Antidepressant Pharmacotherapy: Prescription Practices in Psychiatric Resident Care

Background: Research on treatment of depression has raised concerns regarding adequacy of medication trials and rationality of drug choice. Little data exists regarding pharmacotherapy by psychiatric residents. As practice habits begun in training will likely persist after graduation, examination of residents\u27 antidepressant use may ultimately improve treatment by psychiatrists. Methods: Charts of new patients presenting to the Wake Forest University Psychiatry Resident Clinic were reviewed. Survey was made of medications prescribed to 112 patients diagnosed with major depression, dysthymia, depressive disorder NOS, adjustment disorder with depressed mood, or bipolar disorder with a documented depression during the studied period. Drug choice and maximum dose were noted. Results: Most-prescribed antidepressants included sertraline, trazodone, citalopram, mirtazapine, venlafaxine, and bupropion. The most used tricyclic antidepressant was amitriptyline (n=7), with an average highest dose of 110.7 mg per day. No MAOIs were prescribed. Augmentation treatment with lithium was prescribed twice and thyroid hormone once. No patients received ECT. Conclusions: Depressed patients in this resident clinic were treated primarily with SSRIs and other newer antidepressants. Little use was made of TCAs, MAOIs, ECT or traditional augmentation strategies. Further research should aim to determine whether more education in older antidepressant treatment modalities should be emphasized

Electroconvulsive Therapy (ECT): An Introduction for Elder Law Professionals

Electroconvulsive therapy (ECT), colloquially called shock therapy, is often denounced as barbaric by members of the lay population. However, it is actually a highly efficacious treatment for depression, which can be particularly common and severe in the elderly. This discussion illuminates the potential benefits and risks of this controversial treatment

Screening for Suicide Risk in Adult Sleep Patients

Outpatient visits for sleep-related difficulties and the rate of suicide in the United States have both increased by more than 20% since 1999. Research suggests that anywhere from 75% to 91% of suicide decedents had contact with a physician within the year prior to fatally attempting suicide. Although the prevalence of such contacts among sleep clinicians is unknown, it is important to note that sleep disturbances in general are both a risk factor and potential warning sign for suicide. Screening for suicide risk among sleep patients is recommended, especially among those with a history of psychiatric and chronic medical conditions. Using evidence-based screening tools, such as the Columbia suicide severity rating scale, when screening patients for suicide risk is recommended despite the need for more research on the efficacy of suicide screening. For sleep clinic professionals who do not have the time to comprehensively assess and manage suicide risk, they are encouraged to implement suicide prevention policies within their departments and clinics and to follow the best available evidence to inform these policies. A protocol for screening for suicide risk in sleep clinics is outlined along with triage and documentation recommendations