The frequency of antidepressant induced mania has been elusive, with some studies finding high rates of manic switching and others finding very few or no manic episodes among patients taking antidepressants.

There is a strange disconnect between what we psychiatrists do in daily practice and what official antidepressant treatment guidelines recommend. Treatment guidelines typically say, essentially, that all antidepressants are equal in efficacy, but real psychiatrists have strong personal preferences, based on some combination of the scientific literature, the advice of experts, our clinical experience, and perhaps even the personalities of the last drug reps we saw in the office.

Pristiq (desvenlafaxine extendedrelease tablet) was approved by the FDA in February of 2008 for the treatment of major depression.

Suddenly, psychopharmacology has apparently become “all Seroquel, all the time.” AstraZeneca’s atypical antipsychotic (generic name, extended release quetiapine), which already had FDA approval for schizophrenia and bipolar mania, recently won approval for bipolar depression, and is now pushing for indications in depression and generalized anxiety disorder (GAD).

Because of the dearth of FDA –approved medications for eating disorders, psychotherapy has gradually become the treatment of choice. Nonetheless, clinical trials of off-label uses of various medications have yielded a few impressive results, particularly for bulimia and binge eating disorder.

A recent study investigated the relationship between the use of SSRIs prior to or during pregnancy and the development of gestational hypertension and preeclampsia.

Two recent meta-analyses compared second-generation antidepressants (SGADs) to each other regarding efficacy and safety.

A recent trial examined the impact of augmenting antidepressant treatment with risperidone. Participants had not shown a treatment response after taking an antidepressant for at least five weeks, and were then randomly assigned to receive either risperidone or placebo augmentation along with the same dose of their antidepressant.

In a naturalistic study, researchers identified 87 patients in an outpatient clinic who had taken SSRIs for depression and who were clinically stable for at least five years. After five years, 27 patients elected to discontinue SSRIs, and 60 elected to continue.

Dr. Fassler, you are a child psychiatrist and you testified at the original FDA hearings leading to the black box warnings on antidepressants. Can you give us some insight into how that process played out?