N.Y. Sues GlaxoSmithKline Over Paxil

The NY Times
June 3, 2004
Two Studies, Two Results, and a Debate Over a Drug
By BARRY MEIER

The two drug trials were known within SmithKline Beecham as Study 329 and Study 377.

Study 329 suggested that the company’s popular drug Paxil might help depressed adolescents. Study 377, completed not long afterward, indicated that Paxil provided no more benefit than a sugar pill in treating depressed young people.

But only the favorable study was widely publicized by Paxil’s maker. The company chose not to discuss publicly the trial with negative results, and those findings came to light only when an outside researcher on the study team decided to disclose them at a medical conference.

“That particular study would have been buried,” said that researcher, Dr. Robert Milin of the Royal Ottawa Hospital in Canada. “It would have been buried to the public.”

Federal regulators in this country are now scrambling to reassess the effectiveness and safety of antidepressants like Paxil, after British regulators touched off a controversy last year by asking drug companies for unpublished data from antidepressant trials. That data suggested that several antidepressants, including Paxil, might give rise to suicidal thoughts in some young users - a potential problem not revealed in any published studies.

Yesterday, the New York State attorney general, Eliot Spitzer, entered the fray by taking the unusual step of suing Paxil’s maker, which is now GlaxoSmithKline. Mr. Spitzer’s suit accuses the company of consumer fraud for not disclosing all of its Paxil data.

Officials of GlaxoSmithKline defend their record, saying they provided all the results of their Paxil clinical trials to the Food and Drug Administration, as required by law. But the stories of Study 329 and Study 377 provide a window into a far broader issue - the fact that the results of many human clinical trials of drugs are often never widely publicized and that, in some cases, doctors may never learn that the trials were even conducted.

These days, most drug trials are sponsored by pharmaceutical companies. And for more than a decade, a growing number of medical experts have been urging drug makers to release more trial data and to create uniform means of disclosing results through central registries, so that policy makers and doctors can easily learn the results. Those advocates argue that such central databases are necessary because drug companies, as well as medical journals and researchers, tend to spotlight only trials that show positive results.

Last week, GlaxoSmithKline agreed to make two executives available for this article to discuss its handling of Studies 329 and 377 and how information about them was disseminated. But yesterday, a company spokeswoman, Mary Anne Rhyne, said that in light of Mr. Spitzer’s lawsuit the company had decided not to allow those interviews.

Under F.D.A. rules, a company seeking approval of a new drug must submit the results of all the clinical trials it runs. But the agency holds that information in confidence - on the ground that it is proprietary - until the drug is approved for sale. At that point, summaries and descriptions of those trials, but not the complete underlying data, are publicly released.
Somewhat different rules apply to so-called postmarketing tests in which approved drugs are investigated for new purposes - like prescribing antidepressants for pediatric use. Safety information from such trials is supposed to be promptly reported to the F.D.A. But postmarketing data involving the drug’s effectiveness need not be reported until the maker seeks agency approval for a new claim or use, a process that could take years.

“We fully understand the desire for access to information and we firmly believe that consumers should be as well informed as possible,” said an F.D.A. official, who insisted on anonymity. “However, such a listing would not add the information F.D.A. already receives under current regulations.” For their part, drug industry officials say that it is the editors of medical journals, not corporate executives, who decide which trial reports to publish. With a few exceptions, drug makers have resisted the idea of establishing trial registries. And the industry’s trade group, the Pharmaceutical Research and Manufacturers of America, has never called for such an initiative. But Dr. Alan Goldhammer, the group’s associate vice president for regulatory affairs, said the group might revisit the issue in light of the antidepressant controversy.

Currently, a few trial registries exist, like the National Institutes of Health’s database of current trials of drugs for life-threatening diseases. And in two weeks, policy makers at the American Medical Association are expected to vote on a proposal that would urge the government to create a public registry of clinical drug trials. Only a few companies have responded to the calls by some researchers for public registries. In 1996, the British unit of Schering, the German drug maker, agreed to create such a listing. The British company Glaxo Wellcome decided in 1998 to take a similar step. Two years later the company merged with SmithKline Beecham, and officials of GlaxoSmithKline said in a brief statement yesterday that they were now working on an improved version of the registry.

The drive to create databases of clinical trial results soon sputtered for lack of industry support, according to people involved in the effort. But even industry critics acknowledge that drug makers are not the only roadblocks to the wider dissemination of trial results. Journals also favor research reports that show strong findings, and researchers say they have little incentive to push for the publication of a trial without a conclusive finding.

Those who call for trial registries, however, argue that it is unethical not to disseminate trial results widely. The participating patients, they say, typically believe that the findings, whatever the outcome, will benefit medicine. “We are telling people that they are participating in research,” said Dr. Kevin A. Schulman, a professor of medicine and business administration at Duke University. “But most of the time what they are participating in is proprietary marketing research by companies who have total discretion over whether to publish the results.”

It is unclear how, or even if, a database of trial results would change the practice of medicine. Some researchers say they can often retrieve unpublished data by asking companies for it or by ferreting out abstracts of unpublicized findings presented at meetings.

Still, they point out that without a comprehensive trial registry they cannot tell what they may be missing. Just as important, some experts say, a system of disclosing trial results would help prevent the type of chaos now surrounding the use of pediatric antidepressants because the debate over a drug’s efficacy and safety might have already taken place.

The fates of Study 329 and Study 377 appear to underscore that point. Both tests were conducted during the mid-1990’s at various hospitals and medical centers - Study 329 at facilities in the United States and Study 377 at test centers outside of this country, including Canada, Mexico, Europe, South Africa and the United Arab Emirates.

Study 329, with its potentially positive findings for Paxil, was completed first. Its results were presented beginning in 1998 at several meetings of medical professionals. Meanwhile, a report of the trial, which was led by Dr. Martin B. Keller, a department chairman at Brown University Medical School, was submitted to a medical journal for publication, a process that subjects a study to peer review by scientists not involved in the trial.

Dr. Keller declined to be interviewed for this article. But Dr. Neil Ryan, a professor at the University of Pittsburgh, who was also involved, said he believed that the study was rejected by some journals before The Journal of the Academy of Child and Adolescent Psychiatry accepted it for publication in 2001.

In the case of Study 377, the one with negative findings, there were no press releases or publications. And without the action of Dr. Milin and a Canadian colleague, Dr. Jovan Simeon, the study’s findings might have been seen only by regulators and a few researchers.

Dr. Milin was an unlikely rabble-rouser. In an interview, he said he was a strong believer in the use of antidepressants like Paxil in adolescents. He wanted to report the study’s findings, he said, mainly because its negative results might have reflected trial design flaws that he did not want to see repeated in other studies. “I feel you need to present all the data even if it is negative,” he said.

While drug trials in adults take place at a few sites, Dr. Milin and other researchers said that one problem with the pediatric antidepressant tests was that they were dispersed across a dozen or more clinical centers because each unit often had only a few young patients who qualified. Dr. Milin said he was spurred to take action after SmithKline officials told him in 1998 that they did not intend to submit the study for publication. An internal 1998 SmithKline memorandum, disclosed this year during the antidepressant controversy, also said the company had “no plans to publish data from Study 377.”

Dr. Milin said that when he told SmithKline executives that he planned to present the study’s finding at a 1999 meeting of the American Academy of Child and Adolescent Psychiatry, the company did not object. Dr. Milin said he last heard from GlaxoSmithKline officials about six months ago, after the controversy erupted over unpublished data from trials like Study 377. Company officials, he said, wanted to make sure that the copy of the report they had in their file was the same one he had presented five years earlier.

As for Study 377, Dr. Milin said he assumed that SmithKline officials would have publicized the trial, any design problems notwithstanding, had its results been different.

“If they had got a positive outcome,” he said, “I would suspect that they would have pushed to get it published.”

This is very interesting indeed! Last yr. they tried to put my child on Paxil and I refused, thank God! My neighbor’s husband was taken of Paxil and went into seizures and delirium. I have read many people have a very hard time stopping this drug. Jan

I don’t know what the doctors are saying to their patients now, but several years ago, when a doctor I was seeing for anxiety tried (very hard) to get me to take it (he was upset when I refused, and refused me as a patient after that— that’s true!), he told me there were virtually no side effects, and that Paxil is not addictive. How can that be, when I read and hear about so many people who can’t get off this drug, and they have such a terrible time with it? I am glad I stood my ground, and refused to take that stuff.

http://www.latimes.com/features/health/la-he-offlabel7jun07,1,2968921.story?coll=la-home-health

When drugs are used off-label
Doctors often prescribe medicines for other than their intended use.
The benefits are well-proven, but the risks are often unknown.
By Daniel Costello
Special to The Times

June 7, 2004

After two months of sleepless nights, anxiety and constantly feeling like she was “swimming in a thick fog all day long,” Caryl Westwood was
fed up. She suspected her pain medication, Neurontin, which her doctor
had recently prescribed for her lower back pain.

What Westwood didn’t know - and she says her doctor didn’t tell her - was that Neurontin wasn’t a pain medication at all. Instead, it was a
powerful epilepsy drug that doctors across the country were increasingly prescribing for many conditions for which the drug had not been approved: attention deficit disorder, migraines, drug and alcohol addiction, and pain. Surprisingly, there was little clear proof Neurontin worked for any of these conditions.

Although doctors are allowed to prescribe an FDA-approved drug for any reason they see fit, companies are barred from marketing or promoting
drugs for any use beyond what’s listed on its label. Last month, Pfizer
Inc. agreed to plead guilty and pay a $430-million fine to settle
federal criminal charges that the pharmaceutical giant promoted Neurontin for uses for which it had no scientific support.

According to the government’s complaint, the promotion amounted to an “illegal and fraudulent promotion scheme” that put patients “at risk.” It is estimated that 90% of Neurontin’s $2.7 billion in sales last year were for off-label uses.

“I’m angry,” says Westwood, a 52-year-old food service worker from Santa Fe, N.M. “How could a doctor not tell their patient about this? How
can the government let this happen?”

Off-label prescription drugs are immensely common - accounting for up to 40% of all prescriptions written each year. In the vast majority of
cases, the practice is safe. Moreover, off-label use has spawned many medical innovations that doctors might otherwise not have discovered.

It’s how medical science first learned that aspirin could reduce the
risk of heart disease; that antibiotics were the best way to treat
ulcers; and that an angina drug produced an unexpected side effect in men, which would later lead to the development of the blockbuster drug Viagra.

Moreover, stories about the importance of off-label usage to treat life-threatening conditions such as AIDS and cancer are plentiful. Most
front-line drugs used to treat terminal illnesses are approved for one
purpose, but then quickly prescribed as a second or third option for
patients with other illnesses who don’t respond to traditional treatments. A
1997 survey by the American Cancer Society found that 60% of cancer
doctors used drugs for unapproved reasons.

The American Medical Assn. says it strongly supports doctors’ rights to prescribe FDA-approved drugs for any reasons that physicians believe
are helpful. Such uses do not, as some critics charge, amount to turning
patients into human guinea pigs, says Dr. Nancy Nielsen, a Buffalo,
N.Y., internist and speaker of the AMA’s House of Delegates. Doctors, she says, “are making decisions based on the best science and what’s in the
patient’s best interest.”

Still, the Neurontin case and other ongoing federal investigations into drug makers’ promotions of off-label uses, indicate that the government
is growing increasingly worried about the issue. The concern is that
some drug companies are finding ways to abuse the system and promote their products for unapproved use even when they have little good science to back up their claims. Both Schering-Plough Corp. and Wyeth are being investigated by the federal government for their off-label prescription practices.

In some cases, taking a drug off- label may be a waste of money. As highly effective as some new drugs can be, older and cheaper drugs often are sometimes just as effective. In other cases, there’s a risk to taking medications for conditions for which the FDA never evaluated the drug. It wasn’t long ago, after all, that doctors were regularly prescribing fen-phen, a combination of two FDA-approved drugs - fenfluramine and phentermine - as an unapproved weight-loss treatment that was later suspected of causing heart valve damage in up to 30% of users.

Dr. Raymond Woosley, vice president of the Arizona Health Sciences
Center at the University of Arizona in Tucson, says that most patients
taking off-label drugs are getting the best treatment.

Even so, Woosley cautions that patients should be careful, especially when taking a relatively new drug that is being prescribed for several off-label uses, or when a drug is being used off-label for medical conditions not well understood by doctors and for which there are no “standard” treatments.

One example: drugs used to treat neurological conditions, such as depression, attention deficit disorder or anxiety. The brain “is still a vastly confusing area,” he says, “and that’s something drug companies can exploit.”

*

Working the system

One important way that companies can circumvent regulations is by
capitalizing on the different rules and accepted practices involving
scientific research. In some cases, well-respected research articles demonstrating another use for an FDA-approved drug appear in major medical journals years before the agency catches up and endorses it.

In those cases, it’s perfectly acceptable for drug companies to talk about those newly discovered benefits. The problem is, not all research
is created equal. In some cases, drug companies conduct their own
research and then hire ghostwriters to put their name on a paper before it’s submitted for publication. (That relationship isn’t always disclosed.)

As recently as the mid-’90s, the FDA tried to block companies from sending questionable research material directly to doctors. The agency was stymied by successful industry lawsuits claiming the practice was protected under free speech. The FDA still insists that drug companies can
distribute research only after a physician has requested it.

There are ways around that too. Some doctors say that drug representatives start a conversation by saying they can’t talk about off-label uses. But then, they will say that other doctors have used the drug for different reasons and they’d be happy to send along information about some ideas.

The AMA’s Nielsen acknowledges that she and other physicians remain concerned about the increasing influence drug makers have over doctors’ decision-making.

Mariann Caprino, a Pfizer spokeswoman, says the illegal activity
highlighted in the Neurontin case happened before the company acquired
Warner-Lambert in 2000.

Officials of Schering-Plough acknowledged in an interview that the
company is under investigation by the U.S. Justice Department for off-label marketing of a cancer medication, while Wyeth said the federal Office of Personnel Management, the agency that oversees benefits for federal employees, has subpoenaed company records involving Wyeth’s promotion of an antidepressant drug, Effexor.

*

Curbs in question

It’s unclear just how effective the government’s actions will be in curbing off-label marketing. Two years ago, the pharmaceutical industry instituted voluntary guidelines to ban most gifts and payments to doctors, which were aimed at slowing aggressive marketing tactics around both on-label and off-label promotions.

But some companies continue to underwrite seminars for doctors where off-label uses are discussed while others pay doctors to sit in the room
with patients and discuss treatment advice, a financial agreement some characterize as quid pro quo payments.

Doctors are not required to tell patients they are writing off-label
prescriptions, but many will discuss it if patients ask. Patients can
also seek information about a drug’s authorized uses on the FDA’s website
(www.fda.gov).

As part of its settlement agreement, Pfizer is required to spend a portion of its fine - $38 million - on a public-awareness campaign for doctors and patients.

After hearing about Pfizer’s fine last month, Westwood says she decided to file a complaint against her doctor with the state medical board for
not informing her Neurontin was not approved by the FDA as a pain
medication and certain other uses. She realizes that the board is unlikely
to act, but she remains resolute.

“I don’t want anyone to have to go through this,” she says. “It’s not right.”

Well.

I got up late this morning, and this is the first thing I read. OMG.

But that’s OK, nothing like getting the Irish up first thing in the morning to start the day, yes? This article sickened and disgusted me.

That woman who is suing her doctor? How I feel for her. I have lived her confusion, pain and frustration and then some. Thanx for posting, Dad.

In the 80’s, I was diagnosed with severe panic attacks and anxiety disorder. The very first thing a psychiatrist prescribed for me was Xanax. It worked. It was good. After years of a kind of suffering I don’t have the time or the will to describe here, finally there was some relief.

But he didn’t want me to continue taking the Xanax, it being a benzodiazepine, a class of drugs which are addictive. I do not dispute that they are addictive, so I am not looking for any kind of argument or debate here. Much too tired for that. Just felt the need to type my comments regarding this article.

I have long suspected that doctors freely prescribe medications for uses the drugs were not intended for, and also that these meds just don’t work for what the doctor has prescribed them for, if that makes sense. And contrary to what the article says, I HAVE indeed felt like a human guinea pig in the last 15 years or so. Who gave these doctors the right to play God, and prescribe what they’d like to “try out” on you, without even telling you, the “lowly patient”, that the med isn’t even approved for the problem the patient has? And you had better be a strong person if you dare to question it.

I have been to different doctors, so I do know what I’m talking about. And I don’t mean “doctor-shopping”; I mean I needed to be referred to different doctors by my psychologist, whom I do trust, by the way. And believe me, there is a pattern that I’ve seen. The next doc will be surprised at what the previous doc has prescribed, and would even tell me things like, “I don’t know why your doctor prescribed that— that medication is for (fill in the blank).” It was always news to me, what the drug prescribed to me, that didn’t work, was really for.

Let’s see…what all have I been prescribed, that I actually took, other than the benzos, that didn’t work (and that I can remember)? Desiprimine, Buspar, Prozac, and Luvox. Desiprimine caused horrible dry mouth where I could barely swallow, which is supposed to be a minor inconvenience, but I couldn’t perform my job while taking it, and when I stood up, the room spun as if I would pass out. This was years ago, but I do remember the doctor being annoyed when I refused to take it anymore. Buspar? It did absolutely nothing, like taking a sugar pill. Prozac made me feel kind of cheerful, but the fatigue that came with it was debilitating. I was on my break from work one afternoon, and actually fell asleep in the breakroom. So I stopped taking the Prozac, to the annoyance of my doctor. And then there was Luvox. I found out later that it hadn’t even been APPROVED at all by the FDA for ANYTHING at the time the doctor prescribed it. Luvox is one hell of a nightmare, let me tell you. I was awake all night, could not get up out of bed during the day, lost my appetite completely (it was weird—I would actually “forget” to eat), and I don’t think I need to mention the “sexual side effects”. I stopped taking Luvox the day I passed out into my cubicle at work. When I complained to my doctor, he said it couldn’t have been the Luvox.

The list of medications recommended to me by physicians that I have refused to take is even longer. Zoloft, Paxil, Effexor, Celexa, Wellbutrin, gosh, the list goes on and on. Also, a doctor prescribed Serzone for me about four years ago, and *I informed him* you cannot take Serzone with Xanax. He didn’t care for that much. I have read recently that Serzone has been removed from the US market, see link below.

http://www.yourlawyer.com/practice/overview.htm?topic=Serzone

The last medication that I refused to take was something called Gabitril. I went online to read about it, and found out it is for seizures, and not panic disorder at all. Here is what I read on Gabitril’s website:

Why is GABITRIL (tiagabine HCl) being prescribed for me?

“Your doctor has prescribed GABITRIL because your condition may be caused by an imbalance of a chemical called GABA in your brain.”

What???

Needless to say, I refused to take that too.

Again, thanx for posting, Dad. And by the way, I am not some junkie, although it must sound that way by what I have just typed. I am a reasonably intelligent woman, who happens to have panic disorder.

In my haste to type my comments earlier, I neglected to mention that the drug Luvox also made me feel like a “zombie”, like I had somehow lost my identity…I believe the technical term for it is “depersonalization”. Scary feeling indeed. Surprisingly enough, I rather like the person who I am. And several of the meds made me feels as if I were “swimming through a fog”, as the woman in the article says, which included Luvox and Desiprimine.

Why did/do I continue going to doctors, if my experiences with them were/are so negative? Because, if possible, the chronic panic attacks are worse. Anyone who has ever truly had one will tell you the very same.

More on Serzone… please read. Physicians prescribe this medication for children, and yes, it is very similar to the SSRI’s, which include Paxil, Zoloft, Prozac, Celexa, Lexapro, Luvox, etc.

Maker To Pull Antidepressant Off Market
AP - LAURAN NEERGAARD

05/19/04 - The maker of Serzone will pull the controversial antidepressant off the U.S. market next month.

The end to U.S. sales comes after Serzone was pulled off the market in many other countries, and as maker Bristol-Myers Squibb was under mounting pressure from lawsuits. Serzone has been linked to dozens of cases of liver failure and injury, including at least 20 deaths.

A Bristol-Myers spokesman confirmed the decision in an interview Wednesday, a day after the company notified wholesalers that distribution would end June 14.

The end to sales “is long overdue,” said Dr. Sidney Wolfe of the consumer group Public Citizen. “None of the other antidepressants causes liver damage like this.”

Wolfe last spring sued the Food and Drug Administration seeking to force a ban on Serzone. That suit will proceed in an effort to also end sales of generic versions of Serzone, called nefazodone, Wolfe said.

Bristol-Myers spokesman Rob Hutchison said that the decision had nothing to do with safety questions and that the company would continue to vigorously defend the pending lawsuits.

“We still believe, and I believe the FDA does, too, as well as physicians, that nefazodone is an important therapeutic option for patients with depression,” Hutchison said.

Instead, the company is discontinuing Serzone because of rapidly declining sales after generic competitors hit the market last year, he said. “Our market share is very small.”

Sales of 16 other very old products also will cease, he added.

Bristol-Myers ended Serzone sales in Europe over a year ago, citing declining sales. Canadian regulators banned the drug last fall because of the liver risk. Sales in Australia and New Zealand are about to end, too.

The FDA has received reports of at least 55 cases of liver failure, including 20 deaths, and another 39 cases of less severe liver injury since Serzone began selling in 1994. In 2002, the FDA added to Serzone’s label its strongest type of warning about the liver risk, maintaining that liver toxicity is a rare risk adequately managed by warning patients.

But Wolfe notes that the World Health Organization and Canadian regulators last year compared a number of popular antidepressants and found only Serzone was linked to an increased risk of serious liver injury.

Canadian authorities said they banned the drug because there was no way to predict which patients would be at risk for liver failure. Routine liver tests haven’t reduced that risk, they said.

K.C. (and other medication users) — something you should have started doing long ago, and I hope you have now: read the PDR (Physician’s Desk Reference). It’s a huge fat book that summarizes all the pertinent information for all drugs on the market. The’s a Canadian book as well and I keep forgetting what it’s called. Your doctor MUST have a copy of this and your pharmacist *should* — it would be a good cause for malpractice if he doesn’t even have the info available.
Having a number if allergies and chemical sensitivities, some caused by mis-prescribing like you have experienced, I started doing this years ago. Good doctors are happy to have me help them check out if something is OK for me or not, and some pharmacists enjoy being able to use their knowledge for more than pill-counting. If you get a doctor who wants to play God and won’t let you look, find another doctor.
Also when you go to the pharmacy, the large bottle of pills that the pharmacist serves out of has a copy of the same info or even more printed on a long long strip of thin paper, all folded up and stuffed into the bottle. Unfortunately these papers get thrown out or lost because they get in the way, but if he opens a new bottle he can get it for you; my pharmacist did this for me several times.
DON’T go by the little computer printout that some pharmacists hand you; it’s dumbed down to the extent that there’s no real information left in it.

When you get the PDR or the long long paper, it’s in very small print; well, modern pharmacies usually sell magnifying glasses too. And it has all these long unfamiliar words — hmmm, one of the many many reasons we need to teach and learn phonics and the decoding of unfamiliar words and analysis of roots and word parts; work on it and note down any you need to check. Lots of modern pharmacies also have a ten-cent photocopy machine and you should be able to make a copy to take home if you can’t stand at the counter long enough.

Now, there is one warning in all this. Honest medical and scientific research requires that the listings note ALL dangers and ALL side effects, no matter how rare or how minor. If two people out of five thousand get headaches (which may or may not be caused by the medication, and people do sometimes get headaches) the researchers are ethically required to report “rare headaches” or “possibility of headaches”. If one or two people out of ten thousand are diagnosed with liver disease, the researchers are ehically required to report a potential of liver damage — and they should be so required — although the liver damage may have come from many sources, not necessarily this new drug. So when you read the PDR you see these long long lists of side effects and dangers and you think this stuff is poison and nobody should ever take it, or you may be suggestible and start to feel all the symptoms of every side effect ever heard of. This is one reason some doctors try to keep people from reading all the warnings, because they fear the suggestion effect. It’s a common pattern that students of medicine and nursing have the symptoms of every disease known, same thing. If you do find yourself getting symptoms because you’ve read about them, it might be better to get someone you trust (with your life) to check things out for you. Otherwise, just remind yourself firmly and regularly that that was a rarely reported effect in the book and you don’t *need* to feel that way.

“K.C. (and other medication users) — something you should have started doing long ago, and I hope you have now: read the PDR (Physician’s Desk Reference). It’s a huge fat book that summarizes all the pertinent information for all drugs on the market. The’s a Canadian book as well and I keep forgetting what it’s called. Your doctor MUST have a copy of this and your pharmacist *should* — it would be a good cause for malpractice if he doesn’t even have the info available. ”

I did say that I didn’t have the strength or will to debate this issue, so I’m not going to. Just wanted to relate what my experiences have been. I do have a copy of that huge book, the PDR. However, it is dated 1993, so point taken, Victoria. Time to get a new one. For the past few years, I’ve been looking the meds up online at their website, and then explaining to the doctor exactly WHY I won’t take it.

I have seen at least 7 different psych’s to prescribe my medication over the years, and 4 of them were eerily alike in their policies. One was OK. One was absolutely great, a wonderful lady, but she closed her practice in 1996. Another was good too, but he was killed in a plane crash 4 years ago. Let me just say, those 2 were true gems, and were extremely difficult to locate. I consider myself lucky to have found them, and had them in my life to help me as long as I did.