How This Shrink Picks Antidepressants
Dinah at Shrink Rap wrote an article about how she chooses antidepressants for patients who come and see her. The factors, which Dinah’s full article elaborates, include: Past history of response, Family history of response, Patient preference, Other Medical Issues, My Best Guess at What Will Help the Target Symptoms, My Best Guess at the Side Effect Profile, and The Patient’s Financial Concerns and What I have Samples of. Dinah also talks about concerns with weight gain on antidepressants, and how this is often a very individual side effect even if the drug “class” itself has been associated (statistically) with weight gain in patients.
Fixing Yourself, Mental Health Research, and Teen Suicide Increase
Marie sent me a video meditation on all the stuff she’s bought to try to “fix” herself; it was one of the more creative blog entries I’ve received. Here’s the link to Marie’s video meditation and to her blog, Diary of a Bad Buddhist. I don’t know what “dialectical materialism” is, but it makes Marie happy, and at least it only takes up virtual space and not the space in her house!
GrrlScientist is quite prolific and sent me three entries, one relating to mental health research and two relating to suicide trends. In terms of the research material, I’d recently written about the potential utility of the enzyme Protein Kinase C in designing novel drugs for treating the mania phase of bipolar disorder, although I have reservations about the clinical study itself (too few participants). GrrlScientist covers a few other recent developments in bipolar disorder research.
I had seen the recent CDC report on teen suicide and wanted to bring it to your attention. I also remember last year when GrrlScientist wrote about her own suicide attempt and her experiences in the psychiatric ward (and no one taking good care of her parrots!).Thus GrrlScientist can write about suicide prevention from a personal perspective and I encourage you to visit her article.
Part of the speculation around the increase in suicide amongst teens is whether the 2003 mandatory “black box” warning for antidepressants had something to do with this trend. In other words, are teens killing themselves due to depression that is not treated, as doctors have become wary about prescribing SSRI-class of antidepressant drugs to children and teens after numerous reports of SSRI-induced suicidal ideation? GrrlScientist writes about this also.
Last week, I listened to a radio interview with one of the authors of CDC’s suicide trend and this question was raised. The author didn’t directly address it, only emphasizing that suicide is a complex behavior and is contributed by many factors. I think treating teen and child depression can get tricky, and the black box warning serves to make doctors aware of the risks involved when prescribing these drugs off-label (i.e. not approved by the FDA) for such vulnerable population of patients. That’s not to say that a doctor cannot prescribe an SSRI antidepressant for a patient whose condition requires immediate treatment, but the risk warnings caution doctors to carefully watch and monitor that patient if an off-label prescription is given.
Breast Cancer Drug in Bipolar Mania Suggests Novel Therapy Options
Reuters reported on a study by the National Institute of Mental Health that showed breast cancer drug tamoxifen may have an effect on the “manic” symptoms of bipolar disorder. The researchers used tamoxifen because of its effect on protein kinase C (PKC), an enzyme that has many effects on cells, including brain cells. PKC may be overactive in bipolar mania. The study was published in the September 2007 issue of the medical journal, Bipolar Disorders.
My major concern about this study is that it is extremely small: only 16 patients. These 16 patients were then given either tamoxifen or placebo for 3 weeks, and 10 out of the 16 patients had reduced mania symptoms compared with placebo. According to the study, effects were observable within 5 days. According to Reuters, tamoxifen is “too dangerous” of a drug for use in bipolar disorder, and this study is meant to encourage the search for bipolar disorder drugs that target PKC. One of the study investigators believes that targeting PKC may allow for faster effects of antimania drugs.
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