Selective serotonin reuptake inhibitors and atypical antidepressants: A review and update for psychologists.

Psychologists are increasingly being required to care for patients who are concurrently undergoing pharmacological treatment, particularly when patients suffer from mood disorders, such as major depression. In addition, nonpsychiatric physicians are prescribing antidepressant medications with greater frequency, thereby increasing the likelihood that the physician with which the psychologist must collaborate will have a limited understanding of psychiatric illnesses. As independent mental health professionals, psychologists have a right and a responsibility to be actively engaged in all aspects of their patients' treatment, including pharmacotherapy. A prerequisite for providing this level of professional care is a solid grounding in the principles and actions of pharmacological agents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The new antidepressants. Selective serotonin reuptake inhibitors

This article provides a resource for choosing among available SSRIs to treat pediatric patients. SSRIs are addressed according to five areas of interest: treatment efficacy data, untoward effects profile, pharmacokinetic characteristics, potential drug-drug interactions, and cost. Strategies for SSRI dosing and pretreatment work-up are also discussed. Included in the article is a reference table for SSRI dosing, available preparations, and cost per dose. Also included is an abbreviated reference table of important cytochrome P-450 isoenzymes, isoenzyme inhibition by SSRIs, and selected psychotropic and somatic medication substrates.     

Newer antidepressants. Beyond selective serotonin reuptake inhibitor antidepressants

This article outlines the use of alternative agents to TCAs and SSRIs. Features of the more commonly used alternative antidepressant agents are outlined. In addition, antidepressant agents that are currently either under development or used in other countries are indicated for completeness because it seems likely that many of these will be introduced in the United States within the next few years. Many of these agents will be used by pediatricians and child psychiatrists for treatment of depression in children, and although much further research is needed, the future for alternative antidepressants and augmenting strategies is extremely promising.     

Selective serotonin reuptake inhibitors in pregnancy and lactation

Selective serotonin reuptake inhibitors (SSRIs) have become the agents of first choice in the treatment of depression because of their safe side effect profile. This paper reviews the current literature on the use of SSRIs in pregnancy and lactation concerning their safety. There are human studies that only used fluoxetine in pregnancy, which established its safety. SSRIs are excreted in breast milk, and their long-term effects on the newborn are unknown at this time. The decision to use SSRIs in pregnancy should be made on a case by case basis with active involvement of the patient in the informed consent process during which the risks and benefits are discussed and documented.     

Selective serotonin reuptake inhibitors dissociate fenfluramine's anorectic and neurotoxic effects: importance of dose, species and drug

Fenfluramine, a clinically prescribed appetite suppressant, has been found to damage brain serotonin (5-HT) neurons in every animal species tested to date. Recent findings indicate that fluoxetine, a selective 5-HT reuptake inhibitor (SSRI), can prevent fenfluramine-induced 5-HT neurotoxicity without blocking fenfluramine-induced appetite suppression. The purpose of our studies was several-fold: 1) To determine whether the ability for fluoxetine to dissociate fenfluramine-induced anorexia and neurotoxicity is dose-related; 2) to ascertain whether other SSRIs also prevent fenfluramine-induced neurotoxicity without altering its anorectic effect; 3) to determine whether similar fluoxetine/fenfluramine interactions are seen in another animal species (i.e., mice) and 4) to determine whether decreases in food intake seen after the fluoxetine/fenfluramine combination can be attributed to nonspecific behavioral suppression. Results from our studies indicate that fluoxetine's effects are, indeed, dose-related, because higher doses of fluoxetine are required to protect against the 5-HT neurotoxic effects of higher doses of fenfluramine. Further, our results indicate that fluoxetine's effects generalize to all other SSRIs tested (citalopram, paroxetine and sertraline), as well as to other species (mice). Finally, our results demonstrate that anorexia in animals receiving the fenfluramine/fluoxetine combination is not secondary to nonspecific behavioral suppression, because water intake is increased although food intake is decreased in the same animals. Together, these data suggest that the anorectic and 5-HT neurotoxic effects of fenfluramine may involve different mechanisms, and that by combining fenfluramine with SSRIs, it may be possible to exploit fenfluramine's clinically useful properties (e.g., anorexia) without risking brain 5-HT neural injury.     

Postpneumonectomy syndrome: recognition and management

STUDY OBJECTIVE: Postpneumonectomy syndrome (PPS) results from extreme shift and rotation of the mediastinum after pneumonectomy producing symptomatic proximal airway obstruction and air trapping. Herein, we review our experience in the treatment of PPS. PATIENTS: Five patients with PPS were treated at our institution between 1991 and 1997. Four patients had previous right pneumonectomy; one patient had left pneumonectomy. Dyspnea was the presenting symptom in all five patients. The time interval to onset of symptoms and to surgical correction ranged from 6 months to 9 years (median: 6 months) and 9 months to 29 years (median, 21 months) after pneumonectomy, respectively. INTERVENTION: The clinical diagnosis of PPS was confirmed with chest radiograph, two-dimensional echocardiography, pulmonary function tests, CT scan, and awake fiberoptic bronchoscopy. Correction of PPS required reexploration of the pneumonectomy space followed by anterior pericardiorrhaphy and insertion of a saline solution-filled Silastic prosthesis (Dow Corning; Midland, MI) for the purpose of correcting the overshift of the mediastinum. There was no morbidity or mortality. RESULTS: All patients had relief of dyspnea. Corrective repositioning of the mediastinum was confirmed by chest radiograph, CT scan, and awake fiberoptic bronchoscopy. There was a mean increase in the cross-sectional diameter, as measured by CT scan, of the obstructed bronchus by 166.7% (range, 100 to 300%) in four patients. One patient had no change in the measured diameter. Postoperatively, the peak expiratory flow rate increased by a mean of 44.2% (range, 40 to 49%) in all five patients. CONCLUSION: The presence of PPS should be considered in all patients presenting with progressive dyspnea after pneumonectomy. Repositioning of the mediastinum with a saline solution-filled prosthesis and anterior pericardiorrhaphy is easily performed and provides immediate and lasting symptomatic relief.     

The efficacy of selective serotonin reuptake inhibitors for the management of chronic pain

Using a tensiometer in accordance with the drop volume principle, the surface tension decrease with time was determined for whole and for 2%, 10%, and 50% aqueous solutions of saliva from one healthy donor. The reduction of surface tension with time was also measured for 10% and 20% saliva solutions with added samples of Streptococcus salivarius KRF2, S. sanguis KRF3, and Actinomyces naeslundii 2t-55. The results show that 1) there is a time dependence of the surface tension reduction of both whole saliva and diluted saliva, 2) an increase of the concentration of whole saliva in salivary solutions gives rise to larger and more rapid surface tension reduction, 3) the proteinaceous components of saliva appear to have a dominant contribution on surface tension in whole saliva and diluted saliva, and 4) the surface-active proteinaceous components in saliva have the ability to dominate the air-saliva interface also in the presence of high concentrations of salivary bacteria.     

Review of cardiovascular effects of fluoxetine, a selective serotonin reuptake inhibitor, compared to tricyclic antidepressants

The objective of this study is to find out which mathematical model best explains the temporal fluctuations of the axial blood flow velocity waveforms in the basal arteries of the brain. Blood flow velocity time series were sampled by transcranial Doppler (TCD) examination of the middle cerebral arteries in 10 healthy volunteers. A recently developed mathematical test (surrogate data analysis) was used to examine whether the spectral Doppler maximum waveform consistent with some prespecified model (null hypothesis). We tested four different null hypothesis. 1. Uncorrelated white noise. 2. Linearly filtered noise. 3. Linearly filtered noise with a static nonlinear amplitude transformation. 4. Noisy nonlinear limit cycle. All null hypotheses except the last one could be rejected. We conclude that the TCD waveforms are best described as nonlinear limit cycle with some percentage of noise, either dynamical and/or observational, which is uncorrelated from one single oscillation to the next. These results are a strong argument to perform nonlinear analysis in future TCD studies in order to obtain a better understanding of the cerebral hemodynamics.     

Time management training for school psychologists.

Describes a program for training school psychologists in time management, which was derived from a behavioral problem-solving framework and can be used by a practitioner either alone or with initial assistance from a supervisor. It consists of 4 steps: orientation to time management, time management problem analysis, plan development and implementation, and plan evaluation. Utilization of the program by 2 school psychology practitioners appears to have increased the amount of time devoted to behavioral counseling and to planning and evaluation of individualized education programs, without decreasing quality of assessment services. The program was judged to be socially valid by 10 outside practitioners. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Successful outcome in a patient with chemical sensitivity. Treatment with psychological desensitization and selective serotonin reuptake inhibitor

A 49-year-old male was diagnosed as having primary aldosteronism at age 39, and he was treated with antihypertensive drugs. In 1995, a computed tomogram revealed a mass in the right adrenal gland. Radiological examinations and endocrinological data revealed the presence of a pheochromocytoma in the right and an adrenocortical tumor in the left adrenal gland. Right adrenalectomy and left partial adrenalectomy were performed. Histologically, the right adrenal mass was compatible with pheochromocytoma, and the left adrenal mass was an adrenocortical adenoma. Endocrinological data as well as blood pressure returned to normal after operation.     

Progressive resistance to a selective serotonin reuptake inhibitor but not to cognitive therapy in the treatment of major depression.

Recent research suggests that there may be a reduction in therapeutic response after multiple administrations of antidepressant drug (AD) therapy in patients with major depressive disorder. This study assessed the response to AD therapy and cognitive therapy (CT) of patients with a history of prior AD exposures. A sample of 240 patients with moderate-to-severe major depressive disorder entered a randomized controlled trial comparing pharmacotherapy with paroxetine to CT. Treatment was administered for 16 weeks. History of prior AD exposure was assessed with structured interviews, self-report, and medical records. Analyses were conducted using hierarchical linear models on the intent-to-treat sample. After controlling for various demographic and clinical factors, more prior AD exposures predicted poor response to paroxetine therapy but not to CT, as measured by the Hamilton Rating Scale for Depression (Hamilton, 1960; Williams, 1988). Whereas CT outcome was not significantly related to the number of prior AD exposures, a higher number of prior AD exposures was significantly associated with a lower response to paroxetine. If these findings are replicated in methodologically rigorous studies of paroxetine and other antidepressants, CT should be recommended, in preference to AD, for patients with multiple prior AD exposures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fish on prozac: Effect of serotonin reuptake inhibitors on cognition in goldfish.

[Correction Notice: An erratum for this article was reported in Vol 122(4) of Behavioral Neuroscience (see record 2008-09788-005). In the aforementioned article, Figures 2, 3, and 4 are incorrect. The correct figures are printed in the erratum.] The authors studied the effect of fluoxetine (a specific serotonin reuptake inhibitor--SSRI) on active avoidance learning in fish. In an active, two-way, shuttle-box avoidance task we compared escape and avoidance of shock among fish receiving chronic administration of fluoxetine (Prozac), others receiving a 5-HT1A receptor antagonist (WAY 100,635; Sigma, St. Louis, MO) and controls. The receptor-blocked group performed significantly more Avoids than the fluoxetine group, which was lowest in performance, or than controls, which were slightly higher, and not significantly different from, the fluoxetine group. This conforms to results reported in rats. Active avoidance learning may be stimulated by the 5-HT1A receptor antagonist. Fluoxetine-treated fish seemed less active in their home tanks than controls or blocker-treated fish. These results suggest that at the dosages used in this experiment, the 5-HT1A receptor antagonist WAY 100,635 may have positive effects on cognition in fishes and its action may not necessarily be restricted to blockage of 5 HT reuptake inhibition. It seems that serotonin mechanisms may be highly conserved in vertebrate evolution. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Onychomycosis: recognition, diagnosis, and management

A series of hydroxynaphthazarins has been synthesized. Some of them were found in in vivo experiments to be protectors of myocardium under ischemia-reperfusion and to reduce the infarction zone by 50% without any adverse effect. All compounds exhibit a moderate or small toxicity and are active in low doses.     

Digital infarction in a patient with Raynaud''s phenomenon associated with treatment with a specific serotonin reuptake inhibitor. A case report

Palatopharyngeal injuries due to impaction of rigid objects held in the mouth are common. Most are essentially innocuous injuries requiring no specific treatment. However, there is the potential for perforation of the pharyngeal wall with the subsequent development of serious infection such as retropharyngeal abscess or mediastinitis. This possibility is more likely to be suspected in the presence of a visible laceration or puncture wound at the site of impact in the mouth or pharynx. We report three cases in which occult pharyngeal perforation occurred without any clinical signs of breech of the pharyngeal wall. In all cases a lateral soft tissue neck X-ray was diagnostic of perforation, showing the presence of retropharyngeal air. We, therefore, advocate the routine performance of soft tissue neck X-rays in all patients who present with a history of falling on a rigid object held in the mouth.     

SHARE: International hospitality for psychologists.

Comments on the original article, "U.S. psychology and world psychology," by M. R. Rosenzweig (see record 1986-10248-001). Rosenzweig chastised U.S. psychologists for their neglect of psychology abroad and helpfully mentioned SHARE as one of the ways in which individuals can participate in international psychology. He recommended that psychologists volunteer to host international visitors through their own institutions or through SHARE. The current author, SHARE chairperson from 1973 to 1984, notes that SHARE cordially seconds Rosenzweig's suggestion. Psychologists may register with SHARE as hosts, travelers, or both. SHARE is currently co-sponsored and financed by 10 international and national psychological organizations, including 5 divisions of APA. There are no fees to participants. Participation as a host or guest is available to members in good standing of a sponsor group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phones, phonies, and psychologists.

"The Classified Telephone Directory and the APA Directory… continue to provide crude barometer readings of some public activities by individuals claiming to be 'psychologists.'… At the present time, 55.8% of all individual advertisers are APA members, as compared to 46.7% in 1953 and 18.5% in 1947. In actual numbers, the extent of the APA takeover of the 'Psychology Section' is even more impressive: from 38 in 1947 to 323 in 1957, an increase of 750%p In comparison, the growth of non-APA members has been only 53% (from 167 to 256). Whereas in 1947 non-APA advertisers outnumbered listed APA members 5:1 (167:38), ten years later the ratio is better than even in favor of APA psychologists (256:323)." Tables of data surveying 1957 advertisers in the "Psychology Section" of Classified Telephone Directories for 1957, and 3 tables indicating data for the years 1947, 1949, and 1953 as well are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phones, phonies, and psychologists.

A study of the Psychology Section of the Classified Telephone Directories of 20 major cities indicate "that the professional showcase of professional psychology has become more respectable and that the growing competition from APA members has made the market place of the Classified Telephone Directories less attractive for enterprising 'phonies.' " (PsycINFO Database Record (c) 2010 APA, all rights reserved)