Psychopharm Myths

Research Update

Brexpiprazole Ineffective in Mania

Topics: Brexpiprazole | Mania | Mood Stabilizers | Psychopharm Myths | Psychopharmacology | Research Update

REVIEW OF: Vieta E et al, J Psychopharmacol 2021;35(8):971–982 TYPE OF STUDY: Phase III randomized controlled trials Brexpiprazole is FDA approved in schizophrenia and as an adjunct for major depression and is one of the better-tolerated antipsychotics. Like aripiprazole, it is a partial D2 and 5-HT1A agonist. Unlike most antipsychotics, brexpiprazo

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Clinical Update

Disulfiram: An Underused Strategy for Alcohol Use Disorders

Topics: Abstinence | Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Disulfiram | Free Articles | Psychopharm Myths

Alcohol ranks third among preventable causes of death in the US, but it is by far the most undertreated. Fewer than 8% of people with alcohol use disorders (AUDs) receive treatment for their disease, and only a minority of them receive FDA-approved medications. Those medications are acamprosate (Campral), naltrexone (Vivitrol, ReVia), and disulfiram (An

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Clinical Update

Oxcarbazepine: Close, but no Cigar

Topics: Bipolar Disorder | Carbamazepine | Free Articles | Mania | Mood Stabilizers | Oxcarbazepine | Pharmacology | Psychopharm Myths | Psychopharmacology

You are selecting a mood stabilizer for a 29-year-old woman with mania. If it works, she’ll need to take it long term, but with adherence rates hovering around 50% in this illness, that’s not a likely prospect. The FDA-approved options are not very high on tolerability, but what about oxcarbazepine? Oxcarbazepine (Trileptal) is often used in bipo

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Highlight From This Issue

Topics: Bipolar Disorder | Carbamazepine | Mania | Mood Stabilizers | Oxcarbazepine | Pharmacology | Psychopharm Myths | Psychopharmacology

In bipolar disorder, oxcarbazepine is slightly better tolerated than carbamazepine, but less effective. While its medical risks are different, they are by no means safer than carbamazepine’s. Its drug interactions can be a problem as well. On average, higher doses of second-generation antidepressants do not bring greater recoveries in major depress

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Mirtazapine Augmentation: Running Low on Rocket Fuel

Topics: Antidepressant Augmentation | Antidepressants | Depression | Depressive Disorder | Mirtazapine | Pharmacology | Pharmacology Tips | Psychopharm Myths | Psychopharmacology | Psychopharmacology Tips | SSRIs | Treatment-Resistant Depression | Venlafaxine

Adding mirtazapine (Remeron) to a serotonergic antidepressant is a popular augmentation strategy. When added to venlafaxine, the combo was thought to possess a particularly potent synergy that Stephen Stahl called “California Rocket Fuel.” However, the strategy has failed in a handful of new studies, some of them much larger than the original data.

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Ask The Editor

Is Paxil the Best SSRI for Anxiety?

Topics: Antidepressants | Anxiety | Anxiety Disorder | Generalized Anxiety Disorder | Panic Disorder | Pharmaceutical Industry | Pharmacology | Pharmacology Tips | Practice Tools and Tips | Psychopharm Myths | Psychopharmacology | Psychopharmacology Tips | PTSD | Social Anxiety Disorder | SSRIs

Dear Dr. Aiken: Your review of Paxil’s risks in the May issue failed to mention a benefit that’s unique to this drug. Isn’t it the best SSRI for anxiety? Dr. Aiken: Paroxetine’s (Paxil’s) reputation as the anti-anxiety SSRI got off to a running start. It was first launched for panic disorder in 1996, two years before its approval for depres

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