Are newer antidepressants really "better tolerated"?

Do your patients suffer from excessive yawning?

OBJECTIVE

Yawning has been described in relation to drugs such as serotonin reuptake inhibitors, levodopa, dopamine agonists, MAO B inhibitor, morphine, methadone, buprenorphine, dextromethorphan, benzodiazepine, lidocaine, and flecaine. This is a report of two patients, on long-term escitalopram therapy (more than 8 weeks) with stable dosing, who presented excessive yawning. Escitalopram is widely used in major depressive disorder and generalized anxiety disorder.

METHOD

A clinical description of two cases.

RESULTS

Two females (62 and 59 years old, respectively) developed excessive daytime yawning. It was not associated with sedation or a feeling of needing sleep. The dosage was reduced and yawning disappeared some hours later. The patients' depression did not recur.

CONCLUSION

Yawning has been described in relation to different selective serotonin reuptake inhibitors and remitted following their discontinuation; it is interesting that the reported yawning in these two cases disappeared with the reduction of dosage, rather than the interruption of treatment.

Practical psychopharmacology in HIV-1 and acquired immunodeficiency syndrome

HIV-1 infection poses a challenge for psychiatrists of the medically ill. Many factors concerning the care of HIV-1-infected patients need to be considered when prescribing psychotropics. These include careful diagnosis, taking into account medical disorders associated with HIV-1 that can present with psychiatric symptoms, as well as medications that HIV-1 patients may be taking that can cause a variety of neuropsychiatric side effects. Another important issue is the potential for drug-illness interactions. In general, HIV-1 patients seem to be more sensitive to the development of adverse drug reactions than do non-HIV-1 patients, especially as the illness progresses. It is also important to be cognizant of the complex multidrug regimens that many HIV-1 patients are on to avoid known drug-drug interactions and be on the alert for other potential interactions when using psychotropic medications.