Things were bound to get ugly. The total market for antipsychotics is $10 billion, there are five very similar atypicals jockeying for an extra nibble of that huge pie, and each atypical is backed by an aggressive pharmaceutical firm. You do the math.

If you who have chosen to spend inordinate amounts of your precious time reading these pages over the last year, you will remember the February 2003 (TCR, 1:2) issue in which TCR slammed Zyprexa for causing diabetes. Well, we're going to slam Zyprexa again this year, but not quite as viciously.

Tired of industry-funded antipsychotic trials? The NIMH comes to the rescue with the "CATIE" project (Clinical Antipsychotic Trials of Intervention Effectiveness). Blissfully un-industry-funded researchers have enrolled 1500 schizophrenic patients at 50 different sites, and have randomly assigned them to Zyprexa, Seroquel, Risperdal, Geodon, or Trilafon (perphenazine).

Dr. Buse, as an endocrinologist with a specialty in diabetes, I'm hoping you can help educate both myself and my psychiatrist readers about diabetes and antipsychotics. To begin with, we've been hearing a lot lately about the "metabolic syndrome." What is it?

Raymond Cavanaugh, M.D., is a psychiatrist in private practice in Lawrence and Lynn, Massachusetts, and has an interesting take on the differences between the atypicals.

We have some good news and we have some bad news. First, the good news: Cymbalta (generic name: duloxetine) is an effective dual reuptake antidepressant with a good safety profile. Now, the bad news: it appears to have no advantages over existing antidepressants.

Whether you do ECT (electroconvulsive therapy) or not, and research indicates that less than 8% of you actually perform it (Hermann et al, Am J Psychiatry 1998; 155:889-894), you need to know about it, because you will have to decide when to refer your treatment-resistant patients for it, and you will have to know what to say to them about it as they pepper you with a multitude of questions, as they always do (and should).

Sorry, no earthshaking developments in the antidepressant world in 2003, but here are some developments that you’ll find useful in your practice.

Dr. O'Reardon, you had mentioned at the end of our last interview (see TCR, Vol. 1, No. 1) some of the augmentation and combination strategies that you like to use in your clinic but we didn't have time to get into the actual specifics of these. To begin with, how do you decide when to augment? What kinds of drug failures do you try to establish?

The first ECT (electroconvulsive therapy), was performed by an Italian psychiatrist, Ugo Cerletti, who had initially assessed the safety of the treatment with dogs. He performed the first treatment on a human on April 18, 1938.