Drug Classes

Lamotrigine Interactions: Practical Recommendations on Divalproex, Carbamazepine and Oral Contraceptives Use

James Phelps, MD Director Mood Disorders Program Samaritan Mental Health, Corvallis, OR.   There are two drug interactions with lamotrigine that must be managed with special care. When lamotrigine is added to divalproex and when lamotrigine is used with carbamazepine. If the patient is already on divalproex and you are adding lamotrigine, cut lamotrigine dose…

Read More

Antipsychotic-Induced Dystonia: Diagnosis and Management

Michael D. Jibson, MD, PhD Professor of Psychiatry Director of Residency Education University of Michigan   Acute dystonic reactions are associated with antipsychotic use, especially with high-potency first-generation antipsychotics. About 90% of these reactions occur either in the first four days of treatment or after an increase in dose. Risk factors include large muscle mass,…

Read More

Antipsychotics for Agitation: Differences Between Tablets, Orally Disintegrating Tablets and Sublingual Formulations

Michael D. Jibson, MD, PhD Professor of Psychiatry Director of Residency Education University of Michigan This presentation discusses how to prescribe oral antipsychotics for acute agitation (standard tablets, orally disintegrating tablets, and a sublingual formulation). Orally disintegrating antipsychotics (Abilify Discmelt, Zyprexa Zydis, Risperdal M-Tab) are not absorbed transmucosally, they have to be swallowed. Orally disintegrating…

Read More

Managing Geriatric Bipolar Disorder: Use of Lithium and Anticonvulsants

Sandra A. Jacobson, M.D. Research Associate Professor University of Arizona College of Medicine-Phoenix This presentation discusses selected concepts on the use of mood stabilizers in the elderly. Lithium serum levels are kept low (0.4 and 0.8 mEq/L), even for the treatment of mania in elders. Lithium should be dosed on a once nightly basis with…

Read More

Treatment-Resistant Depression: Augmentation with Second-Generation Antipsychotics (Aripiprazole vs Quetiapine)

Prof. Philip Cowen Professor of Psychopharmacology Department of Psychiatry University of Oxford, UK This presentation compares advantages and disadvantages of using quetiapine vs. aripiprazole as augmentation for treatment-resistant depression. It also addresses the common question of when to augment (antidepressant + SGA) vs. when to switch (prescribing a different antidepressant). Combination and Augmentation: Clarifying Concepts…

Read More

Inflammation and Depression: Use of Anti-Inflammatory Agents and The Role of Inflammatory Markers (CRP)

Prof. Philip Cowen Professor of Psychopharmacology Department of Psychiatry University of Oxford, UK This presentation summarizes recent findings on the role of inflammation in depression. A study suggests patients with elevated levels of inflammatory markers (C-reactive protein) have a differential response to a specific antidepressant. The efficacy of celecoxib and infliximab in treatment-resistant depression is…

Read More

Mirtazapine Essentials: MOA, Indications, Adverse Effects, Pharmacokinetics and Dosing

Author: Flavio Guzman, MD Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA), it doesn’t have effects as monoamine reuptake inhibitor. A significant feature is its effect as histamine 1 antagonist. This antihistamine effect is linked to sedation and weight gain. Mirtazapine is commonly used in the elderly population. In this group of patients…

Read More

Fluvoxamine Essentials: Mechanism of Action, Indications, Pharmacokinetics and Dosing

Author: Flavio Guzman, MD Besides being a SERT inhibitor, fluvoxamine is an agonist at sigma 1 receptors. The drug is approved in the US for the treatment of OCD but not depression. This is interesting as this is a widely used antidepressant in other countries. Fluvoxamine has the potential for drug-drug interactions through inhibition of…

Read More

Sertraline Essentials: Mechanism of Action, Indications, Pharmacokinetics and Dosing

Author: Flavio Guzman, MD Sertraline is a moderate inhibitor of CYP2D6. In terms of drug-drug interactions this is not as significant as with fluoxetine or paroxetine. It has a similar side effects profile to other SSRIs. The dosage range goes from 50 to 200 mg/day. Pharmacology and MOA   Sertraline is an inhibitor of the…

Read More

Antidepressant Discontinuation Syndrome: Diagnosis, Prevention and Management

Author: Flavio Guzman, MD Discontinuation symptoms can occur with all antidepressant classes, and you will see many articles referring to SSRI discontinuation syndrome. The reason is that SSRIs are by far the most commonly prescribed antidepressant class. This syndrome consists of usually mild and reversible symptoms that can be grouped into six categories. As a…

Read More