New Depression Drugs Unlikely to Unseat Prozac, Doctors Say
Bloomberg News
November 2, 1998, 4:00 a.m. ET
New Depression Drugs Unlikely to Unseat Prozac, Doctors Say
Paris, Nov. 2 (Bloomberg) -- New depression drugs made by
Pharmacia & Upjohn Inc., American Home Products Corp. and others
are a valuable addition to treating patients, but are unlikely to
replace current market leaders like Prozac, doctors said.
In presentations at Europe's biggest gathering of
psychiatrists, doctors said the newer antidepressants appear to
work better in treating some patients with the debilitating
disease. However, some said drugs like American Home's Effexor,
Pharmacia & Upjohn's Edronax and others aren't enough of an
advance for physicians to switch in large numbers.
Effexor, Edronax and Ixel, made by France's Pierre Fabre
Medicament, are part of new classes of depression drugs that
their makers hope will unseat the dominance of so-called SSRIs.
The leading SSRIs are Eli Lilly & Co.'s Prozac, Pfizer Inc.'s
Zoloft and SmithKline Beecham Plc's Paxil. Combined, the three
drugs generated sales of $5.5 billion in 1997.
''I don't think the new drugs will supplant SSRIs, because
people have gotten very used to SSRIs,'' said Pierre Blier, a
professor of psychiatry at Montreal's McGill University who has
studied both Edronax and Ixel. ''Many people don't see the
difference between SSRIs and the other drugs.''
Nonetheless, doctors said drugs like Effexor, Ixel and
Edronax will be useful in providing new treatment choices for
what they say is a major disease that is widely unrecognized and
untreated. The new drugs are a major topic of discussion at the
11th European Congress of Neuropsychopharmacology (ECNP)
conference.
Cost of Depression
According to the World Health Organization, depression costs
an estimated $44 billion in direct and indirect costs in the U.S.
alone each year. That includes hospitalization, drug treatment,
psychiatric care and other costs. Up to 10 percent of all
depressed patients commit suicide as a result of their illness.
Stuart Montgomery, a professor at Imperial College in London
and a former ECNP president, said that those costs could be
reduced with wider use of antidepressants on an outpatient basis,
a move that would also alleviate patient suffering.
''We are seeing gross undertreatment of depression in the
U.S. and Europe,'' said Montgomery, who estimated that only 10
percent of all potential patients receive treatment. ''I think
it's a scandal worldwide.''
Montgomery advocated mandatory drug treatment in some cases,
particularly as depression exerts a growing cost to society in
terms of treatment and lost productivity.
''It would be cheaper to enforce the treatment of
depression,'' Montgomery told psychiatrists at one symposium
sponsored by Pierre Fabre Medicament. ''We need to convert people
who absorb taxes to people who create them.''
Montgomery hailed the crop of new drugs although he agreed
with Blier that they would probably never supplant SSRIs, or
selective serotonin reuptake inhibitors. ''We need all the new
drugs,'' he said.
Other doctors echoed Montgomery's views, particularly for
short-term incidences of depression. Some said drug therapy,
because it addresses chemical imbalances in the brain, is more
effective than psychotherapy in many cases.
''People should take more drugs for depression,'' said Edith
Holsboer-Trachsler, a professor at the Psychiatric University in
Basel, Switzerland, who estimated that drug therapy can
effectively treat some 80 percent of depressed patients.
''Psychotherapy takes longer and is more expensive.''
Larger Share
Drugmakers are making a major push at the conference to
convert doctors to use their medicines, hoping to grab a larger
share of a $30 billion market for central nervous system drugs
that Lehman Brothers forecasts will grow by 15 percent a year
over the next four years as new drugs are introduced.
Effexor, Ixel and Serzone, made by Bristol-Myers Squibb Co.,
are all part of a newer class of drugs called SNRIs, while
Edronax is in a class called NARIs. All act on various
communication ports in brain cells called receptors.
Still, Holsboer-Trachsler acknowledged that there is much
patient resistance to psychiatric drug treatment, particularly in
Europe, where older drugs called tricyclics are used more
frequently than in the U.S.
Tricyclics, which include generic drugs like imipramine and
amitryptyline, are effective against the disease, but cause
negative side-effects like dry mouth and blurred vision which
cause patients to stop taking the drugs.
SSRIs cause fewer side-effects, although patients do
commonly complain of nausea and sexual dysfunction while taking
those drugs. The newer SNRIs, NARIs and other drugs known as
NaSSAs appear to have even fewer side-effects, although studies
are underway that drugmakers hope will show that more
comprehensively.
Holsboer-Trachsler said herbal treatments like St. John's
Wort, a plant with bright yellow flowers, have become big sellers
in Europe for patients who avoid doctors. The herb, available
without a prescription, is now the biggest-selling depression
treatment in Germany and has been used for centuries, she said.
It is also available in the U.K. and other countries.
She said that while St. John's Wort ''seems to be effective
in mild to moderate depression,'' the herb does cause side
''photoallergic'' reactions in some patients, causing them to
break out in spots when exposed to the sun.
The U.S. National Institutes of Health said last month it
would launch the first study of St. John's Wort in a 336-patient,
three-year study. The study aims to compare the herb with SSRIs
in its effect against depression.
--Dane Hamilton in Paris through the London newsroom (44-171) 330- |
