Folks,
At this Annual meeting, a Connecticut psychiatrist told me of success with pramipexole in one of his refractory MDD pt. By email, the next day, the following from Paulo Negro, whom many of you know: “I had a lot of luck with the combination of pramipexole 125-250mcg TID + aripiprazole 2.5mg QAM or 2.5mg x3/week in patients already on antidepressants. There is something of value in pursuing dopaminergic modulation in this population.”
Six items from the APA Annual meeting:
4. Polypharmacy also was addressed as to anxious depression [an entity, hopefully, that will move from its DSM-IV appendix status to be with other disorders in DSM-V]. Typically it has been associated with poorer treatment outcome compared to non-anxious depression. [We might add that there is some evidence that suicide is more common in anxious depression than pure MDD.] In fact, in most but not all studies, individuals with anxious depression were also found to be less likely to respond to antidepressant treatment than those without anxious depression, regardless of the t ype of antidepressant used. In addition, no significant differences in efficacy have typically been shown among
antidepressants of the same or different class, with the exception of a pooled analysis showing significantly higher rates of remission with a serotonin norepinephrine reuptake inhibitor compared to a selective serotonin reuptake inhibitor. Polypharmacy is used quite commonly to treat anxious depression. Although none of the following treatments have been approved for anxious depression, augmenting agents such as benzodiazepines, non-benzodiazepine hypnotics, anticonvulsants, atypical antipsychotics, and buspirone are common options. While logical that psychotherapy should be potent with anxious depression, even CBT studies are lacking.
5. A panel yesterday on GID virtually echoed the position WPS took earlier this year and summarized in the WPS newsletter this spring.
6. Following is a list, probably incomplete, of psychiatrists recognized for various accomplishments at last night’s APA Annual meeting convocation: Simon Auster, Boyd Burris, Irwin Papish, William Stockton, Glenn Miller, Robert Ursano, Charles Kaelber, Caroline DuPont, Michael Knable, Ellen Leibenhuft, Danny Pine, Rachel Ritvo, Art Stein, Carolyn Robinowitz, and Wil son Compton.
Two items from today’s NY Times:
1. Psychiatrist at Cornell, R.A. Friedman, had a column complaining that psychiatrists are too reluctant to use Li, implying that was true because Li was not marketed. [On a review of a County clinic’s records early this month, I found 42% of the pts had received a trial of Li recently. Maybe “town” is less Li-phobic than “gown.”]
2. A brief item headlined, “Small gifts found to influence doctor.” Actually the study was on medical students.
Roger |
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