Several studies have suggested that lithium response has a genetic component. Whether someone with bipolar will respond to treatment with lithium seems to be strongly associated with the presence or absence of a family history of response to the medication. A recent article in the Lancet reports the results of a genome-wide association study of lithium response in 2563 patients collected …
Buprenorphine for Depression – A Combination Approach
While we were in the midst of a seeming epidemic of concern about opiate prescribing and possible overuse of opiates by physicians, it is ironic that we are also seeing a small stream of articles being published about the potential effectiveness of opiate agonists in treating patients with treatment resistant depression. I’ve been interested in this topic since Enoch Callaway, …
Lowering Medication Costs – Update
The New York Times recently reviewed two websites that offered to substantially reduce the cost of psychiatric medications for those without adequate insurance coverage. We’ve updated the section of this website that provides links to information about lowering the costs of medications and that mentions the option of purchasing medications from Canada as well as information about these two sites. …
Pramipexole in Unipolar and Bipolar Depression
For many years we’ve been impressed with the response in some patients with bipolar depression to relatively high doses of pramipexole. Pramipexole is an agent that enhances dopamine neurotransmission and has been approved for the treatment of Parkinson’s disease. There are relatively few medications that significantly affect dopamine, one of the three monoamine neurotransmitters associated with depression and pramipexole is …
Rapastinel for Depression
The U.S. Food and Drug Administration (FDA) has granted Breakthrough Therapy designation to rapastinel, which follows the medication receiving a 2014 Fast Track Designation from the FDA. Rapastinel, an investigational medication for adjunctive treatment of major depressive disorder, is an intravenous drug that is a novel NMDA receptor agonist. It is being developed by Allergan. The Breakthrough Therapy designation is a new …
Functional Brain Imaging and Antidepressant Response
One of the most exciting initiatives currently in the important area of the treatment of depression is the International Study to Predict Optimized Treatment in Depression (iSPOT-D). This large multi-center initiative is based on a private industry and academic partnership that is designed to both identify best practices in the treatment of depression and also commercialize them. The most recent publication from this …
SSRI Dose Response
It has long been unclear whether higher doses of SSRIs are associated with greater response. What has been clear is that higher doses are associated with significantly increased side effects. In fact previous research, whether individual studies or meta-analyses have failed to find a significant dose response with the result that many have felt that there is a flat dose response …
Oxytocin in Humans
The February 2016 edition of Biological Psychiatry focused on the neurohormone oxytocin and its effects on both normal and abnormal human behavior as well as its potential role in the treatment of psychiatric disorders. This is apropos given that oxytocin has been described as the “love hormone” and Valentine’s Day is right around the corner, but oxytocin is involved in …
Vortioxetine for Cognitive Impairment in Depression
Takeda and Lundbeck announced that the Food and Drug Administration (FDA)’s Psychopharmacologic Drug Advisory Committee (PDAC) voted to support the efficacy of vortioxetine (Brintellix) for treating cognitive dysfunction in adults with major depressive disorder (MDD). The advisory committee also reviewed evidence to suggest that cognitive dysfunction in people with major depressive disorder was an appropriate target for treatment. Several recent …
Benzodiazepines and Dementia
High use of benzodiazepines is not associated with an increased risk for dementia or Alzheimer’s disease according to a large prospective study published in the British Medical Journal. Previous research had suggested that there might be a link and we all know that single doses of benzodiazepines impair cognition and memory so it made sense that there might be such …