Health and Medical News and Resources

General interest items edited by Janice Flahiff

[News item] Why Big Pharma is not addressing the failure of antidepressants

Why Big Pharma is not addressing the failure of antidepressants.

From the 14 May 2015 post at The Conversation

Around a quarter of people experience depression at some point in their lives, two-thirds of whom are women. Each year more than 11m working days are lost in the UK to stress, depression or anxiety and there are more than 6,000 suicides. The impact of depression on individuals, families, society and the economy is enormous.

Front-line therapies usually include medication. All the commonly prescribed antidepressants are based on “the monoamine hypothesis”. This holds that depression is caused by a shortage of serotonin and noradrenaline in the brain. Existing antidepressants are designed to increase the levels of these chemicals.

The first generation of antidepressants were developed in the 1950s and a second generation came in the 1980s. Products such as Prozac and Seroxat were hailed as “wonder drugs” when they first came onto the market.

In the roughly 30 years since, these kinds of drugs have come to look tired and jaded. Patents have expired and there are doubts about their efficacy. Some scientists even argue the drugs do more harm than good.

Broken model

There has been no third generation of antidepressants. This is despite there having been moon-landing levels of investment in research. The antidepressant discovery process that gave rise to the earlier drugs is clearly broken. It is also apparent that this process had never worked that well, since the only real improvements over the previous 60 years were a reduction of side-effects.

By the mid-2000s the major pharmaceutical companies started disinvesting in this area. Government funding for basic research into depression and charitable funding followed a similar pattern. In 2010 GSK, AstraZeneca, Pfizer, Merck and Sanofi all announced that they had stopped looking for new antidepressants altogether. Professor David Nutt, the former government drug advisor, declared this to be the “annus horribilis” for psychiatric drug research. The likelihood now is that there will be no new antidepressants for decades.

However, there continues to be an urgent and pressing need for more effective treatments. The question the drug companies now need to ask themselves is, did they fail because the task was impossible, or did they fail simply because they got things wrong? Our view is that there was a systems failure.

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May 19, 2015 Posted by | Psychiatry | , , , , , | Leave a comment

Aspirin to Zoloft: Ways Medicines Work

From the 8 August 2013  US National Library of Medicine article

Most medicines work by binding to and modifying the actions of proteins, tiny molecular machines that perform important cellular tasks. Details about protein structure and function help scientists develop medicines that block proteins or otherwise interact with them. But even when a drug is designed to target a specific protein, it can sometimes impact others, causing side effects. The way medicines work also can be influenced by how a person’s body absorbs and processes them.

Findings from research funded by the National Institutes of Health have shed light on how some common medicines work.

HIV protease with saquinavir.

HIV protease with saquinavir.
View larger image.

Antibiotics, Antivirals

Antibiotics and antiviral drugs attack proteins that are only found in the targeted bacterium or virus and that are crucial for the pathogen’s survival or multiplication. In many cases, the targets are enzymes, which are proteins that speed up chemical reactions. The antibiotic penicillin, for example, hones in on an enzyme that builds bacterial cell walls, causing infecting bacteria to burst and die. Protease inhibitors like saquinavir shut down an enzyme that would otherwise help HIV spread in the body.

Anticancer Agents

Tubulin with taxol.

Tubulin with taxol.
View larger image.

Many anticancer drugs act by killing cells that divide rapidly, but they can also affect healthy dividing cells. For example, paclitaxel (Taxol), which is prescribed for breast, ovarian and other cancers, works by binding to the tubulin protein, inhibiting the formation of structures called microtubules that are needed for cell division. Newer anticancer drugs are more discriminating, often targeting important proteins that are abnormally active in certain cancers. One such drug, imatinib mesylate (Gleevec), halts a cell-communication pathway that is always “on” in a cancer of the blood called chronic myelogenous leukemia. Gleevec’s target is a protein called a kinase, and the drug’s design is based on years of experiments on the basic biology of how cancer cells grow.

Antihistamines, Antidepressants, Aspirin

Adrenergic receptor with carazolol, a beta-blocker.

Adrenergic receptor with carazolol, a beta-blocker. View larger image.

Some of the most widely prescribed drugs function by blocking proteins called G protein-coupled receptors, which play key roles in transmitting the signals that allow a cell to respond to its environment. The drug loratadine (Claritin) relieves allergies by blocking the histamine receptor; antidepressant medications (such as Prozac, Paxil and Zoloft) affect the serotonin receptor; and beta-blockers treat heart disease by interfering with the adrenergic receptor. Signaling can also be stopped by targeting the enzymes that create a molecule involved in the process. This is how aspirin works—it inhibits the enzyme cyclooxygenase, which makes pain-signaling molecules called prostaglandins.

Weight Loss, Cholesterol Blockers

Pancreatic lipase with an inhibitor similar to orlistat.

Pancreatic lipase with an inhibitor similar to orlistat.
View larger image.

Medicines taken to control weight or cholesterol also work by interacting with specific proteins. The weight-loss drug orlistat (Xenical or Alli) blocks the action of pancreatic lipase, reducing the amount of fat that is absorbed from food. Cholesterol-lowering medications, such as atorvastatin (Lipitor) and simvastatin (Zocor), block the action of HMG-CoA reductase, an enzyme involved in making cholesterol.

Future Directions

With a better understanding of the specific relationships between a drug and its target (and off-target) proteins, researchers are using a variety of existing data to identify and test FDA-approved drugs for new uses and to predict potential side effects. This could reduce the time and cost of bringing drugs to market. Scientists are also learning more about how a person’s genes may influence the effectiveness and safety of certain drugs. Another area of active research involves developing new ways to deliver drugs to specific organs or disease sites, also improving therapeutic benefits and reducing side effects.

Content adapted from the poster “How Do Drugs Work?” available from the RCSB Protein Data Bank. Images courtesy of David S. Goodsell, The Scripps Research Institute.

Learn more:

Also in this series:

This Inside Life Science article also appears on LiveScience Link to external Web site.

 

August 25, 2013 Posted by | Educational Resources (High School/Early College(, Health Education (General Public) | , , , , , , , , , , , , | Leave a comment

Many get antidepressants for no psychiatric reason

Many get antidepressants for no psychiatric reason

From the February 4, 2011 Health Day news article by Frederik Joelving

NEW YORK (Reuters Health) – More than a quarter of Americans taking antidepressants have never been diagnosed with any of the conditions the drugs are typically used to treat, according to new research.

That means millions could be exposed to side effects from the medicines without proven health benefits, researchers say.

“We cannot be sure that the risks and side effects of antidepressants are worth the benefit of taking them for people who do not meet criteria for major depression,” said Jina Pagura, a psychologist and currently a medical student at the University of Manitoba in Canada, who worked on the study.

“These individuals are likely approaching their physicians with concerns that may be related to depression, and could include symptoms like trouble sleeping, poor mood, difficulties in relationships, etc.,” she added in an e-mail to Reuters Health. “Although an antidepressant might help with these issues, the problems may also go away on their own with time, or might be more amenable to counseling or psychotherapy.”

The researchers tapped into data from the Collaborative Psychiatric Epidemiologic Surveys, which include a nationally representative sample of more than 20,000 U.S. adults interviewed between 2001 and 2003.

Roughly one in ten people told interviewers they had been taking antidepressants during the past year. Yet a quarter of those people had never been diagnosed with any of the conditions that doctors usually treat with the medication, such as major depression and anxiety disorder.

According to The National Institute of Mental Health, nearly 15 million American adults suffer from major depression, and 40 million more have anxiety disorders.

Although the survey didn’t include all mental illnesses that might have led doctors to prescribe an antidepressant — say, obsessive-compulsive disorder or to help quit smoking — other experts said the new findings are not exaggerated.

“Reviews of claims records, which are diagnoses actually given by health care professionals, suggest that only about 50% of patients who are prescribed antidepressants receive a psychiatric diagnosis,” said Dr. Mark Olfson, a psychiatrist at Columbia University in New York.

“These findings raise questions about the clinical appropriateness of antidepressant treatment selection for many primary care patients,” he added in an e-mail to Reuters Health.

With sales of $9.9 billion in 2009, up three percent since the previous year, antidepressants rank fourth among prescription drugs in the U.S., according to IMS Health, a company that analyzes the pharmaceutical industry.

Popular brand names include Pfizer’s Zoloft, Forest Laboratories’ Lexapro and Eli Lilly’s Prozac.

While studies have shown the drugs may help some people with depression, they come with a price tag — and not only the $100 or more that a month’s supply can cost. Some users experience sexual problems or gain weight, for instance.

“Nearly all medication has side effects, so there are undoubtedly a large number of Americans who are taking antidepressants that may not be effective at treating their conditions, yet they suffer from the side effects,” said Jeffrey S. Harman, an expert in health services at the University of Florida in Gainesville, who was not involved in the new study.

“Not to mention inappropriate use of our health care dollars that comes along with inappropriate prescribing,” he added in an e-mail.

Still, Harman said the findings, published in the Journal of Clinical Psychiatry***, didn’t necessarily mean doctors are prescribing more antidepressants than they should.

“As far as overprescribing, I don’t think you can say that it is occurring as a blanket statement,” he explained. “There are undoubtedly many people being prescribed antidepressants that may not be effective for them, but there are also millions of Americans suffering from depression who are not being prescribed antidepressants or are being prescribed them at a suboptimal dose.”

Pfizer did not comment directly on the new findings, but told Reuters Health it was dedicated to ensuring “that patients and their doctors have the most up to date medical information on which to base their treatment decisions.”

SOURCE: http://bit.ly/eXPVSL*** Journal of Clinical Psychiatry, online January 25, 2011.

 

*** For suggestions on how to get this article for free or at low cost, please click here

 

 

February 9, 2011 Posted by | Uncategorized | , , , , | Leave a comment

Surviving the Holiday Blues

From the December 17 Health Day news item by Randy Dotinga

FRIDAY, Dec. 17 (HealthDay News) Christmas and other winter holidays are supposed to be a happy time of year, which makes it all the more stressful when they are anything but joyous.

This is the time of the year when people are especially vulnerable to depression, Dr. Angelos Halaris, a psychiatrist with the Loyola University Health System, said in a university news release. Shopping and entertaining can be stressful, while reflecting on lost loved ones can renew feelings of grief. Add to that the turmoil caused by the poor economy. All these things can help depression gain a foothold in certain individuals.

What to do? If you’re feeling extremely depressed and unable to function, consult a mental health professional immediately. Danger signs include two or more weeks of mood problems, crying jags, changes in appetite and energy levels, overwhelming shame or guilt, loss of interest in daily activities, difficulty concentrating and grim thoughts about death or suicide.

If you feel like your symptoms aren’t severe but still make you miserable, Halaris has these suggestions:

“Exercise works. Having replenishing relationships matter. Doing things that you find rewarding and fulfilling is helpful, as is attending religious services,” Halaris said in the news release. “Getting plenty of sleep and taking care of yourself works. We all have our limits, and learning to live within those limits is important.”

Be aware that depression, exhaustion and lack of interest in life could be a sign of seasonal affective disorder, caused by the lack of sunlight. One frequent symptom is a desire for sweets.

“The most common type of this mood disorder occurs during the winter months,” Halaris said. “SAD is thought to be related to a chemical imbalance in the brain, brought on by lack of light due to winters shorter days and typically overcast skies.”

What can you do about SAD? “If at all possible, get outside during winter, even if it is overcast,” Halaris said. “Expose your eyes to natural light for one hour each day. At home, open the drapes and blinds to let in natural light. SAD can be effectively treated with light therapy, antidepressant medication and/or psychotherapy.”

If you feel the blues because you’re lost in grief, Loyola bereavement counselor Nancy Kiel suggests that it’s important to acknowledge your loss.

“Start a new tradition to honor and remember your loved one,” Kiel said. “Light a special candle or at dinner, have everyone share a favorite memory or all can take part in a loved ones favorite holiday activity. Do something that would make your loved one smile.”

She also suggests that you avoid shopping at the mall — go online instead — and focus on being around people who are caring and supportive.

SOURCE: Loyola University Health System, press release, Dec. 10, 2010.

 

December 21, 2010 Posted by | Consumer Health | , , , , , , , | Leave a comment

Pain and depression: Is there a link?

From the Mayo Clinic article by Daniel K. Hall-Flavin, M.D.

Pain and depression are closely related. Depression can cause pain — and pain can cause depression. Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.

In many people, depression causes unexplained physical symptoms such as back pain or headaches. Sometimes this kind of pain is the first or the only sign of depression.

Pain and the problems it causes can wear you down over time, and may begin to affect your mood. Chronic pain causes a number of problems that can lead to depression, such as trouble sleeping and stress. Disabling pain can cause low self-esteem due to work, legal or financial issues. Depression doesn’t just occur with pain resulting from an injury. It’s also common in people who have pain linked to a health condition such as diabetes or migraines.

To get symptoms of pain and depression under control, you may need separate treatment for each condition. However, some treatments may help with both.

Because of shared chemical messengers in the brain, antidepressant medications can relieve both pain and depression.

Psychological counseling (psychotherapy) can be effective in treating both conditions.

Stress-reduction techniques, meditation, staying active, journaling and other strategies also may help.

Treatment for co-occurring pain and depression may be most effective when it involves a combination of treatments.

If you have pain and depression, get help before your symptoms worsen. You don’t have to be miserable. Getting the right treatment can help you start enjoying life again.

Some related links

Pain (MedlinePlus topic) has links to overviews, latest news, alternative therapies, health check tools, videos, research, and more

Depression (MedlinePlus topic) has links to overviews, latest news, treatments, related issues, and more

Depression (eMedicine Health) includes information on types of depression, causes, treatments, getting help, and much more
American Chronic Pain Association includes a consumer guide to pain medications and treatments, pain management tools

December 14, 2010 Posted by | Consumer Health | , , , , , , | Leave a comment

   

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