No abstract

Postpartum depression (PPD) is one of the three major categories on the spectrum of postpartum psychiatric syndromes. Postpartum psychiatric syndromes are classified as either postpartum blues, postpartum depression, or postpartum psychosis. Postpartum depression is important to recognize clinically because of the effect it can have on the mother-child bond. The neurosteroid allopregnanolone, a progesterone derivative, is important for its role in positively modulating GABAA receptors. GABA-mediated signaling has been previously implicated in major depressive disorder. Allopregnanolone-mediated signaling has been identified as an important therapeutic target. Treatment with an allopregnanolone-analog, brexanolone, has been shown to improve depression scores in trials for the treatment of PPD. Brexanolone is a positive allosteric modulator of GABAA and is the first drug approved by the FDA to treat postpartum depression. Brexanolone enhances the inhibitory effects of GABAA, restores dysfunctional GABAA transmembrane channels, and mimics a naturally produced progesterone metabolite that fluctuates during pregnancy and postpartum. One open-label study and two phase two studies have some significant reduction in HAM-D scores after treatment and that the effect was still there 30 days post-treatment. Per the data reported, intravenous infusion of brexanolone could be efficacious and safe for the treatment of women suffering from postpartum depression.

Purpose of Review The present investigation is a comprehensive review regarding the use of Suvorexant for insomnia treatment. It covers the background, pathophysiology, and significance of addressing insomnia, the pharmaceutical details of Suvorexant, and its safety, efficacy, and implications in treating insomnia. We further discuss Suvorexant’s role in targeting insomnia with other comorbidities. Recent Findings Insomnia refers to poor quality and/or quantity of sleep. While there are many existing treatments such as benzodiazepines, melatonin agonists, TCAs, and atypical antipsychotics used to target various receptors involved in normal induction and maintenance of sleep, Suvorexant is an antagonist that specifically targets orexin receptors. Recent clinical studies suggest that Suvorexant is both clinically safe and effective. Quantity and quality of sleep are measured in various ways, yet the consensus points towards Suvorexant’s effectiveness in improving sleep time, onset, latency, and quality compared to placebo. In addition to helping improve isolated insomnia, Suvorexant helps improve sleep in patients that have other comorbidities such as obstructive sleep apnea, Alzheimer’s disease, dementia, acute stroke, and delirium. While Suvorexant is safe, there are still adverse effects associated with the drug that needs to be considered. The most common adverse effects include dizziness, somnolence, headaches, and cognitive impairment. Summary Insomnia is a major public health concern that affects many people worldwide and has been linked to many adverse health outcomes. While there are existing treatments that target different receptors and pathways of normal sleep induction and maintenance, Suvorexant is a novel drug that targets dual orexin receptors. Its safety and efficacy, mechanism of action, pharmacokinetic parameters, and relative lack of rebound and withdrawal effects render suvorexant a reliable choice for the treatment of insomnia.

Introduction Medical student mental health and wellness has been an increasingly hot topic over the past decade. Much of the research, however, has remained focused more on anxiety and depression and less on other less common but just as detrimental mental health disorders such as PTSD, bipolar disorder, OCD and others. In addition to the more traditional psychological stresses medical students experience, they also experience physical consequences of their training, often with sleep patterns suffering most initially. Methods The questionnaire consists of thirty-five questions, compromising of demographic questions, questions relating to USMLE exams and education, the STOP-Bang Questionnaire, Epworth Sleepiness Scale, Fatigue Severity Scale and PTSD DSM-V Questionnaire. This survey was sent out between March and April of 2020 and was distributed to all medical students and residents with an LSU Health Shreveport email address via RedCAP, an encrypted electronic survey tool. Results A total of 78 participants responded to our survey, with 91.1% identifying as medical students and the rest as residents. 64.1%, identified as female, 34.6% identified as male and 1.3% declined to answer. While 43% of our participants found their educational experience emotionally traumatizing, 75% of them felt that preparing and/or taking USMLE exams was emotionally traumatizing. In regards the portions of our questionnaire that served as sleep disorder screening questions, the average score for the STOP-Bang was 1.48 (SD +/- 1.15) the average score for the ESS was 6.85 (SD +/- 4.72) and the average score for the FSS was 32.04 (SD +/- 11.99). It should be noted that, while the average score of the PTSD screening portion was 20.34 (SD +/- 17.47), 18 participants scored above 38, the minimum score needed to qualify for a PTSD diagnosis. Conclusion These results suggest some correlations that warrant further future study. It is worrisome that while less than half of our participants stated their educational experience as harrowing, 75% stated preparing for and/or taking these required exams was emotionally traumatizing. The possible connections suggested here between USMLE exams and an increase in fatigue, lack of motivation and PTSD symptoms urge us to look more closely at the impact of the USMLE. Support (if any):

No abstract