APA Warns Against Common Uses of Antipsychotics
In September 2013, the American Psychiatric Association (APA) released a list of common, but potentially dangerous and inappropriate, uses for antipsychotics. The APA’s list includes the following recommendations:
- Don’t prescribe any antipsychotics without an appropriate initial evaluation and ongoing monitoring
- Don’t routinely prescribe two or more antipsychotic medications together
- Don’t prescribe antipsychotics as first-line treatment for behavioral and psychological symptoms of dementia
- Don’t routinely prescribe antipsychotics as first-line treatment of insomnia in adults
Don’t routinely prescribe antipsychotics medications as first-line treatment in children and adolescents for anything except psychotic disorders
The list was released as a part of the “Choosing Wisely” initiative, a program developed by the American Board of Internal Medicine (ABIM) Foundation to encourage physicians and their patients to discuss medical tests and procedures that may be unnecessary or harmful. Choosing Wisely currently lists more than 250 tests or procedures that may be harmful to patients. More than 80 specialty societies and groups have signed on to the program.
More information the APA’s recommendations can be found at www.psychiatry.org/choosingwisely.
NEW DRUG APPROVAL
Vortioxetine (Brintellix) approved for MDD
The FDA has approved vortioxetine (Brintellix) for the treatment of major depressive disorder (MDD). Brintellix is a novel antidepressant thought to work by enhancing serotonergic acitivty as a serotonin (5-HT) reuptake inhibitor and agonist of the 5-HT1A receptor, among other mechanisms.
The efficacy of Brintellix was established through six 6- to 8-week studies at doses ranging from 5 mg to 20 mg/ day and one 24- to 64-week maintenance study in adults at doses of 5 mg to 10 mg/day. One short-term study of the 5 mg/day dose was in the elderly.
Brintellix is available as 5 mg, 10 mg, 15 mg, and 20 mg immediate-release tablets. The maximum recommended daily dose is 20 mg/day. Brintellix is contraindicated in people taking MAOIs, the antibiotic linezolid (Zyvox), or IV methylene blue. The most common side effects are nausea, vomiting, and constipation.
The Brain May Remove Toxins During Sleep
Scientists have discovered that the brains of mice clean toxins from between cells while they are sleeping. During sleep, the space between brain cells increases by about 60%, allowing the glymphatic system, or the brain’s “plumbing” system, to flush the brain with fluid.
So called because it acts like the lymphatic system but is mediated by glial cells, the glymphatic system allows for the removal of waste products from cerebrospinal fluid (CSF). Researchers found that, while mice slept, brain cells shrank as CSF flowed through the brain parenchyma and ultimately into venous drainage. Past research has shown that toxins involved in neurodegenerative disorders accumulate between brain cells. In fact, researchers injected mice with beta-amyloid, a protein associated with Alzheimer’s disease, and found that it disappeared faster in the brains of mice who were sleeping than those who were awake.
The results of this study show hope for further understanding and treating neurodegenerative diseases, including Alzheimer’s disease. The study can be found in the October 18, 2013 issue the journal Science (Xie et al, Science 2013;342(6156):373–377).