Ways to Save on Prescription Drugs

The cost of prescription drugs will not stop rising anytime soon, but there are a number of ways to save. Here are some suggestions:

The place to start is with your choice of insurance company or plan. Find out about the range of prescription benefits and whether or not the medications you’re taking are covered under your plan. Clarify co-pay information and whether or not brand name drugs are covered. This is particularly important if you take several medications. Medicare beneficiaries can switch their prescription-drug coverage between November 15 and December 31.

Comparison-shop among several pharmacies. There are often disparaging price differences for the same drug from pharmacy to pharmacy. There are also a number of useful Web sites that can assist you with comparison-shopping. The site www.destinationRx.com lets you compare prices and suggests generic substitutes that you can discuss with your medication prescribers. Explore www.Rxvouchers.com for coupons you could use for medications.

A number of assistance programs are available through states, nonprofits and drug companies. Contact the Partnership for Prescription Assistance at 888.477.2669 or www.pparx.org for eligibility requirements. PPA helps the uninsured or those struggling financially to gain access to about 475 assistance programs that are either free or very low cost.

Find out if your doctor is willing to prescribe either a less expensive brand of the medication you’re taking or a generic. More and more pharmacies are following Wal-Mart’s lead and are offering some generics for as little as $4.00 per prescription.

Ask your doctor and pharmacist for samples. Most physicians are more than willing to part with an overstock of samples, although drug companies have curtailed sample distribution to doctors in recent years.

Purchasing prescriptions via mail order, particularly in larger quantities, offers handsome savings in many instances.

Discuss whether you actually need all the prescriptions you’re taking with your doctor. The average length of a physician visit these days is about seven minutes in length, so an overall evaluation of your medication profile is often overlooked.

There are a number of ways to save money on prescription drugs, but the keys are to shop around, ask a lot of questions and use resources such as assistance programs to your best possible advantage.

Frequently Asked Questions

Q. When diagnosing depression in a client, how concerned should I be about identifying specific depression subtypes? Do specific subtypes suggest different treatment modalities?

A. For years now, clinicians have attempted to categorize depressions into “subtypes.” A few examples are: typical vs. atypical, reactive vs. biological and psychotic vs. non-psychotic. There are as many as 12 subtypes of Major Depressive Disorder, according to The Diagnostic and Statistical Manual, 4th Edition (DSM-IV).

The important question though is whether labeling a depression by subtype assists the clinician in treating the client more effectively, or whether diagnosing a specific subtype implies that a different treatment modality should be utilized. With few exceptions, the answer is no.

Subtypes generally are poor predictors of treatment response. There are some exceptions however: Seasonal Affective Disorder, for example, may respond to light therapy as well as antidepressants, and psychotic depressions all but always require antidepressant treatment augmented with antipsychotics.

Don’t be overly concerned about subtypes. Pigeonholing depression is short-sighted and undermines what’s most important: Treating the “whole” patient from a bio-psycho-social perspective.

Fish Oil May Deter Schizophrenia

“Fat” is a bad word in our society, but omega-3 fatty acids are one of the superstars when it comes to improving nerve conduction. High levels of omega-3 fatty acids in the brain also reduce neuroinflammation, a factor commonly seen in people with depression. Cell membranes consist partly of omega-3s, which make it easier for the neurotransmitters norepinephrine, serotonin and dopamine to pass through cell membranes. This is an essential fatty acid, which means it is not produced by the body and must be obtained via foodstuffs or through supplementation. Foods high in omega-3 fatty acids include: salmon, tuna, cod, mackerel, sardines, walnuts and flaxseed. One to two grams daily of fish oil as a supplement to a balanced diet is advisable, especially for those susceptible to depression.

A new study suggests that fish oil may also be a possible deterrent to schizophrenia. One theory supporting this hypothesis is that those with schizophrenia don’t process fatty acids properly, leading to damaged brain cells. Omega-3 fatty acids in fish oil could possibly help brain cells to repair and subsequently stabilize.

Researchers are starting a large international study in eight cities with the goal of replicating their findings. These findings appear in this month’s Archives of General Psychiatry.

Antipsychotics and Kids: The Controversy Goes On and On

On December 4, 2009, the FDA approved the use of two more antipsychotic medications — Zyprexa and Seroquel — for treating schizophrenia and bipolar disorder in teens. Risperdal and Abilify are also specifically approved for the same use in this age group.

In association with the approval of Zyprexa and Seroquel, the FDA also stated it wants to know more about the risk of weight gain and diabetes in youth taking these drugs and other antipsychotics as well.

It has been clear for years that weight gain and other endocrine risks are associated with these medications, and their warning labels say so. Some evidence however, suggests that these issues are even more paramount in kids.

A study published in the November, 2009 issue of JAMA ( Journal of the American Medical Association) found that children and adolescents using antipsychotics gained significantly more weight over an 11-week period than comparable kids who weren’t taking the drugs. Those on Zyprexa demonstrated the most weight gain – 19 pounds – although weight gain was also associated with several others of these antipsychotics.

Zyprexa labeling does warn that youth are not only likely to gain weight, but are prone to gain more weight compared to adults taking the drug. But the labels for the other antipsychotics the FDA is investigating – Risperdal, Abilify, Geodon and Seroquel – don’t state whether children and teens are at higher risk than adults for weight gain. Frankly, I believe the reason for this is that Zyprexa clearly produces the most weight gain – regardless of age.

The safety conundrum associated with second-generation antipsychotic use in the treatment of schizophrenia and bipolar disorder in youth will linger until a new, safer generation of compounds is developed. These safer agents aren’t coming soon, as some big Pharma companies are planning to cut billions of dollars in annual research and development spending. When it comes to treating psychotic and bipolar disorders in children, I staunchly agree that the balance needs to favor minimizing risks. However, for children with serious and potentially dangerous behavioral problems such as severe aggression, violent outbursts and out-of-control tantrums, what other viable options are there outside of the use of these drugs? Mood stabilizers such as lithium and Depakote carry similar risks of marked weight gain, in addition to other debilitating side effects. Benzodiazepines are not approved for use in the pediatric population period, and carry the risk of potential abuse and dependence. Lastly, with many states experiencing severe cutbacks in mental health care services, there is a paucity of well trained, experienced behavioral specialists with the requisite skills for managing the above-mentioned behaviors in youth. And even if very capable behaviorists were in adequate supply, how on earth could the management of out-of-control behavior be successfully or even adequately facilitated in the absence of medication augmentation?

The bottom line is this: Don’t look for prescribers of these medications to change their prescription-writing habits anytime soon. Why? Because for children with serious and potentially dangerous behavioral problems associated with schizophrenia, bipolar disorder or other associated syndromes, physicians as a whole continue to conclude that the benefits of medication use typically outweigh the risks.

Frequently Asked Questions

In my next few blogs, I will provide answers to the most frequently asked questions fielded from conferences, seminars, e-mail and telephone contact. So if you’ve wondered about the answers to these questions or have encountered them in your work with clients, please read on! I’m delighted to be of service in this capacity.

Q. How long does it take for Zoloft, Paxil, Effexor and Wellbutrin to take effect?

A. At least 50 percent of those who will eventually respond to the above mentioned antidepressants will begin to demonstrate improvement within one week of treatment initiation. Users most often report an increase in energy and productivity, and a decrease in sensitivity (particularly to inappropriate comments from others), and anger within the first seven days of use.

Remission of mood symptoms is tougher. This may span over an 8-12 week period, because depression is neurotoxic. Depression suppresses levels of a key neural growth hormone known as BDNF (brain-derived neurotrophic factor), leading to the eventual death of neurons in critical memory and reasoning areas of the brain, including the hippocampus and prefrontal cortex. Simply put, depression causes brain damage, and it takes 8-12 weeks for antidepressants to aid in the repair of this neurotoxicity.

Q. Should adults take ADHD drugs?

A. Absolutely adults should take ADHD drugs. Seventy percent of those diagnosed with ADD/ADHD in childhood or adolescence go on to experience symptoms in adulthood. If untreated, these adults will struggle with distractibility and inattention throughout their entire lives. Many adults do, however, “outgrow” the hyperactivity/impulsivity component of this disorder. Adults unable to manage can benefit from any of the medications typically prescribed to youth, such as the dextroamphetamine and methylphenidate psychostimulant preparations, the antidepressant Wellbutrin and the non-stimulant Strattera.

Repetitive Transcranial Magnetic Stimulation (rTMS)

Repetitive Transcranial Magnetic Stimulation was approved by the FDA in October 2008 for patients with major depression who have failed one prior antidepressant trial.

Stimulation of the brain is accomplished by a pulsed magnetic field that is passed through a coil of wire encased in plastic and held close to the head. This magnetic field penetrates the scalp and skull. The stimulation is made at regular intervals, thus the term “repetitive” TMS.

In studies, rTMS appears to change brain activity beyond the duration of the actual procedure. Also, the procedure differs from Electroconvulsive Treatment (ECT) in that it stimulates the brain in a focal manner, thereby preventing the grand mal seizure and minimizing the transitory memory loss associated with ECT.

rTMS is performed on an outpatient basis, with a course of 20-30 treatments, each lasting approximately 40 minutes, and delivering 3,000 pulses. The most common reported side effect is mild headache. The cost per 40 minute session: approximately $400. Ouch!

The Alcohol and Antidepressant Use Conundrum

There are two factors to consider when assessing the combined use of alcohol and antidepressants: first, the likelihood that an antidepressant’s effectiveness will be altered by alcohol (will consuming alcohol prevent or diminish the potential positive effects of the antidepressant?); and second, the chance that there will be some untoward and unintended consequences between alcohol and antidepressants.

Given the complexity of individual biochemistry, the answer to the first question is difficult to nail down; but it more than likely depends on the quantity and frequency of alcohol use. There are a few studies indicating that any amount of alcohol – even just one alcoholic beverage – can lead to a diminished antidepressant response. I recommend to those using antidepressants that they consume no more than two (2) alcoholic beverages a week. Of course, many balk at that recommendation.

As far as the untoward and/or unintended consequences of combining alcohol with antidepressants, it largely depends on the actions of the antidepressant prescribed, particularly its capacity for producing sedation. For instance, there is much less concern about additive sedation if alcohol is ingested in combination with a non-sedating antidepressant. On the other hand, combining alcohol with a sedating antidepressant may lead the individual to become more intoxicated than would otherwise be anticipated.

In the end, anyone taking an antidepressant that is reluctant to significantly modify or even relinquish their alcohol use, has a decision to make. To them, I pose this question: What’s the positive intention for possibly sabotaging your improvement by continuing to engage in a behavior that is not in your best interest? Often enough I get the response, “well, I want what I want when I want it.” I always remind those that cling to such a belief system that they do so at their own risk – a risk that may very well compromise their physical and emotional health.

Saphris (asenapine): A New Entry Into the Ever-Growing Antipsychotic Mix

On August 14, 2009, the FDA approved Saphris (asenapine) as a new second-generation antipsychotic for the treatment of both schizophrenia and bipolar disorder. It is available only as a sublingual tablet, meaning that it is not effective if swallowed, and it must be left under the tongue to dissolve for it to be absorbed into the bloodstream. The available studies haven’t shown that Saphris (asenapine) provides any unique therapeutic advantage over other second-generation antipsychotics. The main contribution is that clinicians and patients will have yet another option, as if the clinical community needs another antipsychotic that is not special in any other way, and certainly not deserving of “novel” or “designer” drug status.

The manufacturer, Schering-Plough, is promoting the drug on the premise that it’s more effective at improving the negative and cognitive symptoms of schizophrenia compared to other atypical antipsychotics, and that Saphris (asenapine) has a better safety profile.

The safety profile issue has been used over and over before. While the drug demonstrated less weight gain compared to Risperdal ( risperidone) or Zyprexa (olanzapine), it has an elevated level (18%) of extrapyramidal symptoms (EPS) – comparable to first generation antipsychotics.

Schering-Plough’s specialty sales force is handling the detailing of Saphris (asenapine) – as opposed to its primary cast of sales representatives – targeting psychiatrists to prescribe this new antipsychotic.

Public Speaking: More Feared than Death?

I am often asked by new or aspiring speakers how to overcome the fear and sometimes downright paralysis associated with speaking in public. You may have read or heard about some people that fear public speaking more than death! Although this is utterly ridiculous, there are those that wouldn’t stand before an audience and utter a single word, phrase, sentence or speech under any circumstances or for any price.

Fear of speaking in public is considered a performance anxiety disorder. Of these disorders, public speaking is indeed the most feared. Others include test-taking anxiety and athletic performance when the game is “really on.” So if you’ve recently been tapped to deliver a first-ever talk to your garden club, PTA, or church social, here are a few tips for conquering your fear of public speaking:

• - Seek out speakers that you’ve heard before and believe to be competent, effective and enjoyable. Ask if you could send them a tape of a talk you’ve recently given or plan to deliver, or invite them to hear you in person if you’re speaking in their neighborhood. What you want is frank feedback that can be used to critically examine your progress. Ask these speakers what they believe you’ve done well, what should be further developed and what underwhelms them, which might be abandoned. Taking these steps will help build confidence.
• - Choose an association of professionals that is geared to provide feedback. Toastmasters is a good alternative because it offers speakers an opportunity to hone their skills in front of a supportive audience.
• - If possible, prior to the speech you’re giving, chat informally with some participants, particularly in smaller groups. Use these people as your “friendlies.” Their smiles and nods will quickly increase comfort levels.
• - When appropriate, speak with the use of visuals, this helps mitigate the feeling that the audience is “staring you down.”
• - Prior to the speech, do something or think of something that makes you laugh. Listen to a humor tape, think about some enjoyable times you’ve had, watch a good comedy. This will promote relaxation, and you want to feel as though you’re in a “fun mood” before you hit the platform.
• - Consider the use of “beta blocker” drugs (Inderal, for example) to help alleviate some of the peripheral manifestations of anxiety, such as trembling or excessive sweating. Beta blockers should only be used after consulting with your physician and should never to be considered a substitute for other ways of handling your fear.
• - Seek not to be perfect, but to be comfortable. Audiences don’t care if you’re perfect, but they will only be comfortable if you seem to be.
• - Understand that mature, motivated, and intelligent audiences want you to succeed.

Finally, take heed of the following: Your presentation will not mark a turning point for all of civilization. Prepare well, show up, deliver, and then go home. The Earth will continue to revolve around the Sun, no matter what happens to you on stage.

Atypical Depression and Chromium Use

Atypical depressed individuals tend to sleep excessively, eat too much (particularly carbohydrates and lots of simple sugars), experience an often profound reactive dysphoria (melancholia) and tend to be very sensitive to interpersonal rejection. This depression is characterized by lethargy and often significant debilitation. Also, approximately 80 percent of atypical depressives meet diagnostic criteria for phobias and panic attacks.

Chromium picolinate in some control studies helps decrease carbohydrate cravings by improving blood sugar regulation. That said, the other aforementioned profound symptoms of atypical depression don’t respond to this trace mineral in any significant way. Most certainly, chromium does not facilitate improvement in panic or phobias.

To read the volumes of ever-increasing information on the subject of alternative medications, herbal products, vitamins, nutrients and minerals, one is led to believe that the latest “natural” miracle cure is either on the horizon or already here. There are many claims to fame in this regard, but most of them fall by the wayside if or when they are subjected to scientific research.

One other problem with chromium is that many consumers, regardless of specific instructions, will purchase the WRONG type of chromium. Chromium picolinate has efficacy in reducing carbohydrate cravings, not other forms of chromium.

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