Taking moderate to high daily doses of antidepressants for more than 2 years is associated with an 84% increased risk for diabetes, according to a large observational study. The increased risk was particularly notable for paroxetine and amitriptyline. Weight gain might explain much of the relation between antidepressant use and diabetes, according to the study authors. The study was published online April 1 in the American Journal of Psychiatry. These results were regarded as preliminary, too preliminary to have any major impact on clinical practice, said lead author Frank Andersohn, MD, from Charité-University Medical Center, in Berlin, Germany. He added that although early evidence shows that combining an antidiabetes drug with an antidepressant might prevent diabetes among depressed patients, the benefits and risks of this approach need to be considered. Meanwhile, there are methods to reduce the risk for diabetes, physical activity and attaining optimal body weight. The bottom line, the authors stated, is that more studies are needed.

The APA 2001 Practice Guideline on Borderline PD [better “Mercurial Disorder”], suggested psychotherapy was the treatment of choice and medications could be valuable in addressing prominent symptoms. This month's J of Personality Disorders has a meta-analysis suggesting that, for anger in these pts, topiramate and lamotrigine seem superior to carbamazepine. Aripiprazole seems superior to the antidepressants.  SSRIs were not impressive.  A recent Carlat report also concluded that topiramate, 250 mg/d, lamotrigine, 200 mg/d, and aripiprazole, 15 mg/d, were effective against anger in these pts, and spoke well of oxcarbazepine, valproate, and omega 3s.

Also in the Carlat report, an interviewee specializing in medicating pregnant women prefers, if she feels she should use an SSRI: fluoxetine, sertraline or citalopram. [Paroxetine is the only SSRI rated a category D.]

Your New-Yorker-reading patients may ask you about modafinil, stimulants or piracetam, as there is a long article suggests that this nation is not going to be able to halt the use of "neuroenhancing" meds. The article says that cognitive functions are enhanced by these meds, especially in people whose cognitive levels are not very high.  The article also suggests these meds will not help creativity.  The article does mention tolerance as a problem. 

In answer to a question to me, TMS is available locally at Walter Reed [probably limited to military pts], Sibley Hospital, and at the office of Sinan Duzyurek, MD, 2440 M St, DC, 20037, phone, 202 466 3966. TMS, FDA approved for depression, is given daily 5/week x 4-6 weeks, so about 25 TMSs. Each treatment lasts 40 minutes.

Roger