February 2007

Acupuncture for Depression: Missing the Point
Depression-specific acupuncture was no better than nonspecific acupuncture for patients with major depression.

Adjunctive Galantamine in Schizophrenia
Galantamine (formerly Reminyl, currently Razadyne) added to risperidone (Risperdal) treatment for schizophrenia patients offered some benefits.

Adverse Effects of Erectile Dysfunction Drugs
Drugs for erectile dysfunction, such as sildenafil (Viagra) and vardenafil (Levitra), may worsen sleep apnea and can cause seizures.

Deep brain stimulation decreased obsessive compulsive symptoms in 10 patients.

Clozapine for Treatment-Resistant Schizophrenia
Clozapine (Clozaril and others) was superior to other second-generation antipsychotics for treatment-resistant patients with schizophrenia.

In Brief
Rasagiline Approved for Treatment of Parkinson's Disease; Paliperidone Approved for Treatment of Schizophrenia; PCOS Reversed When Valproate Discontinued.

Antipsychotics and New MIs
A large study suggests that antipsychotic drugs do not increase the risk of a new myocardial infarction (heart attack).

Take Ziprasidone with Food
Adequate absorption of ziprasidone is promoted by taking it with a meal that contains at least 30% fat.

In Brief

February 2007

The US Food and Drug Administration (FDA) has approved rasagiline (Azilect), a monoamine oxidase type B inhibitor, for the treatment of Parkinson's disease (Med Lett Drugs Ther 2006;48:97-99). As with all monoamine oxidase inhibitors, rasagiline may interact with antidepressants. It should not be taken with mirtazapine (Remeron and others), selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, or tricyclic antidepressants. Fluoxetine (Prozac and others) should be stopped 5 weeks before treatment with rasagiline is initiated.

Another new drug recently approved by the FDA is paliperidone (Invega), an antipsychotic manufactured by Johnson & Johnson, who also makes risperidone (Risperdal). Paliperidone is the principal active metabolite of risperidone. It will be sold in an extended-release formulation for the treatment of schizophrenia. In three 6-week studies of paliperidone involving 1665 subjects, doses ranging from 3 to 15 mg/day were superior to placebo in relieving symptoms of schizophrenia (FDA News. Accessed December 28, 2006). Common adverse effects were restlessness, extrapyramidal symptoms, tachycardia, and somnolence. In the final year of risperidone's patent protection, it will be interesting to see if paliperidone offers clinical benefit to offset what, in 2008, will be a much higher price than its "parent" drug.

Last year, Joffe et al reported that women taking valproate (Depakote) in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study had a greater risk of developing the polycystic ovarian syndrome (PCOS) than women taking other mood stabilizers (10.5% vs. 1.4%, respectively) (BTP 2006;29:54, Biol Psychiatry 2006;59:1078-1086). Joffe and coworkers conducted a follow-up study to determine if symptoms of PCOS would resolve when valproate was discontinued (Biol Psychiatry 2006;60:1378-1381). Five of nine women who had developed new-onset menstrual cycle irregularities with hyperandrogenism while taking valproate in the original study participated, as did 9 of 19 women who had been taking valproate for 6 months or less (and therefore were at risk of developing PCOS). Two of these nine subjects developed PCOS features before the second assessment. PCOS features persisted at follow-up in three women who continued taking valproate but resolved in three of four women who discontinued it. There was no statistically significant difference in body mass index between those who continued and those who discontinued valproate. Thus it appears that when valproate triggers PCOS, discontinuing it may reverse the syndrome.

Heather S. Hopkins