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:
- Benzodiazepines marketed in the 60s and 70s have been medication of choice for catatonia. At this annual meeting it was suggested that a newer benzodiazepine, zolpidem, may be effective.
- Olfactory refere nce syndrome is characterized by a fixed belief that one is emanating body odor despite evidence to the contrary. It has been classified as delusional disorder-somatic subtype (DSM-IV). The evidence from the world literature suggests, however, the response to antidepressants and to a lesser extent psychotherapy appears to be much better than antipsychotic drugs.
- Polypharmacy is the rule rather than the exception in the treatment of bipolar disorder, with the average patient prescribed between three and five different classes of medications at any given time. The complexity of symptoms in bipolar disorder – periods of depression, mania,=2 0hypomania, and mixed states; subsyndromal symptoms of both poles of illness; concurrent comorbid conditions such as anxiety, ADHD, and substance abuse; and the sensitivity of patients to psychosocial stress – makes it highly likely that multiple medication classes will be initiated during treatment. While the purpose for starting
medications is usually clear, the reason for continuing medications is frequently less certain; this is especially the case when the goals are relapse prevention and functional improvement. Since the illness is life-long, it was suggested that we test the need of the meds.
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 |
Having problems with message search?
Fill out this form to ensure your group is one of the first to be migrated to the new message search system.
Offline 
Send Email
