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Latest Results for Psychopharmacology

Sunday, August 3, 2014

August 2014

Scientists Find Potential Biomarker for Suicide

Identification and Replication of a Combined Epigenetic and Genetic Biomarker Predicting Suicide and Suicidal Behaviors

The American Journal of Psychiatry

Abstract Results and Conclusions
The DNA methylation scan identified an additive epigenetic and genetic association with suicide at rs7208505 within the 3′ untranslated region of the SKA2 gene independently in the three brain cohorts. This finding was replicated with suicidal ideation in blood from three live cohorts. SKA2 gene expression was significantly lower in suicide decedents and was associated with genetic and epigenetic variation of rs7208505, possibly mediated by interaction with an intronic microRNA, miR-301a. Analysis of salivary cortisol measurements suggested that SKA2 epigenetic and genetic variation may modulate cortisol suppression, consistent with its implicated role in glucocorticoid receptor transactivation. SKA2 significantly interacted with anxiety and stress to explain about 80% of suicidal behavior and progression from suicidal ideation to suicide attempt.
These findings implicate SKA2 as a novel genetic and epigenetic target involved in the etiology of suicide and suicidal behaviors.

Study Finds That Common Lab Test Can Help Predict Antidepressant Treatment Response

An Inflammatory Biomarker as a Differential Predictor of Outcome of Depression Treatment With Escitalopram and Nortriptyline

The American Journal of Psychiatry

Abstract Results   
C-reactive protein (CRP) level at baseline differentially predicted treatment outcome with the two antidepressants (CRP-drug interaction: β=3.27, 95% CI=1.65, 4.89). For patients with low levels of CRP (<1 mg/L), improvement on the MADRS score was 3 points higher with escitalopram than with nortriptyline. For patients with higher CRP levels, improvement on the MADRS score was 3 points higher with nortriptyline than with escitalopram. CRP and its interaction with medication explained more than 10% of individual-level variance in treatment outcome.
An easily accessible peripheral blood biomarker may contribute to improvement in outcomes of major depressive disorder by personalizing treatment choice.


St. John’s Wort Interactions Can Be Dangerous

Use of St. John's Wort (SJW) in Potentially Dangerous Combinations

The Journal of Alternative and Complementary Medicine

SJW was mentioned in 2,230,000 visits (120,000 visits/year). On average, visits mentioning SJW had 3.1 other drugs mentioned. Of the visits at which SJW was listed, 28% (620,000 visits over the 18-year study period) also listed a drug that is unsafe to use with SJW. Leading medications that could interact with SJW and that were listed at SJW visits included SSRIs (13.7%), benzodiazepines (9.8%), warfarin (4.2%), statins (3.3%), verapamil (1.0%), digoxin (1.0%), and oral contraceptives (0.6%).
Frequent use of SJW in potentially harmful combinations was observed. These interactions are likely to lead to harmful consequences such as serotonin syndrome, heart disease due to impaired efficacy of antihypertensives, or unplanned pregnancy due to contraceptive failure. Patients may have a false sense of safety with so-called “natural” treatments like SJW. Particularly for patients who are taking many other medications, SJW may be no safer than standard allopathic treatments.
Limitations of the study include the fact that only medications recorded by the physician could be analyzed. Patients who were using SJW or other therapies that interact with it, but did not inform their physician fully, would not be included, so this study may actually underestimate the rate of SJW interactions.
It is crucial for physicians to know the dangers of “natural” treatments and to communicate the risks to patients effectively.4,5 In addition, labeling requirements for herbal supplements such as SJW need to provide appropriate cautions and risk information.4 Physicians also need to be trained to always ask, in a nonjudgmental and understanding manner, whether the patient is taking any supplements, vitamins, minerals, or herbs. Particularly before prescribing any of the common drugs that might interact with SJW, clinicians should be sure they have determined whether patients are using this very popular CAM treatment.


Odor Identification May Be Able to Detect Risk for Cognitive Decline, Study Finds

2014 Alzheimer’s Association International Conference in Copenhagen

Quetiapine Appears Effective in Treatment of Borderline Personality Disorder, Study Finds

Comparison of Low and Moderate Dosages of Extended-Release Quetiapine in Borderline Personality Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial

The American Journal of Psychiatry

Abstract Results
Participants in the low-dosage quetiapine group had significant improvement on the Zanarini scale compared with those in the placebo group. Time to response (defined as a reduction of 50% or more on the Zanarini scale total score) was significantly shorter for both the low-dosage quetiapine group (hazard ratio=2.54, p=0.007) and the moderate-dosage quetiapine group (hazard ratio=2.37, p=0.011) than for the placebo group. Among participants who completed the study, 82% in the low-dosage quetiapine group were rated as “responders,” compared with 74% in the moderate-dosage group and 48% in the placebo group. Treatment-emergent adverse events included sedation, change in appetite, and dry mouth. The overall completion rate for the 8-week double-blind treatment phase was 67% (67% for the low-dosage quetiapine group, 58% for the moderate-dosage quetiapine group, and 79% for the placebo group). Participants who experienced sedation were more likely to drop out.
Participants treated with 150 mg/day of quetiapine had a significant reduction in the severity of borderline personality disorder symptoms compared with those who received placebo. Adverse events were more likely in participants taking 300 mg/day of quetiapine.


New pharmaceutical product to prevent heroin deaths


Science Daily

A method for needle-free, intranasal administration of the anti-opioid drug naloxone has been developed. The product is in its final round of clinical trials and has retrieved Fast Track status from the FDA.


Naltrexone may be effective in diminishing impulse control disorders in Parkinson's disease patients

Science Daily

Parkinson's disease (PD) patients may confront a common but largely unrecognized challenge: the occurrence of impulse control disorders (ICDs) such as compulsive gambling, sexual behavior, eating, or spending. A team of investigators conducted a pilot study and found that the opioid antagonist naltrexone may be an effective treatment for diminishing ICD symptoms in PD patients.


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