Patients who survived acute MI used more aspirin, beta blockers than sudden death population examined.

Common psychotropic medications such as antipsychotics, antidepressants and benzodiazepines may contribute to an increased risk for sudden death during an acute coronary event, according to a study presented at Heart Rhythm 2009.

Jussi Honkola, MD,of the University of Oulu, Finland, and colleagues conducted a prospective substudy of the FinGesture study, comparing the medications of 321 patients who had sudden cardiac death due to an acute coronary event as confirmed by a medicolegal autopsy, with 609 patients who survived an acute MI. Researchers examined medication histories from autopsy records and conducted interviews with the patient’s relatives.

The researchers found that patients who had died had used more antipsychotics compared with the MI survivors (10.9% vs. 1.4%), more antidepressants (7.4% vs. 3%) and benzodiazepines (18.4% vs. 5%).

The study results also showed the MI survivors used beta blockers more frequently compared with those who died (adjusted OR 0.47, 95% CI 0.24-0.93, P=0.03), and aspirin use was also more common among MI survivors (adjusted OR 0.31, 95% CI 0.15-0.64, P=0.002).

Honkola J. PO02-120. Presented at: Heart Rhythm 2009; May 13-16, 2009; Boston.

FROM CARDIOLOGY TODAY, Section: ARRHYTHMIA DISORDERS, May 18, 2009

Bipolar patients often relapse: study

Results of a study suggest that bipolar disorder has a high relapse rate. In the study, researchers found evidence that three fourths of the hospitalizations for treatment of bipolar disorder are repeat admissions.

The study findings were reported today at the American Psychiatric Association's annual meeting in San Francisco.

Bipolar disorder, also known as manic depression, typically causes wide swings in mood -- sometimes from extreme incapacitating depression to euphoric recklessness.

"It is well known that bipolar disorder is a recurrent disease, so we considered it important to assess hospitalization patterns as an indication of the course of illness," principal investigator Dr. Urban sby from Danderyd University Hospital, Sweden, told Reuters Health prior to his presentation.

READ MORE @ REUTERS

Preventing Another Camp Liberty

Midway through her 2004 deployment to Iraq's Anbar province, Navy psychologist Heidi Kraft was e-mailing her husband about her experiences, and the message somehow turned into verse. The poem became the basis for her memoir "Rule Number Two: Lessons I Learned in a Combat Hospital" -- lessons that she revisited last week following the shooting at a combat stress facility in Baghdad. Kraft, who left active duty after nine years in the Navy and now treats combat stress patients, spoke with Outlook's Rachel Dry about how the military handles mental health and why PTSD can be like a sprained ankle. Excerpts:

Last Monday, Sgt. John M. Russell allegedly walked into a combat stress facility at Camp Liberty in Baghdad and opened fire, killing five service members. What did you think when you heard about the shooting?

My heart sank. I was so terribly saddened to hear it. As a provider, I can understand how something like this might have happened. Certainly if someone expresses either suicidal or homicidal thoughts, that person is categorized as a psychiatric emergency and steps are taken to stabilize that person. Sometimes those thoughts are not expressed in a way that makes it very clear what you're dealing with, and sometimes there's nothing to be done.

READ MORE @ WASHINGTON POST

Cardiac Risks Hold Up Approval of Two Antipsychotics

FDA advisors remain skeptical about the safety of two antipsychotics for which regulatory approval is being sought and are especially troubled by potentially fatal cardiac risks.

Despite positive efficacy data from placebo-controlled trials, experts on a Food and Drug Administration (FDA) psychopharmacology advisory committee have reservations about potentially dangerous adverse effects of two antipsychotic medications under regulatory review for approval.

The FDA held meetings in April to seek the committee's advice on whether sertindole, a second-generation antipsychotic (SGA), should be approved for the treatment of schizophrenia and prevention of suicide in schizophrenia patients, and whether quetiapine XR extended-release tablets should be approved for treating major depressive disorder (MDD) as a monotherapy and as an adjunctive therapy to an antidepressant and for treating generalized anxiety disorder (GAD) as a monotherapy.

READ MORE @ PSYCHIATRIC TIMES

The Psychological Toll of Early Onset Alzheimer's Disease

Lisa Carbo knew something was wrong. The former registered nurse from Metairie, La., began experiencing difficulty in remembering how to perform various functions at her job. Multitasking became harder. Eventually she was written up for poor performance, prompting her to seek medical help.

Carbo was diagnosed with early onset Alzheimer's disease in November 2007, at the age of 53.

Before her Alzheimer's diagnosis, Carbo had plans for her golden years. "I hoped to semi-retire, spend the rest of [my] life with someone, continue to be productive, travel," she said. "I love animals, I had planned to do a lot more volunteering with animal shelters."

Her diagnosis changed everything: She lost her job and her boyfriend left her. "All those hopes and dreams are smashed. They're all gone. It's like everything that you planned on for your life is gone."

Fortunately for Carbo, she was able to find help to deal with the depression brought about by her diagnosis. She began taking antidepressants and started seeing a therapist.

READ MORE @ ABC NEWS

Antidepressants: Brand Name or Generic?

For many antidepressants, the issue of brand-name versus generic has no practical significance. Elavil was first marketed almost a half century ago, and its patent has long expired. It lives on, however, but as generic amitriptyline. Today, only a few antidepressants are still fully protected by patents, namely, Cymbalta (2010), Lexapro (2012), and Pristiq (2022) for major depressive disorder (MDD); and Seroquel (2011) and Symbyax (2017) for bipolar depression.

The issue of brand-name versus generic, however, is far more complex than merely listing patent expiration dates. Patents can be extended, challenged, and infringed on; financial considerations are enormous; and patient care issues are often of central importance. To place antidepressants in proper perspective, it is first necessary to provide some general background about patents and drug regulation.

READ MORE @ PSYCHIATRIC TIMES

Role of Acupuncture in the Treatment of Depression Benefits and Limitations of Adjunctive Treatment and Monotherapy

Acupuncture is being integrated into Western medicine, particularly for treatment of pain, nausea, asthma, and neurological conditions.1 Although the exact mechanism of action for acupuncture is unknown, it is associated with an increase in the level of neurobiologically active substances, such as endorphins and enkephalins.2 There are also data indicating that acupuncture induces the release of norepinephrine, serotonin, and dopamine.3-5

ADVERSE EFFECTS

Acupuncture is well tolerated compared with tricyclic antidepressant medications.6-9 Adverse effects are mild and transient and include tiredness, drowsiness, exacerbation of primary symptoms, and itching in the area of acupuncture.10 Complications such as pneumothorax, infection, cardiac conditions, and spinal cord injury are extremely rare.10

AVAILABLE DATA

The number of studies of Western acupuncture in the treatment of depression and conditions associated with depression is limited.10 Even fewer reports provide objective data to support efficacy (eg, neurotransmitter) level change, imaging studies, and electroencephalographic alterations. Only 7 randomized comparative studies have been published, even though the first attempts to compare acupuncture with conventional treatments for depression began in the 1970s.

READ MORE @ PSYCHIATRIC TIMES

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

Antidepressants: The right people aren't always getting them

The medications are widely used to treat complaints such as loneliness or low energy. Meanwhile, studies say many with depression go untreated.

It was just over 20 years ago that the antidepressant Prozac was first approved by the U.S. Food and Drug Administration. The medication was touted as nothing short of a miracle: Not only was it was highly effective in treating depression, it also caused very few side effects.

The drug's popularity grew rapidly, and pharmaceutical companies got busy developing a variety of other, chemically similar antidepressants, collectively referred to as selective serotonin reuptake inhibitors (or SSRIs). There are at least half a dozen SSRIs on the market, including Lexapro, Paxil, Zoloft, Celexa and Luvox.

Since the introduction of these drugs, the number of Americans being treated for depression has increased dramatically; the Centers for Disease Control and Prevention says antidepressants are the most commonly prescribed medication in the country. But it's not always the right people taking them. Some who probably have very little to gain from their use are on SSRIs; others who stand to benefit are not.

READ MORE @ LOS ANGELES TIMES

Women Stopping Antidepressant Medication For Premenstrual Syndrome Experience Relapse

A report in the May issue of the Archives of General Psychiatry (one of the JAMA/Archives journals) indicates that many women take the antidepressant called sertraline to relieve severe premenstrual symptoms, and it seems that half of them go through relapse after six to eight months after stopping the medication. There is a higher probability of relapse for women with more severe symptoms and those who consumed the drug during a shorter period.

Background facts sustained in the report demonstrate that premenstrual syndrome (PMS) is one of the most frequent health problems among women of reproductive age. Sertraline hydrochloride and other antidepressant medications are approved to treat PMS when it is most severe, also known as premenstrual dysphoric disorder (PMDD).

The authors explain: "There is little information about the optimal duration of treatment, although anecdotal reports and small pilot investigations suggest that premenstrual symptoms return rapidly in the absence of effective medication."

READ MORE @ MEDICAL NEWS TODAY

Is The FDA Easing Up? How one company turned a rejection into a thumbs up, and what it could mean for the drug industry as a whole.

After the Food and Drug Administration told Vanda Pharmaceuticals that the company's schizophrenia drug was "not approvable" last July, Wall Street marked the tiny biotech for dead.

The FDA asked for a new clinical trial; Vanda insisted it could change the agency's mind with its existing data. Its shares sank from $4 to 45 cents. A hedge fund, Tang Capital Partners, started a proxy fight to try and get Vanda to liquidate and distribute the proceeds to shareholders.

Then Wednesday night, the FDA announced it was approving the drug, Fanapt, based on data from 3,000 patients. Vanda shares exploded 700% to $8. That's the kind of jackpot that could start getting investors interested in gambling on tiny biotechs again.

But the Vanda story may signal something far more important for investors than just a reminder that biotech stocks can pop: an easier FDA. Both Wyeth ( WYE - news - people ), which is being bought by Pfizer ( PFE - news - people ), and Schering-Plough ( SGP - news - people ), which is being bought by Merck ( MRK - news - people ), were rebuffed last year by the FDA after submitting data for schizophrenia drugs.

READ MORE @ FORBES

More Americans taking drugs for mental illness

Many more Americans have been using prescription drugs to treat mental illness since 1996, in part because of expanded insurance coverage and greater familiarity with the drugs among primary care doctors, U.S. researchers said on Tuesday.

They said 73 percent more adults and 50 percent more children are using drugs to treat mental illness than in 1996.

Among adults over 65, use of so-called psychotropic drugs -- which include antidepressants, antipsychotics and Alzheimer's medicines -- doubled between 1996 and 2006.

"What we generally find is there has been an increase in access to care for all populations," said Sherry Glied of Columbia University in New York, whose study appears in the journal Health Affairs.

READ MORE @ REUTERS

For Old Drugs, New Tricks - Advice Veers Away From Flushing Unused Pills

At the Leesburg Pharmacy, located in a Loudoun County strip mall, a big, round fish tank sits atop the prescription counter. There are no fish inside, not even any water: The tank is a repository for unused medications. People can drop off the Vicodin that didn't get used once the pain of a root canal subsided. Or the heart pills remaining after a grandmother's death. Or an asthma inhaler that had passed its expiration date. Or an antidepressant that turned out to have unpleasant side effects.

Once a week, the tank is emptied; the drugs are packed in cartons by pharmacy personnel and ultimately incinerated by a commercial waste firm.

"Our customers are thrilled because they had no idea what else to do with this stuff," said Cheri Garvin, chief executive of the employee-owned pharmacy.

These are customers who are trying to do the responsible thing. Over the years, Americans have been alerted to the dangers of a lot of problematic waste materials -- paint thinner, batteries, air conditioners. But leftover pills can seem so small, so easily disposable, that many people routinely flush them down toilets, wash them down sinks or throw them in trash that goes to a landfill.

And then they often end up in places where they shouldn't be, like the public water supply.

The average American takes more than 12 prescription drugs annually, with more than 3.8 billion prescriptions purchased each year, according to the Kaiser Family Foundation. The most commonly cited estimates from Environmental Protection Agency researchers say that about 19 million tons of active pharmaceutical ingredients are dumped into the nation's waste stream every year.

READ MORE @ WASHINGTON POST

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

New Route To Treat Depression - Finding could help people failed by current antidepressants

A NEW TARGET for treating depression, discovered by researchers in Iowa, may offer an alternative to current antidepressants, which target other mechanisms to treat the condition.

"The mechanism issue is important because if a patient doesn't respond to one drug, the chances of them responding to another drug that works through the same mechanism are low," says John A. Wemmie, who led the research team. Wemmie is an associate professor of psychiatry and neurosurgery at the University of Iowa and a staff physician and researcher at the Iowa City Veterans Affairs Medical Center.

Wemmie's team focused on a biochemical pathway involving acid-sensing ion channel (ASIC) proteins expressed by neurons. ASICs are activated by protons that are believed to act as neurotransmitters (C&EN, Jan. 14, 2008, page 10). Wemmie and his colleagues concentrated on the ASIC1a class of these ion channels, which are abundant in regions of the brain associated with mood.

The research group had previously shown in mice that ASIC1a activity is associated with anxiety, which often accompanies depression. In the new work, the researchers showed that mice lacking the gene for ASIC1a were less susceptible than normal mice to depression caused by stress. In a second experiment, the researchers treated normal mice with A-317567, an experimental ASIC inhibitor that Abbott Laboratories has been studying for pain treatment. Wemmie's team reports that blocking ASIC1a in this way produced antidepressant effects in the animals (J. Neurosci. 2009, 29, 5381).

READ MORE @ CHEMICAL & ENGINEERING NEWS

AAN: Atypical Antipsychotic Reduces Autism Irritability

Aripiprazole (Abilify) may be effective off-label for treating the irritability associated with autism, researchers here said.

The atypical antipsychotic fared significantly better than placebo on a parent-rated scale of irritability (P<0.05), Donald Lewis, M.D., of Sentara Norfolk General Hospital in Virginia, and colleagues reported at the American Academy of Neurology meeting.

It also had significant advantages over placebo with regard to clinician assessments of Aripiprazole and hyperactivity.

Only one atypical antipsychotic -- risperidone (Risperdal) -- is currently FDA approved for irritability associated with autism. However, treatment guidelines recommended that other atypical antipsychotics be considered for behavioral problems in autism.

Researchers involved in the current study could not comment on whether aripiprazole was in the process of FDA approval for this indication.

But Benjamin L. Handen, Ph.D., of the University of Pittsburgh, who was not involved in this study but is involved in similar trials, said FDA approval for the indication would give doctors an alternative for children who respond poorly to risperidone.

READ MORE @ MEDPAGE TODAY

Drugs 'can help mild depression'

Antidepressants can help mild to moderate depression and should not just be used in bad cases, researchers say.

Current guidelines urge doctors to avoid antidepressants as an initial treatment in mild depression.

But an NHS-funded study of 200 patients from across England found the drugs, called SSRIs, were more effective than GP advice and support alone.

The team hope national advisers will look at their findings, reported on the Health Technology Assessment website.

Study leader Professor Tony Kendrick, a GP and researcher at the University of Southampton, said although the National Institute of Health and Clinical Excellence wants doctors to restrict SSRIs to the most severe cases, GPs frequently prescribe them for milder cases.

"Just because someone has mild depression does not mean it is a mild illness, because it can cause them to be off work for months," he said.

"And often you don't have psychological treatments to offer because they're not available so you end up prescribing quite frequently."

READ MORE @ BBC

Researchers find common genetic variations in autistic people

Findings show that many autistic people have a deviation in a portion of their DNA that affects the way brain cells connect with one another. The discovery may lead to treatments.

Researchers have found that many people with autism share common genetic variations, a discovery that may improve diagnosis and offers the promise of developing treatments for the frustratingly mysterious disorder.

Their findings, published in the journal Nature, compared the genomes of thousands of autistic people with those of thousands of people without the disorder -- a massive task that new technology has only recently made possible. The genome is the complex system of DNA coding that builds and runs the human body.

The review showed that most autistic people examined have a genetic variation in a portion of their DNA that affects the way brain cells connect with one another. Scientists also reported a link between autism and small "mistakes" in another DNA segment involved with cell communication. Both reports add weight to the idea that autism is related to problems with the way brain cells connect.

READ MORE @ LOS ANGELES TIMES

Off-Label Prescribing

Medications cannot be marketed in the United States without an FDA determination that they are safe and effective for their intended use. To obtain such certification, pharmaceutical companies submit their products to rigorous scrutiny (eg, in vitro studies, animal studies, human clinical trials) and present the subsequent data to the FDA, which determines whether the medication in question is safe and effective for a specific purpose. FDA approval comes with specific labeling requirements for the product, including the approved indications for use, the appropriate dosing, and the specific populations for its use. Once a medication has been approved for a specific use, physicians and other prescribers are permitted to prescribe the medication for conditions not covered by the approved use.

Several recent studies have dem­onstrated that off-label prescribing is very common among physicians, particularly among psychiatrists. Legal scholars have estimated that approximately 40% to 60% of prescriptions are for off-label use.1 In one important study, researchers examined office-based prescribing patterns for 160 commonly prescribed medications and determined that approximately 21% were for off-label use. In this study, off-label use was most common for cardiac medications (46%), anticonvulsant medications (46%), and asthma medications (42%). The investigators also found that most off-label use (73%) had limited or no scientific support.

The greatest disparity in the percentage of scientifically supported versus unsupported off-label use occurred with psychiatric medications. In 96%, the off-label use was determined to have little or no sound scientific evidence for the condition for which the drug was prescribed.2

READ MORE @ PSYCHIATRIC TIMES

What Is Neuropathy? What Causes Neuropathy?

Neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders, and exposure to toxins. One of the most common causes of neuropathy is diabetes.

Neuropathy can affect nerves that control muscle movement (motor nerves) and those that detect sensations such as coldness or pain (sensory nerves). In some cases - autonomic neuropathy - it can affect internal organs, such as the heart, blood vessels, bladder, or intestines.

READ MORE @ MEDICAL NEWS TODAY