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Preventing weight gain associated with lithium
Goodwin and Goldstein (2003) advocate the following measures to prevent weight gain in patients on lithium carbonate: Dietary/lifestyle measures Encourage daily physical exercise Restrict fluid intake to non-sugary liquids (e.g., water, diet soft drinks) Avoid intake of simple carbohydrates, particularly early in the day (lithium may induce mild hypoglycemia, causing patients to increase caloric intake as they ?chase? their blood sugar through the day) Medical/pharmacological measures Measure free T4 and supplement thyroid hormone if necessary (T4 at or below the lower quartile of normal may indicate hypothyroidism, another cause of weight gain If possible, avoid concurrent medications with additive weight gain effect Consult with primary care physician about other options if weight gain exceeds 5 lbs despite preventive measures Ref: - Goodwin, F.K. & Goldstein, M.A. (2003) Optimizing lithium treatment in bipolar disorder: a review of the literature and clinical recommendations. Journal of Psychiatric Practice, 9, 5, 333-343.

WATCH: Nice to Meet You, Enjoy the Flu

Diet
Coffee May Also Reduce Risk Of Diabetes

Letter Of The Week
— from Karen Lynne Lambert
“Regardless of how politics may try to dissuade or delude you, all you need to know is that my [chronic fatigue immune dysfunction syndrome] is infectious. It is contagious. And it is spreading, unleashed, in the world's population. I am not afraid to say that I have AIDS without HIV — my second official clinical diagnosis. I am equally as unafraid of saying the most obvious thing about chronic fatigue syndrome: It sure does look like AIDS to me. We talk openly about preparing for an impending avian flu pandemic. Why not talk about the HIV-negative AIDS epidemic that already exists (and is spreading) amongst us?”

Management of depression in patients with epilepsy
Preictal and ictal depression do not usually require treatment with antidepressants, as an improvement in seizure frequency should reduce the occurrence of these forms of depression (Labert & Robertson, 1999). Antidepressant therapy will be usually necessary in patients suffering from interictal depression or comorbid depressive disorders. SSRIs are recommended as first-line treatment (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). Citalopram and sertraline can be considered first-line SSRIs because of their minimal pharmacokinetic interactions with antiepileptic drugs (Kanner and Nieto, 1999; Barry et al., 2001). If depression develops, it should be determined whether the patient takes an antiepileptic drug with a known depression-inducing effect, or if treatment with an antiepileptic drug with mood-stabilizing effects was discontinued. In first case, replacement with an antiepileptic drug with mood-stabilizing effects, such as carbamazepine, valproate, lamotrigine, gabapentin or topiramate can be considered. In the latter case, the discontinued agent should be readministered (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). In agitated patients who require treatment with sedative preparations, mirtazapine can be considered a treatment option. In general, dosages should be increased carefully and in small increments. Regular EEG recordings are recommended (Prueter and Norra, 2005). Ref: - Barry, J.J., Lembke, A. & Hyunh, N. (2001) Affective disorder sin epilepsy. In: Ettinger, A.B. & Kanner, A.M. (Eds.), Psychiatric issues in epilepsy: a practical guide to diagnosis and treatment, Lippincott Williams and Wilkins: Philadelphia. pp 45 - 71. Kanner, A.M. & Nieto, J.C. (1999) Depressive disorders in epilepsy. Neurology, 53, 5 (suppl 2), s 26 - s32. Kanner, A.M. & Palac, S. (2000) Depression in epilepsy: a common but often unrecognised comorbid malady. Epilepsy and Behavior, 1, 37-51. Labert, M.V. & Robertson, M.M. (1999) Depression in epilepsy: etiology, phenomenology, and treatment. Epilepsia, 40 (suppl 10), s21 - 47. Prueter, C. & Norra, C. (2005) Mood disorders and their treamtnet in patients with epilepsy. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 1, 20-28.

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