Studies of hormonal supplements for patients with fibromyalgia have had mixed results. One study of 9 months of subcutaneous growth hormone showed benefit in fibromyalgia patients who had low insulin-like growth factor levels. Because this medication is quite costly ($1500 per month) and because the study results cannot be broadly generalized (i.e., most patients with fibromyalgia do not have low levels of insulin-like growth factor), (more…)

Antidepressants are among the most widely studied medications for the treatment of fibromyalgia. The analgesic effect of antidepressants of the earliest placebo-controlled clinical trials demonstrated modest effectiveness of amitriptyline at doses of 25 to 50 mg nightly. Cyclobenzaprine, a muscle relaxant with structural similarity to the tricyclics, has shown efficacy in several short-term clinical trials. A recent meta-analysis of the literature on fibromyalgia cyclobenzaprine flexeril has shown effectiveness in treating some symptoms and providing overall improvement but did not show reduction of fibromyalgia fatigue or tender points (see Goldenberg reference). (more…)

It is always important in the treatment of dementia to have clear therapeutic goals established in partnership with the patient and family. Often, the concept of quality of life is an important guide to therapy, as this reflects the values of the individual and his or her family. This section discusses both non-pharmacological and pharmacological treatments of dementia. Remember that non-pharmacological approaches are always appropriate. (more…)

It is now almost axiomatic that late-life depression is under detected, under diagnosed, and under treated. Although this basic fact has not changed, there has been tremendous progress over the past 10 years in ensuring that older adults with depressive disorders are in fact appropriately assessed, triaged, and provided adequate treatment for their symptoms. (more…)