April 14, 2009

LA Times Reports Small Efficacy In Abilify Used As An Anti-Depressant

The Los Angeles Times had an interesting package of articles yesterday on the wide use of atypical antipsychotics in the US (one of which I've already addressed). In one, the paper reported about the lack of efficacy in Abilify used as an add-on treatment for depression:

"[T]he clinical trials cited as evidence of Abilify's power to vanquish depression have been met with skepticism. In the most-cited company-funded study, published in the April 2008 Journal of Psychopharmacology, researchers found that among depressed subjects who supplemented their antidepressant with Abilify, rather than with a placebo, 25.4% reported some relief of their symptoms. Among those taking a dummy pill with their antidepressant, 15.2% reported some improvement in their mental health."

This won't be news to readers of this site, as I reported on the very slim efficacy (and teensy effect size) of Abilify used in such a manner last November. Among other things, I noted that patients had more than twice the chance of experiencing akathisia on Abilify than they did in improving their depression symptoms. This issue was first raised by Emory University psychiatrist Douglas Bremner on his website. Interestingly, the paper's report cites CL Psych's blog on issues around Abilify (good for him or her) and quotes Danny Carlat, a Tufts University psychiatrist:

"'The results are extremely unimpressive; they just squeak by,' says Massachusetts psychiatrist Daniel Carlat, editor of the respected Carlat Psychiatry Report. For a clinician or a patient's family, the difference between those on Abilify and those who took a placebo 'would be hard to actually see,' he adds."

I'm glad to see the LAT putting this information out in the mainstream world, but I kind of giggle at the fact that I've been raising a ruckus around Abilify's use as an anti-depressant for some time now. Just saying.

Interestingly, Bristol-Myers Squibb, the drug's maker, had this to say to the paper:

"Sonia Choi, a spokeswoman for Bristol-Myers Squibb, said the company does not comment on its promotional efforts for Abilify and that it continues to monitor the safety and effectiveness of Abilify for depression in the wake of the FDA's approval for that use. In the meantime, she noted, the company is committed to making public the results of studies involving all of its drugs, including Abilify."

While the company may well monitor the safety and effectiveness of the drug, they sure aren't being forthcoming with the public. As I noted last December when I contacted Choi with, among other things, an inquiry on akathisia I got no answer:

"I also asked Choi what the company knew about akathisia on Abilify and what percentage of patients experienced the condition when taking Abilify.

"'I don't know,' she said, an interesting response from the company's spokeswoman for Abilify."

What makes me think she'd be no more forthcoming now.

Posted by Philip Dawdy at April 14, 2009 12:03 AM
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Comments

"...among depressed subjects who supplemented their antidepressant with Abilify, rather than with a placebo, 25.4% reported some relief of their symptoms. Among those taking a dummy pill with their antidepressant, 15.2%reported some improvement in their mental health."

OK, but this says Abilify comes to almost doubling the rate of improvement in symptoms compared to placebo.

That is actually impressive and not something to be dismissed.

Posted by: David B. at April 15, 2009 05:39 AM

I was on Abilify when I was a teenager. I got terrible akathisia from it. It was scary. One dya, all of a sudden, I couldn't stop moving. I would sit down, then stand up, pace around the room, jump up and down, start dancing, kick out my legs and arms. For weeks it l;asted. I couldn't sit still or sleep, it was terribler and terrifying and I had no clue what the heck was going on. I remember I missed some school and searched "Restless leg syndrome" while shaking and standing up while sitting, because I thought that was going on. Eventually, I was told it might be from the pill. Eventually, the akathisia went away after a couple weeks. I had to go to school when the akathisia went down and I remember it was awful. That was many, many years ago, but it was scary. It's fun to look back on in retrospect. You could say you haven't lived until you've experienced the torture of akathisia. It's unfair how no one else got to experience that. You begin to appreciate what it's like not to feel like crawling out of your skin when the akathisia is gone. For years, I didn't know what it was so I said and thought I had the "jitters" and felt "jittery and fidgety" and I described it like that for years and eyars until I saw the word akathisia. I was relieved that it could be captured in one word.

Posted by: Princess at April 16, 2009 07:46 PM

I hope that Philip will approve this comment, as my fingers were poised to make it on the ECT thread below when it was suggested the thread be closed. Please take exception and post this.

After reading every word carefully, I believe that was one of the most poetic, heartfelt, heartbreaking, and eloquent series of comments ever posted on furious seasons. Dissimilar to other ECT War threads, it demonstrated the anger, pleading, real-life emotion, and party line swirling around "psychiatric" treatment more clearly than I have ever seen here. One main reason for its compelling nature was that "we" were playing against a foil; a person who presented himself as a robot: d.-guller-the-all-knowing-condescending-sometimes-all-sneering-psychiatrist. Every psychiatrist-in-training (and in practice) should read that thread then look in the mirror and learn from it. Following that daily exercise, they should then ask themselves if this is the kind of life they really want to lead, say a mantra, medidate, go out into nature and, in the end, ....just say "no". For demonstrated in this eloquent thread is a profession that "just says no" to LIFE. Life in all its permutations, longings, beauty, flaws. Not the one example given of the one person in a thousand, or a million, who is in extremis and for whom extreme measures must be taken - the person given as an example by d.guller. It's all the rest of us, trying so clearly here to cry out for the inhumanity to end and the humanity to begin.

Philip, I beg you to at least self-publish the most incredible of the threads here and get them out THERE for all to see. We will pass the hat again for it. We want to live and be free, and we want this for all, including those trapped in a profession lacking in freedom and humanity, spirit, compassion, or love, either as "doctor" or as "patient."

Thank you for your consideration.

Posted by: I forget at April 17, 2009 10:43 PM
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