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Party drug ketamine closer to approval for depression

From CNN:

The Food and Drug Administration put the experimental drug esketamine (also known as ketamine) on the fast track to official approval for use in treating major depression, Janssen Pharmaceutical announced Tuesday. This designated "breakthrough therapy" would offer psychiatrists a new method for treating patients with suicidal tendencies and would qualify as the first new treatment for major depressive disorder in about half a century.

In some quarters, though, this potentially effective medicine can't escape its reputation as "Special K," a street drug known for producing a high similar to an out-of-body experience -- and sometimes used as a date rape drug.

Ketamine was first synthesized in 1962 by Calvin Stevens at Parke Davis Laboratories, according to Encyclopedia Britannica. It received FDA approval for use in humans in 1970, and shortly after, Army doctors used the drug on American soldiers fighting in Vietnam as an analgesic and sedative. Yet its minor hallucinogenic side effects soon warned doctors off treating people. Today, ketamine's most common use is as a veterinary anesthetic.

A concern with using ketamine to treat depression is that it can reverse tolerance to opioids, Coffman said. Essentially, patients will get a higher dose of pain medicines, she explained, so any psychiatric uses would require "close oversight" by a multidisciplinary team of doctors.
Iosifescu said the short-term effects are known, but the long-term effects remain mysterious.
 
Another concern is the similarity between prescription ketamine and the street drug, a substance of abuse.

These are all reasons why Janssen's formulation will be provided and administered in doctors' offices or clinics, not distributed by pharmacies.
Posted: 8/22/2016 10:21:00 AM

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Scopolamine: An old drug with new psychiatric applications

From EurekAlert!:

Scopolamine is an anticholinergic drug with many uses. For example, it prevents nausea, vomiting, and motion sickness.

However, scopolamine is re-emerging as an antidepressant, with recent studies showing that scopolamine can rapidly improve mood in depressed patients. In addition, in a new study published in Biological Psychiatry this month by Dr. Moriel Zelikowsky and colleagues at the University of California, Los Angeles, it may also be a possible treatment for anxiety disorders.

Exposure therapy, where the key goal is the elimination of fear through repeated 'safe' exposure to the threat, is commonly employed for the treatment of anxiety disorders. However, its effectiveness is diminished because humans and animals alike tend to be very sensitive to context, causing extinction learning to be dependent on the environment in which it occurs. This makes memories formed during extinction unstable. As a result, extinguished fears commonly return when people put themselves in new situations.

In an effort to solve this dilemma, Fanselow and his team took a novel theoretical approach. Employing an animal model of exposure therapy, they found they were able to disrupt the rats' contextual processing during extinction using low doses of scopolamine, which blocked the return of fear when the rats were exposed to both the original and a new context.

Posted: 2/13/2013 8:59:00 AM

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Two antidepressants ineffective for dementia

From msnbc.com:

Two antidepressants that are commonly given to Alzheimer's disease patients appear not only to be ineffective but may give side effects such as nausea and drowsiness, a study in Britain has found.

In a paper published in the medical journal The Lancet on Tuesday, researchers urged doctors to think twice before prescribing these drugs to Alzheimer's patients with depression.

The two drugs used in the study were sertraline, marketed by Pfizer under the brand name Zoloft, and mirtazapine, known as Remeron in the United States.

They urged clinicians and investigators to reframe the way they treat Alzheimer's patients with depression and to reconsider routine prescription of antidepressants.

Posted: 7/19/2011 3:05:00 PM

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Taking Antidepressants in Pregnancy: A Tough Choice

From ABC News:

For the first time ever, obstetricians and psychiatrists have issued joint guidelines for the treatment of women with depression who are pregnant and for those thinking about getting pregnant.

To summarize the detailed and comprehensive report: Experts believe that the risk of untreated depression to the health of the mother and baby are considerable and should be balanced against the risk of treatment with medications. They recommend that women with mild or controlled depression should try to wean off their medications before becoming pregnant. Psychotherapy such as talk therapy should always be used for women with depression and that this therapy may be enough for many women.

However, they are recommending continuing or even beginning antidepressant medication in pregnant women with severe depression for which no other treatment has been effective. It is this information that gained the most media attention and has many women understandably worried. The report does emphasize that there needs to be a lot more research on the short-term and long-term risk of these medications. Both untreated depression and use of antidepressants have been linked to smaller birth weights and even premature births along with possible problems for the baby after birth.

Antidepressants have been linked to a combination of symptoms in the baby in the immediate postpartum period such as rapid pulse and a drop in blood sugar. They attribute these symptoms either directly to the medication or to the withdrawal of the medication. So any baby born to a mother on these medications needs to be monitored closely for these symptoms at birth. Developmental problems in the baby have also been raised – however the report mentions that both untreated depression and medications may increase the risk.

Women with severe depression and those who have been suicidal in the past have a much higher chance of relapsing if medications are stopped. Relapse can occur during the pregnancy affecting the health of the mother and the baby – and after the pregnancy during the post partum period. Taking medication for them may be their only choice -- and it is always a difficult one. Medication sometimes can be the only treatment that works.

Posted: 9/8/2009 12:45:00 PM

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Antidepressant Use Nearly Doubles

From WebMD:

Antidepressant use has nearly doubled in the U.S, according to a new study.

Meanwhile, the use of psychotherapy by those prescribed the antidepressants has declined during the same period studied, from 1996 to 2005.

The study appears in the Archives of General Psychiatry.

For the 1996 survey, nearly 19,000 people aged 6 and older were included, and more than 28,000 in the 2005 survey. A designated adult in each household answered questions about prescribed medications, medical visits, and other information.

The rate of antidepressant treatment increased from 5.84% to 10.12 % -- or from 13 million people to about 27 million, the researchers found.

One exception to the trend involved African-Americans. "African-Americans really did stand out as one group that didn't experience a significant increase in antidepressant use," Olfson says. In 1996, 3.6% of African-Americans surveyed were on antidepressants and 4.5% in 2005.

Another important finding, Olfson says, is that fewer people on antidepressants surveyed in 2005 also took part in psychotherapy or "talk therapy." Although 31.5% of those surveyed in 1996 on antidepressants also did talk therapy, just 19.8% of those surveyed in 2005 both took antidepressants and participated in psychotherapy.

Often, the two are recommended together for depression.

The researchers say a number of factors explain the increasing use of antidepressants. "There has been broad and growing acceptance of antidepressant medicine in the U.S.," Olfson tells WebMD.

Other factors explaining the increase, according to Olfson:
  • Major depression is more common. Two surveys found the prevalence of major depression in adults rose from 3.3% in 1991-1992 to 7.1% in 2001-2002.
  • Since 1996, several new antidepressants have come on the market.
  • Clinical guidelines support the use of antidepressants for conditions other than depression, such as anxiety disorders.
     
Posted: 8/4/2009 3:03:00 PM

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Antidepressant, Sleeping-Pill Sales Get No Rest in Recession

From Advertising Age:

You snooze, you lose? Not for some pharmaceutical companies seeing big sales jumps for sleep aids and antidepressants, despite lower marketing spending in both categories.

According to IMS Health, prescriptions for major sleeping-pill brands rose 7% last year, while antidepressant-brand prescriptions jumped 15%.

The economy, it appears, is keeping us up at night, according to a new "Sleep In America" poll out this week from the Washington-based National Sleep Foundation. Some 31% of respondents said they are losing sleep over the dismal economy and their own financial situation.

Even more surprising, prescriptions are up despite a dramatic decrease in marketing -- in the case of sleeping aids, by hundreds of millions of dollars.

Dr. Robert Aronson, a sleep specialist at Cardinal Sleep Center in Joliet, Ill., said there is a correlation between the falling economy, a lack of sleep and the uptick in prescriptions and purchase of sleep aids -- and he doesn't see it ending soon. "The economic problems are likely to be protracted," he said. But, he added, continual use of sleep aids or antidepressants are "not good because sedative hypnotics are best used for short-term insomnias due to transient stressors."

Sales of antidepressants in 2008 were up 2% compared to 2007. While prescriptions were up, dollar sales of prescription sleep aids were down 30% in '08 vs. '07 because the patent expired on Ambien (which was succeeded by Ambien CR). Sales were also hurt by the introduction of the cheaper generic Zolpidem, not to mention the emergence of more wallet-friendly over-the-counter sleep medications such as Unisom.

The total over-the-counter market for sleep aids reached $604 million in 2008, an increase of 9% over 2007 according to Packaged Facts, a division of Rockville, Md.-based Market Research Group.

Posted: 3/6/2009 9:48:00 AM

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