After reading these articles, you should be able to…

In the dark old days of American Psychiatry, most patients were diagnosed with schizophrenia and prescribed Thorazine (chlorpromazine) or its equivalent. One of the true pioneers of rational medication treatment is Donald Klein of Columbia University, who in 1962 was a psychiatrist practicing at Hillside Hospital in New York.

Alright, we can see you stifling that yawn, and we know what you’re thinking: “What on earth is there to say about treating panic disorder other than to use SSRIs or benzos?” Well, we’re up for the challenge!

Nobody doubts that benzodiazepines (“benzos” or BZs) are effective in treating a wide range of anxiety disorders, but many believe that they are addictive, difficult and perhaps dangerous to stop taking, and that they cover up anxiety instead of truly treating it. Let’s take a closer look at each of the concerns.

Dr. Goddard, you’ve done a lot of neurobiological research in anxiety disorders. It’s a very complex area, but basically what goes on in patients’ brains when they have a panic attack?

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.