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.

Based on data from eight randomized double-blind, placebo-controlled trials, researchers found that 79% of patients who responded to placebo in the initial phase of the trial maintained their response while continuing to take placebo during the continuation phase of the trial.

Much of what is confusing and controversial in the treatment of bipolar disorder revolves around the role of antidepressants. Are they dangerous or safe? Are they effective or ineffective? Does it matter whether the patient has Bipolar I or II?

A few studies have shown that orally disintegrating Zyprexa Zydis appears to cause less weight gain than standard Zyprexa, but they have been short term studies.

After many years of trying, Wyeth finally received FDA approval for its new antidepressant, Pristiq (desvenlafaxine). Don’t get too excited, though – Pristiq is simply the active metabolite of Effexor and it’s unclear whether it adds anything of value to our current quiver of antidepressants.

We typically warn our patients about common side effects, such as headache, GI distress and sexual dysfunction when we start SSRIs. Here are some of the side effects that we don’t necessarily talk to patients about, but should be able to recognize and discuss in particular contexts.