Excessive salivation is a common and troubling adverse effect of clozapine therapy, occurring in about 30% of patients. Recently, Israeli researchers evaluated another potential treatment, metoclopramide (Reglan), which is a drug for nausea and other gastrointestinal problems. Since metoclopramide commonly causes dry mouth, the authors of this paper reasoned that it might work for clozapine-induced hypersalivation.
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Skin picking disorder is a compulsive behavior affecting 5% of people. N-acetylcysteine is an antioxidant that increases glutamate, and studies have shown that it is effective for excoriation’s sister disorder, trichotillomania (hair pulling). These data prompted investigators to try N-acetylcysteine in the treatment of SPD.
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When patients become severely suicidal, we have few good treatment options. Recognizing the need for more options, Israeli researchers studied the use of very low doses of buprenorphine in suicidal patients. Patients with suicidal ideation were recruited from four medical centers.
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In the summer of 2011, the Food and Drug Administration (FDA) reported that post-marketing surveillance showed that patients taking greater than 40 mg/day of citalopram were at greater risk of QT prolongation. Shortly thereafter, the Department of Veterans Affairs (VA) alerted its providers to this warning. VA researchers recently published a study detailing the results of this warning on patients.
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Dr. Vivien Burt discusses mood disorders and pregnancy. It’s now pretty widely recognized that pregnancy does not protect against mental illness, and the postpartum period is certainly a time of very high vulnerability for women, especially if they’ve had a history of psychiatric illness.
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We’ve been hearing for some time now about the FDA’s plans to revise the long-standing categories A, B, C, D, and X designations for risk of using medications in pregnancy. The new rule (referred to as PLLR for Pregnancy and Lactation Labeling Rule) was proposed in 2008, finalized in 2014, and implementation began during the summer of 2015.
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Dr. Simone Vigod describes her approach to prescribing medications during pregnancy. She starts by assessing the severity of the symptoms and the impact on function. Women usually fall into two categories: those who are not on medication and have become symptomatic, and those who have been taking medication, who are perhaps in remission, and are unsure about going off medication during pregnancy.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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