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http://jewishworldreview.com/1102/koerner1.asp
Pharmaceutical companies have come up with a new strategy to market their drugs: First go out and find a new mental illness, then push the pills to cure it.
http://www.NewsAndOpinion.com | Word of the hidden epidemic began spreading in the spring of 2001. Local newscasts around the country reported that as many as 10 million Americans suffered from an unrecognized disease. Viewers were urged to watch for the symptoms: restlessness, fatigue, irritability, muscle tension, nausea, diarrhea, and sweating, among others. Many of the segments featured sound bites from Sonja Burkett, a patient who'd finally received treatment after two years trapped at home by the illness, and from Dr. Jack Gorman, an esteemed psychiatrist at Columbia University. Their testimonials were intercut with peaceful images of a woman playing with a bird, and another woman taking pills.
The disease was generalized anxiety disorder (GAD), a condition that, according to the reports, left sufferers paralyzed with irrational fears. Mental-health advocates called it "the forgotten illness." Print periodicals were awash in stories of young women plagued by worries over money and men. "Everything took 10 times more effort for me than it did for anyone else," one woman told the Chicago Tribune. "The thing about GAD is that worry can be a full-time job. So if you add that up with what I was doing, which was being a full-time achiever, I was exhausted, constantly exhausted."
The timing of the media frenzy was no accident. On April 16, 2001, the U.S. Food and Drug Administration (FDA) had approved the antidepressant Paxil, made by British pharmaceutical giant GlaxoSmithKline, for the treatment of generalized anxiety disorder. But GAD was a little-known ailment; according to a 1989 study, as few as 1.2 percent of the population merited the diagnosis in any given year. If GlaxoSmithKline hoped to capitalize on Paxil's new indication, it would have to raise GAD's profile.
That meant revving up the company's public-relations machinery. The widely featured quotes from Sonja Burkett, and the images of birds and pills, were part of a "video news release" the drugmaker had distributed to TV stations around the country; the footage also included the comments of Dr. Gorman, who has frequently served as a paid consultant to GlaxoSmithKline. On April 16-the date of Paxil's approval-a patient group called Freedom From Fear released a telephone survey according to which "people with GAD spend nearly 40 hours per week, or a 'full-time job,' worrying." The survey mentioned neither GlaxoSmithKline nor Paxil, but the press contact listed was an account executive at Cohn & Wolfe, the drugmaker's P.R. firm.
GlaxoSmithKline's modus operandi-marketing a disease rather than selling a drug-is typical of the post-Prozac era. "The strategy [companies] use-it's almost mechanized by now," says Dr. Loren Mosher, a San Diego psychiatrist and former official at the National Institute of Mental Health. Typically, a corporate-sponsored "disease awareness" campaign focuses on a mild psychiatric condition with a large pool of potential sufferers. Companies fund studies that prove the drug's efficacy in treating the affliction, a necessary step in obtaining FDA approval for a new use, or "indication." Prominent doctors are enlisted to publicly affirm the malady's ubiquity.
Public-relations firms launch campaigns to promote the new disease, using dramatic statistics from corporate-sponsored studies. Finally, patient groups are recruited to serve as the "public face" for the condition, supplying quotes and compelling human stories for the media; many of the groups are heavily subsidized by drugmakers, and some operate directly out of the offices of drug companies' P.R. firms.
The strategy has enabled the pharmaceutical industry to squeeze millions in additional revenue from the blockbuster drugs known as selective serotonin reuptake inhibitors (SSRIs), a family of pharmaceuticals that includes Paxil, Prozac, Zoloft, Celexa, and Luvox. Originally approved solely as antidepressants, the SSRIs are now prescribed for a wide array of heretofore obscure afflictions-GAD, social anxiety disorder, premenstrual dysphoric disorder. The proliferation of diagnoses has contributed to a dramatic rise in antidepressant sales, which increased eightfold between 1990 and 2000. Prozac alone has been used by more than 22 million Americans since it first came to market in 1988.
For pharmaceutical companies, marketing existing drugs for new uses makes perfect sense: A new indication can be obtained in less than 18 months, compared to the eight years it takes to bring a drug from the lab to the pharmacy. Managed-care companies also have been encouraging the use of medication, rather than more costly psychotherapy, to treat problems like anxiety and depression.
But while most health experts agree that SSRIs have revolutionized the treatment of mental illness, a growing number of critics are disturbed by the degree to which corporate-sponsored campaigns have come to define what qualifies as a mental disorder and who needs to be medicated. "You often hear: 'There are 10 million Americans with this, 3 million Americans with that,'" says Barbara Mintzes, an epidemiologist at the University of British Columbia's Centre for Health Services and Policy Research. "If you start adding up all those millions, eventually you'll be hard put to find some Americans who don't have such diagnoses."
When Paxil hit the market in 1993, the drug's manufacturer, then known as Smith- Kline Beecham, lagged far behind its competitors. Eli Lilly's Prozac, the first FDA-approved SSRI, had already been around for five years, and Pfizer had beaten SmithKline to the punch with Zoloft's debut in 1992. With only a finite number of depression patients to target, Paxil's sales prospects seemed limited. But SmithKline found a way to set its drug apart from the other SSRIs: It positioned Paxil as an anti-anxiety drug-a latter-day Valium-rather than as a depression treatment.
SmithKline was especially interested in a series of minor entries in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatric bible. Published by the American Psychiatric Association since the 1950s, the DSM is designed to give doctors and scientists a common set of criteria to describe mental conditions. Entries are often influenced by cultural norms (until 1973, homosexuality was listed as a mental disorder) and political compromise: The manual is written by committees of mental- health professionals who debate, sometimes heatedly, whether to include specific disorders. The entry for GAD, says David Healy, a scholar at the University of Wales College of Medicine and author of the 1998 book The Antidepressant Era, was created almost by default: "Floundering somewhat, members of the anxiety disorders subcommittee stumbled on the notion of generalized anxiety disorder," he writes, "and consigned the greater part of the rest of the anxiety disorders to this category."
Critics note that the DSM process has no formal safeguards to prevent researchers with drug-company ties from participating in decisions of interest to their sponsors. The committee that recommended the GAD entry in 1980, for example, was headed by Robert L. Spitzer of the New York State Psychiatric Institute, which has been a leading recipient of industry grants to research drug treatments for anxiety disorders. "It's not so much that the industry is there in some Machiavellian way," says Healy. "But if you spend an awful lot of time with pharmaceutical companies, if you talk on their platforms, if you run clinical trials for them, you can't help but be influenced."
SmithKline's first forays into the anxiety market involved two fairly well-known illnesses-panic disorder and obsessive-compulsive disorder. Then, in 1998, the company applied for FDA approval to market Paxil for something called social phobia or "social anxiety disorder" (SAD), a debilitating form of shyness the DSM characterized as "extremely rare." Obtaining such a new indication is a relatively simple affair. The FDA considers a DSM notation sufficient proof that a disease actually exists and, unlike new drugs, existing pharmaceuticals don't require an exhaustive round of clinical studies. To show that a drug works in treating a new disease, the FDA often accepts in-house corporate studies, even when companies refuse to disclose their data or methodologies to other researchers, as is scientific custom.
With FDA approval for Paxil's new use virtually guaranteed, SmithKline turned to the task of promoting the disease itself. To "position social anxiety disorder as a severe condition," as the trade journal PR News put it, the company retained the New York-based public-relations firm Cohn & Wolfe. (Representatives of GlaxoSmithKline and Cohn & Wolfe did not return phone calls.)
By early 1999 the firm had created a slogan, "Imagine Being Allergic to People," and wallpapered bus shelters nationwide with pictures of a dejected-looking man vacantly playing with a teacup. "You blush, sweat, shake-even find it hard to breathe," read the copy. "That's what social anxiety disorder feels like." The posters made no reference to Paxil or SmithKline; instead, they bore the insignia of a group called the Social Anxiety Disorder Coalition and its three nonprofit members, the American Psychiatric Association, the Anxiety Disorders Association of America, and Freedom From Fear.
But the coalition was not a grassroots alliance of patients in search of a cure. It had been cobbled together by SmithKline Beecham, whose P.R. firm, Cohn & Wolfe, handled all media inquiries on behalf of the group. (Today, callers to the coalition's hot line are greeted by a recording that announces simply, "This program has successfully concluded.")
There were numerous good reasons for SmithKline to keep its handiwork discreet. One was the public's mistrust of pharmaceutical companies; another was the FDA's advertising regulations. "If you are carrying out a disease-awareness campaign, legally the company doesn't have to list the product risks," notes Mintzes, the University of British Columbia researcher. Because the "Imagine Being Allergic to People" posters did not name a product, they didn't have to mention Paxil's side effects, which can include nausea, decreased appetite, decreased libido, and tremors.
Cohn & Wolfe's strategy did not end with posters. The firm also created a video news release, a radio news release, and a matte release, a bylined article that smaller news-papers often run unedited. Journalists were given a press packet stating that SAD "affects up to 13.3 percent of the population," or 1 in 8 Americans, and is "the third most common psychiatric disorder in the United States, after depression and alcoholism." By contrast, the Diagnostic and Statistical Manual cites studies showing that between 3 and 13 percent of people may suffer the disease at some point in their lives, but that only 2 percent "experience enough impairment or distress to warrant a diagnosis of social phobia."
Cohn & Wolfe also supplied journalists with eloquent patients, helping to "put a face on the disorder," as account executive Holly White told PR News. P.R. firms often handpick patients to help publicize a disease, offering them media training and sending them on promotional tours. In 1994, for example, drugmakers Upjohn and Solvay funded a traveling art show by Mary Hull, a Californian who suffered from obsessive-compulsive disorder and spoke frequently with journalists about the disorder's toll-as well as her SSRI-aided recovery. Not coincidentally, the companies were awaiting FDA approval to market their SSRI, Luvox, for the treatment of obsessive-compulsive disorder. Among the patients most frequently quoted in stories about social anxiety disorder was a woman named Grace Dailey, who had also appeared in a promotional video produced by Cohn & Wolfe.
Also featured on that video was Jack Gorman, the Columbia University professor who would later make the rounds on Paxil's behalf during the GAD media campaign. Gorman appeared on numerous television shows, including ABC's Good Morning America. "It is our hope that patients will now know that they are not alone, that their disease has a name, and it is treatable," he said in a Social Anxiety Disorder Coalition press release.
Dr. Gorman was not a disinterested party in Paxil's promotion. He has served as a paid consultant to at least 13 pharmaceutical firms, including SmithKline Beecham, Eli Lilly, and Pfizer. Another frequent talking head in the SAD campaign, Dr. Murray Stein of the University of California at San Diego, has also served as a SmithKline consultant, and the company funded many of his clinical trials on SAD.
Retaining high-profile academic researchers for promotional purposes is standard practice among drug companies, says Mosher, the former National Institute of Mental Health official. "They are basically paid for going on TV and saying, 'You know, there's this big new problem, and this drug seems to be very helpful.'"
Cohn & Wolfe's full-court press on SAD paid immediate dividends. In the two years preceding Paxil's approval, fewer than 50 stories on social anxiety disorder had appeared in the popular press. In May 1999, the month when the FDA handed down its decision, hundreds of stories about the illness appeared in U.S. publications and television news programs, including the New York Times, Vogue, and Good Morning America. A few months later, SmithKline launched a series of ads touting Paxil's efficacy in helping SAD sufferers brave dinner parties and public speaking. By the end of last year, Paxil had supplanted Zoloft as the nation's number-two SSRI, and its sales were virtually on par with those of Eli Lilly's Prozac. (Neither Prozac nor Zoloft has an indication for SAD.)
The success of the Cohn & Wolfe campaign didn't escape notice in the industry: Trade journals applauded GlaxoSmithKline for creating "a strong anti-anxiety position" and assuring a bright future for Paxil. Increasing public awareness of SAD and other disorders, the consulting firm Decision Resources predicted last year, would expand the "anxiety market" to at least $3 billion by 2009. In 2000, the New York chapter of the Public Relations Society of America named the Cohn & Wolfe SAD campaign "Best P.R. Program of 1999."
The lessons of "Imagine Being Allergic to People" were also not lost on Zoloft's manufacturer, Pfizer. In 1999, Pfizer gained FDA approval to market Zoloft as a treatment for post-traumatic stress disorder (PTSD). Until then, the condition had been associated almost exclusively with combat veterans and victims of violent crime; now, Pfizer set out to convince Americans that PTSD could, in fact, afflict almost anyone.
The company funded the creation of the PTSD Alliance, a group that is staffed by employees of Pfizer's New York public-relations firm, the Chandler Chicco Agency, and operates out of the firm's offices. The Alliance connects journalists with PTSD experts such as Jerilyn Ross, president and ceo of the Anxiety Disorders Association of America, a group that is heavily subsidized by Pfizer as well as GlaxoSmithKline, Eli Lilly, and other drug-industry titans.
In the months following the launch of Pfizer's campaign, media mentions of PTSD skyrocketed. Just weeks after the Alliance's founding in 2000, for example, the New York Times ran a story citing Pfizer-supplied statistics on childhood PTSD, according to which 1 in 6 minors who experience the "sudden death of a close friend or relative" will develop the disorder. Other stories highlighted studies promoted by the alliance according to which 1 in 13 Americans will suffer from PTSD at some point in their lives.
Eye-catching figures are integral to disease marketing campaigns, though the quality of the data is sometimes dubious. A report published last February in the Archives of General Psychiatry warned that high estimates on the number of people suffering mental-health conditions often include people whose symptoms are so mild as to not require treatment. "When people look at numbers that say close to 30 percent of the American public has a mental disorder and therefore needs treatment, most would say that is implausibly too high," the study's lead author, William E. Narrow, told the Associated Press.
Many of the statistics used to promote new disorders are taken from studies published in second-tier journals, which frequently depend on direct corporate support. One publication that has drawn fire is the Journal of Clinical Psychiatry, whose major funders include GlaxoSmithKline and Eli Lilly. In 1993, the journal published a study claiming that anxiety disorders cost the United States $46.6 billion per year, primarily due to lost productivity. That figure was repeated in countless press releases and made its way into articles in the Washington Post and USA Today.
The study was produced by the Institute for Behavior and Health, a research firm headed by Dr. Robert DuPont, who served as President Ford's drug czar. The institute's tax returns indicate that its programs are funded almost exclusively by industry research grants; in 1999, for example, it conducted clinical trials on behalf of Merck, Pfizer, and Solvay. DuPont was paid more than $50,000 that year for 10 hours of work per week, in addition to a $56,000 fee that the institute paid to his for-profit consulting firm. The 1993 anxiety study was paid for in part by Upjohn, maker of the SSRI Luvox.
Studies published in medical journals are also useful in reaching a key audience for disease-awareness campaigns-doctors. Physicians, especially general practitioners, are under growing pressure to make quick diagnoses and to treat mental-health conditions with drugs rather than refer patients to psychotherapy. Primary-care physicians now write upwards of 60 percent of antidepressant prescriptions, according to the Amer-ican Psychiatric Association. "There is a pressure to have treatments that are perceived as faster or more efficient," says Dr. Robert Michels, chief of psychiatry at Cornell Medical College.
Drug companies are understandably eager to help physicians identify conditions that can be treated with their products. One widely distributed diagnostic checklist, a 15-minute test that promises to screen for 17 different disorders using special software, was developed by GlaxoSmithKline. Pfizer has funded a test designed to help obstetricians and gynecologists identify women with mental-health problems. According to a 2000 study, sponsored by Pfizer and published in the American Journal of Obstetrics, a full 20 percent of all ob-gyn patients may need psychiatric treatment for anything from depression and anxiety to eating disorders.
Most of all, though, pharmaceutical makers seek to build word of mouth about a condition in the general public-the kind of water-cooler buzz that prompts people to ask their doctor about a disease, and the drug that might treat it. To that end, corporations have increasingly embraced patient organizations that work to publicize mental illness. One such group is the National Mental Health Awareness Campaign, created two years ago to eliminate "the fear and shame that is still strongly associated with mental disorders." The organization is particularly concerned with teenagers, and has run several ads on mtv that encourage unhappy youths to call a toll-free number or visit its Web site. A couple of weeks after the September 11 terrorist attacks, it released the results of a survey, which found that 30 percent of adults questioned felt their mental health had worsened since the tragedy. The group's press release urged "parents and children traumatized by the recent terrorist attacks to avail themselves of the opportunity to speak to mental health professionals."
The campaign's brochures say it has received financial support from the Surgeon General's office. The organization is less forthright about its ties to FoxKiser, a pharmaceutical lobbying firm whose clients include Bristol-Myers Squibb and AstraZeneca. Michael Waitzkin, a partner at FoxKiser, is on the campaign's board of directors, and until recently the campaign was headquartered in FoxKiser's Washington office. (It now operates from the office of the P.R. firm Health Strategies Consultancy.)
The National Mental Health Awareness Campaign wasn't the only group to step up its profile in the wake of the attacks. On September 26 the PTSD Alliance-the group headquartered in the offices of Pfizer's P.R. agency, Chandler Chicco-issued a statement warning that post-traumatic stress can affect anyone who has "witnessed a violent act" or experienced "natural disasters or other unexpected, catastrophic, or psychologically distressing events such as the September 11 terrorist attacks." During the following month, according to the trade jour-nal Psychiatric News, Pfizer spent $5.6 million advertising the benefits of Zoloft in treating PTSD-25 percent more than it had spent, on average, from January to June.
But the biggest presence in TV drug advertising after September 11 was GlaxoSmithKline, which in October 2001 spent $16 million promoting Paxil-more than it had spent in the first six months of the year combined. In December, the company rolled out a series of new commercials, often broadcast during prime-time news programs and built around lines such as "I'm always thinking something terrible is going to happen" and "It's like a tape in my mind. It just goes over and over and over."
In their search for new uses, SSRI makers are no longer limiting themselves to disorders with chiefly psychological symptoms. In the March 15 issue of the Journal of Clinical Oncology, Mayo Clinic researchers funded by Eli Lilly reported that Prozac "is a realistic alternative to estrogen replacement for reducing hot flashes" in menopausal women. A recent study at the University of Pennsylvania, funded by the pharmaceutical companies Aventis and Novartis, indicated that SSRIs can decrease the risk of heart attack in smokers.
But by far the most controversial addition to the list of maladies treatable with SSRIs is a condition whose very existence is in dispute: premenstrual dysphoric disorder (PMDD), a female ailment whose symptoms include sharp monthly mood swings and physical pain. PMDD has been listed since 1987 in the Diagnostic and Statistical Manual appendix, which catalogs potential disorders "proposed for further study."
According to Paula J. Caplan, a psychologist and visiting scholar at Brown University who was a member of a DSM committee that evaluated research on PMDD, proponents of including the condition "claimed they were so careful in defining it that it wasn't just going to be someone with cramps during their period. But they were talking about 3 to 5 percent of [menstruating] women. If you do the math as conservatively as possible, 3 to 5 percent gives you one and a half million women [in the United States]." Caplan resigned from the committee before it voted to list PMDD in the appendix.
Though the condition remains controversial in the medical profession-one 1992 study found that men and women suffered from PMDD's symptoms at almost the same rate-its inclusion in the DSM proved a god-send for Eli Lilly, the manufacturer of Prozac. In 2000, the company gained FDA approval to market Prozac as a treatment for the condition; Eli Lilly promptly re-packaged Prozac as a pink-coated pill called Sarafem and launched a P.R. campaign warning that "millions of menstruating women" suffer from PMDD. "Does juggling work, family and personal commitments leave you feeling frazzled and stressed out?" the Sarafem Web site asks. "We have some tools to help."
The idea of characterizing uncomfortable menstrual symptoms as a mental disorder troubles Caplan, who wonders where the medical community will draw the line. "I could say to you, 'Well, your propensity to call people and ask them probing questions is a disorder,'" she says. "'We'll call it intrusive exploratory disorder.'"
No such malady is yet listed in the DSM. But the quest for new uses for the SSRIs is continuing. At last year's annual convention of the American Psychiatric Association, researchers presented a major study on a new "hidden epidemic"-compulsive shop- ping. Jack Gorman, the Columbia psychiatrist who had earlier helped publicize anxiety disorders, made another appearance on Good Morning America to discuss the new condition, which host Charles Gibson told viewers could affect as many as 20 million Americans, 90 percent of them women. In the wake of the new study, Gorman said, scientists would "almost certainly" look into treating the disease with SSRIs.
The study in question was funded by Forest Laboratories, for which Gorman has served as a consultant. A laggard in the SSRI business, the company hopes to carve out the compulsive-shopping niche for its pill, Celexa. Expect the publicity machine for something

;o)
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There's no doubt that (in order to sell something) there must be a demand. However, with regard to disease, people do not generally develop symptoms that produce disability or impairment of life functioning based on hearing of a new disease. Those who do are referred to as hypochondriacs--certainly not in the mainstream. In my view, what many of these companies are doing is putting a label on a symptom or a cluster of symptoms and performing scientific studies to show that the product alieviates those symptoms. The fact that a name actually exists for someone's biologic disorder probably provides a great deal of relief on its own. However, this is nothing new. Pharma companies have been discovering organisms as the cause for various infectious diseases and then creating products to treat them. They have been discovering biochemical pathways of inflammation and then creating a variety of anti-inflammatory drugs to treat. And we could go on. If there was no symptomatic relief (regardless of what the label on the disease is), the drugs wouldn't sell because there would be no demand. Could certain drugs be mis-prescribed? Yes, I think so. Do we have a conspiracy here? I think not.
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Thisguyntx wrote :
Could certain drugs be mis-prescribed? Yes, I think so. Do we have a conspiracy here? I think not.


This is a very interesting notion introduced in the long post by Delighted. I don't doubt that even many more conditions can be "described" by asking questions in a survey and even giving labels and acronyms, at which point they become elgibile for consideration in the media lexicon and the the DSM publication.

The next step, treatment, is where it becomes potentially perverse, as drug companies and alternative medical practicioners step up to the soap box to hawk their wares and ways to "treat" the condition. Just because we can describe and label a human condition does not mean we should feel compelled to start treating it. Sometimes we are simply dealing with the fringes of human normalcy, those beyond 1 0r 2 standard deviations from the poorly defined norm, the outliers that by definition populate the human race. Just because a person is not functionning optimally in our society, does not make it society's duty to uplift that person to "normal" functioning.

I acknowledge that it would be nice to know how to affect a variety of behaviors by effective treatments---just as we benefit as a society from treatments for depression and mania, for examples. But, first we need to make sure that these treatments are not being imposed indiscriminately on people who are not necessarily desiring to change. Next, we need to demand a high level of proof from drug and alternative treatment methods that they are indeed effective. Finally, we as a society are going to need to reckon with the societal cost of allowing indiscriminate proliferation of conditions that "need" treatment.

At some point we will be faced with tough decisions about cost-effectiveness and the ethics of this trend.

urche

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I acknowledge that it would be nice to know how to affect a variety of behaviors by effective treatments---just as we benefit as a society from treatments for depression and mania, for examples. But, first we need to make sure that these treatments are not being imposed indiscriminately on people who are not necessarily desiring to change. Next, we need to demand a high level of proof from drug and alternative treatment methods that they are indeed effective. Finally, we as a society are going to need to reckon with the societal cost of allowing indiscriminate proliferation of conditions that "need" treatment.


I'd have core dumped on this whole thing if it were not for the erudite prior replies and analyses already done and stated.

Clearly, jamming medicines into patients is not the right answer. It happens far, far too oftem as it is.

SSRI's are not right for everyone with depressive disorders. They can be particulary NOT good for many patients. For the right patients, they are certainly safer, better, and more quickly acting than the tricyclics that are associated with so many coronary problems.

We can group these medications into a few categories (assumed and already given forgiveness from folks like U, et al):

[This is my own de novo chart, so sue me]

I. Direct adrenergics / stimulants
a. the amphetamines and other PEA derivatives
b. cocaine and derivatives

II. Atypicals
b1. methylphenidate
b2. pemoline (Cylert)
b3. the French anti-narcoleptics
b4. direct agents such as phenylethyltetrazine that are basically horrible drugs to give anyone, though they sure could be considered stimulants, I guess, if having your patient have a seizure isn't a problem as such

III. Monoamine Oxidase Inhibitors (MAOI)'s
(such as tranylcypromine)

IV. Tricyclics

V. SSRI's
Everybody from:
Paxil
Prozac
and a handful more; they all seem to have the same indications and side effects, except for certain special indications; the side effects can be quite serious behaviorally, though the life-threatening side effects compared with the MAOIs or tricyclics are mild.


VI. Direct adrenergic stimulants - Phase II
Wellbutrin

VII. Atypicals Part II
Dimethylaminoethanol (DMAE)
SAM-E [sulfonylsomthing blah methane, don't make me do this]
Tyrosine


Another example of why doctors, qualified other prescribers, pharmacists and nurses are needed in the great health care food chain.

I agree that all or none of this should be imposed on unwilling or uninformed patients, but that's been a tenet of US psychiatric law for years; patients in forensic psychiatric hospital or in outright prison conditions have been able to refuse any medication except under extraordinary circumstances.

We only discussed CNS stimulants.

RSH.
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In re: Delighted's message (Pharmaceuticals #284)

The disease was generalized anxiety disorder (GAD), a condition that, according to the reports, left sufferers paralyzed with irrational fears. Mental-health advocates called it "the forgotten illness." Print periodicals were awash in stories of young women plagued by worries over money and men. "Everything took 10 times more effort for me than it did for anyone else," one woman told the Chicago Tribune. "The thing about GAD is that worry can be a full-time job. So if you add that up with what I was doing, which was being a full-time achiever, I was exhausted, constantly exhausted."


Thanks again, D, for this huge pile of information, I'm still processing it.

I've been thinking about this for a while, and while not having a copy of DSM at hand, I do know a patient that won't leave her house except once a week, and has a lot of what is being popularized as GAD. Or old fashioned agoraphobia with anxiety and depression.

To quote a very old Charles Schulz "Peanuts" comic strip, when Lucy had her "Psychiatric Advice 5 cents booth" and Linus was her patient, after an involved interview, she said:

Lucy: "I think you have Pantophobia ".

Linus: "Well, what's that?"

(N.B., Linus Pt. Hx: Who got perfectly well carrying his blanket around without medication until they took it away from him.)

Lucy: "Oh, that's fear of everything."

Linus: "THAT's IT!


RSH.

P.S.: More to follow.
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Referencing Delighted's #284



Though the condition remains controversial in the medical profession-one 1992 study found that men and women suffered from PMDD's symptoms at almost the same rate-its inclusion in the DSM proved a god-send for Eli Lilly, the manufacturer of Prozac. In 2000, the company gained FDA approval to market Prozac as a treatment for the condition; Eli Lilly promptly re-packaged Prozac as a pink-coated pill called Sarafem and launched a P.R. campaign warning that "millions of menstruating women" suffer from PMDD. "Does juggling work, family and personal commitments leave you feeling frazzled and stressed out?" the Sarafem Web site asks. "We have some tools to help."


By the way, I'm not implying D has anything to do with this claptrap other than helping to bring it to light.

I felt "shame on you" about Eli Lilly from the first news of Sarafem.

PMS has been I've thought, widely been demonstrated to be a prostaglandin and hormonally mediated cluster of symptoms, and effective attack of prostaglandin synthesase could do much to alleviate the problems that were "just in your head".

For years, a variety of barbiturate and ergot-derivative combinations, particularly made by Sandoz were promoted for what physicians at the time felt were complaints without specific physical cause. I particularly remember Spacetabs, and combinations involving a "balanced combination of barbiturates" together with some second-order semisynthetic ergots like those used in senile dementia.

After morphia, sulfonal, chloral, barbiturates, then Milltown and Valium. Then Darvon. And Talwin. Just get her out of the office.

PMDD does not seem new to me; it's been a part of PMS for a lot of women. To seize this as the SSRI new bandwagon seems to go against everything I believe in.

And, as an obvious given, women subject to PMS / PMDD are of childbearing years, the most rigorous possible fertility, teratogenicity, and birth outcome studies should have been completed before a seratonin-affecting drug be prescribed for this indication.

RSH.

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More grist for the debate.

Do we need life style drugs?
http://news.bbc.co.uk/2/hi/health/2624547.stm

Myth of female impotence 'created---->
http://news.bbc.co.uk/2/hi/health/2621705.stm


;o)
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More grist for the debate.


Indeed.

Culture has as much to blame as any agenda drug companies have.

Women, in particular, are constantly bombarded with fat = bad, plastic surgery, and innumerable other overt and subliminal messaging via the mass media that result in some serious, if not horrifying, psychiatric disorders.

Odd that this comes up, I just watched something from the BBC (it was produced in Britain, anyway) about BMD (body dysmorphic disorder) and followed the histories of women who were butchered by unnecessary and disfiguring plastic surgeries because of an obsession that they weren't beautiful. And then spending tons more money to fix the butchery just to bring them back to where they could go out in public.

Trigger points for men are of course sexual prowess, hair loss, muscularity, athletic prowess, etc.

In other words, if you don't look like somebody from "Baywatch" and don't have girls or guys hanging all over you, you're defective.

There's a line somewhere that divides excessive vanity from a pathological and dangerous self-image disorder; I don't know if anyone yet knows where that is.

Just as a pharmacological aside, I just don't see how Viagra, which, when properly prescribed (especially after thorough CV workup), which helps male patients with erectile problems due to neurological or vascular impairment, by a purely physical reaction to increasing blood supply to the necessary instrument, would help women with an actual or perceived performance disorder.

Anorexia, bulimia, excessive surgeries, misuse of androgenic and estrogenic hormones, misprescription of anorectic and other drugs, and God knows yet what is to come, isn't hitting the target ethically.

Especially using HgH; I could buy myself that on the internet if I wanted to right now. Nobody seems to explain that administration of HgH after the skull sutures and ephyphyses (sp?) have matured, that it's a homemade Acromegaly kit.

Some of these home-made disorders are relabelling something that is treatable and it happens the drug being pushed is right, no matter what you come up with as the DOD (Disease of the Day).

A lot of the constellation of the BMD type stuff would seem better treated with drugs proven effective for OCD, antidepressants, and therapy.

And, also, prescribing physicians readier with time to talk to the patient than they are with a pen and prescription pad would help. My stepfather, as I said before, was quite stingy with prescribing anorectic agents. He said, (jokingly only, over family dinner [we've been through some of our family dinner stories before]) that the only way diet pills work is to prescribe them and thyroid to the point that the tremors would prevent the patient from being able to hold a fork, or to keep food on it.)

I think general public advertising of prescription drugs was and is a mistake, despite my advocacy and support for the researchers and people in the pharma industry.

Somehow, "Ask your Doctor if Zambooziline (r) C-IV is right for you" turns into patents throwing tantrums if they can't have the pill they just saw in a TV or other media ad, or on 20/20 [before the side effects show up in a sequel (remember "Phen-Phen"?), more money for the media and for trial lawyers, higher malpractice insurance, and drug companies sued into oblivion.

It'd be nice if the PMA put out a generic (pardon the expression) TV ad with a message like, "No medicine is right for everyone, or at every time even for the same patient, and many times, no medication is needed at all. Your <medical professional / prescriber> is trained to understand, counsel, and provide the best solutions for your healthcare needs." Maybe the slugline could be "Sometimes the best pill is none at all. "

Either that, or do something meaningful with "Health Class" that's compulsory in most of the US, instead of the nattering on about drug abuse, drinking, smoking, sex ed, family life, (not that all that isn't important, too) and give some meaningful self-help basic medical training.

Granted, this might be a stretch when so many high school graduates can't find Texas on an unlabelled map of the USA; God forbid they know the meaning of the left and right hand sides of the Periodic Table.

But money invested in educating the public in basic medical concepts could repay itself manyfold. And maybe end us up with fewer doctors ending their day with "If I hear one more patient ask me for Zambooziline, I am going to scream."

RSH.
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Being from Texas, I have no problem finding it on a map, but I must admit that especially the North-East Confuses me. Hopefully, however, finding Texas on a mpa will remain the gold standard (although I wonder how many Texas highschool students can't find it).

Even further off topic rant follows

A health advocay (spelling?) class would be a great add to all types of cricula, especially continuing education. I'd like to see it offered both to young people, and adults of all ages. Going through a rough spell with my wife's Grandparents: Both have some cardiac problems, and Granddad has Parkinson's, most likely vascular dementia, and possibly Alzheimers. I say possibly on the Alzheimers/vascular dementia, as neither has been differentially diagnosed by a neurologist. Anyway, he takes one of the L-dopa drugs, and recently begin halucinating following increased dosage. Of course, no doctor is told until he experiences congestive heart failure, goes to the hospital, and apparently assualts (non-compliant, struck out at) one of the nurse late at night. In any event, they moderated his dosage of the L-dopa product, and also placed him on Seraquil, which apparently moderates dopamine/sertonin levels in the brain.

Upshot of all this:
1. the mentally sharp grandmother never reported her husbands hallucinations, and other side effects.

2. they commonly take supplements based on magazine style advertising, and often ignore advice on those same supplements when

3. They continue to take the advice of a cardiologist who has given them bad advice (quality of life reducing) in the past, and did so following this hospitalization episode.

Anyway, thats why I'm pretty sure we could use a different style of health class..

Danbobtx

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Upshot of all this:
1. the mentally sharp grandmother never reported her husbands hallucinations, and other side effects.

2. they commonly take supplements based on magazine style advertising, and often ignore advice on those same supplements when

3. They continue to take the advice of a cardiologist who has given them bad advice (quality of life reducing) in the past, and did so following this hospitalization episode.

Anyway, thats why I'm pretty sure we could use a different style of health class..

Danbobtx


From your mouth to God's ear. Not to mention maybe we could stem the tide of hypochondria a little bit. Maybe.

RSH.
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Granddad has Parkinson's, most likely vascular dementia, and possibly Alzheimers.

Some Parkinson's patients develop dementia. But whether a person is suffering from Parkinson's-associated dementia, vascular dementia, Alzheimers, Loewy-body dementia, etc., etc., they all share the same basic symptoms despite the different underlying pathology. Some medication issues may differ, but behavioral coping involves the same understanding and strategies. Differences there are attuned to the individual differences that characterize different dementia patients.

A piece of advice, from one who's been coping with it for a while (my dad was diagnosed with Alzheimers in June, 1996): guide your grandparents and/or your parents to their local Alzheimers Association chapter. Their orientation meetings, their targeted meetings, their support and information and guidance -- all for free -- are invaluable and extraordinary and typically makes all the difference between being overwhelmed and managing.


sheila
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