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IN THIS ISSUE:
August 2010

Anticonvulsants and Suicide Risk
Findings from a recent study support the US Food and Drug Administration's 2008 conclusion that anticonvulsants increase the risk of suicidal ideation and behavior.

The Generic Medication Question
Variability in the bioavailability of generic medications can affect efficacy and tolerability in some patients.

Antidepressant-Induced Mania?
Evidence from a meta-analysis of controlled and open trials suggests that antidepressants increase the risk of a switch from depression into hypomania or mania in patients with bipolar disorder and in those with major depression.

Medications to Reduce Antipsychotic-Induced Weight Gain
The overall effect of medications as antidotes to antipsychotic-induced weight gain is modest; diet and exercise should be the first-line strategy.

In Brief
Veterans with PTSD Have Greater Risk of Dementia; Bupropion Safe and Effective Aid for Smoking Cessation in Schizophrenia

Smoking and Clozapine Levels
Elevations in plasma clozapine (Clozaril and others) concentrations following smoking cessation can be dramatic and potentially lead to serious toxicity.

In Brief

August 2010

Veterans with posttraumatic stress disorder (PTSD) have a nearly twofold greater risk of developing dementia compared to those without PTSD. Searching the Department of Veterans Affairs National Patient Care Database in a stratified, retrospective cohort study, Yaffe and collaborators identified veterans, 55 years or older, who did not have dementia between 1997 and 2000 and had at least one visit to a VA health care facility between 2001 and 2007 (Arch Gen Psychiatry 2010;67:608-613). Of 181,093 participants, 53,155 had been diagnosed with PTSD. The veterans' mean baseline age was 68.8 years, and 96.5% were men. During the follow-up period, dementia was newly diagnosed in 31,107 veterans (17.2%). Those with PTSD had a 7-year cumulative incident dementia rate of 10.6% versus 6.6% in veterans without PTSD (P < .001). Results were similar when participants with a history of head injury, substance abuse, or clinical depression were excluded. The authors suggest several explanations for patients with PTSD having an increased risk of developing dementia, including damage to the hippocampus, alterations in the hypothalamic-pituitary-adrenal axis, and proinflammatory cytokines due to chronic stress.

Is bupropion (Wellbutrin and others) safe and effective as an aid for smoking cessation in adults with schizophrenia? People with schizophrenia have greater odds of smoking than the general population (Bobes et al. Schizophr Res 2010;119:101-109) and lower rates of smoking cessation. Tobacco may alleviate some schizophrenia symptoms, and its use as "self-medication" may make it harder for patients to quit smoking. Although the safety and efficacy of bupropion as a treatment for nicotine dependence has been shown in the general population, it is metabolized by the cytochrome P450 hepatic enzyme system and may interact with antipsychotics commonly used to treat schizophrenia. Tsoi and others conducted a systematic review and random-effects meta-analysis of randomized controlled trials (Br J Psychiatry 2010;196:346-353). Data pooled from seven studies involving 260 subjects showed that biochemically confirmed self-reported smoking cessation rates were significantly higher after treatment with bupropion than after treatment with placebo, both at the end of treatment (P = .004) and 6 months later (P = .05). Subgroup analysis suggested that abstinence may be more likely when bupropion is combined with nicotine replacement therapy than when it is used alone. There was no significant difference in positive (P = .28) or negative symptoms (P = .49) between patients treated with bupropion and those in the placebo group.

Heather S. Hopkins