September 2007

Prazosin for PTSD Nightmares
Adjunctive treatment with the α1-blocker prazosin (Minipress and others) reduces trauma nightmares and sleep disturbance in patients with posttraumatic stress disorder.

Treating Bipolar Depression
Antidepressants add little benefit in treating bipolar depression, but the risk of inducing mania appears small.

Are SSRIs Teratogens?
There is a small risk of congenital malformations with fetal exposure to selective serotonin reuptake inhibitors, particularly paroxetine (Paxil and others), during the first trimester.

In Brief
Benefits of Antidepressants versus Suicide Risk; Rivastigmine Does Not Slow Progression to Alzheimer's Disease

Antidepressants Can Help Prevent Depression after Stroke
Antidepressant drugs may provide relief for many patients suffering from depression following stroke.

In Brief

September 2007

Last month, we reported on the decision of the US Food and Drug Administration (FDA) to revise the black box warning on antidepressant drugs to include young adults (BTP 2007;30:34). We also described a meta-analysis of studies in children and adolescents that found the benefits of antidepressant treatment to be much greater than the small but increased risk from suicidal ideation or attempts (Bridge JA et al. JAMA 2007;297:1683-1696). Two recent studies support the idea that antidepressants decrease the risk of suicidal behavior rather than increase it. RD Gibbons and colleagues found a decline in suicide attempts after treatment initiation in 226,866 depressed veterans compared with the same patients prior to treatment (Am J Psychiatry 2007;164:1044-1049). These investigators also showed a lower rate of suicide attempts in patients receiving selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressants than in those who did not get antidepressant treatment. GE Simon and J Savarino found that in over 100,000 depressed patients, including adolescents and young adults, suicide attempts were highest in the month prior to treatment initiation, next highest in the first month of treatment, and lower as treatment continued (Am J Psychiatry 2007;164:1029-1034). These data are reassuring and suggest that antidepressants do much more good than harm.

In a double-blind trial, HH Feldman and others randomly assigned 1018 patients with mild cognitive impairment to treatment with either rivastigmine (Exelon; mean dose, 5.7 mg/day) or placebo to examine whether the active medication would slow progression to Alzheimer's disease (Lancet Neurology 2007;6:501-512). During 4 years of follow-up, 17.3% of patients treated with rivastigmine developed Alzheimer's disease compared with 21.4% of placebo-treated patients—a statistically insignificant difference. Overall adverse events did not differ between the two groups, but specific cholinergic side effects, such as nausea and vomiting, occurred more frequently in the rivastigmine-treated group.

Heather S. Hopkins