October 2010

Exercise in Schizophrenia
Regular exercise can positively affect mental and physical health in people with schizophrenia.

Recognizing and Mitigating Delirium
Preventing delirium in hospitalized older patients saves lives and decreases dementia.

Lorcaserin: A New Drug for Weight Loss?
Lorcaserin has a better safety and adverse event profile but no greater efficacy than currently available weight loss agents.

In Brief
Bupropion during Pregnancy May Increase Risk of ADHD in Offspring; Bipolar Disorder Screening Recommended for Patients with Fibromyalgia

Treating Bipolar II Depression
Only quetiapine (Seroquel) is established as a first-line treatment for bipolar II depression; lithium, selective serotonin reuptake inhibitors (SSRIs), lamotrigine (Lamictal), and pramipexole (Mirapex and others) are second-line options.

In Brief

October 2010

When a woman takes bupropion (Wellbutrin and others) during pregnancy, there may be an increased risk of attention-deficit/hyperactivity disorder (ADHD) in her children (R. Figuroa. J Dev Behav Pediatr, in press). Figueroa obtained information on births, parental mental health diagnoses, maternal exposure to antidepressants, and ADHD in children from a sample of health plans in the United States from 1997 to 2006. Out of 38,074 families, 431 children (1.13%) were diagnosed with or treated for ADHD at or before age 5 years. A diagnosis of ADHD in a child was strongly associated with a diagnosis of ADHD in one of the parents. Other psychiatric disorders in the mother, but not in the father, also increased the risk of ADHD in the offspring. Children with the highest risk of ADHD-related claims came from mothers with mental retardation or pervasive developmental disorder, followed by bipolar disorder, psychotic disorder, and depressive disorders. The significant association between ADHD in the offspring and bupropion treatment in the mothers occurred only when women filled a prescription for bupropion during pregnancy, specifically during the second trimester, but not when prescriptions were filled for bupropion before or after pregnancy. Exposure to selective serotonin reuptake inhibitor antidepressants, by contrast, was associated with ADHD in the offspring when a prescription was filled after pregnancy, but not before or during. The author notes that ADHD has been linked to dopaminergic abnormalities and hypothesizes that bupropion taken during pregnancy could increase the risk of ADHD through dopamine reuptake inhibition. This observational study cannot confirm a causal relationship between antidepressant treatment and ADHD, nor that maternal mental illness causes or worsens ADHD in offspring, only that it increases the probability of it being diagnosed or treated. Figuroa concludes that evaluations of children with ADHD should include assessing the mental health of caregivers.

The norepinephrine serotonin reuptake inhibitors (NSRIs) duloxetine (Cymbalta) and milnacipran (Savella) have recently been approved by the US Food and Drug Administration for the treatment of fibromyalgia. Because patients with bipolar disorder may experience destabilization of mood when treated with such agents, Wilke and colleagues screened patients with fibromyalgia for comorbid bipolar disorder (Bipolar Disord 2010;12:514–520). Of 128 consecutive new fibromyalgia patients referred to a tertiary care center rheumatology practice who were assessed using four screening questionnaires, 32 (25%) screened positive for bipolar disorder, 100 (78%) were clinically depressed, and 67 (52%) reported daytime sleepiness. Subjects who screened positive for bipolar disorder had more severe depression than those with a negative screen. The authors recommend systematic assessment for bipolar disorder in patients with fibromyalgia prior to pharmacologic treatment.

Heather S. Hopkins