One year ago we reviewed the status of transcranial magnetic stimulation for depression, and concluded with the following TCPR Verdict: “TMS for depression: Approval is highly unlikely.” We were wrong.

In this issue of TCPR, we focus on TMS (Transcranial Magnetic Stimulation), which has just been approved for treatment resistant depression. There are also other brain devices in various stages of research and development. Here is a quick run-down of four of them.

Two recent meta-analyses examined the comparative efficacy of antidepressants versus psychotherapy in the treatment of depression and dysthymia (Cuijpers P et al., J Clin Psychiatry 2008, online ahead of print; Imel et al., J Affect Dis 2008;110:197-206).

Last year, we reviewed a meta-analysis implying that bupropion is as effective as SSRIs for the treatment of patients with mixed anxiety and depression (TCPR, Aug 2007). In a new paper, these same researchers have sliced and diced the data a bit differently in order to answer this topic more confidently.

VNS (vagus nerve stimulation) was initially developed and approved for treatment-refractory epilepsy. Cyberonics conducted one sham-controlled study for treatment-resistant depression, and while this double-blind study showed no statistical benefit over placebo, an open-label extension showed enough benefit to impress someone at the FDA.

We generally think of major depression as a single disorder with various possible symptoms. The only specific profile that we sometimes look for is atypical depression, encompassing reverse neurovegetative symptoms and reactivity of mood.

Fibromyalgia is usually considered a rheumatologic condition characterized by at least 3 months of widespread pain and the presence of tender points. About two thirds of fibromyalgia patients also suffer from depression, and many such patients eventually find their way to our offices.

Why don’t we start with the issue of agitation? The question in many psychiatrists’ minds is how seriously we should take the FDA advisory about the dangers of atypical antipsychotics?

Dr. Brizendine, as the director of the UCSF Women’s Mood and Hormone Clinic, you receive many referrals of women who are having difficulty with menopause. What are the typical problems that women have during this period?