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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Anyuser on August 17, 2002, at 15:51:04
Here is an excerpt from an article about Lexapro on Forbes.com:
"Like many follow-up drugs, Lexapro is essentially a fragment of the drug that preceded it. There are two pieces of the Celexa molecule that may be active in the body, but only one of them seems to be involved in helping to relieve symptoms of depression. So scientists at Lundbeck cut the Celexa molecule in half to see if it would work better that way.
"This is a common strategy for companies trying to replace a blockbuster that is losing patent protection. AstraZeneca (nyse: AZN - news - people ) is trying it with Nexium, the follow-up to ulcer drug Prilosec, once the best-selling drug in the world. Schering-Plough's (nyse: SGP - news - people ) Clarinex is a slightly altered form of Claritin, the blockbuster antihistamine.
"Drug companies have taken a lot of flack for trying to switch patients to such new-and-improved versions of old drugs.
"But not everyone agrees that Lexapro is far superior to Celexa. The Danish Medicines Agency reportedly complained that the new drug is no better than Celexa. In Denmark, Lundberg has lost patent protection on Celexa and is trying to switch patients from the cheap, old antidepressant to the new, expensive Lexapro. (Both drugs are sold under different names overseas.)"
That has a depressing ring of truth to me. Now compare that to the following excerpt from an article on Lexapro on WebMD.com:
"Andrew Farah, MD, medical director of behavioral services at High Point Regional Health System in North Carolina, says intolerable side effects are the main reason that only about 40% of those who seek treatment for depression complete the recommended therapy.
"'The real advance is that this drug seems to be devoid of virtually all side effects,' says Farah, who is also a clinical professor at Wake Forest University. 'I think most people who have tried antidepressants in the past and didn't like them because of the side effects will be very pleased with this one.'"
Which version is closer to the truth?
Posted by Ritch on August 17, 2002, at 16:31:47
In reply to Lexapro: what to expect?, posted by Anyuser on August 17, 2002, at 15:51:04
> Here is an excerpt from an article about Lexapro on Forbes.com:
>
> "Like many follow-up drugs, Lexapro is essentially a fragment of the drug that preceded it. There are two pieces of the Celexa molecule that may be active in the body, but only one of them seems to be involved in helping to relieve symptoms of depression. So scientists at Lundbeck cut the Celexa molecule in half to see if it would work better that way.
>
> "This is a common strategy for companies trying to replace a blockbuster that is losing patent protection. AstraZeneca (nyse: AZN - news - people ) is trying it with Nexium, the follow-up to ulcer drug Prilosec, once the best-selling drug in the world. Schering-Plough's (nyse: SGP - news - people ) Clarinex is a slightly altered form of Claritin, the blockbuster antihistamine.
>
> "Drug companies have taken a lot of flack for trying to switch patients to such new-and-improved versions of old drugs.
>
> "But not everyone agrees that Lexapro is far superior to Celexa. The Danish Medicines Agency reportedly complained that the new drug is no better than Celexa. In Denmark, Lundberg has lost patent protection on Celexa and is trying to switch patients from the cheap, old antidepressant to the new, expensive Lexapro. (Both drugs are sold under different names overseas.)"
>
> That has a depressing ring of truth to me. Now compare that to the following excerpt from an article on Lexapro on WebMD.com:
>
> "Andrew Farah, MD, medical director of behavioral services at High Point Regional Health System in North Carolina, says intolerable side effects are the main reason that only about 40% of those who seek treatment for depression complete the recommended therapy.
>
> "'The real advance is that this drug seems to be devoid of virtually all side effects,' says Farah, who is also a clinical professor at Wake Forest University. 'I think most people who have tried antidepressants in the past and didn't like them because of the side effects will be very pleased with this one.'"
>
> Which version is closer to the truth?
>
Anyuser,It would be very interesting if a large trial was conducted with depressed patients that were given ONLY the "R" OR the "S" isomers (50-50%, and nobody but an outside research group knew who got what). THEN, do the same questionnaires, etc., and tabulate the results. Then the proof would definitely be in the pudding. I wonder if the FDA might entertain the idea of future trials involving this concept. If this was done-then we wouldn't have any amibiguity about it. Who knows, maybe Forest *has* done such a study and is sitting on it. It could be a positive result for escitalopram and for marketing reasons they are saving it up for the big duke-out with Lilly's duloxetine release. If they haven't done such a study, they should consider it since they would have a very powerful argument for their product should it appear favorable.
Mitch
Posted by Linkadge on August 17, 2002, at 16:52:40
In reply to Lexapro: what to expect?, posted by Anyuser on August 17, 2002, at 15:51:04
I think people should be given the
inactive isomer and told to report
what side effects they experience,
then we can know for sure what
we are getting rid of
Link
Posted by Phil on August 17, 2002, at 17:14:29
In reply to Lexapro: what to expect?, posted by Anyuser on August 17, 2002, at 15:51:04
From what I've read, Lex will be more powerful per milligram than Celexa, which makes sense.
Forest has 3 more years patent protection on the fastest selling AD, Celexa. They are bringing in a hopefully better drug at a cheaper price and not holding it back till Celexa has generated enormous profits alone. Unless I'm missing something, that seems to be a very nice thing to do. A lot of people will switch to Lexapro from Celexa as soon as it hits. My pdoc and I plan on that. This won't help Celexa sales.
Unless it was all bs, Andrew Slomon's father, who is head of Forest, took time at home with his son during his son's bouts of depression and went to Denmark later to see what he could find to help his son. That is why Celexa is in the US. Sounds like maybe not so bad a guy.
Hopefully, I'm not being naive but why would Forest bring in Lexapro now when they already have a cash cow. Why not save it to kick Lilly's ass later on? I hope we're seeing a company with it's priorities in the right place. I realize I could be missing the whole picture.
As far as Lilly goes, I think they must be the most cutthroat company around. When losing their patent on Prozac, they introduce weekly dosing that I've heard sucks. Then put Prozac in a pink and purple capsule for women's Premenstral Dysforic Disorder which I also heard they basically invented the condition to have a marketing tool to sell Serafem.
They then started making noise about a Zyprexa / Prozac combo, both are Lilly drugs, for another condition which I can't remember. Probably treatment resistant depression.
Say xyz car is selling like crazy with no end in sight. It would be silly for xyz to come out, mid-year, with the same model except that it's faster, less braking problems, and cheaper.Sorry for the ramble. Just woke up from a 2 hour power nap and my writing is probably disconnected.
Need input from Cam.
Posted by Anyuser on August 17, 2002, at 17:52:23
In reply to Lexapro: what to expect?, posted by Anyuser on August 17, 2002, at 15:51:04
"The fundamental concept underlying single-enantiomer drug development is chirality (derived from the Greek word for hand), which is the ability of some molecular structures to take on either a "left-handed" or "right-handed" configuration. In the same way we distinguish our left hand from our right hand, enantiomers in a chiral molecule may be differentiated as an S-enantiomer (from the Latin sinister meaning "left") and the R-enantiomer (from the Latin rectus for "right"). Since the enzymes in our cells are also chiral, as are other receptors that play an important part in how cells work, they typically prefer to bind to one of the enantiomers of a drug. In other words, only one of the enantiomers of a drug fits the receptor's site like a key that fits a lock."
I don't pretend to understand all this science. Could it be that all the benefit and all the side effects came from the S-enantiomer and the R half does nothing good or bad? In that case the benefit of Lexapro compared to Celexa would be in reduced dose only. But then, why is 10mg Lexapro equivalent to 40mg Celexa? 40mg Celexa should have twice as much of the good S half as 10mg Lexapro.
I am concerned by the possibility that the benefits of any SSRI are baked into the same cake with the detriments. That is, you can't have one without the other. Say, you've got to have more 5HT floating around to raise your mood, and more 5HT floating around makes you fat, apathetic, and sexually numb. Period.
Who knows? PsychoBabblers should be posting all the gory details by mid-September.
Posted by Anyuser on August 17, 2002, at 17:53:55
In reply to Lexapro: what to expect?, posted by Anyuser on August 17, 2002, at 15:51:04
I just love that phrase.
Posted by Phil on August 17, 2002, at 18:10:58
In reply to devoid of virtually all side effects, posted by Anyuser on August 17, 2002, at 17:53:55
Devoid, hmm.
On the other side of my long post, the first AD I was on was Amitriptyline. I was on it 5 years and it's about as dirty a drug as you can get.
Since then, I've never taken an AD or combo that came close to the effectiveness of Amitrip.
Some of that dirty stuff must help but it can get unpleasant.
Could it be they are introducing Lexapro knowing it's crap? I guess as Anyuser said, we'll know soon enough.
Posted by Anyuser on August 17, 2002, at 19:39:40
In reply to Re: devoid of virtually all side effects » Anyuser, posted by Phil on August 17, 2002, at 18:10:58
Posted by Ritch on August 17, 2002, at 21:37:15
In reply to Re: devoid of virtually all side effects » Anyuser, posted by Phil on August 17, 2002, at 18:10:58
> Devoid, hmm.
>
> On the other side of my long post, the first AD I was on was Amitriptyline. I was on it 5 years and it's about as dirty a drug as you can get.
> Since then, I've never taken an AD or combo that came close to the effectiveness of Amitrip.
> Some of that dirty stuff must help but it can get unpleasant.
> Could it be they are introducing Lexapro knowing it's crap? I guess as Anyuser said, we'll know soon enough.
Amitriptyline and other TCA's *are* dirty. I have tried (re)taking them recently and they are harder to tolerate overall than all the new stuff that everybody is willing to trash. Lexapro isn't going to be crap. It is going to be helpful just like other AD's can be helpful. It theoretically can't be any worse than Celexa (which isn't that bad). I just posted the R and S isomer double-blind trial because that would be an ultimate acid-test of their claims, that's all. At WORST, it could turn out that Lexapro is no better than Celexa, but you would still only have to ingest half the medication-so your body wouldn't have to eliminate an unnecessary portion of the medication. Being on polypharmacy for years, I don't see that "worst-case" scenario as being something that would prevent me from giving it a fair trial.Mitch
Posted by Phil on August 18, 2002, at 0:26:06
In reply to Devolutionary antidepressant....probably not, posted by Ritch on August 17, 2002, at 21:37:15
I'm switching 9/9, my next appt. We'll see.
Posted by Phil on August 18, 2002, at 0:33:07
In reply to Why did you stop Amitriptyline? (nm) » Phil, posted by Anyuser on August 17, 2002, at 19:39:40
It was time. The SE were always there and I didn't feel as good as the first few years. That old freedom was calling. Plus I met a very fun lady. I'll leave it there.
Tried it again almost 2 years ago...nada. Don't miss it and the SE are much more hazardous in your late forties than they were in your late twenties.
Posted by Mr.Scott on August 19, 2002, at 1:54:35
In reply to Re: Lexapro: what to expect? / Cam, you around?, posted by Phil on August 17, 2002, at 17:14:29
Citalopram is the #1 most used AD in the world
Forest has the marketing rights to Citalopram in the US under Celexa, but not in Europe where it actually is the number 1 prescribed antidepressant. In Europe and all other non-us companies, citalopram is owned by various other companies.
Forest will have full international rights to Lexapro and will launch a campaign to convert the entire world on Citalopram (Celexa and other names) to the new improved Leaxapro. Much more marketshare and money.
Believe me when I tell you that there is not a single person in the pharmaceutical industry who cares about you and your depression as much as they care about you and your money. Their motivations are always 100% based on bottom line revenue. Don't ever think for a second they have any other motivation whatsoever. Altruism is not welcome in this industry. Thats what Church on Sunday is for.
Scott
Posted by dave40252 on August 19, 2002, at 12:08:12
In reply to Forest is no Angel don't be fooled!, posted by Mr.Scott on August 19, 2002, at 1:54:35
> Citalopram is the #1 most used AD in the world
>
> Forest has the marketing rights to Citalopram in the US under Celexa, but not in Europe where it actually is the number 1 prescribed antidepressant. In Europe and all other non-us companies, citalopram is owned by various other companies.
>
> Forest will have full international rights to Lexapro and will launch a campaign to convert the entire world on Citalopram (Celexa and other names) to the new improved Leaxapro. Much more marketshare and money.
>
> Believe me when I tell you that there is not a single person in the pharmaceutical industry who cares about you and your depression as much as they care about you and your money. Their motivations are always 100% based on bottom line revenue. Don't ever think for a second they have any other motivation whatsoever. Altruism is not welcome in this industry. Thats what Church on Sunday is for.
>
> ScottTrue. Still, the best way for them to accomplish that would be to make one that really IS better, don't you think? I take Celexa, i have no big hopes for lexapro, but will keep an open mind and may give it a try sometime, assuming p-doc agrees.
Posted by Phil on August 19, 2002, at 12:10:25
In reply to Forest is no Angel don't be fooled!, posted by Mr.Scott on August 19, 2002, at 1:54:35
I'm sure you're right and..church wears off as soon as people walk out the door.
Posted by Maximus on August 19, 2002, at 14:18:41
In reply to Forest is no Angel don't be fooled!, posted by Mr.Scott on August 19, 2002, at 1:54:35
You're right Mr. Scott. We don't have to be fooled by this poor (to say the least) marketing.
At best, this Lexapro will be a good SSRI (and nothing more) and may be as potent as Paxil. But i would not hold my breath for the side effect profile.
Big hype, but a boring SSRI.
Good luck!
Dr.Brigitte, Biochemist.
Posted by Mr.Scott on August 19, 2002, at 20:36:59
In reply to Re: Forest is no Angel don't be fooled! » Mr.Scott, posted by Phil on August 19, 2002, at 12:10:25
I'll still try it with high high hopes, I just know Forest isn't doing anything that wouldn't fill their pockets. It's better than Communism, but still someone ought to get off their ass and find something new.It's like the paltry $300,000 spent by pharmaceutical companies in 2001 on R&D looking for a cure for AIDS. Why bother when they can "RAKE IT IN" treating it for a lifetime instead of curing it. Some of their marketing directors make more than $300,000 a year!!!
I'm sorry just pissed off and venting..
Scott
Posted by phil on August 20, 2002, at 17:56:31
In reply to Re: Forest is no Angel don't be fooled!, posted by Mr.Scott on August 19, 2002, at 20:36:59
Posted by Mr.Scott on August 21, 2002, at 0:36:45
In reply to $300,000.00, Surely you jest..don't you? (nm) » Mr.Scott, posted by phil on August 20, 2002, at 17:56:31
Thats the number we came up with when we were looking into the vaccine market. All the R&D money goes to treatment. There was a pool of 12 billion dollars total that year for all pharma R&D. (Another 12 billion dollars on marketing I should add). All the funding for curing AIDS has come from private (ie. educational institiutions, AIDS groups, etc.) and government funding not from the pharmaceutical industry. So when I say $300,000 I mean strictly pharma spending not other sources. They have Billion dollar drugs on patent and therefore no incentives.
I speak the truth.
Scott
Posted by Phil on August 21, 2002, at 12:01:07
In reply to Re: $300,000.00, Surely you jest..don't you? » phil, posted by Mr.Scott on August 21, 2002, at 0:36:45
Posted by Dr. Bob on August 21, 2002, at 15:24:38
In reply to Re: Forest is no Angel don't be fooled!, posted by Mr.Scott on August 19, 2002, at 20:36:59
> It's like the paltry $300,000 spent by pharmaceutical companies in 2001 on R&D looking for a cure for AIDS...
I'd like any discussion of pharmaceutical company budgets to be redirected to Psycho-Social-Babble, thanks.
Bob
PS: And follow-ups regarding posting policies to be redirected to Psycho-Babble Administration.
Posted by moxy1000 on August 22, 2002, at 19:26:37
In reply to Re: Forest is no Angel don't be fooled!, posted by Mr.Scott on August 19, 2002, at 20:36:59
Did you know Howard Soloman, the CEO of Forest, has a son who has suffered horribly from Depression? (His name is Andrew Soloman, he wrote an awesome book called the "noonday demon.")Also, did you know that Mr. Soloman's wife committed suicide? It's public knowledge...business weekly did a story on it about two months ago. Do be careful with your assumptions. Not every drug company is evil - but remember, they are not charitable organizations, either. They have to make money, just like any other business. But it does appear that this company has a vested interest in wiping depression from the planet.
Just my two cents.
This is the end of the thread.
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