August 27, 2004

Polypharmacy (multi-drug treatments) for Bipolar

Last week The Wall Street Journal examined "polypharmacy," a treatment for patients with depression and other brain disorders that involves customized "drug cocktails" of multiple medicines.

With "polypharmacy", patients who do not respond to one medication alone take several treatments that target different brain chemicals or the same parts of the brain with drugs that act slightly differently.

Physicians "arrive at the right mix by tinkering with a sequence of different drugs based on past experiences, word of mouth and drug company marketing," the Journal reports.

Polypharmacy, "driven in part by the shortcomings of many available medications," is "psychiatry's answer to HIV/AIDS drug cocktails and combinations of cancer drugs," the Journal reports. Polypharmacy is based on the theory that mental illnesses are based in biology.

Patients who take several different medications likely will have "multiple side effects -- and multiple prescription bills," according to the Journal. The treatment of schizophrenia patients with multiple medications has become controversial because of the increased cost, and officials for some state health care programs have "balked at paying for combinations of psychiatric drugs without evidence that the treatment actually works," the Journal reports. In addition, some psychiatrists "question whether more drugs are necessarily better," according to the Journal.

According to S. Nassir Ghaemi, a psychiatrist who wrote a book on polypharmacy, a large amount of evidence exists that supports the effectiveness of the treatment in patients with bipolar disorder. A government-funded study that involves patients with depression scheduled for release in 2005 also could provide evidence of the effectiveness of polypharmacy

Posted by szadmin at 2:42 AM | Comments (2)

Transcranial Maganetic Stimulation Looks Hopeful for Bipolar Disorder

repetitive Transcranial Magnetic Stimulation or rTMS - May be helpful for Bipolar Disorder

From Canada's Toronto Star comes this news that suggests rTMS may be helpful for Bipolar Disorder.

The News story suggests that "The 61-year-old St. Catharines man says he "lost everything" after he developed bipolar mood disorder. Despite trying several different medications and numerous rounds of electroshock therapy, nothing seemed to stabilize his wild and debilitating mood swings. At one point, he was so despondent, he tried to kill himself.

Then Schmidt learned of a new approach available in Hamilton that showed good results with hard-to-treat (or treatment-resistant) cases like his own.

The treatments are called Transcranial Magnetic Stimulation or rTMS - and this treatment uses pulsed magnetic fields to alter the brain's chemistry.

As the news story suggests, there have been many research studies over the past 10 years have shown the treatment can help depression and stabilize mood swings as effectively as electroshock therapy (known as ECT) without the discomfort, memory loss and seizures that are part and parcel of that treatment.

However, unlike ECT, there isn't the need for a general anesthetic during rTMS. And because the magnetic pulses target a small, yet specific, brain region, the procedure does not cause seizures or any major side effects, research shows. The only commonly reported after-effect is a headache, experienced after treatment by 10 to 20 per cent of patients.

"Schmidt was ready to try anything to avoid ECT. He began working with Dr. Gary Hasey of the mood disorders program at St. Joseph's hospital in Hamilton, Ontario Canada and soon he started therapy with rTMS." the Star reports.

Within a few weeks, Schmidt states that he felt like "a new man. I could not believe it ... it worked and there was nothing scary about it," he says. "You don't have anesthetic and really feel nothing. But it has changed my life. I have hope."

The treatment was first developed in 1985 and is still undergoing refinement and research as new tests and studies explore how to use it safely and effectively. It works based on principles similar to regular MRI scans, but rTMS uses different frequencies of magnetic pulses aimed at a small area - about the size of a silver dollar - in the brain's prefrontal cortex. Researchers have long believed this part of the brain regulates mood.

However, though researchers knew rTMS could be highly effective for some patients, getting lasting results was a challenge.

Studies were conducted with pulses of different frequencies. Some targeted the left or right side of the brain and others both sides.

Health Canada has approved various makes of the device since the mid-1990s. This spring, a firm called Mindcare Centres, opened a private clinic in Toronto treating people for $3,000 to $6,000, depending on whether the patient needs maintenance sessions.

Iain Glass, president of Mindcare Centres, says the new clinic in Toronto, and one that opened in Vancouver two years ago, have treated about 100 people to date - with the majority showing significant improvement. Clinic treatments last about half an hour.

Dan Strasbourg, spokesperson for the Ontario health ministry, says repetitive Transcranial Magnetic Stimulation has been reviewed by the Ontario Health Technology Advisory Committee and its recommendations to the ministry will be posted on the committee's website on Wednesday. The committee will recommend whether rTMS should be used, where and when, and if government resources will be spent on it.

Dr. Anthony Levitt, psychiatrist-in-chief at Sunnybrook and Women's College Health Sciences Centre, hopes to bring the therapy to his hospital should the government review permit. He believes it is based on sound, evidence-based medicine.

Levitt says if you imagine depression as caused by an over-excited brain chemistry, rTMS targets the part of the brain that helps co-ordinate brain chemistry so it can work normally.

If the health ministry approves the device for use in Ontario hospitals, "it will provide an excellent alternative to ECT in some people," he says.

Despite the initial price tag, Levitt says he thinks rTMS may turn out to be more cost-effective than ECT. believes. In addition, "it is less invasive and safer."

But some doctors think the device is not ready for clinical use. Hasey, who treated Schmidt, has been researching rTMS in Hamilton since 1997. Though the therapy has promise, it will take at least five years of continued refinements before it is ready for clinical use, he feels.

His work shows the procedure works very well in 30 per cent of cases, with another 20 to 30 per cent of patients showing improvement.

Since individuals' physiology varies so much, researchers still can't reliably target the correct brain site, he says. "If they are off by a few centimetres, maybe the patient doesn't respond. But it's not due to the treatment, it is due to where they are applying it," he says.

The best candidates for the treatment are younger patients and those without psychotic depression, studies show. Over the years that rTMS has been researched, people with a history of seizures or who have close relatives with seizure disorders have been excluded as have those with pacemakers, certain heart conditions or ferromagnetic items implanted in their skull.

Hasey is conducting research that he says may indicate people who respond to rTMS have different brain wave patterns than people who do not. His clinic in Hamilton is conducting studies of rTMS for depression and bipolar disorder and is looking for volunteers.

Posted by szadmin at 2:36 AM | Comments (18)

Pfizer gets approval for Geodon in Bipolar Mania treatment

Pfizer said on Monday (August 23rd) that the U.S. Food and Drug Administration approved its antipsychotic drug Geodon for the treatment of acute bipolar mania.

Posted by szadmin at 1:58 AM | Comments (17)

Jane Pauley's New Book on Her Bipolar Disorder

New Autobiography by "Today Show" Host Jane Pauley...


The Hartford Courant reported today on Jane Pauley's new autobiography, including a lot of coverage of her bipolar disorder. The newspaper stated that:

"In the world of celebrities, if Pauley wants to write a book about herself, she darn well better be tormented by demons. And it turns out she is.

Pauley is now 53, not what they call young anymore in the youth-worshiping TV business. She's married to the handsome and similarly successful cartoonist Garry Trudeau, and they have three grown children who are also handsome and seem normal.

"Skywriting: A Life Out of the Blue" (Random House, $25.95), which goes on sale today, has been hyped as Pauley's tale of her struggle with bipolar disorder, which she got as a result of steroids and antidepressants prescribed to combat a recurrence of hives.

Pauley writes, that she ended up in a psychiatric hospital because of the horrific mood swings the hives medication brought on."

The review of her book ends by stating that:

"Maybe it's impolite to compare, but if Pauley wanted to use her influence positively, she should have been like Katie Couric of "Today," who, after her husband's death, took on the cause of colon cancer with a vengeance.

Pauley's book takes us on an enjoyable ride, but in the end, it seems more hype than heart."

Posted by szadmin at 1:00 AM | Comments (10)

Seroquel Approved for Bipolar Mania

AstraZeneca (AZN) announced that the U.S. Food and Drug Administration (FDA) has approved additional efficacy labeling information based on 12-week data for Seroquel (quetiapine fumarate), a psychotropic medication indicated for the treatment of acute manic episodes associated with bipolar I disorder.

The data, part of the large scale effort to examine the use of Seroquel in bipolar disorder, showed that after 12 weeks, approximately two thirds of patients receiving Seroquel achieved remission.

Posted by szadmin at 12:52 AM | Comments (0)

Bipolar Disorder Lacking in Services

World Health Organization Study Results

A survey by the World Health Organization shows that in most parts of the world, people with the most serious mental health problems -- including Bipolar Disorder -- are not getting the treatment they need.

A standard interview was used to diagnose more than 60,000 people in eight developed and six less developed countries, including the United States, Canada, and several European and Latin American nations, as well as Lebanon, Nigeria, Japan, and China. The questions covered anxiety and mood disorders, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, drug dependence, and alcoholism.

A special feature of this survey was a question about severity. Mental illness was defined as severe if it involved bipolar (manic-depressive) disorder, physical dependence on drugs or alcohol, a suicide attempt, or any disorder that had interfered with everyday activities for a month or more in the previous year.

The rate of mental disorders varied extraordinarily widely, from 4% of people interviewed in China to 26% of those interviewed in the United States. Anxiety and mood disorders were most common.

The proportion of people with a serious psychiatric disorder ranged from under 1% to nearly 8% in various countries. The proportion of psychiatric disorders described as mild also varied greatly, from 33% in Colombia to a high of 81% in Nigeria.

The survey had some deficiencies. Its estimates of mental illness were probably low because people with psychiatric disorders are less likely to participate in surveys. The response rate was different in different countries, and the interview might not have worked well in some places because of reluctance to admit serious emotional problems. That could explain why, in countries with surprisingly low rates of acknowledged severe mental illness, a high proportion of patients admitted seeking help for supposedly mild symptoms.

Posted by szadmin at 12:47 AM | Comments (4)