January 07, 1999

Slap-happy medicine
A new patch promises to deliver an antidepressant that doctors are
claiming works better than Prozac

Luiza Chwialkowska--National Post

Canadians already spend hundreds of millions of dollars on nicotine
patches to help them quit smoking, nitroglycerine patches to ease
angina, and estrogen patches to restore hormones lost in menopause. But
as the millennium unfolds, they may be able to slap on an even more
pleasing remedy: the happy patch.

A Florida-based pharmaceutical company is developing the first
"transdermal delivery system," or patch, that will deliver
antidepressant medication directly into the bloodstream.

"It really is wild. It's the Second Coming. It's out of this world,"
says Alexander Bodkin, a Harvard psychiatrist who is leading the
clinical trials of the patch. Not only will the patch deliver the drug
in a quick and easy way, says Bodkin, but the new delivery method will
resurrect a long-ignored depression medication, Eldepryl, that for some
people has stronger effects than such popular medications as Prozac or
Zoloft.

"The Prozac experience for many people is relief. Anxiety lightens,
fretfulness subsides, negative emotions become attenuated and quiet and
go down to the normal range. Which is wonderful," explains Bodkin. " But
the brain systems which mediate reward, engagement
. . . are not affected by Prozac."

Patients who used the patch drug, however, felt "energized, activated,
and stimulated," he says.

Eldepryl, or selegiline, is a so-called monamine oxidase inhibitor
(MAOI), a class of drugs considered highly effective for fighting
depression. Some MAOIs are available in Canada. But Eldepryl has only
recently become available here for patients suffering from
Parkinson's disease.

The unique property of Eldepryl, according to Bodkin, is that not only
does it raise seratonin levels in the brain the way Prozac does, it also
raises levels of dopamine. Higher dopamine levels may account for what
Bodkin calls the "striking cheer-giving effects" of the drug.

Some patients "couldn't even remember how it felt to be depressed," he
says.

Eldepryl has been known to have antidepressant effects since 1967, but
the pill was associated with dangerous side effects such as high blood
pressure and stroke. The side effects disappear, Bodkin says, when the
drug is administered through a patch. Taken orally, Eldepryl could
interfere with the body's ability to process certain foods. However,
skin delivery allows the chemical to bypass the digestive system.

"The pills melt in your stomach, so anything lining your gut gets
poisoned . . . If you take it to the skin, you basically go straight to
the brain and only a little bit goes to the liver and the gut lining,"
says Bodkin.

Unlike other antidepressants, which can cause headaches and sexual
dysfunction in some people, Bodkin says the new patch has "essentially
no side effects."

The only downside? Skin irritation. It can be quite itchy," he says.

There's also the patch itself. "It's a little more conspicuous than
Prozac because you can see patches and some people might be
uncomfortable with that," Bodkin concedes. "On the other hand, there are
some people who forget to take their pills," he says.

He says that patients consume only half of the antidepressant medication
they are prescribed. "People forget, people deny, people wish they
didn't have the problems they have," he says. The patch could help
people who are too distraught to follow their medication schedule.

Bodkin tested the idea with the co-operation of six medical centres
across the United States, including McLean Hospital, a
Harvard-affiliated psychiatric facility in Belmont, Mass., where he
works, at two sites in Philadelphia, and one each in Kansas, Florida,
and Washington State.

Eighty-nine patients used a skin patch containing selegiline, and 88
patients used a placebo patch with no medication. The initial tests
showed that the patch system had "impressive" antidepressant properties.

Somerset Pharmaceuticals, Inc., the company leading the trials, cautions
that it is still "exploring" how safe and effective the drug is. But
Bodkin is busy turning away eager patients who want to join his new,
larger study now under way. "We're swamped," he says.
The appeal of the patch could be enormous. The antidepressant market is
worth more than $300-million in Canada alone.

Bodkin says the patch could be the next Prozac, the next
psycho-pharmaceutical success story. And if the patch system works, its
benefits may not be limited to Eldepryl, he says. "You could do all
kinds of things with this delivery system."

Last year, Canadians spent more than $28-million on nicotine patches and
gums, according to research firm ACNielsen. Nitroglycerine patch sales
topped $36-million last year, and
estrogen patches are worth more than $29-million a year, according to
IMS Health, a medical information company.

Could caffeine patches be next? "Why not?" Bodkin says. But he adds a
word of caution about a possible patch proliferation. "People might
start getting a little lumpy."
--
Judith Richards, London, Ontario, Canada
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