November 2010

SAMe for Depression?
The first placebo-controlled trial of SAMe as an adjunct to antidepressants in patients with treatment-resistant depression has yielded positive results.

IV Ketamine for Bipolar Depression
In a randomized, add-on trial, one infusion of IV ketamine improved depressive symptoms in patients with treatment-resistant bipolar depression.

Receptor-Binding Profiles of New Antipsychotics
The new antipsychotics paliperidone (Invega), iloperidone (Fanapt), and asenapine (Saphris) have different receptor-binding properties.

Sex Steroids for Schizophrenia?
In a double-blind trial, low-dose pregnenolone but not dehydroepiandrosterone (DHEA) improved outcomes in patients with schizophrenia when used to augment antipsychotic treatment.

In Brief
FDA Advisory Committee Votes Against Approval of Weight-Loss Drug Lorcaserin; Neonatal Levels of Vitamin D Associated with Increased Schizophrenia Risk; Warning Issued that Anticonvulsant Drug Lamotrigine (Lamictal) Can Cause Aseptic Meningitis

ADHD Symptoms, Food Additives, and Genetic Variations
Genetic variations may underlie differences in how artificial food dyes affect attention-deficit/hyperactivity disorder (ADHD) symptoms in children.

In Brief

November 2010

Last month, we described a study of the weight-loss drug lorcaserin (BTP 2010;33:40-41). Lorcaserin was found to be similar in efficacy to currently available medications with a superior overall safety profile. On September 17, the US Food and Drug Administration's (FDA's) Endocrinologic and Metabolic Drugs Advisory Committee voted nine to five against its approval, stating that available data do not show that the potential benefits of lorcaserin for long-term use in overweight and obese individuals outweigh the potential adverse effects. The FDA was set to make a final decision on the medication by October 22.

In a recent study in Denmark, McGrath and others found that both low and high concentrations of neonatal vitamin D were associated with increased risk of schizophrenia (Arch Gen Psychiatry 2010;67:889-894). Participants in the study were individuals with schizophrenia born between 1981 and 1994 and controls with no history of the illness matched for sex and date of birth. Dried blood spots have been systematically stored for individuals in Denmark since May 1, 1981. The investigators identified 424 case-control pairs for whom the level of 25(OH)D3 could be successfully measured from the neonatal blood samples. Neonatal vitamin D status was significantly associated with the risk of schizophrenia in a nonlinear relationship. Compared with those in the fourth quintile, those in the first through third quintiles had a 2-fold increased risk. Those in the fifth quintile also had a significantly increased risk compared with those in the fourth quintile. The authors hypothesize that this nonlinear relationship could represent different underlying exposure-risk relationships reflecting genetic variation.

The US Food and Drug Administration has issued a warning to patients and physicians that the anticonvulsant drug lamotrigine (Lamictal) can cause aseptic meningitis (JAMA 2010;304:1317). Over a 5-year period, 40 cases of aseptic meningitis were reported in patients taking lamotrigine. Symptoms include headache, fever, chills, nausea, vomiting, stiff neck, rash, sensitivity to light, drowsiness, and confusion. In most cases, the symptoms resolved after lamotrigine was discontinued. For 15 patients, however, symptoms returned when they began taking lamotrigine again. Physicians are advised to discontinue lamotrigine treatment if a patient develops aseptic meningitis and an alternate cause for the illness cannot be found.

Heather S. Hopkins