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October 2008

Two Drugs for Fibromyalgia
Pregabalin (Lyrica) and duloxetine (Cymbalta) are approved in the United States for the treatment of fibromyalgia.

Preventing Poststroke Depression
In a 2008 study by Robinson and colleagues, escitalopram (Lexapro) and problem-solving therapy decreased the likelihood of poststroke depression.

Duloxetine for Elderly Patients with GAD
Due to possible adverse events, duloxetine (Cymbalta) should be a second-line option for elderly patients with generalized anxiety disorder.

In Brief
Switch to Aripiprazole Reduces Cardiovascular Risk in Schizophrenia; SSRIs Are Effective for Treating PMS/PMDD; Statins May Protect Against Dementia

Antidepressants for Social Anxiety Disorder
Sertraline (Zoloft and others), paroxetine (Paxil and others), venlafaxine (Effexor and others), and fluvoxamine (Luvox and others) appear to be the most efficacious antidepressants for the treatment of social anxiety disorder, with escitalopram (Lexapro) a reasonable alternative.

In Brief

October 2008

In a double-blind, randomized trial, Newcomer and colleagues compared the metabolic effects of aripiprazole (Abilify) with olanzapine (Zyprexa) in overweight people with schizophrenia or schizoaffective disorder who were previously treated with olanzapine (J Clin Psychiatry 2008;69:1046-1056). After 16 weeks, subjects who were switched from olanzapine to aripiprazole had a significantly greater decrease in weight from baseline than those who continued on olanzapine treatment—a mean loss of 1.8 kg (4.0 lb) versus a mean gain of 1.41 kg (3.13 lb) (P < .001). Patients treated with aripiprazole also had decreases in triglyceride levels while those taking olanzapine had increases, and the differences in percentage change in triglyceride levels were significant at all time points. On the downside, patients taking aripiprazole had statistically significantly worse endpoint scores on the mean Clinical Global Impression-Improvement scale than those taking olanzapine, and more subjects discontinued aripiprazole than olanzapine due to adverse effects. The authors conclude that switching to an antipsychotic medication with a lower metabolic risk may reduce cardiovascular risk in patients with schizophrenia or schizoaffective disorder but must be tempered by possible loss of efficacy and different side effects.

How do selective serotonin reuptake inhibitors (SSRIs) compare with one another in treating premenstrual symptoms? Shah and coworkers conducted a meta-analysis of 29 double-blind, randomized, controlled trials comparing an SSRI with placebo for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) (Obstet Gynecol 2008;111:1175-1182). The studies comprised almost 3000 women and involved the SSRIs citalopram (Celexa and others), fluoxetine (Prozac and others), fluvoxamine (Luvox and others), paroxetine (Paxil and others), and sertraline (Zoloft and others). All SSRIs significantly improved symptoms of PMS and PMDD, except for fluvoxamine (for which only one small trial met inclusion criteria), although the effect size of improvement was smaller than previously reported. Continuous dosing was more effective than intermittent dosing.

Another study shows that statins may protect against dementia. Statins reduce low density-lipoprotein cholesterol levels and protect against cardiovascular events. Some epidemiological studies have found they are associated with a decreased risk of dementia. Cramer et al followed 1674 subjects who were at least 60 years old and free of cognitive impairment at baseline for 5 years (Neurology 2008;71:344-350). Of these subjects, the 452 (27%) who used statins at some time during the study were about half as likely as those who did not use statins to develop dementia or cognitive impairment.

Heather S. Hopkins