OCTOBER 14, 2008

OCTOBER 14, 2008

DISCLOSURES... and paxil, paroxetine, seroxat, etc etc

My disclosures are on my web sites (click the link called "disclosures"), and interested readers can follow the links to see the topics of my research, which include the effects of paroxetine and other medications on the brain, which has in the past (not currently) been funded by grants from GSK. I am not on any speaker's bureaus, or advisory boards, and I posted here yesterday that I got dropped from giving talks several years ago because I didn't want to use exclusively company generated slide sets, as I viewed that as the use of academics for marketing.

In the past five years I have consulted on a single occasion to Novartis and on one other occasion to Wyeth on the topic of the use of brain imaging in pharmaceutical research.

It has been brought to my attention that a press release from Emory in 2003 related to my research on the effects of paroxetine on memory and the brain used the brand name "Paxil" in the title. I had not noticed that before, and I will ask that the press release be changed to remove the brand name from the title.

I was asked last week if I had any "ghostwritten" articles. I posted then that two out of 215 of my publications involved paid editorial support, both came out of conferences. Both papers involved editing of drafts that came from the authors.]

Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KRR, Nemeroff CB, Bremner JD, et al: Mood disorders in the medically ill: Scientific review and recommendations. Biol Psychiatry 2005; 58 (3):175-189.

Editorial support was provided by Scientific Therapeutics Information, Springfield, New Jersey.

Sponsor: Depression and Bipolar Support Alliance, Chicago, Illinois (Lydia Lewis, President)

Conference Underwriters: Abbott Laboratories; Bristol-Myers Squibb Company; Cyberonics; Eli Lilly and Company; Forest Laboratories; Glaxo- SmithKline; Janssen Pharmaceutica Products; Organon Inc.; Pfizer Inc.; Wyeth Pharmaceuticals

Nemeroff CB, Bremner JD, Foa EB, Mayberg HS, North CS, Stein MB: Posttraumatic stress disorder: A state-of-the-science review. J Psychiatr Res 2006; 40(1):1-21.

Editorial support from CTC Communications, funded by educational grant from GlaxoSmithKline.

Here is a previous blog I wrote on the topic of ghostwriting.

Other than those two exceptions, which I personally feel comfortable with, I have always written papers by myself in collaboration with authors.

COMMENTS

Bob Fiddaman wrote on Tue, 14 Oct 2008 17:57:39,

Why do you wish the brand name to be removed from the title?
Do you or your research team honestly believe that Paxil/Seroxat/paroxetine, call it what you will, actually help reverse memory loss?
Are you aware of the official and 'non-official' adverse reports of this particular drug?
Jesus Doug, when will someone from Emory come out and speak out against Paxil?
I think maybe you/Emory or GSK should research why so many people are having trouble with this drug rather than carry out studies trying to find yet another illness/ailment it can supposedly cure!
Who came up with the idea anyway?
Were scholars all sitting around one day drinking coffee and discussing Paxil then out of the blue did one suggest that you should do a study regarding Paxil and memory loss? Did GlaxoSmithKline approach you or did Charles Nemeroff suggest it to you?
Emory already has tarnished its image with the way it closed its eyes whilst Nemeroff was raking in the dollars - Did it do so because GlaxoSmithKline were kind enough to fund research such as Paxil improving memory?

I will ask you this Doug, seeing as you seem to be learned in Paxil and its effects:

Patient comes to you and it is deemed by both you and he/she that they are ready to taper off 40mgs of Paxil that they have been on for approx 6 years. How long will/should it take that person to taper off 40mgs? What regime would you recommend for the tapering Doug?
I would be interested to know your position on this.

To recap:

How long would/should it take a patient to taper off 40mg of Paxil?
What tapering system would you recommend?
Regards
Bob

Kimberly wrote on Tue, 14 Oct 2008,

Comment : Doug, Have you ever taken Paxil yourself? Memory loss is the single most annoying short and long term side effect of SSRIs. I have yet to meet anyone that has not reported memory loss shortly after taking that drug. It has been two years since I have t [truncated]

Truthman30 wrote pharmalot.com on Tue, 14 Oct 2008,

There are many more links to that research , as its very recent ..
http://www.guardian.co.uk/science/2006/oct/24/medicalresearch.drugs1
I wonder how long the manufacturers of these SSRI’s have been sitting on their own studies?…
And more importantly what information have they not disclosed? ..
Just wanted to ask you Doug?..
Do you think from your own research that SSRI’s are good for the brain?, as in cognitive memory etc..
Because I can tell you from experience that 4 years on Paxil almost destroyed mine..
So i fail to see how your research could come to its conclusion..
Call me cynical if you want..
But it seems to me that psychiatry makes money promoting these medications , and then even the psychiatrists who disclose the truth about teh side effects , they make money from divulging that angle..
So its a win win situation for you guys..
Unfortunately the patient and sufferer is the one who bears the brunt of all of this .. Treat a patient with an experimental drug , promote it from drug industry funding, mess a patients life up, then admit the side effects and get paid for speaking about that.. Sounds like a cushy number to me…

Bob Fiddaman and Kimberly and Truthman30: I think the brand name should not be used because that is tantamount to advertising. The press likes to use the brand name (i.e. Paxil in this case) as opposed to the generic name (paroxetine) because it is easier for the public to remember, which is why whoever wrote this press release (not me) probably did that. Thank you for bringing this to my attention.

As for whether I think it helps memory, in our studies of PTSD diagnosed individuals (who have problems with memory) 9 months of treatment does seem to help memory measured on neuropsychological tests of memory. The 2003 was done while I was at Yale and Dr. Nemeroff was not part of the study. I came up with the idea for the study after seeing Ron Duman, PhD, present his research that SSRIs promote hippocampal nerve growth (hippocampus is a brain area involved in memory). I submitted funding requests to several makers of SSRIs and GSK was the only company interested in funding. [Bob asked why this was: answer, only Paxil and Zoloft are approved in the US for PTSD, and GSK probably was most excited about the drug.] We currently don't have funding from GSK but we do do research on the effects of medication on the brain (including paroxetine) funded by governmental agencies. We currently use generic paroxetine for our research (not Paxil).[question about that from Bob, a generic company may make their own paroxetine, it is the same active ingredient, yes, but since it is a different actualy plant it may not be identical].

As for the implication that universities may be biased toward not closely policing personal income gained by physicians from pharmaceutical companies because of funding received from pharmaceutical companies, my answer is (as I wrote in my book) I think that the medical industry in general is influenzed by pharma and the reasons are numerous, but include payments to Key Opinion Leaders (KOLs) who then sit on the advisory panels for drug approval, funding of community medical education, etc. etc. I myself don't give a lot of industry funded talks, as I said before.

Bob, As for your particular situation, it looks like you took Seroxat which my understanding is not identical to Paxil [different manufacturing in UK but not sure]. In any case Kimberly complains of memory problems. I had heard that as well for Lisa Van S who comments on pharmalot.com but her child was a teen. And Truthman30, I don't know your history, or your name for that matter. I don't treat teens, only adults with PTSD involved in research studies of the brain. I haven't seen in my own practice people complaining of memory problems, usually memory gets better, but I couldn't exclude the fact that it happens in some people. I am always open to new information from people who are actually taking the medication. Since there isn't any evidence that doses of more than 20 mg are more effective we don't go above that, and we don't treat for more than nine months. And we always taper for at least a month and work with the individual if they have side effects. However if you were on 40 you might try two months, going down 10 mg every two weeks.

And no, Kimberly, I have not taken paroxetine/Paxil.

This is for educational purposes, please don't take it as medical advice.

Doug Bremner

"Sara" wrote on Tue, 14 Oct 2008,

Comment : Bit of a cheek Bob (Fiddaman), making play about Emory Uni staff taking bungs from GSK. When you dont make plain that you stand to make material gain by raising awareness / litigation , cunningly disguised as internet/media blackmail

Sara: You signed as writing from furious seasons weblog, although I am not sure if this is truly the case. People who are involved in litigation have the right to make their opinions known, but as always potential conflicts of interest should be declared, although potential financial gain in the UK is much less than in the US.

Doug Bremner MD

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