Patch Raises New Hope for Beating Depression
by MARY DUFFY New York Times December 3, 2002
It was the first type of antidepressant, and for many people the monamine
oxidase, or MAO, inhibitor remains the best hope for relief from major
depression.
The trouble is that the side effects can be so serious that MAO inhibitors are
rarely prescribed. When taken with certain foods, for example, they may bring
on sudden and severe hypertension.
The problems, however, may soon be resolved.
A study reported in November in The American Journal of Psychiatry suggests
that by administering the MAO inhibitor selegiline in patch form, patients can
receive the antidepressant benefits of the drug without the usual side
effects.
In research conducted at six sites, 42 percent of the subjects treated with
the patch recovered from major depression within six weeks, and many showed
great improvement much sooner. In the study, neither subjects nor researchers
knew who had received the dummy medication.
One subject, requesting anonymity, told how his mood changed after a few weeks
on the patch, saying: "It was like a switch had gone on. Before I had the
patch, I couldn't function. Suddenly, I had a dramatic change in outlook. I
could look forward to things."
Monamine oxidase is an enzyme found in the brain and in the digestive system.
By inhibiting MAO in the brain, the antidepressant is believed to give
patients a better supply of neurotransmitters to fight the symptoms of
depression. Taken orally, however, the medication also blocks MAO in the
digestive system, and that interferes with the detoxification of tyramine, a
harmful byproduct of many aged foods.
Patients receiving MAO inhibitors are instructed to follow a tyramine-restrictive
diet, which means no aged cheeses, no red wine, no soy sauce, no fermented
foods and little or no alcohol. Eating tyramine-rich food while taking a MAO
inhibitor can cause sudden and severe hypertension.
Delivering selegiline through the skin, however, changes the way the
medication is absorbed. Rather than first being filtered through the
intestines and liver, in patch form, the drug is aimed at the central nervous
system.
"With this study we've demonstrated a way of getting an MAO inhibitor to the
brain without interfering with the MAO in the digestive system," said the
study's lead author, Dr. Alexander Bodkin of the clinical psychopharmacology
research program of McLean Hospital in Belmont, Mass. The study was supported
by the developers of the selegiline patch, Somerset Pharmaceuticals of Tampa,
Fla.
While subjects in this study were instructed to follow a tyramine-restricted
diet, in subsequent studies they were not.
Dr. Beverly McCabe, a professor of dietetics and nutrition at the University
of Arkansas for Medical Sciences and a co-author of the "Handbook of Food and
Drug Interaction," to be published in January, believes this form of drug
delivery offers great promise. "I would think the risk of a tyramine reaction
would be very low with transdermal selegiline," Dr. McCabe said. "The drug
would absorbed into the bloodstream more evenly, which would also be
beneficial."
Dr. Frederic Quitkin, director of the depression evaluation service at the New
York State Psychiatric Institute in Manhattan, said, "MAO inhibitors are
really great drugs: complicated to use, but extremely effective." As for the
selegiline patch, he said, the research is encouraging. But he cautioned, "It
will require further study to see how effective it is."
Another notable finding in the study of 177 patients was the 94 percent
compliance rate for those on the selegiline patch. That is significant, said
Dr. Bodkin, because compliance rates with oral antidepressants are typically
much lower.
One side effect, in 36 percent of subjects, was a reaction, like redness or
irritation, at the site of the patch. For most patients, Dr. Bodkin said, the
irritation is minor compared with the side effects of most antidepressants.
Source:
http://www.nytimes.com/2002/12/03/health/psychology/03PATC.html?tntemail0
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