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.

Although we tend to feel comfortable counseling patients to continue antidepressants during pregnancy, because most of them do not appear to cause congenital abnormalities, mood stabilizers are trickier.

The STEP-BD study is an NIMH-funded study of patients with bipolar disorder, which has already yielded a number of intriguing findings, some of which we covered in an earlier issue (TCPR, Aug 2006). This study followed 293 patients with acute depression, most of whom received both mood stabilizers and antidepressants.

On November 20, 2007, the FDA issued an “early communication” warning about possible dangerous side effects of Chantix (varenicline), a new smoking cessation agent that affects brain nicotine receptors. Several cases of new-onset depression, suicidal ideation, and aggressive or erratic behavior have been reported via the Medwatch program.

Dr. Fink, recently you and your colleague, Michael Taylor, reviewed the latest studies of electroconvulsive therapy in patients with major depression in JAMA (Fink M and Taylor MA, JAMA 2007;298(3):330-332). I thought we might start by talking about ECT efficacy. How effective is it?

After reading these articles, you should be able to…

Clearly, sleeping pills work; the more relevant issue is whether there are any significant differences among them, and whether we should pony up 3 dollars per pill for the Maserati medications or just 3 cents per pill for perfectly adequate Civics.

Four questions for a quick initial evaluation of insomnia.

On February 8, 2007 the model and actress Anna Nicole Smith was found dead in her hotel room at the Seminole Hard Rock Hotel in Florida.