January 2010

Asenapine to Treat Schizophrenia and Bipolar Disorder
The new antipsychotic asenapine (Saphris) appears comparable to other second-generation agents but requires sublingual administration.

Clozapine Plus Other Antipsychotics
A paper by Taylor and Smith suggests that adding another antipsychotic to clozapine (Clozaril and others) for treatment-resistant patients has minimal therapeutic benefit.

Isotretinoin (Accutane) May Exacerbate Symptoms in Patients with Bipolar Disorder
Isotretinoin (Accutane) may destabilize mood in patients with bipolar disorder.

Stimulants Associated with Sudden Death in Young Patients
Stimulants such as methylphenidate may increase the risk of sudden unexplained death in young patients.

In Brief
Depression Risk Lower with 'Whole Foods' Diet; Anxiety during Menopause Not Improved by Black Cohosh

Lithium, Thyroid Function, and Depressive Relapse
Patients with bipolar disorder treated with lithium may develop depressive episodes due to changes in thyroid function.

Fighting Fire with Fire: Injectable Heroin for Heroin Addicts?
Diacetylmorphine merits consideration as a treatment of last resort for heroin addicts who don’t respond to methadone therapy.

In Brief

January 2010

Akbaraly and others examined dietary patterns and their association with depression in 3486 middle-aged Caucasian office workers in London (Br J Psychiatry 2009;195:408-413). On a self-report questionnaire, participants (mean age, 55.6 years) recorded the frequency with which they had consumed over 125 food items during the previous year. Two dietary patterns were identified: "whole food" (heavily loaded by vegetables, fruits, and fish) and "processed food" (heavily loaded by sweetened desserts, fried food, processed meat, refined grains, and high-fat dairy products). Depressive symptoms were measured 5 years later using the 20-item, self-report Center for Epidemiologic Studies—Depression scale. After controlling for a large range of sociodemographic variables, health behaviors, and health parameters (including chronic disease and cognitive functioning), investigators found that participants with the highest intake of whole foods had lower odds of depression (OR = 0.74, 95% CI 0.56-0.99) than those in the lowest tertile for the whole food pattern. In contrast, high intake of processed food was associated with increased odds of depression (OR = 1.58, 95% CI 1.11-2.23) compared with the lowest intake of processed food. These findings are in line with studies that show health benefits from adherence to a "Mediterranean" diet; that is, one high in fruits, vegetables and fish and low in meat and dairy products (eg, Sofi et al. BMJ 2008;337:a1344).

During menopause, many women experience psychological symptoms (such as irritability and anxious or depressed mood) in addition to vasomotor symptoms. Vasomotor symptoms are often treated with hormone replacement therapy, while benzodiazepines or antidepressants may be prescribed for anxiety. Due to side effects of these treatments, however, some women turn to "alternative" therapies, including black cohosh (Cimicifuga racemosa). Amsterdam and others conducted a small double-blind, parallel-group trial on the efficacy and tolerability of black cohosh extract for the treatment of anxiety disorder due to menopause (J Clin Psychopharmacol 2009;29:478-483). Twenty-eight women were randomly assigned to treatment with black cohosh or placebo, but 1 subject in each group withdrew consent prior to treatment, 2 in each group were lost to follow-up, and 1 in the black cohosh group discontinued due to adverse events. After 12 weeks of treatment, there was no significant group difference in change over time in total scores on the Hamilton Anxiety Rating Scale (HAM-A) (P = .294). The proportion of subjects with a reduction of ≥ 50% in baseline HAM-A scores at study endpoint was also not significantly different between the two groups (P = .140). The study may have been limited by the small sample size, choice of black cohosh preparation, and/or dosage used. The authors call for more adequately powered studies to assess the anxiolytic properties of this herbal remedy.

Heather S. Hopkins