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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 74 to 98 of 135. Go back in thread:
Posted by SLS on January 7, 2007, at 6:57:14
In reply to atypicals, etc., posted by med_empowered on January 7, 2007, at 0:06:57
I'm surprised you haven't brought into the conversation the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.
It supports your point of view.
I don't think it proves very much more than that perphenazine is a pretty good typical antipsychotic. I didn't like it when I took it, though. I felt numb and passified. I felt like a zombie. The same was true of Thorazine and Prolixin. I have not experienced such a thing with any of the atypicals, and I have taken them all with the exception of clozapine. Not only that, but the atypicals have been more effective in producing an antidepressant effect. Zyprexa was a potent antimanic and produced great clarity of thought.
n=1
Paper versus real life.
I don't know what to make of the CATIE study. It has been scrutinized and debated, of course. If you search on Google, you will find critiques of it. I really don't think much of the design, and I think the study was to ambitious, but I'll let Google worry about that.
---------------------------------------------Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia
Jeffrey A. Lieberman, M.D., T. Scott Stroup, M.D., M.P.H., Joseph P. McEvoy, M.D., Marvin S. Swartz, M.D., Robert A. Rosenheck, M.D., Diana O. Perkins, M.D., M.P.H., Richard S.E. Keefe, Ph.D., Sonia M. Davis, Dr.P.H., Clarence E. Davis, Ph.D., Barry D. Lebowitz, Ph.D., Joanne Severe, M.S., John K. Hsiao, M.D.,
for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators
Background The relative effectiveness of second-generation (atypical) antipsychotic drugs as compared with that of older agents has been incompletely addressed, though newer agents are currently used far more commonly. We compared a first-generation antipsychotic, perphenazine, with several newer drugs in a double-blind study.
Methods A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and randomly assigned to receive olanzapine (7.5 to 30 mg per day), perphenazine (8 to 32 mg per day), quetiapine (200 to 800 mg per day), or risperidone (1.5 to 6.0 mg per day) for up to 18 months. Ziprasidone (40 to 160 mg per day) was included after its approval by the Food and Drug Administration. The primary aim was to delineate differences in the overall effectiveness of these five treatments.
Results Overall, 74 percent of patients discontinued the study medication before 18 months (1061 of the 1432 patients who received at least one dose): 64 percent of those assigned to olanzapine, 75 percent of those assigned to perphenazine, 82 percent of those assigned to quetiapine, 74 percent of those assigned to risperidone, and 79 percent of those assigned to ziprasidone. The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine (P<0.001) or risperidone (P=0.002) group, but not in the perphenazine (P=0.021) or ziprasidone (P=0.028) group. The times to discontinuation because of intolerable side effects were similar among the groups, but the rates differed (P=0.04); olanzapine was associated with more discontinuation for weight gain or metabolic effects, and perphenazine was associated with more discontinuation for extrapyramidal effects.
Conclusions The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons. Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone. Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism.
---------------------------------------------
- Scott
Posted by ed_uk on January 7, 2007, at 7:52:47
In reply to Re: the case for neuroleptics is kind of weak, posted by linkadge on January 6, 2007, at 21:02:44
Hi Link
Althought Cogentin and other anticholinergics can often suppress acute EPS, they do not generally relieve the symptoms of TD. In fact, TD symptoms are frequently aggravated by anticholinergics.
Ed
Posted by ed_uk on January 7, 2007, at 7:58:42
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 22:38:32
>I'm believing ever more strongly that they should really think about taking some of these drugs themselves before making comments like that.
That is so true. It would be very helpful if pdocs actually tried a range a psych drugs to find out how they make them feel. If they are telling you that Risperdal only causes mild side effects (or whatever), let them try a 6mg tablet are see how it makes them feel. There was a very interesting study where a group of pdocs were given a moderate dose of droperidol, a neuroleptic. Almost all of them found it extremely unpleasant, and some had to be admitted to a psych ward for treatment after receiving a single dose. One pdoc became profoundly suicidal.
Ed
Posted by ed_uk on January 7, 2007, at 8:00:19
In reply to Re: Patient paid to accept neuroleptic depot injec » linkadge, posted by yxibow on January 6, 2007, at 22:38:40
Hi Jay
Niacin frequently causes flushing. Niacinamide (nicotinamide) is the variety of vitamin B3 which doesn't cause flushing.
Regards
Ed
Posted by ed_uk on January 7, 2007, at 8:07:36
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 23:18:36
Good afternoon Professor Quintal,
Docs in the UK would rather give you *anything* than precribe a benzo. Perhaps they'll offer you a depot next time? :)
Ed
Posted by ed_uk on January 7, 2007, at 8:10:21
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by Quintal on January 6, 2007, at 23:30:49
I agree. Seroquel, like other APs, has no 'recreational value'.
>As far as I can tell from the other case report the guy simply got frustrated about the doctors trying to deprive him of a med that had been very effective.....
Which is understandable. This isn't 'addiction'.
Ed
Posted by ed_uk on January 7, 2007, at 8:11:56
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by laima on January 6, 2007, at 23:46:49
>Did you notice if he had a zyprexa pen?
You know, I think I have a Zyprexa pen. Providing pens is one of the only advantages of drug reps IMO!
Ed
Posted by ed_uk on January 7, 2007, at 9:07:40
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by ed_uk on January 7, 2007, at 8:11:56
Hmm, my thread is getting quite long. I like it when this happens.
Ed
Posted by laima on January 7, 2007, at 9:41:48
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by ed_uk on January 7, 2007, at 9:07:40
Wasn't there something in the news last year about doctors in the US resolving to accept fewer gifts from pharmaceutical salespeople? If so, what ever happened with that? Or was that only a resolution not to accept big gifts like golf outings?
I have an ambien flashlight- I suppose it's for those times ambien's not working. Zyprexa toilet tissue sounds like a great idea- I think a zyprexa measuring tape might be handy, too. Or a scale...
Posted by linkadge on January 7, 2007, at 12:02:36
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 22:38:32
>I did eventually take it and he refused to >believe that 5mg was making me feel spaced out >and drowsy. He also thought Zyprexa would cause >no significant impairment in driving performance >even if taken in the morning.
Wow. They just believe whatever those leaflets tell them. Ask him to go home, take 10mg of zyprexa, and then see if you remember how to butter toast.
Actually I remember an article about a psychiatrist who, had a whole paradigm shift in the way she dealt drugs, after ingesting some haldol.
Linkadge
Posted by linkadge on January 7, 2007, at 12:44:09
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by ed_uk on January 7, 2007, at 7:58:42
>Almost all of them found it extremely >unpleasant, and some had to be admitted to a >psych ward for treatment after receiving a >single dose. One pdoc became profoundly >suicidal.
The effects of the drug were probably compounded by a cumulative..."what have I been doing to my patients"
Linkadge
Posted by linkadge on January 7, 2007, at 12:47:58
In reply to Re: zyprexa pens, posted by laima on January 7, 2007, at 9:41:48
>I have an ambien flashlight- I suppose it's for >those times ambien's not working.
Good one!!
Linkadge
Posted by linkadge on January 7, 2007, at 12:48:57
In reply to Re: zyprexa pens, posted by linkadge on January 7, 2007, at 12:47:58
Or maybe when you wake up at night and can't sleep. The flashlight helps you find the drugs faster.
Linkadge
Posted by ed_uk on January 7, 2007, at 13:32:13
In reply to Re: zyprexa pens, posted by laima on January 7, 2007, at 9:41:48
>I think a zyprexa measuring tape might be handy, too. Or a scale...
How appropriate. I'll suggest it if I see a drug rep from Lilly!
Ed
Posted by Quintal on January 7, 2007, at 15:28:46
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by linkadge on January 7, 2007, at 12:02:36
>Wow. They just believe whatever those leaflets tell them. Ask him to go home, take 10mg of zyprexa, and then see if you remember how to butter toast.
I did ask him if he would take it himself and he said he would. I also asked him if he would object to a person taking 5mg Zyprexa driving the school bus his children used and he said he would have no problem with that. I can't help but wonder if I was involved in a serious accident if the fact that I was taking Zyprexa would be brought up in court? I imagine it would - it's just too irresponsible to ignore it.
>Actually I remember an article about a psychiatrist who, had a whole paradigm shift in the way she dealt drugs, after ingesting some haldol.
That's very gratifying to hear, but not really surprising.
Q
Posted by Quintal on January 7, 2007, at 16:06:28
In reply to Re: zyprexa pens » laima, posted by ed_uk on January 7, 2007, at 13:32:13
What's the most bizarre piece of promotional material anyone has seen? We've had Risperdal door jambs, Abilify cupboards, Ambien flashlights and of course the ubiquitous pens, mugs and notepads......
I've seen Xyzal clocks, Neoclarityn tissues (my GP has chronic rhinorrhea and is usually sniffling into one) and a Lustral plant pot.
Q
Posted by ed_uk on January 7, 2007, at 16:07:17
In reply to Re: Patient paid to accept neuroleptic depot injec » linkadge, posted by Quintal on January 7, 2007, at 15:28:46
>I did ask him if he would take it himself and he said he would.
........but I assume he never has!
>I also asked him if he would object to a person taking 5mg Zyprexa driving the school bus his children used and he said he would have no problem with that.
He sounds irresponsible.
Ed
Posted by Quintal on January 7, 2007, at 16:09:35
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by ed_uk on January 7, 2007, at 16:07:17
>........but I assume he never has!
No, and never will either I bet........
>He sounds irresponsible.
I think he was just trying to annoy me.
Q
Posted by ed_uk on January 7, 2007, at 16:20:28
In reply to Big Pharma Bribes/Freebies/Propoganda/Brainwashing » ed_uk, posted by Quintal on January 7, 2007, at 16:06:28
I have some Zestril scissors - not that scissors are bizarre.
Ed
Posted by laima on January 7, 2007, at 17:15:06
In reply to Re: zyprexa pens » linkadge, posted by linkadge on January 7, 2007, at 12:48:57
Yes! Ambien: A Night-time Lifestyle. "If Our Signature Product Doesn't Make You Sleepy: You'll Love Our Flashlight."> Or maybe when you wake up at night and can't sleep. The flashlight helps you find the drugs faster.
>
>
> Linkadge
Posted by laima on January 7, 2007, at 17:16:27
In reply to Re: zyprexa pens » laima, posted by ed_uk on January 7, 2007, at 13:32:13
Of course! Such products would be akin to the already existing Ambien Flashlight. :)
> >I think a zyprexa measuring tape might be handy, too. Or a scale...
>
> How appropriate. I'll suggest it if I see a drug rep from Lilly!
>
> Ed
Posted by Phillipa on January 7, 2007, at 17:18:29
In reply to Re: zyprexa pens » linkadge, posted by laima on January 7, 2007, at 17:15:06
Well they also send on great vacations for using their products. When cymbalta came out I never had to pay for it. Every one left that pdocs office with a bag of cymbalta. Love Phillipa each and every month
Posted by laima on January 7, 2007, at 17:26:05
In reply to Re: Big Pharma Bribes/Freebies/Propoganda/Brainwashing » Quintal, posted by ed_uk on January 7, 2007, at 16:20:28
You know, I am rather surprised that psychiatrists don't "try" any drugs during their training. It wouldn't be so far-fetched for them to do so, in a controlled setting. Look how many universities give students all kinds of drugs in experiments in controled settings. Seems to me it's very hard to describe a drug experience acurately enough that the other person comprehends exactly what that consciousness felt like. Of course, I could imagine someone arguing back that the drug would affect a "healthy" person differently. Kind of like that tiredish old debate about if anti-depressents do anything beneficial for a nondepressed person, if ADD drugs offer any benefit to a non-ADD person, etc. I can just picture a group of psychiatrists deducing zyprexa made them feel weird because they are not psychotic. I read an article once about a drug expo where one of the companies built some kind of "schizophrenia tank" that psychiatrists could enter to "experience what the world is like for patients". I'm sure it was very dramatic-I remember reading that it was full of flashing lights and noises. The point was that the drug therapy with the sponsored product was very desperately urgent. However- no one seemed to address whether or not the tank was an accurate portrayal of anyone's experience, or exactly how the drug fit in.
Posted by notfred on January 7, 2007, at 17:27:38
In reply to Big Pharma Bribes/Freebies/Propoganda/Brainwashing » ed_uk, posted by Quintal on January 7, 2007, at 16:06:28
> What's the most bizarre piece of promotional material anyone has seen? We've had Risperdal door jambs, Abilify cupboards, Ambien flashlights and of course the ubiquitous pens, mugs and notepads......
>
Well I would not single out Big Pharma; most large
product manufactures have lots of promo goods.
I have the same promo product with different brand
names (same pens and paper branded by Cisco and Juniper).And then there are all to Joe Camel products.
Posted by notfred on January 7, 2007, at 17:32:08
In reply to Re: zyprexa pens, posted by Phillipa on January 7, 2007, at 17:18:29
"When cymbalta came out I never had to pay for it. Every one left that pdocs office with a bag of cymbalta. Love Phillipa each and every month"
This would be a good thing. My pdoc gave me at least $1,000 worth of Lunestra to tide me over till my I beat down my insurance to make them pay for it.Generally if start a new med I start with a weeks worth of samples. It helps to figure out the dose
and if I can tolerate a med prior to filling (and paying for) a script.
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Dr. Bob is Robert Hsiung, MD,
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