What do I do about treatment-resistant depression?
10.03.10
There exists reluctance on the part of both clinicians and patients to push antidepressant treatment to full remission. Additionally, treatment times longer than those used previously are required to achieve remission. A modest improvement at 6 weeks may require a dose increase or a longer time period (up to 12 weeks) at the same dose for a full response.
BOTTOM LINE
Patients who are resistant to monotherapy for depression should be evaluated carefully for medication compliance, substance abuse, bipolar disorder, and social stressors. The combination of antidepressant medication and psychotherapy is more effective than either treatment alone for patients with severe recurrent depression. Patients who fail to remit after the institution of one SSRI may achieve remission when a second SSRI is substituted. Patients who fail to remit after two trials of SSRIs should be switched to a different class of medication, and dual-action medications may be more effective in patients
Source: Journal of the American Academy of Physician Assistants
SSRI Birth Defects Class Action Lawsuit
01.03.10
Selective serotonin reuptake inhibitors (SSRIs) are used as antidepressants. Drugs included in the SSRI class are Prozac, Zoloft, Paxil, Symbyax, Celexa, Cymbalta, Effexor and Lexapro. However, some studies, including one published in the
New England Journal of Medicine have linked SSRIs to serious birth defects, including persistent pulmonary hypertension of the newborn (PPHN).
The study found that women who took SSRIs during their third trimester were six times more likely to deliver babies born with PPHN—or to have babies that would develop primary pulmonary hypertension—than women who did not take SSRIs during their third trimester.
Source: Lawyers and Settlements
Borderline Personality Disorder in Teenagers
25.02.10
When The Times’s Personal Health columnist Jane Brody wrote about borderline personality disorder in “An Emotional Hair Trigger, Often Misread,” hundreds of readers had questions about the diagnosis and treatment of the troubling condition, characterized by impulsive behaviors, shifting moods and often frequent thoughts of suicide.
Here, Dr. Alec Miller, professor of clinical psychiatry and behavioral sciences and chief of child and adolescent psychology at Montefiore Medical Center at the Albert Einstein College of Medicine in the Bronx, responds to readers’ questions about borderline personality disorder in teenagers. Dr. Miller has spent the past 15 years working with adolescents and adults with borderline personality disorder and borderline features in inpatient, outpatient and school settings. He is also director of Montefiore’s Adolescent Depression and Suicide Program and co-founder of Cognitive and Behavioral Consultants of Westchester in White Plains, N.Y.
Source: New York Times (blog)