Tag:

Psychiatric Medication

Withdrawal from Psychiatric Meds Can Be Painful, Lengthy

by John M. Grohol, Psy.D. 7/1/2024

Withdrawal from Psychiatric Meds Can Be Painful, Lengthy Although this will not come as news to anyone who’s been on any one of the most common psychiatric medications prescribed — such as Celexa, Lexapro, Cymbalta, Prozac, Xanax, Paxil, Effexor, etc. — getting off of a psychiatric medication can be hard. Really hard.

Much harder than most physicians and many psychiatrists are willing to admit.

That’s because most physicians — including psychiatrists — have not had first-hand experience in withdrawing from a psychiatric drug. All they know is what the research says, and what they hear from their other patients.

While the research literature is full of studies looking at the withdrawal effects of tobacco, caffeine, stimulants, and illicit drugs, there are comparatively fewer studies that examine the withdrawal effects of psychiatric drugs. Here’s what we know…

7/1/2024 41 comments

Does Interpersonal Psychotherapy Work for Depression?

by John M. Grohol, Psy.D. 10/14/2023

written by John M. Grohol, Psy.D.

Does Interpersonal Psychotherapy Work for Depression? Psychotherapy. You know, I spend a lot of time talking about it here, and it’s no wonder — it’s an effective treatment modality that too many people simply aren’t even considering. Much less using.

Psychotherapy research is less likely to be biased than other types of treatment research, too, because researchers tend not to be treatment providers nor have any direct (or even indirect) financial incentives in the outcomes of their research. Sure, there remains the “publication bias” that affects all research, but generally speaking, I tend to trust psychotherapy research data more than I do most psychiatric medication research.

So I was interested to read a recent meta-analysis on a specific form of psychotherapy called interpersonal psychotherapy for the treatment of depression. Its treatment focus is on the relationships of the person who is coming into treatment — whether they be family, romantic, friends, or others.

Interpersonal psychotherapy doesn’t get as much press or attention as other popular forms of psychotherapy (such as cognitive behavior therapy), so fewer practitioners use it and fewer consumers know of it.

But is it effective? Here’s what the researchers found out.

10/14/2023 5 comments

New Brain Mechanism Discovered for Anxiety

by John M. Grohol, Psy.D. 9/11/2023

written by John M. Grohol, Psy.D.

File this in the folder of new research discoveries that could lead to new, better targeted medications for one of the world’s most common mental concerns — anxiety.

According to the National Institute of Mental Health (NIMH), approximately 40 million American adults ages 18 and older — or nearly 1 in 5 people in this age group in a given year — have an anxiety disorder. Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.

Currently, the standard of care for anxiety treatment is either a short-acting psychiatric medication — most often a benzodiazepine for the treatment of things like panic disorder — and psychotherapy.

All of this could change if University of Alberta neuroscientists have their way. We’ve long known chemicals in the brain associated with an increase or decrease in anxiety. But their new research discovered exactly how those chemicals work, opening the door for more targeted brain treatments to be developed in the future.

9/11/2023 4 comments

FAA Still Stigmatizes Depression, Mental Illness

by John M. Grohol, Psy.D. 5/2/2023

written by John M. Grohol, Psy.D.

The U.S. Federal Aviation Administration (FAA) on Friday cleared pilots who have depression to regain their flying privileges, with one tiny caveat — they have to be taking one of only four “approved” antidepressants. I can only express my extreme disappointment at this decision because while it has the potential to help pilots take to the air again if they were suffering from depression, it fails to recognize other effective treatments for depression.

Apparently, the FAA doesn’t recognize the effectiveness of psychotherapy in the treatment of depression. This despite something on the order of four decades’ (or more) worth of research demonstrating its effectiveness for everything from mild to severe depression. In fact, if anything, there’s more research that calls into question the effectiveness of these four antidepressants than there is showing they help.

5/2/2023 28 comments

Test Predicts Depression Medication Response

by John M. Grohol, Psy.D. 1/10/2023

written by John M. Grohol, Psy.D.

Test Predicts Depression Medication Response Did you know that as much as some doctors and researchers like to think that medicine is a science, it is very much an art too?

You can see that no more clearly than in the decision process doctors use to prescribe a specific psychiatric medication. Ask a psychiatrist what their usual depression treatment regimen is, and they’ll usually talk to you about using one or two different antidepressants they are most familiar and comfortable with prescribing — not which medication is best for the patient.

Why is that? Wouldn’t you like to prescribe the most effective medication for a particular patient based upon their brain’s chemical structure and likely reaction to it? We sure would, but until recently, we had few ways to determine how a person might react to particular antidepressant medication.

Luckily, the days of trial and error and guesswork in this particular area of treatment may be coming to an end.

A new medical test — called a biomarker test — appears to help predict a patient’s response to a specific antidepressant. The test is non-invasive, painless and fast, taking about 15 minutes. Six electrodes (which measure brain activity) are placed around the forehead and on the earlobes (the electrodes don’t hurt — they are only measuring devices).

Here’s what the study found:

Subjects were then randomly assigned to continue with escitalopram or were given a different drug. A total of 73 patients who remained on escitalopram were tracked for 49 days to see if their results matched the prediction of the ATR biomarker. The ATR predicted both response and remission with an accuracy rate of 74 percent, much higher than any other method available.

The researchers also found that they could predict whether subjects were more likely to respond to a different antidepressant, bupropion, also known as Wellbutrin XL.

So although this test only worked on two medications — Lexapro and Wellbutrin XL — it’s a very good start in this area. And while 74 percent may not seem high, it’s much better than the current prescription strategy of trial and error, where only one-third of patients will respond to the randomly selected antidepressant medication they are prescribed (according to STAR*D, and then it’s more trial and error for those remaining two-thirds).

This test also shows the likely future of medical tests for serious mental conditions such as clinical depression. Rather than traditional blood-work laboratory tests, we’re far more likely to see these kinds of brainwave measuring devices. Such devices help collect data on how our brain is functioning and reacting, without any needles or pain. And while we’ve long been aware of their usefulness for a wide range of applications (from brain research to neurofeedback treatments), this is the first study of its kind demonstrating a simple way to discriminate between drugs and their effectiveness in our brains.

I can imagine that perhaps in a few more years, we’ll have biomarker tests for virtually all psychiatric medications, taking a large part of the guesswork out of the equation. And providing patients with better, more targeted care, more quickly.

Read the full article: Test Selects Best Depression Medication

1/10/2023 9 comments

Lexapro Maker Accused of Fraud

by John M. Grohol, Psy.D. 9/16/2022

written by John M. Grohol, Psy.D.

Yet another story about a drug maker getting into trouble for its off-label marketing practices for a psychiatric medication, this time to children and teens. The drugs? Lexapro and its older sibling, Celexa. The manufacturer of them? Forest Laboratories. The New York Times has the story:

In a civil complaint filed by the United States attorney’s office in Boston, federal prosecutors alleged that former top executives at Forest concealed for several years a clinical study that showed that the drugs were not effective in children and might even pose risks to them, including causing some to become suicidal.

From 2001 to 2004, Forest heavily promoted results from another clinical trial it had financed that showed that the drugs were effective, without disclosing the negative study to those researchers, its own medical advisers or its sales representatives, the complaint said.

Ooops! Can’t do that, and of course, drug executives know you can’t do that. So the only question remaining is whether the executives knew what the Justice Department is claiming, and if they have the evidence, well, guess what…

The real interesting story is how we continue to learn about these transgressions by pharmaceutical companies. It’s not through great investigative skills on the part of the government, it’s because employees of the companies charged keep bringing these problems to the government’s attention! If it weren’t for such individuals stepping up and blowing the whistle, it’s likely the transgressions would never see the light of day. Kudos to folks who take such a brave step forward.

But here’s the bizzaro part — one arm of the government has known since 2002 that Celexa had negative findings. Guess which arm?

In 2002, Forest submitted results from Dr. Wagner’s study, which were positive, and those from the Lundbeck study, which were negative, to the F.D.A.

Based on the Lundbeck findings, regulators rejected pediatric approval for Celexa, finding that the report was “a clearly negative study that provides no support for the efficacy of citalopram” in children. The agency, however, did not disclose the study’s results because Forest had submitted them confidentially.[…]

In court papers, prosecutors said that the existence of the Lundbeck study first came to public light when The New York Times published an article about it. Three days after that article was published in June 2004, Forest acknowledged the study as well as an another, earlier trial that also failed to show any benefits of Lexapro as a depression treatment for children.

So even though the U.S. Food and Drug Administration knew in 2002, it took another two years before this information came to the public light. And not because of the government bringing it to light, but because of investigative reporting on the part of the media.

There is no clearer indication that the FDA is terribly broken than by looking at this example. The FDA is supposed to be protecting the public from such behaviors, and instead — because of a confidentiality agreement it apparently was beholden to — it kept this valuable information private. Just truly astounding.

Read the full article: Lexapro Maker Forest Is Accused of Fraud.

9/16/2022 1 comment