Suddenly, psychopharmacology has apparently become “all Seroquel, all the time.” AstraZeneca’s atypical antipsychotic (generic name, extended release quetiapine), which already had FDA approval for schizophrenia and bipolar mania, recently won approval for bipolar depression, and is now pushing for indications in depression and generalized anxiety disorder (GAD).

Because of the dearth of FDA –approved medications for eating disorders, psychotherapy has gradually become the treatment of choice. Nonetheless, clinical trials of off-label uses of various medications have yielded a few impressive results, particularly for bulimia and binge eating disorder.

A recent study investigated the relationship between the use of SSRIs prior to or during pregnancy and the development of gestational hypertension and preeclampsia.

Two recent meta-analyses compared second-generation antidepressants (SGADs) to each other regarding efficacy and safety.

A recent trial examined the impact of augmenting antidepressant treatment with risperidone. Participants had not shown a treatment response after taking an antidepressant for at least five weeks, and were then randomly assigned to receive either risperidone or placebo augmentation along with the same dose of their antidepressant.

In a naturalistic study, researchers identified 87 patients in an outpatient clinic who had taken SSRIs for depression and who were clinically stable for at least five years. After five years, 27 patients elected to discontinue SSRIs, and 60 elected to continue.

Dr. Fassler, you are a child psychiatrist and you testified at the original FDA hearings leading to the black box warnings on antidepressants. Can you give us some insight into how that process played out?

In the September 2007 issue of TCPR, we reviewed the very mixed literature on whether it makes sense to increase the dose of an antidepressant to achieve a response. We concluded that there is insufficient evidence, but that as long as you can avoid side effects, there is no compelling reason not to try dose escalation.

The most recent findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial provided little help regarding which medication to prescribe if an initial SSRI trial failed to result in remission of depressive symptoms.

Sildefanil (Viagra) has been shown helpful in treating antidepressant-induced sexual dysfunction (AISD) in men, but no controlled trials had tested its effectiveness in women. In this trial, 98 women with SSRI associated sexual dysfunction were randomly assigned to either sildefanil or placebo; all participants continued their SSRI, and their sexual functioning was assessed at multiple times.