Fatty Acids for Perinatal Depression?

According to a Medical Letter review of the recently approved atypical antipsychotic asenapine (Saphris), "available data on its efficacy are not impressive." Asenapine is formulated in a sublingual tablet and is approved for acute schizophrenia and manic or mixed bipolar episodes. Its receptor affinity profile is similar to other atypicals. Three placebo-controlled trials have been conducted in schizophrenia and 2 have been conducted in acute manic or mixed episodes. Results of the trials were mixed. In 2 of the schizophrenia trials, 5 mg asenapine b.i.d. was superior to placebo, but 10 mg b.i.d. was not more effective than haloperidol or placebo. In the third trial, olanzapine was significantly more effective than placebo but 5 mg asenapine b.i.d. was not. In short-term bipolar disorder studies asenapine was more effective than placebo and noninferior to olanzapine at reducing mania severity. Adverse effects included akathisia and other extrapyramidal symptoms, diminished oral sensation, somnolence, and dizziness. Asenapine can prolong the QT interval, cause weight gain, and increase prolactin levels. Concomitant use with a strong CYP1A2 inhibitor such as fluvoxamine can increase asenapine concentrations and concomitant use can increase paroxetine concentrations nearly 2-fold. Asenapine should not be used by patients with severe hepatic impairment and patients should not eat or drink for at least 10 minutes after administration. Adherence to sublingual dosing may be problematic for patients experiencing acute mania or schizophrenia.