C italopram (Celexa, Forest Laboratories, New York, NY) is one of the most widely prescribed selective serotonin reuptake inhibitors (SSRIs) in our practice. It has had good tolerability and low discontinuation rates in practice and in clinical trials.1-3 The recent US Food and Drug Administration (FDA) recommendation to not use doses higher than 40 mg/d because of potential QTc prolongation has been causing various difficulties. 4 This warning has raised concerns from both psychiatrists and generalists at our institution both in regard to continuation of therapy that has been effective for patients that have responded to doses over 40 mg/d and in regard to the potential to use this medication above that dose range in future patients. Specifically, in our practices, there are patients who are doing well on higher doses. These patients are predominantly in our general and subspecialty psychiatry practices. Further, in our primary care practices, large numbers of patients take citalopram, and drug-drug interactions with agents such as proton pump inhibitors (PPIs), which can increase blood levels in patients taking 40 mg/d or less of citalopram, have also caused substantial prescribing problems. Members of the Mayo Clinic Neurology/Psychiatry Task Force as well as selected members from the Heart Rhythm Services group reviewed factors that should be communicated to prescribers in relation to citalopram prescribing in light of these new warnings regarding QTc prolongation and the risk for potential morbidity and mortality from drug-induced arrhythmias including torsades de pointes and sudden cardiac arrest.When we prescribe a drug for a patient, each of us must consider official warnings as well as the warnings from our electronic prescribing platforms regarding drug interactions. This becomes more complex as the body of knowledge regarding our pharmaceutical armamentarium evolves. As physician and pharmacy leaders in psychopharmacology issues at our large medical institution, we are asked to provide a framework of relevant information to groups of our prescribers in complex situations such as the recent FDA warnings on citalopram. 4 Providing information that meets the needs of both primary and tertiary care populations of patients, as well as prescribers with varying degrees of knowledge, can be challenging but potentially of substantial value.The 4 major factors the group decided to address included:

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The morality of embryo adoption, or heterologous embryo transfer for rescue, remains controversial despite the issuance of Dignitas personae (2008). When evaluating such bioethical controversies, it is crucial to take account of the personal order. Personalism provides a fresh and heretofore underdeveloped perspective toward resolving this polarized issue in bioethics. I will argue that it is not discriminatory to oppose embryo adoption on the basis of the heterology between rescuer and embryo because the lack of genetic relatedness reflects a more profound lack of personal relatedness. The persons involved in embryo adoption are not meant for the bodily relationship of pregnancy because of the incommunicability of relationships that involve the total gift of the human body. From the perspective of biology, pregnancy is natural life support for the embryo. From the perspective of personhood, pregnancy is fundamentally a relationship of embodied persons, one that is irreplaceable and radically exclusive. The clinical implications of this analysis will be discussed.

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