The largest and most rigorous study to date on the treatment of bipolar depression was just published in the New England Journal of Medicine. The study, conducted as part of the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), enrolled a total of 366 subjects with either bipolar I or II disorder during a major depressive episode.
The combination of Effexor (venlafaxine) and Remeron (mirtazapine) has been dubbed “California Rocket Fuel” by Stephen Stahl (see page 290 of his Essential Psychopharmacology, 2nd Edition) because of the multiple ways the combination boosts various neurotransmitter systems.
An FDA advisory panel has recommended that TMS not be approved for the treatment of major depression. Neuronetics, the maker of the NeuroStar device (www.neuronetics.com), submitted data from three studies, but only one was a placebo-controlled double-blind trial (Study 101).
Dr. Oransky, as Deputy Editor of The Scientist, I know that you spend a great deal of time looking at medical statistics, and you do an excellent job of making these concepts understandable in your column in CNS News, Statistically Speaking.
I know that you published a famous meta-analysis several years ago in which you compared the remission rates of patients on venlafaxine with SSRIs and placebo. Can you remind us of what that study showed?
The latest foray into the controversial issue of antidepressant-induced switching appeared in the February issue of The American Journal of Psychiatry (2006;163:232-239). The last time TCPR took up this topic (June 2005), we reviewed a meta-analysis of antidepressant use in bipolar disorder. That paper concluded that SSRIs cause the same rate of manic switching as placebo (Am J Psychiatry 2004;161:1537-1547). The authors of the newly published research would beg to differ.
While it’s certainly interesting to theorize about neurotransmitters and antidepressants, the recent STAR*D findings bring up a difficult topic: Does mechanism matter?
What steps should clinicians take if psychopharmacologic treatments and school behavioral strategies are insufficient for managing a child with ADHD? We've all been there. ADHD,...