The differences in metabolic side effects and cardiovascular risk resulting from antipsychotics make the initial choice of medication important in controlling long-term effects from treatments used for schizophrenia, researchers said here at the 22nd European College of Neuropsychopharmacology (ECNP) Congress.
W. Wolfgang Fleischhacker, MD, Biological Psychiatry Department, Medical University Innsbruck, Innsbruck, Austria, and colleagues analysed data from the European First Episode Schizophrenia Trial (EUFEST) study to determine the effects of several first- and second-generation antipsychotics on cardiovascular risk factors in patients with or without metabolic syndrome (MS) risk. Results of the study were presented on September 14.
READ MORE @ DOCTOR'S GUIDE
Showing posts with label comorbidities. Show all posts
Showing posts with label comorbidities. Show all posts
Wednesday, September 16, 2009
Wednesday, July 29, 2009
Treatment-Resistant Bipolar Disorder - A Review of Psychotherapeutic Approaches
The concept of treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition.1 Whether the term refers to nonresponse to 1 or more standard treatments, at what dosages, and for what phases of bipolar disorder is unclear. Treatment resistance in bipolar disorder should always be based on a specific phase of treatment: mania or depression and acute or maintenance.
Treatment resistance is extremely common. Even under optimal maintenance conditions, almost half of bipolar patients with symptom remission will have a recurrence in 2 years under standard care (including medication combinations).2
Optimizing phase-specific , s is crucial. This may include raising the dosage of an initial treatment according to response unless limited by adverse effects. Acute treatments are often continued into maintenance. Combinations are commonplace, and the number of potential combinations is large. Decisions about which medications to use first or in what combinations, as well as dosing issues, require good clinical judgment on the part of each clinician because there is little evidence to drive such decisions.
READ MORE @ PSYCHIATRIC TIMES
Treatment resistance is extremely common. Even under optimal maintenance conditions, almost half of bipolar patients with symptom remission will have a recurrence in 2 years under standard care (including medication combinations).2
Optimizing phase-specific , s is crucial. This may include raising the dosage of an initial treatment according to response unless limited by adverse effects. Acute treatments are often continued into maintenance. Combinations are commonplace, and the number of potential combinations is large. Decisions about which medications to use first or in what combinations, as well as dosing issues, require good clinical judgment on the part of each clinician because there is little evidence to drive such decisions.
READ MORE @ PSYCHIATRIC TIMES
Friday, May 22, 2009
APA: Heart Risks May Impair Depression Treatment
Cardiovascular risk factors may be linked to lack of response to antidepressant treatment, researchers found.
Patients with diabetes, dyslipidemia, hypertension, and obesity were twice as likely to be unresponsive to antidepressant medication as other patients (P<0.05 to 0.01), Dale D'Mello, M.D., and Alric Hawkins, M.D., both of Michigan State University in East Lansing, reported at the American Psychiatric Association meeting.
The lack of response was not significantly more common among smokers, though.
The researchers' preliminary cohort study also revealed that those with comorbid cardiovascular risk factors were older at onset of depression and had tried -- unsuccessfully -- a greater number of antidepressant drugs.
READ MORE @ MEDPAGE TODAY
Patients with diabetes, dyslipidemia, hypertension, and obesity were twice as likely to be unresponsive to antidepressant medication as other patients (P<0.05 to 0.01), Dale D'Mello, M.D., and Alric Hawkins, M.D., both of Michigan State University in East Lansing, reported at the American Psychiatric Association meeting.
The lack of response was not significantly more common among smokers, though.
The researchers' preliminary cohort study also revealed that those with comorbid cardiovascular risk factors were older at onset of depression and had tried -- unsuccessfully -- a greater number of antidepressant drugs.
READ MORE @ MEDPAGE TODAY
Tuesday, May 12, 2009
Participants in antidepressant drug trials are atypical patients, UT Southwestern researchers report
One reason antidepressant medication treatments do not work as well in real life as they do in clinical studies could be the limited type of study participants selected, researchers at UT Southwestern Medical Center have found.
"We are basing our judgment of clinical care in the United States on samples of patients that are totally different from the patient population actually treated in primary care and mental health facilities," said Dr. Madhukar Trivedi, professor of psychiatry at UT Southwestern and senior author of a study published in the May issue of the American Journal of Psychiatry. "Antidepressants should not be seen as a panacea. The general belief is that they work well, but they are less effective in real-world practice, and more work is needed."
As part of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study scientists found that only 22 percent of the 2,855 participants treated with a commonly prescribed antidepressant would have met the criteria for inclusion in a typical antidepressant efficacy trial. Those who did meet criteria had shorter bouts of depression, quicker response to medication, less severe side effects and fewer adverse events compared with those people with depression who would have been excluded from such a trial, used to gain Food and Drug Administration approval of the drugs used.
The STAR*D trial was the first large-scale study to define the effectiveness of several treatment steps in primary care and mental health settings for people with depression, Dr. Trivedi said.
The six-year, $35 million STAR*D study is the largest investigation on the treatment of major depressive disorder and is considered a benchmark in the field of depression research. It initially included more than 4,000 people from outpatient treatment sites across the country. About 65 percent of STAR*D participants, however, had a medical co-morbidity such as diabetes that typically would have excluded them from participating in other clinical trials to test the efficacy of antidepressants, said Dr. Trivedi, co-principal investigator of STAR*D.
READ MORE @ EUREKAERT
"We are basing our judgment of clinical care in the United States on samples of patients that are totally different from the patient population actually treated in primary care and mental health facilities," said Dr. Madhukar Trivedi, professor of psychiatry at UT Southwestern and senior author of a study published in the May issue of the American Journal of Psychiatry. "Antidepressants should not be seen as a panacea. The general belief is that they work well, but they are less effective in real-world practice, and more work is needed."
As part of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study scientists found that only 22 percent of the 2,855 participants treated with a commonly prescribed antidepressant would have met the criteria for inclusion in a typical antidepressant efficacy trial. Those who did meet criteria had shorter bouts of depression, quicker response to medication, less severe side effects and fewer adverse events compared with those people with depression who would have been excluded from such a trial, used to gain Food and Drug Administration approval of the drugs used.
The STAR*D trial was the first large-scale study to define the effectiveness of several treatment steps in primary care and mental health settings for people with depression, Dr. Trivedi said.
The six-year, $35 million STAR*D study is the largest investigation on the treatment of major depressive disorder and is considered a benchmark in the field of depression research. It initially included more than 4,000 people from outpatient treatment sites across the country. About 65 percent of STAR*D participants, however, had a medical co-morbidity such as diabetes that typically would have excluded them from participating in other clinical trials to test the efficacy of antidepressants, said Dr. Trivedi, co-principal investigator of STAR*D.
READ MORE @ EUREKAERT
Wednesday, May 6, 2009
Why Antidepressants Don't Live Up to the Hype
In the '90s, Americans grew fond of the idea that you can fix depression simply by taking a pill — most famously fluoxetine (better known as Prozac), though fluoxetine is just one of at least seven selective serotonin reuptake inhibitors (SSRIs) that have been prescribed to treat hundreds of millions of people around the world.
But in the past few years, researchers have challenged the effectiveness of Prozac and other SSRIs in several studies. For instance, a review published in the Journal of Affective Disorders in February attributed 68% of the benefit from antidepressants to the placebo effect. Likewise, a paper published in PLoS Medicine a year earlier suggested that widely used SSRIs, including Prozac, Effexor and Paxil, offer no clinically significant benefit over placebos for patients with moderate or severe depression. Meanwhile, pharmaceutical companies maintain that their research shows that SSRIs are powerful weapons against depression. (Here's a helpful blog post that summarizes the debate.)
Now a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients — those with a limited range of psychological problems. People whose depression is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs — which is unfortunate for the 45% to 60% of patients in the U.S. who have been diagnosed with a common mental disorder like depression and also meet the criteria for at least one other disorder, like substance abuse. (Multiple diagnoses are known in medical parlance as comorbidities.)
READ MORE @ TIME
But in the past few years, researchers have challenged the effectiveness of Prozac and other SSRIs in several studies. For instance, a review published in the Journal of Affective Disorders in February attributed 68% of the benefit from antidepressants to the placebo effect. Likewise, a paper published in PLoS Medicine a year earlier suggested that widely used SSRIs, including Prozac, Effexor and Paxil, offer no clinically significant benefit over placebos for patients with moderate or severe depression. Meanwhile, pharmaceutical companies maintain that their research shows that SSRIs are powerful weapons against depression. (Here's a helpful blog post that summarizes the debate.)
Now a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients — those with a limited range of psychological problems. People whose depression is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs — which is unfortunate for the 45% to 60% of patients in the U.S. who have been diagnosed with a common mental disorder like depression and also meet the criteria for at least one other disorder, like substance abuse. (Multiple diagnoses are known in medical parlance as comorbidities.)
READ MORE @ TIME
Saturday, July 28, 2007
PedMed: Multi-drug use questioned
Be it a sign of a growing dependency on drug treatments or increasing incidence of coexisting pediatric illnesses, the number of children taking multiple medications is rising at rates some deem unhealthy.
The National Center for Health Statistics reports some 3 million tykes and teens under 18 were taking three or more prescription drugs during the study month in 2002.
In some cases, youngsters suffer simultaneous conditions, so-called comorbidities, which call for separate medicines.
For example, studies show up to one in five children newly diagnosed with type 2 diabetes may also have a psychiatric condition, including depression, attention-deficit/hyperactivity disorder, autism, developmental delay, schizophrenia and bipolar disorder.
READ MORE @ UPI
The National Center for Health Statistics reports some 3 million tykes and teens under 18 were taking three or more prescription drugs during the study month in 2002.
In some cases, youngsters suffer simultaneous conditions, so-called comorbidities, which call for separate medicines.
For example, studies show up to one in five children newly diagnosed with type 2 diabetes may also have a psychiatric condition, including depression, attention-deficit/hyperactivity disorder, autism, developmental delay, schizophrenia and bipolar disorder.
READ MORE @ UPI
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