Recent Research Findings You Can Use
In this guest column, Mei T. Liu, PharmD, BCPP (Clinical Assistant Professor,
Ernest Mario School of Pharmacy, Rutgers University and Psychiatry Clinical Pharmacist at Princeton House Behavioral Health) will be presenting
Lurasidone (Latuda�), a new treatment option for bipolar depression.
Treatment of bipolar depression is a major challenge for patients and their doctors due to the limited medications proven to be helpful. This article will discuss lurasidone (Latuda�), the new FDA approved treatment option and its place in therapy for bipolar depression.
Patients who have bipolar disorder may experience episodes of hypomania/mania and depression throughout their lifetimes. Depending on the symptoms, each mood episode may require slightly different treatments. Patients in a hypomanic/manic phase can be treated with lithium, divalproex (Depakote�), and most second generation antipsychotics such as olanzapine (Zyprexa�), quetiapine (Seroquel�), risperidone (Risperdal�) and aripiprazole (Abilify�), etc. However, treatment of bipolar depression is a major challenge since only a few medications have proven to be helpful. Guidelines suggest lithium, lamotrigine(Lamictal�), and only two second generation antipsychotics, quetiapine (Seroquel�) and olanzapine/fluoxetine (Symbyax�), may be used as possible treatment options for bipolar depression. Use of antidepressants remains controversial due to the inconsistent evidence regarding the benefits for bipolar depression and the concern for causing a switch to hypomania/ mania. More treatment options for bipolar depression are needed since patients with bipolar disorder spend considerably more time in depressive, rather than manic, episodes.
Lurasidone (Latuda�) is a second generation antipsychotic that was approved by the FDA in October 2010 for the treatment of schizophrenia. It received FDA approval in July 2013 for the treatment of bipolar depression either by itself or as an add-on therapy with mood stabilizer such as lithium or valproate. Two short-term clinical studies have been published that showed the benefit of lurasidone for the treatment of depressive episodes in adult patients with bipolar I disorder. The most commonly reported side effects included movement disorder, such as having the urge to move constantly, and muscle stiffness, feeling tired, nausea, vomiting, diarrhea, and anxiety. The recommended starting dose for bipolar depression is 20 mg per day with a maximum dose of 120 mg per day. Lurasidone should be taken with food (minimum of 350 calories) to help increase the absorption of the medication. The drug concentration of lurasidone can be affected by other medications so check with doctors and pharmacists for further information. Dose adjustment is also recommended for patients with kidney or liver problems.
Compared to other second generation antipsychotics, lurasidone seems to have less weight gain, increase in cholesterol, or blood sugar as side effects. However, movement side effects associated with lurasidone could be a concern. Since lurasidone does not have generic formulations available, it can be expensive for patients with no insurance coverage. Short term studies indicate that lurasidone is a new treatment option for bipolar depression, and it is a reasonable alternative, especially in patients who cannot tolerate or have limited response from their current medications. Clinical trials with longer durations and head to head comparisons with other antipsychotics are still needed to confirm the long term safety and efficacy of lurasidone for bipolar depression.
The following articles have been selected by the National Institute of Mental Health and are some of the cutting edge research in mental health.
Mental Health Research at the National Institutes of Health
The majority of the December 6, 2013, "Washington Journal" focused on the National Institutes of Health (NIH). Dr.Thomas Insel talked about advances in mental health research and treatment. Topics included the disparity between the treatment of medical illnesses and mental health issues, the NIH Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, a partnership between several government agencies tasked with the goal of developing the knowledge and tools to better understand the language of the brain; and Alzheimer's disease and dementia.
NIH deposits first batch of genomic data for Alzheimer's disease
Researchers can now freely access the first batch of genome sequence data from the Alzheimer's Disease Sequencing Project (ADSP), the National Institutes of Health (NIH) announced. The ADSP is one of the first projects undertaken under an intensified national program of research to prevent or effectively treat Alzheimer's disease. The first data release includes whole genome sequence data from 410 individuals in 89 families.
Gene Discoveries for Autism
NIH Director Francis Collins describes new gene discoveries for autism spectrum disorder (ASD). Affecting an estimated 1 in 88 U.S. children, ASD is a complicated and diverse group of developmental brain disorders that interfere with language, normal communication, and social interaction. Unlike some other conditions that are caused by mutations in a single gene, as many as 1,000 genes, as well as various environmental factors, are suspected to contribute to the risk of developing ASD.
Study breaks blood-brain barriers to understanding Alzheimer's
A NIH-funded study in mice shows how a breakdown of the brain's blood vessels may amplify or cause problems associated with Alzheimer's disease. The results, published in Nature Communications, suggest that blood vessel cells called pericytes may provide novel targets for treatments and diagnoses.
More than one million Americans, most of them older adults, are affected by Lewy Body dementia (LBD), a "cousin" of Alzheimer's disease and Parkinson's disease. This publication describes LBD-a brain disorder that can affect cognition, movement, sleep, and behavior-and offers practical advice for people with the disease and caregivers.
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