What is postpartum depression (PPD), and why does it occur? PPD is generally defined as major depressive symptoms occurring within three months of childbirth. Don’t confuse PPD with the very common postpartum blues, a phenomenon that occurs in over half of women who give birth, peaks about four days after delivery, and fully remits by 10 days postpartum (N Engl J Med 2002; 347:194-199).

Dr. Hendrick, thanks for your return visit to the pages of TCR! I’m wondering whether, as a specialist in the psychiatric treatment of women, you can tell us about particular drug interactions that you feel we should be more aware of in treating women.

“You can use vitamins to help a woman through those things,” said Tom Cruise, denigrating Brooke Shields’s use of an SSRI to treat her postpartum depression, which she detailed in her recent book Down Came The Rain: My Journey Through Postpartum Depression.

Suddenly, putting patients to sleep is all the rage in psychiatry. Over the last year, two new hypnotics have been approved by the FDA – Lunesta (eszopiclone) in December 2004 and Rozerem (ramelteon) in July 2005. Indiplon (the generic name) is on the launching pad for approval in early 2006.

Tapering patients off benzos (BZs) is certainly more art than science, but TCR has unearthed a surprising number of studies that help bring more science into the process. These studies are, by modern standards, ancient, because research follows the money, and there’s no longer much money to be made in benzodiazepines. So file these studies under “oldies but goodies”!

Whether one should prescribe BZs to patients with a history of alcoholism is a controversial question, and one that tends to polarize psychiatrists into the “purists” versus the “realists.” Most alcoholics take BZs at some point in the course of their disorder, sometimes illegitimately, but often as part of a bona fide treatment program.

Dr. Talmadge, in your practice, do you ever prescribe benzodiazepines to people with substance abuse histories?

My standard practice in treating patients with very frequent panic attacks had always been to start both a benzo and an antidepressant, with the expectation of eventually tapering the benzo. But I noticed, both with my patients and those I inherited from other psychopharmacologists, that hardly anyone ever seemed to get off benzos despite my preparing the patient for this plan.

When Aricept (donepezil) was first approved by the FDA in 1996 for the treatment of Alzheimer’s Dementia (AD), there was an almost euphoric sense that we were finally beginning to make progress in treating a previously untreatable disease.

In 2003, the FDA approved Namenda (memantine) as a treatment for moderate to severe Alzheimer’s Dementia (AD). Backed by the legendary marketing expertise of Forest Labs, the medication has become remarkably popular, gradually eating into the market share of the cholinesterase inhibitors (CIs). The question, as always, is whether this popularity is justified by the data.