More about lamotrigine-valproate interactivity (mitigated by an inducer?)

Corroborating a previously reported finding that valproate reduces the clearance of lamotrigine in adults with bipolar disorder (thereby raising its blood concentrations), and suggesting that it may do so in pediatric epileptic youth, is a study reported recently on the Web (B. Koriskova and colleagues, Basic and Clinical Pharmacology and Toxicology, published online, ahead of print, on January 25, … Read the rest

Recurrence in bipolar disorder unlikely the result of “antidepressant tolerance”

While a preponderance of studies of antidepressant-treated bipolar depression have observed equivocal long-term outcomes characterized by non-robust antidepressant response and insufficient reprise of quality of life, a recent English-language study, published in a Polish medical journal by University of Pennsylvania researcher Jay Amsterdam and Indiana University colleague L. Lorenzo-Luaces (JD. Amsterdam and L. Lorenzo-Luaces, Psychiatria Polska 52(6):957-969, 2019), attributes diminishing … Read the rest

In utero valproate exposure and ADHD

 

A population-based study reported by a Danish group (J. Christiansen and colleagues, JAMA Netw Open 2019 January 4; 2(1):e186606) is a recently published example that prenatal exposure to valproate may be associated with a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD).

The authors assess the statistical significance of an association between in utero exposure to valproate and subsequent diagnosis of … Read the rest

Stimulants for ADHD: no increased risk of seizures

This nicely designed “data mining” study, by Swedish researchers (I. Brikell and colleagues, Epilepsia, January 25, 2019; doi: 10.1111/epi. 14640), reminds us that persons with attention-deficit/hyperactivity disorder (ADHD) and epilepsy need not avoid pharmacotherapy of ADHD for fear of increasing the likelihood or severity of seizures.

Using Swedish population registers to identify 21,557 persons with a history of seizures … Read the rest

Pharmacogenetic testing: be informed or be misled

 

A guideline consists of treatment recommendations intended to represent evidence-based best practices. Guidelines often appear in synchrony with dissemination of new information or emergence of new technology, informing their introduction to practice amid better-established treatments that have proved insufficiently effective or tolerable. In the example of applying genotype-inferred phenotypes intended to minimize adverse effects of slow metabolism and/or drug-drug … Read the rest