We know that headaches are common in the general population, but they are particularly common among patients with psychiatric problems. According to one review, (Pompili M et al., J Headache Pain 2009; 10(4):283-290) patients with depression have a 46% lifetime prevalence of migraine, while bipolar patients have a 51% prevalence. Patients with migraines have triple the risk of developing depression than patients without migraines.
One year ago we reviewed the status of transcranial magnetic stimulation
for depression, and concluded with the following TCPR Verdict: “TMS for
depression: Approval is highly unlikely.” We were wrong. The FDA approved the Neuronetics Neurostar TMS machine for the treatment of patients with major depression who have failed one prior antidepressant trial. Did they make the right decision?
Pristiq (desvenlafaxine extendedrelease tablet) was approved by the FDA in February of 2008 for the treatment of major depression. In the April 2008 issue of TCPR, we reviewed the efficacy data available at that time. We concluded that it is a marginally effective antidepressant with no clear advantages over its precursor molecule, venlafaxine extended release (Effexor XR). How has Pristiq fared over the past year and half?
Health care reform is back on the national agenda with a vengeance. Obama made this a central part of his campaign platform and recently met with various insurance and medical groups to begin the lobbying and persuasion process. Why does the Obama administration appear to have high hopes for another attempt at universal health care? And what might such a system mean for psychiatrists?
On May 28, 2008, The Food and Drug Administration announced a major revision in the labeling of the pregnancy and breast-feeding risk of drugs. The current labeling system was devised in 1979 and has been criticized over the years for being confusing and for failing to incorporate the most recent data. In the new system, package inserts will carry a short monograph on the pregnancy and lactation risks of each drug.
Recently, the FDA gave its first two approvals for medications to treat fibromyalgia (FM): first Lyrica (pregabalin) and then Cymbalta (duloxetine). While it is nice that FM is receiving some attention from big pharma, the badge of FDA approval should be taken with a grain of salt.
The last time we took a close look at transcranial magnetic stimulation (TMS) was three years ago (TCPR, Jan 2005), and we concluded that it had promise as a treatment for major depression. In that article, we reported that the company making the device, Neuronetics, would apply for FDA approval as early as Fall of 2005, and that we could be passing magnetic coils over our patients’ heads as early as 2006.
Many psychiatrists are already hearing from patients about “this new technique” of using EEG to predict whether a given antidepressant will work. How good is this technology? Is it even remotely ready for prime time?
VNS (vagus nerve stimulation) was initially developed and approved for treatment-refractory epilepsy. Cyberonics conducted one sham-controlled study for treatment-resistant depression, and while this double-blind study showed no statistical benefit over placebo, an open-label extension showed enough benefit to impress someone at the FDA. In a controversial decision in which the unanimous rejection of an advisory panel was overturned, the FDA approved VNS for treatment-resistant depression on July 15, 2005.
Ronald C. Albucher, MD, is the director of counseling and psychological services and clinical assistant professor of psychiatry, Stanford University in Palo Alto, CA.
Steve Balt, MD is a psychiatrist in private practice in the San Francisco Bay area.
Richard Gardiner, MD, is a psychiatrist in private practice in Potter Valley, CA.
Alan D. Lyman, MD, is a child and adolescent psychiatrist in private practice in New York City, NY.
James Megna, MD, PhD, is the director of inpatient psychiatry and an associate professor of psychiatry and medicine at SUNY Upstate Medical University in Syracuse, NY.
Robert L. Mick, MD, is a contract physician in addiction medicine and military psychiatry in Bloomfield, NY.
Michael Posternak, MD, is a psychiatrist in private practice in Boston, MA.
Glen Spielmans, PhD, is an assistant professor of psychology at Metropolitan State University in St. Paul, MN.
Marcia L. Zuckerman, MD is director of Psychiatric Services at Walden Behavioral Care in Waltham, MA.
All editorial content is peer reviewed by the editorial board. Dr. Albucher, Dr. Balt, Dr. Gardiner, Dr. Goldberg, Dr. Lyman, Dr. Megna, Dr. Mick, Dr. Posternak, Dr. Spielmans, and Dr. Zuckerman have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity. Dr. Balt discloses that his spouse is employed as a sales representative for Otsuka America, Inc.