Robert H Howland

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (235)626.91 Total impact

  • Robert H. Howland
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    ABSTRACT: Drug overdose is the leading cause of injury death in the United States, and most deaths are related to prescription drugs. A substantial proportion of these deaths involve opioid or benzodiazepine drugs, and many overdoses include a combination of both drug classes. Buprenorphine/naloxone has an unusual pharmacology that distinguishes it from other opioid drugs. Animal and human studies have found that buprenorphine is associated with a ceiling to its cardiorespiratory depressant effect at higher doses, such that it may have a wider safety margin compared to other opioid drugs. Compared to buprenorphine alone, buprenorphine/naloxone is associated with less cardiorespiratory depression. Drug safety data from the National Poison Data System, Drug Abuse Warning Network, and other sources suggest that the safety of buprenorphine/naloxone is favorable compared to the morbidity and mortality associated with other opioid drugs and other classes of psychotropic drugs.
    No preview · Article · Dec 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: Buspirone, first synthesized in 1968 and marketed in 1986, is a pharmacologically unique azapirone drug. It is effective for treating generalized anxiety, but not other anxiety disorders. Buspirone also is efficacious for depression, either alone or together with an antidepressant drug, and for treating adverse sexual effects. Studies of buspirone for substance use disorders have had disappointing outcomes, although it may be useful for treating coexisting anxiety and one controlled study suggested efficacy for heroin detoxification. Buspirone may be considered a treatment option for managing irritability, agitation, and aggression in older adult patients with dementia as well as in pediatric patients, although additional effectiveness studies are warranted. Buspirone and melatonin may synergistically promote neurogenesis, supporting the potential use of this combination for treating depression and cognitive impairment. [Journal of Psychosocial Nursing and Mental Health Services, 53(11), 21-24.].
    No preview · Article · Nov 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: Microorganisms inhabiting the gut exist in a symbiotic relationship with our bodies, performing many essential metabolic tasks for human physiology. The gut-brain axis is a bidirectional communication system integrating neural, hormonal, and immunological signaling between the gut and brain. There is strong experimental evidence from animal studies that the intestinal microbiome has an important role in the control of brain development, function, and behavior. A small number of clinical studies, mainly in healthy individuals, using probiotic formulations as an experimental probe suggest that gut bugs may indeed act like a drug and affect the brain, but much more work is needed. [Journal of Psychosocial Nursing and Mental Health Services, 53(10), 22-24.].
    No preview · Article · Oct 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: Many drugs are carbon-based, and carbon-hydrogen bonding is particularly relevant for understanding important properties of drug molecules. Deuteration refers to the selective replacement of protium hydrogen isotope atoms in small-molecule drugs with deuterium hydrogen isotope atoms. Deuteration of a drug is most likely to affect pharmacokinetic properties, such as metabolism, rather than its pharmacodynamic effects. For this reason, the metabolism of certain drugs may be favorably influenced when deuterium is substituted for protium, resulting in improved safety, tolerability, or efficacy. Examples of deuterated drugs that have been evaluated in clinical studies include paroxetine, tetrabenazine, and dextromethorphan. [Journal of Psychosocial Nursing and Mental Health Services, 53(9), 13-16.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Sep 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: Skeletal muscle can be considered a secretory organ that produces myokines and other humoral factors having autocrine-, paracrine-, and endocrine-like signaling effects throughout the body. Exercise has such profound pharmacological and physiological effects that it should be considered a drug therapy. Exercise has documented benefits for preventing or treating many physical and mental disorders or their sequelae, and it has a potential role in managing adverse effects associated with drug therapies. If exercise were a drug evaluated by the Food and Drug Administration, it might be approved for a large number of therapeutic indications. Exercise can be appropriately prescribed for virtually anyone for primary, secondary, or tertiary prevention of many mental and physical disorders. [Journal of Psychosocial Nursing and Mental Health Services, 53(8), 13-16.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Aug 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: A head-to-head debate published in The BMJ was centered on the question "Does long-term use of psychiatric drugs cause more harm than good?" One of the debaters stated that virtually all psychotropic drug use could be stopped without deleterious effects, claiming that these drugs have minimal benefits, are immensely harmful, and cause more than 500,000 deaths each year. In the current article, this conclusion is disputed by the discussion of the history of psychiatric therapeutics, limitations of research investigations, inherent morbidity and mortality associated with mental disorders, and importance of direct care experience with psychiatric patients and their families. [Journal of Psychosocial Nursing and Mental Health Services, 53(7), 15-19.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Jul 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: Overweight and obesity are associated with significant morbidity and mortality. This is a known problem among individuals with psychiatric illness, which may be partly due to the adverse metabolic effects of certain psychotropic drugs. Melatonin, liraglutide, and naltrexone/bupropion are examples of drugs with different mechanisms of action that have favorable effects on obesity or medication-related weight gain. Melatonin is appropriate to consider for any patient who will be started on a psychotropic drug that is potentially associated with weight gain or other adverse metabolic effects. Liraglutide should also be considered appropriate for use in overweight or obese psychiatric patients, including those with medication-associated weight gain. The use of naltrexone/bupropion may be problematic in patients with bipolar disorder or schizophrenia because of the potential adverse effects of the bupropion component of the combination. All three drugs deserve further dedicated studies in psychiatric patient populations. [Journal of Psychosocial Nursing and Mental Health Services, 53(6), 19-22.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Jun 2015 · Journal of Psychosocial Nursing and Mental Health Services
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    ABSTRACT: Transcranial Magnetic Stimulation (TMS) customarily uses high-field electromagnets to achieve therapeutic efficacy in Major Depressive Disorder (MDD). Low-field magnetic stimulation also may be useful for treatment of MDD, with fewer treatment-emergent adverse events. To examine efficacy, safety, and tolerability of low-field magnetic stimulation synchronized to an individual's alpha frequency (IAF) (synchronized TMS, or sTMS) for treatment of MDD. Six-week double-blind sham-controlled treatment trial of a novel device that used three rotating neodymium magnets to deliver sTMS treatment. IAF was determined from a single-channel EEG prior to first treatment. Subjects had baseline 17-item Hamilton Depression Rating Scale (HamD17) ≥ 17. 202 subjects comprised the intent-to-treat (ITT) sample, and 120 subjects completed treatment per-protocol (PP). There was no difference in efficacy between active and sham in the ITT sample. Subjects in the PP sample (N = 59), however, had significantly greater mean decrease in HamD17 than sham (N = 60) (-9.00 vs. -6.56, P = 0.033). PP subjects with a history of poor response or intolerance to medication showed greater improvement with sTMS than did treatment-naïve subjects (-8.58 vs. -4.25, P = 0.017). Efficacy in the PP sample reflects exclusion of subjects who received fewer than 80% of scheduled treatments or were inadvertently treated at the incorrect IAF; these subgroups failed to separate from sham. There was no difference in adverse events between sTMS and sham, and no serious adverse events attributable to sTMS. Results suggest that sTMS may be effective, safe, and well tolerated for treating MDD when administered as intended. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · May 2015 · Brain Stimulation
  • Robert H Howland
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    ABSTRACT: Alcohol use disorder is an important public health problem for which evidence-based treatments should be used. In the current article, two recent publications related to this topic (i.e., a featured article from The Atlantic and a brief guide from the Substance Abuse and Mental Health Services Administration [SAMHSA]) are critically evaluated. Both publications emphasize that evidence-based medications are underused for the treatment of alcohol use disorder. The featured article was critical of faith-based Alcoholics Anonymous(®) 12-step programs, but the critique was not based on a sound evaluation of research pertaining to their use. The brief guide prepared for SAMHSA was developed by a scientific consensus panel reviewing current evidence of the effectiveness of available medications, but focused only on those that have been approved by the U.S. Food and Drug Administration (FDA) for this indication, neglecting to describe potentially effective off-label use of other FDA-approved medications. [Journal of Psychosocial Nursing and Mental Health Services, 53(5), 11-14.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · May 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: Brexpiprazole (also known as OPC-34712 or Lu-AF41156) is a novel molecular compound chemically and structurally similar to aripiprazole. This drug is currently under review by the U.S. Food and Drug Administration as a monotherapy for schizophrenia and an adjunct to antidepressant medication for major depressive disorder. Additional clinical trials include studies of brexpiprazole in attention-deficit/hyperactivity disorder and posttraumatic stress disorder, and for agitation associated with dementia of the Alzheimer's type. Brexpiprazole is an example that illustrates how pharmacological drug diversity may be translated to multipurpose uses. [Journal of Psychosocial Nursing and Mental Health Services, 53(4), 23-25.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Apr 2015 · Journal of Psychosocial Nursing and Mental Health Services
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    Full-text · Article · Mar 2015 · Brain Stimulation
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    Full-text · Article · Mar 2015 · Brain Stimulation
  • Robert H Howland
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    ABSTRACT: Fumagillin, an antimicrobial compound first isolated in 1949 from the fungus Aspergillus fumigatus, four decades later was unexpectedly found to inhibit angiogenesis. Interest in developing angiogenesis inhibitor drugs as possible treatments for cancer led to the synthesis of analogs of fumagillin. Preclinical studies of various analog drugs confirmed that they inhibited angiogenesis, but they also were associated with weight loss as an adverse effect. Because adipose tissue can grow and regress throughout adulthood, is highly vascularized, and has angiogenic properties, interest in investigating anti-angiogenic agents in animal models of obesity found that fumagillin analogs caused dose-dependent reversible weight reduction and adipose tissue loss. Beloranib, a fumagillin analog that is an angiogenesis inhibitor and associated with decreased adiposity in animals, has been studied in phase I clinical trials for cancer. It is currently being investigated for the treatment of obesity and related conditions. Three phase I and three phase II studies found significant degrees of weight loss and acceptable tolerability for beloranib compared to placebo, justifying further clinical development of the drug for obesity. [Journal of Psychosocial Nursing and Mental Health Services, 53(3), 13-16.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Mar 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: A potential adverse effect of some psychiatric medications is an abnormally prolonged corrected QT (QTc) interval and an increased risk of developing Torsade de Pointes (TdP), which is associated with sudden death. Because antidepressant and antipsychotic drug use is increasing and rates of sudden cardiac death are decreasing, the proportion of sudden cardiac death cases that may be attributed to these drugs is likely to be exceedingly small compared to other risk factors. A comprehensive review of the published literature has concluded that there is little evidence that psychotropic drug-associated QTc interval prolongation by itself is sufficient to predict TdP. [Journal of Psychosocial Nursing and Mental Health Services, 53 (2), 23-25.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Feb 2015 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: Seven topics previously described in this column are revisited. The use of quantitative electroencephalography has been shown in a prospective study to be effective for predicting antidepressant treatment response. A novel antidepressant drug, agomelatine, has generated much controversy, and its development for the U.S. market was discontinued. A long awaited revised system for categorizing the safety of medications during pregnancy and lactation has finally been published by the Food and Drug Administration. Dextromethorphan/quinidine, eslicarbazepine acetate, levomilnacipran, and esketamine are recent examples of drugs that were developed based on the complex concepts of chirality and stereochemistry. Lisdexamfetamine, a stimulant drug, failed to show benefit as an augmentation therapy for the treatment of depression. The combination drug naltrexone/bupropion was finally approved as a therapy for obesity, after its cardiovascular safety was confirmed in a prospective premarketing study. Further development of the glucocorticoid receptor antagonist drug mifepristone as a treatment for psychotic depression was stopped based on a large negative trial, but the drug continues to be investigated for other potential psychiatric indications. These examples illustrate how the field of psychopharmacology continues to evolve. [Journal of Psychosocial Nursing and Mental Health Services, 53(1), 9-12.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Jan 2015 · Journal of Psychosocial Nursing and Mental Health Services
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    ABSTRACT: Multiple open-label trials of deep brain stimulation (DBS) for treatment-resistant depression (TRD), including those targeting the ventral capsule/ventral striatum target, have shown encouraging response rates. However, no randomized controlled trials of DBS for TRD have been published. Thirty patients with TRD participated in a sham-controlled trial of DBS at the ventral capsule/ventral striatum target for TRD. Patients were randomized to active versus sham DBS treatment in a blinded fashion for 16 weeks, followed by an open-label continuation phase. The primary outcome measure was response, defined as a 50% or greater improvement on the Montgomery-Åsberg Depression Rating Scale from baseline. There was no significant difference in response rates between the active (3 of 15 subjects; 20%) and control (2 of 14 subjects; 14.3%) treatment arms and no significant difference between change in Montgomery-Åsberg Depression Rating Scale scores as a continuous measure upon completion of the 16-week controlled phase of the trial. The response rates at 12, 18, and 24 months during the open-label continuation phase were 20%, 26.7%, and 23.3%, respectively. The results of this first randomized controlled study of DBS for the treatment of TRD did not demonstrate a significant difference in response rates between the active and control groups at the end of the 16-week controlled phase. However, a range of 20% to 26.7% of patients did achieve response at any time during the open-label continuation phase. Future studies, perhaps utilizing alternative study designs and stimulation parameters, are needed. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Dec 2014 · Biological Psychiatry
  • Robert H Howland
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    ABSTRACT: Most drugs used in psychiatry are classified according to their initial or main therapeutic indications rather than by their pharmacological profiles. A proposed multi-axial, pharmacologically driven nomenclature system that would reclassify existing psychotropic drugs and provide a framework for classifying new drug compounds is described. The five axes of this system would describe a drug's primary pharmacological target and relevant mechanism; relevant neurotransmitter and mechanism; neurobiological activities; efficacy and side effects; and approved indications. The proposed multi-axial system is a common sense but scientifically informed approach for classifying psychotropic drugs that would be practically useful for prescribers, clinicians, and patients. [Journal of Psychosocial Nursing and Mental Health Services, 52(12), 13-15.]. Copyright 2014, SLACK Incorporated.
    No preview · Article · Dec 2014 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland
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    ABSTRACT: To the extent that genetic factors are associated with the efficacy, tolerability, and safety of different drugs, pharmacogenetic tests may be used to personalize medication treatments for an individual. Pharmacogenetic tests, such as GeneSight Psychotropic and the Genecept Assay, are being marketed directly to patients and prescribers despite a relative lack of evidence to support their clinical validity or utility. Pharmacogenetic testing is potentially useful in certain clinical situations, but its usefulness will depend on the knowledge base of the prescriber to be able to interpret the findings for a particular patient. Proposed guidelines on laboratory developed tests will likely encourage, if not require, evidence for the clinical validity and utility of pharmacogenetic tests before they are approved for marketing. [Journal of Psychosocial Nursing and Mental Health Services, 52(11), 13-16.].
    No preview · Article · Nov 2014 · Journal of Psychosocial Nursing and Mental Health Services
  • Robert H Howland

    No preview · Article · Oct 2014 · JAMA Psychiatry
  • Robert H Howland
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    ABSTRACT: Suvorexant is a pharmacologically novel dual antagonist of orexin receptors OX1R and OX2R, which has an effect that promotes sleep by reducing arousal and wakefulness. Its approval for the treatment of insomnia was based on three clinical trials that found it to be efficacious and relatively well tolerated. Somnolence, headache, and dry mouth are the most common side effects. Because suvorexant has unique effects on arousal systems and rapid eye movement (REM) sleep, it is contraindicated in patients with narcolepsy, and its use should be avoided or closely monitored in patients at risk for REM sleep behavior disorder, depression, or delirium. [Journal of Psychosocial Nursing and Mental Health Services, 52(10), 23-26.].
    No preview · Article · Oct 2014 · Journal of Psychosocial Nursing and Mental Health Services

Publication Stats

6k Citations
626.91 Total Impact Points

Institutions

  • 1998-2015
    • University of Pittsburgh
      • • Department of Psychiatry
      • • Department of Medicine
      Pittsburgh, Pennsylvania, United States
  • 1990-2015
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 2013
    • Virginia Commonwealth University
      • Department of Psychiatry
      Richmond, VA, United States
  • 2010
    • Massachusetts General Hospital
      • Department of Psychiatry
      Boston, Massachusetts, United States
  • 2008
    • Northwestern University
      • Asher Center – Study & Treatment of Mood Disorders
      Evanston, Illinois, United States
  • 2007
    • University of Texas at Dallas
      • School of Behavioral and Brain Sciences
      Richardson, Texas, United States