Ellen Campbell -Grizzle
THE U.S. Food and Drug Administration (FDA) has approved the first patch for the treatment of major depression. The drug, selegilene, is not new but now will be branded as Emsam, in a transdermal delivery form.
It belongs to the monoamine oxidase (MAO) inhibitor class that fell out of favour in the 1960s. Oral MAO inhibitors became notorious for interactions with foods such as cheese and processed meat, producing elevated blood pressure with increased risk of strokes.
In the stomach, monoamine oxidase enzymes line the stomach and liver, and break down toxins in all sorts of fermented foods such as cheese, dairy products and wine. In the brain, these enzymes play a role in depression. The patch dosage form allows the drug to bypass the stomach and liver, eliminating a serious side effect while exerting an inhibitory effect on the brain. It is absorbed in the blood stream over a 24-hour period and, therefore, minimises exposure to the digestive tract. The patch reduces MAOs in the brain but not in the stomach.
Many Jamaican patients suffer from major depression and endure related physical and psychological symptoms every day. Data from the 2001 National Household Survey commissioned by the National Council on Drug Abuse revealed that 20 per cent of the population in the 13 to 55 age cohort suffers from major depression. The rate among females is over 1.5 times the rate among males. Urban residents also experience significantly higher rates than rural residents. Depression is one of the leading causes of disability in the world. It is not a sign of personal weakness that can be willed away. Without treatment, symptoms can last for weeks, months or years. Proper treatment can help most people.
SUFFERERS ARE AFFECTED BY:
* A feeling of sadness and worry.
* Loss of interest in pleasure.
* Appetite changes and weight disturbance.
* Sleep disturbance.
* Abnormal fatigue or loss of energy.
* Inappropriate guilt.
* Poor concentration and indecisiveness.
* Abnormal morbid thoughts of death or suicide.
* Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain.
REMISSION WITH DELIGHT
MAO inhibitors are known to produce 'remission with delight'. People feel well quickly and are tempted to stop medication too soon. Researchers in the antidepressant patch study noted that the drug lifted symptoms faster than oral forms and that there was a reduced risk of hypertension or stroke, even when eating a normal diet. The low-dose of antidepressant contained in a patch, reduced the pill burden and offered other potential benefits.
However, experts warn that there are different subtypes of depression and MAO inhibitors will not work for all subtypes. After a decade of testing, the FDA approved the drug with dietary restrictions, particularly for people who do not benefit from other antidepressants. The patch is to be changed daily.
Remember, it is best to gradually reduce the dose of your medication in consultation with your physician. Remember that despite the fact that the patch does bypass the diet problem and goes straight to the blood, the FDA approved the drug with food restrictions. Emsam was developed by Somerset Pharmaceuticals Inc., which is a joint venture between Mylan Laboratories Inc. and Watson Pharmaceuticals and will be marketed by Bristol-Myers Squibb Co.
Ellen Campbell-Grizzle, president, Caribbean Association of Pharmacists; director, information and research, National Council on Drug Abuse; email: yourhealth@gleanerjm.com.
