the end of an era…

Posted on Tuesday 14 January 2014

I was looking on the Psychiatric Times web site for an article, and the ads caught my eye. There were some for vitamin supplements, a few for ipad clones, and then the regular pharma ads – only they weren’t so regular. I guess it’s a testimonial to the dry pipeline. Pristiq® was there, a still in·patent Effexor® clone. Seroquel·XR® was in the house, this time as a stand·alone antidepressant in Bipolar Depression [Seroquel·XR® is in·patent until 2017 though Seroquel® is now generic]. There’s an ad for a christian psychology degree program at Jerry Falwell’s Liberty University. And then a couple of weird sisters. Serotune says it is an "all-natural supplement designed to increase your serotonin, dopamine and GABA levels, and is ideal for those who are looking for a safe, effective way to feel better."
“It doesn’t make me feel like I am taking something to help me feel happy, it just makes me feel like I am happy naturally.”
The safe alternative to ECT mentioned is a Fisher Wallace Stimulator® which is FDA cleared [whatever that means] for insomnia, anxiety, depression and chronic pain. You can order one on-line with a faxed authorization from your licensed healthcare practitioner [including a Psychologist, GP, Physician’s Assistant, Psychiatrist, OBGYN, Chiropractor, Acupuncturist, Nurse, etc.] or you can get phone authorization from their online Acupuncturist [$50]:

"Stop Depression in 2 Weeks or return your device for a refund. Use the Fisher Wallace Stimulator® for 20 minutes, twice a day, to reduce or eliminate depression, including bipolar depression and major depression."

The one that caught my eye was Nuedexta® for Pseudobulbar Affect problems.
Pseudobulbar affect [PBA], also known as emotional lability, labile affect, or emotional incontinence, refers to sudden outbursts of involuntary crying or laughing in patients with neurological disorders, even though there might not be any sad or humorous event to trigger those emotions.
There’s an article from a peer reviewed journal of Managed Care and Hospital Formulary Management [Nuedexta for the Treatment Of Pseudobulbar Affect] with a clinical trial graph to die for:
It’s obviously not a common condition, but if you see a case, this is the medicine to use. What is it? A mixture of Dextromethorphan [the cough suppressant in Robitussin DM] and Quinidine [an older antiarrhythmic drug]. The Quinidine keeps the Dextromethorphan bioavailable. Mechanism of action in PBA, unknown. But here was the part that was interesting:
And there were a few small ads for some of the late·comers: Latuda®, Fanapt®. Otherwise, that was about it. Obviously, this is hardly an in depth study of pharmaceutical advertising in 2014, but it’s an example that can be confirmed by looking at about any site around – the pharma ads we’re accustomed to are dwindling and there are many more that are reminiscent of the patent medicines from a century ago, the kind of ads that were actually the origins of the advertising industry:
And a change from what we’ve become used to:
While I’ve read the Psychiatric Times in the past, I’ve never kept up with the ads. I tend not to see ads [selective inattention?]. But overall, I have noticed that the journal ads are changing: cough medicine for PBA; scalp stimulator for depression; food supplements for enhancing neurotransmitters; etc. Obviously, ads for prescription medications are the ones still in·patent, and in psychiatry, that list is vanishing. And the drugs in·patent are the latter day saints – the so called "me too" drugs. There was a time when the new drugs were hailed as advances or innovations. Now they’re more in the range of "left-overs." Seroquel® has morphed from an antipsychotic, to a depression add-on, to a mania drug, to a stand·alone antidepressant – from Seroquel® to Seroquel·XR® [rivaling A Chorus Line and Cats for longevity]. Just another sign that we are at the end of an era…
    Bernard Carroll
    January 14, 2014 | 8:01 PM

    Leaving aside the stuff like Serotune (they don’t make it transparently clear what the ingredients are), one has to wonder about the return on investment for regular drug advertisements (Pristiq, Seroquel XR). PhRMA may have hit the point of diminishing returns. I keep having this image of a desperate marketing manager fudging the numbers to make it look like the things he does actually make a difference – kind of like the corporate publications director who coordinates ghostwritten and dishonest articles for the journals.

    January 14, 2014 | 9:13 PM

    Very nicely said, Dr. Carroll! I agree.

    January 15, 2014 | 4:21 PM

    You should note that over 1/2 of all the pages in the periodicals forwarded to psychiatrists are ads, and just educational material is at best 40-45% of the magazine/journal after you get rid of the nuisances like table of contents and letters to editor. So, are these really professional resources, or just glorified advertising with some article filler?

    January 15, 2014 | 11:02 PM

    It looks like a motley transition.

    Hmm. Pseudobulbar Affect? I think I might be at risk of this with my MS that is in remission right now (HURRAH!), but I would not take Nuedexta® on a bet. Knowing that such states are physiological and that further analysis and stock-taking is not necessary sounds sufficient to me.

    The Fisher Wallace Stimulator® sounds intriguing. I’ve thought for years that a headband that stimulated parts of the brain to do what ritalin and marijuana had done for me— cutting way down on absence seizures, helping me focus and stay on track, helping me be more in the moment, making it easier for me to do boring and linear tasks— would be perfect. For now, I’ll just keep an open mind about the Fisher Wallace Stimulator®. Won’t expect more than a few laughs about it, and will hope it doesn’t do any damage.

    Aren’t the same pharmaceutical companies (subsidiaries) that make blockbusters and medical equipment making most of the products?

    Nick Stuart
    January 16, 2014 | 10:59 AM

    Interesting. What seems obvious to me from the adverts you have shown is that they are all directed at women. Men’s issues and problems are not deemed important? Does anyone know how much of pharma money is gained from women compared to men? I know that men commit suicide at rates more than 4 times that of women… of course expenditure on cancer research for women is 10 times that for men. And women live longer. .. Interesting society we live in. Does psychiatry only pander to women’s needs? I am just making an observation not a judgement.

    Nick Stuart
    January 16, 2014 | 11:20 AM

    Of course I do not include in my view about the current prevalence of DSM-5 male sexual disfunction which can now be cured by a psychiatric drug. The fault is intrinsic to the man (brain or genes?) and the woman is not at fault. (Probably a chemical imbalance in his ADHD. ). Another psychiatric masterstroke. (excuse the pun).

    Nick Stuart
    January 16, 2014 | 11:37 AM

    How psychiatry targets mothers and women to drug boys. Ha!

    Steve Lucas
    January 16, 2014 | 1:53 PM

    Here is an interesting link on drug company doctor relationships. It is important to note the author feels pressure for bringing this issue to the fore:

    Steve Lucas

    January 16, 2014 | 4:25 PM

    Does psychiatry only pander to women’s needs? I am just making an observation not a judgement.

    Psychiatry pathologizing women more than men and capitalizing on a social tendency to blame themselves for their problems, to not allow themselves to stop functioning because so many people depend on them, and to look to authority and openly discuss their perceived shortcomings is not really “serving” women. The history of psychiatry begins with pathologizing women’s experiences and diagnosing them as “hysterical” for having suffered from trauma.

    Men can look up a psychiatrist as easily as a woman can. Whether anyone is helped in this age of biological psychiatry is a crap shoot.

    January 17, 2014 | 5:31 PM

    And yet, what is the largest growing demographic of addiction in this society the past 5 or so years? Middle aged women, between 35-60 who come in DEMANDING meds these days, so how much is marketing versus the dark side of feminism after 40 years of wanting equality.

    Besides, it is still pervasive that men will NOT seek out mental health services until pressed or forced for the most part. So, advertising that really is wasted at the end of the day, from the advertisers’ point of view.

    January 18, 2014 | 12:25 AM

    Any excuse to suggest that women wanting equal protection under the law is an affront to men, right Joel? And of course the women DEMAND and the men ask politely as always.

    January 18, 2014 | 1:23 PM

    Ha ha ha, gotta love people who just use those statistics that support the select perspective, but once the truth and facts start to stray from agenda, what is that line from a well known movie, “pay no attention to that man behind the curtain”. Well, is it now “pay no attention to that man or woman behind the curtain”?

    My point is women now demand as harshly and abruptly as men have and still do, wiley! And yet, once women are called on it, they want us to forget how they are acting and treat them as “women”, and not pay attention to the attitude and affronts being presented.

    More often than not these days the most rude and abusive patients in my travels have been women, so, welcome to that equality so well pursued. Maybe the agenda should have been to make men more respectful and attentive to how they act and expect, and not just women strive to act like men.

    But, feminism has been well corrupted in many ways. Equality shouldn’t be expecting to be treated like a man, but instead both genders find the best middle ground and be working together as equals.

    That is where the extremists missed the boat and mislead much of women.

    Hey, just my opinion, people should be treated equally irregardless of sex, race, or other differing matters. Just like people should be corrected, and even punished irregardless of same differences. This overtolerance crap of everyone should be given more breaks, more free passes, it does not serve society, but just diminishes it. To bring it back to the post preceding this thread, the overtolerance of colleagues, especially the ones who belong to this corrupt society of the APA, well, who are they kidding?!

    I’ll give you this, Wiley, so far most if not all the most corrupt and pathetic players are men, but, will feminism let women come in and fix the mistakes? No, they will want equal chance to profit and screw things up, as long as there are rewards in the short term. That has been the prominent message of feminism since the 1980s. If it is about money, well, greed and corruption won’t differentiate between testicles and ovaries, just as long as the behaviors mirror selfishness and addiction.

    Hope this clarifies my earlier comment.

    Oh, and any good pistol whipping thoughts of late?

    January 18, 2014 | 7:39 PM

    Perhaps you should stop treating women, Joel. For the benefit of both of you. You complain so much about your patients, I have to wonder why you’re still in this field. You don’t appear to like people at all.

    January 18, 2014 | 9:21 PM

    No, I just don’t like people who write about pistol whipping psychiatrists and then act like it is no big deal! Frankly, I find the antipsychiatrists like you to be so full of crap, and have no clue how obnoxious and offensive you are to psychiatrists who do good care, but to losers like you who think anyone associated with psychiatry is an asshole, well, keep struggling for acceptance and caring.

    And to all these bloggers who put up with people like you with the offensive commentary and then such commenters act so victimized and deserving of compassion, it is why I write repeatedly at my blog, why do people put up with incompetence, irresponsibility, and criminality. And to you specifically Wiley, people who advocate for violence and think because it is written at a mental health blog it deserves a pass, well, don’t ever come to my blog writing your garbage!

    Not that you’ll ever get it, but to answer to readers here who might be interested in knowing why I write what I do, because I don’t put up with the increasing bullsh-t from the antipsychiatry crowd, because you folks reinforce my concern to let the lies go unaddressed gets validity. Dr Nardo here might need your traffic, but I don’t, and my patients who want care and address their needs seem to give me feedback I help them.

    Those who want a free ride, get their wants, and just treat doctors like servants, enjoy your alleged care. Careful what ya wish for, one day it will come back to haunt you.

    So, I realize now reading at blogs like here that just want to spew venom from the commenters, but, enjoy the validation of overtolerance, you have a venue. Sometimes you have to be called on your pervasive and overgeneralizing hate. Don’t worry, I won’t be back, I need to refocus on writing my blog that helps people, and am glad I have moderation at my threads.

    If you as the antipsychiatry crowd want to come and write something at my blog that is critical and harsh, I will probably print it, if it shows at least some respect while being unhappy, but, if you want to pistol whip Freud and us as extensions, save your time and energy in your typing.

    Good luck Mickey with your blog. You are bringing attention to valid issues, but, frankly, your threads have been hijacked by people who want to twist the message to just hate and despise more and more. Think about this woman writing about pistol whipping a psychiatrist, and it goes unchallenged. I won’t forget it, as watching it portrayed in a recent episode of “Justified” shows how brutal it can be felt.


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