Sometime in 2013, we’ll presumably be forced to shell out a hundred bucks or so for the fifth edition of DSM. While we do not have the space to review every potential change here, we will cover those of most clinical importance.

The gold standards of treatment for ADHD are the stimulants amphetamine and methylphenidate. They are old friends, having been used for decades, and there is a wealth of patient experience with them. Although we use them all the time, an occasional review of the tools in our toolbox is always helpful.

We know that for many conditions, both medications and psychotherapy work about equally well. Common sense would dictate that there is some final common pathway of neuropsychiatric change underlying the symptomatic improvements we see. But identifying what is happening in a living human brain is extremely tricky.

Making the decision to put a child on a psychiatric medication is hard enough. The process of discussing this possibility with parents can be even more challenging.

Dr. Connor, you have spent many years working with and studying aggressive children. Why don’t you give us a little background on your interest in these kids?

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.

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.