Tag Archives: Sinequan

Current Therapies for Insomnia

Most individuals who suffer from insomnia either self-treat with nonprescription sleep aids (e.g., antihistamines, herbal remedies), use alcohol as a sedative, or take no drug therapy at all. For those who do seek professional help (approximately one-third of insomniacs), the majority receive physician-prescribed benzodiazepine or non-benzodiazepine sedative hypnotics to treat their insomnia. Such hypnotic agents… Read More »

When to Introduce Antipsychotics

Question. When do you feel antipsychotics should be used to treat anxiety? My patient is very distressed, cannot concentrate and has a hard time with rational thought. He suggested this as a possible option, but what do you think? Answer. Unless the anxiety is really secondary to a psychotic process, I would argue that the… Read More »

Minor Depression: Tricyclic Antidepressant

Tricyclic antidepressants entered the market in the 1960s after the Monoamine Oxidase Inhibitors but quickly lost their popularity when the selective serotonin reuptake inhibitors entered the market. Although tricyclic antidepressants are as effective as the selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors in treating most forms of depression, they have the potential for cardiotoxicity… Read More »

Minor Depression: Escitalopram, Paroxetine, Sertraline, and Fluoxetine

Selective Serotonin Reuptake Inhibitors The seven available agents in the selective serotonin reuptake inhibitor class are citalopram (Lund-beck’s Cipramil, Forest Laboratories’ Celexa, generics) and its single enan-tiomer, escitalopram (Lundbeck’s Cipralex, Forest’s Lexapro); paroxetine (GSK’s Paxil/Seroxat, Novartis’s Frosinor, generics); the controlled-release version of paroxetine (GSK’s Paxil CR); sertraline (Pfizer’s Zoloft); fluoxetine (Eli Lilly’s Prozac, generics); and… Read More »

A young woman with migraines, depression, and anxiety complaining of headache, fever, and diarrhea…

A young woman with migraines, depression, and anxiety is seen in the emergency department (ED) complaining of headache, fever, and diarrhea. She is diaphoretic and mildly agitated, with tachycardia but normal blood pressure. Her neurology examination is remarkable only for hyperreflexia without spasticity. Her magnetic resonance imaging (MRI) scan of the brain is normal. What… Read More »

Mood disorders: Clinical Course

For most people with bipolar disorder (manic-depressive illness), the episode that first leads to diagnosis is manic, although there usually has been an unreported depressive episode earlier. Often the family will complain about the observed manic behavior, although they may have ignored previous depressive withdrawal. Mania may last for weeks or months. It is followed… Read More »


There are about thirty thousand documented suicides every year in the United States, although the actual number is probably higher. Many suicides are disguised as accidents, overdoses, homicides, or reported as other causes of death to protect survivors. It is the eighth leading cause of death for all people, but the third leading cause for… Read More »

Mood disorders: Intervention

As has been indicated, assessment of a primary mood disorder, especially depression, is difficult and involves exploration of many factors, since the mood disorder may be masked by physical problems and other mental disorders. Social workers are trained to look at all of the factors that are impinging on the individual, but they must be… Read More »

Vagus nerve stimulation: efficacy and treatment parameters

Vagus nerve stimulation is approved for the treatment of drug-refractory epilepsy and in the United States received approval in 2005 for treatment-resistant depression (), although there is as yet no acute double-blind evidence for the effectiveness of vagus nerve stimulation in treatment-resistant depression. Figure Schematic to illustrate lead and stimulator positions for vagus nerve stimulation… Read More »

High Frequency rTMS

rTMS – repetitive transcranial magnetic stimulation Efficacy and indications The non-invasive nature of this treatment increases its potential application compared to other more invasive neuromodulatory therapies. Repetitive transcranial magnetic stimulation involves repeated subconvulsive magnetic stimulation delivered with a wand positioned over the left dorsolateral prefrontal cortex (). Positive results in a number of small randomized… Read More »