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Slowdown in psych med development: Is it really so bad?


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Psychiatrist Steve Balt comments on a report from the European College of Neuropsychopharmacology (ECNP) that world health is endangered now that research into psychiatric medications is no longer attractive to big pharma. A related topic: Drug companies whine: "We can't afford brain research"

 

Psychopharm R&D Cutbacks: Crisis or Opportunity?

stevebMD thoughtbroadcast.com June 19, 2011

 

The scientific journal Nature ran an editorial this week with a rather ominous headline: "Psychopharmacology in Crisis." (http://www.nature.com/news/2011/110614/full/news.2011.367.html) What exactly is this "crisis" they speak of? ....that our current psychiatric drugs are only marginally effective for many patients? ....that they can often cause side effects that some patients complain are worse than the original disease? No, the "crisis" is that the future of psychopharmacology is in jeopardy, as pharmaceutical companies, university labs, and government funding agencies devote fewer resources to research and development in psychopharmacology (http://www.pharmatimes.com/Article/11-06-16/Europe_faces_neuropsychiatric_research_vacuum_warns_ECNP_report.aspx). Whether this represents a true crisis, however, is entirely in the eye of the beholder.

 

In 2010, the pharmaceutical powerhouses Glaxo SmithKline (GSK) and AstraZeneca closed down R&D units for a variety of CNS disorders, a story that received much attention (http://mindhacks.com/2010/08/03/is-big-pharma-abandoning-psychiatry/). They suspended their research programs (http://www.sciencemag.org/content/329/5991/502.summary) because of the high cost of bringing psychiatric drugs to market, the potential for lawsuits related to adverse events, and the heavy regulatory burdens faced by drug companies in the US and Europe. In response, organizations like the European College of Neuropsychopharmacology (ECNP) and the Institute of Medicine in the US have convened summits (http://www.ecnp.eu/%7E/media/40318113B7DE4B7B912B408E8988BB1A.ashx) to determine how to address this problem.

 

The "problem," of course, for pharmaceutical companies is the potential absence of a predictable revenue stream. Over the last several years, big pharma has found it to be more profitable not to develop novel drugs....

 

Indeed, when I look back at the drug approvals of the last three or four years, there really hasn't been much to get excited about: antidepressants (Lexapro, Pristiq, Cymbalta) that are similar in mechanism to other drugs we've been using for years; new antipsychotics (Saphris, Fanapt, Latuda) that are essentially me-too drugs which don't dramatically improve upon older treatments; existing drugs (Abilify, Seroquel XR) that have received new indications for "add-on" treatment; existing drugs (Silenor, Nuedexta, Kapvay) that have been tweaked and reformulated for new indications; and new drugs (Invega, Oleptro, Invega Sustenna) whose major attraction is a fancy, novel delivery system.

 

Testing and approval of the above compounds undoubtedly cost billions of dollars (investments which, by the way, are being recovered in the form of higher health care costs to you and me), but the benefit to patients as a whole has been only marginal.

 

The true crisis, in my mind, is that with each new drug we psychiatrists are led to believe that we're witnessing the birth of a blockbuster. Not to mention the fact that patients expect the same, especially with the glut of persuasive direct-to-consumer advertising ("Ask your doctor if Pristiq is right for you!"). Most third-party payers, too, are more willing to pay for medication treatment than anything else (although—thankfully—coverage of newer agents often requires the doctor to justify his or her decision), even though many turn out to be a dud.

 

In the meantime, this focus on drugs neglects the person behind the illness. Not every person who walks into my office with a complaint of "depression" is a candidate for Viibryd or Seroquel XR. Or even a candidate for antidepressants at all. But the overwhelming bias is that another drug trial might work. "Who knows—maybe the next drug is the 'right' one for this patient!"

 

Recently, I've joked with colleagues that I'd like to see a moratorium on psychiatric drug development. Not because our current medications meet all of our needs, or that we can get by without any further research. Not at all. But if we had, say, five years with NO new drugs, we might be able to catch our collective breaths, figure out exactly what we're treating after all (maybe even have a more fruitful and unbiased discussion about what to put in the new DSM-5 (http://thoughtbroadcast.com/2011/06/08/i-want-a-dsm-wiki/) ), and, perhaps, devote resources to nonpharmacological treatments, without getting caught up in the ongoing psychopharmacology arms race that, for many patients, focuses our attention where it doesn't belong.

 

So it looks like my wish might come true. Maybe we can use the upcoming slowdown to determine where the real needs are in psychiatry. Maybe if we can devote resources to community mental health services, to drug and alcohol treatment, pay more attention to our patients' personality traits, lifestyle issues, co-occurring medical illnesses, and respond to their goals for treatment rather than AstraZeneca's or Pfizer's, we can improve the care we provide and figure out where new drugs might truly pay off. Along the way, we can spend some time following the guidelines discussed in a recent report in the Archives of Internal Medicine (http://archinte.ama-assn.org/cgi/content/short/archinternmed.2011.256) , and practice "conservative prescribing"—i.e., making sensible decisions (http://www.minnpost.com/healthblog/2011/06/16/29225/physicians_need_to_radically_rethink_their_prescribing_practices_report_says) about

what we prescribe and why.

 

Sometimes, it is true that less is more. When Big Pharma backs out of drug development, it's not necessarily a bad thing. In fact, it may be precisely what the doctor ordered.

 

http://thoughtbroadcast.com/2011/06/19/psychopharm-rd-cutbacks-crisis-or-opportunity/

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Interesting! I agree that they should be focusing more on other forms of healing. If therapies and such received as much funding as drugs I'm sure mental health problems could be improved much faster.

Off Lexapro since 3rd November 2011.

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Reality check time, folks. The pharmaceutical companies aren't pulling out of psychiatry out of the goodness of their hearts. They're not halting production of new meds because they finally got the message how toxic their meds are and psychiatry needs to do some deep soul searching. No, they're pulling out because they've accomplished their mission of saturating the market. They realized their profit margins will go down the tubes if they pony up the cash to do some real R&D by developing truly novel psych meds and not just more me-too patent extenders. They know molecules can only be tweaked so much. In short, they won. But psychiatry is so pig-headed in its myopia that it doesn't even realize they've been the pharam companies' bit**es for all these years. They are completely enslaved by the whims of the pharma companies' bottom line. They don't see this retraction of big pharma as an opportunity to see the reality and fight pharma corruption but instead just bemoan its impact on their narrow and toxic paradigm of care re: patients new to the ass-kicking machine that is psychiatry won't get to sample new Elf fudge anymore (that is, new psych drugs).

 

Yeah, I guess it may be a blessing in disguise that psychiatry won't have a massive influx of new drugs for the foreseeable future, but the very reason for this phenomenon is because it's business as usual for big pharma, and psychiatry continues to not see the big picture. The band plays on for big pharma, as it always has. :angry:

Been on SSRIs since 1998:

1998-2005: Paxil in varying doses

2005-present: Lexapro.

2006-early '08: Effexor AND Lexapro! Good thing I got off the Effexor rather quickly (within a year).

 

**PSYCHIATRY: TAKE YOUR CHEMICAL IMBALANCE AND CHOKE ON IT!

APA=FUBAR

FDA=SNAFU

NIMH=LMFAO

 

Currently tapering Lexapro ~10% every month:

 

STARTING: 15 mg

11/7/10: 13.5 mg

12/7/10: 12.2 mg

1/6/11: 10.9 mg

2/3/11: 9.8 mg

3/3/11: 8.8 mg

4/1/11: 7.8 mg

4/29/11: 7 mg

5/27/11: 6.4 mg

6/24/11: 5.7 mg

7/22/11: 5 mg

8/18/11: 4.5 mg

9/14/11: 4 mg

10/13/11: 3.6 mg

11/9/11: 3.2 mg

12/7/11: 2.6 mg

1/3/12: 2.1 mg

2/2/12: 1.8 mg

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Cinephile - your analysis is spot on.

 

1989 - 1992 Parnate* 

1992-1998 Paxil - pooped out*, oxazapam, inderal

1998 - 2005 Celexa - pooped out* klonopin, oxazapam, inderal

*don't remember doses

2005 -2007   Cymbalta 60 mg oxazapam, inderal, klonopin

Started taper in 2007:

CT klonopin, oxazapam, inderal (beta blocker) - 2007

Cymbalta 60mg to 30mg 2007 -2010

July 2010 - March 2018 on hiatus due to worsening w/d symptoms, which abated and finally disappeared. Then I stalled for about 5 years because I didn't want to deal with W/D.

March 2018 - May 2018 switch from 30mg Cymbalta to 20mg Celexa 

19 mg Celexa October 7, 2018

18 mg Celexa November 5, 2018

17 mg Celexa  December 2, 2019

16 mg Celexa January 6, 2018 

15 mg Celexa March 7, 2019

14 mg Celexa April 24, 2019

13 mg Celexa June 28, 2019

12.8 mg Celexa November 10, 2019

12.4 Celexa August 31, 2020

12.2 Celexa December 28, 2020

12 mg Celexa March 2021

 

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NEWSFLASH: Whitaker just posted about this issue on his blog. It's a great read.

 

I just sent him an email about his post. I've included it below for talking points purposes on this thread:

 

I liked your newest post about how the pharm companies are pulling out of psych med development.

 

However, I think this is one hell of a mixed bag. I, for one, am furious that the pharma companies basically got away scot free with their sins and now millions of patients worldwide such as me, who were needlessly medicated for many years, are left holding the bag and trying to withdraw and deal with lingering symptoms by themselves. They played the psychiatrists and the patients for chumps, and got away with it.

 

Do you honestly think this will stop the pharmaceutical corruption? Won't they just pick up where they left off in another area of medicine? I mean, what reason do they have to stop if the worst they can expect is a few wrist-slap class action lawsuits? And what are the prospects that patients who suffer from persistent iatrogenic damage from these meds will see the day where treatments are developed for them?

 

Been on SSRIs since 1998:

1998-2005: Paxil in varying doses

2005-present: Lexapro.

2006-early '08: Effexor AND Lexapro! Good thing I got off the Effexor rather quickly (within a year).

 

**PSYCHIATRY: TAKE YOUR CHEMICAL IMBALANCE AND CHOKE ON IT!

APA=FUBAR

FDA=SNAFU

NIMH=LMFAO

 

Currently tapering Lexapro ~10% every month:

 

STARTING: 15 mg

11/7/10: 13.5 mg

12/7/10: 12.2 mg

1/6/11: 10.9 mg

2/3/11: 9.8 mg

3/3/11: 8.8 mg

4/1/11: 7.8 mg

4/29/11: 7 mg

5/27/11: 6.4 mg

6/24/11: 5.7 mg

7/22/11: 5 mg

8/18/11: 4.5 mg

9/14/11: 4 mg

10/13/11: 3.6 mg

11/9/11: 3.2 mg

12/7/11: 2.6 mg

1/3/12: 2.1 mg

2/2/12: 1.8 mg

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Dude, where's the link?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Dude, where's the link?

LOL! Well well well! At long last Alto's long-dormant Valley girl surfaces! San Francisco :rolleyes:

 

But in all seriousness (!), here's the link:

 

LINK

Been on SSRIs since 1998:

1998-2005: Paxil in varying doses

2005-present: Lexapro.

2006-early '08: Effexor AND Lexapro! Good thing I got off the Effexor rather quickly (within a year).

 

**PSYCHIATRY: TAKE YOUR CHEMICAL IMBALANCE AND CHOKE ON IT!

APA=FUBAR

FDA=SNAFU

NIMH=LMFAO

 

Currently tapering Lexapro ~10% every month:

 

STARTING: 15 mg

11/7/10: 13.5 mg

12/7/10: 12.2 mg

1/6/11: 10.9 mg

2/3/11: 9.8 mg

3/3/11: 8.8 mg

4/1/11: 7.8 mg

4/29/11: 7 mg

5/27/11: 6.4 mg

6/24/11: 5.7 mg

7/22/11: 5 mg

8/18/11: 4.5 mg

9/14/11: 4 mg

10/13/11: 3.6 mg

11/9/11: 3.2 mg

12/7/11: 2.6 mg

1/3/12: 2.1 mg

2/2/12: 1.8 mg

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