Some anti-depressant drugs are associated with an increased chance of developing cataracts, according to a new statistical study by researchers at the University of British Columbia, Vancouver Coastal Health Research Institute and McGill University.

The study, based on a database of more than 200,000 Quebec residents aged 65 and older, showed statistical relationships between a diagnosis of cataracts or cataract surgery and the class of drugs called selective serotonin reuptake inhibitors (SSRIs), as well as between cataracts and specific drugs within that class.

Published online today in the journal Ophthalmology, the study does not prove causation but only reveals an association between the use of SSRIs and the development of cataracts. The study could not account for the possibility of smoking – which is a risk factor for cataracts – and additional population-based studies are needed to confirm these findings, the researchers say.

This study of statistical relationships is the first to establish a link between this class of drugs and cataracts in humans. Previous studies in animal models had demonstrated that SSRIs could increase the likelihood of developing the condition.

“When you look at the trade-offs of these drugs, the benefits of treating depression – which can be life-threatening – still outweigh the risk of developing cataracts, which are treatable and relatively benign,” says Dr. Mahyar Etminan, lead author of the article, a scientist and clinical pharmacist at the Centre for Clinical Epidemiology at Vancouver Coastal Health Research Institute and an assistant professor in the Dept. of Medicine atUBC.

Researchers found patients taking SSRIs were overall 15 per cent more likely to be diagnosed with cataracts or to have cataract surgery.

The degree of risk among specific and different types of SSRIs varied considerably. Taking fluvoxamine (Luvox) led to a 51 per cent higher chance of having cataract surgery, and venlafaxine (Effexor) carried a 34 per cent higher risk. No connection could be made between fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) and having cataract surgery.

Co-author Dr. Frederick S. Mikelberg, professor and head of the Dept. of Ophthalmology and Visual Sciences at UBC and head of the Dept. of Ophthalmology at Vancouver General Hospital, notes that the average time to develop cataracts while taking SSRIs was almost two years.

“While these results are surprising, and might inform the choices of psychiatrists when prescribing SSRIs for their patients, they should not be cause for alarm among people taking these medications,” Mikelberg says.

Source: University of British Columbia

Popularity: 1% [?]

Older women who take an antidepressant seem to have a small but noteworthy increased risk of stroke and death compared to older women not on an antidepressant medication, a new study shows.

But given that depression itself is a well-established risk factor for early death, heart disease and other ills, the study’s author told Reuters Health, women who need to take these medications shouldn’t see the new findings as a reason to quit.

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“Women should not stop taking the medications based on this one study,” Dr. Jordan W. Smoller of Massachusetts General Hospital in Boston said in an interview. “What our study does is give patients and doctors a little bit more information about the risk-benefit calculation for older women.”

Antidepressant use in the US has more than quintupled since the early 1990s, Smoller and his colleagues note in their report in the Archives of Internal Medicine.

So-called selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft are now the first-line treatment for most patients, having replaced older medications called tricyclic antidepressants that may harm the heart.

But little is known about how SSRIs affect heart health, especially in postmenopausal women, who are at increased risk for both heart disease and depression.

To investigate, Smoller and his team looked at 136,293 women participating in the Women’s Health Initiative, an ongoing investigation of women’s health after menopause. None of the women were taking antidepressants at the study’s outset.

During follow-up, which lasted about six years, 5,496 of the study participants started taking antidepressants. While there was no association between antidepressant use and heart disease, the researchers did find that women taking SSRIs had a 45 percent increase in risk of stroke and a 32 percent increase in risk of dying from any cause during follow up, compared with nonusers. Use of older tricyclic antidepressants wasn’t linked to stroke, but it did increase by 67 percent the risk of death during follow up.

It’s important to remember, Smoller said, that these numbers represent “relative risk.” The actual risk of stroke or death for women taking the medications was higher than for women who weren’t using them, but it was still quite small.

For example, he explained, during a given year 0.8 percent of the women not using antidepressants would die, compared to 1.2 percent to 1.4 percent of the women taking the medications. And while 0.3 percent of women who weren’t taking SSRIs would have had a stroke in a typical year, 0.42 percent of women using SSRIs would suffer a stroke annually.

Another limitation to the findings, Smoller added, is that the effect observed with antidepressants could have been related to the fact that women who used the medications had other risk factors that couldn’t be completely accounted for — like being depressed.

The increased risk of death and stroke associated with depression itself, he added, is similar to that seen with the antidepressants used in the study.

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No matter what, the researcher said, the relationship between antidepressants and death must be investigated further. “More than 10 percent of Americans are taking antidepressants,” he said. “It’s an important category of medication for us to understand better.”

SOURCE: Archives of Internal Medicine, December 14/28, 2009

Popularity: 3% [?]

Treating depression may help people with diabetes get their blood sugar under control.

In a study of low-income minorities with poorly controlled diabetes, researchers found that antidepressant therapy was associated with improved long-term blood sugar control and reduced blood pressure.

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Rates of depression in people with diabetes are double those in the general population, and even higher among minorities, who are more prone to worse blood sugar control, more diabetes complications, and more severe depression, the researchers point out. Yet few studies have focused on the effect of depression treatment among minorities with uncontrolled diabetes.

To investigate, Dr. Mayer B. Davidson and his colleagues at Charles Drew University in Los Angeles screened low-income patients attending a diabetes clinic for depression.

Ultimately, the study included 89 patients; 45 were randomly assigned to receive the antidepressant medication sertraline (sold as Zoloft) and 44 to a placebo. Everyone in the study also attended monthly diabetes group education programs.

Thirty-nine patients in each group were Hispanic, five were African American, and 1 in the sertraline group was listed as “other.”

According to the investigators, after six months, blood sugar levels had fallen significantly in the sertraline group. That is, hemoglobin A1C levels, a standard measure of long-term blood sugar control, fell 2.0 percent, from 10.0 percent at the outset to 8.0 percent at six months. In general, it’s recommended that people with diabetes strive for an A1C level below 7.0 percent.

In contrast, there was only a 0.9 percent drop in A1C levels in the placebo group (from 9.7 percent at the outset to 8.8 percent at six months).

Blood pressure also fell to a greater degree with sertraline than with placebo, while both groups had similar significant improvements in depression, pain and quality of life.

These results, the researchers say, suggest that patients with diabetes should be screened for depression. For those found to have depression, “an antidepressant should be considered,” they advise.

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In this manner, both depression and uncontrolled diabetes and blood pressure “may be improved.”

SOURCE: Diabetes Care, December 2009

Popularity: 2% [?]

Results from a meta-analysis conducted by FDA researchers suggested that the risk of suicidality associated with antidepressant use “is strongly age dependent.” According to the findings published in the BMJ, adults under 25 years of age who took antidepressants were more than twice as likely to exhibit suicidal behaviour compared with those on placebo, while those over the age of 65 had a reduction in risk, the study authors stated.

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Researchers analysed 372 clinical trials involving a total of 99 231 adults who had been randomly assigned either antidepressant therapy or placebo. The analysis found there was no increased risk of suicidal behaviour for patients between 25 and 64 years of age, and that the net effect of antidepressant use was “possibly protective” for suicidal ideation in this group. Researchers also noted that the risk of suicidal behaviour and ideation was age-related for patients taking antidepressants for psychiatric indications, while the risk was “extremely rare” among patients taking the drugs for non-psychiatric conditions.

In an accompanying commentary, John Geddes of Oxford University and colleagues noted that the FDA study found differences in risk among specific selective serotonin reuptake inhibitors. Data showed Pfizer’s Zoloft (sertraline) decreased the likelihood of suicidal behaviour by about half compared with placebo, while Forest’s Celexa (citalopram) and Lexapro (escitalopram) “seemed to increase the risk of suicidal events,” the commentators noted. They also said “it is becoming apparent that antidepressants vary in both their efficacy and adverse effects.”

The study authors from the FDA indicated that more research is required to understand the varying effects of antidepressant use in the different age groups. In addition, they commented that the findings of the analysis support the agency’s past decision to require warnings on antidepressant drug labels for patients in the under-25 age group.

Source: FirstWord

Popularity: 6% [?]

A few highlights out of ASCO, the big cancer conference on in Orlando this weekend:

Roche’s breast-cancer drug Herceptin extended the lives of some patients with stomach cancer. The drug is used in people whose tumors produce excessive amounts of a protein called her-2. That occurs in about 20%-25% of breast cancer and stomach cancer cases. Patients with advanced stomach cancer that overexpressed her-2 survived a median of 13.8 months when they received Herceptin and chemotherapy, compared with 11.1 months for patients who received chemotherapy and a placebo, Dow Jones Newswires reports.

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A new class of experimental drugs may help women with types of breast cancer that are difficult to treat with existing therapies. The drugs, known as PARP inhibitors, prevent damaged tumor cells from repairing themselves. While the drugs are still in early stages of development, some have shown promise in human trials. Merck, Abbott, AstraZeneca and Sanofi-Aventis are all working on compounds in this class. Here’s a story on the drugs from this morning’s WSJ.

Hormone drugs and antidepressants may affect cancer patients, studies suggested. In one very large study of giving hormone pills to women to receive the symptoms of menopause, women who took a certain hormone combination and went on to develop lung cancer were more likely to die of the disease than women who took a placebo and went on to get lung cancer, the AP reports. Researchers urged caution in interpreting the finding, because there have only been 106 lung cancer deaths in the study so far, too few to make broad conclusions about risk.

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In a separate study, researchers found that women taking certain antidepressants along with the breast-cancer drug tamoxifen were more likely to see their tumors return than women who were taking tamoxifen alone. The drugs, which inhibit an enzyme called CYP2D6, include Paxil, Prozac and Zoloft. Laboratory studies have suggested the drugs might interfere with Tamoxifen, Dow Jones Newswires notes.

Source: The Wall Street Journal

Popularity: 4% [?]

Two antidepressants, Zoloft and Cipralex, work slightly better and are better tolerated compared with 10 other similar drugs for moderate to severe depression, a new review has found.

In Thursday’s online issue of the medical journal The Lancet, an international team of doctors looked at more than 100 previous studies on antidepressants involving nearly 26,000 patients from 1991 to 2007.

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They concluded that Zoloft, or sertraline, and Cipralex, or escitalopram, were the best options when considering benefits, side-effects, and cost.

Edronax was considered the least effective.

“Such findings have enormous implications,” wrote Dr. Sagar Parikh, a psychiatrist at the University of Toronto, in a commentary accompanying the study.

“Now a clinician can identify the four best treatments, identify individual side-effect profiles, explore costs and patients’ preferences and collaborate in identifying the best treatment.”

The study’s authors weighed the drugs based on whether it reduced depression scores on two standardized tests by at least half and if patients had not stopped taking the medication in the last two months.

All of the antidepressants helped and there were no major differences, said the study’s lead author, Dr. Andrea Cipriani of the University of Verona in Italy.

“If a patient is taking a drug and doing well, he should not stop and switch drugs,” Cipriani said.

The other drugs reviewed were:

• Celexa (citalopram)
• Cymbalta (duloxetine)
• Effexor (venlafaxine)
• Ixel (milnacipran)
• Luvox (fluvoxamine)
• Prozac (fluoxetine)
• Seroxat (paroxetine)
• Remeron (mirtazapine)
• Zyban (bupropion)

Side-effects for the various drugs include nausea, sleeplessness, and sexual dysfunction.

The findings may lead doctors to prescribe Zoloft and Cipralex more often, but psychiatrists should also consider alternatives such as behavioural therapy, said Irving Kirsch, a professor of psychology at Britain’s University of Hull.

The study was paid for by the authors’ academic institutions in Britain, Greece, Italy, and Japan.

Cipriani has not received any grants from pharmaceutical companies. Several of his co-authors reported receiving funding from various makers of antidepressants.

Source: cbc.ca

Popularity: 7% [?]

Trick question: They’re all equally effective.

That’s the conclusion a panel of experts came to after analyzing the results of more than 200 studies, and their finding forms the backbone of new guidelines out this week from the American College of Physicians (a professional society for primary-care docs).

The guidelines suggest choosing based on costs, patient preference and differences in side-effect risks.

The guidelines look at so-called second-generation antidepressants, which work by changing the brain’s uptake of naturally occurring chemicals such as serotonin. If you’ve heard of a name-brand antidepressant — Pfizer’s Zoloft, Eli Lilly’s Prozac or Forest’s Celexa — it’s probably in this group.

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But despite all the marketing the companies did to push these drugs during their patent-protected heydays, the authors found “no substantial differences in comparative efficacy” between the drugs’ ability to treat depression. The finding applies across multiple phases of treatment; to patients with depression and symptoms, such as anxiety; and to subgroups such as those defined by age and sex.

There are a few differences in terms of side effects. GlaxoSmithKline’s Wellbutrin, for example, appears less likely to cause sexual dysfunction than certain other antidepressants. Overall, though, the side effects risks are pretty similar across the category.

On the question of suicidal thoughts or behaviors, a frequently discussed side effect associated with these medicines in some studies, the authors found that “no particular drug has an excess risk compared with any other drug in this class.”

Source: The Wall Street Journal

Popularity: 3% [?]

Study data published online Thursday in the New England Journal of Medicine demonstrated that the combination of cognitive behavioural therapy (CBT) and sertraline, marketed as Zoloft by Pfizer, produced a “superior” response rate in children with anxiety disorders, compared with either treatment alone.

The US National Institute of Mental Health-funded CAMS trial involved 488 children between the ages of 7 and 17 with a primary diagnosis of separation anxiety disorder, generalised anxiety disorder or social phobia, who were randomly assigned to receive sertraline, 14 sessions of CBT, a combination of the two therapies or placebo. After 12 weeks of treatment, results showed that 81 percent of children who underwent combined therapy were very much or much improved, compared with 60 percent in the CBT group, 55 percent in the sertraline group and 24 percent in the placebo group.

Researchers noted that adverse events, including suicidal ideation, a potential risk of SSRIs, were no more frequent among study participants taking sertraline than in those taking placebo, and that no child attempted suicide during the trial. NIMH director Thomas Insel commented that “this study provides strong evidence and reassurance…that a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective.”

Source: FirstWord

Popularity: 3% [?]