Q: Are there any new drugs approved in Canada for the treatment of depression? My wife has tried them all and they either do not work or she has side effects that prevent her from continuing treatment.
A: The American Food and Drug Administration has recently approved a new drug for the treatment of major depression. It is called duloxetine, trade name Cymbalta, manufactured by Eli Lily and Co. It stops the neurotransmitters serotonin and norepinephrine from being destroyed by the body at the nerve endings. Lowered levels of these brain chemicals are what lead to severe cases of depression that interfere with sleep and appetite. The ability for this drug to work on both chemical systems puts it on a par with the existing drug Effexor.
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The recommended dosage of Cymbalta is 60 milligrams a day. There was no increased benefit from raising the dosage. Side effects are nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness and increased sweating. I expect that Canada will also approve the use of this drug fairly soon.
Studies are still in progress to assess Cymbalta in the treatment of urinary stress incontinence and also neuropathic pain in diabetics.
Q: I recently visited my nephew who is in a large mental hospital suffering from schizophrenia. I noticed that most of the other patients were smoking andfrequently asked me if I had a cigarette for them. Why do schizophrenics all smoke so much?
A: It is true there is a great deal of smoking in mental hospitals with a high population of schizophrenic patients.
This is partly because years ago, disruptive patients were rewarded with cigarettes for good behaviour. Although this no longer happens, about 80 percent of schizophrenics still smoke heavily, compared to 25 percent of the general population.
It appears that nicotine increases levels of the neurochemical substance dopamine in certain areas of the brain. Schizophrenics have been found to have problems with their dopamine receptors. Studies have shown that the thinking and feeling processes in schizophrenics are improved by nicotine, but the effect is temporary.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
