Anxiety In The Elderly

The American Disorders Association of America states that anxiety disorders are the most common mental illnesses in the United States, affecting 40 million adults across the country.Research shows 6.8 million of these adults suffer from an anxiety disorder called generalized anxiety disorder (GAD), which is a condition of chronic worrying.

"A person with generalized anxiety disorder spends, on average, about 40 hours a week worrying, so it's almost like having a full-time job," Eric J. Lenze, M.D., a geriatric psychiatrist at Washington University School of Medicine in St. Louis, said
"They worry about very real things, but the inability to put those worries out of their minds makes the condition disabling." Other anxiety disorders include obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder and specific phobias.

Several drugs are used to treat GAD.
Benzodiazepines (Valium, Xanax) acts very quickly, but physical and psychological dependence are common side effects.

These drugs can take weeks to change symptoms and can worsen sleep problems and cause

A recent study examined the effects of antidepressants on GAD in adults over 60. Researchers looked into the effects of selective serotonin reuptake inhibitors.

They found after 12 weeks of treatment, 68 percent of patients taking escitalopram (Lexapro) had improved, and only 51 percent of those taking the placebo had improved.

Today I was trying to find and article with the positives but it turns out it was harder then I expected it to be. It seems as though maybe I was focusing on the negative because that was all I could find.

Final Focus; Further research

After going through all of my posts and compiling information I realized that I needed some sort of conclusion to the research because all the information is there but I don't seem to have anything tying it all together. I feel as though I've been focusing heavily on the negative with little positive. For my final stretch of research I would like to find some kind of research with a conclusion to it rather then "this is what we found". Funny that my sister mentioned she also thought I need to touch base with the pros. I think if I can find a couple articles showing that for as much harm it does there is good although not all of my articles convey that. After discussing I didn't really feel as though many of my questions were left unanswered nor where there any new ones. Other then if are pharmaceutical companies are doing in with this drug, what other medicines?

For my oral presentation I want to discuss on how my topic started out as SSRI in general and through out my research it seems adolescents was something that showed up more and more which shifted my focus and enabled me to find out a lot more. I plan on making a poster with pictures of the most common SSRI the most common dosage. I would also like to have a story for each medicine, find articles of people who have used them, one that is positive and one that was negative then a percentage of people who find it useful and ones who don't. A picture of your brain before and after several months of using SSRI with a list of symptoms that may occur. Chart of how many more prescriptions have been written for this category of drug over the past 10 years. All aspects of this presentation I have already acquired. The information was easier to find than I though it would be.

Puttin' It On The Table

I think this was a very astute topic to pick. It's something that is a bit taboo and something that should be and is slowly being addressed. I think you perhaps unknowingly you may have helped some of your peers by choosing this topic. Although there is clearly a very dark side to these drugs, I am wondering if you could find some articles that highlight the positive, things that people are doing right. Also maybe looking into where teens can get help, ie support groups, activist groups. I would also be interested to see if you could find more cases of doctors irresponsibly prescribing drugs (I know that you touched on it). I like that you respond with some more thought provoking questions, but I would also like to see some more of your thoughts, not just questions (again I think it's great that you are questioning). All in all I think you have hit on a very interesting topic that not only could you use for this project, but I think that if it is a subject you are passionate about researching it be carried into other writing/researching projects, maybe interviewing.
Well done!

Drug Maker Accused of Illegally Marketing Antidepressants for Kids and Teens

Forest Laboratories, the maker of the popular brand-name antidepressants Lexapro and Celexa, illegally marketed the drugs for use in children and teens while hiding data showing the drugs were not as effective as other drugs and increased the risk of suicide in younger people.

Lexapro and Celexa are two versions of the same drug, citalopram, and approved by the Food and Drug Administration for use only in adults.

Lexapro is Forest’s best-selling drug, earning the company $2.3 billion in 2008 alone. The company has asked the FDA to approve the drug for use in treating depression in adolescents.

The Justice Department charged Forest Laboratories with illegally marketing Lexapro and Celexa from 2001 to 2004 by disclosing the positive results of a clinical study of the drugs without also releasing data showing the drugs were not effective in many children and could result in some young patients becoming suicidal.

Prosecutors also are seeking to recover money paid for prescriptions of the drugs for children under federal health-care benefits programs. That amount could reach millions of dollars

Forest also is accused of giving tickets to baseball games, gift certificates to expensive restaurants, and other forms of kickbacks to doctors who prescribed its drugs. Some physicians were sent on vacations paid for by the company.

Drug companies are now required to disclose the results of all their clinical trials, regardless of whether the results are positive or negative. However, Forest’s marketing of Celexa and Lexapro to adolescents and children happened before those rules were in place.

Forest knew about two studies conducted in the 1990s regarding the use of Celexa to treat depression in children, according to federal prosecutors. One study reached positive results about the use, while the other came to a negative conclusion on the issue

For years, Forest officials cited the positive study results to physicians in encouraging Celexa as a treatment for pediatric depression, but failed to disclose the negative study findings

Many physicians continue to prescribe Lexapro and Celexa to treat depression in children. The drugs carry a prominent “Black Box” warning to advise doctors and patients about the increased risk of suicide in children and teens.

Teenager bludgeoned his father to death after a GP prescribed him Prozac response

After reading this article it made me question just how much assessment goes into prescribing medications of this class. I'm sure there were other things that added to this situation and this boys stress and anger but in no way would I make this acceptable or excusable because of the drug. I feel as though both doctors should have been in touch with one another and the boys parents should be clearly warned of what down sides may occur. As well as being on this medicine I think it should be a requirement that you need to see a therapist for further help. I believe the medicine and someone to help you sort out and deal with your issues and problems is what needs to be done. I'm sure most people would be resilient but if this is what the result of that is then I think its more then rational. This is only a notch in the belt to other articles which I think should make people alarmed, and pro active.

Teenager bludgeoned his father to death after GP prescribed him Prozac

A teenager bludgeoned his father to death with a hammer and crowbar weeks after a GP prescribed him the controversial anti-depressant Prozac.
Edward Belben, 15, battered his father Gary at least 30 times with the weapons before plunging a knife into his head.
He then attacked his mother, Tanya, 43, with the bloody crowbar and stabbed her in the face with some scissors before she managed to escape.
Belben, now 17, was today convicted of murder and attempted murder after a jury heard he had fallen in with a 'bad crowd' and started taking a cocktail of street drugs including cannabis, cocaine, crack cocaine and amphetamines.
But during the trial the court was told two GPs ignored national guidelines when prescribing him anti-depressants, known as selective serotonin reuptake inhibitors (SSRIs), which have been linked with a range of side-effects including suicide and violence.
Belben was given Citalopram by one GP, Dr Imran Ramjan, even though its use with under-18s was banned in 2003.
When the schoolboy complained of feeling in a 'dream-like state', another doctor at the practice, Teresa Thomas, put him on daily 20mg dose of Prozac - the only SSRI still allowed for children - despite warnings that 12-18-year-olds should start on 10mg.
Belben was also not given any psychiatric help prior to taking the drugs, contrary to National Institute for Health and Clinical Excellence guidance in 2005 that pills should not be the 'first line' remedy for depression in under-18s.
Describing his mental state in the lead up to the attack, he later told a psychiatrist: 'I didn't feel real.'

Gary Belben was battered to death by his son, who then plunged a knife into his head
The GPs who prescribed the drugs could now face a fitness to practise hearing in front of the General Medical Council, which has the power to suspend them or strike them off.
Mental health charities yesterday warned many GPs still routinely hand out SSRIs because of a shortage of mental health experts in the NHS.

In September that year he was given Citalopram but switched to Prozac in November after complaining of the side-effects.
On December 17, the teenager attacked his father, a 59-year-old mechanic, at the family home in Colchester, Essex.
Prosecutor Martyn Levett(CORR) said: 'The defendant took the hammer and hit him on the top of the skull, fracturing it, and then with either the hammer or crowbar or both continued to hit him on top of the skull about 30 times.
'The skull fractured so seriously bits of brain fractured off onto the weapons and also the defendant's clothing.
'After using the weapons to kill the man, experts believe the defendant then plunged the carving knife into his brain.'
Consultant clinical pharmacologist Dr Andrew Herxheimer(CORR), who examined Belben, said: 'The most striking thing he told me was... "a sudden thing came up in my head and I had to do it".'

response to "Antidepressant labels to carry new warning of life-threatening side effect"

what exactly in an SSRI and SNRI causes this? and how come up until now it wasnt printed on a lable? I'm curious to know how many deaths have occured and in what age brackets. During all of my research it seem that this catagory of drug is not wel marketed in letting patients know all side effects including the ones that could happen while pregnate. and "With one in 10 Americans taking prescription antidepressants" thats a lot of possiblity for things to go wrong. Something i dont think we should be gambling with. With so many people on this drug there must be some new focus on trying to modify it. "tripling of prescriptions since 1988.". I would like to know why the prescirption rate as trippled. why are people more and more depressed and why are prescirptions so easly writen? its seems to me that any tom dick and hary could walk into a docotors office and be prescribed an SSRI,SNRI.

Antidepressant labels to carry new warning of life-threatening side effect

The FDA has ordered a wide range of antidepressants to carry new warnings of an unusual but potentially deadly side effect seen most often in the first few weeks of treatment or when a patient increases dosages. The labels of two classes of new-generation medications for depression -- selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) must now notify patients that malignant neuroleptic syndrome has been linked to the use of these drugs. labels to alert patients of the danger were those making Celexa, Cymbalta, Effexor, Lexapro, Paxil, Pexeva, Pristiq, Prozac, Venlafaxine and Zoloft. In Malignant neuroleptic syndrome, patients experience muscle rigidity, extreme variations in body temperature and wild fluctuations of heart rate and blood pressure -- all signs of malfunction in the body's autonomic nervous system, which regulates involuntary body functions. Malignant neuroleptic syndrome has been associated with older antipsychotic medication such as haloperidol, lithium salts and risperidone. But the widespread use of SSRI and SNRI antidepressants has made this syndrome a more common and visible affliction.
With one in 10 Americans taking prescription antidepressants, medicines such as Zoloft, Prozac and Effexor are currently the most commonly prescribed class of drugs in the United States, just ahead of high-blood pressure medicine, according to the Centers for Disease Control. And SSRIs and SNRIs have become by far the most common types of antidepressant dispensed by pharmacies, driving a tripling of prescriptions since 1988.
Malignant neuroleptic syndrome is a rare but extremely dangerous condition that results in death in, by some estimates, 10% to 20% of cases. Until recently, it was so uncommon it was unlikely to be recognized in many emergency departments. But the widespread use of SSRIs and SNRI antidepressants had made this bizarre syndrome a more common affliction seen in emergency departments.

Response to "Stressed by His Short Allele"

My two most recent articles are closely related. Both discuss genetic variation and how certain people react to medicines differently then others. I have to pose the question is this going to put a dent in ones wallet? And are doctors as well as pharmicutical companies going to invest the time and money? "those people who have a short allele for the serotonin transporter have been suggested to exhibit more "anxious" personality traits. This means our differences in gene function may bias our brains and our personalities to create a tendency to be more "negative," "anxious" or reactive to stress." Does this only refer to mental health or are other medicines as well as the way they affect you differed by your genetic makeup?

Stressed By His Short Allele

Individual differences in the genetic makeup of the serotonin system have been shown to increase one's vulnerability to depression, anxiety and other psychiatric conditions, particularly if individuals are exposed to stressful events in their lives. Studies are showing that certain people (those that have the short allele of the serotonin transporter gene) have a greater biological reactivity to stressful events, including a larger hormonal response to stress and a greater brain reactivity to threat. In other words, both the hormonal and brain systems (amygdala) involved in fear and anxiety are more active in response to stress in those individuals who have a certain genetic makeup (short allele). This genetic difference may also account for individual differences in personality; those people who have a short allele for the serotonin transporter have been suggested to exhibit more "anxious" personality traits. This means our differences in gene function may bias our brains and our personalities to create a tendency to be more "negative," "anxious" or reactive to stress.

This begs the question: should modern medicine and psychotherapeutic approaches be extended to better account for these individual genetic variations in the stress response (and the serotonin system)? The idea that we may be able to refine our approach to medicine to account for these types of individual differences (in genetics, personality, the stress response and beyond) is pertinent to the continuing evolution of medicine and science, and one that is indeed increasingly being adopted by clinicians interested in a "personalized medicine" approach to traditional medical treatment and other forms of therapy. Furthermore, looking at a person's biological make-up has applications for being able to better predict which individuals may be more at risk for mental health difficulties.

While the idea that our genetics may be used to tailor our individual medical treatments and to screen us for vulnerabilities could appear to some like a vision from the movie Gattaca (1997 science fiction film), such refinement in our medical approach may prove to be a significant step forward.

Response to Dr. Francis Lee

I had no idea that there was such thing as "pharmacogenetics" which uses your genes and other genetic information to test how you'll react to medications along with classes of medications. But is this going to cost an astronomical amount of money? most likely but instead of all the trial and error shouldn't it be made available. The use of pharmacogenetic testing is viewed by many as an outstanding opportunity to improve prescribing safety and efficacy. Driving this are the 106,000 deaths and 2.2 Million serious events caused by adverse drug reactions in the US each year.

Dr. Francis Lee (Developing Genetic Test To Guide The Treatment Of Depression)

Dr. Lee's researchs into the molecular and neural mechanisms of depression, anxiety disorder and other mental illnesses. In particular, he identified that a genetic variation, or SNP (single nucleotide polymorphism), in the gene for a growth called brain-derived neurotrophic factor (BDNF) may predict patients' responses to drug treatment. This new approach, known as pharmacogenetics, could lead to diagnostic testing to guide the treatment of depression, replacing the current "trial-and-error" method. Dr. Lee's research with mice show that those with the BDNF polymorphism are more prone to anxiety and respond less successfully to a class of common antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine, citalopram, paroxetine, and sertraline.

Dr. Lee is using this research toward treatment of survivors of the 9/11 terrorist attack and veterans of the Iraq and Afghanistan wars that suffer from post-traumatic stress disorder. Working with his NewYork-Presbyterian/Weill Cornell colleague Dr. JoAnn Difede, Dr. Lee screens patients for the BDNF polymorphism. They hypothesize that patients with the polymorphism may not respond the same to SSRIs, but may respond better to different treatment approaches (that do not rely on BDNF function) such as cognitive enhancers like D-cycloserine (DCS) combined with Dr. Difede's virtual-reality exposure therapy. According to Dr. Lee, approximately 30 percent of patients test positive for the BDNF polymorphism.

Response to Antidepressants may damage more sex lives

Not that I can relate to this topic or even being to understand how it effects a persons sex life, but I found this rather interesting. Of course there are pro's and con's to everything but would you think that part of your life would change so dramatically from taking a medication that is supposed to be helping you. After reading this article and doing a little bit more research it showed that some people never stop having these side effect while others once off the medication are perfectly fine. "In the past two or three years, scattered published case reports from around the country have described patients whose sexual symptoms failed to resolve after going off antidepressants". I'm surprised these side effects aren't printed on the bottle. Like in my previous posts pharmaceutical companies fail to warn doctors as well as the patients of possible side effects. Psychologist Audrey Bahrick at the University of Iowa says "Among their symptoms, were "telltale signs" of SSRI-caused dysfunction, unrelated to the known effects of mental illness. They had "pleasureless orgasms," and "genital anesthesia," in which sex feels no more intense than a handshake. She became particularly concerned about adolescents put on antidepressants, whose sexuality might never have a chance to develop normally". With 74.5 % of teens on antidepressants that's a large amount of people it could possibly affect. This article also says this mean about 1 in 8 american adults are affected by SSR's. Kenvin Bennett, a 30 year old whos sexual functions was perfectly fine until he turned 18 and was prescibed Prozac. He has been impotent ever since. His doctors as well as others cant seem to find an alternative explantion other then SSRI.

Response to Dr. Francis Lee

I had no idea that there was such thing as "pharmacogenetics" which uses your genes and other genetic information to test how you'll react to medications along with classes of medications. But is this going to cost an astronomical amount of money? most likely but instead of all the trial and error shouldn't it be made available. Pharmacogenetic testing is viewed by many as an outstanding opportunity to improve prescribing safety and efficacy. Pushing this are the 106,000 deaths and 2.2 Million serious events caused by adverse drug reactions in the US each year. I would like to know more about what exact polymorphism it is that causes the anxiety and stress in comparison to the ones that don't