![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by jealibeanz on April 23, 2007, at 21:33:06
... About the chances of novel and *effective* drugs being released in the near future?
If I could be told that in 3-5 years, a few of the pipeline drugs will make it to market, I might have some hope. It might give me some choices other than SE/NE manipulation, stimulants, and benzo's.
I'm really curious about the CRF anragonists, NMDA antagonists, NK antagonists, nicotinic antagonists, and beta-3 agonists for depression (some for anxiety).
The glucocorticoid receptor antagonists for depression/psychosis seem promising. I'm pretty sure that with my high levels of stress, anxiety, and depression, I further drive up cortisol, that was probably high to begin with.
There have been some studies recently about female, premature, low birthweight infants being prone to anxiety, depression, and ADHD, due to over-production of cortisol. It's most likely an inborn stress response from a poor fetal environment, birth, or infancy. I qualify for all of this!
There's also AMPA, a receptor modulator ADHD. It's not stimulating (nor is it like Straterra). It's got a very novel and interesting mechanism.
Posted by notfred on April 24, 2007, at 1:19:25
In reply to Do any of your doctors have an opinion?, posted by jealibeanz on April 23, 2007, at 21:33:06
Larry posted this a while ago:
http://www.currentpsychiatry.com/article_pages.asp?AID=4795&UID=#2
"Several compound classes—such as neurokinin and glucocorticoid receptor antagonists—are reported to be in phase-III clinical trials, with projected approval within 5 years"
More info here:
Posted by jealibeanz on April 24, 2007, at 5:17:44
In reply to Re: Do any of your doctors have an opinion?, posted by notfred on April 24, 2007, at 1:19:25
Thanks for the articles!
Haha, I find some of the statements in the 2nd article a little over-zealous:
"By the time a drug reaches phase 3, it has already undergone years of scrutiny in the laboratory, animal trials, and smaller human trials and has the best chance of reaching pharmacy shelves within the next 18 months to three years."
18 months would be verrry quick! 3 years doesn't sound like the upper limit, especially with the way the FDA has been handling drugs in recent years. They are very cautious.
I'm not sure if I like that fact or not! We'll be less likely to have dangerous drugs released, or those that lack efficacy, but it definitely takes much longer than it used to.
Scientists have the ability and knowledge to make better drugs than we have now, and have had it for quite some time. A lot of the current pipeline drugs have been in the lab for 15-20 years. That's very long. I'd get frustrated if I were working on drugs that took soo long to get approved... and most get dropped before even thinking about approval. I've heard it said that the development psych drugs are not the big money makers because they fail so often. A test tube or idea of a anatomical target and chemical compound can't accurately predict a human mood response. The drugs that target functional problems may be much easier to predict.(yes, I know, psych drugs do, but the endpoint is more subjective than, for example, lower blood pressure.)
If someone looks at all the pipeline drugs they'd think there's a lot of work going on in the pharmaceutical world regarding psych drugs. Yes, there is, but that has to be compared to drugs that treat other conditions. There's been very little clinical progress in the last 20 years when treating anxiety/depression.
There's been a lot of progress in other areas, and new drugs have been released and used effectively (anti-hypertensives, anti-virals, anti-hyperlipidemia's... haha, I think I made that last one up, the one's that manipulate HDL's and LDL's).
Look at the thread from a few days ago about the trials, results, and release of Prozac. It's almost a different world now in terms in FDA policy! Haha, and who would have thought in 1988 that we'd still be living in a "Prozac Nation" in 2007. Maybe they did because it was touted as a huge break-through and cure-all for depression and other psychiatric illnesses.
I'm sure a major hinderance is recruiting trial 3 subjects, especially with alllll the drugs in the world in development and the restrictions on who can participate. Most people are too cautious to line up like lab rats (No offense to those who participate. I think it's very admirable.) I know I wouldn't qualify for many studies because they usually don't want anyone with comorbidities. For anxiety trials, some exclude anyone who's ever taken a benzodiazepine for an extended period of time... because they know what it's like to have relief and probably have a lower tolerance for anxiety than others!
Posted by jealibeanz on April 24, 2007, at 5:19:59
In reply to Re: Do any of your doctors have an opinion? » notfred, posted by jealibeanz on April 24, 2007, at 5:17:44
Here's something else from the article:
"Two medications already marketed for other indications are awaiting FDA approval for the treatment of anxiety disorders. The phase 3 pipeline holds several drugs indicated for depression and/or anxiety disorders (several drugs are under study for both). These drugs could reach pharmacy shelves by 2008."
OK, I know this was written a year ago, but what drugs are they referring to? And 2008? I won't hold my breath!
Even though depression is being widely recognized in this country, and is reflected in the efforts to make new AD's, this isn't the case with anxiety. It's sort of the disorder that's pushed under the rug with depression, when, in fact, they do not at all share the same symptoms. They're commonly seen as comorbidities, which is why they're thought of as one in the same. If you look at depression screenings, many often throw anxiety symptoms in with the others. It would be helpful if they were looking upon and treated as two separate conditions, not anxiety/depression. Jeez!
They point this out in the article:
<The anxiety pipeline, she said, contains "only a few novel compounds.">
OK, I'm glad this didn't happen:
<In 2003 Pfizer submitted a new drug application (NDA) for pregabalin (Lyrica) for the treatment of GAD; however, in September 2004 the FDA deemed that application "not approvable.">
That probably woulda been the current benzo replacement!
Am I the only one who is skeptical about the "triple reuptake inhibitors"? We already have drugs that inhibit the reuptake of SE, NE, and DA... currently not all at significant levels in one drug, but we have drugs that work on 2 at the same time... and people do combine drugs to target all 3. I don't see this as a breakthrough and I can't imagine why they're being said to have fewer side effects than current AD's. If anything, I'd think there would be more.
Posted by jealibeanz on April 24, 2007, at 5:22:06
In reply to Re: Do any of your doctors have an opinion?, posted by jealibeanz on April 24, 2007, at 5:19:59
<While many analysts cautioned that the next few years will largely bring new drugs that are similar to those already on the market, they also expressed optimism that advancing technologies—including new methods of imaging diseased nervous systems and elucidating the biochemical and anatomical pathways underlying psychiatric disorders—will lead to new medications with highly specific targets, including genes and regulating proteins. >
I find it strange when I read that comment. I've seen it other places as well.
The drugs that are similar to current ones, IMO, are the triple reuptake inhibitors, which are not the drugs in the latest stages of testing.
Posted by notfred on April 24, 2007, at 20:38:02
In reply to Re: Do any of your doctors have an opinion? » notfred, posted by jealibeanz on April 24, 2007, at 5:17:44
There's been a lot of progress in other areas, and new drugs have been released and used effectively (anti-hypertensives, anti-virals, anti-hyperlipidemia's... haha, I think I made that last one up, the one's that manipulate HDL's and LDL's).
Those body systems are easy to understand compared to neurology.
Posted by jealibeanz on April 24, 2007, at 21:08:06
In reply to Re: Do any of your doctors have an opinion?, posted by notfred on April 24, 2007, at 20:38:02
> There's been a lot of progress in other areas, and new drugs have been released and used effectively (anti-hypertensives, anti-virals, anti-hyperlipidemia's... haha, I think I made that last one up, the one's that manipulate HDL's and LDL's).
>
>
> Those body systems are easy to understand compared to neurology.
Yes, the physiology is less complicated than neurological physiology, but still not easy. The conditions all involve numerous organs, mechanisms, hormones, transporters, etc. There's not an isolated cause to the disease. They too take a lot of study in order to determine possible contributers. Then, medication is somewhat trial and error, just like psych meds.I think there has been a larger push to approve drugs for certain conditions in the recent past (i.e. cardiac disease, anti-virals especially regarding HIV and AIDS, and now avian flu).
These conditions are directly looked upon as threatening to one's health and resulting in early death. Psych conditions, aside from suicide of their result, have mainly been looked upon as hindering quality of life. It does seem logical to aggressively target diseases which pose a serious threat to the body.
Hopefully things will change. It appears as if there's been more recognition of the seriousness of mental disease and the lack of effective treatment. Now we just have to wait in order to realize the benefits of increased awareness.
Posted by notfred on April 24, 2007, at 23:15:37
In reply to Re: Do any of your doctors have an opinion? » notfred, posted by jealibeanz on April 24, 2007, at 21:08:06
>
> I think there has been a larger push to approve drugs for certain conditions in the recent past (i.e. cardiac disease, anti-virals especially regarding HIV and AIDS, and now avian flu).
>
AIDS drugs were fast tracked due to political pressure from groups such as ACTUP and the political powers that be **finally** getting that world wide the majority of HIV+ people are hetrosexual. Due to the fact there was less clinical research they were not used till patients had advanced AIDS. Now that the drugs have been researched for some time we know they are only effective early on, even before one has AIDS. . They are best used on HIV+ people who have not progressed to AIDS. People then have a good chance of living for decades.So fast tracking is a gamble. Perhaps 100,000's
of people would be alive today had they gotten AZT, ddC, ect as soon as they came on the market.In cardiac drugs the cardiac system is very well undrestood so making new drugs is easier and the instance of cardiac disease is very high. That makes these drugs very profitable.
There is some irony in that many decry the increase in diagnosis of mental illness yet this should motivate pharma to fund research and development in this area.
Posted by jealibeanz on April 25, 2007, at 15:40:12
In reply to Re: Do any of your doctors have an opinion?, posted by notfred on April 24, 2007, at 23:15:37
I'd love for some drugs to be fast-tracked straight to me! Would be nice.
Anyway, back to the orginical topic, I'd like to hear of any comments from your personal doctors.
Sometimes people have very well-informed doc's who are in the know and may provide more insight that the internet, which has skewed views and reportings.
Has anyone else noticed that many of the individual company's lag behind in updating which phase a pipeline drug is in? Strange. You'd think they'd be eager to display progress.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.