There is a battle underway in the genteel circles of academic psychiatry. The disputed question is: Are antidepressants (ADs) good or bad for patients with bipolar disorder?

We have some good news and we have some bad news. First, the good news: Cymbalta (generic name: duloxetine) is an effective dual reuptake antidepressant with a good safety profile. Now, the bad news: it appears to have no advantages over existing antidepressants.

Whether you do ECT (electroconvulsive therapy) or not, and research indicates that less than 8% of you actually perform it (Hermann et al, Am J Psychiatry 1998; 155:889-894), you need to know about it, because you will have to decide when to refer your treatment-resistant patients for it, and you will have to know what to say to them about it as they pepper you with a multitude of questions, as they always do (and should).

Sorry, no earthshaking developments in the antidepressant world in 2003, but here are some developments that you’ll find useful in your practice.

Dr. O'Reardon, you had mentioned at the end of our last interview (see TCR, Vol. 1, No. 1) some of the augmentation and combination strategies that you like to use in your clinic but we didn't have time to get into the actual specifics of these. To begin with, how do you decide when to augment? What kinds of drug failures do you try to establish?

In case you haven't noticed, antidepressants are under attack. Articles such as "The Emperor's New Drugs" and popular books like "Prozac Backlash" point to a growing public sentiment that psychiatrists need to shed a little hubris.

What a bind we seem to be in. On the one hand, we are short several thousand child psychiatrists in the United States, and parents are beating down our (generalist) doors to get their children medicated. On the other hand, every other piece of news about childhood psychopharmacology seems either bad or lukewarm.

There’s nothing like a close friend suffering psychiatric difficulties to motivate a psychiatrist to do some serious reading. Recently, your humble editor encountered this situation.

Dr. Hendrick, there has been a lot of confusing and seemingly contradictory data about the safety of SSRIs during pregnancy. What’s your take?

Roseann Gumina, M.D., is an obstetrician/gynecologist in private practice in Milwaukee, Wisconsin. Like most OB/GYNs, Dr. Gumina sees more pregnant women on antidepressants in a given year than most psychiatrists are likely to see in a lifetime, and her perspective is informative.