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Vitamins, Monoamines, and Depression
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Vitamins B9 (folic acid) and B12 (cobalamin) may be determinants of mental illness in older adults. Deficiencies of these vitamins have been implicated in the etiology and treatment of both mental and neurologic disorders.
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2/4/2009
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Increased Fracture Risk and Psychotropic Medications
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Osteoporosis is a common medical condition among older aged adults in the United States. It is estimated that 50% of women and 20% of men >50 years of age of Caucasian descent are afflicted, and as a result, they carry higher risk for osteoporotic fractures during their lifetime.
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9/26/2008
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Evidence-based Medicine and Publication Bias
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The profound influence of the pharmaceutical and drug devices industry on clinical medicine, medical education, and research is a source of growing concern raised in the medical literature and media. The potential for bias due to commercial interests prompted editors of leading international medical journals to endorse greater transparency in reporting of clinical trials regarding authorship, financial support, and potential conflict of interest as a prerequisite for reviewing submitted manuscripts.
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7/29/2008
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Treating Agitation in Alzheimer’s Disease: Efficacy of Memantine
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Alzheimer’s disease is a progressive neurodegenerative disorder of increasing prevalence, clinically manifested by memory impairment and declining cognition. Approximately 25 million people worldwide suffer from dementia as a result of Alzheimer’s disease. Greater than 50% of individuals with Alzheimer’s disease experience agitation, aggression, delusions, or hallucinations during the course of their illness.
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5/28/2008
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Mortality Risks and Antipsychotics
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Patients with schizophrenia suffer mortality rates estimated to be twice that of the general population and have a foreshortened life expectancy.
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3/27/2008
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Appetite Regulation: Hormones and Antipsychotics
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Antipsychotics induce unwanted weight gain and metabolic abnormalities in some patients, referred to as the metabolic syndrome. Second-generation antipsychotics have a greater propensity than first-generation antipsychotics to produce these untoward effects.
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1/24/2008
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Antipsychotics: Pharmacology and Clinical Decision Making
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The introduction of several new atypical antipsychotics over the past decade poses uncertainties about what constitutes optimal drug therapy for an individual patient, both in choosing initial drug therapy and ongoing management. The advent of the second-generation antipsychotics (SGAs) bred a new category of drugs with some advantages over traditional agents, although the extent of superiority in efficacy and tolerability over first-generation antipsychotics (FGAs) remains unclear.
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9/24/2007
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CNS Receptor Partial Agonists: A New Approach to Drug Discovery
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Buspirone was the first of a series of central nervous system (CNS) drugs exhibiting selective effects on a single subtype of serotonin (5-HT) receptor. Buspirone binds selectively with high affinity to 5-HT1A receptors and unlike most psychiatric drugs, which are mainly receptor antagonists, functions as a partial agonist at this CNS receptor.
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7/26/2007
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The Role of Dopamine and Norepinephrine
in Depression
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he function of the neurotransmitters dopamine and norepinephrine in the etiology and treatment of depressive disorders is currently an area of intense research. A substantial body of evidence accrued from animal and human studies indicates that these two monoamine neurotransmitter systems play important roles in both the pathophysiology of depression and the therapeutic effects of antidepressants.1,2
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4/23/2007
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Antidepressant Drugs:
Early Onset of Therapeutic Effect
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t is widely accepted that antidepressants have a delayed therapeutic effect1-3 despite having immediate neurochemical actions. However, there is growing evidence that antidepressants at effective doses produce discernible clinical improvement in responding patients within 1–2 weeks.4,5 This alleged delay in therapeutic benefit, which has been attributed to all antidepressants, is assumed to result from an indirect effect on “downstream” neuronal pathways, despite drugs having differences in pharmacologic mechanisms of action.
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2/27/2007
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Insulin Secretion and Psychotropic Drugs
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The heightened interest in the effects of psychotropic drugs on glucose metabolism reflects the current concern about atypical antipsychotics as risk factors for diabetes, hyperlipidemia, and obesity. Reports of severe hyperglycemia with ketoacidosis shortly after initiating treatment with atypical antipsychotics, even in the absence of weight gain, have fostered studies of possible effects of these agents on insulin secretion.
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11/29/2006
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Psychopharmacology Research Tutorial for Practitioners - Antidepressant Drugs: Is a Dual Mechanism Better?
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In the 1950s the serendipitous and nearly simultaneous discovery of the first antidepressant medications, iproniazid and imipramine, predated any understanding of the pharmacologic mechanism of action of drugs effective for the treatment of depressive disorders. To a large extent, discovery of the pharmacologic actions of these antidepressants fostered promulgation of the catecholamine and monoamine hypotheses of depression.
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11/2/2006
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Psychopharmacology Research Tutorial for Practitioners – Psychotropic Drugs: Novel Routes of Administration
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Novel routes of drug administration (other than by ingestion or injection) can be an attractive therapeutic option offering clinical advantages for some medications. Routes of administration, such as transdermal, transnasal, inhalation, and sublingual routes, alter the pharmacokinetics of orally administered drugs in a fashion that can enhance their pharmacologic profiles.
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10/17/2006
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Drug Trials in Psychiatry: Which Statistical Methods Are Best for Assessing Efficacy?
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The statistical analysis of psychiatric drug efficacy trials differs from the analysis of efficacy trials in many
therapeutic areas. The beneficial therapeutic effect of an antidepressant,
anxiolytic, or antipsychotic is generally not apparent following a single dose and usually requires prolonged exposure, unlike, analgesics or hypnotics, for example. In fact, several weeks may elapse before a definitive treatment response occurs and remission typically takes months. Thus, unlike in trials of immediate-onset medication, subjects in psychopharmacologic studies undergo an extended period of treatment with multiple observations of symptoms.
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10/15/2006
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Benzodiazepines: Clinical Use and Abuse
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Before the modern era of psychopharmacology, patients seeking relief of anxiety symptoms were likely to receive one of an array of chemicals that act as generalized central nervous system (CNS) depressants. Since antiquity, alcoholic beverages and forms of laudanum, such as tincture of morphine, were commonly used to alleviate anxiety symptoms and to treat insomnia. Bromide, the first specific sedative-hypnotic agent, was introduced in the mid-19th century. Chloral hydrate and paraldehyde were discovered subsequently, followed by barbital and phenobarbital in the early 1900s. Because these sedative-hypnotic agents are nonspecific CNS
depressants, they share a liability for developing tolerance and physical dependence. Furthermore, overdoses are potentially lethal while abrupt withdrawal following chronic administration can precipitate seizures.
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10/14/2006
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Antidepressant Discontinuation Syndrome
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Discontinuation syndromes occur with many psychotropic agents. Withdrawal syndromes have been sporadically reported with the monoamine oxidase inhibitors and tricyclic antidepressants, although these are generally thought to affect a minority of patients. In contrast, drugs that act as central nervous system depressants, such as sedative hypnotics, opiates, and ethanol, have prominent and potentially severe withdrawal effects.
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9/28/2006
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Serotonin Syndrome
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Although serotonin syndrome was described more than 40 years ago, most clinicians are unfamiliar with the condition. This potentially life-threatening adverse drug reaction is a cause of current concern because of the high utilization of psychopharmacologic therapies with pro-serotonergic properties. This condition warrants prompt diagnosis and aggressive intervention to reduce morbidity and prevent fatalities.
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8/6/2006
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Psychopharmacology Research Tutorial for Practitioners: Antidepressant Efficacy Trials and Management of Subthreshold Depression
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Antidepressant efficacy trials undertaken to obtain marketing approval of a new drug (and provide package insert information) are designed to maximize the probability of success for showing significant treatment effects of the investigational agent. This stratagem, undergirding much of pharmaceutical research and development, is deemed essential by the industry because of the inordinately high cost of developing psychotropic drugs and the disturbingly high rate of failed efficacy trials.
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5/26/2006
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Psychopharmacology Research Tutorial for Practitioners - Clozapine Agranulocytosis: Mechanism of Drug Toxicity
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Drug treatment of schizophrenia has undergone significant changes since 1990 with the introduction of clozapine, the first of the second-generation “atypical” antipsychotics. These agents differ from first-generation antipsychotics, which are primarily dopamine (D)2 receptor antagonists, in that they have affinity for multiple subtypes of serotonin and dopamine receptors in addition to the D2 receptor.
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5/25/2006
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Transdermal Selegiline: A New-Generation MAOI
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A new formulation of the monoamine oxidase inhibitor (MAOI) selegiline was recently approved for the treatment of major depressive disorder. This once-daily transdermal patch known as the selegiline transdermal system (STS) offers an important advantage over existing MAOIs. STS carries significantly lower liability for tyramine-induced acute hypertensive reactions, allowing much more dietary latitude than is possible with the oral MAOIs. While MAOIs were the first antidepressants and have sustained a reputation of unsurpassed efficacy, their clinical utility has been markedly restricted by the liability for severe and sometimes fatal hypertensive reactions resulting from ingesting a meal of high tyramine content.
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4/27/2006
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Clinical Trials: Problems with Negative Outcomes
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A dearth of information about negative and failed drug trials, which are frequent among psychopharmacology studies, is a concern to clinicians and the public. This dearth has spawned outcries to establish a mandated federal registry of all clinical trials, especially industry-sponsored studies.
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3/23/2006
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Public Registry of All Clinical Trials: Why the Concern?
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There is a flurry of proposals that would require pharmaceutical companies to make public the findings of all clinical trials. A recurrent issue, the immediate concern emerges from pediatric trial data indicating that antidepressant drugs may increase suicide risk in children and adolescents.
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3/21/2006
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Psychotropic Drugs and Pregnancy: Guidance for Antidepressants
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Many psychiatric disorders warranting pharmacotherapy have an age of onset overlapping the childbearing years of women. This can pose difficult clinical management decisions for practitioners and female patients when considering possible effects of maternal drug therapy on the developing fetus. Clinicians must carefully weigh the risks and benefits of continuing pharmacotherapy during pregnancy versus discontinuing a psychotropic drug because of possible adverse (or unknown) effects on the fetus.
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3/11/2006
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