Posted by Elizabeth on August 23, 2001, at 10:19:33
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 22, 2001, at 13:55:36
> > But how do we provide an incentive for the drug companies to investigate possible bad effects of their products once the products have been approved for marketing?
>
> • That's a good question. I do believe that even if drug companies are forthcoming with information, it will still be missed. For example, that Effexor withdrawal; I knew about the withdrawal in 1997, before an XR version was made.I remember that Effexor XR was first marketed in fall '97 (I started taking it when Nardil pooped out the second time). I had heard about withdrawal symptoms and "ups and downs" (like people often get with short-acting drugs like Xanax or Ritalin) from Effexor long before that. (The reason I stopped taking it without giving it much of a chance was that the immediate-release formulation made me sick to my stomach about 1/2 hour after each dose.)
> The company, since at least 1998 (perhaps before) had the withdrawal information in it's product monograph.
Really. I didn't notice that. That's interesting. They probably wanted to avoid legal consequences, I guess (weren't they the same co. that marketed dexfenfluramine?).
> I guess if you don't scream it out, not everyone listens (or has the time to read the monograph fully).
All that one would have to do if one were really interested in finding that stuff out would be to look on internet discussion boards such as this one!
> It would be silly for a company (who really has to answer to shareholders) to point out the bad issues of their product. That's what competitors are for.
< g > Yeah. I sort of think of capitalism as a lesser evil compared with the alternatives, but the problem of how to get corporations to do the right thing has always been a puzzle to me.
[re Zyprexa and insulin resistance]
> > Even when it's below the therapeutic dose for psychosis? I was taking 2.5-5 mg/day.
> >
> • Pyschosis can be treated with low doses, as well. I don't think that there is an dose/effect gradient, as seen with Effexor.There is with some of the effects, at least (don't know about the diabetes thing). I found there was a huge difference in the amount of sedation and appetite stimulation (the only effects I noticed from it!) with 2.5 mg vs. 10 mg (the most I ever tried taking).
> • I was talking to the Zyprexa rep yesterday (met him in Starbucks interviewing a new rep), and he says that the increased incidence of type II diabetes is only seen in patients with schizophrenia (he later amended that to be, that patients with schizophrenia were the only one's studied, so far).
Umm...duh? :-) I'm skeptical about whether there's a relationship too. Although I have noticed that the placebo groups in controlled trials of antipsychotic drugs always seem to have a nonzero rate of EPS -- I wonder what causes that. Just expectation effect? Or something more?
> The reason he states that there increased numbers of people getting diabetes from taking Clozaril and Zyprexa is that people with schizophrenia are 4 times as likely as the general population to get diabetes. I asked if this number included unmedicated people and he didn't know.
I'm sure that all the medications used for schizophrenia, except maybe Moban, cause appetite stimulation frequently. Sounds like he was trying to play it down.
> He also blamed increased appetite and poorer than normal dietary skills (eg chips & pop diets), as being risk factors. I really can't believe that we have a number of people with schizophrenia have borderline triglyceride levels and coincidentally become diabetic after starting these two atypical antipsychotics.
Me neither. As I implied above, I do think appetite stimulation is at least part of the cause. (That's not to say that we should blame the patients for not having enough "will power" or whatever.)
> > Is Zyprexa really that common compared to Nardil?
>
> • Zyprexa is prescribed much more than Nardil and for numerous indications, at least here in the north.I'm in the north too, thank you very much. :-)
> Nardil is used as a last resort in treatment-resistant depression.
My impression is that MAOIs are making a comeback. I certainly think they should be considered before ECT, if nothing else. Personally, I found MAOIs to be much more tolerable than TCAs, with the exception of desipramine (which I'm taking now). And I think MAOIs probably work for a much broader range of conditions than TCAs do. Desipramine seems to be working about as well as Parnate did for me (nonpsychotic depression with melancholia) -- I still need buprenorphine but my mood, sleep, appetite, etc. are much improved. And I'm sure you've seen my standard rant about how the dietary restrictions have been overplayed.
> Zyprexa seems to be used before Nardil, even though there is little evidence of efficacy for it's long-term use in depression.
I tried Nardil (in Boston) before ever touching any of the antipsychotics. Most nonpsychotic depressives I've known who tried antipsychotic drugs (usually including atypicals) and who didn't have bipolar disorder or comorbid conditions (OCD, borderline personality, etc.) either got no effect from the neuroleptics, or felt worse on them. As I said, I just felt hungry and tired on Zyprexa, Risperdal, Seroquel, and Mellaril (not all at once). I also tried Moban, which had this weird effect on me that's sort of hard to describe -- I felt really heavy and immobilised, sort of. (Droperidol, which I was given as a sedative when I was in the ICU recently, had a similar effect.)
-elizabeth
poster:Elizabeth
thread:67742
URL: http://www.dr-bob.org/babble/20010822/msgs/76115.html