Dr. Jeff's and Dr. Tanya's Blog

Is strattera (atomoxeine) helpful in controlling ADHD symptoms in the longer term in children and adolescents?

Children and adolescents who are diagnosed with ADHD often need to be prescribed a medication to control their symptoms with several years if not longer. Clinical Psychiatric News, June 2008, vol 36, no. 6, reported on relapse prevention study of 600 children and adolescents who were followed for 18 months. “ADHD rating scale measurements showed relapse rates were lower for those taking atomoxetine, compared with those in the placebo arm.” Based on this data, the FDA approved strattera as a maintenance treatment for children and adolescents with ADHD ages 6 to 15. This study raises a number of important questions. The study compared strattera against placebo. Do other ADHD medications do a better job of controlling ADHD symptoms in children and adolescents in the long term at lower cost? And, does strattera continue to remain effective if the child on prescribed the drug for several years or longer? These questions will have to await further study.

The Bottom Line: A new study appears to support the conclusion that strattera is helpful in controlling ADHD symptoms in children and adolescents for up to one year as compared to placebo.

Reference: http://www.clinicalpsychiatrynews.com/article/S0270-6644(08)70374-6/fulltext

Dr. Tanya Korkosz
Dr. Jeffrey Speller
Psychopharmacology Associates
of New England
www.psychopharmassociates.com

What influences a patient’s decision to either start or stop antidepressant medication?

It has long been known that patient attitudes, beliefs, and thoughts about antidepressant medication can and do significantly influence the patient’s decision to begin or to stop medication. A study published in J Consult Clin Psychol 2008 Feb; 76:149 examines this issue in some detail. This study was reviewed in Journal Watch Psychiatry in the June 2008 Vol. 14 No. 6. The study examined the opinions of individuals, both current users and former users of antidepressant medication, about antidepressant medication and then, nine months later, observed the individuals’ actual use of antidepressant medication. The results of the study were interesting. Intent to discontinue antidepressant among current users of antidepressants was a strong predictor of these patients’ decision to actually stop medication nine months later. These individuals believed that they could manage their problems on their own without the use of antidepressants. Individuals who were formerly prescribed antidepressants and who at nine months were back on medication believed that the benefits of antidepressants were significant, particularly, in decreasing their symptoms of depression. This study raises several interesting question. What can mental health professionals do to better educate patients who stop their medication that their decision to discontinue treatment may not be in their best interest? And, what sources of information, i.e., the internet, family, friends, other patients, primary care physicians, etc., influence patient’s decisions to start or stop medication? And should mental health professionals routinely ask new patients about their opinions about antidepressant use and the sources of their information?

The Bottom Line: This study suggests that former users of antidepressant depression who decide to restart antidepressants typically believe that antidepressants helped them control their depressive symptoms. Individuals who stopped antidepressant use believed that they could manage their problems on their own.

Dr. Tanya Korkosz
Dr. Jeffrey Speller
Psychopharmacology Associates
of New England
www.psychopharmassociates.com

What is the best treatment for depressed individuals who are highly self-critical?

A study published in J Clin Psycology 2008 Mar; 64:231, examined treatments of depressed individuals who were highly self critical. A review of this study was published in the June 2008 edition of Journal Watch, Psychiatry. Other studies have concluded that patients with different childhood histories and an different adult personality styles with respond differently to different treatments. This study examined 102 self-critical adults who received cognitive-behavioral therapy, psychiatric medications, and interpersonal therapy. The results were discouraging. Those individuals who were highly self-critical tended to do poorly in treatment with psychiatric medications and interpersonal therapy. They appeared to do better with cognitive-behavioral therapy. In the light of this study data there are several questions to ponder. Should mental health professionals screen self-critical individuals before they begin treatment of determine what is the best treatment option for them going forward? What would such a screening protocol look like and would in be practical in the day-to-day busy clinical practice? Are all antidepressants inappropriate for the self-critical patient or is there an antidepressant that will have a better chance of treating the depression successfully, either alone or in combination with therapy? Should self-critical patients seek out cognitive-behavioral therapy as their first line treatment and skip a trial of an antidepressant altogether? These answers must await further study.

The Bottom Line: This study suggests that depressed individuals who are highly self-critical respond better to cognitive-behavioral therapy that to psychiatric medications or interpersonal therapy.

Dr. Tanya Korkosz
Dr. Jeffrey Speller
Psychopharmacology Associates
of New England
www.psychopharmassociates.com

What is the best treatment approach for adolescents with hard-to-treat depression?

A study published in JAMA 2008 Feb 27; 299:901 examined treatment approaches for adolescents with hard-to-treat depression—a growing problem considering that more than 40% of adolescents who are diagnosed with a significant depressive disorders do not have a good therapeutic response to their treatment. The study was reported in the May 2008 edition of the Journal Watch. 334 adolescents were included in this study all of whom received an antidepressant, specifically in the SSRI class, for eight weeks with no significant improvement. These adolescents were then given a different SSRI or Effexor (Venlafaxine) some of whom received, in addition, weekly cognitive behavioral therapy (CBT) for 12 weeks. The results of the treatment showed improvement in depression scores and overall functioning with the CBT group showing the biggest gains in improvement. Approximately equal improvement was observed with the either the SSRI or Effexor group. This study points to the clinical usefulness of trying other antidepressants when adolescents don’t improve. It is also important to have hard-to-treat adolescents involved in cognitive-behavioral therapy in addition to receiving their antidepressants. There are a number of questions to ponder for both the parents of hard-to-treat adolescents and their treating mental health professionals. Are all SSRIs the same or some are better that others when treating this patient population? Given the side effect profile of Effexor (withdrawal symptoms when doses are missed, increase in blood pressure, etc.) should the SSRIs be tried first rather than Effexor? How do you convince an adolescent to do cognitive-behavioral therapy and stick with it?

The Bottom Line: Trying a different antidepressant combined with cognitive-behavioral therapy appears to offer the best hope of improving hard-to-treat adolescents.

Dr. Tanya Korkosz
Dr. Jeffrey Speller
Psychopharmacology Associates
of New England
www.psychopharmassociates.com

Do you have an anxiety disorder?

In today’s hectic world, anxiety and fear virtually have become the part and parcel of one’s life. Whether in the exam hall, work place or even at home’s comfort, a person constantly suffers from mental uneasiness. It is quite normal to panic before stepping for a difficult task and it tends to disappear soon after the desired work is over. But what we call as “anxiety disorder” seems never to fade away and gets even worse with passage of time. Generalized Anxiety Disorder, Obsessive compulsive disorder (OCD), Post traumatic stress disorder (PSTD), and Acrophobia (fear of height) are some of the more common anxiety disorders. The patients with these disorders have been observed to unearth tension even from the simplest things of life. They are always anxious. They are constantly in a fearful state. Anxiety disorders are treatable. With the help of skilled and professional assistance, the symptoms of an anxiety disorder can be gradually lessened. Proper medication, cognitive behavioral therapy, prescribed diet, different techniques of relaxation are definitely some of the effective remedies.

The Bottom line: Never let anxiety completely engross your mind. But even if it occurs, specialists are there to help you to diagnose, treat, and manage it.

Sources: See blogposts in: Psychiatric Disorders: Anxiety Disorders

Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates
of New England
www.psychopharmassociates.com