Co-use of donepezil and hypnotics among Alzheimer's disease patients living in the community.

Background: In clinical trials, sleep problems have been identified as side effects of donepezil, an acetylcholinesterase (AChE)-inhibiting medication for the treatment of Alzheimer's disease (AD). Poor sleep quality can exacerbate behavior problems among patients and add to the burden experienced by their caregivers. We examined the relationship between co-use of donepezil and hypnotics in a large sample of persons with AD living in the community.

Neurotransmission of cognition, part 2. Selective NRIs are smart drugs: exploiting regionally selective actions on both dopamine and norepinephrine to enhance cognition.

Selective norepinephrine reuptake inhibitors such as atomoxetine increase both dopamine and norepinephrine in frontal cortex and may thereby enhance cognitive functioning in attention-deficit/hyperactivity disorder.

Neurotransmission of cognition, part 1, Dopamine is a hitchhiker in frontal cortex: norepinephrine transporters regulate dopamine.

Since the frontal cortex has a low density of dopamine transporters, dopamine has to be inactivated there by hitching a ride on the norepinephrine transporter of neighboring norepinephrine neurons.

The metabolic syndrome: psychopharmacologists should weigh the evidence for weighing the patient.

We are in the midst of a North American epidemic of obesity and type 2 diabetes. Since patients with psychiatric disorders who receive psychopharmacologic treatments may be at even greater risk than the general population for weight gain, dyslipidemia, and diabetes and their complications, psychopharmacologists now need standards for how to monitor and manage these risks.

Comparative efficacy between venlafaxine and SSRIs: a pooled analysis of patients with depression.

Background: Serotonergic and adrenergic enhancement may be synergistic and more effective than serotonergic enhancement alone in treating depression. The dual serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine is a dual reuptake inhibitor that may therefore offer greater efficacy than selective serotonin reuptake inhibitors (SSRIs).

Methods: Data from eight randomized, double-blind, controlled studies were pooled to compare efficacy in depressed patients receiving venlafaxine/venlafaxine extended release (XR), SSRIs, or placebo for View Article and Find Full Text PDF

Independent actions on fear circuits may lead to therapeutic synergy for anxiety when combining serotonergic and GABAergic agents.

Both serotonin and GABA powerfully regulate the neuroanatomical circuit that mediates fear in anxiety disorders. This suggests that use of pharmacotherapies acting on both systems may provide synergistic therapeutic actions.

Mirror, mirror on the wall, which enantiomer is fairest of them all?

Numerous psychotropic drugs exist as a mixture of 2 mirror-image stereoisomers of each other, each called an enantiomer and the mixture called a racemate. Often the drug can be improved when only 1 of the enantiomers is administered.

Effects of reboxetine on anxiety, agitation, and insomnia: results of a pooled evaluation of randomized clinical trials.

Several recent clinical trials have established that reboxetine, a new selective norepinephrine reuptake inhibitor (selective NRI), is effective and safe for the treatment of major depression. However, the effects of reboxetine on specific symptoms of anxiety, agitation, and insomnia have not been reported. Data were obtained from nine short-term, double-blind, randomized clinical trials in patients with major depression.

Awakening to the psychopharmacology of sleep and arousal: novel neurotransmitters and wake-promoting drugs.

Exciting new developments in the psychopharmacology of wakefulness are clarifying the neurotransmitters, pathways, and drugs that impact this important physiologic state. Selectively inducing normal wakefulness without stimulating external vigilance may lead to therapeutic benefits not only in sleep disorders but also in cognitive disorders and conditions associated with fatigue.

Does depression hurt?

Depression is an illness that causes symptoms in both the body and the brain, i.e., painful physical as well as emotional and vegetative symptoms.

Selective actions on sleep or anxiety by exploiting GABA-A/benzodiazepine receptor subtypes.

The next generation of anxiolytics may be subtype-selective partial agonists at GABA-A receptors. By exploiting new psychopharmacologic principles, such as the targeting of receptor subtypes that have unique subunits and the partial activation of these subtypes with stabilizers, we may eventually have anxiolytics that are rapid acting, but without sedation, amnesia, or dependence.

The psychopharmacology of energy and fatigue.

Second only to depressed mood itself tiredness, low energy, and listlessness are the most common symptoms associated with depression. Recent understanding of interactions between monoaminergic neurons may help explain why some antidepressants may be more rapidly energy restoring than others.

Dopamine system stabilizers, aripiprazole, and the next generation of antipsychotics, part 1, "Goldilocks" actions at dopamine receptors.

Dopamine system stabilizers are a potential new class of antipsychotic agents without motor side effects. All known effective antipsychotics act at D2 receptors. A novel concept for an antipsychotic without motor side effects is to stabilize these receptors rather than block them harshly.

"Hit-and-run" actions at dopamine receptors, part 1: Mechanism of action of atypical antipsychotics.

Either 5-HT2A antagonism or fast dissociation from D2 receptors may define an atypical antipsychotic. To have little or no motor symptoms from an antipsychotic, it is clear that D2 receptor binding in the striatum must be less than that caused by conventional antipsychotics. Pure 5-HT2A antagonism by itself does not result in robust antipsychotic actions.

Natural estrogen as an antidepressant for women.

Recent well-controlled studies suggest that estrogen has antidepressant actions in perimenopausal women. Estrogen may also have antidepressant actions in postpartum women and across the life cycle for women who are resistant to treatment with various antidepressants. The question, however, of which depressed women to treat with antidepressants, which with estrogen, and which with both remains unanswered.