Psychotropic drug

About: Psychotropic drug is a research topic. Over the lifetime, 2309 publications have been published within this topic receiving 54070 citations.

Is There a Common Resilience Mechanism Underlying Antidepressant Drug Response? Evidence From 2848 Patients

Abstract: Objectives Timing issues of antidepressant drug response are of major clinical relevance, given our current inability to predict when a particular patient will respond to a particular treatment. Method We detailed the time characteristics of recovery in a study of 2848 patients (diagnosed according to DSM-III-R/DSM-IV criteria as having major depressive disorder or major depressive episode) who were treated with 7 different anti-depressants and placebo. A 2-dimensional cure model was used to disentangle the 2 central aspects of psychotropic drug response: the proportion of patients in whom a therapeutic response is induced ( incidence) and the time to onset of improvement ( latency). Random-effects models were applied to quantify unexplained heterogeneity. Patients were recruited between June 1982 and May 1998. Results Our analyses yielded no indication for a delayed onset of antidepressant drug response. Rather, we found highly individual time characteristics of recovery along with a continuous distribution of the time spans to onset of improvement under treatment with all active compounds and placebo. The mean +/- SD time to onset of improvement was 13 +/- 1 days and to response was 19 +/- 1 days. Effective antidepressants appeared to trigger and maintain conditions necessary for recovery from the disorder. Odds-ratio analysis based on a random-effects model revealed that early improvers were at least 3 times more likely to become sustained responders with a pooled OR of 9.25, 95% CI = 7.79 to 10.98. Conclusions Affectively ill patients are likely to possess a common, biological, "resilience"-like component that largely controls recovery from depression. Once triggered, recovery appears to follow a pattern similar to the course observed with placebo, despite marked pharmacologic differences of the triggers. These findings may pave the way for new classes of psychotropic drugs specifically designed to support health-oriented processes underlying the natural resilience of patients.

Pharmacotherapy for Mood Disorders in Pregnancy: A Review of Pharmacokinetic Changes and Clinical Recommendations for Therapeutic Drug Monitoring

Abstract: Untreated mood disorders during pregnancy are associated with health risks to both mother and fetus, making the goal of euthymia paramount.1–4 Guidelines for the management of major depressive disorder and bipolar disorder during pregnancy stress the importance of preconception treatment planning and close clinical monitoring.2,5 Most women who discontinue maintenance antidepressants or mood-stabilizer pharmacotherapy for a pregnancy will experience a relapse during the pregnancy. Therefore, immediate and prophylactic treatment of many women with mood disorders will include pharmacologic treatment.6,7 Treatment during pregnancy is complicated by pharmacokinetic changes, which can result in lowered psychotropic drug levels and/or treatment efficacy. Therapeutic drug monitoring (TDM) is an integral aspect of the standard of care for medications with established therapeutic ranges, a narrow therapeutic index or significant pharmacokinetic variability, which includes some mood stabilizers and tricyclic antidepressants (TCAs). Given the evidence for changes in perinatal physiology and pharmacokinetics, TDM has the potential to optimize dosing by avoiding supratherapeutic doses that would increase drug exposure to the mother and fetus or subtherapeutic dosing that would expose the dyad to the consequences of undertreated psychiatric illness. A comprehensive discussion that includes the potential risks of undertreated mental illness for the mother and fetus, benefits of nonpharmacologic and potential risks, and benefits to psychopharmacologic treatment8–16 is essential to quality patient care. In cases of polypharmacy, TDM can be valuable in avoiding adverse effects due to drug-to-drug interactions. For medications without standardized therapeutic ranges, an individual woman’s drug level at a time when she is clinically asymptomatic that can be used as a target serum drug level during pregnancy may be useful.17,18 The objectives of this review are to summarize the evidence for changes in perinatal pharmacokinetics of psychotropic medications commonly used for mood disorders during pregnancy, consider the implications for clinical and TDM, and make clinical recommendations.

Cardiac side effects of psychiatric drugs.

Abstract: This review describes the common effects of psychotropic drugs on the cardiovascular system and offers guidance for practical management. Selected reports from the literature describing common side effects associated with psychotropic drugs are reviewed, and suggestions for further reading are given throughout the text. Orthostatic hypotension is the most common adverse autonomic side effect of antipsychotic drugs. Among the atypical antipsychotics the risk of orthostatic hypotension is highest with clozapine and among the conventional drugs the risk is highest with low potency agents. Rarely, orthostatic hypotension may result in neurocardiogenic syncope. QTc prolongation can occur with all antipsychotics but an increased risk is seen with pimozide, thioridazine, sertindole and zotepine. QTc prolongation is a marker of arrhythmic risk. Torsade de pointe, a specific arrhythmia, may lead to syncope, dizziness or ventricular fibrillation and sudden death. Heart muscle disease presents most commonly in the elderly as chronic heart failure, but myocarditis and cardiomyopathy, although relatively rare, are devastating, but potentially reversible complications of psychotropic drug therapy have been particularly linked to clozapine treatment. Patients with severe mental illness (SMI) are a 'high risk' population with regard to cardiovascular morbidity and mortality. It is probable that many patients accumulate an excess of 'traditional' risk factors for the development of cardiovascular disease, but other mechanisms including psychotropic drugs may also be influential in increasing risk in this vulnerable group. These risks need to be seen in the context of the undoubted therapeutic efficacy of the psychotropic armamentarium and the relief that these drugs bring to those suffering from mental disorder.

Datapoints: psychotropic drug prescriptions by medical specialty.

Abstract: 1167 T important role of general practitioners in prescribing antidepressant medications and treating depression has been documented. However, the extent to which general practitioners are prescribing other types of psychotropic medications has received less emphasis. This study used data from August 2006 to July 2007 from the National Prescription Audit (NPA) Plus database of IMS to examine this question. IMS collects transaction information each month from approximately 36,000 retail pharmacies, representing about 70% of all retail pharmacies, which when weighted represent all prescriptions filled in retail outlets in the United States. Using a separate sample of retail pharmacy transactions that includes the physician’s Drug Enforcement Administration number, IMS assigns physician specialty information to obtain an estimate of the total number of prescriptions filled in retail pharmacies by medical specialty. As shown Figure 1, of the 472 million prescriptions for psychotropic medications, 59% were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and nonphysician providers. General practitioners wrote prescriptions for 65% of the anxiolytics in the sample, 62% of the antidepressants, 52% of the stimulants, 37% of the antipsychotics, and 22% of the antimania medications. Conversely, psychiatrists and addiction specialists wrote prescriptions for 66% of the antimania medications, 49% of the antipsychotics, 34% of the stimulants, 21% of the antidepressants, and 13% of the anxiolytics. Pediatricians were included as general practitioners and wrote 25% of all stimulant prescriptions but only 3% of all other types of psychotropic medications (data not shown). Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment. However, concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment. Psychotropic Drug Prescriptions by Medical Specialty