when antipsychotics aren’t antipsychotic (or, a multi-tiered fountain filled with rum)

July 14, 2007

The Last Psychiatrist has a very interesting post on how antipsychotics function at different doses. He/she uses the metaphor of a multi-tiered fountain (filled with rum) to talk about Seroquel: you fill the top (sedation) tier of receptors before you overflow into the antipsychotic tier of receptors. I.e., Seroquel is not an antipsychotic on lower doses.

Once the top tier is filled, you cannot fill it any more, which is why people on high doses of Seroquel are not asleep 24/7 but are getting other additional effects.

I don’t have the background knowledge to evaluate this claim independently, but I thought it was interesting enough to pass on, and if I get other confirming/disconfirming info, I’ll pass that along too.

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Suicide Attempts Decline After Depression Treatment, Study Finds

July 2, 2007

In a study of more than 100,000 patients treated for depression, suicide attempts declined during the first month of treatment–whether that treatment consisted of medication, psychotherapy, or both. The findings, published by Group Health researchers in the July American Journal of Psychiatry, show a similar pattern for populations of adolescents and young adults (up to age 24) as for older adults.

Suicide attempts, overall, are not raised by medication, either for adults or adolescents/young adults. Nonetheless, some people do become suicidal despite never having been so before. The prof suggests that this is due to subgroups (duh, some of the 30-40% of bipolar patients who get hypo/manic/mixed, but I wonder if there’s anyone else – maybe we’ll find out eventually).

I do wonder, though, if some of the improvement isn’t regression to the mean – people frequently don’t start treatment until they’re quite bad off, and mood episodes tend to pass with time.


manic mice? and circadian rhythms

June 25, 2007

Manic mice

Mice engineered to lack a specific gene showed behaviors similar to human mania in a study funded in part by NIMH; they were hyperactive, slept less, appeared less depressed and anxious, and craved sugar, cocaine and pleasure stimulation. The rodents’ behavior was more normal after lithium treatment or restoration of a functioning CLOCK protein, which the knocked-out gene codes for.

The article says this is similar to human mania, and it sounds like it’s similar enough to tell us useful stuff, although the mice don’t sound bipolar, just, as they say, behaving similarly to some aspects of manic humans.

The CLOCK protein is involved in circadian rhythms. And so here is some interesting stuff on circadian rhythms in bipolar disorder, and on how lithium works, from one of my favorite bipolar disorder sites, Jim Phelps’ Psych Education. Lots of science, lots of high-level information that isn’t very widely spread, and an excellent site for info on bipolar II in general and on anxiety in bipolar.


risperdal conditionally approved for some uses in youth

June 21, 2007

“[T]he approvable letter concerns treatment of schizophrenia in adolescents aged 13-17 and for short-term treatment of the manic phase of bipolar disorder among children and adolescents ages 10-17”.

I wonder what it’s conditional on.

This was going to be a longer post on kids and antipsychotics, but I got some very good news and am going to go celebrate instead.


results of 2003 antidepressant warnings

June 19, 2007

From Psychiatric News: Diagnosis, Treatment of Youth for Depression Fell After FDA Alert

It’s not just that children and adolescents are less likely to be prescribed SSRIs following the alert – it’s that they’re now less likely to be diagnosed and less likely to be treated at all (there has been no corresponding increase in psychotherapy, atypical antipsychotics, or anxiolytics).

You can view the original journal article here.

In the article they suggest it’s possible that in the wake of the recommendation families may not be fully disclosing symptoms, or filling prescriptions written for them.

They also note that the rates of diagnosis are lower than the published incidence rates (i.e. how many people get diagnosed if you go and look and see, instead of only diagnosing people who come to you). So it’s unlikely that we used to be overdiagnosing and overprescribing, and likely that we are now even further underdiagnosing and undertreating.