Faculty Bibliography

Typically, they lost weight soon after starting treatment, regained that weight over several weeks or months, and then, in some instances, started reporting weight increases of 20-80 pounds over several months of treatment. Most of these patients never had a serious weight problem in the past. It seemed likely that they were gaining weight from the fluoxetine. Moreover, many patients reported that they were not eating more or different food. I would be very interested in knowing whether the effects of psychotropic agents on body weight, especially when patients do not report significant increases in the amount and composition of food intake, may be mediated by some mechanism involving a shift in the activity of adipose tissue type.

Most practicing psychiatrists who are asked why they opt for use of new-generation antipsychotics will say that it is because of their lowered risk of causing tardive dyskinesia (TD). Had that same question been asked several years ago, the answer might have been that these drugs are more effective in treating negative symptoms; have fewer side effects overall, thus improving the probability of patient compliance; and are less likely to produce adverse cardiovascular events than the older medication. However, it seems that the justification for the prescription of new-generation antipsychotics becomes more difficult with each new independent study.

By now most readers of Primary Psychiatry are familiar with the October 2003 alert by the Food and Drug Administration Public Health Advisory citing the risk of suicidality for pediatric patients taking antidepressants. In February 2005, the FDA went further, asking that antidepressant product information contain a black box warning to that effect In May 2007, the warning was extended to young adults 18-24 years of age. Even before the actual warnings were added to the medications, declines in patients being diagnosed with depression were observed, as was a decrease in the prescription of selective serotonin reuptake inhibitors (SSRIs). The drop in prescriptions for SSRIs extended to adult patients, a group not found to be at increased risk for suicide with antidepressants and a group not cited in the warnings. A new analysis by investigators at the Center for Drug Evaluation and Research confirms that patients under 25 years of age who take antidepressants do have a higher risk of suicide, and those above that age do not. The investigators concluded that risk of suicidality associated with antidepressant use is strongly age dependent. 'Compared with placebo, the increased risk for suicidality and suicidal behavior among adults under 25 [years of age] approaches that seen in children and adolescents. The net effect seems to be neutral on suicidal behavior but possibly protective for suicidal ideation in adults aged 25-64 [years] and to reduce the risk of both suicidality and suicidal behavior in those aged >=65 [years]. ' For participants with non-psychiatric indications, suicidal behavior and ideation were extremely rare.

Dr. Parker is Scientia Professor of Psychiatry at the University of New South Wales (UNSW) and Executive Director of the Black Dog Institute in Sydney, Australia. He was formerly Head of the School of Psychiatry at UNSW and Director of the Division of Psychiatry at Prince of Wales and Prince Henry Hospitals. An active researcher, Dr. Parker has focused on modeling psychiatric conditions (depressive, bipolar, and personality disorders) and examining causes, mechanisms, and treatments for mood disorders. In this interview with Dr. Parker, the following topics are discussed: antidepressant efficacy; antidepressants as maintenance therapies; antipsychotics with antidepressant effects; placebo rates; patient response to medication; efficacy study design; and new promising treatments for depression.

Presents an interview with Samuel Gandy. Samuel Gandy, MD, PhD, is Mount Sinai Professor of Alzheimer\'s Disease Research, professor of neurology and psychiatry, associate director of the Mount Sinai Alzheimer\'s Disease Research Center in New York City, and past chair of the National Medical and Scientific Advisory Council of the Alzheimer\'s Association. As an international expert in the metabolism of amyloid that clogs the brain in patients with Alzheimer\'s disease, Dr. Gandy has written over 150 original papers, chapters, and reviews on this topic. In 1989, he and his colleagues discovered medications that could lower the formation of amyloid. He has received continuous National Institutes of Health funding for his research on amyloid metabolism since 1986.

The stimulus bill, which creates the Federal Coordinating Council for Comparative Effectiveness Research, is a top priority for President Obama's administration in its mission to provide more care and better quality care, and to make health care more cost effective. Although not mandated, one goal of the new board will be cost control. A comparative effectiveness board could provide accurate guidance for clinicians making treatment decisions. There are several pitfalls that will need to be addressed.

Presents a session with Jerome M. Siegel. Jerome M. Siegel is professor of psychiatry at the University of California, Los Angeles, former president of the Sleep Research Society, and the recipient of Merit and Javits awards from the National Institutes of Health and the Distinguished Scientist award from the Sleep Research Society. His laboratory has made discoveries concerning the role of hypocretin in human narcolepsy and Parkinson's disease. He has studied the phytogeny of sleep as a clue to sleep function, discovering that the primitive mammal platypus has rapid eye movement sleep and that marine mammals can go without extended periods of sleep for long periods without ill effects.

MedlinePlus gathers information from National Library of Medicine, the National Institutes of Health, and other government agencies and health-related organizations. Preformulated MEDLINE searches are included and link to medical journal articles. There are numerous links to other sites that are very useful. To test the Website, I clicked on the topic 'Panic Disorder' on the link to ClinicalTrials.gov. It provided specific information about 36 clinical trials that are currently recruiting subjects. This Website will prove very helpful for clinicians who want to refer patients to research protocols.

Presents an interview with Andreas V . Alexopoulos. Dr. Alexopoulos is staff physician in the Epilepsy Center of the Neurological Institute at the Cleveland Clinic in Ohio. Some of the topics being discussed in this interview are: clinical research work, diagnosis, and treatment of epilepsy.

My considerations go into the selection of an antidepressant. These include the overall clinical status of the patient, including comorbid disorders, use of other medications, sensitivities to certain side effects, and past history (if any) of treatment with antidepressants. A perennial question involving antidepressants is: Which drug is most effective? As a prescriber and an educator, I am constantly scanning the literature for studies that demonstrate differences in antidepressant efficacy tolerability, and safety. Individual studies, usually funded by the companies that market antidepressants, have been of limited value, given what we now know about publication bias.