Dr. Batelaan and colleagues systematically reviewed relapse prevention trials in patients with anxiety disorders who responded to antidepressants. They focused on patients treated for a variety of anxiety disorders, including panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and specific phobias. They included 28 double-blind studies with a maximum follow-up of one year. There were 2625 patients in the antidepressant group and 2608 in the placebo group. All patients responded to antidepressants and were randomly assigned to either continue the antidepressant or switch to placebo. The authors found that relapse rates were higher and time to relapse was shorter when antidepressants were discontinued. The authors conclude that the risk of relapse increases up to one year after discontinuation of antidepressants. In their discussion of the results, they emphasize that the recommendation to continue treatment for a year “should not be interpreted as advice to taper drugs after this period. [..] In addition to relapse, patients’ preferences and adverse effects should be taken into account when deciding whether to continue or discontinue antidepressants.”
Genetic testing as an additional measure to determine responses and side effects to psychotropic medications is now available in my private practice. The Genecept Assay is a simple, non-invasive, buccal test developped by Genomind. It analyzes ten genes shown to have implications for response to treatments used in depression, bipolar disorder, schizophrenia, anxiety disorders, OCD and ADHD. The analyzed genes target major hepatic enzymes and key neurotransmitter pathways including serotonin, dopamine and glutamate.
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In this video sponsored by the National Institute of Mental Health, Drs. William Copeland and Christopher Sarampote discuss the mental health consequences of childhood bullying . In the July issue of the American Journal of Psychiatry, Drs. Takizawa, Maughan, and Arsenault report bullying data from the British National Development Study. This is a 50-year prospective cohort of 17,638 individuals born in 1958. Parents reported childhood bullying in 7,771 or 44% of them. The authors found that childhood bullying victims have higher psychological distress, rates of depression, anxiety, and suicide, less social relationships, more economic hardship, and poorer perceived quality of life than individuals who were not bullied. In an editorial, Dr. E. Jane Costello suggests improving mental health outcomes of childhood bullying victims by doing more research on primary prevention (i.e., intervention before bullying) , secondary prevention (i.e., intervention during bullying), and tertiary prevention (i.e., intervention to prevent mental health consequences after bullying). Given the high rates of childhood bullying and its consequences, Dr. Costello emphasizes the importance of asking patients and parents about a history of bullying.