As many as 10% of children suffer from attention deficit-hyperactivity disorder (ADHD), a neuropsychiatric behavioral disorder characterized by inattention, hyperactivity, and impulsivity. ADHD can cause significant functional, social, and psychological impairment in children and adults. ADHD treatment in children has been controversial, since the mainstay of treatment is stimulant medications, including methylphenidate and amphetamines. Parents are appropriately concerned about giving their children powerful medications that can lead to liver damage, addiction to stimulants, or abuse of stimulants or illicit drugs. But, untreated ADHD can have dangerous repercussions, including the development of psychiatric disorders. Now, the benefits might outweigh the risks of stimulant medications as a new study reports that stimulants are actually protective against the development of significant psychiatric disorders associated with ADHD. Read more →

At this moment, a trial is underway in India. This trial, named the TIPS trial, involves a new medication — a so-called “polypill” — which contains three antihypertensive drugs, a statin, and aspirin. Its researchers enthuse that it may cut the risk of cardiovascular disease by half in healthy people. So far, the study has shown that the side effects of this medication are minimal, or at least not any worse than those of any of the individual components alone. It’s also demonstrated small but significant reductions in blood pressure and cholesterol. The bigger question is: why do we think we really need this medication in the first place? Read more →

Diabetes in pregnancy is associated with increased morbidity for the mother and the infant. Complications of pregnancy-related diabetes include birth defects, congenital abnormalities, shoulder dislocation during delivery, cesarean delivery, excessive fetal weight and head size, and hypertension. Risk factors for gestational diabetes, or glucose intolerance first diagnosed in pregnancy, include advanced maternal age, overweight or obesity prior to pregnancy, family history of diabetes, and belonging to an ethnic group with a high prevalence of diabetes (African American, Native American, Hispanic, South or East Asian, or Pacific Islander.) A new study published in the Journal of the American Medical Association finds that in addition to the well-known complications of diabetes during pregnancy, women with gestational diabetes are more likely to experience depression during and after pregnancy. Read more →

Practitioners who treat patients with chronic pain understand just how difficult management of that population can be. As of today, the evaluation of pain remains completely subjective; no lab tests or imaging studies can provide any meaningful insight into how much pain a patient feels. When the pain is severe and intractable, the only option becomes opioid analgesics, which have high potential for abuse and are laden with side effects ranging from constipation and sedation to respiratory depression, testosterone deficiency, and immuno-modulation. The trouble with opioids is that they must be ingested in an oral form with systemic absorption regardless of where the actual pain lies. Over the past few years, a quiet murmur has been rippling through the pain practitioner community about the possibility of dispensing morphine as a topical agent. Small scale clinical trials and animal models have shown some promise, and also raised some questions about this experimental approach. Read more →

The National Institute of Mental Health recently cited a study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The study was cited as providing evidence that supports the idea that adolescents with major depressive disorder (i.e., depression) are less likely to relapse after treatment if they receive cognitive behavioral therapy in conjunction with psychotropic medication.

I have to admit that this was not entirely shocking news to me, but I was slightly surprised to find the topic highlighted by NIMH as a “Science Update.” Read more →

The Lancet recently published clinical trial data from a Harvard study which compares the experimental new drug tasimelteon to placebo in treating jet lag. The medication works by binding to the same receptor as melatonin, and activating it as a direct agonist.

Melatonin is a neurotransmitter produced by the brain that is believed to play a pivotal role in the regulation of our “biological clock” or circadian rhythm. Melatonin levels fluctuate in the bloodstream throughout the day, and surge during the nighttime hours when it is dark outside and our bodies are inclined to sleep. The trouble with melatonin is that it falls under the FDA category of supplements and nutraceuticals, and is therefore largely unregulated in terms of potency, manufacturing process, and quality of ingredients. Studies are hard to conduct and successfully repeat for this reason as well. Read more →