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GLG News by this Author

The Selegiline Patch: Will MAOI Treatment of Depression Return?

April 3, 2006

Analysis of:FDA Panel Backs Selegiline Patch For Depression: Majority view 20-mg formulation as safe. | www.clinicalpsychiatrynews.com

The option of having an MAOI in the pharmacologic armamentarium for treating major depression, without dietary worries, would likely bring the selegiline patch moderate success (assuming, of course, FDA approval), though given the growing number of pharmacologic options, its market-share would likely be limited. Unless, of course, the data bears more robust results as have been shown in the orally ingested MAOIs. What is appealing about the selegiline patch is that, should no dietary requirements be warranted, it would re-introduce the “MAOI pathway” as a treatment alternative which has long since fallen out of favor.

Quetiapine for Bipolar Depression

April 3, 2006

Analysis of:A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or | ajp.psychiatryonline.org

This is a very significant study in a clinical population where treatment strategies are still limited and fraught with clinical dilemmas. One such problem is adding an antidepressant to an existing mood stabilizer(s), which risks activating certain patients into mania or rapid-cycling states. Treating Bipolar depression with a medication such as quetiapine that might also have a protective effect against mania (“treatment from below”) represents a new paradigm in treating Bipolar Disorder and evidently would be of enormous clinical value. The use of lamotrigine in treating Bipolar depression is growing, though its slow rate of titration due to the risk of a life-threatening rash makes its use in more severely acute depressions less than optimal.

FDA Issues Public Health Advisory for Paxil Use in Early Pregnancy

April 3, 2006

Analysis of:Paroxetine HCl - Paxil and generic paroxetine | www.fda.gov

Paxil’s increased risk of fetal malformations and change to Category D status in pregnancy will likely lead to its more limited use in woman of child-bearing age, especially if they are considering pregnancy at some point soon. Though still widely prescribed by both the primary care community as well as by psychiatrists, this narrows the population that might be amenable to the use of Paxil. In addition to its shorter ½-life (and therefore its often more significant discontinuation syndrome), this is another development that distinguishes Paxil more negatively than its counterpart SSRI’s.

Buprenorphine (Subutex) Shows Robust Benefits for Opioid Detoxification in Adolescents

April 3, 2006

Analysis of:Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled t | archpsyc.ama-assn.org

While opioid dependence in adolescents may represent a narrower population as compared to the categories of mood disorders, ADHD, and anxiety disorders, this is a growing population for which there are no well-established treatments. That the Subutex arm was so robustly more effective across the outcome measures of treatment retention and transition into relapse prevention treatment is extremely encouraging for its use as a primary detoxification drug in adolescent opioid dependence.

Stathmin: A New Genetic Target for Conditioned Fear and Anxiety

April 3, 2006

Analysis of:Stathmin, a Gene Enriched in the Amygdala, Controls Both Learned and Innate Fear. | www.cell.com

While this is a basic science study in knockout mice, there is considerable excitement that the study’s findings may represent the first major step of a revolutionary breakthrough in understanding anxiety and fear, and may lead the way toward new drug therapies for a host of mental disorders over the next decade. Collaborating on the study were neuroscientists from Columbia, Rutgers, Harvard, and Albert Einstein (including Nobel Prize winner Eric Kandel). While drug therapies based on this research would be a long way off in the future and require much further research, including its applicability to humans, it seems likely that stathmin will fuel its own research and investment industry because the implications are quite profound

Aripiprazole Well-Tolerated in Children and Adolescents at Adult Doses

April 3, 2006

Analysis of:Tolerability of Aripiprazole in Children and Adolescents with Major Psychiatric Diagnoses. | www.medpagetoday.com

The use of aripiprazole is very rapidly growing in the adult population, largely due to its favorable metabolic side effect profile, especially around weight gain. If its clinical utility and safety is established in children and adolescents, of which this study represents an important step, the impact would be enormous. Already, child and adolescent psychiatrists are turning to aripiprazole as a first-line agent, despite its off-label use, because the side effects from other antipsychotic and antimanic drugs can be so damaging and profound.

Pregabalin : A New and Effective Approach for Treating Generalized Anxiety Disorder

April 3, 2006

Analysis of:Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, place | archpsyc.ama-assn.org

Notwithstanding the fact that pregabalin is a drug made by behemoth Pfizer, there are many clinical features to this drug that make it a potentially high impact drug in psychiatry and even primary care circles - and advantageous over the highly prescribed class of benzodiazepines - in the treatment of GAD and possibly other anxiety disorders. However, it is not clear where the FDA stands presently after its September 2004 denial.

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