In surveys, it’s clear that most psychiatrists practice as unimaginatively as I typically do, meaning that their drug of first choice for most depressed patients is an SSRI (Petersen T, et al., Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:177-187).
How high can we safely dose common psychotropics? Given the poor performance of medication combinations in recent studies, it’s time for a close look at the safety and efficacy of raising doses, sometimes known as “dose optimization.”
The controversy over pediatric bipolar disorder has heated up over the past year. A recent study offers evidence for those favoring “narrow” criteria for the pediatric bipolar diagnosis.
In a study only partially funded by the manufacturer of Provigil (modafinil), 85 patients with bipolar depression, already taking mood stabilizers, were randomly assigned to augmentation with Provigil (N=41) or placebo (N=44).
It was a sorely needed study: compare sibutramine (Meridia) with topiramate (Topamax) in patients with psychotropicassociated weight gain. Sibutramine is generally considered one of the most effective weight loss agents.
In psychiatry, we typically order screening labs on new patients for a variety of purposes, including to rule out medical causes of psychiatric symptoms, to record baseline data before prescribing medications that may lead to lab abnormalities, and to screen for general medical problems. What labs should we order for new patients?
When you are planning to start a patient on medications, what labs should you order at baseline, and what should you order over time? This is quite a different question from whether to do a set of labs at the start of treatment to screen for disease etiology, and it’s an area where I believe we should be much more proactive.
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