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IN THIS ISSUE:
May 2010

Citalopram and Escitalopram Overdoses
Overdoses with both citalopram (Celexa and others) and escitalopram (Lexapro) can cause serious toxicity.

Borderline Personality Disorder: A Role for Medication?
Antipsychotics, including aripiprazole (Abilify) and olanzapine (Zyprexa), as well as mood stabilizers, such as topiramate (Topamax) and lamotrigine (Lamictal), alleviate some symptoms of borderline personality disorder, but the effects of antidepressants on this condition are variable.

Morphine to Prevent PTSD
Early treatment with morphine following an injury may reduce the risk of posttraumatic stress disorder (PTSD).

Risperidone-Induced Hyperprolactinemia Lowers BMD in Boys
Both risperidone (Risperdal and others), through its effects on prolactin concentrations, and selective serotonin reuptake inhibitors (SSRIs) can lower bone mineral density in boys.

Priapism with Antipsychotics
Antipsychotic medications with a high affinity for the α1-adrenal receptor, such as chlorpromazine (Thorazine), quetiapine (Seroquel), and ziprasidone (Geodon), may be more likely to cause priapism than those with a low affinity.

In Brief
Spouses of People with Dementia Have Higher Risk of Depression; Modafinil (Provigil) Effective for Treating Fatigue in HIV+ Patients

In Brief

May 2010

Dementia in one's spouse increases the risk of depression. In a prospective, naturalistic study, Joling and coworkers in the Netherlands investigated the incidence of depression and anxiety in spouses of patients with dementia (Am J Geriatr Psychiatry 2010;18:146-153). They compared the medical records of 218 spouses (mean age, 76.2 years) with those of 353 age- and gender-matched controls (spouses of nondemented individuals). Between 2001 and 2007, a new episode of depression was diagnosed in 18 (8%) of the spouses and 7 (2%) of the controls. A new episode of anxiety was diagnosed in 12 (6%) of the spouses and 15 (4%) of the controls. Prescriptions for both antidepressant and anxiolytic medications, the secondary outcome measure, were significantly higher for spouses of demented patients than for the comparison group. While the difference in the rate of anxiety between the two groups was nonsignificant, the risk of diagnosis of incident depression was fourfold greater in the spouses of demented patients.

Modafinil appears to be a safe and effective treatment for fatigue in people with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), per a recent study by Rabkin and colleagues (J Clin Psychiatry, in press). Approximately 30% to 50% of people with HIV/AIDS suffer from fatigue, which can limit function, restrict activities, and possibly contribute to medication noncompliance. Fatigue in this population can have multiple etiologies and has been associated with depression. Investigators studied modafinil (Provigil)—a schedule IV agent approved for the treatment of narcolepsy, obstructive sleep apnea, and shift work-related sleep disorders (BTP 2005;28:6-7,43)—for HIV+ patients who had clinically significant fatigue. One hundred fifteen patients, aged 21 to 75 years, were randomly assigned to modafinil, starting at 50 mg/day and increased up to 200 mg/day, or placebo in double-blind fashion for 4 weeks. An additional 8 weeks of open-label treatment followed for modafinil responders and 12 weeks for placebo nonresponders. The Clinical Global Impressions-Improvement scale was the primary outcome measure for fatigue and depression, and safety was measured with assays of CD4 cell count and HIV ribonucleic acid (RNA) viral load. At week 4, 45 (73%) of 62 modafinil-treated patients were classified as responders compared with 15 (28%) of 53 subjects in the placebo group. There was no significant change in CD4 cell counts, but HIV RNA viral load declined significantly in patients taking modafinil. Of 16 modafinil-treated subjects who had a baseline diagnosis of depression and reported an improvement in mood, only 1 did not also have an improvement in energy. At 6 months, subjects still taking modafinil showed a significant decline from baseline in their HIV RNA viral load and had more energy and fewer depressive symptoms than patients who were not taking modafinil.

Heather S. Hopkins