Axiom Home Page Forums General Discussion The Water Cooler J.P.'s office

Indeed!

I think that calls for a cartoon.

I'm not touching that one. I'm afraid what types of web pages it might end up getting linked to.

Ain't it the truth.

Heeeeee's CA-RAAAAZY!

Says the former King of Spain ...

What's that sig line from, anyway? I'm too lazy to Google it.

It's a line from a Moxy Fruvous song.

A really good Moxy Fruvous song, although the a cappella version is the best.

And yes, I was hoping someone would notice that juxtaposition.

Today's horoscope sounds ominous:

This has been coming for a while, and you're not ashamed to say it. You've just about had it with your current situation, and you want out. Still, you're reluctant to make a move without something solid waiting for you. That's not a lack of guts, either -- it's a sign of maturity. You can buckle down and stand the situation for a few more days. At least until you've made some phone calls to start the ball rolling.

On a lighter note, lunch today was from Moes' Southwest Grill, make your own fajitas (steak, chicken). I ran late seeing patients and the guacamole was gone by the time I got there. O! the humanity!

The AstraZeneca rep says that a new indication for Seroquel XR is coming out next week. She didn't say exactly what it was, but that it is in the realm of depression. Since they already have an indication for add-on (adjunctive) treatment of depression, that must mean that they have succeeded (on their second try) in getting an indication to be monotherapy for depression. I knew, via my favorite psych blog, that they had filed an application for this, and for treatment of anxiety, with the FDA.

This is gonna be controversial. The main reasons: metabolic side effects, and use of medications outside their typical realm. Seroquel was developed as an antipsychotic, and it is a good treatment for schizophrenia. It is in a class of medications that have been proven to also be effective for bipolar disorder. The main drawbacks of Seroquel (and most of its kin) are metabolic: increased appetite --> weight gain --> elevated blood sugar, elevated cholesterol. Plus, Seroquel can cause significant fatigue and sedation. As well as irreversible movement disorders of the Parkinson's type. Oh, yeah, and there's a tiny tiny chance of a severe and often fatal reaction.

Contrast this with the side effect profiles of the newest generation of antidepressants: Prozac, Zoloft, Celexa, Lexapro, Wellbutrin, Effexor, Pristiq, and Cymbalta. They are not perfect, but most people tolerate them just fine. And they're a world apart metabolically (except for Paxil and Remeron, which are weight gainers). They don't have the chance of EPS or NMS.

So, in my practice, Seroquel is not going to be the first medicine I reach for for a depressed patient. It won't be the second, or the third. Maybe the tenth. And there may be some people that it just clicks for, plugging into their brain just right. But just wait and see, for every one of those people, there'll be 10 others that got the med from somebody else and have gained 20 lbs unnecessarily.

Interesting to see some insight into how the process works. Keep 'em coming.