Drugs, depression and psychotic disorders

Patients with psychiatric illnesses often require long-term treatment with drugs to alleviate the symptoms- but finding the most suitable medication for a patient is often difficult due to complications with side-effects or efficacy. This week in BMC Medicine, two articles discuss emerging therapies for bipolar disorder and schizophrenia.

In the first article, Michael Berk and colleagues report the results of a double blind randomised placebo controlled trial to assess if N-acetyl cytseine (NAC) can be used as a treatment for bipolar disorder. Current long-term therapy using mood stabilisers is limited due to lack of efficacy and tolerability, and earlier promising studies have showed that NAC may be used as an adjunct therapy, as it replenishes brain glutathione, an antioxidant which is depleted in bipolar disorders. However, even though NAC has previously demonstrated effectiveness as an anti-depressant, the trial published in BMC Medicine shows that this efficacy cannot be maintained long term for bipolar disorder. The authors note however that further studies will be required to address the efficacy of NAC.

In a debate article on schizophrenia, the side-effects caused by use of antipsychotic drugs is discussed by Bjørn H Ebdrup and colleagues. As overweight and obesity account for 60% of the side effects induced by these drugs, the authors argue that analogues of the gut hormone glucagon-like peptide-1 (GLP-1), which are already associated with weight loss in type 2 diabetes, can be used as an adjunctive treatment for antipsychotic-induced weight gain. Future research will help determine the clinical effects of GLP-1 drugs to treat this severe metabolic side effect and help address this major problem in psychiatry.

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