Antidepressant drug development first began in the mid-twentieth century with the discovery of monoamine oxidase inhibitors and tricyclic antidepressants. Soon after, additional molecular targets and drug entities were created, eventually leading to the development of selective serotonin reuptake inhibitors. Today, antidepressants now rank among the top 10 most commonly used medications in the United States (US) and account for over $11 billion in annual sales. To help ensure the safety and efficacy of these commonly used products, in 1977 the US Food and Drug Administration (FDA) created guidelines to standardize antidepressant studies and the approval process. Although many of the recommendations outlined by FDA are still relevant, the document remains vague when describing key aspects of antidepressant trial design and much of the clinical information is outdated by today's standards. This paper will provide a general overview of the FDA-approval process, summarize FDA's position related to antidepress...
{"title":"Antidepressant medications: The FDA-approval process and the need for updates","authors":"Conor Hanrahan, James P. New","doi":"10.9740/MHC.N186950","DOIUrl":"https://doi.org/10.9740/MHC.N186950","url":null,"abstract":"Antidepressant drug development first began in the mid-twentieth century with the discovery of monoamine oxidase inhibitors and tricyclic antidepressants. Soon after, additional molecular targets and drug entities were created, eventually leading to the development of selective serotonin reuptake inhibitors. Today, antidepressants now rank among the top 10 most commonly used medications in the United States (US) and account for over $11 billion in annual sales. To help ensure the safety and efficacy of these commonly used products, in 1977 the US Food and Drug Administration (FDA) created guidelines to standardize antidepressant studies and the approval process. Although many of the recommendations outlined by FDA are still relevant, the document remains vague when describing key aspects of antidepressant trial design and much of the clinical information is outdated by today's standards. This paper will provide a general overview of the FDA-approval process, summarize FDA's position related to antidepress...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"16 1","pages":"11-16"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87021970","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}
Many consumers use alternative preparations such as herbals, vitamins, and over-the-counter products in an attempt to prevent or improve the outcome of dementia. Despite use by almost half of all patients, evidence supporting their utilization is either conflicting or lacking. Omega-3 fatty acids, vitamin B6, vitamin B12, vitamin C, and beta-carotene currently do not have clinical trials showing evidence impacting the progression or treatment of symptoms associated with dementia. In addition, conflicting data exist pertaining to the beneficial utilization of ginkgo biloba and nonsteroidal anti-inflammatory drugs associated with dementia treatment. While a link to the utility of folate associated with areas of improved cognitive functioning has been suggested, further studies are needed. Vitamin E may have some benefit in patients with Alzheimer's disease, however, may also have risks in patients with comorbid diseases such as cardiovascular disease or diabetes mellitus. With limited options still existing...
{"title":"Utilization of vitamins, herbals, and over-the-counter products to delay progression of dementia","authors":"Jami L. Butz","doi":"10.9740/MHC.N204527","DOIUrl":"https://doi.org/10.9740/MHC.N204527","url":null,"abstract":"Many consumers use alternative preparations such as herbals, vitamins, and over-the-counter products in an attempt to prevent or improve the outcome of dementia. Despite use by almost half of all patients, evidence supporting their utilization is either conflicting or lacking. Omega-3 fatty acids, vitamin B6, vitamin B12, vitamin C, and beta-carotene currently do not have clinical trials showing evidence impacting the progression or treatment of symptoms associated with dementia. In addition, conflicting data exist pertaining to the beneficial utilization of ginkgo biloba and nonsteroidal anti-inflammatory drugs associated with dementia treatment. While a link to the utility of folate associated with areas of improved cognitive functioning has been suggested, further studies are needed. Vitamin E may have some benefit in patients with Alzheimer's disease, however, may also have risks in patients with comorbid diseases such as cardiovascular disease or diabetes mellitus. With limited options still existing...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"69 1","pages":"196-200"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88873161","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}
Insomnia is the most common sleep disorder, and antidepressants are increasingly being used for its management. This article reviews the existing data concerning the use of antidepressants in the treatment of primary insomnia.
{"title":"Antidepressant management of insomnia disorder in the absence of a mood disorder","authors":"P. Nazarian, Susie H Park","doi":"10.9740/MHC.N188364","DOIUrl":"https://doi.org/10.9740/MHC.N188364","url":null,"abstract":"Insomnia is the most common sleep disorder, and antidepressants are increasingly being used for its management. This article reviews the existing data concerning the use of antidepressants in the treatment of primary insomnia.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"37 1","pages":"41-46"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81381458","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}
Individuals with schizophrenia and schizoaffective disorders are at higher risk than the general population for the development of chronic medical conditions, such as type II diabetes. This review article will focus on the 2014 recommendations from the American Diabetes Association for diagnosis, management, and assessment of glycemic control in patients with type II diabetes
{"title":"Screening, diagnosis, and management of type II diabetes: A review of the 2014 American Diabetes Association guidelines","authors":"Sweta M Patel, A. Thompson","doi":"10.9740/MHC.N194573","DOIUrl":"https://doi.org/10.9740/MHC.N194573","url":null,"abstract":"Individuals with schizophrenia and schizoaffective disorders are at higher risk than the general population for the development of chronic medical conditions, such as type II diabetes. This review article will focus on the 2014 recommendations from the American Diabetes Association for diagnosis, management, and assessment of glycemic control in patients with type II diabetes","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"37 1","pages":"107-113"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82558761","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}
The percentage of patients who have failed to completely or partially respond to multiple trials of antidepressants at adequate doses and for an adequate duration of therapy has varied in the literature and is considered substantial. Numerous strategies exist to treat poor antidepressant response, but often medications are selected on a “trial and error” basis. Genetic factors may play a role in poor response or intolerance to treatment with antidepressants which lead to treatment failures. Currently, available genetic testing as well as genetic testing currently under research may help guide clinicians with proper medication and dose selection.
{"title":"Pharmacogenomic testing for treatment resistant depression","authors":"S. Leckband","doi":"10.9740/MHC.N207183","DOIUrl":"https://doi.org/10.9740/MHC.N207183","url":null,"abstract":"The percentage of patients who have failed to completely or partially respond to multiple trials of antidepressants at adequate doses and for an adequate duration of therapy has varied in the literature and is considered substantial. Numerous strategies exist to treat poor antidepressant response, but often medications are selected on a “trial and error” basis. Genetic factors may play a role in poor response or intolerance to treatment with antidepressants which lead to treatment failures. Currently, available genetic testing as well as genetic testing currently under research may help guide clinicians with proper medication and dose selection.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"99 1","pages":"236-239"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75476052","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}
Hypertension affects a large portion of the United States' population and is a significant risk factor for cardiovascular events. A variety of treatment guidelines exist including the American Diabetes Association, European Society of Hypertension/European Society of Cardiology and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. The following is a summary of these guidelines regarding the effective treatment of hypertension.
{"title":"Recent changes in the treatment of hypertension","authors":"Bridget Bradley, L. Carlson","doi":"10.9740/MHC.N197964","DOIUrl":"https://doi.org/10.9740/MHC.N197964","url":null,"abstract":"Hypertension affects a large portion of the United States' population and is a significant risk factor for cardiovascular events. A variety of treatment guidelines exist including the American Diabetes Association, European Society of Hypertension/European Society of Cardiology and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. The following is a summary of these guidelines regarding the effective treatment of hypertension.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"64 1","pages":"143-145"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78632617","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}
Major depressive disorder is a serious, recurrent condition with significant impact on a person's quality of life and functioning, which carries a significant risk of premature death due to suicide. There is evidence that supports the effectiveness of lithium as an augmentation strategy for treatment-resistant depression, as well as for reducing suicidality in this population. This review introduces several theories regarding the proposed mechanism behind lithium's anti-suicidal effects and summarizes a selection of the pertinent literature supporting lithium's beneficial effects on suicidality.
{"title":"A review of the evidence supporting the use of lithium augmentation therapy for the reduction of suicidal behavior in patients with unipolar depression: Revisiting an overlooked benefit of an older medication","authors":"Elizabeth Jackson, Rene A. Endow-Eyer","doi":"10.9740/MHC.N207175","DOIUrl":"https://doi.org/10.9740/MHC.N207175","url":null,"abstract":"Major depressive disorder is a serious, recurrent condition with significant impact on a person's quality of life and functioning, which carries a significant risk of premature death due to suicide. There is evidence that supports the effectiveness of lithium as an augmentation strategy for treatment-resistant depression, as well as for reducing suicidality in this population. This review introduces several theories regarding the proposed mechanism behind lithium's anti-suicidal effects and summarizes a selection of the pertinent literature supporting lithium's beneficial effects on suicidality.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"29 1","pages":"221-225"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81020884","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}
Symptoms of insomnia are highly prevalent among adults and insomnia is often a chronic condition which may occur for years. Sedative hypnotics including benzodiazepines (BZDs), zolpidem, eszopiclone, and zaleplon (NBZDs) are commonly used to treat insomnia. The longest controlled studies evaluating the safety and efficacy of NBZDs were 12 months in duration and 2 months in duration for the BZD, temazepam. These studies suggest that NBZDs continue to be effective and safe when used for up to 12 months. The short-term adverse effects are more common and more severe for BZDs than for NBZDs. Despite the current practice of using sedative hypnotics for longer durations, studies have yet to evaluate the long-term adverse effect profile.
{"title":"The long-term use of sedative hypnotics in chronic insomnia","authors":"Chelsie B. Heesch","doi":"10.9740/MHC.N190097","DOIUrl":"https://doi.org/10.9740/MHC.N190097","url":null,"abstract":"Symptoms of insomnia are highly prevalent among adults and insomnia is often a chronic condition which may occur for years. Sedative hypnotics including benzodiazepines (BZDs), zolpidem, eszopiclone, and zaleplon (NBZDs) are commonly used to treat insomnia. The longest controlled studies evaluating the safety and efficacy of NBZDs were 12 months in duration and 2 months in duration for the BZD, temazepam. These studies suggest that NBZDs continue to be effective and safe when used for up to 12 months. The short-term adverse effects are more common and more severe for BZDs than for NBZDs. Despite the current practice of using sedative hypnotics for longer durations, studies have yet to evaluate the long-term adverse effect profile.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"11 1","pages":"78-81"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84174747","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}
Buprenorphine and buprenorphine/naloxone sublingual tablets were approved by the FDA in 2002. In 2010, the buprenorphine/naloxone sublingual film was approved to address concerns of diversion, time for tablet dissolution, and unintentional exposure in children with the tablet. This article will compare the buprenorphine sublingual formulations in terms of pharmacokinetics, safety, diversion and misuse, cost, and patient preference. It will explore current data suggesting advantages or disadvantages of the various formulations since conclusive data are minimally available.
{"title":"Buprenorphine for opioid dependence: Are there really differences between the formulations?","authors":"Rebecca L. Graham","doi":"10.9740/MHC.N186952","DOIUrl":"https://doi.org/10.9740/MHC.N186952","url":null,"abstract":"Buprenorphine and buprenorphine/naloxone sublingual tablets were approved by the FDA in 2002. In 2010, the buprenorphine/naloxone sublingual film was approved to address concerns of diversion, time for tablet dissolution, and unintentional exposure in children with the tablet. This article will compare the buprenorphine sublingual formulations in terms of pharmacokinetics, safety, diversion and misuse, cost, and patient preference. It will explore current data suggesting advantages or disadvantages of the various formulations since conclusive data are minimally available.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"50 1","pages":"17-21"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84662455","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}
Prescription rates and polypharmacy are increasing, resulting in a greater potential for drug interactions. Psychiatric patients frequently have co-morbid medical conditions, which further increases the risk of polypharmacy and drug interactions. Drug interactions that affect drugs with narrow therapeutic windowsare of particular concern. This review presents some of these drug interactions and provides strategies for identifying and resolving them.
{"title":"An overview of clinically significant drug interactions between medications used to treat psychiatric and medical conditions","authors":"D. Hoeft","doi":"10.9740/MHC.N197904","DOIUrl":"https://doi.org/10.9740/MHC.N197904","url":null,"abstract":"Prescription rates and polypharmacy are increasing, resulting in a greater potential for drug interactions. Psychiatric patients frequently have co-morbid medical conditions, which further increases the risk of polypharmacy and drug interactions. Drug interactions that affect drugs with narrow therapeutic windowsare of particular concern. This review presents some of these drug interactions and provides strategies for identifying and resolving them.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"11 1","pages":"118-130"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88110394","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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