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 <[log in to unmask]> ^^^ \ / \ | / Today’s Research \\ | // ...Tomorrow’s Cure \ | / \|/ ```````