Cymbalta launch Symposiums by Eli Lilly
Depression will be the second leading cause of disability worldwide by the year 2020- Prof. Musarrat Hussain
Relief from painful symptoms of depression
doubles the probability of remission
Remission should be the goal for treatment
of depression - Prof Margot Schmitz

KARACHI: Depression is a major clinical, social, physical and economical problem which varies from country to country.   By the year 2020, it is projected that major depression will be the second leading cause of disability second only to coronary diseases worldwide. At present over 340 million people above the age of 18 years are affected by major Depression. This was stated by Prof Musarrat Hussain, Head of Psychiatry Department at JPMC, Karachi. He was speaking at a meeting organized by M/s Eli Lilly Pakistan to mark the launch of Lilly’s new antidepressant called Cymbalta (Duloxetine HCL). Prof Margot Schmitz, Professor of Neuropsychology at Sigmund Freud University, Vienna, Austria was the guest speaker who has been a principal investigator in phase III trials for thirteen blockbuster drugs for the treatment of depression. These launch symposiums by Lilly were also organized at Lahore and Rawalpindi and  attended by large number of physicians representing primary care as well as eminent psychiatrists.

Prof. Margot Schmitz, Prof. Musarrat Hussain and Dr. Majid Abdi speaking at Cymbalta launch symposium organized by M/s Eli Lilly Pakistan at Karachi recently.

Prof. Musarrat Hussain further stated that depression is the 4th leading cause of disease or disability worldwide. It is not simply to know treatment but one has to diversify patients behavior differently. Psychiatrists are far less than required in Pakistan and people have to go to family physicians because psychiatric care facility is not available all over the country. Depression presents differently in primary care compared to psychiatric settings because process of detection and treating depression is different. The prevalence of depression in Karachi, Lahore and Quetta was quoted to be 36%, 53% and 44% according to a study conducted by Mugford et al in 2002. It has been seen to be twice as common in women as compared to men, it is highly prevalent in affluent classes when compared to other mental disorders. It was emphasized that depression often presents with emotional symptoms masked by painful physical (somatic) symptoms and therefore makes the diagnosis of depression very difficult in the primary care setting. Therefore, diagnosis may be missed in up to 50% cases of depression. It is a chronic illness which is often under diagnosed and inadequately treated. Physical symptoms of depression are prevalent in primary care settings. Psychiatrist, Neurologists and family physicians should have a close association which will help to treat and manage psychiatric care besides ensuring a dialogue between doctors and patient, Prof. Musarrat concluded.   

Prof Margot Schmitz speaking about the neurobiology of pain in depression said that somatic symptoms of depression can be attributed to the imbalance between nor-epinephrine and serotonin in the descending pain pathways within the spinal cord. These neurotransmitters are now known to modulate ascending pain signals. Goal of treating depression Prof Margot Schmitz said should be to improve both emotional and painful physical symptoms of depression. Since emotional symptoms respond early, it is actually the residual physical symptoms such as aches and pains that reduce response to therapy and thereby increase the relapse in such patients. Drugs that have effects on both norepinephrine and serotonin may be more effective antidepressants than those that are specific for just one neurotransmitter. Duloxetine, a dual reuptake inhibitor of norepinephrine and serotonin, is an efficacious and well-tolerated treatment for the emotional symptoms of depression and also treats the painful physical symptoms of depression. Effective treatment of both emotional and painful physical symptoms may be linked with a higher level of remission, which is the goal of treatment, she added.  

SSRIs, Prof Margot Schmitz stated are only capable of inhibiting the reuptake of serotonin and need to be given in higher doses to inhibit the reuptake of norepinephrine. Cymbalta, she said, is a  dual reuptake inhibitor because it is potent inhibiting both serotonin and norepinephrine equally, the effect of which was seen in terms of high response and remission rates for patients with MDD treated with Duloxetine HCL 60mg daily which  is effective and safe even for the elderly, she added. It is the most balanced agent available at the moment with 60 mg once daily dose. It has been studied at doses of 5-400 mg in QD and BD doses. Duloxetine HCL is a fast acting drug, after two weeks one can see the change. It is effective regardless of baseline severity. Depression symptoms improve and pain decreases even if you switch the drug to patients and even after one week therapy significant improvement is seen in psychiatric anxiety. Long term treatment with Duloxetine HCL 60mg OD prevents relapse of depression, she concluded.

Dr. Majid Abadi conducted the proceeding of the symposium. Mr. Rana Azfar Zafar welcomed the participants while Dr. Ghulam Murtaza Qasuri, Medical Director Eli Lilly presented the vote of thanks.

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