Venlafaxine XR and its major active metabolite, desvenlafaxine, are serotonin-norepinephrine reuptake inhibitors. Both are FDA-approved for the treatment of major depressive disorder and have essentially the same pharmacologic and pharmacokinetic profiles; however, the recommended dosing is notably different. The FDA approved recommended starting and maintenance dose for desvenlafaxine is 50 mg daily, while venlafaxine XR requires titration from 37.5 mg daily to the maintenance dose of 150 - 225 mg daily. The dose recommendation for desvenlafaxine is based on results from 8-week acute-phase clinical trials, but complete therapeutic response is not always achieved in this short time period. Venlafaxine XR relies on CYP2D6 for conversion to desvenlafaxine while desvenlafaxine has no significant metabolism by CYP2D6 at recommended doses. Both venlafaxine XR and desvenlafaxine have limited clinically significant drug interactions. The most striking difference between the two products is cost.
{"title":"Key differences between Venlafaxine XR and Desvenlafaxine: An analysis of pharmacokinetic and clinical data","authors":"Michelle D Colvard","doi":"10.9740/MHC.N186977","DOIUrl":"https://doi.org/10.9740/MHC.N186977","url":null,"abstract":"Venlafaxine XR and its major active metabolite, desvenlafaxine, are serotonin-norepinephrine reuptake inhibitors. Both are FDA-approved for the treatment of major depressive disorder and have essentially the same pharmacologic and pharmacokinetic profiles; however, the recommended dosing is notably different. The FDA approved recommended starting and maintenance dose for desvenlafaxine is 50 mg daily, while venlafaxine XR requires titration from 37.5 mg daily to the maintenance dose of 150 - 225 mg daily. The dose recommendation for desvenlafaxine is based on results from 8-week acute-phase clinical trials, but complete therapeutic response is not always achieved in this short time period. Venlafaxine XR relies on CYP2D6 for conversion to desvenlafaxine while desvenlafaxine has no significant metabolism by CYP2D6 at recommended doses. Both venlafaxine XR and desvenlafaxine have limited clinically significant drug interactions. The most striking difference between the two products is cost.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"6 1","pages":"35-39"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83650098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite limited supporting evidence, off-label uses of atypical or second generation antipsychotics (particularly olanzapine, quetiapine, and risperidone) are not uncommon. The off-label use of these agents for the treatment of insomnia is the focus of this review. While atypical antipsychotics are associated with a lower risk of tardive dyskinesia, extrapyramidal side effects, and more favorable effects on cognitive deficits and negative symptomatology in schizophrenic patients compared to typical or first generation antipsychotic agents, they are not without risks. Metabolic adverse effects are particularly problematic with atypical antipsychotics, even at doses lower than those used to treat FDA-approved indications. The receptor affinity profiles of most atypical antipsychotic agents promote sedation. The level of H1-histamine receptor blockade is believed to be most associated with somnolence and sedation. Several studies evaluating the safety and efficacy of the atypical antipsychotics quetiapine, o...
{"title":"Off-label use of atypical antipsychotic agents for treatment of insomnia","authors":"Anna K. Morin","doi":"10.9740/MHC.N190091","DOIUrl":"https://doi.org/10.9740/MHC.N190091","url":null,"abstract":"Despite limited supporting evidence, off-label uses of atypical or second generation antipsychotics (particularly olanzapine, quetiapine, and risperidone) are not uncommon. The off-label use of these agents for the treatment of insomnia is the focus of this review. While atypical antipsychotics are associated with a lower risk of tardive dyskinesia, extrapyramidal side effects, and more favorable effects on cognitive deficits and negative symptomatology in schizophrenic patients compared to typical or first generation antipsychotic agents, they are not without risks. Metabolic adverse effects are particularly problematic with atypical antipsychotics, even at doses lower than those used to treat FDA-approved indications. The receptor affinity profiles of most atypical antipsychotic agents promote sedation. The level of H1-histamine receptor blockade is believed to be most associated with somnolence and sedation. Several studies evaluating the safety and efficacy of the atypical antipsychotics quetiapine, o...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"45 1","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88921628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Compared with the general adult population, patients with schizophrenia and bipolar disorder have a 1.5 to 2.8 fold increase in mortality rates. This increase in mortality is multifactorial, including both natural causes and suicide. Additionally, antipsychotic medications have been associated with several adverse effects, including weight gain, hyperlipidemia, and the onset of diabetes. These adverse effects can place patients at risk for metabolic syndrome and atherosclerotic cardiovascular disease (ASCVD). Regular monitoring and treatment of risk factors for ASCVD, including hyperlipidemia, should be provided in clinical practice. The American College of Cardiology and the American Heart Association recently published updated recommendations for the management of cholesterol to reduce ASCVD. These national guidelines, based on a large body of clinical trials, describe 4 specific patient populations at high risk for ASCVD that should be considered candidates for therapeutic lifestyle changes and pharmac...
{"title":"Management of elevated blood cholesterol in the psychiatric patient: What's new in the guidelines?","authors":"J. Sebaaly","doi":"10.9740/MHC.N194571","DOIUrl":"https://doi.org/10.9740/MHC.N194571","url":null,"abstract":"Compared with the general adult population, patients with schizophrenia and bipolar disorder have a 1.5 to 2.8 fold increase in mortality rates. This increase in mortality is multifactorial, including both natural causes and suicide. Additionally, antipsychotic medications have been associated with several adverse effects, including weight gain, hyperlipidemia, and the onset of diabetes. These adverse effects can place patients at risk for metabolic syndrome and atherosclerotic cardiovascular disease (ASCVD). Regular monitoring and treatment of risk factors for ASCVD, including hyperlipidemia, should be provided in clinical practice. The American College of Cardiology and the American Heart Association recently published updated recommendations for the management of cholesterol to reduce ASCVD. These national guidelines, based on a large body of clinical trials, describe 4 specific patient populations at high risk for ASCVD that should be considered candidates for therapeutic lifestyle changes and pharmac...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"27 1","pages":"100-106"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77428697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION It is estimated that about 90% of older adults with dementia experience neuropsychiatric symptoms. These symptoms include but are not limited to agitation, aggression, delusions, and hallucinations. Neuropsychiatric symptoms are often treated with antipsychotics. However, the use of antipsychotics in the dementia population is associated with an increased risk of death, mostly due to cerebrovascular events. All antipsychotic medications (both first generation and second generation) have a Black Box Warning for increased mortality in elderly patients with dementiarelated psychosis.
{"title":"Treating the neuropsychiatric symptoms of dementia: A case based approach","authors":"Joshana K Goga, Q. Tran, S. Walters","doi":"10.9740/MHC.N2045","DOIUrl":"https://doi.org/10.9740/MHC.N2045","url":null,"abstract":"INTRODUCTION It is estimated that about 90% of older adults with dementia experience neuropsychiatric symptoms. These symptoms include but are not limited to agitation, aggression, delusions, and hallucinations. Neuropsychiatric symptoms are often treated with antipsychotics. However, the use of antipsychotics in the dementia population is associated with an increased risk of death, mostly due to cerebrovascular events. All antipsychotic medications (both first generation and second generation) have a Black Box Warning for increased mortality in elderly patients with dementiarelated psychosis.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"74 1","pages":"207-210"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85553230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mood disorders are highly prevalent throughout the United States, and high rates of relapse, recurrence, and treatment failure lead to treatment resistance. This article will review the available literature and treatment recommendations for treatment resistant mood disorders in special populations including: geriatrics, children and adolescents, pregnancy, and comorbid substance use disorders.
{"title":"Special populations: Treatment resistant mood disorders","authors":"Gina M. Guinta, Rebecca L. Graham","doi":"10.9740/MHC.N207186","DOIUrl":"https://doi.org/10.9740/MHC.N207186","url":null,"abstract":"Mood disorders are highly prevalent throughout the United States, and high rates of relapse, recurrence, and treatment failure lead to treatment resistance. This article will review the available literature and treatment recommendations for treatment resistant mood disorders in special populations including: geriatrics, children and adolescents, pregnancy, and comorbid substance use disorders.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"31 12 1","pages":"240-245"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82749019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep disturbances are very common in patients suffering from post-traumatic stress disorder (PTSD) and can have various negative sequelae, including worsening of perceived levels of stress, depression, and suicidal ideation. Although PTSD treatment can lead to improved sleep in some patients, there are a number of patients whose sleep disturbances do not remit even after treatment and can persist long after the original trauma. There are various non-pharmacological and pharmacological treatment modalities that have been studied. Non-pharmacological therapies include image rehearsal therapy (IRT), cognitive behavioral therapy for insomnia (CBTI), prolonged exposure (PE), and eye-movement desensitization and reprocessing (EMDR). Pharmacological studies include alpha-1-adrenergic receptor antagonists, alpha-adrenergic agonists, selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) monoamine oxidase inhibitors (MAOIs), other an...
{"title":"Treatment of sleep disturbances in post-traumatic stress disorder","authors":"M. Tomas","doi":"10.9740/MHC.N190104","DOIUrl":"https://doi.org/10.9740/MHC.N190104","url":null,"abstract":"Sleep disturbances are very common in patients suffering from post-traumatic stress disorder (PTSD) and can have various negative sequelae, including worsening of perceived levels of stress, depression, and suicidal ideation. Although PTSD treatment can lead to improved sleep in some patients, there are a number of patients whose sleep disturbances do not remit even after treatment and can persist long after the original trauma. There are various non-pharmacological and pharmacological treatment modalities that have been studied. Non-pharmacological therapies include image rehearsal therapy (IRT), cognitive behavioral therapy for insomnia (CBTI), prolonged exposure (PE), and eye-movement desensitization and reprocessing (EMDR). Pharmacological studies include alpha-1-adrenergic receptor antagonists, alpha-adrenergic agonists, selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) monoamine oxidase inhibitors (MAOIs), other an...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"3 2 1","pages":"91-97"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88247499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melatonin is an endogenous indolamine produced by the pineal gland which may have a role in the biological regulation of circadian rhythms, sleep, and mood. Melatonin receptor activation in the hypothalamus likely regulates circadian rhythms. In the United States, melatonin is marketed as a dietary supplement. Clinical trials in children and adults have shown modest clinical benefit in the treatment of insomnia. Adverse events reported in patients receiving melatonin were not significantly different in type or occurrence from those reported in patients receiving placebo. Considering the potential for benefit, lack of significant adverse events, and lack of abuse potential, melatonin may be considered a valid therapeutic option for improving outcomes in certain pediatric and adult patients with insomnia.
{"title":"Role in therapy of melatonin for the treatment of insomnia in children and adults","authors":"Ian R. McGrane, S. Corman","doi":"10.9740/MHC.N190085","DOIUrl":"https://doi.org/10.9740/MHC.N190085","url":null,"abstract":"Melatonin is an endogenous indolamine produced by the pineal gland which may have a role in the biological regulation of circadian rhythms, sleep, and mood. Melatonin receptor activation in the hypothalamus likely regulates circadian rhythms. In the United States, melatonin is marketed as a dietary supplement. Clinical trials in children and adults have shown modest clinical benefit in the treatment of insomnia. Adverse events reported in patients receiving melatonin were not significantly different in type or occurrence from those reported in patients receiving placebo. Considering the potential for benefit, lack of significant adverse events, and lack of abuse potential, melatonin may be considered a valid therapeutic option for improving outcomes in certain pediatric and adult patients with insomnia.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"63 1","pages":"52-58"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81459894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2012, the American Geriatrics Society (AGS), along with a panel of 11 experts, updated the Beers Criteria which has evolved significantly since its inception in 1991. The Beers Criteria, in general, classifies medications/medication classes as: (1) potentially inappropriate for use in all older adults, (2) potentially inappropriate for older adults with certain diseases or symptoms and (3) requiring extra caution when used in older adults. Although each patient must be evaluated individually, the Beers Criteria is a useful clinical tool that can be used when initiating pharmacologic agents in both ambulatory and institutionalized patients. The concept behind use of the Beers Criteria is that it allows prescribers to readily identify, and avoid, medications associated with negative outcomes in older adults therefore decreasing the risk of adverse drug events (ADEs). Within this review article, there will be a highlight of potentially inappropriate medications (PIMs) commonly seen in clinical practice se...
{"title":"Potentially inappropriate medications in older adults: A review of the 2012 Beers Criteria and the implications in persons with dementia","authors":"N. Brandt, T. Turner","doi":"10.9740/MHC.N204331","DOIUrl":"https://doi.org/10.9740/MHC.N204331","url":null,"abstract":"In 2012, the American Geriatrics Society (AGS), along with a panel of 11 experts, updated the Beers Criteria which has evolved significantly since its inception in 1991. The Beers Criteria, in general, classifies medications/medication classes as: (1) potentially inappropriate for use in all older adults, (2) potentially inappropriate for older adults with certain diseases or symptoms and (3) requiring extra caution when used in older adults. Although each patient must be evaluated individually, the Beers Criteria is a useful clinical tool that can be used when initiating pharmacologic agents in both ambulatory and institutionalized patients. The concept behind use of the Beers Criteria is that it allows prescribers to readily identify, and avoid, medications associated with negative outcomes in older adults therefore decreasing the risk of adverse drug events (ADEs). Within this review article, there will be a highlight of potentially inappropriate medications (PIMs) commonly seen in clinical practice se...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"17 1","pages":"166-169"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81542929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persons older than 65 years numbered 39.6 million in 2009 representing 12.9% of the U.S. population. There will be roughly 72 million older persons by 2030, more than twice their number in 2000. Babyboomers entered this category in 2011 largely accounting for this increase in the older population. This growth will have wideranging implications for the country including in health care management. Treatment of dementia has become a higher priority in the last 10 years as the risks compound with the aging population. Along with the aging population and better recognition of dementia, the prevalence of dementia has grown in this decade and is expected to climb between 8 and 13 million by 2050.
{"title":"Dignifying dementia: Accepting the limitations of medications","authors":"Joshana K Goga","doi":"10.9740/MHC.N204533","DOIUrl":"https://doi.org/10.9740/MHC.N204533","url":null,"abstract":"Persons older than 65 years numbered 39.6 million in 2009 representing 12.9% of the U.S. population. There will be roughly 72 million older persons by 2030, more than twice their number in 2000. Babyboomers entered this category in 2011 largely accounting for this increase in the older population. This growth will have wideranging implications for the country including in health care management. Treatment of dementia has become a higher priority in the last 10 years as the risks compound with the aging population. Along with the aging population and better recognition of dementia, the prevalence of dementia has grown in this decade and is expected to climb between 8 and 13 million by 2050.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"30 1","pages":"162-163"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75533932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that often presents before the child enters the educational system and is characterized by developmental deficits with impairments in three main areas [1] personal, [2] social, and [3] academic or occupational functioning. The neurodevelopmental disorders represent a group of conditions with an onset early in the developmental period. Sleep disorders are commonly reported by parents of children with an ASD diagnosis with between 50% to 80% of parents reporting sleep problems with their children. Problems can be categorized into dyssomnias (problems falling and/or remaining asleep) and parasomnias (abnormal and/or unnatural movements, behaviors, emotions, perceptions, and dreams).
{"title":"Autism spectrum disorders and sleep disturbances in a pediatric patient","authors":"Nancy Brahm, D. Stewart","doi":"10.9740/MHC.N188366","DOIUrl":"https://doi.org/10.9740/MHC.N188366","url":null,"abstract":"INTRODUCTION Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that often presents before the child enters the educational system and is characterized by developmental deficits with impairments in three main areas [1] personal, [2] social, and [3] academic or occupational functioning. The neurodevelopmental disorders represent a group of conditions with an onset early in the developmental period. Sleep disorders are commonly reported by parents of children with an ASD diagnosis with between 50% to 80% of parents reporting sleep problems with their children. Problems can be categorized into dyssomnias (problems falling and/or remaining asleep) and parasomnias (abnormal and/or unnatural movements, behaviors, emotions, perceptions, and dreams).","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"66 1","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74485808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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