Are ADHD Medications and Cardiac Risks Linked?

According to a September 17th AHRQ press release, The Agency for Health Research and Quality (AHRQ) together with the Food and Drug Administration (FDA) plan to conduct a huge examination of data from 500,000 patients who are taking medication for Attention Deficit Hyperactivity Disorder (ADHD) to see if the medication increases the risk of cardiovascular problems. The data of both children and adults will be examined, and the study is expected to last two years.

It is already known that medications for ADHD can increase heart rate and blood pressure in patients taking the drug regime, and there have been case study reports of cardiac incidents, according to Dr. Gerald D. Pan, MD of the FDA's Office of Surveillance and Epidemiology, as stated in the AHRQ press release. The study is to determine whether there is a causal relationship between cardiac problems and a person's taking ADHD medications or whether cardiovascular problems are due to the person's already being at risk for the cardiac incidents. The data to be examined is from a preliminary seven FDA year study which ended in 2005.

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It's premature to blame FDA for suicide rise

The front page headline in the Washington Post was alarming: "Youth suicides increased as antidepressant use fell." A new study argued that a record increase in youth suicides in 2004 may have been the unintended consequence of federal warnings that antidepressants such as Prozac can trigger suicidal thoughts in children. Media outlets across the country reported the painful irony that the Food and Drug Administration's attempt to prevent suicides seemed to have increased them by discouraging doctors from properly treating depressed young people.

"We may have inadvertently created a problem," lamented Thomas Insel, director of the National Institute of Mental Health, to the Post earlier this month.

But a closer look at the numbers suggests that the suicide fears are at least premature, if not baseless, say people who specialize in health statistics.

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Kids with ADHD have reason to hope

A.J. Copeland, 13, of Washington, D.C., started eighth grade this month with an announcement: "He said, 'I'm going to make all A's this year,' " recalls his mother, Tamara Copeland.

For a boy who was diagnosed at age 6 with attention deficit/hyperactivity disorder (ADHD) and who has struggled with school, that statement might seem unrealistic. But his mother is cautiously optimistic: Thanks to years of trial and error with medications and behavior-changing strategies, A.J. may well be turning a corner, she says. Though improvements have been "erratic," A.J.'s new attitude is a good sign, she says. "It says to me that he is beginning to understand he is part of controlling his destiny."

The Copelands and millions of other families have reason for hope as another challenging school year begins for children with the common disorder: According to a study updated this summer, most children treated for ADHD — whether with medication, behavioral therapy or both — do improve over time.

The roles of specific therapies and educational strategies remain unclear. Children who received medication, with frequent checkups to adjust doses and drug choices, did best in the first 14 months of the study. But that advantage waned by the three-year mark, according to a set of reports in the August Journal of the American Academy of Child and Adolescent Psychiatry.

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Darkness Invisible

Here is the question lurking behind the recent news of Owen Wilson’s suicide bid: In a culture that encourages outing everything from incest to pedophilia, is depression the last stigma, the one remaining subject that dares not gossip its name? Does a disclosure about depression, especially from someone who seems to have it all, violate an unspoken code of silence — or, at the least, make us radically uncomfortable with its suggestion of a blithe public face masking a troubled inner life?

Most of us have experienced the everyday, transient blues — the emotions nibbling around the edges of depression (whether they manifest themselves as a sense of malaise, dejection or comic-tinged despair) that can be brought on by a shift in the weather or an unfortunate event. They may be chronic yet benign, the sort of moroseness that causes the narrator of Camus’s “Stranger” to stand around listlessly puffing on a cigarette. Sadness is probably more endemic to the human subtext than sanguine spirits, which is why funereal songs like Billie Holiday’s “Gloomy Sunday” strike a universal chord and why Freud conjectured that “ordinary unhappiness” (as opposed to what he called “hysterical misery”) was the best the talking cure could hope to achieve.

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Complementary Therapies for Schizophrenia: Expanding the Clinician's Toolbox

Clinicians and patients are increasingly seeking nonconventional treatments as adjuncts to conventional therapies for schizophrenia. Here, a discussion of the most promising complementary therapies and how to use them.

Given the burdens of living with schizophrenia and other psychotic disorders, and the increasing emphasis on improving patients' quality of life, it's no wonder that clinicians and patients are seeking additional treatment options for psychotic disorders. Clinicians who use, study and advocate for nonconventional or "complementary" therapies in psychiatry -- treatments ranging from dietary supplements to Chinese herbs to yoga -- see an opportunity to expand the acceptance and use of these therapies as adjuncts to conventional treatments for schizophrenia.

These practitioners acknowledge that the evidence supporting most nonconventional therapies for schizophrenia is still decidedly modest: The number of rigorous, well-designed studies is limited, and research findings on several of the therapies are inconsistent.

Still, dozens of studies in recent years have found evidence that when combined with antipsychotics, several nontraditional therapies -- most notably Omega-3 fatty acids, glycine, folate, Chinese herbal medicines, yoga practices and spiritually focused group therapy -- yield measurable and sometimes clinically significant benefits in some schizophrenic patients. Based on limited and mainly small or uncontrolled studies, nonconventional therapies may be effective particularly in easing negative symptoms, cognitive symptoms and/or antipsychotic side effects.

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The endocrine effects of the psychiatric drug Zyprexa are extremely dangerous, says Swedish Professor in Psychiatry

Speaking out about the harmful effects of the psychiatric drug Zyprexa, the Swedish Professor in Psychiatry, Rolf Adolfsson, said: “There is nothing worse than seeing a young person 17-18 years with a weight gain of 40-50 kg, and no one does anything! What is Swedish psychiatry doing?”

The psychiatrist spoke out in Swedish national television, in a program covering the illegal marketing of Zyprexa and the harmful effects of the new so called atypical neuroleptics. Zyprexa is the 6th most sold drug in Sweden, all categories.

Despite the fact that nine States in the US are suing the manufacturer of Zyprexa, Eli Lilly, and despite the fact that almost 30.000 persons have been awarded 1.2 billion dollars due to the injuries caused by Zyprexa, there has been a complete silence about this affair in Sweden.

Until now.

The Professor, who according to the program has been investigating harmful effects of drugs for the last 7 years, further said: “I’ve seen so many complications, and I have met so many patients – that I completely choke. Are we so damned gullible, and it must be – there is only one thing – marketing.”

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Antidepressant as Good as Antipsychotics for Dementia

The antidepressant citalopram (Celexa) may be as effective as often-prescribed antipsychotic drugs to control the agitation and psychotic symptoms associated with dementia, a new study suggests.

Agitation and psychotic symptoms are often more disturbing than the memory loss associated with Alzheimer's and other forms of dementia and are also the most difficult challenge for family members caring for an elderly person. Currently, antipsychotic drugs such as risperidone (Risperdal) are used to control these symptoms. But often the side effects, including sedation, tension and apathy, can be debilitating, the study authors said.

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When Antidepressant Drugs Are Not Enough - A New Study On Their Combination With Psychotherapy

A group of Dutch investigators has reported on a new study on the combination of antidepressant drugs and psychotherapy in the September issue of Psychotherapy and Psychosomatics.

Although several forms of effective therapy exist for outpatients suffering from major depressive disorder, many patients do not profit from treatment. Combining psychotherapy and medication may be an effective strategy. However, earlier studies have rarely found a clear advantage for the combination. Where an advantage was found, a possible placebo effect of adding 2 types of treatment could not be ruled out as cause for the superior effect of the combination. A total of 353 patients were screened, of whom 193 were randomized over 4 conditions: nefazodone plus clinical management, interpersonal psychotherapy (IPT), the combination of the two or the combination of IPT and pill-placebo. All patients suffered from major depressive disorder and had a score of at least 14 on the 17-item Hamilton Rating Scale (HAMD).

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Adverse drug reactions rise sharply, study says

The number nearly triples since the FDA began a new reporting system in 1998. The main culprits are painkillers.

The number of serious adverse events and deaths attributed to prescription medications has nearly tripled since the Food and Drug Administration initiated a system in 1998 to make it easier to report significant side effects, researchers said today.

Twenty percent of drugs accounted for 87.1% of adverse effects, and the biggest offenders were painkillers and drugs that modify the immune system to treat arthritis, according to the report in the Archives of Internal Medicine.

A quarter of the increase could be attributed to a boost in prescriptions and another 15% to the introduction of new biotechnology drugs since 1998, but the rest of the increase could not be explained, said drug safety expert Thomas J. Moore of the Institute for Safe Medication Practices in Huntingdon Valley, Pa.

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Suicides up after warning, study shows

A 22% drop in prescriptions for antidepressants for teens and children following government warnings about hazards of the drugs led to a sharp increase in suicides the following year, according to Chicago researchers.

The change in labeling in 2003 warned that use of the drugs could increase suicidal thoughts and behavior among youths, but the labeling seems to have backfired, according to a report in the September issue of the American Journal of Psychiatry.

In the year after the change in labeling, the suicide rate rose 14% among those younger than 19, the largest increase since the government started collecting suicide statistics in 1979, said biostatistician Robert D. Gibbons and his colleagues at the University of Illinois at Chicago.

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McGill study promises faster-acting anti-depressants

A McGill University study has found that a new class of drugs known as serotonin4 (5-HT4) receptor agonists may take effect four to seven times faster than traditional selective serotonin reuptake inhibitors (SSRIs). The study, led by former McGill post-doctoral fellow in psychiatry Guillaume Lucas with his supervisor, the late Dr. Guy Debonnel, was published in the September 6 issue of the journal Neuron.

Existing SSRI-class drugs, widely prescribed as anti-depressants, can take up to six weeks to become effective, with potentially serious clinical consequences. Dr. Lucas, now an associate researcher at the Centre de Recherche Fernand Séguin of Université de Montréal, said, "These delays are not only a matter of patient comfort, it's really important, especially when you are treating major depressions that could lead to suicide."

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Teen antidepressant warning had ripple effect

Following the US Food and Drug Administration's warning about the possible risk of suicide among teens when they're treated with antidepressant drugs known as SSRIs, the rates of diagnosis and treatment of depression among adults have declined significantly, according to a new report.

"While some degree of decline in antidepressant prescribing was not unexpected after the black box warning was issued, few if any had predicted diagnosing to decline, or that other modes of treatment (psychotherapy or other medications) would remain relatively unchanged," Dr. Robert J. Valuck told Reuters Health. "It was thought that the latter two may increase to compensate for fewer antidepressant prescriptions being written."

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Study Provides Snapshot of ADHD Prevalence in U.S, Children

Almost 9% of U.S. children ages 8 to 15 meet standard diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), but less than half of them receive treatment.

Only 47.9% of the 2.4 million who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for ADHD had reportedly had their conditions diagnosed by a health care professional or been treated with medication, according to a report in the September issue of the Archives of Pediatrics & Adolescent Medicine.

A research team led by Tanya E. Froehlich, M.D., of Cincinnati Children's Hospital Medical Center did a cross-sectional phone survey of the parents or caregivers of 3,082 eight- to 15-year old children who were participants in the National Health and Nutrition Examination Survey.

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Lilly's Schizophrenia Drug Targets Different Brain Chemicals

Eli Lilly and Co.'s experimental schizophrenia drug, which may replace its top-selling Zyprexa, was just as effective without causing patients to gain weight, according to a study.

Unlike other schizophrenia medicines on the market, the new compound doesn't target dopamine, a chemical that functions within the brain's reward system. It affects glutamate, involved in learning and memory. The study showed the new drug candidate to be as effective as Zyprexa in reducing symptoms such as hallucinations and social withdrawal.

The new drug candidate, dubbed LY2140023, would be the first for the disorder affecting glutamates, a company official said. Zyprexa, with $4.3 billion in 2006 sales, now faces competition from less expensive copies in Canada and Germany, the Indianapolis-based company said on June 8. The drug's U.S. patent expires in 2011.

``Discovering an antipsychotic drug that doesn't work through dopamine is the holy grail of drug development,'' said Gerald Marek, Lilly's chief scientific officer of psychiatric disorders, in an Aug. 30 telephone interview. ``It looks like we've hit upon a target that will ultimately do this.''

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More Children Being Treated for Bipolar Disorder

The number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, researchers are to report on Tuesday, in the most comprehensive study to look at the controversial diagnosis. And experts say the numbers have almost certainly risen further in the years since.

Most experts believe the jump reflects the fact that doctors are more aggressively applying the diagnosis to children, not that the number of new cases has gone up. But the magnitude of the increase is surprising to many experts, who say it is likely to intensify a debate over the validity of the diagnosis that has shaken the field of child psychiatry in recent years.

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Practice guideline for the assessmet and treatment of patients with suicidal behaviors

BIBLIOGRAPHIC SOURCE(S)
American Psychiatric Association. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Arlington (VA): American Psychiatric Association; 2003 Nov. 117 p. [846 references]
GUIDELINE STATUS
This is the current release of the guideline.
MAJOR RECOMMENDATIONS
Each recommendation is identified as falling into one of three categories of endorsement, indicated by a bracketed Roman numeral following the statement. The three categories represent varying levels of clinical confidence regarding the recommendation. Definition of grades of recommendation [I-III] are presented at the end of the "Major Recommendations" field.

Suicide Assessment

The psychiatric evaluation is the essential element of the suicide assessment process [I]. During the evaluation, the psychiatrist obtains information about the patient's psychiatric and other medical history and current mental state (e.g., through direct questioning and observation about suicidal thinking and behavior as well as through collateral history, if indicated). This information enables the psychiatrist to 1) identify specific factors, signs, and symptoms that may generally increase or decrease risk for suicide or other suicidal behaviors and that may serve as modifiable targets for both acute and ongoing interventions, 2) address the patient's immediate safety and determine the most appropriate setting for treatment, and 3) develop a multiaxial differential diagnosis to further guide planning of treatment. The breadth and depth of the psychiatric evaluation aimed specifically at assessing suicide risk will vary with setting; ability or willingness of the patient to provide information; and availability of information from previous contacts with the patient or from other sources, including other mental health professionals, medical records, and family members. Although suicide assessment scales have been developed for research purposes, they lack the predictive validity necessary for use in routine clinical practice. Therefore, suicide assessment scales may be used as aids to suicide assessment but should not be used as predictive instruments or as substitutes for a thorough clinical evaluation [I].

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Topics to Review with Patients When considering use of antidepressants

University of Oklahoma College of Medicine
INTRODUCTION
To increase the chance of successful pharmacologic antidepressant therapy for patients with depression, clinicians should review several specific topics with their patients before the initiation of such therapy. Discussion points range from alternatives to pharmacologic therapy to common adverse effects of specific medications.
Clinicians can begin the discussion by soliciting specific aspects of the patient’s condition, including any previous experience with antidepressant therapy, the patient’s expectations for therapy, and any external sources of information regarding therapy. After establishing expectations and understanding the past history of the patient’s condition, alternatives to drug therapy may be considered and discussed.

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Pharmageddon: the prescription pill epidemic

Our increasing reliance on pills has resulted in a 27 per cent rise in prescriptions written by doctors in just five years. It's costing the NHS £10bn a year, £200m of which is wasted on drugs that are never used. Nina Lakhani reports on a dangerous addiction.

Britain is in the grip of a prescription drug-taking epidemic, with unprecedented numbers of medicines being handed out by GPs, costing billions of pounds and stretching already tight NHS resources to breaking point.

Prescription drug use has increased by 27 per cent in the past the five years and the NHS drug bill topped £10bn in 2006. GPs prescribed 918 million medicines last year compared with 721 million five years ago, according to figures obtained by The Independent on Sunday.

Health experts put rocketing prescription numbers down to medical advances, but also point to poor prescribing by GPs, growing public demand for a "pill for every ill" and aggressive marketing tactics by the pharmaceutical industry, which prompted one MP to warn that the UK is heading towards what he called "pharmageddon".

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Headway in developing a faster-acting antidepressant

The key might be provided by studying the effect that ketamine, an anesthetic, has on a neurotransmitter.

After years of little progress, scientists are making headway in the search for a better, faster-acting antidepressant. Experiments with an anesthetic called ketamine have yielded important clues about the biology of depression, leading scientists to attack the mood disorder in new ways.

Improved treatments are sorely needed. Depression affects about one in 10 adult Americans each year, while current drugs work in only 50% to 60% of patients, can cause sexual problems and take weeks to work. They also carry a small risk of suicidal thoughts and behaviors in adolescents and young adults.

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Bipolar Disorder Relapses Halved WIth New Program

Melbourne mental health researchers have succeeded in halving the number of relapses experienced by people with bipolar disorder which strikes two in 100 Australians, accounts for 12 per cent of suicides each year and costs the country at least $1.5 billion annually.

With funding from the MBF Foundation and Beyond Blue, a team led by the Mental Health Research Institute of Victoria has developed an innovative structured group program to help people with bipolar disorder to better manage their condition.

The 12-session program, led by trained mental health clinicians, enables people battling the disorder to effectively monitor their mood, assess personal triggers and early warning signs of oncoming illness and take the necessary steps to stay well.

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