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Ketamine comes in several forms. The only one that the FDA has approved as a medication for depression is a nasal spray called esketamine (Spravato). It’s for adults who either haven’t been helped by antidepressant pills, have major depressive disorder, or are suicidal. They continue on their antidepressant and receive esketamine at a doctor’s office or in a clinic, where a health care provider watches over them for 2 hours after the dose. For treatment-resistant depression, patients usually get the nasal spray twice a week for 1 to 4 weeks; then once a week for weeks 5 to 9; and then once every week or 2 after that. The spray has a “black box” warning about the risk of sedation and trouble with attention, judgment, and thinking, as well as risk for abuse or misuse of the drug and suicidal thoughts and behaviors.
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On its own, 500mg paracetamol has a success rate of around 43% meaning it only helps around 4 out of 10 people. In fact, researchers have found that, for every 3.5 people taking it, only one would experience good pain relief. Oddly, there is no evidence that higher doses (600mg to 1g) are more effective – in fact, they appear to be less effective than the 500mg dose! Products that combine paracetamol with ibuprofen work in up to 70% people, however, as mentioned above. A study published in the British Medical Journal, which looked at the results from 13 clinical trials, concluded that paracetamol is not effective for reducing back pain, and that it provides only minimal, short-term benefit for people with osteoarthritis of the hip or knee. The most likely explanation is that these conditions are associated with low-grade inflammation, and paracetamol lacks any anti-inflammatory action.
Tramadol is a synthetic, atypical, centrally-acting analgesic that binds to the µ-opioid receptors and also inhibits the reuptake of serotonin and noradrenaline, resulting in both opioid and antidepressant-like effects. Tramadol is considered a “weak opioid” and is a prescribing option at Step two of the analgesic ladder, alongside codeine and dihydrocodeine (see: “The principles of managing acute pain in primary care”). There are no robust studies suggesting that tramadol provides either more or less analgesia than codeine or dihydrocodeine. Like codeine and dihydrocodeine, tramadol is metabolised by CYP2D6, which produces a metabolite that has substantially greater affinity for the µ-opioid receptor than its parent drug.2 Eight to 10% of people of European descent are poor CYP2D6 metabolisers and 3 to 5% are ultra-rapid metabolisers;2 there is no published data for Maori or Pacific peoples. People who are poor CYP2D6 metabolisers are likely to experience reduced analgesia with tramadol (and codeine) and ultra-rapid metabolisers may be more sensitive to adverse effects.
Although many parents reported side effects, they can often be managed. For example, some children have problems later in the day and a long-acting formulation is best, but sometimes the effect might persist into the evening, suppressing appetite for dinner and delaying bedtime. “There is no substitute for carefully evaluating the effect of a medication after it has been used to determine if it should be increased, decreased, or switched to something else,” Goldstein says. Parents should also note that a child might begin to show withdrawal symptoms when a dose wears off, and might need tips for avoiding this. These management skills are something that can be developed with the doctor responsible for prescribing the medication. For more help understanding ADHD and what you can do to help your child, including whether to medicate, see HealthPoint.net’s ADHD guide and Decision Point tool.
Zolpidem ( Ambien , Edluar, Intermezzo): These medicines work well at helping you get to sleep, but some people tend to wake up in the middle of the night. Zolpidem is now available in an extended release version, Ambien CR. This may help you go to sleep and stay asleep longer. The FDA warns that you should not drive or do anything that requires you to be alert the day after taking Ambien CR because it stays in the body a long time. You should not take zolpidem unless you are able to get a full night’s sleep — at least 7 to 8 hours. The FDA has approved a prescription oral spray called Zolpimist, which contains zolpidem, for the short-term treatment of insomnia brought on by trouble falling asleep.
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