ABSTRACT
Gabapentin is a relatively new anticonvulsant indicated for adjunctive therapy in the treatment of partial seizures, with and without secondary generalization, in adults with epilepsy. Overall, it has a minimal side effect profile compared with other anticonvulsant agents. Postmarketing surveillance is needed to further delineate the spectrum of adverse events that may be experienced by patients treated with this medication. This is a case report of a 25-year-old man with a 10-year history of mood swings that progressively worsened and resulted in a suicide attempt 8 months before his first appointment. A diagnosis of bipolar disorder was established, and a clinical interview ruled out other mental disorders. The patient was administered gabapentin 300 mg/day, and the dose was titrated upward to 900 mg/day. A follow-up appointment revealed improved control of his bipolar symptoms. However, the patient reported that he could not have an orgasm during sexual intercourse. The medication was changed to valproic acid 250 mg three times daily. His bipolar symptoms remained under control and the anorgasmia resolved. This was maintained at the next follow-up appointment. The side effect profile and therapeutic monitoring requirements of gabapentin are favorable when compared with those of other anticonvulsant agents. However, because this agent is relatively new, especially for use in the treatment of bipolar disorder, a more thorough development of its side effect profile is needed. Observing, recording, and reporting atypical adverse events and side effects are critical to postmarketing surveillance and enhance the clinician's ability to make rational therapeutic decisions.
Subject(s)
Acetates/therapeutic use , Amines , Antimanic Agents/therapeutic use , Bipolar Disorder/complications , Cyclohexanecarboxylic Acids , Orgasm/drug effects , Sexual Dysfunction, Physiological/drug therapy , gamma-Aminobutyric Acid , Acetates/adverse effects , Adult , Antimanic Agents/adverse effects , Bipolar Disorder/psychology , Gabapentin , Humans , Male , Sexual Dysfunction, Physiological/complications , Sexual Dysfunction, Physiological/psychologyABSTRACT
Antidepressant drugs that act on serotonin and noradrenergic systems may be analgesic. The newer antidepressant mirtazapine (Remeron) has activity on noradrenergic and serotonergic transmission and is approved for the treatment of a Major Depressive Disorder. This paper describes a case that suggests that mirtazapine may also be useful in the treatment of chronic pain.
Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Back Pain/drug therapy , Mianserin/analogs & derivatives , Accidental Falls , Back Pain/etiology , Chronic Disease , Humans , Male , Mianserin/therapeutic use , Middle Aged , MirtazapineABSTRACT
Ninety-three patients, including 47 patients with Generalized Anxiety Disorder (GAD) and 46 patients with Major Depression (MD), were entered into recent clinical trials. Clinicians acknowledge that during the initial screening process, clear separation between depressed and anxious patients may be difficult. By using the DSM-IV criteria, the Hamilton Depression and Anxiety Scales, and a variety of other structured evaluations, patients were divided into the two diagnostic groups. The Millon Multiaxial Inventory (MCMI-III) was administered to all 93 patients as part of their initial assessment, but was not used in the diagnostic decision making process or in assignment to a particular clinical study. Upon completion of these studies, the Millon data were analyzed utilizing a cutoff score of 75, conforming to previous studies. Statistically significant differences in Millon personality patterns between MD and GAD patients included dependent, obsessive-compulsive, self-defeating, and borderline traits. Patients exhibiting dependent, self-defeating, and borderline patterns were statistically more likely to be included in clinical trials of MD rather than GAD. Also, patients with MD were more likely to disclose clinical information and exhibit self-critical behavior when compared to those with GAD. These results suggest that the MCMI-III may detect personality differences between anxious and depressed outpatients presenting for clinical trials.
Subject(s)
Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Personality Disorders/diagnosis , Personality Disorders/psychology , Personality Inventory , Surveys and Questionnaires , Adult , Aged , Anxiety Disorders/complications , Depressive Disorder, Major/complications , Female , Humans , Male , Middle Aged , Personality Disorders/complications , Psychiatric Status Rating Scales , Self-Assessment , Severity of Illness IndexABSTRACT
Olanzapine is a relatively new antipsychotic agent which appears to be effective in the treatment of both the positive and negative symptoms of schizophrenia. Reported here is the case of a patient who developed symptoms of mania secondary to treatment with olanzapine. Physicians prescribing olanzapine should be aware of this potential complication.
