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Drug Firms Reassess Strategies For Drugs To Treat Depression
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| Health & Medicine
Monday, February 14, 2005
Drug Firms Reassess Strategies For Drugs To Treat Depression
BY AMY REEVES
http://www.investors.com/editorial/health.asp?view=1
The Food and Drug Administration's decision last fall to put its strongest
available warning — a "black box" — on antidepressants for children brought with
it a spate of publicity.
The public heard wrenching testimony from parents who said the drugs had
actually contributed to their children's suicides.
But investors want to know: What effect has this actually had on drug sales?
Pharmacy benefit manager Medco Health Systems (MHS) recently released a survey
looking into that question. It found that the number of patients younger than 18
on antidepressants did indeed drop by 10% last year.
The biggest plunge was in the third quarter, when use dropped 19% compared with
the same period in 2003. In the fourth quarter, when antidepressant use usually
peaks, use was down 16%.
"I think (the surprise) was probably in the extent of the decrease," said Glen
Stettin, Medco's vice president of plan management. "We expected some decrease
in prescribing."
The numbers were a sharp turn from recent trends. Medco's data show a 20% rise
in the number of children on behavioral medications between 2000 and 2003.
Antidepressant use gained 27%.
That's one reason selective serotonin reuptake inhibitors, or SSRIs, have been
such big business for drug makers such as Pfizer, (PFE) Eli Lilly, (LLY) Wyeth
(WYE) and Forest Laboratories. (FRX)
But analysts say the underage contingent is too small to have a major financial
impact on the drug giants.
"The vast majority of antidepressants are used in adults," said analyst Robert
Hazlett of SunTrust Robinson Humphrey. "This is something we're watching, but
it's not of significant consequence economically to the larger companies we
follow."
Since smaller Forest Labs depends heavily on its two SSRIs, Lexapro and Celexa,
Hazlett says it might be suffering more from the turndown. He adds that Forest
is having other problems that probably have more impact.
It's also hard to tell how much the negative news is contributing to an overall
modest slowdown in the market. Analyst Albert Rauch of A.G. Edwards says there
might be a "slight rebasing" in how the drug class is being used.
Ironically, the suicide danger came from the fact that the drugs were working.
One symptom of major depression is a lack of decisiveness. Some patients on
SSRIs are better able to make decisions and get their volition up before their
black moods lift. Hence, suicide.
"I think (its use) was a little too casual," Rauch said. "I think the treatment
of depression was too casual: 'We have the cure for it, just take this pill.'
But these people do have an illness, and they're prone to suicide. They should
be watched until the drugs have actually had the full impact."
Often the prescribing doctor isn't even a mental-health specialist, Stettin
says. That's why Medco deemed it important to disseminate as much information as
possible to the doctors and pharmacists it does business with.
"From psychiatric specialists, the feedback was, 'We knew that already,' "
Stettin said. "But a good deal of these drugs are prescribed by nonmental-health
specialists. For them, timely information is most important."
The casualness of SSRI use has led some to argue that the drugs were being
overprescribed.
Others worry that the safety concerns might scare people away from using the
drugs when they actually need them.
One result is a bigger effort to educate patients and family members. In
addition to Medco's alerts for its clients, an independent group recently
launched a Web site called ParentsMedGuide.org to help parents and family
physicians sort through the data.
Analyst Hazlett says drug makers are still working out how to market their
products under the new regulations. He still sees a bright future for the drug
class, however.
"SSRIs still are, and will still be, the standard of care for treating
depression," he said. "We expect sales growth to pick up over time."
Rauch offers a similar view. Though he criticizes the reduction of depression
treatment to pill-popping, he also contends sales growth for these drugs is
justified.
"Depression is fairly prevalent in the population," Rauch said. "I think (the
problem) is not just the casualness in the use of these antidepressants, but the
casualness in people's attitudes toward depression and its seriousness as a
disease."
"In the history of science, thinking in terms of entities has always tended to precede thinking in terms of processes.
Alchemists and astrologers thus spoke of mysterious substances and concealed their methods from public scrutiny.
Psychiatrists have similarly persisted in speaking of mysterious maladies and have continued to refrain from
disclosing fully and frankly what they do."
- Thomas Szasz M.D., Primary Values and Major Contentions
| |
| Squiggles 2005-02-15, 8:32 am |
| An apparent presentation to McGill Psych. staff on the matter:
What a tangled web--
(hope you can read this on your screen; it's a PDF file,
if not I think i can search the appropriate references):
http://www.acsa-caah.ca/pdf/conf/e10.PDF
Squiggles
| |
| G. McKenzie 2005-02-15, 8:32 am |
| I have been of the opinion that depression was over-diagnosed for years now.
That opinion was solely based on me seeing people who were "diagnosed"
depressive who could not understand my depressive moods and would say things
like "just smile and act happy - that'll work wonders for you." If they
were depressive they would see the fallacy in that statement. Anyway (I'm
getting side-tracked) if depression is over-diagnosed, then it would follow
that anti-depressants are over-prescribed.
I do have a question, though. When I was on AD's alone, I experienced more
agitated hypomania. What is the probability that the increase in suicides
is related to a misdiagnosis of depression for someone who is bipolar?
G.
"jake" <invalid@invalid.com> wrote in message
news:8ipu01htlngk8utel0da7spl0m0rgl5vmc@4ax.com...
> Health & Medicine
>
> Monday, February 14, 2005
> Drug Firms Reassess Strategies For Drugs To Treat Depression
>
> BY AMY REEVES
>
> http://www.investors.com/editorial/health.asp?view=1
>
> The Food and Drug Administration's decision last fall to put its strongest
> available warning - a "black box" - on antidepressants for children
> brought with
> it a spate of publicity.
>
> The public heard wrenching testimony from parents who said the drugs had
> actually contributed to their children's suicides.
>
> But investors want to know: What effect has this actually had on drug
> sales?
>
> Pharmacy benefit manager Medco Health Systems (MHS) recently released a
> survey
> looking into that question. It found that the number of patients younger
> than 18
> on antidepressants did indeed drop by 10% last year.
>
> The biggest plunge was in the third quarter, when use dropped 19% compared
> with
> the same period in 2003. In the fourth quarter, when antidepressant use
> usually
> peaks, use was down 16%.
>
> "I think (the surprise) was probably in the extent of the decrease," said
> Glen
> Stettin, Medco's vice president of plan management. "We expected some
> decrease
> in prescribing."
>
> The numbers were a sharp turn from recent trends. Medco's data show a 20%
> rise
> in the number of children on behavioral medications between 2000 and 2003.
> Antidepressant use gained 27%.
>
> That's one reason selective serotonin reuptake inhibitors, or SSRIs, have
> been
> such big business for drug makers such as Pfizer, (PFE) Eli Lilly, (LLY)
> Wyeth
> (WYE) and Forest Laboratories. (FRX)
>
> But analysts say the underage contingent is too small to have a major
> financial
> impact on the drug giants.
>
> "The vast majority of antidepressants are used in adults," said analyst
> Robert
> Hazlett of SunTrust Robinson Humphrey. "This is something we're watching,
> but
> it's not of significant consequence economically to the larger companies
> we
> follow."
>
> Since smaller Forest Labs depends heavily on its two SSRIs, Lexapro and
> Celexa,
> Hazlett says it might be suffering more from the turndown. He adds that
> Forest
> is having other problems that probably have more impact.
>
> It's also hard to tell how much the negative news is contributing to an
> overall
> modest slowdown in the market. Analyst Albert Rauch of A.G. Edwards says
> there
> might be a "slight rebasing" in how the drug class is being used.
>
> Ironically, the suicide danger came from the fact that the drugs were
> working.
>
> One symptom of major depression is a lack of decisiveness. Some patients
> on
> SSRIs are better able to make decisions and get their volition up before
> their
> black moods lift. Hence, suicide.
>
> "I think (its use) was a little too casual," Rauch said. "I think the
> treatment
> of depression was too casual: 'We have the cure for it, just take this
> pill.'
> But these people do have an illness, and they're prone to suicide. They
> should
> be watched until the drugs have actually had the full impact."
>
> Often the prescribing doctor isn't even a mental-health specialist,
> Stettin
> says. That's why Medco deemed it important to disseminate as much
> information as
> possible to the doctors and pharmacists it does business with.
>
> "From psychiatric specialists, the feedback was, 'We knew that already,' "
> Stettin said. "But a good deal of these drugs are prescribed by
> nonmental-health
> specialists. For them, timely information is most important."
>
> The casualness of SSRI use has led some to argue that the drugs were being
> overprescribed.
>
> Others worry that the safety concerns might scare people away from using
> the
> drugs when they actually need them.
>
> One result is a bigger effort to educate patients and family members. In
> addition to Medco's alerts for its clients, an independent group recently
> launched a Web site called ParentsMedGuide.org to help parents and family
> physicians sort through the data.
>
> Analyst Hazlett says drug makers are still working out how to market their
> products under the new regulations. He still sees a bright future for the
> drug
> class, however.
>
> "SSRIs still are, and will still be, the standard of care for treating
> depression," he said. "We expect sales growth to pick up over time."
>
> Rauch offers a similar view. Though he criticizes the reduction of
> depression
> treatment to pill-popping, he also contends sales growth for these drugs
> is
> justified.
>
> "Depression is fairly prevalent in the population," Rauch said. "I think
> (the
> problem) is not just the casualness in the use of these antidepressants,
> but the
> casualness in people's attitudes toward depression and its seriousness as
> a
> disease."
>
>
> "In the history of science, thinking in terms of entities has always
> tended to precede thinking in terms of processes.
> Alchemists and astrologers thus spoke of mysterious substances and
> concealed their methods from public scrutiny.
> Psychiatrists have similarly persisted in speaking of mysterious maladies
> and have continued to refrain from
> disclosing fully and frankly what they do."
>
> - Thomas Szasz M.D., Primary Values and Major Contentions
>
>
| |
|
| On Sun, 13 Feb 2005 19:18:18 GMT, "G. McKenzie" <gmckenzie1993@earthlink.net>
wrote:
>I have been of the opinion that depression was over-diagnosed for years now.
>That opinion was solely based on me seeing people who were "diagnosed"
>depressive who could not understand my depressive moods and would say things
>like "just smile and act happy - that'll work wonders for you."
yeah...the jiminy cricket theory of depression..
yuk!
sometimes whistling a happy tune just doesnt hack it!!!
> If they
>were depressive they would see the fallacy in that statement. Anyway (I'm
>getting side-tracked) if depression is over-diagnosed, then it would follow
>that anti-depressants are over-prescribed.
>
>I do have a question, though. When I was on AD's alone, I experienced more
>agitated hypomania.
> What is the probability that the increase in suicides
>is related to a misdiagnosis of depression for someone who is bipolar?
well...due to the supression of negative trial results,maximizing of advertising
hype and TV exortations for folk to pressure their untrained GPS directly..my
guess would be that it has happened quite a lot..
certainly its a common occurence in support groups I moderate..
you are by no means alone..
>
>G.
>
>
>"jake" <invalid@invalid.com> wrote in message
>news:8ipu01htlngk8utel0da7spl0m0rgl5vmc@4ax.com...
>
| |
|
| On Sun, 13 Feb 2005 10:22:28 -0500, Squiggles <squiggle@sympatico.ca> wrote:
>An apparent presentation to McGill Psych. staff on the matter:
>
>What a tangled web--
>
>(hope you can read this on your screen; it's a PDF file,
>if not I think i can search the appropriate references):
>
>http://www.acsa-caah.ca/pdf/conf/e10.PDF
>
>Squiggles
wow!
bad enough with adults... but to that they put children at risk for profit and
greed is real depressing (excuse the pun)
http://www.acsa-caah.ca/pdf/conf/e10.PDF
page 46..
Academic child psychiatry
• Drug treatment for depression very good for
marketing of psychiatry
• Strong investment in biologic model of
depression
• Strong alliance with drug companies:
– Willingly signed non-disclosure agreements
• Fundamental violation of academic ethics
| |
| Squiggles 2005-02-15, 8:32 am |
|
jake wrote:
> On Sun, 13 Feb 2005 10:22:28 -0500, Squiggles <squiggle@sympatico.ca> wrote:
>
>
>
>
> wow!
>
> bad enough with adults... but to that they put children at risk for profit and
> greed is real depressing (excuse the pun)
>
> http://www.acsa-caah.ca/pdf/conf/e10.PDF
> page 46..
>
> Academic child psychiatry
> • Drug treatment for depression very good for
> marketing of psychiatry
> • Strong investment in biologic model of
> depression
> • Strong alliance with drug companies:
> – Willingly signed non-disclosure agreements
> • Fundamental violation of academic ethics
>
Yeah, I was surprised to read this too; however there was one
point I couldn't figure out:
See Page 14, where it says
"So, things were looking pretty dang good for the
pharmacotherapy of depression in children and adolescents
December 9, 2003..." --
page 15,
"December 10, 2003. WARNING TO ALL PHYSICIANS AND PHARMACISTS
Medicine and Healthcare Regulagory Agency - GREAT BRITAIN..."
__________
What happened in such a short interim - how did the drug go
from permissible to dangerous so fast?
Squiggles
| |
| Orange 2005-02-15, 8:32 am |
| <snip>
> Yeah, I was surprised to read this too; however there was one
> point I couldn't figure out:
>
>
> See Page 14, where it says
>
> "So, things were looking pretty dang good for the
> pharmacotherapy of depression in children and adolescents
> December 9, 2003..." --
>
> page 15,
>
> "December 10, 2003. WARNING TO ALL PHYSICIANS AND PHARMACISTS
>
> Medicine and Healthcare Regulagory Agency - GREAT BRITAIN..."
>
>
> __________
>
> What happened in such a short interim - how did the drug go
> from permissible to dangerous so fast?
>
> Squiggles
I interpreted that as meaning that the warning was published on December
10. After the warning, people began to look more critically at the
drugs. Nothing had happened recently except that the agency, by
reviewing old data, determined that a warning was necessary.
I could be wrong about this; for instance, I have no idea what caused
the agency to review the safety of the drug. The whole presentation
required a lot of fill-in-the-blank guessing and was probably intended
to accompany a lecture that would, er, fill in those blanks.
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