Nikhil Nihalani

Psychiatric medication‐induced obesity: a review

A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the aetiology of this weight gain and the potential treatments being used to alleviate this side‐effect. We found solid evidence that weight gain is often associated with the mood stabilizers, and antipsychotics and antidepressants. Only few weight neutral or weight loss producing psychotropics are available, and weight gain, outside of an immediate side‐effect, may generate secondary side‐effects and medical comorbidity. Weight gain may cause hypertension, diabetes, osteoarthritis, sedentary lifestyle, coronary artery disease, etc. Given the likelihood of inducing weight gain with psychotropic medications and the longitudinal impact on physical health, a thorough literature review is warranted to determine the epidemiology, aetiology and treatment options of psychotropic‐induced weight gain.

Psychiatric medication induced obesity: an aetiologic review

A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment, but consensus shows that weight gain is prominent. The present review looked at the aetiology and cause of weight gain associated with psychotropic use and presents hypotheses as to why patients gain weight on antipsychotics, mood stabilizers and antidepressants. It is found that most psychotropic medications induce some weight gain, and clinicians are encouraged to utilize active interventions to alleviate the weight gain in order to prevent more serious obesity related comorbidities.

Psychiatric medication‐induced obesity: treatment options

A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. The authors undertook a comprehensive literature review in order to provide a better understanding of novel treatment options in regards to alleviating weight gained by use of antidepressants, antipsychotics, and mood stabilizers. There are no agents for management of this weight gain approved by the Food and Drug Administration (FDA), and existing studies on options are mainly uncontrolled, small‐scale projects with limited power to produce coherent conclusions. There is a clear need for larger studies on existing options, and future psychotropics without these side‐effects are currently in the pipeline.

Tiagabine in anxiety disorders

GABA has been implicated in both the aetiology and treatment of anxiety. Tiagabine is currently the only selective GABA reuptake inhibitor available in US markets; it exerts its action via GAT-1 transporter blockade presynaptically, facilitating GABA neurotransmission. Preclinical studies and current human studies suggest tiagabine possesses anxiolytic properties. The anxiolytic properties of tiagabine have also been suggested in a number of case series, open-label studies and placebo-controlled studies in patients with different anxiety disorders. Throughout these studies, tiagabine has been reasonably tolerated; the most commonly reported adverse events include dizziness, headache and nausea. Tiagabine may be a useful addition to currently available drugs for anxiety; however, the data from small open-label investigations remain to be confirmed in larger controlled studies.

Duloxetine: Review of Its Pharmacology, and Therapeutic Use in Depression and Other Psychiatric Disorders

BACKGROUND The discovery of antidepressant medications has revolutionized the treatment of depression and other psychiatric illnesses. The coming of the selective serotonin (5-HT) reuptake inhibitors (SSRIs) marked a new era in the treatment of depression. These therapies frequently fall short of getting the patient to remission. Agents with a dual action have subsequently been developed which inhibit the reuptake of both 5-HT and NE, getting more patients to remission. Physical symptoms are associated with depression, preventing the patient from obtaining complete recovery. This article provides an overview of the pharmacology, efficacy, and techniques for the clinical use of duloxetine, a dual reuptake inhibitor, which has recently become available. METHODS The English literature has been reviewed including both controlled and uncontrolled studies. RESULTS Duloxetine is a dual reuptake inhibitor with actions on serotonin as well as norepinephrine. It has been shown to have efficacy in treating depressive symptoms including those with painful physical symptoms. Common side effects include nausea, insomnia, and dizziness. CONCLUSIONS The article has been written with clinicians as the target audience, the data suggesting it can be used as a first line agent.

Obesity and psychotropics.

Weight gain is on the rise in the United States as is the diagnosis and treatment of mental disorders. These two phenomena are distinctly separate but tend to overlap in that most psychotropic agents approved for use in the United States are associated with the potential to induce weight gain. Metabolic disorders such as diabetes, hypercholesterolemia, and hypertension are also on the rise and often associated with weight gain and clearly associated with certain psychotropic medications. This article serves to provide a succinct review regarding the epidemiology, etiology, and treatment options for psychotropic‐induced obesity.

How Should Psychiatrists Dress?—A Survey

Personal attire is an important part of being a professional. This survey is an attempt to determine the patient’s and psychiatrists view point about how a psychiatrist should dress to work. A human subjects research board approved survey of seven questions was offered to patients and a similar survey of nine questions was offered to psychiatrists. The replies obtained were combined and tabulated. One hundred patients and 77 psychiatrists responded to the survey. Both the patients and psychiatrists considered dress to be an important part of the doctor–patient relationship. The psychiatrists appear to be more concerned and critical about their dress as compared to patients.

Relationship of irritable bowel syndrome (IBS) and major depression in Mumbai, India *

Correspondence Address Prakash S Masand, MD, Department of Psychiatry, Duke University Medical University, Box 3391, Durham, NC 27710, USA Tel: /(1) 919 684 6137 Fax: /(1) 919 668 3653 E-mail: masan001@mc.duke.edu Irritable bowel syndrome (IBS) has been reported in 10 /22% of adults. Several clinical studies and reports from different researchers show that, among patients seeking medical attention for IBS, 70 /90% may have psychiatric co-morbidity, most commonly mood disorders, anxiety disorders and somatization disorder. In contrast, few studies have looked at the prevalence of IBS in psychiatric patients. Using a semi-structured clinical interview, we studied the prevalence of IBS among patients with major depression in Mumbai, India. We compared 50 patients seeking treatment for major depression in a psychiatric outpatient setting to a control group of 86 patients who were seeking treatment for medical illnesses in a medicine inpatient unit of Nair Hospital (a university hospital affiliated to Topiwala National Medical College) in Mumbai, India. Patients in the control group did not have any Axis I disorder. IBS was diagnosed according to the Rome I criteria. Nine patients (18.0%) with major depression met the criteria for IBS, in contrast to three patients (3.5%) in the control group (P /0.0104). Patients with major depression and IBS were more likely to report symptoms of back pain, weakness, and nocturnal abdominal pain as compared to patients with major depression who did not have IBS. (Int J Psych Clin Pract 2003; 7: 127 /130)