Sunday, September 25, 2011

Effects of lithum on developing fetus

Lithium is a drug that is used in Bipolar affective disorder and resistant depression. However, it is a rather toxic molecule to the human body. But it is safe within certain dose range.

There are several documented cases of birth defects caused by Lithium in humans. They include Epstein anomaly. It is a heart anomaly that can become a severe problem in later life.

In addition, high doses of lithium can cause several abnormalities in the rat fetus. They include high incidence of cleft palate, growth retardation, brain liquification and pulpy brain, hepatomegaly and digital abnormalities. However, incidence in humans are not available because of the obvious reasons.

But stopping lithium during pregnancy can cause severe relapse of bipolar disorder. Which can result in more damages to the fetus and the mother. So doctors weigh risks and benefits of continuing lithium during pregnancy. Sometimes your doctor may decide to continue lithium with the aforementioned risks. In addition, there are very few safer bipolar maintenance therapy options available to the doctors. Some doctors may change the drug regimen to anti-psychotic medications with mood stabilizing properties such as seroquel/zyprexa.


Teratogenic effects of lithium and ethanol in the developing fetus.

Thursday, September 15, 2011

Best drugs for insomnia after giving up alcohol

According to a systematic review (Pharmacological Treatment of Insomnia in Alcohol Recovery: A Systematic Review) published in Alcohol and Alcoholism journal, there are several drugs that can be used for insomnia or lack of sleep seen in patients who gave up alcohol. In most patients, these sleep problems can go on for months.

Usually chronic alcohol dependence patients need to be detoxified before stopping alcohol. It is because alcohol changes the person's brain chemistry and sudden alcohol withdrawal can cause severe reaction that can even kill the person. Therefore, doctors give certain drugs to allow the brain to adjust to sudden withdrawal of alcohol. 

However, after taking off these detox drugs (Usually Librium) some patients complain insomnia for a prolonged period and it can cause treatment failure (Returning to take alcohol).

The treatment of insomnia in alcoholic patients has been poorly studied by doctors. In addition, treating sleep problems in alcohol recovery phase is complicated by the fact that some of the most commonly used medications to treat sleep disturbance are thought to have a high abuse potential e.g Ambien, Benzodiazepines (Vallium).

Above study has identified some drugs that can be used for this condition. They are

1. Trazadone (Desyrel)
2. Gabapentine (Neurontin)
3. Lormetazepam (Noctamid)

However, contrary to popular belief Ambien and other Z drugs are not effective in this condition.


Sunday, September 4, 2011

Effects of antipsychotic medications on dementia – Analysis of CATIE-AD study

Dementia is known to cause memory impairment, personality change, problems in judgments, and intellectual impairment. These changes taken together are called impairments in cognitive capacity.

Doctors usually prescribe antipsychotic medications for dementia, especially to calm down acutely disturbed patients. In addition, some patients are given regular dose of antipsychotics as a maintenance therapy to improve sleep and agitation. Most common antipsychotics prescribed are Risperidone (Risperdal®), Quetiapine (Seroquel ®), and Olanzapine (Zyprexa®).

However, there is a recent debate among doctors regarding the long term outcome of this practice. One of the reasons is the blood lipid abnormalities seen in patients who are prescribed atypical antipsychotics such as Risperidone (Risperdal®), Quetiapine (Seroquel ®), and Olanzapine (Zyprexa®). This could lead to heart problems such as heart attacks. In addition, these problems could increase the memory impairment seen in Alzheimer's disease due to blockage of vessels in the brain.

Now doctors have concluded several studies on this regard. One of such is the “Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer's Disease study (CATIE-AD)” study. As the name suggest it looked into the relationship between prescription of antipsychotic medications and Alzheimer’s dementia. This study mainly looked at memory impairment and other cognitive impairments seen in dementia patients who are prescribed antipsychotics.

How the CATIE-AD study is conducted?

This study carried out in more than 400 patients. Most of them are community dwelling moderate to severe dementia patients. These patients were randomly allocated to different treatment groups and they were prescribed Risperidone, Quetiapine and Olanzapine. In addition, patients were given different medications in different times similar to crossover design. This study was carried out around three years.

Results of the study

This study reported a statistically significant cognitive impairment associated with antipsychotic medications. That means people who were prescribed antipsychotics showed greater memory impairment than the people who were not prescribed them.


Many other studies that were performed around the time showed conflicting results.

This study is not a very large study and the cross over design can have many problems that would change the outcome. However, it will certainly put more weight on the argument that antipsychotics cause cognitive impairment. But other options available for agitation and psychosis seen in dementia patients such as benzodiazepines may also cause cognitive impairment. Therefore, in practice it is difficult to stop prescribing antipsychotics for patients with dementia.

Consequences of Antipsychotic Medications for the Dementia Patient - Am J Psychiatry 168:767-769, August 2011

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