Dosage guidelines for new pharmaceutical products are typically based on strictly controlled clinical trials that may not represent every possible patient or situation. In practice, physicians often find that dosages must be raised or lowered to achieve ideal efficacy. Geodon (ziprasidone), an atypical antipsychotic, is one such example of a psychotropic medication for which recommended dosing and real-world practice do not always agree. The use of Geodon with schizophrenia patients is well documented, and dose levels are equally well understood. With bipolar disorder, however, the picture is not as clear. Best practices for prescribing Geodon to individuals with bipolar are still being determined.

Several studies have proven that Geodon brings about significant and remarkable rapid improvement in manic or psychotic symptoms of bipolar. The current clinical guidelines suggest beginning with a daily dose of 80 mg, then stepping up to a dose ranging from 120 to 160 mg. There is compelling evidence, however, that initializing treatment with a high dose of Geodon, rather than the “step up” approach, leads to better outcomes and a greater likelihood that the individual will stay the course. As with many psychiatric disorders, patients with bipolar often neglect to stick with their medications. When symptoms can be improved more rapidly, patients have immediate motivation to follow their prescriptions more strictly.

A study in Korea assessed the response of individuals with bipolar to varying dosages of Geodon over a 6-week period. Some individuals were started at a low dose and then stepped up, while others began treatment at the higher dosage. The results demonstrated that patients who began with the higher dosage had better remission of bipolar manic symptoms and scored better at the end of treatment on a variety of psychological wellness tests. Furthermore, there was no significant difference between the groups in terms of side effects or withdrawal from the study. These results strongly suggest that there is no benefit to beginning treatment at a lower dose, despite recommendations from the drug maker.

Geodon belongs to the class of atypical antipsychotics, but its activity on the neurochemical level is unique among its peers. Because of its unique properties, Geodon is effective in the treatment of a variety of mental illnesses, and it is considered relatively safe and well tolerated. The drug’s usefulness in treating bipolar is still somewhat unknown. Research in Korea and elsewhere, however, has shown that starting individuals with bipolar who are experiencing manic symptoms on a relatively high dose of Geodon is a feasible first-line treatment.

References

1. Woo, Y. S., Bahk, W., Jo, S. H., Yoon, B., Lee, J. G., Kim, W., et al. (2011). Effect of initial ziprasidone dose on treatment outcome of Korean patients with acute manic or mixed episodes. Psychiatry Investigation, 8, 207-213.
2. PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Ziprasidone. Retrieved March 10, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001070/

Several research studies have investigated the possibility that the antidepressant medication Luvox (fluvoxamine) could be an effective therapy for alcoholism. Most of the studies involved rats, but researchers consider the results applicable to humans as well. Despite the enormous public health burden of alcoholism, treatments for the disease are still well behind the curve. The rate of successful remission and abstinence is low, regardless of treatment plan. Comorbid disorders such as severe depression or anxiety further complicate matters and increase the likelihood of eventual relapse. Adequate treatment usually requires a combination of approaches—cognitive therapy for treatment of mood disorders, pharmaceuticals for managing alcohol withdrawal and cravings, and ongoing counseling to reduce the chances of a return to drinking.

A study with lab rats revealed that Luvox potentially reduces the response to food, or alcohol, or both, depending upon the experimental conditions. The goal of the study was to determine if Luvox might reduce the craving for alcohol, but the results were not conclusive in that regard. Significant changes in stimulus response were recorded even at very low doses of the medication. When food and alcohol were presented together, rats treated with Luvox responded less to food but maintained the same consumption of alcohol. However, presenting one stimulus and then another in sequence had differential effects. Responses to the second stimulus, regardless of whether it was food or alcohol, were decreased in the presence of Luvox. The temptation has always been to link all reward-seeking behaviors into a single category. Studies like the above, however, demonstrate that food-seeking and drug- or alcohol-seeking are biologically distinct events. The intricate and complex workings of such behaviors are still largely mysterious.

Due to uncertainties in its effectiveness for the purpose, Luvox is unlikely to play a role in the reduction of alcohol cravings. The rat studies returned mixed or confusing results, and no human trials have demonstrated a predictable, reliable mechanism of action. At this time,  there  isn’t enough evidence to conclude that the medication can successfully manage alcohol cravings. However, Luvox is effective in treating the depression and anxiety that accompany the recovery process after alcoholism. As a safe and effective mood stabilizer, Luvox reduces the chances of relapse. When Luvox is combined with cognitive therapy, a person recovering from alcohol addiction has a high likelihood of achieving a healthy outcome.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluvoxamine. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
2. Ginsburg, B. C., Lamb, R. J. (2006). Fluvoxamine effects on concurrent ethanol- and food-maintained behaviors. Experimental and Clinical Psychopharmacology, 14(4), 483-492.

Major depressive disorder (MDD) is more prevalent in the pediatric population than previously believed. According to some estimates, between 2% and 8% of children and adolescents have mood disorders. Depression in childhood often predicts recurrent episodes of depression later in life. This population is also at heightened risk of psychiatric disorders, substance abuse, social maladjustment, homelessness, and criminality. Clearly, depression in young people is not a problem that can be safely ignored. Early therapeutic intervention is essential and usually consists of cognitive-behavioral therapy and medication. Currently, the only antidepressant medication approved for use in children and adolescents is Prozac (fluoxetine). However, the lasting effects of Prozac exposure during youth are still not completely known. Conventional wisdom suggests that the benefits of treatment likely outweigh long-term risks, particularly in cases of MDD.

The adolescent brain, just like the adolescent body, experiences profound and rapid development. Chemicals in the brain called neurotransmitters direct cellular and structural growth throughout the brain, and this process gives rise to the adult brain: a well-regulated, stable organ that manages consciousness and the central nervous system. During the period of rapid growth, any disruptions or chemical stimuli can lead to functional changes later in life. For this reason, antidepressant use in childhood has come under great scrutiny. Prozac alters the balance of neurotransmitters in the brain. Some have argued that Prozac exposure during adolescence may result in lasting, even permanent behavioral changes. Researchers conducted a controlled experiment with adolescent rats to address some of these issues.

Rats given Prozac during adolescence displayed significant behavioral changes when tested as adults. For example, they showed less response in a forced-swim test and more response to anxiety-producing situations, such as a new environment. The increased anxiety was reduced by a second exposure to Prozac. Most disturbingly, sexual behavior in adulthood was impaired by Prozac taken during adolescence. This finding was completely unexpected. However, the researchers cautioned that the relationship between brain development and behavior is enormously complicated, and the current study only highlights this complexity. How much of these results translate to humans is also an open question. Rats are typically used in these studies because they mimic human physiology and neurobiology. Still, the underlying mechanisms of behavior are not well understood.

The adolescent rat study, among others, adds powerful evidence to the argument that Prozac initiates profound changes in the brain. These changes manifest themselves as behavioral and mood alterations. Human research is necessary to determine the scope of these alterations. As it stands, prescription of this antidepressant for children with MDD is still warranted.

References

1. PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluoxetine. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/
2. Iniguez, S. D., Warren, B. L., Bolanos-Guzman, C. (2010). Short- and long-term functional consequences of fluoxetine exposure during adolescence in male rats. Biological Psychiatry, 67(11), 1057-1066.

Traumatic brain injury (TBI) represents a uniquely challenging medical condition. Repair of the physical, emotional, and cognitive damage is a long and often grueling process. In the wake of brain injury, patients often experience amnesia, altered consciousness, and profound confusion. Many of these symptoms mirror the psychotic states of schizophrenia; however, the root causes of these symptoms are, of course, quite distinct. Still, it’s not an uncommon practice for attending physicians to prescribe antipsychotic drugs such as Haldol (haloperidol) for TBI patients who exhibit aggression or restlessness. This practice is not without controversy, as several studies have shown that psychotropic medications, especially the typical antipsychotic drugs, may slow recovery from brain injury. A study published in Life Sciences adds even more compelling data to the argument against antipsychotic drugs for patients with TBI.

In a study of brain recovery rates under different conditions, a small group of rats were subjected to a controlled brain injury. The control group was anesthetized but no surgery was performed. The rats were further divided into three distinct groups. One group received a regular dose of Haldol, another received Risperdal (risperidone, an atypical antipsychotic), and a third group received neither drug. All the rats were given daily assessments of motor skills, reflexes, and cognitive functioning. Because antipsychotic drugs have a sedative effect, the drugs were only administered after each day’s performance testing. This is an important distinction because previous studies often gave drugs before testing, potentially skewing the results. Researchers sought to uncover any ill effects from these medications independent of sedation.

Although the sample size of this particular study was small, the results were quite significant. Regardless of whether the rats were given Haldol or Risperdal, their performance tests showed a slower rate of improvement than their unmedicated counterparts. They were slower to regain reflexes and slower to make their way through a specific kind of maze. It was previously argued that the newer so-called atypical antipsychotic drugs like Risperdal might be a better choice for aggressive or psychotic TBI patients. This study argues that there is no significant difference between the older and newer drugs. What does that mean for humans with brain injuries? In a nutshell, these results argue for avoidance of antipsychotic medications while recovering from TBI unless absolutely necessary.

References
Hoffman, A., Cheng, J., Zafonte, R., Kline, A. (2008). Administration of haloperidol and risperidone after neurobehavioral testing hinders the recovery of traumatic brain injury-induced deficits. Life Sciences, 83(17-18), 602-607.  doi: 10.1016/j.lfs.2008.08.007

Irritable bowel syndrome (IBS) is a relatively common condition that results in abdominal discomfort, bloating, diarrhea, and constipation. According to the Mayo Clinic, IBS develops more often in women than in men and is also more likely to develop before the age of 35. Unlike other diseases that affect the intestines, IBS causes no permanent damage and does not appear to increase the risk of colon cancer. Mild and moderate cases of the condition can often be managed with lifestyle changes rather than medication. In more severe cases of IBS, certain prescription medications have been shown to reduce symptoms and improve quality of life.

Tricyclic antidepressants, the so-called first generation of antidepressant medications, have for years been prescribed to people with serious cases of IBS. There are several competing theories as to why these medications work so well for this condition. On the one hand, tricyclics have pain-relieving properties as one of their secondary effects. Less pain may lead a patient to report symptomatic improvement, particularly if pain was his or her dominant complaint. Another theory maintains that IBS is somehow linked with depression, and a reduction in the symptoms of depression may simultaneously reduce symptoms of IBS. The connection between mental state and IBS is not well understood and demands further research. Yet a third theory maintains that tricyclics alter the way the brain processes nerve signals from the intestines. This may lead to a more relaxed colon or less urgent or painful feelings when having a bowel movement.

Clinical researchers in Belgium surmised that newer antidepressant medications might be just as effective against IBS as the older tricyclics, with potentially fewer adverse effects. They conducted a trial with Celexa (citalopram) to determine its usefulness in managing IBS symptoms. Celexa belongs to the class of antidepressants known as selective serotonin reuptake inhibitors. What little research has been done on these medications and IBS has been promising. An earlier study showed that Celexa works to relax the colon shortly after food consumption, a possibly therapeutic action for anyone with IBS. The most recent study involved a crossover design with a placebo-controlled group. After an initial treatment period, the groups switched places for a second treatment period. Participants kept daily journals of their symptoms, and examinations during the trial provided empirical data. The results were significant but not as informative as the team had hoped. Celexa did lead to improvement of many symptoms but not bowel regularity. Interestingly, most participants reported a much improved sense of well-being that did not always match their objective symptom improvement. This suggests that Celexa’s psychotropic properties may have as much to do with its effectiveness on IBS patients as anything else.

Other studies with a similar approach have produced mixed results. The lesson here, according to the researchers, is that the emotional health and well-being of IBS patients cannot be neglected. A pharmaceutical solution is often sought when lifestyle changes and talk therapy might be more beneficial without the risk of side effects.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Citalopram.  Retrieved March 10, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001041/
2. MayoClinic.com. (n.d.). Irritable bowel syndrome. Retrieved March 13, 2012, from http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106
3. Tack, J., Broekart, D., Fischler, B., Van Oudenhove, L., Gevers, A.M., Janssens, J. (2006). A controlled crossover stud of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome. Neurogastroenterology, 55, 1095-1103.

Probation officers assume a large level of responsibility for the offenders in their care and the community at large. They are responsible for monitoring criminal offenders and assessing what level of risk they pose to the general public. When offenders commit an infraction, such as a technical violation of not meeting the conditions of their probation, it is up to the probation officer to manage that infraction and ultimately decide the consequence. Individuals who struggle with mental health issues such as depression, schizophrenia, and bipolar account for a large percentage of offenders. Unlike offenders with substance abuse problems, the main cause of reincarceration for mentally ill offenders is a technical violation, not a new criminal offense. Research has shown that in fact, mentally ill offenders are just as unlikely to commit a new offense as are offenders with no history of mental illness or drug abuse. But unfortunately, mentally ill offenders are monitored more closely and assessed more harshly than substance abusing offenders.

Jennifer Eno Louden of the Department of Psychology at the University of Texas recently conducted a study to better evaluate the conditions by which probation officers assess and manage mentally ill offenders. Her goal was to determine whether these offenders were being unfairly assessed, resulting in increased rates of reincarceration. Louden enlisted 234 probation officers and presented them with probation violation scenarios committed by a mentally ill offender, an offender with substance use issues, an offender with both problems, and an offender with neither. She evaluated their risk assessments and management recommendations and found that even though statistics show substance users as more likely to engage in violent acts, the officers rated the mentally ill offenders as being 13% more likely to commit acts of violence.

The primary risk management strategy recommended by the officers was forced psychological treatment, usually in the form of medication. Although mental health treatment is not a negative recommendation, forcing the treatment is seen as a cause for concern. For these individuals, many of whom have schizophrenia, the negative side effects of medication can cause more harm than good. The goal of treatment was not helping the offenders address their mental health problems but rather managing their behavior; however, it did not help them decrease their chance of reoffending. Louden believes this study demonstrates the need for further training and education for probation officers who work with mentally ill offenders. She said, “By targeting interventions away from a sole focus on mental disorder toward robust predictors of recidivism, real improvements can be made in the criminal justice outcomes for offenders with mental disorders.”

Reference:
Eno Louden, J., Skeem, J. L. (2012). How do probation officers assess and manage recidivism and violence risk for probationers with mental disorder? An experimental investigation. Law and Human Behavior. Advance online publication. doi: 10.1037/h0093991

Despite decades of research and several new classes of antidepressant medications, successful treatment of depression is still an elusive goal. In particular, people with major depressive disorder (MDD) often fail to respond to the first line of treatment or relapse after a short period of recovery. The search for new therapies and combinations of therapies is ongoing. Recently, the antipsychotic medication Abilify (aripiprazole) has been prescribed as a secondary treatment for MDD patients, often with positive outcomes.

Originally designed as a treatment for symptoms of schizophrenia and other psychotic disorders, Abilify’s usage has expanded widely in just a few years. Now, doctors are prescribing this medication for conditions ranging from bipolar disorder to certain forms of autism. Like all psychotropic medications, Abilify works by altering the balance of chemicals in the brain called neurotransmitters. Several of these neurotransmitters, including serotonin and dopamine, are largely responsible for a person’s emotional state. Abilify has demonstrated great potential to stabilize emotional states for a wide variety of patients. This includes the capacity to reduce anger and aggressive outbursts, which is why its original usage was for psychotic patients.

In 2007, the Food and Drug Administration approved Abilify as a supplementary treatment option for patients with MDD who were already following a course of traditional antidepressants. Several clinical trials and controlled experiments have demonstrated that Abilify may offer a “boost” to the mood stabilizing attributes of antidepressants. At the same time, Abilify may work to offset some of the more unpleasant side effects of these drugs, such as sexual dysfunction.

In addition to its effectiveness as a supplementary therapy, clinical trials and tests indicated that Abilify is a relatively safe and well-tolerated medication in depressed patients. The most commonly reported side effect associated with the medication was restlessness. Rarely was this side effect bothersome enough to cause the patient to discontinue taking Abilify.

Millions of people experience the debilitating symptoms of depression every day. Nevertheless, a reliable cure or even a more effective treatment for depression is likely still many years away. Because the brain is the body’s most sophisticated organ, understanding how best to restore the proper neurochemical balance is difficult. Discovering the most successful early treatment options is therefore important in reducing relapse and improving long-term outcomes.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Major depression. Retrieved February 20, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/
2. Pae, C., Forbes, A., & Patkar, A. A. (2011). Aripiprazole as adjunctive therapy for patients with major depressive disorder. CNS Drugs, 25(2), 109-127.

Making a diagnosis of generalized anxiety is sometime a tricky proposition. Anxiety has many manifestations as well as many underlying causes. Anxiety may be chronic and always at the edge of a person’s consciousness or the condition may flare up in acute episodes called panic attacks. Appropriate treatment is essential and typically involves a mix of cognitive-behavioral therapy, pharmaceuticals, and careful follow-up by the treating physician. Xanax (alprazolam) is currently one of the preferred medications for dealing with many anxiety-related psychological illnesses. Anxiety should not be ignored, as the effects of nervous tension and fear include a decrease in quality of life, along with possible secondary effects such as high blood pressure.

Researchers in the Netherlands recently tested a model for understanding the nature of anxiety in humans. At the same time, the experiment highlighted the effectiveness of certain medications at reducing some aspects of anxiety. Specifically, these researchers used the startling effects of white noise and electric shocks to induce surprise or fear in the subjects. In addition to Xanax, subjects were given Lyrica (pregabalin), diphenhydramine (a common sedative ingredient in over-the-counter cold remedies), or placebo. Individual anxiety levels were measured through subjective reporting and a number of objective tests, including eye movements, pupil dilation, and skin conductance. The design of the experiment included random shocks and noises, both with and without prior warning.

As expected, shocking events preceded by a warning produced less anxiety than those that came by surprise. Both Xanax and diphenhydramine reduced overall levels of anxiety but for very different reasons. Whereas Xanax works by altering certain neurotransmitter levels, diphenhydramine has a more general, systemic effect. Surprisingly, subjects given Lyrica showed very little modulation of their anxiety levels. Researchers surmised that because Lyrica takes longer (up to 6 hours) to reach peak effectiveness, the experiment wasn’t capturing an accurate picture of events.

This experiment confirmed that Xanax is effective at reducing one manifestation of anxiety: the so-called “fear-potentiated startle response.” However, the results were less informative about anxiety in general than the researchers had hoped. The sample size was too small to uncover any new revelations about the nature of human anxiety. Ideally, research will one day make the work of quickly and accurately diagnosing anxiety disorders much easier and more straightforward.

References
Baas, J., Mol, N., Kenemans, J. L., Prinssen, E. P., Niklson, I., Xia-Chen, C., et al. (2009). Validating a human model for anxiety using startle potentiated by cue and context: the effects of alprazolam, pregabalin and diphenhydramine. Psychopharmacology, 205, 73-84.

Major depression continues to be one of the most common and debilitating chronic mood problems afflicting adults. According to the Mayo Clinic, there is no quick fix for those who have this disease. Appropriate treatment includes a long process of psychotherapy, lifestyle changes, and medication. Recently, several studies have indicated that the antidepressant drug Paxil (paroxetine) may increase the risk of suicidal thoughts or even attempted suicide in certain patients. As a member of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), Paxil is one of the most frequently prescribed treatments for depression on the market. The concern over suicide has led researchers to look back at previous studies in an attempt to reassess both the effectiveness and the safety of this particular medication.

Researchers studied the results of 40 double-blind, placebo-controlled clinical trials of Paxil. As a whole, the trials included nearly 7,000 adult participants, most of whom were diagnosed with either moderate or major depression. In a typical clinical trial of a medication, participants who leave the trial early are not taken into account; their data are incomplete and inconclusive. For the present review, however, researchers considered early withdrawal to be an indicator of either ineffective treatment or adverse effects. Surprisingly, the same proportion of trial participants left their respective studies early, regardless of whether they were taking placebo or Paxil. One would expect that more of those taking Paxil would remain in the study, but the numbers tell a different story. The researchers point out another flaw in depression research in general—the dependence on rating scales rather than overt and empirical evidence. Because depression is a psychological illness with few, if any, quantifiable symptoms, gauging its severity becomes very subjective.

When researchers pooled the results from all 40 trials together, the beneficial effects of Paxil were significant but only marginally more significant than placebo. If 100 patients are treated with Paxil, then an average of 53 of them will have a positive response, compared with 42 for placebo. In essence, this medication performs only 11% better than a sugar pill. When researchers considered the potential adverse effects of Paxil, including suicidal tendencies and attempted suicides, the picture became even murkier. Of all the SSRIs, Paxil has been shown to produce the greatest spike in suicidal thoughts, especially in young adults and adolescents.

The researchers conclude that the fields of psychology and pharmacology are in need of better experimental design. They argue that current designs overstate the effectiveness of antidepressant medications while simultaneously downplaying adverse effects. For Paxil at least, a closer look at a large cross-section of data reveals that it may not be quite as effective as once thought. As always, doctors should carefully screen their patients before prescribing any antidepressant medications. Any hint of suicidal tendencies argues against its prescription.

References

1. Barbui, C., Furukawa, T.A., Cipriani, A. (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. Canadian Medical Association Journal, 178(3), 296-305.
2. MayoClinic.com. (n.d.). Depression (major depression). Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175

For combat veterans, posttraumatic stress disorder (PTSD) is an all too common psychiatric condition. The symptoms of PTSD include high anxiety, a heightened state of arousal, aggression, and sleep disturbances. Many with PTSD report feelings similar to combat situations, as if they never really left the battlefield. When it is accompanied by moderate or major depression, those with PTSD are notoriously unresponsive to traditional therapies and medications. Self-injurious and self-destructive behaviors, even psychotic behaviors, are not uncommon events for the most severely affected veterans. Finding new and better treatment protocols is therefore essential.

Recent research indicates that Abilify (aripiprazole), a relatively new antipsychotic medication, may represent a moderately more successful approach for treating PTSD and major depressive disorder in veterans. Study authors performed a retrospective review of veterans’ charts to determine what effect, if any, the introduction of Abilify had on these patients’ PTSD and depression scores. A total of 27 charts were analyzed. Many of these patients were also receiving traditional antidepressants, anti-anxiety medications, or psychotherapy. All consented to participate in research on the use of Abilify to manage their symptoms. Most had shown very little or no response to their prior courses of treatment.

The study consisted of a 12-week trial of Abilify, with regular monitoring for side effects or improvements in mood. The overall positive response rate, both in terms of PTSD and depression, were rather low. At the end of 12 weeks, about 20% of these veterans showed significant improvement in their depression. Likewise, 37% showed improvement in their PTSD symptoms. These are not excellent results, but historically this population has been very resistant to most clinical approaches. Any improvement over failed techniques is worthwhile, and even small improvements to quality of life are deemed worth pursuing. Furthermore, Abilify has no potential for abuse and relatively few side effects. It is much better tolerated than many of the traditional antidepressants and anti-anxiety medications.

PTSD makes readjustment to civilian life an uphill battle for many veterans. Too many find themselves in a cycle of fear, self-loathing, anger, depression, and substance abuse. Abilify, originally developed as a first-line treatment for schizophrenic patients, has shown the potential to ease the symptoms of PTSD in at least some of these veterans. More research is needed, but the outlook is promising.

References
Richardson, J.D., Fikretoglu, D., Liu, A., McIntosh, D. (2011). Aripiprazole augmentation in the treatment of military-related PTSD with major depression: a retrospective chart review. BMC Psychiatry, 11, 86.

Abilify (aripiprazole), manufactured by Bristol-Myers Squibb, was approved for use by the U.S. Food and Drug Administration in 2002. An antipsychotic medication, Abilify has shown noteworthy success in treating the symptoms of schizophrenia. Since its introduction, this medication has also been used for easing manic depression in adults. In people who have not responded well to traditional antidepressants, Abilify is sometimes prescribed as a secondary, additional treatment. As a result of increasingly diverse uses, this medication has entered the top 15 in terms of total drug sales. Like all psychotropic drugs, Abilify works by altering the levels of certain chemicals in the brain called neurotransmitters.

Determining the toxic dose of any new medication is essential in developing appropriate safety guidelines. According to the authors of a study published in Clinical Toxicology, “Limited data exist describing the characteristics of [Abilify] poisonings” (Young et al., 2009). Part of the reason for such limited data is undoubtedly the newness of the medication itself. In an effort to fill in these gaps in knowledge, researchers performed an analysis of Abilify overdose events recorded in the California Poison Control Center database. They excluded cases where the record was not sufficiently complete or other substances were ingested along with Abilify. After eliminating such results, researchers were left with 286 usable cases.

Slightly more than half of these cases were female, and the overall median age was about 19 years. The youngest recorded overdose patient was 6 months old. Researchers divided the cases into three distinct age groups (0-6, 7-17, 18+ years) to determine whether there might be an age-related response to Abilify overdose. A standard dosage for this medication depends a great deal on the individual case; however, dosage typically starts at 2 mg for pediatric patients and can increase to 15 mg for adults. It should be noted that Abilify is not prescribed for children less than 13 years old (PubMed Health, 2011). Researchers also placed each case into a group based on dosage level. Group 1 consisted of doses less than 20 mg. In group 2, dosage ranged from 21 to 90 mg. All doses of 91 mg or higher fell into group 3.

Results of the analysis showed that out of 286 cases, 128, or nearly half, showed no symptoms whatsoever. For those who did report symptoms, drowsiness was the most common complaint, followed by nausea/vomiting, muscle twitch, and tremors. In no case was the overdose considered life threatening, and none of the patients appeared to have experienced permanent effects. For adults, only those in dosage group 3 (91 mg+) were statistically likely to experience symptoms. In pediatric cases, symptoms presented themselves even at the group 2 level. In 176 cases of overdose, no treatment was required other than observation. When treatment was administered, activated charcoal given orally was the most common course of action.

While this was only one study of one database, the data seem to indicate that Abilify is not an especially toxic medication. However, the effects of overdose vary from person to person, and underlying conditions may play a role in an individual’s response. As always, keeping medications in a secure location and following dosage instructions to the letter are essential safety measures.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Retrieved February 19, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/
2. Mayo Clinic. (n.d.). Dystonia. Retrieved February 19, 2012. Available from: http://www.mayoclinic.com/health/dystonia/DS00684
3. Young, M. C, Shah, N., Cantrell, F. L., Clark, R. F. (2009). Risk assessment of isolated aripiprazole exposures and toxicities: a retrospective study. Clinical Toxicology, 47, 580-583.

Adderall (dextroamphetamine and amphetamine) is one of the preferred treatment options for adults with attention-deficit hyperactivity disorder (ADHD). The medication works by increasing an individual’s ability to pay attention and control impulsive behaviors. In people without ADHD, abuse of Adderall generates a euphoric sensation, included elevated feelings of confidence and power. When taken as prescribed, Adderall carries a risk of several unpleasant side effects. These include difficulty sleeping, nervousness, restlessness, and headache. Chest pain, rapid heartbeat, and shortness of breath are all signs of a potentially serious condition, warranting immediate medical attention.

Although the risk is small, there have been several documented cases of young people experiencing sudden heart attacks after taking Adderall without a prescription. The dosages were not especially high in many of these cases. In one such example, a young male suffered an acute heart attack after ingesting 30 mg of Adderall and drinking an unspecified amount of alcohol. He had no history of heart abnormalities. Still more troubling, cardiac events are possible even in the absence of abuse. A 15-year-old boy in otherwise good health experienced a heart attack in response to his usual dose of Adderall. He fully recovered, and terminating the prescription removed any signs of heart irregularities. Doctors are not certain what causes these effects in people. Currently, there’s no test to determine who will or will not develop cardiac side effects when taking Adderall. The best practice right now is to monitor an individual’s symptoms closely and intervene at the first sign of trouble. In addition, a history of heart issues may argue for a treatment plan that does not include a powerful stimulant like Adderall.

The extended-release formulation of Adderall was removed from the Canadian market for several years out of concerns about heart attacks and rampant abuse of the medication. It was eventually reintroduced with stricter guidelines for attending physicians. As always, those who abuse prescription medications like Adderall face far greater risks of dangerous, even lethal, side effects. Heart rhythm problems and heart attacks are the most troubling potential consequences of Adderall abuse. Even those who take the medication according to a doctor’s prescription face the small but real threat of cardiac problems. As research into ADHD and stimulant medications continues, safer drugs and drugs less prone to abuse will most likely be introduced.

References:

1. Centers for Disease Control and Prevention. (n.d.) Facts about ADHD. Retrieved from http://www.cdc.gov/ncbddd/adhd/facts.html
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
3. Jiao, X., Velez, S., Ringstad, J., Eyma, V., Miller, D., Bleiberg, M. (2009). Myocardial infarction associated with Adderall XR and alcohol use in a young man. Journal of the American Board of Family Medicine, 22(2), 197-201.
4. Sylvester, A.L., Agarwala, B. (2012). Acute myocardial infarction in a teenager due to Adderall XR. Pediatric Cardiology, 33(1), 155-157.