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The Carlat Guide to Medications Used for Insomnia

This handy table lists the medications most often used to treat insomnia.

Sleeping Pills: Which Ones for Which Patients? [Subscribers Only]

Insomnia

Insomnia is one of the most common comorbidities you’ll see in your depressed and anxious patients. But it is often misunderstood. While the common view is that insomnia is caused by a primary psychiatric or medical condition, it is more accurate to simply say that patients have insomnia and depression at the same time. Insomnia is almost never an isolated problem.

Cognitive Deficits in Schizophrenia

In what ways, if any, are cognitive problem a distinct feature of schizophrenia? And how can we use this information to guide treatment?

Latuda: “Procognitive” or Pro-Profit? [Subscribers Only]

Lurasidone (Latuda) was approved by the FDA for schizophrenia in October 2010 and is the 10th atypical antipsychotic in our toolbox. The key question is: does lurasidone have any advantages over existing agents, or is it just another “me-too” drug?

Long Acting Injectable Antipsychotics: A Primer [Subscribers Only]

They used to be called “depot” antipsychotics, but the powers that be have renamed them “long acting injectables” (LAIs), presumably to help remove some of the stigma associated with their use. But no matter what you call them, suddenly every drug company is racing to introduce its own LAI neuroleptic.

Saphris and Fanapt: Two New Antipsychotics

You've probably heard about Fanapt (iloperidone) and Saphris (asenapine), two antipsychotics that have recently won FDA approval for the acute treatment of schizophrenia, and, in the case of Saphris, for the treatment of manic and mixed episodes of bipolar disorder. Are these more “me too”...

Typical Antipsychotics: A Brief Review

Those of us who completed residency anytime during the last 10 years were indoctrinated against the use of conventional neuroleptics because of their array of side effects, particularly extrapyramidal syndromes (EPS) and tardive dyskinesia (TD).

The CATIE Trial: The Story is in the Dosing

Few clinical trials have ever generated as much buzz as the series of trials known as CATIE. CATIE stands for “Clinical Antipsychotic Trials of Intervention Effectiveness,” and is the only set of trials ever done comparing the major second-generation antipsychotics. And because CATIE is funded entirely by NIMH, its results are thought to be quite trustworthy (NEJM 2005;353:1209-1223).

Do Second-Generation Antipsychotics Treat Depression? An Update

In this article, guest author Dr. Shalom Feinberg, takes a hard look at the most recent data on the effectiveness of SGAs for depression in its various guises, including treatment-resistant depression (TRD) and bipolar depression (BD).

Invega: Can You Say "Patent Extender?"

Janssen’s marketing team apparently missed the fact that the word in the English language that sounds most like “Invega” is “inveigle,” meaning “to entice, lure, or ensnare by flattery or artful talk or inducements” (www.dictionary.com). You may have already heard some “artful talk” from your Janssen reps, who are keen to have you convert your patients from Risperdal to Invega. Will you be doing your patients a favor by taking the plunge? Or will you simply be giving them the same wine in a fancier bottle?

Antipsychotic Updates

Here is some selective coverage of interesting recent developments in antipsychotic medications.

Introducing...Fanapta!

You’ve probably heard about Fanapta (iloperidone), a new antipsychotic marketed by Vanda Pharmaceuticals. No, it hasn’t been approved officially yet, but it is likely to win approval in July, and the company has already been taking out teaser ads in the journals and has even sponsored a touring promotional CME program run by Stephen Stahl.

Prescribing Atypical Antipsychotics: What are the Risks?

Over the past several years, the use of antipsychotics has expanded dramatically. Aside from the traditional indication, schizophrenia, various members of this class have received FDA approval for bipolar mania, bipolar depression, major depression, and autism, and increasingly they are used off-label for anxiety, insomnia, and agitation. As with any type of medication that becomes popular quickly, unforeseen side effects have emerged, some minor, others serious. In this article we will briefly review some of the more serious potential risks.

Prescribing Atypical Antipsychotics: What are the Risks?

Over the past several years, the use of antipsychotics has expanded dramatically. Aside from the traditional indication, schizophrenia, various members of this class have received FDA approval for bipolar mania, bipolar depression, major depression, and autism, and increasingly they are used off-label for anxiety, insomnia, and agitation.