January 03, 2008

Disordered America: Dental Anxiety Disorder

A reader kindly passed along at item from the Wall Street Journal's Health Blog (second item) about a drug developed by Addex that was designed to treat dental anxiety disorder. DAD is apparently one of many specific phobias that are covered by the DSM. The new drug failed its Phase 2 clinicals.

I've been well-versed in psychiatry, psychology and the DSM for two decades and it just staggers me that every so often I run into yet another "disorder" that strikes me as being a completely legitimate response to human experience. Some people utterly hate going to the dentist because once they get there a stranger is going to stick their hands in the patient's mouth and start drilling. Being anxiety-ridden about such an experience is well within the range of normal behavior. In fact, I think it might be a bit more abnormal for someone to not be anxious about having their teeth drilled.

My further frustration with this drift to a disordered America is that the folks making up the rules are doctors. They are the norm of human behavior in the 21st Century and if we don't respond to human experiences in the same manner in which they do, if we don't follow their behavioral and health habits, then we are somehow sick and disordered and in need of treatment. Have these clowns ever heard of free will and individual choice? Did they skip that lecture in college? Have any of you spent significant social time with a doctor? I can assure you that they are among the most arrogant, money-grubbing, attention-seeking little idiots you'll ever encounter. Hm. Arrogant, money-grubbing, attention-seeking...sounds like a disorder to me.

I am aching for the day when some doc declares smoking cigarettes a form of insanity that requires involuntary hospitalization and forced medication. Or when some researcher pontificates that dislike of homosexuals is a mental disorder. Oh wait, that one already happened. (Note: I am not advocating dislike of homosexuals, just pointing out that it hardly passes muster as a mental illness.)

But to come back to DAD and Addex. How big a market could there possibly be for DAD? Wouldn't it make sense to take a Valium or something if you're scared of the dentist? Why do pharma companies invest tens of millions of dollars into research to treat non-disorders?

Because, as P.T. Barnum once noted, there's a sucker born every minute.

Posted by Philip Dawdy at January 3, 2008 01:20 PM
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Comments

I just had my first root canal last week. The dentist, made my anxiety lesson by stopping, telling me to breathe through my nose and listen to the Enya tape. The novacaine also helped.

I was still breathing way to heavy and heart was moving too quickly, but the dentist was good, and I hope I never have a repeat experience.

Next thing you know they will be putting that anxiety you get when you visit the doctor and your blood pressure goes slightly up.

Posted by: susan at January 3, 2008 01:47 PM

Is dental anxiety disorder a fear of dentists, teeth, and/or dental work, or maybe a fear of people with braces? You're on fire this year Phillip.

Posted by: Sally at January 3, 2008 01:49 PM

Nitrous works, honest to God, what's next.Not to mention the last time I was loaded up on nitrous, covered in 3 blankets and had music on to drown out the noise-- it was not a delusion when I saw a pharma rep in the waiting area! complete with lunch.

Posted by: Stephany at January 3, 2008 01:54 PM

This almost strikes me as some kind of ironic parody, like something Jon Stewart would make up -- DAD. Can you even believe researchers are spending time on this when people are dying of AIDS and cancer and half the world is starving? Let's get back to doing research on real medical issues and not this hokey stuff that just enables people to contemplate their navels and get worked up about every little anxiety they can think of. This smacks of greed and marketing and so many things that are obnoxious about capitalism and free markets frankly (not that there aren't good things about them too). People really need to grow up and stop handing themselves over to medical professionals for every little thing. Of course the system will take advantage if that's what they do.

Posted by: Sara at January 3, 2008 03:00 PM

What a crock! Big Pharma hits a new low.

Posted by: Francesca Allan at January 3, 2008 03:06 PM

I can hear the DTC's already - Do you fear going to the dentist, do you fear having your teeth pulled, fear having a dentist drill in your mouth? 9 out of 10 psychiatrist believe DAD (dental anxiety disorder) isn't normal and you should be on medication today. Research has shown untreated DAD leads to eating a restricted diet and late in life, no teeth. Talk to your doctor today about DAD, you will be glad you did.
Tell your doctor if you experience sucidal thoughts, gain 300 pounds, increased blood pressure, decreased sexual drive, they have medications to counter any unwanted side effect to your DAD medication.


Posted by: Jane at January 3, 2008 03:12 PM

With the sad state of affairs that currently exist, I suspect that more people in the United States avoid going to the dentist for finanical reasons than for reasons related to anxiety. It's just another unneeded product in search of a market, while real needs go unmet - all just a side-effect of the ever-widening gap between the "haves" and the "have-nots". Very sad.

Posted by: Kent at January 3, 2008 04:43 PM

Wouldn't a true dental phobia consist of more than anxiety over dentist appointments? When I think phobia I imagine paralyzing fear from photographs of dentists' offices, being in the same room as one of the tools, or seeing someone dressed like a dentist.

And I've never heard of a drug for a phobia before. I always thought the cure was therapy with gradual increments of exposure.

In terms of this being an anxiety disorder, I've still never heard of a drug for something so specific as dental anxiety that wasn't already being used for general anxiety.

Jane: Please consider adding this to your DTC ad:

Announcer: "Addex works by increasing the amount of serotonin in the brain which blocks anxiety receptors located in the dental cortex."

Animation: Cartoon of a nerve cell being attacked a mob of small dentistry-related monsters (depicted by small graphics of tools, chairs, retainers, etc). Suddenly the nerve is showered by cartoon red circles, each labeled with a big "S," which soon buries the nerve cell. Dentistry monsters act confused, bump into each other, etc.

Man, I should so go into advertising.

Posted by: Jon S. at January 3, 2008 07:27 PM

"How big a market could there possibly be for DAD? Wouldn't it make sense to take a Valium or something if you're scared of the dentist? Why do pharma companies invest tens of millions of dollars into research to treat non-disorders?"




From the article:




[It's] a relatively simple way to see if a drug might also work for generalized anxiety disorder, the chronic psychiatric condition that is more commonly discussed in the medical world.

"We are interested in proof of concept," Mutel said. “As soon as we have opened these possibilities, then we leave the rest to be done by a large pharmaceutical company.”

Indeed, Addex seems to be doing something of a Phase II fashion show for ADX10059, dressing up the drug in different indications to lure a Big Pharma collaborator. It’s already shown promise against reflux (aka GERD) and migraines in Phase IIa studies.

“We want to move it up to the stage where we will find a partner,” Mutel said. “We will never be able to do a Phase III in migraine or a Phase III in GERD.”

In other words, relief of dental anxiety is a relatively discrete, easier to measure [proof] concept. The idea is to show that it's effective in this more easily measured situational anxiety so that it can attract money and further devolopment as an anxiolytic for other anxiety conditions and neurological conditions.

Posted by: Dr X at January 3, 2008 07:36 PM

(Gah, I had a huge long comment written out but it vanished from the text field as I tried to copy it after I'd hit 'post', so here it is again. Apologies to Philip if this ends up being a double post.)

I've never heard of a drug for such a specific anxiety that wasn't already effective for general anxiety. And I've definitely never heard of any drugs for phobias.

Jane, please consider the following for your DTC ad:

Announcer: "Addex works by increasing serotonin the brain which blocks anxiety receptors in the nerve cells in the dental cortex."

Animation: Cartoon of a nerve cell. Little icons depicting dentistry related objects float around. A large red circle marked with a big "S" descends, chasing all the dentistry-icons away.

Man, I should go into advertising.

Posted by: Jon S. at January 3, 2008 07:42 PM

What do you expect? Psychiatry is a pseudoscience and a dangerous religion of biological determinism and reductionism, also scientism. Psychiatric diagnoses are nothing but slander, and they are more often self fulfilling prophecies.

Bipolar Disorder and schizophrenia do not exist. They only exist inside a book created by the APA, and the 'diseases' in it are voted into existence rather than the product of biological evidence and hard science.

What exists are extreme states of mind that are temporary if left to heal on their own. Psychosis lasts a few weeks maximum, but flood that brain with neuroleptics and expect a sedated person, but a brain that is handicapped from returning to its orginal balance. Which it would naturally do if left to its own devices.

If people commit a crime, lock them up. Regardless of the cause. Why is it that every bipolar and schizophrenic I know had their first psychosis when either they had taken recreational drugs, or when a lifetime of psychosocial problems and family issues was coming to a head?

Bipolar disorder does not exist. There is no such thing as maintenance treatment. There is only a perturbed individual who was never allowed to heal from an initial extreme state of mind. There is only an individual who in an age of scientism has trusted a charlatan. There is only an individual who is so shit scared of becoming psychotic again they will submit to a disgusting pseudoscience telling them they have a lifelong genetic brain disease. Only a weak and distressed and overly trusiting individual would set themselves aside from the litter of society, alienate themselves, stigmatise themselves, take dangerous compounds for life, based on a 'science' that is more a 'faith' than anything else.

Just look at the weasel words and phrases in every drug's brochure, 'believed to act in this way' 'has been shown to reduce symptoms'

SINCE WHEN DID REDUCE EQUATE TO ELIMINATE! REDUCE IN PSYCHIATRY MEANS MASK AND PROLONG.

How could anyone allow every neuron in the seat of their soul to be gang raped daily by corporate greed mixed with rubbish biological determinism pseudoscience which is based on a pile of lies that sell drugs and allow parents and society to shift the blame for the human wreckage that is created by modern civilization?

How could ANYONE be so foolish? This is the scandal of the 21st century, and the fight is going to heat up I can tell you. Because there is a pharmacaust going on right here and right now.

Posted by: Kingmaker at January 3, 2008 07:50 PM

As I am reading this, I am in a great deal of physical pain from my teeth and gums because I haven't been able to afford dental care for several years. Consequently, I now suffer from Periodontal Disease, Advanced (PDA), comorbid with Gumming Anxiety, Generalized (GAG). I told my pdoc about this dilemma and he said that he believes I am starting to exhibit symptoms of Primary Irritability, Severe, Transient (PIST). Therefore, he has prescribed an older drug normally prescribed to treat diarrhea and pain. It's called Laudanum, and he is pretty sure that it has been approved for off-label use for PIST and for what he called "pretty much anything." He said it is expensive and my insurance won't cover it as it is not on their drug formulary, but he had plenty of free samples in his drawer, file cabinet and a hip flask.

Sure glad I don't have DAD.

Must close as I can feel my Extra-Ghizal Acronym Deficiency Syndrome (EGADS) kicking in.

Posted by: rocketdog at January 3, 2008 09:02 PM

I'm sure Treatment Advocacy Center will love this diagnosis and blame their victims', er, adult children's, dental problems, as well as the dental problems of the homeless on agnosia as it relates to DAD, and then maybe we can have more toothless people on psych drugs. As with homeless, where the solution is housing, it will never occur to TAC that the solution to dental problems is dental care not psych drugs.

Posted by: Sally at January 4, 2008 07:11 AM

Jon S. - Wow, great idea. Let's try into invoke fear, and then at the end, we can have all the carton characters smiling and giggling as they leave dental offices.
You really should consider advertizing as a career move!

Posted by: Jane at January 4, 2008 09:16 AM

Thanks for the great joke about DAD. Too bad it´s true. Maybe we could HELP Pharma, dream up a bunch of new syndromes, and they could sell different colors of sugar water as a remedy. Something tasty that doesn´t kill people.

Posted by: Sorrowful at January 5, 2008 05:36 PM

[It's] a relatively simple way to see if a drug might also work for generalized anxiety disorder, the chronic psychiatric condition that is more commonly discussed in the medical world.

**
when did general anxiety stop being part of the human condition and start being a chronic psychiatiric disorder?

Posted by: jenna at January 5, 2008 11:53 PM

Can you just pop an Addex before you go to the dentist? Or is DAD a lifelong condition that requires maintenance medication, because you never know when you might have to see the dentist?

Is there a companion drug, slightly different and just as expensive, that will help me manage my Monthly Bills Anxiety (MBA)?

Posted by: Johanna at January 6, 2008 07:23 AM

I was reading the comments by Kingmaker, and franckly, having been stucked with mental illness for the last 20 years, the last five on medication, I take a bit offense when somebody in essence, says that mental diseases dont exist. Just locked them up for a few weeks and all will be allright!


"How could anyone allow every neuron in the seat of their soul to be gang raped daily by corporate greed mixed with rubbish biological determinism pseudoscience which is based on a pile of lies that sell drugs .....?
"

How can they? Because the mental pain get so intense, you prefer to die rather than continue. I refused to take drugs for years. Paid thousands in alternative therapies. Stick, (or not) whatever name on the disease or non-disease, one thing that is freakily real is the suffering, the pain. Most of the time than not, the patients, the psychiatrists, the nurses are in the trenches fighting with the tools they've got at hand.

For all the after effects of the drug I now live with, for the last few years, at least, I had some kind of a life.

Posted by: Marie at January 7, 2008 06:09 AM

FOR KINGMAKER:
You can't spell, don't write well, are ignorant and your ideas bigoted and wrong.

Mental illness does exist. You are mistaken.

People like you shouldn't be allowed to post this trash on the internet. You should be ashamed of yourself.

Posted by: Anonymous at August 31, 2009 07:50 AM
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