When antidepressants cause mania

Antidepressants are often prescribed for people with bipolar disorder, but some of them may do more harm than good (the drugs, not the people) (although it’s true for the people, too, I suppose).

Certain antidepressants can increase “mitochondrial energetics,” says a research team from the Mayo Clinic, and when given to a bipolar person, “may elevate the risk of treatment-emergent mania.”

In other words, if we were still calling it “manic depression” these meds would turn that manic part up to 11.

The increased energy expenditure of mania associated with impulsivity, poor judgment, psychosis, and loss of insight can drive high-risk behaviors, often resulting in hospitalization or incarceration.

But which drugs might cause that? There’s the rub — they aren’t sorted that way. “These data suggest categorizing antidepressants based on mitochondrial energetics may be of value.”

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Would you recognize the signs of mental illness or substance abuse if they weren’t incredibly obvious? Face it: probably not. But catching those signs early is critical to getting patients on the right path.

That’s why the Georgia Pharmacy Foundation is offering an important CE course: Mental Health First Aid. It’ll teach you to identify and respond to signs of mental illnesses and substance abuse sooner rather than later.

The course: 5½ hours live training, plus 2 hours self study — a total of 7.5 hours of CPE credit for pharmacists and technicians. (You’re expected to complete the home study portion first.)

The next date: Saturday, March 18, from 9:00 am – 3:30 pm on the UGA CoP campus in Savannah.

GPhF is making this training available to pharmacists, pharmacy techs, and student pharmacists for just $49.00. (It’s normally $170.00.)

Be ready to recognize and help the people who need it.

Click here for details!

A different PrEP delivery

An experimental form of HIV PrEP is being tested at the University of Pittsburgh — a combination of tenofovir alafenamide and elvitegravir that’s not a pill. If it entered the market, it would be a form of on-demand protection, rather than the daily dose of oral drugs like Truvada and Descovy. (To be fair, those are often taken on-demand as well, although that’s still off-label.)

So far the tests have been small-scale (21 people) and in the lab, but they’ve been promising. That’s not surprising, considering that oral antivirals have been shown to be 99% effective in reducing HIV risk.

The ultimate goal, say investigators, is to add yet another PrEP delivery method to the growing menu of oral and injectable options that at-risk men and women can use.

Playing with patents could mean pending penalties

Has Merck been playing games with the patent system to protect Keytruda from generic competition? The Senate, led by Senator Elizabeth “Don’t Mess With Consumers” Warren, thinks so, and it wants the U.S. Patent and Trademark Office to look into it.

In short, Merck keeps tweaking Keytruda without actually changing the basic drug. As the company put it, it’s creating “innovations around composition of matter, method of use, formulation, dosing and combinations with other agents.”

Which is fine, except when (Warren et al. say) it’s trying to use minor tweaks — e.g., a subcutaneous injection formula — to extend its patent on drug itself. In fact, they pointed out, 74% of Merck’s new patents on Keytruda cover “different indications and formulations of the drug, not the key antibody.”

“These efforts by Merck appear to be part of a long-standing pattern of drug manufacturers’ abuse of the patent system,” they wrote, adding that Merck’s use of patents is “an example of anti-competitive business practices.”

ICYMI: Moderately confusing

Big news! The Energy Department apparently has low confidence that the SARS-CoV-2 virus likely originated in a lab leak. Why yes, the words “likely” and “low confidence” make the entire conclusion confusing, but it makes for headlines. (The Wall Street Journal breathlessly reported “Lab Leak Most Likely Origin of Covid-19 Pandemic, Energy Department Now Says,” not mentioning the “low confidence” part till later.)

Other agencies had similarly low confidence the virus spread naturally, although the FBI said it had moderate confidence it came from a lab leak.

The one thing everyone seems to agree on is that, even if it was a lab leak, it was accidental. Still, it’s critical that we spend more time and money arguing over its origins. Once we’re confident we know how it happened, we can … I dunno. Write a strongly worded letter, perhaps.

Today’s non-pharma, cool science story

Swedish materials scientists have grown electrodes in living flesh (of a fish, for starters), but by using the fish’s own sugars to build the electrodes inside itself without damaging tissues.

The result, published in the journal Science, paves the way for the formation of fully integrated electronic circuits in living organisms.

What they hope: These might be used for brain therapies to treat conditions like Parkinson’s or even to advance prosthetics.

What the reality will be:

Short Takes

Double-duty OTC test

The FDA has authorized Lucira Health’s combo flu and Covid test. It takes about 30 minutes, uses a shallow nasal swap (thank you!) and is about 90% accurate for both. Note: It’s been describe as a “major milestone,” but not a game-changer.

One booster will do the trick

One booster a year will (probably) be enough, even for the immunocompromised, according to the CDC’s Advisory Committee For Immunization Practices. The current CDC recommendation is that at-risk folks get more frequent boosters, so this would be a change … although the ACIP did say some flexibility is important, especially as we see what new variants might be in store.

Whew! Nothing can go wrong now.

The viruses that killed one person and sickened another in Cambodia are from an endemic clade of bird flu — i.e., it’s not some new variant that will soon sweep the globe and lead to a new crop of post-apocalyptic video games. It’s one that’s been “among birds and poultry for many years and has sporadically caused infections in people.”