Clinical Psychology & Psychiatry

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13 posts · 25,762 views

Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

CL Psych
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  • October 1, 2010
  • 04:19 PM

Cymbalta and Effexor: Hype Over Science

by CL Psych in Clinical Psychology & Psychiatry

Remember the hype around the serotonin-norepinephrine reuptake inhibitors (SNRIs)? Effexor and Cymbalta impact both serotonin and norepinephrine, so they should be more effective than SSRI’s in treating depression? Mind you, that’s not a high bar to clear - it’s not like SSRI’s are much better than placebo. So get the hell outta the way, Prozac and Paxil, because Cymbalta and Effexor will unleash their incredible efficacy onto the world of psychiatry. Doubt me? Read this 2009 articl........ Read more »

Schueler, Y., Koesters, M., Wieseler, B., Grouven, U., Kromp, M., Kerekes, M., Kreis, J., Kaiser, T., Becker, T., & Weinmann, S. (2010) A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatrica Scandinavica. DOI: 10.1111/j.1600-0447.2010.01599.x  

  • May 14, 2010
  • 02:22 PM

Eli Lilly: Our Drug Failed, So it Has Serious Potential

by CL Psych in Clinical Psychology & Psychiatry

These folks at Lilly must think we are exceptionally stupid. As in can't tie our own shoes. A study in the Journal of Psychiatric Research recently found that their experimental antidepressant LY2216684 was no better than placebo. Here are a couple of quotes from the abstract:LY2216684 did not show statistically significant improvement from baseline compared to placebo in the primary analysis of the Hamilton depression rating scale (HAM-D17) total score. Escitalopram demonstrated sign........ Read more »

  • March 16, 2010
  • 10:43 AM

Editorial Support, CME, and the Primary Care Companion

by CL Psych in Clinical Psychology & Psychiatry

By now, everyone who has been paying attention should know that a journal article which lists "editorial support" is an article that was ghostwritten. Yet the average reader of these articles is apparently uninformed enough to not care. Why else would so many articles get published which feature "editorial support provided by [insert name of ghostwriter here]." One my my favorite journals, under the "so bad, it's good" category, is the Primary Care Companion to the Journal of Clinical P........ Read more »

Thase, M., Gaynes, B., Papakostas, G., Shelton, R., & Trivedi, M. (2009) Tackling Partial Response to Depression Treatment. The Primary Care Companion to The Journal of Clinical Psychiatry, 11(4), 155-162. DOI: 10.4088/PCC.8133ah3c  

  • December 16, 2009
  • 05:08 PM

Atypical Antipsychotics For Depression: Now With "Considerable Evidence"

by CL Psych in Clinical Psychology & Psychiatry

I've been wanting to write about this for months. Here goes. We know that antipsychotics are the new panacea for all things mental health-related, including depression (1, 2, 3). But critics kept pointing to a pesky lack of evidence that such treatments actually worked. Bristol-Myers Squibb, manufacturer of Abilify, has been running a disinformation campaign in medical journals to tout its drug as an antidepressant. Their attempts to paint a positive picture of Abilify's antidepressant prop........ Read more »

  • October 30, 2009
  • 10:42 AM

Transcranial Magnetic Stimulation for Depression: Not so Effective, but FDA Approved

by CL Psych in Clinical Psychology & Psychiatry

Apparently, the FDA will approve just about anything as an antidepressant. Despite patients indicating that they don't perceive Abilify to work as an antidepressant, the FDA approved it, likely leading to tens of thousands of Americans being able to enjoy a taste of akathisia while getting all the psychological benefits of a placebo. Good work, FDA. The shift of antipsychotics into antidepressants has been documented in many places and is, ironically, very depressing (1, 2, 3, 4).The FDA's "a........ Read more »

  • June 9, 2009
  • 08:21 AM

Abilify for Depression: Patients Give it an Oh-For-Three

by CL Psych in Clinical Psychology & Psychiatry

Abilify for depression: you've seen the ads. You've hopefully read this blog (1, 2) and the excellent series in the LA Times from Melissa Healy. The advantage over placebo is nothing to get particularly excited about. Especially from the patients' point of view. As I have mentioned previously, the two studies that were touted by key opinion leaders are supporting the efficacy of Abilify for depression suffered from a number of problems. Most germane to this post, the patient self-report rat........ Read more »

Robert M. Berman, Maurizio Fava, Michael E. Thase, Madhukar H. Trivedi, René Swanink, Robert D. McQuade, William H. Carson, David Adson, Leslie Taylor, James Hazel.... (2009) Aripiprazole Augmentation in Major Depressive Disorder: A Double-Blind, Placebo-Controlled Study in Patients with Inadequate Response to Antidepressants. CNS Spectrums, 14(4), 197-206.

  • May 7, 2009
  • 02:53 PM

Phase V, Abilify, and Vanishing Akathisia

by CL Psych in Clinical Psychology & Psychiatry

If you've been reading about Abilify for depression on this site, you've probably noticed that I've been down on Abilify for causing akathisia in a frighteningly high percentage of patients. In two recent trials, akathisia occurred in 25% of Abilify patients compared to 4% of placebo patients. What, exactly, is akathisia? That's still a matter of some debate. Let's turn to a recent Journal of Clinical Psychiatry article on the topic. Entitled "Akathisia: An Updated Review Focusing on Second........ Read more »

Kane, J., Fleischhacker, W., Hansen, L., Perlis, R., Pikalov, A., & Assunção-Talbott, S. (2009) Akathisia: An Updated Review Focusing on Second-Generation Antipsychotics. The Journal of Clinical Psychiatry. DOI: 10.4088/JCP.08r04210  

  • March 10, 2009
  • 08:46 AM

Abilify, Depression, and the Memory Hole

by CL Psych in Clinical Psychology & Psychiatry

The Primary Care Companion to the Journal of Clinical Psychiatry has a piece on Abilify for depression that illustrates many of psychiatry's woes. Full text of the article is here. The journal published an article titled "Examining the efficacy of adjunctive aripiprazole in major depressive disorder: A pooled analysis of two studies." The paper combines data from two previously published studies which examined the addition of Abilify to existing antidepressant treatment (1, 2). One of psychi........ Read more »

Thase ME, Trivedi MH, Nelson JC, Fava M, Swanink R, Tran Q, Pikalov A, Yang H, Carlson BX, Marcus RN.... (2008) Examining the efficacy of adjunctive aripiprazole in major depressive disorder: A pooled analysis of 2 studies. Primary Care Companion to the Journal of Clinical Psychiatry, 440-447.

  • January 27, 2009
  • 09:52 AM

Abilify For Depression: I'm Not the Only Skeptic

by CL Psych in Clinical Psychology & Psychiatry

In April 2008, findings were published in the Journal of Clinical Psychopharmacology which claimed that the atypical antipsychotic aripiprazole (Abilify) was an effective add-on treatment for depression. I heartily disagreed with the study's conclusions, noting that the patient-rated depression measure did not demonstrate an advantage over placebo, an inconvenient result that the authors tried to explain away as if was unimportant. I also pointed out that the study design was biased in favor o........ Read more »

Ronald N Marcus et al. (2008) The Efficacy and Safety of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder. Journal of Clinical Psychoopharmacology, 28(2), 156-165.

  • January 7, 2009
  • 02:11 PM

Sowing the Seeds of Lexapro

by CL Psych in Clinical Psychology & Psychiatry

I'm reading an article with my jaw completely agape and I thought I'd share the pain. The good people at Forest Pharmaceuticals have put together a tragic waste of journal space. The editorial board at the journal Depression and Anxiety should call an emergency meeting to see how this thing got published. Any peer reviewer who put a stamp of approval on this should be forced to listen to Michael Bolton's Greatest Hits at maximum volume for 12 hours straight.OK, so what am I having a fit about?........ Read more »

  • December 4, 2008
  • 10:29 AM

Lamictal: Break Out the Shovel

by CL Psych in Clinical Psychology & Psychiatry

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  • September 30, 2008
  • 02:14 PM

Gabitril Goes Down

by CL Psych in Clinical Psychology & Psychiatry

Gabitril (tiagabine) is an antiseizure medication from Cephalon, which just forked out a cool $425 million to settle charges that it marketed several drugs for unapproved conditions, including Provigil and Gabitril. Government investigators claimed that Gabitril was marketed as a treatment for anxiety, which is too bad considering that it struck out in three clinical trials against a placebo. Each study found no evidence that Gabitril was better than a sugar pill.Gabitril was also allegedly ma........ Read more »

Mark H. Pollack, Jane Tiller, Fang Xie, & Madhukar H. Trivedi. (2008) Tiagabine in Adult Patients With Generalized Anxiety Disorder. Journal of Clinical Psychopharmacology, 28(3), 308-316. DOI: 10.1097/JCP.0b013e318172b45f  

  • September 8, 2008
  • 11:39 AM

Atypical Antipsychotics for All, Oregon Chapter

by CL Psych in Clinical Psychology & Psychiatry

Oh boy. Here we go again. A study published online ahead of print at the Journal of Clinical Psychiatry notes that among Oregon Medicaid patients who received a prescription for an atypical antipsychotic: 52% had a depression diagnosis34% had an anxiety diagnosis15% had a PTSD diagnosis But only 15% had a schizophrenia diagnosis and 27% had a bipolar diagnosis. So... the majority of atypical scripts were written off-label. Seroquel was the most frequently prescribed atypical, followed by Zy........ Read more »

Daniel M Hartung, Jennifer P Wisdom, David A Pollack, Ann M Hamer, Dean G Haxby, Luke Middleton, & Bentson H McFarland. (2008) Patterns of atypical antipsychotic subtherapeutic dosing among Oregon Medicaid patients. Journal of Clinical Psychiatry. DOI: ej07m03658  

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