SOURCE: DocGuide News
March 3, 2014 | Jenny Powers

Aspects of patient history emerged as 2 of 3 independently associated clinical predictors of whether patients currently being treated for major depressive disorder (MDD) will respond to treatment, according to a study presented here at the European Psychiatric Association (EPA) 22nd European Congress of Psychiatry.

Treating patients with treatment-resistant MDD (TRD) remains a challenge because it occurs frequently and is associated with a high number of relapses and hospitalisations plus the increased use of clinical treatments, said Georgio Di Lorenzo, MD, Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy, on March 2. He and colleagues conducted this analysis to identify clinical variables that could predict nonresponse in patients with MDD.

TRD was defined as the failure to respond to at least 2 different adequate trials of antidepressant treatment in the patient’s current episode, according to Dr. Di Lorenzo. He pointed out that the responder/nonresponder categories were established at the end of the hospitalisation period after treatment.

Cox regression models comparing variables in 253 patients who were hospitalised for TRD showed that patients with a history of ≥5 depressive episodes (odds ratio [OR] = 2.27) and those with a history of early-life adversities (OR = 1.60) were at increased risk of responding poorly or not at all to treatment for their current depression. Having a comorbid anxiety disorder was also determined to be predictive of poor response to current treatment (OR = 1.85).

Of the hospitalised patients with TRD, 154 were categorised as responders and 99 as nonresponders, according to whether they displayed at least a 50% decrease in the severity of their symptoms, measured by the Hamilton Rating Scale for Depression (HAM-D) 17.

The investigators concluded that the mechanisms for treatment resistance and poor response were likely to vary according to the clinical variables.

“The mechanism for treatment resistance in patients with ≥5 prior depressive episodes is probably linked to changes in brain morphology,” said Dr. Di Lorenzo, who also theorised that nonresponse in patients with early-life adversities could be linked to changes in the hypocanthus area of the brain.

Patients with a comorbid anxiety disorder showed poor response to antidepressive medication that was most likely linked to the physiological effects of GABA in the brain.

Dr. Di Lorenzo remarked that he has previously published a study showing that “dopaminergic modulation can be achieved with rotigotine and used to improve response and relieve anxiety in depressed patients.”

This pamphlet is the culmination of many hours worth of work born out of necessity. 

As I began to encounter more clients in my community practice, I had a growing realization that benzodiazepine (BNZ) dependence is an insidious and widespread issue. More often than not the dependent person, is not an "addict", but a person using their medication as prescribed.

I understand that providers in their desire to lessen the suffering of those they serve, feel that benzodiazepine medications are the answer. They work to quickly quell anxiety and insomnia almost miraculously. However, they are a short-term solution for what is frequently a long-term problem. As I tell my clients, its like putting a patch on a breaking dam - it will hold in water very effectively for awhile, but it isn't getting to the root of the problem that underlies the symptoms. 

Benzodiazepines have their time and place for psychiatric distress, but that is short-term limited duration therapy (with some specific exceptions) and it is important that the client taking these medications is aware of this. Too often, I have individuals in my office dependent on a medication, like Xanax who were never informed about the nature and possible consequences of BNZ use.  

Prescribers have "gotten smart" about prescribing practices with pain medications, like Oxycodone, its time we do the same for benzodiazepines. And that starts with education.

Download a PDF of the tri-fold pamphlet, using the link below.

SOURCE: Neuroleptic Malignant Syndrome Information Service
Patricia I. Rosebush

What is serotonin syndrome?
Serotonin syndrome (SS) is the most serious clinical manifestation of serotonergic agent use. It is presumed to reflect centrally increased serotonergic neurotransmission although this has not been proven. It has been referred to as a toxidrome or toxic syndrome. The diagnosis is made on clinical grounds in patients who have taken one or more agents that are presumed to ‘increase’ serotonin. The incidence of SS is quite low during routine treatment but increases to approximately 15% in patients who overdose with serotonergic agents. 

Common side-effects associated with SSRIs 

• Headaches: new onset or worsening of a pre-existing problem 
  
• Gastrointestinal disturbances, particularly nausea, upper gastric discomfort and diarrhea 
  
• Restlessness or akathisia, perhaps associated with suicidality in younger patients
  
• Tremor 
• Sexual dysfunction 
  
• Easy bruising 
  

Other reported complications of SSRI use

• Increased risk of upper gastrointestinal bleeding, especially in conjunction with non-steroidal anti-inflammatory medications Increased risk of intra-operative bleeding 
  
• Increased risk of developing osteoporosis 
  
• Extrapyramidal side-effects 
  
• Syndrome of inappropriate secretion of anti-diuretic hormone (SIADH), especially in the elderly 
  

It is, therefore, important for the treating clinician to consider each patient’s medical and psychiatric history, with attention to the potential for SSRIs to complicate or worsen certain conditions such as migraines 

Patients appreciate physicians’ awareness of the side-effect profile of the medications they prescribe and usually welcome the opportunity to be appropriately educated. This enhances compliance, primary prevention and early detection as well as timely intervention when problems arise 

>>> Read the Full Article HERE

Much like the mood tracking chart, this month-long chart allows clients to track their severity of attention-deficit systems and several other factors. A great tool while trialing a new medication to look at effectiveness. Also, a great conversation starter about behavior patterns and their impact on symptomolgy, ie. sleep (or lack there of). 

I'm planning on attending the first ever Bipolar Summit hosted by Global Medical Education, are you? 

Where: Newport, RI
When: May 16th & 17th

In an effort to encourage informed prescribing practices, BTB has created an online forum to discuss medications/disorders/concerns/etc...

Folks will have to register to be a part of the forum, a necessity to keep things "professional".  

There will be sub-forums, listed by medication, disorders, general concerns/experiences and then there will be individual topics, such as Fetizma and lyme disease. 

Want to try it out and join the conversation?  Go HERE

SOURCE: National Alert Networks
February 18, 2014

Potential inaccuracy of electronically transmitted medication history information used for medication reconciliation. According to this alert, inaccurate information is likely related to the strength of a medication resulting from missing special characters, like decimal points. Providers are encouraged to contact the EHR vendor to see if this alert applies to them.