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February 2008

New Medicines for GAD: Duloxetine and Quetiapine
Duloxetine (Cymbalta) and quetiapine (Seroquel) are effective in treating generalized anxiety disorder.

In Brief
FDA Warns About Varenicline Psychiatric Adverse Effects; Index Ranks States on Prevalence of Depression and Suicide

Norepinephrine Uptake Inhibition
Atomoxetine (Strattera) inhibits norepinephrine uptake at lower doses than does venlafaxine (Effexor and others) or paroxetine (Paxil and others).

Rimonabant Causes Depression and Anxiety
Rimonabant works as a weight loss agent but may cause depression and anxiety.

Selegiline Augmentation for Negative Symptoms of Schizophrenia
Patients with schizophrenia who take selegiline (Eldepryl, Emsam) in addition to antipsychotic drugs may have greater improvement in negative symptoms.

Managing Psychosis in Parkinson's Disease and DLB
Psychosis in Parkinson’s disease or dementia with Lewy bodies is difficult to treat, and patients are sensitive to side effects of drugs used for these conditions.

In Brief

February 2008

Last November, we noted three cases of psychiatric adverse effects occurring in patients taking the drug varenicline (Chantix) for smoking cessation (BTP 2007;30:44–45). Now comes word that the US Food and Drug Administration has issued a warning that patients may experience new-onset depressive symptoms, suicidal ideation, and aggressive and erratic behavior following the initiation of varenicline therapy (, Accessed December 20, 2007). The warning also notes that varenicline may cause drowsiness. The FDA is reviewing post-marketing cases submitted by the manufacturer of varenicline, Pfizer, as well as media reports, including one case in which erratic behavior led to a patient's death. The role of varenicline in these cases is unclear, as smoking cessation itself, and accompanying nicotine withdrawal symptoms, may exacerbate underlying psychiatric illness. In addition, alcohol consumption may have been involved in the fatality. However, the patients described in these cases did not all have pre-existing psychiatric illness nor had they all discontinued smoking. The FDA recommends that varenicline-treated patients be monitored for behavior and mood changes and advised to be cautious when driving or operating machinery until they know how quitting smoking with the help of varenicline may affect them.

A recent report found a correlation between the availability of and access to mental health services and the prevalence of depression and suicide in each state in the United States (Mental Health America and Thomson Healthcare: Ranking America's Mental Health: An analysis of depression across the states. November 29, 2007. Available at, Accessed December 20, 2007). Using federal and state databases, the authors established a "depression index" that ranks states on the seriousness and prevalence of depression and suicide rates. New York has the lowest annual suicide rate (6 per 100,000), and Alaska has the highest (23 per 100,000). Areas in which there is greater availability of psychologists and psychiatrists, more adults receiving mental health treatment, and more health insurance coverage for mental illness have decreased rates of death from suicide. Access to health insurance is a key factor—the higher the percentage of state residents who report that health care is unaffordable, the greater the prevalence of depression and the rate of suicide in that state.

Heather S. Hopkins