As we reviewed in the July/August 2009 issue of TCPR (Vol 7, Issue 7), cardiac disease leads to major depression, and, conversely, depression is a risk factor for developing cardiac disease.

SAMe, long a favorite of Italian psychiatrists, has hopped the pond and installed itself as a “natural” remedy for depression in the U.S.

Historically, research into the effectiveness of antidepressants for depressed youths has been unimpressive. The history of SSRI use in children has been fraught with its own series of disappointments and controversies.

The extent to which antidepressants are effective for pediatric depression continues to stir controversy, as discussed in this issue of CCPR.

No clinician wants to be a “pill-pusher,” and most of our patients do not want that kind of treatment. So what can we offer our depressed patients beyond medications?

Most people with bipolar disorder are maintained on antidepressants, but the evidence base is rather meager. In a recent trial, researchers recruited 70 patients with bipolar disorder, all of whom had responded to a combination of a mood stabilizer and an antidepressant.

Scopolamine is an anticholinergic most often used in patch form to prevent sea-sickness or post-surgical nausea. A recent double-blind, placebo-controlled trial looked at intravenous scopolamine’s effects as a treatment for unipolar depression.

The frequency of antidepressant induced mania has been elusive, with some studies finding high rates of manic switching and others finding very few or no manic episodes among patients taking antidepressants.

There is a strange disconnect between what we psychiatrists do in daily practice and what official antidepressant treatment guidelines recommend. Treatment guidelines typically say, essentially, that all antidepressants are equal in efficacy, but real psychiatrists have strong personal preferences, based on some combination of the scientific literature, the advice of experts, our clinical experience, and perhaps even the personalities of the last drug reps we saw in the office.

Pristiq (desvenlafaxine extendedrelease tablet) was approved by the FDA in February of 2008 for the treatment of major depression.