Finland Study Finds Metabolic Syndrome 270% Higher in Schizophrenia: In a study of 5613 members of the Northern Finland 1966 Birth Cohort, the prevalence of metabolic syndrome was higher in subjects with schizophrenia compared with the comparison group (19% vs. 6%, p = .010). The prevalence of metabolic syndrome in subjects with other psychoses was 5%. After controlling for sex, the results of logistic regression analysis showed that the risk of metabolic syndrome in schizophrenia was 3.7. A 4-Fold Risk of Metabolic Syndrome in Patients With Schizophrenia: The Northern Finland 1966 Birth Cohort Study. Saari KM, Lindeman SM, et al. University of Oulu, Oulu, Finland. J Clin Psychiatry. 2005 May;66(5):559-563. For more, see Diabetes and Schizophrenia.

Anti-Depressants Increase QTc in Schizophrenic Patients: In a study of 19 schizophrenic women, mean QTc intervals significantly increased when an anti-depressant was added to their anti-psychotic (citalopram, escitalopram, sertraline, paroxetine, fluvoxamine, mirtazapine, venlafaxine or clomipramine) or lithium. (24 ms) but not in 19 others treated with only an anti-psychotic (haloperidol, olanzapine, risperidone or clozapine)(-1 ms) (p < 0.01). The number of patients who exceeded the threshold of borderline QTc interval value (450 ms) differed between the two groups, with seven patients on added anti-depressants (38%) compared to one on anti-psychotics alone (7%) (p < 0,05). QT interval prolongation related to psychoactive drug treatment: a comparison of monotherapy versus polytherapy. Sala M, Vicentini A, et al. University of Pavia, Italy. Ann Gen Psychiatry. 2005 Jan 25;4(1):1. For more, see Arrhythmias in Schizophrenia.

Auto Safety: Air Bags No Benefit: A new analysis of existing data indicates that, controlling for other factors, airbags are actually associated with slightly increased probability of death in accidents. NHTSA recorded 238 deaths due to airbags between 1990 and 2002, all occurred at very low speeds. They also cause deaths at high speeds, but these have been attributed to the crash. Previous studies used data from the Fatality Analysis and Reporting System (FARS), a high-quality compilation of information about every highway accident for which a death occurred. The Crashworthiness Data System (CDS), another high-quality dataset, containing random samples of all accidents, was used in the new study. Mary C. Meyer, University of Georgia, Chance 6/05. While the value of airbags seems dubious in the new study, the value of seatbelts is not. The analysis found that proper use of a seatbelt reduces the odds of death by 67% for any given speed category and airbag availability. Airbags, however, cause no statistical difference in car-crash deaths, except for unseatbelted occupants at low speeds, where the odds of death are estimated to be more than four times higher with an airbag than without. v

Zoster Vaccine Works to Prevent Shingles: Shingles is a blistering rask causing pain in one area of skin on one side of the body or face. Caused by reactivation of the virus that caused chickenpox, which persists in a dormant state within nerve cells in everyone infected by chicken pox, shingles affects 60% of people who live to age 85. Shingles and a complication called postherpetic neuralgia (PHN), consisting of pain originating in damaged nerves that can persist for months or years. The Shingles Prevention Study involved more than 38,500 men and women, age 60 or older. Half of the subjects received a placebo and the other half received a single injection of the zoster vaccine-- containing a live, attenuated (weakened) form of varicella-zoster virus, the virus responsible for chickenpox and shingles. The zoster vaccine is a new, higher potency version of the vaccine that has been used to prevent chickenpox in children since 1995. During over three years of follow-up, 642 cases of shingles occurred in the placebo group, compared to only 315 in the vaccinated group. The total burden of pain and discomfort caused by shingles was reduced by 61% in vaccine recipients compared with placebo recipients. Moreover, vaccinated subjects were only a third as likely as placebo recipients to develop postherpetic neuralgia. Michael N. Oxman, Univ. Calif. San Diego. New Eng. J Med 6/2/05. For more, see Herpes Zoster.

Shark Cartilage: No Benefit in Advanced Cancer: In a DB PC study of 83 patients with incurable breast or colorectal carcinoma and good performance status and organ function, patients were all to receive standard care and then to be randomly selected to receive either a shark cartilage product or an identical-appearing and smelling placebo 3 to 4 times each day. There was no difference in overall survival between patients receiving standard care plus a shark cartilage product versus standard care plus placebo. Evaluation of shark cartilage in patients with advanced cancer. Loprinzi CL, Levitt R, et al. Mayo Clinic. Cancer. 2005 May 23. Ed: This larger study simply documents what smaller studies have found. Shark cartilage is worthless for treating cancer. v

Psyllium Allows Reducing Statin Dose: In a 12-week DB PC study, 68 patients were randomized to receive 20 mg of simvastatin plus placebo, 10 mg of simvastatin plus placebo, or 10 mg of simvastatin plus 15 g of psyllium (Metamucil) daily. After 8 weeks the mean LDL-C levels in the group receiving 10 mg of simvastatin plus placebo fell by 55 mg/dL, compared with 63 mg/dL in the group receiving 10 mg of simvastatin plus psyllium (P = .03). The mean lowering of LDL-C in the group receiving 20 mg of simvastatin plus placebo was the same as that in the group receiving 10 mg of simvastatin plus psyllium. Similar results were seen for apolipoprotein B and total cholesterol. No significant changes from baseline triglyceride or high-density lipoprotein cholesterol levels occurred. Effect of combining psyllium fiber with simvastatin in lowering cholesterol. Moreyra AE, Wilson AC, Koraym A. University of Medicine of New Jersey. Arch Intern Med. 2005 May 23;165(10):1161-6. Ed: This strategy cost reduce the risk of side-effects and expense. For more on lowering bad cholesterol, see Cholesterol.

Birth Control Pills Might Lower Libido: The birth control pill increases the level of sex hormone binding globulin (SHBG) - a protein produced in the liver that lowers testosterone levels, thereby reducing sexual drive. This increase was still found in women who had stopped taking the pill for a year. The researchers studied the use of the pill on 124 women at a sexual dysfunction clinic. Those who continued taking the Pill had four times the normal SHBG levels of women who had never taken it. Those women in the study who stopped taking the pill at the beginning of the study still had twice the normal level of SHBG after a year. Claudia Panzer, et al. Boston University. 5/26/05. Ed: This uncontrolled study doesn't mean much. It needs to be replicated with controls and in women who have their libido levels measured before starting the pill.  I really doubt that any libido impact will be found. v

Student IQs Decreasing: Since the late 1990's, the IQ scores of students in 14 industrialized nations has been decreasing.  Earlier, from 1954 to 1981, IQs had been increasing in Europe, a phenomenon attributed to the Flynn effect and better nutrition.  Siegfreid of the University of Erlangen analyzed data from 250,000 students from 2000 and 2003 as well as reports from other sources in the 1990s. The results showed decreases in IQ in Germany, Switzerland, and Austria. Thomas Teasdale, psychologist at the University of Copenhagen, was the first to note decreases in Denmark in the 1990s. Wolfgang Weiss, another professor, points to genetics and educated people having too few children.  Info-Weldt, de. 6/6/05. Ed: In all likelihood, this is a genetic effect since the fertility rates of the well-educated are well below average in each of these countries.  Genetic inheritance has been shown to be the primary contributor to IQ and academic performance, especially in well-nourished countries. For more, see Intelligence. 

Topiramate No Benefit for Child/Teen Bipolars: In a DB PC study of 56 children and adolescents with bipolar disorder type I, at four weeks all but two measures showed no benefit from topiramate. The study was stopped early because a larger study of adult bipolar disorder found no benefit. Topiramate side-effects included decreased appetite, nausea, diarrhea, and paresthesia. A Pilot Controlled Trial of Topiramate for Mania in Children and Adolescents With Bipolar Disorder. Delbello MP, Findling RL, et al. University of Cincinnati, University Hospitals of Cleveland, Johnson & Johnson Pharmaceutical; and Ortho-McNeil Pharmaceutical. J Am Acad Child Adolesc Psychiatry. 2005 Jun;44(6):539-547. Ed: This study shows the disturbing mixing of university and drug industry staff. For more, see Bipolar in Childhood.

Vitamins C and E Helped Delay Delivery in Premature Rupture: In a DB PC study of 60 women with singleton pregnancies of 26 to 34 weeks' duration and preterm premature rupture of membranes, vitamin C (500 mg/day) and vitamin E (400 IU/day) did not reduce the number of cases of chorioamnionitis, early neonatal sepsis, and respiratory distress syndrome. However, the number of days of delayed delivery (latency) was increased to 10.5 days vs. 3.5 days (P=0.03) for placebo. All women received 2 doses of betamethasone in the first 24 h after admission as well as broad-spectrum antibiotic prophylaxis.  Vitamins C and E in the latency period in women with preterm premature rupture of membranes. Borna S, Borna H, et al. Tehran University, Iran. Int J Gynaecol Obstet. 2005 May 19

Progesterone Helps Prevent Preterm Birth: In a review of the 7 DB PC studies to date, women who received progesterone were significantly less likely to give birth before 37 weeks (seven studies, 1020 women, RR = 0.58), to have an infant under 5.5 pounds (six studies, 872 infants, RR = 0.62), or to have an infant diagnosed with intraventricular hemorrhage (one study, 458 infants, RR = 0.25). The effect on infant mortality has not been proven. Progesterone supplementation for preventing preterm birth: a systematic review and meta-analysis. Dodd JM, Crowther CA, et al. The University of Adelaide, Australia. Acta Obstet Gynecol Scand. 2005 Jun;84(6):526-33. For more, see Pregnancy.

Risedronate (Actonel) Helped Knee Osteoarthritis: In a 1-year DB PC study of 284 patients with mild to moderate OA of the medial compartment of the knee, those receiving risedronate at 15 mg showed improvement of the WOMAC index, particularly of physical function, significant improvement of the patient global assessment (P < 0.001), and decreased use of walking aids relative to patients receiving the placebo (P = 0.009). A trend towards less joint-space narrowing was observed in the group receiving 15 mg risedronate. Eight percent of patients on placebo and 4% on 5 mg risedronate had detectable progression of disease (joint-space width >or= 25% or >or= 0.75 mm) versus 1% on 15 mg risedronate (P = 0.067). Risedronate (15 mg) significantly reduced markers of cartilage degradation and bone resorption. Effect of risedronate on joint structure and symptoms of knee osteoarthritis: results of the BRISK randomized, controlled trial [ISRCTN01928173]. Spector TD, Conaghan PG, et al. St Thomas' Hospital, London, UK. Arthritis Res Ther. 2005;7(3):R625-33. For more, see Arthritis.

Crohn's Disease: Selenium Decreased: Selenoprotein-P is a selenium-rich serum protein that carries more than 50% of serum selenium. In a study of 20 healthy controls, 34 patients with ulcerative colitis, and 37 patients with Crohn's disease (CD), there was no significant difference in serum selenoprotein-P levels between healthy controls (3.4 mug/mL) and patients with ulcerative colitis (3.0  mug/mL). However, selenoprotein-P levels were significantly lower in CD (1.8 mug/mL). Serum selenoprotein-P levels in patients with inflammatory bowel disease. Andoh A, Hirashima M, et al. Shiga University, Otsu, Japan. Nutrition. 2005 May;21(5):574-9. v

Brain Derived Neurotrophic Factor Polymorphism Minor Effect: Converging lines of evidence point to brain-derived neurotrophic factor (BDNF) as a factor in the pathophysiology of depression. The Val allele of the BDNF Val66Met substitution polymorphism showed a significant association with higher mean neuroticism scores of the NEO-Five Factor Inventory (NEO-FFI) in healthy subjects, and previous studies suggested the Val allele to be increased in bipolar disorder families. In a study of 343 unrelated German adults who were carefully screened for psychiatric health, the trait-related anxiety score was higher in Val/Val (35.0) compared to Val/Met (33.4) and Met/Met (32.0) genotypes (p<0.042). The NEO neuroticism scores were also higher in Val/Val (29.5) than in Val/Met (28.4) or Met/Met (26.8), but not at a significant rate.  Association of a functional BDNF polymorphism and anxiety-related personality traits. Lang UE, Hellweg R, et al. University of Tuebingen,  Germany. Psychopharmacology (Berl). 2005 Jun;180(1):95-9. Ed: Numerous genetic variations have been found to be somewhat increased in depressed and anxious individuals. For more, see Genetics in Depression.

DISC1 SNPs Linked to Bipolar and Schizophrenia in Scottish Women: The Translin-associated factor X/Disrupted in Schizophrenia 1 (TRAX/DISC) region was first implicated as a susceptibility locus for schizophrenia by analysis of a large Scottish family in which a t(1;11) translocation cosegregates with schizophrenia, bipolar disorder and recurrent major depression. In a new study of linkage disequilibrium in a representative sample of the Scottish population across the 510 kb of TRAX and DISC1, SNPs representing each haplotype block were selected for case-control association studies of both schizophrenia and bipolar disorder. A strong association with bipolar disorder in women was detected in a region of DISC1 (P=0.00026). The association between bipolar women and DISC1 remained significant after correction for multiple testing. Association between the TRAX/DISC locus and both bipolar disorder and schizophrenia in the Scottish population. Thomson PA, Wray NR, et al. University of Edinburgh, UK. Molecular Psychiatry 19 April 2005 For more, see Genetics in Bipolar Disorder.

Irresponsible "Research" From University of Illinois, Chicago, on Children: In small prospective 6-month open (uncontrolled) trial which supposedly examined the effectiveness and safety of divalproex sodium (Depakote) in pediatric mixed mania, 34 children with a mean age of 12 were treated with divalproex. The researchers claim an "effect size" (Cohen's d) based on change scores from baseline was 2.9 for the YMRS and 1.23 for the Child Depression Rating Scale-Revised and a response rate (>/=50% change from baseline YMRS score and </=40 score on CDRS-R at the end of study) of 73.5%. They also claim the medicine was safe and well tolerated. Divalproex sodium for pediatric mixed mania: a 6-month prospective trial. Pavuluri MN, Henry DB, Carbray JA, Naylor MW, Janicak PG. University of Illinois at Chicago (UIC). Divalproex sodium for pediatric mixed mania: a 6-month prospective trial. Bipolar Disord 2005: 7: 266-273. Ed: This is total bogus. The researchers are claiming that in a totally uncontrolled study that the improvement was due to the medication. It is impossible to make such a claim based on an uncontrolled study. Divalproex has also been associated with a markedly higher suicide rate vs. lithium and considerable weight gain. Such uncontrolled reports should never be published, since many physicians are influenced by such meaningless "findings." Shame on the University of Illinois. Do a DB PC study and don't publish open trials. For more, see Irresponsible Medicine and Open Trial Claims. This report does nothing to advance the body of knowledge and only increases the risk that children will be mistreated. 

Divalproex No Better than Lithium for Bipolar Children: Youths (139) ages 5-17 years with bipolar I or II disorder were initially treated with Lithium and divalproex (DVPX). Then, in a DB PC study of 60 patients achieving remission criteria for four consecutive weeks, half were given either Lithium or DVPX for up to 76 weeks. The treatment groups did not differ in survival time for emerging symptoms of relapse (p = .55) or survival time until discontinuation for any reason (p = .72). Double-blind 18-month trial of lithium versus divalproex maintenance treatment in pediatric bipolar disorder. Findling RL, McNamara NK, et al. Case Western Reserve University. J Am Acad Child Adolesc Psychiatry. 2005 May;44(5):409-17. Ed: This is the study the University of Illinois should have done! For more, see Lithium and Divalproex. Lithium is much less expensive, causes less weight gain, and is much better at preventing suicide.  Of course, a minority will have side-effects which can't be controlled and need an alternative, e.g., carbamazepine, divalproex, or an anti-psychotic.

Medication Compliance Markedly Reduced Rearrest in Bipolar Juveniles: In a very small study of probation records of all adolescents (N = 31) released during a 1-year period from a county juvenile corrections treatment facility who had DSM-III-R bipolar disorder, were stabilized on medication, and had agreed to continue treatment at an adolescent psychiatry clinic, the number of serious offenses (felonies and misdemeanors) was markedly reduced while subjects were on medication (4 offenses in 2992 days) versus off medication (39 offenses in 6108 days) (p < .0001). The off-medication rate of offending was 4.8 times higher than the on-medication rate. Probation violations were also significantly reduced while subjects were on medication (p < .001). Recidivism in medication-noncompliant serious juvenile offenders with bipolar disorder. Dailey LF, Townsend SW, et al. Hennepin County Medical Center, Minneapolis. J Clin Psychiatry. 2005 Apr;66(4):477-84. v

Menstrual Problems Common in Bipolar Women: In a study of 80 bipolar women not on birth control pills, 65% reported current menstrual abnormalities, and 50% reported one or more menstrual abnormalities that preceded the diagnosis of bipolar disorder. Of the 15 developing menstrual abnormalities since treatment for bipolar disorder, 14 were on valproate (p = 0.04). Of the 15, 12 reported changes in menstrual flow (heavy or prolonged bleeding) and five (33%) reported changes in cycle frequency. No significant differences were observed between women receiving or not receiving valproate in mean levels of free or total serum testosterone levels. Three of the 50 women (6%) taking VPA, and 0% of the 22 taking other antimanic medications, met criteria for PCOS (p = 0.20). Other reproductive and metabolic values outside the normal range across treatment groups included elevated 17 alpha-OH progesterone levels, luteinizing hormone: follicle-stimulating hormone ratios, homeostatic model assessment (HOMA) values, and low estrogen and dehydroepiandrosterone sulfate (DHEAS) levels. Preexisting menstrual abnormalities predicted higher levels of 17 alpha-OH progesterone, free testosterone, and estrone as well as development of new menstrual abnormalities. Body mass index (BMI) was significantly positively correlated with free testosterone levels and insulin resistance (HOMA) across all subjects, regardless of medication used. Reproductive function and risk for PCOS in women treated for bipolar disorder. Rasgon NL, Altshuler LL, et al. Stanford A. Bipolar Disord 2005: 7: 246-259.  v 

Placebo Studies Safe for Mania: In a review of all placebo-controlled, double-blind, randomized trials of medication for the treatment of acute manic episode and the prevention of manic/depressive episode that were part of a registration dossier submitted to the regulatory authority of the Netherlands between 1997 and 2003, the 11 studies of acute manic episode, including 1,506 patients (117 person-years) in the treatment group and 1,005 patients (71 person-years) in the placebo group, no suicides and no suicide attempts occurred. In four placebo-controlled studies of the prevention of manic/depressive episode, including 943 patients (406 person-years) in the treatment group and 418 patients (136 person-years) in the placebo group, two suicides (493/100,000 person-years of exposure) and eight suicide attempts (1,969/100,000 person-years of exposure) occurred in the treatment group, but no suicides and two suicide attempts (1,467/100,000 person-years of exposure) occurred in the placebo group. Suicide risk in placebo-controlled trials of treatment for acute manic episode and prevention of manic-depressive episode. Storosum JG, Wohlfarth T, et al. Medicines Evaluation Board of the Netherlands. Am J Psychiatry. 2005 Apr;162(4):799-802. v

Poor Quality Report From Harvard Encourages Lithium Plus Carbamazepine for Treatment Failures: Researchers found 14 small, usually brief, clinical trials of maintenance treatment with lithium plus carbamazepine which suggested added benefit of combination treatment over either agent alone. In a low-quality "post hoc analysis", of 46 bipolar I patients identified as not improving during long-term monotherapy in a mood disorders clinic, comparing days per year hospitalized in 3 consecutive time periods: before prophylactic treatment, during monotherapy with lithium (N = 31) or carbamazepine (N = 15), and during their combined use (N = 46), there was a significant reduction in hospitalized days per year during combination therapy, averaging a decrease of 55.9% (p = .004). Hospitalizations per year fell by 36.1%, and median time to recurrence nearly doubled during combination therapy. Rates of adverse effects increased 2.5-fold and use of adjunctive psychotropic agents increased by 21.9%. The researchers claimed that "combining lithium with carbamazepine yielded substantial benefit," but such a poor quality, uncontrolled study cannot be used to support any type of conclusion. Long-term combination therapy versus monotherapy with lithium and carbamazepine in 46 bipolar I patients. Baethge C, Baldessarini RJ, et al. Harvard- McLean. J Clin Psychiatry. 2005 Feb;66(2):174-82. For more, see Lithium. 

Abnormal Tryptophan Hydroxylase-2 Gene Found in 10% of Depressed: Researchers have found a (G1463A) single nucleotide polymorphism (SNP) in the gene for the rate-limiting enzyme of neuronal serotonin synthesis, human tryptophan hydroxylase-2 (hTPH2). The functional SNP in hTPH2 replaces the highly conserved Arg441 with His, which results in approximately 80% loss of function in serotonin production when hTPH2 is expressed in PC12 cells. SNP analysis of 87 patients with unipolar major depression revealed that nine patients carried the mutant (1463A) allele, while among 219 controls, only three did. The dysfunctional SNP was not found in 60 bipolar disorder patients. Loss-of-function mutation in tryptophan hydroxylase-2 identified in unipolar major depression. Zhang X, Gainetdinov RR, et al. Duke University. Neuron. 2005 Jan 6;45(1):11-6. For more, see Genetics of Depression. This study supports the use of 5-HTP for depression, since 5-HTP is the product manufactured by the body through the use of this gene.  The body then make 5-HTP into serotonin.

Quetiapine (Seroquel) Did as Well as Lithium for Mania: In a 12-week DB PC study of 302 patients with bipolar I mania, quetiapine (72/107) and lithium (67/98) groups were more likely to complete the study than the placebo group (35/97). Quetiapine and lithium did equally well. The most common adverse events for quetiapine were dry mouth, somnolence, and weight gain, while lithium was associated with tremor and insomnia. A randomized, double-blind, placebo-controlled efficacy and safety study of quetiapine or lithium as monotherapy for mania in bipolar disorder. Bowden CL, Grunze H, et al. University of Texas Health, San Antonio. J Clin Psychiatry. 2005 Jan;66(1):111-21. Ed: While I prefer Geodon as the first atypical to try on cost and side-effects grounds, atypical anti-psychotics are good mood stabilizers. For more, see Atypicals for Mania. 

Fish Oil May be Safer than Fish: Fish contain environmental toxins such as mercury, polychlorinated biphenyls, and organochlorine pesticides. In a study of 5 commercial fish oil brands, the levels of polychlorinated biphenyls and organochlorines were all below the detectable limit. Measurement of organochlorines in commercial over-the-counter fish oil preparations: implications for dietary and therapeutic recommendations for omega-3 fatty acids and a review of the literature. Melanson SF, Lewandrowski EL, et al. Harvard. Arch Pathol Lab Med. 2005 Jan;129(1):74-7. For more, see Omega-3s.

Lithium Helped Compulsive Gamblers with Bipolar Disorders: Selective serotonin reuptake inhibitors may be effective for some patients with pathological gambling, but those with bipolar spectrum disorders may relapse during treatment. In a 10-week DB PC study of 40 pathological gambling patients with bipolar spectrum disorders, those given lithium carbonate significantly improved compared to placebo on total pathological gambling scores on the Yale-Brown Obsessive Compulsive Scale, including both thoughts/urges and behavior, as well as on the Clinical Global Impression severity of pathological gambling scale. Affective instability (the Clinician-Administered Rating Scale for Mania score) was also lower in the group treated with sustained-release lithium carbonate compared to placebo. Ten (83%) of 12 completers were rated as responders in the sustained-release lithium group versus five (29%) of 17 in the placebo group. Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders? Hollander E, Pallanti S, et al. Mount Sinai School of Medicine, New York, NY. Am J Psychiatry. 2005 Jan;162(1):137-45. v

Amphetamines Used on Bipolar Children: An 8-week open-label trial of divalproex (Depakote) to control manic symptoms in 40 bipolar children ages 6-17 with mania and ADHD symptoms was followed by a 4-week DB PC crossover of added mixed amphetamine salts was safe and effective for treatment of ADHD symptoms. With divalproex sodium, 32 subjects achieved > or =50% reduction in Young Mania Rating Scale baseline scores, but only three participants had significant improvement in ADHD symptoms. For the 30 subjects who entered the placebo-controlled crossover trial, mixed amphetamine salts was significantly more effective than placebo for ADHD symptoms. No significant side effects or worsening of manic symptoms was observed. Randomized, placebo-controlled trial of mixed amphetamine salts for symptoms of comorbid ADHD in pediatric bipolar disorder after mood stabilization with divalproex sodium. Scheffer RE, Kowatch RA, et al. University of Texas Southwestern Medical Center at Dallas. Ed: I am very skeptical of this brief 4-week study of amphetamines for bipolar children. First of all, I would not have used Depakote in view of its higher suicide rates vs. lithium. Then I would have tried non-medication interventions for ADHD, at least initially. Amphetamines can certainly increase psychotic symptoms and 4 weeks might not be long enough to detect the damage. Since stimulants don't help academic achievement in carefully done studies, their benefits may not be as great as commonly believed. For more, see Stimulants for ADHD and ADHD.

Olanzapine May Have Anti-Depressant Effect in Bipolars: In a secondary analysis of a 6-week DB PC study of olanzapine (5-20 mg/day) or placebo combined with ongoing valproate or lithium open treatment for 344 patients in mixed or manic episodes, in the dysphoric subgroup (n=85) mean HRSD depression score improvement was significantly greater in olanzapine co-therapy patients than in those receiving placebo plus lithium or valproate (P<0.001). Substantial contributors to this superiority included the HRSD suicide item (P=0.001). Total Young Mania Rating Scale improvement was also superior with olanzapine co-therapy. Efficacy of olanzapine combined with valproate or lithium in the treatment of dysphoric mania. Baker RW, Brown E, et al. Lilly Corporate Center, Indianapolis, IN. Br J Psychiatry. 2004 Dec;185:472-8. Ed: Most atypical anti-psychotics have been shown to have some anti-depressant effect and probably all of them do. For more, see Atypicals in Bipolar Disorder.

Auditory Hallucinations Decreased by Repeated Transcranial Magnetic Stimulation: Right-handed patients experiencing auditory hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 132 minutes of rTMS was administered over 9 days at 90% motor threshold using a in a DB sham-controlled study. Hallucination Change Score was more improved for rTMS relative to sham stimulation (p = .008) as was the Clinical Global Impressions Scale (p = .0004). Hallucination frequency was significantly decreased during rTMS relative to sham stimulation (p = .0014). There was no evidence of neurocognitive impairment associated with rTMS.  Temporoparietal Transcranial Magnetic Stimulation for Auditory Hallucinations: Safety, Efficacy and Moderators in a Fifty Patient Sample. Hoffman RE, Gueorguieva R, et al. Biol Psychiatry. 2005 Jun 2. Ed: This is the 3rd of 3 DB studies reporting benefit. Pretty exciting stuff. rTMS is also good for depression. For more, see rTMS for Schizophrenia.

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Thomas E. Radecki, M.D., J.D.

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