Pfizer's Success Tied Closely to Pristiq
Jordo is a member of The Motley Fool Blog Network -- entries represent the personal opinion of the blogger and are not formally edited.
Most often, it is easy for patients to quit taking medicines that they are prescribed. Most of the times, they go 'cold turkey', which is a slang term used to describe when a patient suddenly stops taking a certain medicine after a prolonged period of usage. Such drastic steps cause withdrawal symptoms which can be very unpleasant and sometimes dangerous too. Most patients quit taking their antidepressants because of two side effects: hair loss and sexual dysfunction. Men tend to worry about both these conditions than women, though compliance issues are seen in both genders. It is difficult to assess why certain patients display more side effects than others and why they find most antidepressants intolerable to their sexual well being.
Most commonly prescribed antidepressants can be classified under SSRI (Selective Serotonin Reuptake Inhibitors), SNRIs (Selective Serotonin Norepinephrine Reuptake Inhibitors), Tricyclic Antidepressants, and atypical antidepressants that work in different ways. Eli Lilly's (NYSE: LLY) Prozac was one of the first SSRIs to become popular and is prescribed even to this day. However, SSRIs cause a lot of side effects and the most common cause for going cold turkey with Prozac is sexual dysfunction. Certain antidepressants such as GlaxoSmithKline (NYSE: GSK) Wellbutrin (Bupropion) and Remeron (Mirtazapine) are prescribed by psychiatrists when their patients complain of sexual dysfunctions.
Bupropion is particularly effective in treating SSRI induced sexual dysfunction and it is also known to heighten sexual desire among people who do not have depression, but suffer from lowered libido. However, many patients that I have interviewed complain that Bupropion causes hair loss. Patients also complain that Remeron causes excessive drowsiness and that they can't wake up on time. These side effects may sound trivial, but for a patient with clinical depression, who has to manage his own mood disturbance, these side effects can cause compliance issues.
Bristol-Myers Squibb (BMY) discontinued selling nefazodone because of the incidence of hepatotoxicity. In fact, it used to be prescribed under the name of Serzone but has now been discontinued. Pfizer's (NYSE: PFE) Zoloft (sertraline) continues to be prescribed for not only depression, but also Obsessive Compulsive Disorder. Novartis' (NVS) Tofranil (imipramine) is another drug that continues to be prescribed with varying degrees of side effects.
Newer drugs like Pfizer’s Pristiq and Eli Lilly’s Cymbalta are prescribed more often these days, because patients experience lower compliance issues. Pfizer announced that the extended-release version of Pristiq showed promising results in a long term study. The study compared Pristiq against a placebo, and those who received 50mg of Pristiq displayed a relapse probability of 14.3% whereas those who were given a placebo has a relapse rate of 30.2% over a six month period. This is very good news for those who have invested in Pfizer as the company has long been dismissed as being too stagnant.
After the success of sildenafil citrate (Viagra), Pfizer has had to look for another cash cow that could bring its days of glory back again. Pristiq seems to be doing just that, thanks to favorable studies that point towards lesser compliance issues and relapse rates. Like I had mentioned earlier, going cold turkey can cause severe withdrawal symptoms among patients, and can be extremely unpleasant. It is difficult to make sure that patients comply with gradual tapering instructions especially when they experience hair loss or sexual dysfunction. Even when these side effects are negligible, a person who is depressed and anxious usually magnifies the symptoms and goes into a fear psychosis. Pristiq may be the best medicines in such a case, as those who suddenly stopped Pristiq after 24 weeks did not exhibit discontinuation symptoms when compared with those who tapered gradually.
Side effects arising from antidepressants can cause a lot of negative feelings among patients. Though much of these side effects are either negligible or temporary, the mental state of a depressed and anxious patient is such that he or she would start suspecting treatment of any sort. I have begun to believe that cognitive behavioral measures (CBT) can be very effective when it comes to treating individuals with depression and anxiety.
CBT is a scientifically valid method to treat dysfunctional thought patterns which are believed to be the basis of depressive disorders. These dysfunctional thoughts can be challenged, restructured and replaced with functional thoughts that are helpful to the individual. However, I feel it is always better to combine psychotherapy with pharmacotherapy, as the former takes care of cognitive and psychological aspects of the disorder whereas the latter takes care of neuro-chemical imbalances.
With that in mind, Pristiq seems to be a safer option to be prescribed to those who may be suspicious of psychiatric treatment. It is better to prescribe a drug that elicits far less discontinuation symptoms, as one can’t predict if a patient will eventually go cold turkey. Even if patients do stop Pristiq abruptly, they would not have to experience unpleasant discontinuation symptoms, which they would otherwise have to experience if they are prescribed other drugs.
At the end of the day, the sole purpose of treating an individual is to improve his quality of life. If it means we have to choose Pristiq and CBT together, then so be it! I believe Pfizer will work towards studying Pristiq further and releasing scientific data as soon as they are available. It would be very interesting to see scientific evidence of the efficacy of combining CBT with Pristiq among depressed patients. In the coming few months, we can expect a lot of research and development to take place in the field of bio-psychiatry, and Pfizer has begun to kick-start that movement by releasing important efficacy data about Pristiq.
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