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.

Antipsychotics and New MIs

February 2007

People with schizophrenia have a life expectancy about 20% shorter than that of the general population.1,2 A major contributor to this increased mortality risk is cardiovascular disease. Some have speculated that mental illness itself adds to cardiovascular risk. The lifestyle associated with chronic mental illness-—including smoking, obesity, physical inactivity, and poor diet—certainly does. In addition, antipsychotics, both the first and the second generation, have been associated with increased risk of cardiac mortality. Nakagawa and others conducted a population-based case-control study using available records in Denmark to assess whether the risk of being hospitalized for a first-time myocardial infarction (MI) was increased among patients who take antipsychotics.3

Investigators identified over 21,000 cases of first-time hospitalization for MI. During the same 12-year period, they also identified over 100,000 sex- and age-matched control subjects who had not experienced an MI. Data on prescriptions were then analyzed for antipsychotic drugs filled before the patients were hospitalized.

There was no increased risk of being hospitalized for a first MI whether patients were taking first- or second-generation antipsychotics. There was also no association between cumulative dose of antipsychotics and the risk of being hospitalized for an MI. Although some antipsychotic drugs have been associated with increased risk of causing cardiac arrhythmias, this large study suggests that they do not increase the risk of a new MI.

1Newman SC, Bland RC: Mortality in a cohort of patients with schizophrenia: A record linkage study. Can J Psychiatry 1991;36:239-245.

2Harris EC, Barraclough B: Excess mortality of mental disorder. Br J Psychiatry 1998;173:11-53.

3Nakagawa S, Pedersen L, Olsen ML, Mortensen PB, Sørensen HT, Johnsen SP: Antipsychotics and risk of first-timehospitalization for myocardial infarction: A population-based case-control study. J Intern Med 2006;260:451-458.