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.
The recent FDA approval of aripiprazole tablets with sensor met with a myriad of reactions, including concerns about patient privacy and autonomy. In this Perspectives article, authors from the FDA share insights as to the approval process and the many considerations involved in their decision to approve the product.
Older age, poor sleep, and the use of the "Z" sedative hypnotic drugs (eg, zolpidem) commonly go together. In this Clinical and Practical Psychopharmacology article, Dr Andrade discusses the findings and implications of a recent meta-analysis that focused on the risk of falls and fractures associated with these drugs.
It is important to highlight the significance of pharmacodynamics and pharmacokinetics in drug interactions. These interactions affect drug plasma concentrations and must be considered when a patient is taking more than 1 medication. Although in most cases the mechanisms of these interactions can be explained, some cannot due to unknown metabolic pathways, the mechanism of action of particular drugs on the body, and idiosyncratic drug reactions. Here, read about the authors' clinical experience with the concomitant use of olanzapine and cyclosporine A.
Psychopharmacotherapy is often shoehorned into a 15-minute session, or "med check," that inhibits the therapeutic alliance and frustrates both patients and clinicians. This ASCP Corner article delineates an "existential psychopharmacology" approach that emphasizes the need for human-to-human connection for successful medication treatment.
Cognitive impairments due to electroconvulsive therapy, traumatic brain injury, and neurologic and psychiatric disorders are prevalent. Could the galantamine-memantine combination significantly improve socio-occupational functioning in these patients? Read this narrative review to find out more.
Tablet splitting is common among patients on oral pharmacotherapy. But, does the practice of splitting tablets containing psychoactive medication for medical or economic reasons result in the expected doses? Read on to find out more.
Serotonin syndrome is a rare condition that can occur in patients taking certain serotonergic medications, and symptoms can range from mild to fatal. The authors of this article used 2 major databases to assess prevalence, incidence, and economic impact of serotonin syndrome with use of serotonergic agents. This study provides practical information to help you better understand the benefits and risks of prescribing serotonergic agents.
The history of lithium as a psychiatric medication is marked by its serendipitous discovery, lengthy path to US Food and Drug Administration approval, and controversy surrounding its current status in bipolar disorder treatment. Without doubt, the discovery of lithium as a psychotropic agent forever changed the course of psychiatry. The drug's fascinating, and sometimes contentious, history is reviewed here.
Many patients with major depressive disorder do not respond to initial treatment. Could buprenorphine be a promising candidate for treatment of depression in patients who do not respond to standard antidepressants? Read this case report to find out more.
In this installment of his Clinical and Practical Psychopharmacology column, Dr Andrade provides a meta-review of 6 meta-analyses examining the risk of autism spectrum disorder associated with use of antidepressants during pregnancy and considers whether maternal mental illness is a major determinant of that risk.
When addressing changes in symptom severity in patients with psychiatric disorders, it is important to consider psychosocial stressors before jumping to pharmaceutical interventions. Here, read 2 cases presented to illustrate this point
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.”