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IN THIS ISSUE:
August 2007

Adding Atomoxetine to an SSRI: A Negative Study
Adding atomoxetine (Strattera) to sertraline (Zoloft and others) did not increase remission rates for depressed patients who responded incompletely to the antidepressant alone.

Risperidone and Prolactin in Young Patients
Prolactin levels increased in children and adolescents treated with risperidone (Risperdal) for pervasive development disorder.

In Brief
Topiramate and Cognitive Impairment in Children; Brain Structure Abnormalities in Pedophiles

More on Antidepressants and Suicide
A meta-analysis of studies of children and adolescents with depression, obsessive compulsive disorder, or anxiety disorders found a small increased risk of suicidal ideation/suicide attempt, but no completed suicides.

Lithium and the Risk of Alzheimer's
Lithium treatment may decrease the risk of Alzheimer's disease in patients with bipolar disorder.

T3 Augments SSRI Treatment
Adding triiodothyronine (T3) to sertraline (Zoloft and others) treatment increased response and remission rates in depressed patients.

A Tale of Two Interactions
Quetiapine (Seroquel and others) can raise levels of r-methadone, and carbamazepine (Tegretol and others) can lower levels of aripiprazole (Abilify).

In Brief

August 2007

Topiramate (Topamax), an antiepileptic drug approved by the US Food and Drug Administration for the treatment of partial and primary generalized seizures as well as prophylaxis of migraine, is also used to promote weight loss in individuals with obesity, drug-induced weight gain, and eating disorders. Adults treated with topiramate for weight loss have experienced neuropsychological impairments in several cognitive domains, including verbal function. Obese children and adolescents who receive topiramate also may experience broad-spectrum cognitive impairments. In an open-label study by F. K. Aarsen et al, deficits in attention, memory, and language comprehension were detectable within 3 months of starting the drug in 14 children with alimentary obesity or brain tumor (Neurology 2006;67:1307-1308). At 6 months, problems with memory, psychomotor speed, language, attention, visual-spatial perception, and intelligence were subjectively apparent. In nine children who continued the drug for a year, neuropsychological functioning returned to baseline levels. Negative effects on cognitive abilities may initially be subclinical: at 3 months, only 1 child with a decline in scores on attention, language, or memory tests reported cognitive complaints. At 6 months, however, 71% of the children mentioned cognitive dysfunctions, suggesting that these effects are both time- and dose-dependent. Language function should be monitored in young patients who receive topiramate. Topiramate was effective in reducing appetite and weight in this population.

Brain regions important for sexual development show structural impairment in pedophiles. In a study by K. Schiltz and others, 15 nonviolent male pedophilic perpetrators had a significantly smaller amygdalar volume, mostly on the right side, when compared with healthy control subjects (Arch Gen Psychiatry 2007;64:737-746). Reduced gray matter was observed in the right amygdala, hypothalamus (bilaterally), septal regions, substantia innominata, and bed nucleus of the striae terminalis. The reduction in amygdalar volume was not progressive or age dependent, and therefore, could not be explained by atrophy or a degenerative process over time. It might reflect developmental disturbances or environmental insults at critical periods of sexual maturation. Eight of the perpetrators had enlargement of the anterior temporal horn of the right lateral ventricle. Earlier studies suggest right-sided lesions of the temporal lobe enhance libido and affect sexual function more than left-sided damage.

Heather S. Hopkins