Side Effects

In Brief

IM Olanzapine Plus Benzodiazepines: Safe or Unsafe?

Topics: Antipsychotics | Benzodiazepines | olanzapine | Psychotic Agitation | Side Effects

The Eli Lilly warning followed reports of 160 adverse events, including 29 fatalities, linked to IM olanzapine/IM benzodiazepine combinations from January 2004 to September 2005 (Marder SR et al, J Clin Psychiatry 2010;71(4):433–441). Looking closely at these cases, it is unclear that this medication combination actually caused the fatalities. Many of

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Clinical Update

Battle of the Bulge: Obesity and Antipsychotic-Induced Weight Gain

Topics: Aripiprazole | Benzphetamine | Bupropion | Diabetes | Diethylpropion | Exercise | Insulin resistance | Liraglutide | Metabolic syndrome | Metformin | Naltrexone | olanzapine | Phendimetrazine | Phentermine | Samidorphan | Semaglutide | Side Effects | Topiramate | Waist circumference | Weight gain | Ziprasidone

Many psychiatric medications cause weight gain, including mood stabilizers, antidepressants, and especially antipsychotics. Most weight gain secondary to antipsychotic use occurs in the first 6 months of therapy, so it’s important to monitor weight closely and intervene early in a patient’s treatment. We counsel patients at every visit about healthy

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Expert Q&A

Weight Gain and Metabolic Side Effects

Topics: Aripiprazole | Clozapine | Diabetes | Exercise | Insulin resistance | Liraglutide | Metabolic syndrome | Metformin | olanzapine | Quetiapine | Risperidione | Samidorphan | Side Effects | Topiramate | Waist circumference | Weight gain | Ziprasidone

CHPR: Dr. Marder, can you please tell us about your work? Dr. Marder: Sure. My work has focused on pharmacologic and nonpharmacologic approaches to improving the outcomes of serious mental illnesses, particularly schizophrenia. I’m very interested in ways to combine psychosocial interventions with pharmacological approaches and to reduce adverse side

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Research Update

SSRIs vs SNRIs in Pediatric Anxiety Disorders: Which Are More Tolerable?

Topics: Anxiety | efficacy | Obsessive Compulsive Disorder | OCD | Serotonin Norepinephine Reuptake Inhibitors | Serotonin Specific Reuptake Inhibitors | Side Effects | SNRIs | SSRIs

REVIEW OF: Mills JA and Strawn JR, J Am Acad Child Adolesc Psychiatry 2020;59(11):1240–1251 STUDY Type: Meta-analysis For children with anxiety disorders and OCD, SSRIs produce faster and greater improvement than SNRIs (Strawn JR et al, J Am Acad Child Adolesc Psychiatry 2018;57(4):235–244.e2). Unfortunately, adverse effects slow down our dose

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Research Update

Which Medications Have the Lowest Risk of Side Effects?

Topics: Antidepressants | Antipsychotics | Lithium | Mood Stabilizers | Psychotropic medication | Side Effects | Stimulants

REVIEW OF: Solmi M et al, World Psychiatry 2020;19(2):214–232 Adverse effects are important considerations when choosing psychotropic medications, especially in children and adolescents. This study pooled available research to compare the safety profiles of various psychotropics used in the pediatric population. The authors screened thousands of st

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Research Update

Varenicline and Bupropion: Soaring Again With EAGLES?

Topics: Addiction | Addiction Treatment | Bupropion | Chantix | Co-occurring disorders | Dual diagnosis | FDA Warnings | Medication | Pharmacology | Research | Research Update | Side Effects | Smoking Cessation | Smoking Cessation Agents | Substance Use | Substance use disorders | Suicidality | Suicide | Tobacco | Varenicline | Wellbutrin

Review of: Anthenelli RM et al, Lancet 2016;387(10037):2507–2520 Varenicline (Chantix) and bupropion (Zyban and others) are effective treatments for tobacco use disorder, but their use (and sales) took a big hit in 2009 when the FDA slapped both with black box warnings linking them to psychiatric complications, including suicidal ideation. Although

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Clinical Update

An Unexpected Opioid: Loperamide Misuse

Topics: Free Articles | Opioids | Over the counter medication | safety | Side Effects

Loperamide, a common antidiarrheal available at pharmacies across the country, has unexpectedly become one of the latest in a growing trend of over-the-counter medications being repurposed for recreational use. Over the past 10 years, the broader public has discovered that supratherapeutic doses of loperamide can result in opioid-like euphoric effects.

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Clinical Update

“What About the Implant, Doc?” Appraising Various Formulations of Buprenorphine

Topics: Buprenorphine | extended-release | Medication | Medication adherence | Opioid epidemic | Opioid Use Disorder | Pharmacology | safety | Side Effects

With other epidemics in the world dominating our attention, let’s not forget the epidemic of opioid-related deaths. Unlike the current viral epidemic, the opioid epidemic is eminently treatable. The figure on page 3 shows the reduction in heroin overdoses in Baltimore, MD, as increasing numbers of patients received opioid agonist treatment (Schwartz R

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Article

How to Treat Tardive Dyskinesia

Topics: Amantadine | Austedo | Deutetrabenazine | Ginkgo | Ingrezza | Keppra | Levetiracetam | Melatonin | Psychopharmacology | Psychopharmacology Tips | Side Effects | Tardive dyskinesia | Valbenazine | Vitamin B6 | Vitamin E | VMAT2 Inhibitors

Your patient is a 56-year-old male who recovered from a difficult-to-treat depression 4 years ago after quetiapine was added to his citalopram. As he talks, you notice that his fingers are tapping in a rapid, random pattern and his feet are wiggling. When questioned, he explains, “I just do that when I’m anxious.” Should you stop the antipsychotic

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Article

Antipsychotic Maintenance: How Long is Enough?

Topics: Antidepressant Augmentation | Antidepressants | Antipsychotics | Bipolar Disorder | Deprescribing | Depression | Depressive Disorder | Mania | Metabolic syndrome | Mood Stabilizers | olanzapine | Psychopharmacology | Psychopharmacology Tips | Risperidone | Side Effects | Tardive dyskinesia

Your 58-year-old patient started risperidone to augment lithium 2 years ago. It got her out of a severe mania, and she has stayed well since then. Now she’s worried about long-term risks and wondering if it’s time to come off. Augmentation with an atypical antipsychotic may offer rapid relief from mania and depression, but antipsychotics’ potenti

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Research Update

Sleepwalking on Antipsychotics and Lithium

Topics: Antipsychotics | Lithium | Second Generation Antipsychotics (SGAs) | Side Effects | Sleep | Sleep Disorders | Somnambulism

REVIEW OF: Gouverneur A et al, Br J Clin Pharmacol 2021;87:3971–3977 STUDY TYPE: Retrospective analysis Sleepwalking and sleep-eating are common parasomnias, also known as somnambulism and sleep-related eating disorder. Both can be side effects of benzos, z-hypnotics, and—rarely—antidepressants. This review looked at parasomnias’ association w

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Research Update

Comparison of GI Side Effects of Antidepressants

Topics: Antidepressants | Depression | Depressive Disorder | Free Articles | Mirtazapine | Side Effects | SNRIs | SSRIs

REVIEW OF: Oliva V et al, Prog Neuropsychopharmacol Biol Psychiatry 2021;109:110266 TYPE OF STUDY: Meta-analysis of placebo-controlled trials Antidepressants often cause gastrointestinal (GI) side effects, but it’s not clear which ones are the worst actors. A recent meta-analysis helps to clarify the picture. The investigators searched the li

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Clinical Update

Stimulants and Creativity

Topics: ADHD | Amphetamines | ArModafinil | Attention Deficit Hyperactivity Disorder | Creativity | methylphenidate | Modafinil | Provigil | Side Effects | stimulant | Stimulants

Your patient is a 25-year-old music teacher with ADHD. Though her organizational skills have improved with methylphenidate, she complains that it impairs her performance as a jazz musician: “I feel self-conscious, like a robot.” Popular lore holds that creative people have ADHD traits and that ADHD bestows advantages in creative thinking. Stock cha

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Research Update

Mood Stabilizers: What You Don’t Know Can Hurt Them

Topics: Antipsychotics | Aripiprazole | Asenapine | Bipolar Depression | Bipolar Disorder | Bipolar II | Cariprazine | Lithium | Lurasidone | Mania | Medication adherence | Mood Stabilizers | olanzapine | Oxcarbazepine | Pharmacology | Pharmacology Tips | Psychopharmacology | Psychopharmacology Tips | Quetiapine | Research | Research Update | Risperidone | safety | Saphris | Side Effects

Review of: Bai Y et al, J Clin Psychopharmacol 2020;40(2):167–179 STUDY TYPE: Combined meta-analysis and literature review of placebo-controlled trials Medication adherence is an ongoing struggle in bipolar disorder, and it’s compounded by the fact that our patients often don’t advertise their ­non-adherence. While numbers vary, reviews general

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Expert Q&A

Medication Side Effects Part II: Weight Gain, Akathisia, Hair Loss, and Orthostasis

Topics: Akathisia | Falls | Hair loss | Orthostasis | Pharmacology Tips | Psychopharmacology Tips | Side Effects | Weight Loss Medications

Editor’s note: In the June/July issue, Dr. Mago shared a sampling of his strategies for nausea, sweating, and dry mouth. We wrap up that conversation here with a few more tips on managing side effects. Weight gain TCPR: What’s your approach to antipsychotic-induced weight gain? Dr. Mago: Prevention is better than treatment. So, when possible, we

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Expert Q&A

Medication Side Effects: Nausea, Sweating, and Dry Mouth

Topics: Pharmacology | Pharmacology Tips | Side Effects

TCPR: What’s the best way to manage side effects: lower the dose of the current medication or use an antidote? Dr. Mago: If the patient can stay well on a lower dose, that’s usually my first approach. Most side effects are dose related. TCPR: For the rest of this interview, we’ll assume that lowering the dose or changing the medication was not

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