Wendy Aron

Sounds Awful

Why I Say Yes to Drugs

Better living through pharmaceuticals

Posted Jul 08, 2013

I think pills get a bad rap. I know that pills are often not a stand-alone answer. And I know the right ones can be hard to come by. I also know that a prescription pad in irresponsible hands can be disastrous.


But pills are also a big part of the reason I do not spend my days splayed on the couch sobbing, or planning to pull an Anna Karenina on the railroad tracks near my home.


So, as I said, I think pills have their place. And I believe pills might one day be one answer to the brain dysfunction that causes misophonia because they have worked for other brain illnesses in the past. I don’t even think it’s necessarily going to be a brand new pill, but one that has been approved for something entirely different—what doctors refer to as an off-label drug.


Though off-label prescribing has been controversial, particularly with regard to psychiatric medications, the authors of a recent study conducted at the University of Georgia concluded: “…physicians are more likely to prescribe off-label when there are fewer FDA-approved alternatives and when a patient's insurance has less restrictive formularies. These substitution patterns suggest that off-label prescribing by physicians enhances the welfare of patients.”


I think misophonia fits into these parameters well, but how exactly will the pharmacological research that leads to a medication for our disorder come about?


“Typically, the idea for the research is generated by a medical school faculty member who is interesting in investigating the drug, although the teaching hospital involved has to approve of it,” says Dr. Bruce Leuchter, the director of clinical neuropsychiatry at Weill Cornell Medical College and New York-Presbyterian Hospital in New York City. “The study can be sponsored by a drug company, funded by a government or association grant, or by some combination of all three.”


An example of such a study is going on right now in Ontario, Canada, where McMaster University Medical Center and Pfizer are collaborating on a study of the efficacy of pregabalin, a drug generally used for diabetic nerve pain, as a viable treatment option for obsessive compulsive disorder, when added to a traditional anti-depressant.


According to Dr. Leuchter, studies like this one are usually set in motion when a doctor who is also a faculty member at a medical school affiliated with a teaching hospital sees a patient with a condition that has proven treatment resistant. In some instances, a new pharmaceutical solution presents itself serendipitously, says Dr. Leuchter. “And that gets the faculty member interested in conducting a full-scale study to see if what we know about mechanisms of action in the brain—for instance, dopamine as it relates to impulsivity problems—can translate into change for a large patient population.”


An alert reader brought an article to my attention which describes the great things that can happen when an inquisitive practitioner reads about the results of off-label drug trials like the ones to which Dr. Leuchter refers. The NPR story: “How an Unlikely Drug Helps Some Children Consumed by Fear,” should be required reading for all misophonics.


“As people in the medical community continue to see the potential for off-label drugs to benefit orphan disorders, I think the interest in off-label clinical drug trials will remain stable or grow,” says Dr. Leuchter. The first step toward finding an effective drug treatment for a disorder like misophonia, he says, is for a sufferer to go to a physician, preferably one in an academic setting, and inform him of the condition. (Tip: Reread the previous sentence.)


In the meantime, if you want to keep tabs on clinical drug trials that may already be going on, or any other government-funded treatment research for that matter, you can log onto clinicaltrials.gov, or sign up for email alerts from medical societies, which generally monitor these developments closely, says Dr. Leuchter.


I will be following this advice because I believe in giving pills a chance.