This report describes an unusual case of severe depression that developed as a result of a series of neurologic insults, starting with a stroke that was followed by a rare form of seizures, lateralized periodic discharges. Read on to find out more.
Besides congenital malformation, what other risks might be associated with antiepileptic drugs during pregnancy? In this article, Dr Andrade discusses the results of a recent network meta-analysis evaluating outcomes such as fetal loss and preterm birth associated with use of various antiepiletic agents.
Could electroconvulsive therapy have beneficial effects on sleep? This study looked at combination therapy with venlafaxine and ECT in a depressed elderly population—read the article to see whether ECT helped with their sleep-related symptoms.
Which antiepileptic drugs present the greatest risks during pregnancy? In this installment of Clinical and Practical Psychopharmacology, Dr Andrade looks at the evidence to determine the drugs associated with the greatest potential danger to the fetus, as well as the ones that seem to pose no added risk.
Lamotrigine is recommended for use in the maintenance treatment of both bipolar I and bipolar II disorders. Because of its low teratogenic risk and relative safety during lactation, lamotrigine was used in 3 women with bipolar II disorder to see if postpartum depression could be prevented.
Baclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit
To the Editor: Dr Andrade’s analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that “individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers” and that “baclofen may be particularly useful in patients with liver disease,” deserves comment.1
First, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282; 320 patients, as with Bacloville), was negative (see Braillon et al2).
Second, Dr Andrade should have warned readers that Bacloville’s results are most questionable, lacking robustness. Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team was changed when data were sold to the French pharmaceutical company applying for the marketing authorization in France. As Ronald H. Coase warned, “If you torture the data long enough, it will confess.”