The first generation of antipsychotic medications, known as the typical antipsychotics, has demonstrated great effectiveness in treating a variety of mental health issues. Schizophrenia is the most frequent cause for the prescription of a typical antipsychotic. These typical antipsychotics also cause a variety of side effects, including sleep disturbances and movement disorders.

Tremors and loss of muscle tone can sometimes become so severe that patients have to discontinue treatment. More recently, the atypical antipsychotics have offered the same clinical results with fewer side effects. However, the side effects that can occur with this class of medications are troubling in their own right.

Although the reasons aren’t clear, atypical antipsychotics can lead to serious metabolic side effects. Prolonged use of these medications can result in obesity and even diabetes. Zyprexa (olanzapine) has the greatest risk of causing harmful metabolic effects. Previous research has indicated that a little-understood relationship between atypical antipsychotics, glucose, and insulin is responsible for weight gain and fat accumulation in those who take atypical antipsychotics.

At Penn State University, researchers conducted a study with live rats to better understand how and why antipsychotic medications lead to changes in human metabolism. One group of rats received daily Zyprexa for several weeks, while another group had a single, acute dose of the drug. The rats given the single dose exhibited an almost immediate drop in their activity levels, without a matching decrease in food intake.

In essence, these rats took in more nutrition than necessary. At the same time, significant changes to insulin meant that the extra calories were converted into fat stores. The acute responses were also observed in the chronically-dosed rats. Surprisingly, the rats did not all gain significant amounts of weight. Still, the body composition of these rats changed in drastic way whether they gained weight or not. Fatty tissue as a proportion of body weight increased steadily for the first three weeks of the study before plateauing. Similar effects have been observed in humans in small studies.

Measurable and significant weight gain is the primary concern when prescribing an atypical antipsychotic. It is arguably the most serious side effect, as increased body mass raises the risk of numerous chronic health problems. However, the rat study at Penn State showed that even without large weight gains, body composition can change in distinctly unhealthy ways. More fatty tissue leads to altered hormone levels and potentially more plaque in the blood stream. This study makes a strong case that patients taking atypical antipsychotics, especially Zyprexa, should have regular blood work to ensure healthy insulin and glucose levels.

References:

1. Albaugh, V.L., Judson, J.G., She, P., Lang, C.H., Maresca, K.P., Joyal, J.L, and Lynch, C.J. (2011). Olanzapine promotes fat accumulation in male rats by decreasing physical activity, repartitioning energy and increasing adipose tissue lipogenesis while impairing lipolysis. Molecular Psychiatry, 16, (5), 569-581.
2. Olanzapine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000161/

The benzodiazepines are a class of drugs typically prescribed for the treatment of anxiety or chronic seizure. They work by slowing the electrical activity in the brain, resulting in a sedative effect. Doctors may prescribe these drugs for brief or prolonged periods, or simply as needed—such as in the event of a panic attack. The potential adverse effects of benzodiazepines are fairly well understood by the medical community. People may experience drowsiness, headache, dizziness, and an unsteady feeling. High doses have an intoxicating effect similar to alcohol consumption.

However, the effect of chronic low doses of medications like Xanax (alprazolam) and Klonopin (clonazepam) on human tissue and organs is still to be determined. Previous studies have suggested that long-term administration of benzodiazepines may weaken the immune system, although no conclusive evidence of such a link exists.

A clinical experiment with rats tested the effects of Klonopin and Xanax on stressed and nonstressed male rats. The stress procedure involved confining the rats to a small mesh cage for 2.5 hours each morning. Some rats received Klonopin, some Xanax, and others only a control solution of distilled water. The study continued for four weeks, after which the rats were euthanized and the clinicians carefully examined them. The research team was most interested in the health of the immune system, and they primarily investigated lymph glands and blood cell counts. The findings have implications for the treatment of anxiety in humans.

Both stressed and nonstressed rats showed immune system deficits after treatment with either Klonopin or Xanax. Rats treated with Xanax demonstrated the most serious deficits, possibly because of the medication’s unique chemical structure. Because of the experimental design, researchers were able to distinguish between immune deficiencies caused by stress alone and those caused by medication. Nonstressed, medicated rats showed less decline than their stressed counterparts, but the decline was still clinically meaningful. It’s worth noting also that these rats received relatively low doses of medication. Continued administration beyond four weeks might reveal even more profound immune system effects.

These results argue for more caution when prescribing anti-anxiety medications. Both Xanax and Klonopin appear to degrade the immune system in distinct ways. Overall, Klonopin’s effects were less severe than those of Xanax, but were still worrisome. Patients with already compromised immune systems may want to avoid this class of medications if possible. Otherwise, Klonopin may be the safest choice. In addition, short-term use of the drug is definitely preferable to a long-term prescription.

References:

1. Elmesallamy, G. E., Abass, M. A., Refat, N., and Atta, A. H. (2011). Differential effects of alprazolam and clonazepam on the immune system and blood vessels of non-stressed and stressed adult male albino rats. Interdisciplinary Toxicology, 4(3), 132-143.
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Alprazolam. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000807/

Obsessive compulsion (OCD) can begin with obsessive, irrational thoughts and fears. These irrational thoughts are followed by ritualistic actions, such as repetitive hand washing, door closing, or gestures. These rituals are the means to cope with the intrusive, irrational thoughts, but instead a vicious cycle is set into motion. Severe OCD can completely disrupt an individual’s life and also affect family and friends, as they watch their loved one become more and more consumed by compulsive behaviors.

The exact cause of OCD is unknown and may be different for each individual, but a deficit of the neurotransmitter serotonin has been identified as a likely culprit. Treatment for OCD involves both intensive cognitive behavioral therapy and high doses of antidepressant medications. Specifically, drugs belonging to the selective serotonin reuptake inhibitor (SSRI) class have shown success in achieving remission for individuals with OCD.

Luvox (fluvoxamine) is an SSRI but is structurally quite different from other drugs in the class such as Paxil (paroxetine) or Prozac (fluoxetine). Currently, it is the preferred treatment option for people with OCD. Interestingly, studies have shown that the action of Luvox and other antidepressants in treating OCD is completely independent of depression. In other words, a person with OCD need not be depressed to benefit from Luvox treatment.

Other studies have suggested that Luvox improves the response to behavioral therapy. This shouldn’t be surprising, as nearly all psychiatric conditions benefit from a multipronged treatment approach. Luvox is also safe and well-tolerated. Another antidepressant, Norpramin (desipramine), may actually be slightly more effective than Luvox, but it carries a greater risk of side effects.

With OCD, dosages near the high end of the safety guidelines are necessary to achieve improvement and eventual remission. Recently, a new, extended-release formulation of Luvox has been developed that may be well suited to the treatment of OCD. The dosage of the immediate-release formulation must be gradually increased, thereby delaying the positive effects. The extended-release version, on the other hand, offers a much faster onset of symptom improvement.

Concentrations of medication in blood plasma are a reliable indication of drug concentrations in the brain. Blood plasma measurements have confirmed that the Luvox extended-release formula achieves an effectiveness threshold much faster than the standard, immediate-release formulation. With its combination of fast action and safety, Luvox extended-release may soon be the first-line treatment for adults with moderate or severe OCD.

References:

1. PubMed Health. (n.d.). National Center for Biotechnology Information. Fluvoxamine. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
2. Ordacgi, L., Mendlowicz, M. V., Fontenelle, L. F. (2009). Management of obsessive-compulsive disorder with fluvoxamine extended release. Neuropsychiatric Disease and Treatment, 5, 301-308.

Generalized anxiety (GAD) is the most commonly diagnosed form of anxiety among adults. Symptoms of GAD include excessive worry or fear that interferes with daily life. For younger adults, a wealth of data exists showing the effectiveness and safety of Lexapro (escitalopram) in treating GAD. However, far less information exists regarding treatment outcomes for older adults.

Surveys indicate that at least 7% of adults in residential living centers undergo treatment for GAD. Those living on their own may experience GAD at an even greater rate. The elderly population as a whole experiences mood problems at a disproportionately higher rate. In addition, the elderly often have comorbid conditions such as dementia or major depression. For these reasons and others, elderly individuals with GAD often respond poorly to treatment. A study published in the Journal of the American Medical Association shed light on the question of whether Lexapro is a good choice for older adults, but still there are more questions than answers.

Study authors recruited 177 subjects aged 60 years or older with confirmed diagnoses of GAD. Approximately half of the participants received a 12-week treatment with Lexapro, while the remainder received placebo. A variety of psychological tests were administered to gauge response to the treatment. Self-reporting also weighed heavily in the final results.

Because adverse effects represent a potentially more serious concern among older adults, vital signs were taken at regular intervals. At the end of the 12-week study, the Lexapro group showed significant improvement in GAD symptoms. Side effects were mostly minor and included fatigue and sleep disturbances. Regular checks of vital signs confirmed that Lexapro caused no cardiac anomalies for any of the participants.

Among the interesting findings from this study is the observation that Lexapro only separated itself from placebo at week 4. This finding highlights the fact that adherence to a treatment regimen is an essential, but sometimes neglected, component of generating benefits for the individual. Geriatric individuals are in fact more likely to miss doses or stop taking medication entirely, especially if 2 or 3 weeks pass with no changes to their anxiety. Add to this circumstance the fact that elderly people often have additional diagnoses and decreased cognitive functioning, and this population becomes far more at risk.. Primary care physicians must be sure to emphasize the slow-acting nature of Lexapro as they screen the elderly for anxiety problems.

Reference:

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
2. Jenze, E. J., Rollman, B. L., Shear, M. K., Dew, M. A., Pollock, B. G., Ciliberti, C., Constantino, M. (2009). Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. Journal of the American Medical Association, 301(3), 295-303.

A study sponsored by the University of Chicago will test the effectiveness of Lexapro (escitalopram), a selective serotonin reuptake inhibitor (SSRI), in the treatment of borderline personality (BPD). As an SSRI, Lexapro belongs to the most commonly prescribed class of antidepressant medications. In recent years, the use of antidepressants has expanded to include chronic pain conditions, irritable bowel syndrome, and other mental health issues distinct from depression. In the current study, researchers intend to show that antidepressants can reduce thoughts of self-harm in individuals with BPD. The study is currently recruiting male and female subjects aged 18 to 40 years who have not taken an SSRI in the last two months.

As a mental health condition, BPD has not always been taken seriously. Many therapists simply viewed people with borderline personality issues as difficult cases, rather than examples of a specific but little-understood condition. People with borderline often respond poorly to traditional therapies, perhaps leading to the damaging stigmatization of BPD (Kernberg and Michels, 2009). Recently, however, BPD is among the most intensely studied personality issues.

While there are still more unknowns than knowns, the recognition of BPD as a legitimate condition with both a biological and psychiatric basis is firmly established. Approved treatments include customized cognitive behavioral therapy, anti-anxiety medications, and in some instances, low doses of antipsychotic medications. An ideal, one-size-fits-all approach has yet to be discovered. Because of the variable manifestations of the condition, such an approach may not even exist.

Self-loathing, self-harm, and thoughts of suicide are unfortunately quite common in people diagnosed with BPD. The University of Chicago study will include a placebo control group and an experimental group. Both groups will undergo eight weeks of treatment, with the experimental group receiving 10 to 20 milligrams of Lexapro.

The primary outcome measure for the study will be self-harm ideation; researchers expect the experimental group to report far fewer thoughts of self-harm. A second outcome measure will be symptoms of depression. The study’s recording methods will consist of electronic diaries for each participant and weekly therapeutic interviews.

Despite mountains of research and clinical investigations, there is still a long way to go in the treatment of BPD. Therapists are in search of methods that ensure long-term improvement in patients’ symptoms. Even today’s best interventions often only deliver short-term success. Because the risk of self-harm and suicide is so very real in this population, the University of Chicago Study will hopefully offer insight into reducing these outcomes.

References:

1. Kernberg, O., & Michels, R. (2009). Borderline personality disorder. The American Journal of Psychiatry, 166(5), 505-508. Retrieved May 25, 2012, from the ProQuest database.
2. Selective Serotonin Reuptake Inhibitors (SSRIs) in Borderline Personality Disorder – Full Text View – ClinicalTrials.gov. (n.d.). Home – ClinicalTrials.gov. Retrieved May 25, 2012, from http://clinicaltrials.gov/ct2/show/NCT01103180?cond=%22Personality+Disorders%22&rank=11

Major depressive disorder (MDD) is a mental health problem with both psychological and physical effects. Someone diagnosed with depression may have strong feelings of sadness or a loss of interest in normal activities; physical symptoms may include lethargy, body pains, insomnia, and headaches. Despite decades of research and study, fast and effective treatment for depression remains an unfulfilled goal. Currently, the preferred approach for depression treatment begins with cognitive behavioral therapy and may include one or more psychotropic medications. 

Suicide risk is a serious complicating factor in the treatment of major depressive disorder, and choosing the appropriate drug intervention remains a haphazard procedure. Because many antidepressants are potentially linked with a heightened risk of suicidal behavior, doctors must exercise caution. Response to psychotropic drugs, particularly antidepressants, is highly individual. A period of trial and error is often necessary before doctors can identify the optimum drug or drug combination. In cases of possible suicidal thoughts and behavior, the best course of action is often observation, possibly in an inpatient facility.

A recently completed study at the New York State Psychiatric Institute promises to offer some guidance in the selection of treatment for severely depressed individuals with suicidal tendencies. The study consisted of two groups, one receiving Paxil (paroxetine) and the other receiving Wellbutrin (bupropion). The choice of these specific drugs was deliberate: Paxil belongs to the selective serotonin reuptake inhibitors (SSRI) category and is among the most frequently prescribed antidepressants; Wellbutrin is a non-SSRI medication with a different mechanism of action. However, both medications still carry the “black box” warning to notify doctors and pharmacists of potentially dangerous side effects, namely the increased suicide risk. A second aspect of the study included functional MRI scanning of each participant’s brain—once at the beginning of the 8-week trial and once more at the conclusion. Participants were given a cognitive task during the scan to assess how each of them processed sensations of reward.

The initial phase of the study is complete. Data on the 125 participants is currently being compiled and analyzed. Researchers hope that one of the drugs will reveal itself as a more effective remedy for major depression, although they may find that one of the drugs leads to a higher rate of side effects. In any event, the data from this study will help attending physicians and therapists make better choices when treating their most severely depressed patients.

References:

1. Bupropion, t. c. (n.d.). WELLBUTRIN XL® (bupropionhydrochloride extended-release tablets). DailyMed. Retrieved July 18, 2012, from http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=14812
2. Depression (major depression). (n.d.). Mayo Clinic. Retrieved July 18, 2012, from http://www.mayoclinic.com/health/depression/DS00175
3. Paroxetine/Bupropion in Suicide Attempters/Ideators With Major Depression. (n.d.). ClinicalTrials.gov. Retrieved July 18, 2012, from http://clinicaltrials.gov/ct2/show/NCT00429169?recr=Open&intr=%22Bupropion%22&rank=16

A nationwide study will determine if Abilify (aripiprazole) has the potential to relieve the involuntary muscle movements, or tics, commonly associated with Tourette’s syndrome. Children aged 7 to 17 years old will be recruited for the study, with completion set for August 2013. To be eligible, participants must have a diagnosis of Tourette’s syndrome and tics severe enough to disrupt daily activities. Exclusion criteria include pregnancy, obsessive-compulsive disorder, mood disorder, suicidal thoughts, or another diagnosed mood disorder. As with most clinical trials, researchers have designed the criteria to isolate the condition (Tourette’s) and the intervention (Abilify) to the fullest extent possible.

Participants will be placed into one of four treatment groups. In group one, participants will receive a placebo pill that is indistinguishable from Abilify. Groups two through four will each receive various dosages of the study drug. Doses will be administered once weekly for a period of eight weeks. The Yale Global Tic Severity Scale will be employed at the beginning and end of the study to quantify any symptomatic changes. Study authors believe that both the study drug and experimental procedures represent little or no safety risk to participants. However, parents or guardians must provide informed consent before enrollment.

According to the National Library of Medicine, Abilify belongs to a class of medications known as atypical antipsychotics. Originally, these medications were developed as replacements for the first generation of antipsychotic drugs. Although schizophrenia and other psychotic disorders were the impetus behind the creation of these drugs, research in the last twenty years has revealed that Abilify, and drugs like it, can have beneficial effects on a number of mental health conditions. Abilify works by altering the level of certain chemicals in the brain, and doctors know that Tourette’s syndrome results from an imbalance of brain chemicals. These chemicals, known as neurotransmitters, are responsible for the regulation of mood and movement, among other things. It is believed that Abilify may restore some degree of balance for those experiencing disruptive tics because of Tourette’s syndrome.

Abilify continues to show promise as a multipurpose psychotropic medication. So far, it’s been used to treat bipolar disorder, severe depression, and aggression in autistic children. In cases of severe depression, Abilify is often combined with a standard antidepressant medication. Tourette’s syndrome only affects a small percentage of individuals, but those with severe symptoms often have trouble navigating in daily life. It is hoped that Abilify, combined with various modes of therapy, will improve their experience.

References

1. Aripiprazole – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/
2. Efficacy & Safety Study of Once-weekly Oral Aripiprazole in Children and Adolescents With Tourette’s Disorder. (n.d.). ClinicalTrials.gov. Retrieved June 22, 2012, from http://clinicaltrials.gov/ct2/show/NCT01418352?intr=%22Aripiprazole%22&rank=8
3. Gilles de la Tourette syndrome – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001744/

Bipolar disorder actually refers to a group of mental health conditions that feature alternating and unpredictable mood states. These conditions are sometimes referred to in terms of the “bipolar spectrum.” Mania, an intensely elevated or euphoric mood, and depression are the mental states typically associated with bipolar disorder. Doctors classify the various subtypes of this disease based upon the severity and occurrence pattern of mania and depression. Bipolar II disorder, for example, entails a higher rate of major depressive episodes, with relatively few instances of mania. Appropriate treatment for all forms of bipolar disorder involves regular cognitive therapy sessions and mood stabilization via pharmaceutical interventions. Doctors may prescribe an indefinite course of psychotropic medications to prevent a patient from lapsing into either depression or mania.

The antidepressant medication Prozac (fluoxetine) is part of a typical treatment plan for those suffering from bipolar II disorder. Prozac works by altering the ratio of certain chemicals within the brain. Rigorous testing has confirmed that this medication is both safe and effective, with relatively minor side effects in most patients. The current guidelines for bipolar II treatment recommend discontinuing Prozac within several weeks of depression remission, because clinicians suspect that prolonged antidepressant therapy may trigger a manic state. The mood stabilizer lithium is therefore preferred for long-term maintenance therapy. A team of clinical investigators set out to challenge the notion of Prozac’s danger, testing Prozac against lithium in a double-blind, placebo-controlled study in a group of individuals with bipolar II disorder.

All participants in the study had recently recovered from a depressive episode with the assistance of Prozac. One group was switched to lithium, one to placebo, and one continued on Prozac. Participants were blind to their treatment condition, and the study moved forward for 50 weeks. Psychiatric interviews and patient self-reporting helped pinpoint relapse events and overall mental health status. The results of the study were surprising even to the researchers. Those taking lithium were 2.5 times more likely to relapse than those taking Prozac. Similarly, the time to relapse, when it did occur, was far longer with Prozac than lithium. Most importantly, episodes of mania in the Prozac group were not significantly greater than either the placebo or lithium group.

Conventional wisdom argues against maintenance treatment with antidepressants for bipolar individuals. However, recent study results have challenged that wisdom, at least in the case of bipolar II disorder. For those suffering from this variety of the disease, long-term treatment with Prozac appears to be safe and effective for both preventing relapse and staving off manic episodes.

References

1. Amsterdam, J.D. & Shults, J. (2010). Efficacy and safety of long-term fluoxetine versus lithium monotherapy of bipolar II disorder: a randomized, double-blind, placebo-substitution study. American Journal of Psychiatry, 167, (7), 792-800.
2. Fluoxetine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/

People battling cancer often experience fatigue and low energy levels, despite getting adequate rest. Fatigue is one of the largest negative impacts on a cancer patient’s quality of life. In fact, in some surveys, patients identify fatigue as a more bothersome effect of cancer than pain. Treating the secondary effects of advanced disease, including fatigue, is one of the main goals of modern cancer research. Lifestyle interventions, such as physical exercise or group therapy, have yet to demonstrate significant improvement in terms of patient fatigue levels. Pharmaceutical approaches may be most effective in reducing cancer-related fatigue.

Ritalin (methylphenidate) is generally prescribed for attention deficit disorder in children and narcolepsy in children and adults, and it’s available in both immediate and sustained release formulations. There is conflicting evidence as to whether Ritalin might be useful in reducing cancer-related fatigue. While some studies have shown significant improvement in cancer patients’ quality of life after taking this medication, others have produced negative or insignificant results.

With cancer, researchers sometimes have difficulty separating the effects of an experimental treatment from a patient’s routine treatment. The most recent study of Ritalin and cancer fatigue, conducted in part by the Mayo Clinic, showed no significant improvement for all but the most serious cases of tiredness. Participants were placed into drug or placebo groups and administered identical tablets for three weeks. Fatigue and quality of life surveys were conducted at regular intervals. As with all drug research, however, primary effect is not the only consideration; adverse effects must be considered and carefully weighed against the desired outcome.

In the Mayo Clinic study, participants receiving daily sustained-release Ritalin reported nervousness and loss of appetite at a rate far greater than the placebo group. Patients with Stage III or IV cancer and severe fatigue showed the most significant improvement, but they also experienced the most adverse events. Whether or not the potential benefits outweigh risks must be decided on a case-by-case basis. Researchers acknowledged that perhaps immediate release Ritalin could offer greater benefit, and future investigations may take up this line of reasoning. As for now, a non-pharmaceutical approach to managing cancer-related fatigue may still be the safest alternative in most instances.

Fatigue, sleepiness, and even depression often linger for months or years after cancer has gone into remission. In many cases, the effects of cancer treatments are so damaging to healthy cells that full recovery is an uphill struggle. Currently, there is no overwhelmingly effective approach to reducing fatigue in cancer patients and survivors. Ritalin might be useful in advanced stages of the disease, but more study is needed to be certain.

References

1. Methylphenidate – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 16, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/
2. Moraska, A.R., Sood, A., Dakhil, S.R., Sloan, J.A., Barton, D., Atherton, P.J., Suh, J.J. et al. (2010). Phase III, Randomized, Double-Blind, Placebo-Controlled Study of Long-Acting Methylphenidate for Cancer-Related Fatigue: North Central Cancer Treatment Group NCCTG-N05C7 Trial. Journal of Clinical Oncology, 28, (23), 3673-3679.

When assessing a patient for major depressive disorder (MDD) and choosing the most appropriate course of treatment, personality type is a major consideration. Research has demonstrated that people with high levels of neuroticism and/or low levels of extraversion often respond less well to treatment and have higher relapse rates. Briefly, neuroticism is a personality trait that includes a tendency toward negative emotions and emotional instability. Extraversion, on the other hand, describes a tendency toward positive feelings, including but not limited to higher levels of socialization and self-confidence. A recent study published in the Archives of General Psychiatry examined the links between personality type, cognitive therapy, and the antidepressant medication Paxil (paroxetine).

In multiple studies of the drug Paxil, participants who showed significant improvement in their depression also reported greater feelings of confidence and liveliness. The authors of these studies generally describe these personality changes as effects of the overall improving mood of the patients. A more recent study ponders whether selective serotonin reuptake inhibitors (SSRI) medications, Paxil in this case, do in fact work to change personality states resulting in a lessening of depressive symptoms. The study was broken into three groups: a placebo group, a therapy group, and a group receiving Paxil. Depression and personality ratings were gathered from each participant at regular intervals throughout the 16-week study.

As many previous studies have shown, even people receiving placebo showed noteworthy improvement in their depression. However, the personality trait scores underlined a potentially significant fact. Neuroticism and extraversion were both relatively unchanged in the placebo group, while those receiving Paxil or cognitive therapy showed improvement in both of these key areas. This suggests that Paxil may work to alter personality traits on the molecular level. Cognitive therapy also led to decreased neuroticism and increased extraversion, but the reasons for these changes are not as clear. What is clear is that these personality changes predict a better long-term outcome for patients and a lower chance of relapse.

The lesson from this research is that clinicians should be mindful of specific personality traits when treating an individual with MDD. Paxil, and possibly all of the SSRI medications, may work to improve depression on a more fundamental level than anyone realized. The data has always been there, in a sense, but perhaps the interpretation was lacking. As researchers unlock the mysterious relationship between moods and chemical neurotransmitters, more specifically targeted drugs will be developed. Furthermore, as the early warning signs of depression—neuroticism, low extraversion—are better identified, interventions will be possible to prevent this debilitating mental health condition before it occurs.

References

1. Depression (major depression) – MayoClinic.com. (n.d.). Mayo Clinic. Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175
2. Tang, T.Z., DeRubeis, R.J., Hollon, S.D., Amsterdam, J., Shelton, R., & Schalet, B. (2009). A placebo-controlled test of the effects of paroxetine and cognitive therapy on personality risk factors in depression. Archives of General Psychiatry, 66, (12), 1322-1330.

As an illegal psychostimulant drug, cocaine has ravaging effects both on the individual user and on society as a whole. The addictive qualities of cocaine are well-documented, and users often persist in their abuse despite one negative consequence after another. The search for effective, reliable treatments for cocaine addiction is ongoing. Recently, the antipsychotic drug Abilify (aripiprazole) has shown some potential as a treatment both for those currently addicted to the drug and those in the recovery stages. A pair of experiments with mice demonstrated that Abilify blocks some of the positive, rewarding effects of stimulant drugs while also reducing the odds of relapse.

In the earlier mouse study, Abilify reduced “self-administration” of cocaine in mice. As the dosage of Abilify was increased, the effect was more pronounced. At the same time, the mice did not seem to “overcome” the effects of Abilify by administering higher doses of cocaine. Researchers believe that part of this medication’s action on the cellular level actually negates the action of cocaine and possibly other stimulants. Another positive aspect of Abilify is that it seems to lack any obvious rewarding qualities of its own. The mice did not self-administer more Abilify in lieu of cocaine, an important quality that enhances its potential as a treatment for drug-addicted humans.

A later study examined whether Abilify could reduce relapse of cocaine addiction. In this experiment, mice were presented with the opportunity to self-administer cocaine after a 2-week period of withdrawal from the drug. Mice that had been given scheduled doses of Abilify showed far less potential for relapse. Apparently, the medication establishes a kind of “blockade” around the receptor sites to which cocaine typically attaches. This revelation is important for those who work directly with individuals in the field of drug addiction.

Addiction to cocaine and other stimulants continues to be a public health epidemic. Researchers are on a quest to discover effective pharmaceutical treatments for addiction. Because of repeated successful trials, low incidence of side effects, and generally high tolerability, Abilify has been identified as a potentially very useful tool in the battle against psychostimulant addiction. Abilify both reduces the immediate reward effects of cocaine and reduces the odds of relapse during the recovery phase. As a supplement to group counseling or talk therapy, treatment with Abilify may give recovering addicts a powerful advantage in their struggle to restore normalcy in their lives.

 References

• Feltenstein, M. W., Do, P. H., See, R. E. (2009). Repeated aripiprazole administration attenuates cocaine seeking in a rat model of relapse. Psychopharmacology, 207, 401-411.
• Sorensen, G., Sager, T. N., Petersen, J. H., Brennum, L. T., Thogersen, P., Bengtsen, C. H., Thomson, M., … Woldbye, D. P. D. (2008). Aripiprazole blocks acute self-administration of cocaine and is not self-administered in mice. Psychopharmacology, 199, 37-46.

Most classes of antidepressant medications, including the selective serotonin reuptake inhibitors (SSRIs), are thought to require 2 or more weeks of use before therapeutic effects become noticeable. The consumer guidelines for a drug like Celexa (citalopram) clearly advise patients not to expect immediate benefits but to continue taking their medication as prescribed. However, a recent study has cast doubt on the notion that SSRIs really take weeks to build up to therapeutic levels. If the results are confirmed with subsequent experiments, then our understanding of these medications will be greatly enhanced. Observing the neurochemical mechanism behind specific SSRIs will naturally lead to more beneficial prescribing patterns and better patient outcomes.

In a study of the SSRI Celexa, 26 participants were given either a single dose of the drug or a dose of placebo, a harmless sugar pill. None of the participants had depression, a fact which allowed researchers to study specific physiologic responses without interference. Three hours later, participants were shown images of frightened faces while brain activity in their amygdala was measured via magnetic resonance imaging. Psychiatrists have theorized that hyperactivity in the amygdala is a measurable effect of depression that places the individual in a constant state of heightened anxiety. In the single-dose Celexa study, participants given medication showed a muted response in their amygdala when viewing frightened or anxious faces. Researchers observed a spike in amygdala activity in those who received placebo. These findings demonstrate that potentially therapeutic effects begin as quickly as a few hours after the first dose of Celexa, and by extension any SSRI. Interestingly, none of the participants reported either a change in mood or unusual side effects. The study authors theorize that the action on the amygdala has both immediate benefits on an unconscious level and longer term effects on anxiety.

Depression is often described as a constellation of symptoms and effects. Because of its many manifestations, the disease is a long way from being fully understood. There is currently no fool-proof, one-size-fits-all treatment for depression. Research on antidepressant medications like Celexa helps us identify what’s happening in the depressed brain. Armed with that knowledge, we can tailor more effective medications in the future. The study under discussion, for example, highlights the possibility that Celexa’s beneficial effects begin with the amygdala, the brain’s primitive fear center. More importantly, these effects begin almost immediately, contrary to previous assumptions.

References
Murphy, S., Norbury, R., O’Sullivan, U., Cowen, P., Harmer, C. (2009). Effect of a single dose of citalopram on amygdala response to emotional faces. British Journal of Psychiatry, 194(6), 535-540.