January 2009 — Winter Blues

During this time of year, we hear much more about patients seeking attention for SAD (Seasonal Affective Disorder). Carbohydrate cravings, oversleeping, fatigue, lethargy, anhedonia, increased sensitivity and depression with winter onset are common characteristics.

With winter, come longer nights and shorter days. There are many who start their day in darkness only to emerge from their workplaces in the dark too. Exact numbers of sufferers are hard to determine; some suggest that around 5% of the general population experience winter depression and another 10-20% have subsyndromal SAD (s-SAD).

For patients with mild SAD, spending more time outdoors or sitting closer to bright windows while at home or in the office can be successful treatment option. Other treatment options include light therapy, medications and psychotherapy.

A patient brochure on SAD is downloadable from the American Psychiatric Association.

We encourage you to access the main depression monograph at Epocrates Online. This and hundreds of other disease monographs are also available with Epocrates® Essentials or Epocrates® Essentials Deluxe mobile software.

Also in this issue:

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Medical Myths of the Season Debunked

The holiday season presents an opportunity to probe commonly held medical myths recounted during this time of the year. Researchers remind us of the need to apply scientific investigation to conventional wisdom.

1. Sugar causes hyperactivity in children. At least 12 double blind randomized controlled trials detected no behavior differences between children who had sugar vs. those who did not.
2. Suicides increase over the holidays. While the holidays might be a difficult time for some, there is no good scientific evidence to suggest a holiday peak in suicides.
3. Poinsettia toxicity. Even though public health officials have reported that poinsettias are safe, many continue to believe this is a poisonous plant.
4. Excess heat loss in the hatless. A recent study confirms that there is nothing special about the head and heat loss. Any uncovered part of the body loses heat and will reduce the core body temperature proportionally.
5. Nocturnal feasting makes you fat. In a study of over 2500 patients, eating at night was not associated with weight gain, but eating more than three times a day was linked to being overweight or obese.
6. You can cure a hangover. From aspirin and bananas to Vegemite and water, internet searches present seemingly endless options for preventing or treating alcohol hangovers. No scientific evidence supports any cure or effective prevention for alcohol hangovers.

Link to the free full-text BMJ article in pdf format.

Recent FDA MedWatch Safety Alerts

Antiepileptic Drugs and Suicidality
Oral Sodium Phosphate (OSP) – New Boxed Warning
Tinzaparin Sodium – Increased Risk of Death in Older DVT Patients with Renal Insufficiency
Hydromorphone HCl 2 mg Tablets: Potential for Oversized Tablets
20 mEq Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection
Class 1 Recall: Sun Med Greenline/D MacIntosh No. 3 Laryngoscope Blades
Stryker Custom Cranial Implant Kits

Psychiatry Compendica

This free application offers comprehensive information on over 25 diagnoses. Built for the generalist and specialist, this application provides succinct reference information with comprehensive diagnostic and therapeutic recommendations from leading psychiatrists. Plus, get published guidelines and literature on national guidelines, clinical trials, and clinical expertise.

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Available on Palm OS with Epocrates Rx®, Epocrates Rx Pro, Epocrates Essentials and Epocrates Essentials Deluxe mobile software.

Pill ID

Ever have a patient come to you with a pill of unknown origin? With this feature, you can identify a drug based on its physical characteristics such as color and shape.

Simply select some key characteristics and quickly see a list of drugs that match the criteria, with a convenient visual reference guide.

Tapping on a drug image enlarges the picture, making it easier for you to see any imprint codes found on the drug and thus confirm the match.

Available on BlackBerry™ with Epocrates Rx and Epocrates Rx Pro mobile software and on iPhone™ with Epocrates Rx mobile software and Epocrates Online.

New PhRMA Guidelines In Effect

The new PhRMA guidelines were put into effect on January 1, 2009. Pharmaceutical and biotechnology companies first adopted ethical marketing guidelines July 1, 2002. These guidelines were recently updated to provide further clarification on appropriate marketing practices.

One of the big changes limits pharmaceutical and biotechnology reps to only give away items of educational value, below $100. That means no pens, pads, toys, etc.

So what is appropriate? A one-year subscription to Epocrates Rx Pro or Epocrates Online Premium. Also available is a six-month subscription to Epocrates Essentials.

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Updates at a Glance

New Drugs Bravelle (urofollitropin) Cinryze (C1 inhibitor (human)) Ellence (epirubicin) epirubicin (generic) Follistim AQ (follitropin beta) Gonal-F (follitropin alfa) Gonal-F RFF (follitropin alfa) Menopur (menotropins) Proleukin (aldesleukin) Repronex (menotropins) sumatriptan (first-time generic for Imitrex) Veripred 20 (prednisolone)	New Disease and Condition Topics Available* Constipation in children Chronic pain syndromes Wrist fractures Epicondylitis Heat stroke Trachoma Leprosy Placenta previa Miscarriage Breech Presentation Endometrial cancer Organophosphate poisoning *Disease information can be found in Epocrates Online or Epocrates Online Premium	MobileCME Headlines Unknown Primary Melanoma Presenting with Nodal Metastasis Measuring the Potential for Opioid Abuse, Matching Therapeutic Approach Case Study: RA Educational Challenge: Window of Opportunity for Treatment
	How to Get these Updates Mobile: Update(sync) your device regularly to download free updates, including new drug monographs and MobileCME activities. If you don't have MobileCME, download it here. Add new formularies to your profile in My Account. Online: Log in to Epocrates Online for continually updated drug information and disease content. Select new formularies in the DRUGS tab.

Get Epocrates on Your New Device

Did you get a new handheld over the holidays? Make sure it has Epocrates by using the installation links below. Follow the step-by-step instruction to see how simple it is:

1. iPhone
2. BlackBerry
3. Palm, Pocket PC and Windows Mobile Smartphone

Do you want to transfer an existing subscription to a new device? Just follow these instructions.

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