution in a capsule, but it's also true that the medical establishment by and large pushes pills, largely due to the history of the development of antibiotics. Penicillin was a wonder drug that could cure nearly anything that ailed you. It was a miracle back when people died of minor cuts and tooth aches with what we would now consider to be alarming frequency. Pills and surgery were miracles, and modern medicine has yet to move beyond the early flush of the success of mechanical intervention.

Drugs can have a dramatic effect on behavior and emotion; but take the drug away and the effect dissipates. Antibiotics "cure" because they kill off disease causing organisms; but depression and anxiety are not caused by killable critters. They are an outgrowth of the way we look at and interact with the world, and that doesn't come in a pill.