Helge Hasselmann
Drug treatment of refractory schizophrenia remains a major challenge, but clozapine continues to be gold standard
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Schizophrenia is a crippling condition that often (in about 20-30% of patients) shows an inadequate response to first-line antipsychotic drugs. Because it is associated with significant, often devastating reductions in quality of life, the management of refractory cases of schizophrenia represents a major challenge to psychiatry. As pharmacotherapy is the treatment of choice, stringent guidelines [read the full story…]
Recent review suggests Agomelatine is as effective as other antidepressants, but controversy persists
In spite of widely available different antidepressants, major depression does not respond adequately in up to one third of patients. Overall, the need for both reliable and well-tolerated treatment has remained unmet for a sizeable proportion of people with depression. In the past couple of years, there has been controversy about the suitability of Agomelatine (Valdoxan) [read the full story…]
Little differences among antidepressants regarding sexual dysfunction, but bupropion performs best
Antidepressant treatment is associated with a variety of side effects, including emotional changes, weight gain or fatigue. As pharmaceutical treatment has evolved, clinicians have become increasingly aware of another major adverse effect of modern antidepressants: sexual dysfunction. Current figures estimate that up to every second patient will, at some stage, experience reduced sexual function, which [read the full story…]
Lithium is less expensive than olanzapine in treatment-resistant depression, but has unclear clinical benefits
Treatment-resistant depression (TRD) still represents a challenge to psychiatric practice. Since patients have usually failed at least two antidepressants, drugs originally prescribed for other conditions are often tried as an augmentation (Souery er al., 2006). Amongst them, lithium (a mood-stabiliser used in the treatment of bipolar disorders) as well as atypical antipsychotics (AAPs, indicated for [read the full story…]
Largest RCT so far suggests that ketamine may be useful in the acute treatment of refractory depression
Major depression is a serious mental illness that often does not respond to mainstream drug treatment (antidepressants). In addition, there is usually a delay of 2-6 weeks before mood improves significantly. In situations like this, when at least two conventional antidepressants have been tried without success, depression is considered treatment-resistant. While multiple different strategies to [read the full story…]
New Cochrane review finds weak evidence that drug combinations are more effective than monotherapy in psychotic depression
Major depression remains a serious condition that often proves refractory to pharmacological or psychotherapeutic interventions. Because depression can have many “faces”, clinicians should be aware of the great symptom variability among depressed patients and consider subforms when prescribing medication. In a sizeable amount of patients (up to 25%, Coryell et al., 1984), depression presents with [read the full story…]
Newer antipsychotics may increase the risk of pneumonia in schizophrenia
Because of a more favourable side effects profile (not necessarily clinical superiority), second-generation antipsychotics (SGAs) are today the most commonly used drugs to treat psychotic disorders such as schizophrenia (Jones et al., 2006). While rather frequent adverse reactions, including weight gain, diabetes or sedation, are largely recognised, recent studies point at increased risk of pneumonia [read the full story…]
Common antidepressants associated with increased risk of postpartum haemorrhage
Postpartum haemorrhages are serious birth complications that represent one of the leading causes of maternal mortality and morbidity. While incidences of postpartum haemorrhages have risen steadily in the past decades (in the US alone, numbers increased from 2.3% to 2.9% from 1994 to 2006), there is little evidence as to why. Antidepressants – especially selective [read the full story…]
Tricyclic antidepressants are associated with higher risk of bone fracture
While most people would likely associate tricyclic antidepressants (TCAs) with more common adverse effects such as dry mouth, sedation and constipation, there is some evidence to suggest increased occurrence of bone fractures (Vestergaard, Rejnmark, & Mosekilde, 2006). However, the topic remains controversial and conflicting results about the association of TCAs and fracture risk abound (e.g. [read the full story…]
Observational study: antidepressant suicidality warnings may be counterproductive
Selective serotonin reuptake inhibitors (SSRIs) have long been suspected to – paradoxically- increase suicidal behaviour in adolescent and pediatric patients. Consequently, national watchdogs started issuing black label warnings for all SSRIs to educate physicians and patients about associated risks. While clearly curbing the amount of antidepressant prescriptions, concerns have been voiced that this step has [read the full story…]
