Sunday, June 19, 2016


I was privileged to attend an educational session at Black and Blue Restaurant hosted by Lundbeck the company that brings us Trintellix.  The Black and Blue Restaurant was an excellent setting for a small group meeting with superb food and service.  At the end of an often 12 hour day full of surprises and emergencies the last thing I want to do is get more education, given I’m already educated beyond my intelligence.
Yet, I was impressed with this latest of antidepressants and glad that it plugged a true gap in the much needed armentarium that doctors bring to fight disease.  Patients often complain of neurocognitive effects of depression. Many have had excellent mood relief and sleep benefits and reduced anxiety but still complained that they didn’t ‘think’ as ‘clearly’ as before. Often the effect  of their depression on concentration, memory, especially focus is an early symptom of depression but not as recognized as the low mood, thoughts of worthlessness and even suicidal ideation and the panic.  Yet when those symptoms are relieved there is really too often this lingering sense most noted subjectively that they’re not in the game, that their brain is sluggish or they’re not as ‘bright’ as they were.
Along comes Trintellix.  The students in my practice loved it.  Afraid of taking anything that would effect their studies I was able to offer this newest of antidepressants and hear the positive reports that yes it worked for depression and anxiety but most importantly it helped them get back the edge on their studies.
So when I’ve tried a medication clinically and seen it work I’m glad to have dinner bought for me to find out more about the medication and how others are finding it.
That’s how clinically medications are used.  I’ve learned of Truvada a medication that prevents people from getting HIV having unprotected sex with people who have HIV.  I’ve not had the opportunity to prescribe it as the medication after millions of research dollars is only available at approximately $50 a pill. Yet I would prescribe it first chance because there is a need and the cost benefit is most positive.  However after I started using it I ‘d be glad to learn what others were finding clinically.  As a researcher clinician I study the journals and studies mostly put out by university departments and those put out by the industry before using a medication.
Pharmaceutical companies, like car companies like Ford  or Toyota and any other big manufacturing company, keep good stats and monitor the experience of the medications., their product.   Because people were finding the 10 mg tablet of Trintellix was triggering GI symptoms even when it was taken with the largest meal at dinner, the 5 mg tablet was released which didn’t cause the GI symptoms.  After 2 weeks I’ve increased my patients to 10 mg even though 5 mg is actually an effective dose, while most of my patients are on 10 to 20 mg.
I’ve given samples which I received very thankfully as well as prescriptions. The samples are a god send for patients starting a new medication. They’re like a ‘test drive’.  They don’t really tell if a medication is going to work because you usually need to be on the medication for a couple of weeks and the samples are usually only for a week. However 90% of all side effects with medications especially the worst allergic reactions happen right away. This allows a patient to save spending $100 or so on a month supply of medication if there is a problem as well as saving them the cost of the first weeks of treatment.
I liked that there were maybe 10 clinical psychiatrists there that night. Several had academic appointments and most were affiliated with a hospital but several like me were solely in private clinical practice doing the work of actually seeing patients.  I knew a couple personally and several by their excellent reputation so it was pleasant to be there. A couple of the young guys impressed me too.  Women and men and a half dozen ethnic backgrounds so typical of Vancouver were present.  Almost all were parents too, so were giving up time with families to learn, which is so typical of the healing profession still.
These are the notes I took.It really was a great presentation by Dr. Dianne Macintosh, a self proclaimed ‘soccer mom’.  I really appreciated learning of it’s safety in the elderly.
Eileen Sutchuck
Dr. Dianne McIntosh
Multi-dimensional disorder
1 in 5 mental illness
51billion cost of mental illness
Multimodal -5ht1a
Montgomery - Asberg Depression Rating Scale
- proven efficacy
Hamilton Anxiety and depression
Broad efficacy 
Nausea side effect best start 5 mg or 5 mg eod
No difference in weight gain from placebo so very much appreciated
Sexual side effects not much similar copra led
Tests of cognitive function
Sheehan Disability Scale (SDS)
Digit Symbol Substitution Test (DSST)
RAVLT acquisition - 
RAVLT delayed recall
Memory tests
Vortioxetine well replicated
Objective performance data improved
Katona et al - elderly study
Lundbeck provided some of these cognitive assessment tests that were specifically made for brief clinical use in a busy office. I’d not used them though I started using clinical tests in my practice way before the mainstream trend.  Hamilton and Beck Depression scales have been around for a long time but I only just started using the PDQ’s a few years back. I’d not used the SDS so really was thankful to be given a copy. One worries about copyright so it’s great when there’s freeware that can enhance one’s practice.  
All round a very good evening and worthwhile. My patients will benefit from the practical insights I gained and the discussions I had with colleagues.    I really prefer eating take out at home on the couch with the dog in front of the tv after a long day of work after what now is looking like a life time of  clinical service.  The Black and Blue, Eileen and Dianne made the whole experience enjoyable.

I really am thankful to Lundbeck for their work in providing a new medication which really fills a need. I think the speed of society and the increased need for neurocognitive function with computers and cell phones, increased time pressures and more complex intellectual problem solving in the workplace brought the need for Trintellix to the forefront.  In the old days people were just glad to no longer be wanting to kill themselves and not having panic attacks where they thought they were going to die.  Now they and their bosses want people back at work with the capacity to think sharp and focus so Trintellix was needed.  Now it’s here.  

No comments: