After reading these articles, you should be able to…

Few clinical trials have ever generated as much buzz as the series of trials known as CATIE. CATIE stands for “Clinical Antipsychotic Trials of Intervention Effectiveness,” and is the only set of trials ever done comparing the major second-generation antipsychotics. And because CATIE is funded entirely by NIMH, its results are thought to be quite trustworthy (NEJM 2005;353:1209-1223).

Those of us who completed residency anytime during the last 10 years were indoctrinated against the use of conventional neuroleptics because of their array of side effects, particularly extrapyramidal syndromes (EPS) and tardive dyskinesia (TD).

Dr. Hsiao, you were NIMH’s project officer for the CATIE trial. What was your goal when you came up with the idea for CATIE?

Following the introduction of the first neuroleptics in the 1950s, pharmaceutical companies continued screening compounds for psychoactive properties. In 1959, at Wander Laboratories (ultimately purchased by Sandoz), researchers were surprised to discover a chemical similar to tricyclic antidepressants that had antipsychotic properties. They named it clozapine.

After reading these articles, you should be able to…

Vagus nerve stimulation (VNS) is certainly new—but is it effective? It took the FDA a long time to make up its mind, but eventually it approved the treatment in May 2005. (For more details on why the FDA flip-flopped on the issue, see “FDA Approval of VNS,” this issue.) In this article, we scrutinize the two pivotal studies leading to approval.

First they said yes to VNS, then no, then yes. And now they’re trying desperately to explain their final answer.

If, after reviewing our admittedly lukewarm evaluation of the VNS data, you decide that you want to offer it to your patients, here’s some useful information.

Most psychiatrists pretty much agree that all antidepressants are more or less equally effective. So if you start with that premise and you have 10-15 antidepressants out there, why are you picking one versus another? And what algorithm are we all using? Dr. Zimmerman developed a questionnaire for psychiatrists to fill out immediately after they wrote antidepressant prescriptions. We asked, “What influenced you to choose that medication?”