depakote bipolar depression
I am the first to admire the strength and virtues of the free enterprise model as it applies to drug development and sales. This model encourages pharmaceutical companies to employ talented people and to take risks in developing new drugs for serious medical problems. But let's be honest, current practices also produce unwanted effects.
1. When the drug was wonderful last month suddenly is not good.
It was interesting to see how companies pharmaceutical suddenly reach new patentable variations in their medications only when their old patents are expiring. For example, since the 1970s, the company Abbott has been doing a dance with different formulations of valproic acid (used for seizures, migraines and bipolar disorder). At first, the brand Depakene, but when that ran out of patent, Depakene suddenly no longer serves, and Depakote (just different enough to be patentable) was the drug should only think. Then, when the patent ran out Depakote suddenly was not good, either. Now, Depakote ER (extended release) is the only way to fly.
This approach to reworking the oldest drug quality formats has worked for other drug companies, too. For example, GlaxoSmithKline has been through the same dance with their formulations of bupropion for depression, evolution of Wellbutrin Wellbutrin SR (sustained release) for Wellbutrin XL (extended version). Wyeth, and a good thing, followed suit with antidepressant venlafaxine, going from Effexor Effexor XR (extended release). It's amazing how just a coincidence these new and better medicines suddenly arise only when the old drugs expire and face generic competition.
2. When we made us forget that older drugs work well.
Since 1954 we have had effective counter drugs to treat schizophrenia, psychotic, but From the 1990s a number of the new antipsychotics emerged, now called the "atypical" or "novel" anti-psychotics. Suddenly, the older drugs – all generic and therefore a reasonable price – not good. Only the new patented anti-psychotics were good and you might even be guilty malpractice if prescribed an older drug (or follow the prescription of one to a patient who seemed fine). Moreover, a generation of psychiatrists new cycle through training programs with this concept in mind, rarely written a prescription for an older medicine.
The alleged superiority of new drugs has been tested in the recently concluded CATIE (Clinical Antipsychotic Trials on the effectiveness of the intervention) the study and found to be absent. The study compared four new drugs to an older drug, perphenazine, and differences in results were minimal to none.
3. Al divert attention from the treatments without medication.
Pharmaceutical companies sell drugs. Therefore, when it comes to marketing of their products, they have no interest in promoting – or even mention – non-pharmacological treatments. There are vendors doing the rounds of doctors' offices to remind physicians of rigor demonstrated the benefits of stress management training for migraine and tension headache or cognitive-behavioral for depression.
4. By connecting with us in the samples.
Doctors' offices to receive samples of the patented brand (high-up) and no non-patented drugs (low mark up) drugs. Therefore, patients are due to the high-cost drugs through the loss of these "leaders".
5. When a medical practice.
Pharmaceutical companies aggressively cutting the thought leaders, as faculty members at medical schools, with impressive financial benefits such as fees for speaking engagements. Funding is also medical publications. The effects of these marketing activities in medical practice are not necessarily beneficial for patients.
For example, tissue plasminogen activator (tPA) is an expensive clot dissolving drugs approved for use in stroke patients. Its benefits are modest and its risks are real (hemorrhage brain death). Thoughtful physicians could reasonably conclude that the benefits of tPA administration does not outweigh the risks. But this is not the message coming from the thinking of many leaders and publications. Instead, the implication is that the administration of this drug is a standard of care, and the omission which constitutes negligence.
6. When sales representatives promote unapproved uses.
Recently, a Pfizer sales representative told me that the your company's drug, pregabalin is effective in preventing migraine. You should not have said that. Pregabalin is approved by the FDA for the treatment of epilepsy and nerve pain, but not migraine. Although doctors in the U.S. are allowed to prescribe drugs for "off-label" uses, pharmaceutical companies are prohibited from advertising their drugs for unapproved uses. In fact, Pfizer ran into trouble by pushing another drug, gabapentin for unapproved uses.
7. When doctors do not think critically about what they are doing.
This, strictly speaking, there is a deficiency of pharmaceutical companies. But since the vendors only see that doctors are expensive, branded drugs, the names of the cheapest (or most effective) alternatives can not come to mind when writing prescriptions.
(C) 2006 by Gary Cordingley
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles see his website at: http://www.cordingleyneurology.com.
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