Faculty Bibliography

Listed on the next page are those who served as peer reviewers this past year. Their efforts are crucial to the integrity of the content of Primary Psychiatry. In taking the opportunity to acknowledge our peer reviewers, it is also timely to remind our readers that all articles considered for publication are reviewed by myself and at least two experts on their subject. Any Continuing Medical Education supplements that are published go through a separate peer review/content validation by the Mount Sinai School of Medicine. I do not oversee those supplements, as they are supported via educational grants from industry, and I have elected to avoid even a perception that I might be in a position to influence the content of these supplements

Selecting the best strategy to optimize antidepressant response is a major ongoing clinical challenge. The need for more effective approaches for producing remission has been made clear by recent evidence that confirms treatment with any single antidepressant drug produces remission in only ~33% of patients, and that when antidepressants do work, they are of most benefit to those with more severe depressive symptoms. Patients with moderate levels of depression who seek care because they are either distressed or impaired by their symptoms may, paradoxically, be more difficult to bring into remission than those with a more pronounced disorder. An abundance of studies have shown that numerous augmentation or switching strategies may be effective for some patients, but no body of evidence demonstrates consistent superiority of any. In summarizing lessons learned from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, the most ambitious attempt to date to address the question of antidepressant enhancement options, Rush wrote that 'the gap between what we do in practice and what we know is very large.' In the near future, another study should be published that looks at whether it is better to start treatment with a combination of antidepressants rather than monotherapy. In anticipation of that article, I want to review the STAR*D trial and its major finding and describe the Combining Medication to Enhance Depression Outcomes (CO-MED), which looks at whether it is better to start treatment with two drugs instead of one.

This article presents an interview with Kiki Chang, MD. Dr. Chang is associate professor of Psychiatry and Behavioral Sciences in the Division of Child Psychiatry at the Stanford University School of Medicine in California. His research includes brain imaging, genetics, and medication and psychotherapy trials. Dr. Chang provides readers with answers to the following questions (among others): How is bipolar disorder diagnosed in children and adolescents? How is that diagnostic process different than for an adult? Do you think that bipolar disorder has become a default diagnosis in children and adolescents? Does family history of alcoholism help predict whether there is a higher risk of bipolar disorder? Do you think bipolar disorder is caught most of the time now, or is there still a ways to go in terms of recognition?

While reading the Wall Street Journal on the morning of March 8, 2010, I came across the following headline under the New Medical Findings section: 'Say What? New Risk in Pain-Reliever Use,' (Singer-Vine, 2010). This was of particular personal interest to me because in recent years there has been decline in my hearing, along with an increase in tinnitus. Reading this article made me question whether years of using ibuprofen for various ailments had caused or contributed to my hearing problems. It also caused me to realize how often it is that we only find out about some serious drug adverse effect many years or even decades after it has come into clinical use. The current article discusses this issue, especially as it relates to the use of antidepressants.

Most of the articles in this issue of Primary Psychiatry address different ways to diagnose mental disorders and their manifestations. Given the reliance on diagnostic criteria and rating scales, our understanding of what clinical entities represent are constantly evolving. It is important that we keep-current about any data that improve our efforts to understand the disorder at hand.