Pharmacotherapy and Depression Severity

| February 15, 2010 | 0 Comments

Dear Colleagues:

Welcome to the February issue of Psychiatry 2010. As you are all very aware, the recent study in JAMA by Fournier et al on antidepressant drug effects and disease severity received a lot of media attention, and as is all too often the case many media outlets took the results of this study at face value and used them to supplant the results of hundreds of other clinical trials on antidepressant effectiveness, with headlines like “Antidepressants not Effective for Mild or Moderate Depression” and “SSRI Antidepressants No Better than Placebo Says JAMA.” Subsequent expert commentaries were then published in well-known newspapers regarding the study results, and the blogs were buzzing with everyone’s take. It seems antidepressant effectiveness is a “burning” issue among the general public, and there doesn’t appear to be middle ground: either antidepressants work for everyone or they work for no one—even though that’s not what the results of the study said at all. As the talk about these study results still simmers, we at Psychiatry 2010 thought it would be relevant to look at drug therapy for depression a little differently, which brings us to this month’s Trend Watch.

In this month’s Trend Watch, the authors analyzed use of therapeutic drug classes for the treatment of depression by the three levels of physician-reported disease severity (mild, moderate, and severe) to understand if the mix of therapeutic classes used to treat depression changes as disease severity increases. The authors found that as disease severity changes, so too do the proportions of the various therapeutic classes used in depression. It appears that the mix of drug classes used in severe depression are becoming less similar to the class mix for moderate depression over time. Dr. Richard Weisler from Duke University Medical Center, Durham, North Carolina, and University of North Carolina at Chapel Hill Departments of Psychiatry, Raleigh, North Carolina, provides an expert commentary on the data.

As for the rest of the issue, Sansone and Sansone, in this month’s The Interface, review the phenomenon of hoarding and explore how age of onset of its characteristics may distinguish it as a symptom of another underlying disorder or as a distinct syndrome.

Next, Khawaja et al review the usefulness of partial hospitalization programs, which can be used in place of an inpatient unit for patients who need crisis stabilization and amelioration of their acute symptoms, but who are not imminently homicidal or suicidal. A case vignette is provided for illustration.

Following this, Deshmukh et al provide a systemic review of limited but currently available studies on effective and safe methods for the pharmacological management of aggression in children and adolescents and provide treatment guidelines based on these data.

Finally, we wrap up the issue with two of our regular columns. In this month’s Update on Cognition, Harvey and Penn describe social abilities relative to individuals with schizophrenia: emotion perception, theory of mind, and attributional style. The authors discuss how these abilities are currently measured and describe how research could improve the current measurement of these abilities to make them more clinically useful. And in this month’s Meymandi at Large, Dr. Meymandi, in a style all his own, reviews the book, Psychoanalysis and Neuroscience, by Mauro Mancia.

Amir Kalali, MD
Editor, Psychiatry 2010

Category: Editor's Message: Issue Highlights, Mood Disorders, Past Articles, Psychiatry, Psychopharmacology

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