Psychopharmacology

Each year, the CDC's National Center for Health Statistics creates a report on the current health status of the US. In addition to the issues usually addressed in this report, such as information on morbidity and mortality, vaccination rates, and use of health care resources, the recently released report contained a special feature on pain.

A great deal of data exists about the dangers of polypharmacy. Persons with psychiatric disorders experience increased risk for adverse drug interactions because of the great frequency with which multiple medications are used.

A young mother has just learned from her gynecologist that she is 2 months pregnant. She has had 7 major depressive episodes over the past 8 years, 3 of which were accompanied by serious suicide attempts. She is asking you if she should stop taking the antidepressant at this time. What do you advise?

Panic disorder is a common psychiatric illness that can have a chronic, relapsing course. The question of whether pregnancy represents a time of increased risk for recurrence of panic symptoms has been a matter of debate.

Women with postpartum depression frequently experience intrusive, obsessive ruminations that are part of a depressive episode. Many women with postpartum depression have significant anxiety, and many reach the level of meeting criteria for full-blown anxiety disorders. An anxiety disorder may also precede and contribute to the development of a depressive episode.

Antiepilepsy drug use in children presents special challenges because, unlike adults, treatment-emergent neuropsychological deficits occur against the backdrop of cognitive and psychosocial development, with treatment decisions having lifelong implications.

Increasing variations in mechanisms of action of atypical antipsychotics, side-effect profiles, and efficacy among the atypicals enable clinicians to tailor treatments to individual response, side-effect history, and current medical conditions.

Our perceptions about antidepressant efficacy have been inflated by the "file drawer" effect: the selective publication of positive studies and suppression of negative ones.