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A variety of neuropsychiatric drugs recently introduced or in the late stages of development may provide psychiatrists with new treatment alternatives.
The drugs include some that would traditionally be thought of as psychiatric drugs, and others that, for a variety of reasons, are likely to prove useful to psychiatrists.
Late last year, the U.S. Food and Drug Administration (FDA) cleared the anti-epilepsy drug tiagabine, marketed by Abbott Laboratories under the name Gabitril, as an adjunctive treatment for partial seizures in patients 12 years and older.
Research presented by Johns Hopkins University scientist Gregory Krauss, M.D., at the annual meeting of the American Epilepsy Society in Boston in December found tiagabine was well tolerated in treating patients comorbid with psychiatric disorders. The finding may be useful to psychiatric clinicians because older antiepilepsy drugs sometimes compound psychiatric symptoms in patients needing treatment for both epilepsy and a psychiatric disorder.
Psychiatrists frequently encounter patients suffering from intractable headaches, including migraine. Late last year, the FDA approved for marketing zolmitriptan, manufactured by Zeneca Pharmaceuticals under the name Zomig. Zolmitriptan is the second of a class of drugs whose prototype is sumatriptan, marketed by GlaxoWellcome's Cerenex Pharmaceutical division as Imitrex. Both drugs are serotonin agonists believed to work by constricting cerebral blood vessels and controlling the release of substances that inflame nerve endings surrounding those vessels.
Between 16 million and 18 million Americans suffer from migraines, and a total of 45 million Americans suffer from some form of chronic, recurrent headache, including migraine, according to the National Headache Foundation. A spectrum of drugs, including antidepressants and beta-blockers, has been used off-label to treat refractory migraine, observed neurologist Robert Daroff, M.D., editor-in-chief emeritus of the journal Neurology. Although headache specialists will continue to use a variety of treatments, the addition of a second serotonin agonist to the pharmacopoeia suggests that migraine therapy, like drug therapy for psychiatric disorders, is becoming increasingly sophisticated.
Psychiatrists interested in obtaining further information on headache from organizations unaffiliated with drug companies may contact the following: American Association for the Study of Headache at (609) 845-0322 and URL address In the ever-burgeoning realm of selective serotonin reuptake inhibitors (SSRI's) used to treat depression, Forest Laboratories announced this January that it was seeking FDA approval for citalopram. If and when approved, the antidepressant will be in direct competition with fluoxetine, sertraline, and paroxetine (marketed as Prozac, Zoloft, and Paxil, respectively).
The fierce competition for the multimillion-dollar antidepressant market is evident in the ongoing effort to market both new and existing SSRI's. For example, a recent study in the Journal of the American Medical Association found that the cardiovascular side effects of paroxetine were fewer than those of the tricyclic drug nortriptyline. The study was aggressively promoted by Paxil's manufacturer, SmithKline Beecham, although the study contrasted the effects of two entirely different classes of drugs with different modes of action.
Bayer Corporation announced late last year that it was filing a New Drug Application (NDA) with the FDA for metrifonate, a cholinesterase inhibitor designed to treat "mild-to-moderate dementia of the Alzheimer's type," according to Bayer. At about the same time that Bayer announced the NDA, Bayer and the Alzheimer's Association announced that they were launching a "multimillion-dollar, five-year joint effort involving research funding, education programs for health care professionals and people afflicted with Alzheimer's disease, and support programs for people with the disease and their caregivers."
An estimated 4 million Americans have Alzheimer's disease, and almost half of all individuals over age 85 have the disease, according to the Alzheimer's Association. The National Institute on Aging projects that by the year 2050, there will be 31 million Americans aged 85 or older. Caring for Alzheimer's patients in the U.S. today costs an estimated $100 billion a year. The Alzheimer's Association can be reached at (312) 335-8700.