Mr. H., now 49, was first diagnosed with ADHD at the age of 40, when he was evaluated at the suggestion of an old friend, a psychologist who had known him in grade school.
Lawrence H. Diller, MD
Private Practice, Behavioral Pediatrics, Walnut Creek, California
Clinical Faculty, UCSF School of Medicine
Author, The Last Normal Child, Running on Ritalin and Should I Medicate My Child?Dr. Diller has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Dr. Diller, as a behavioral pediatrician you certainly prescribe stimulants and other psychiatric medications to children, but at the same time you have spent much of your career speaking and writing about some the potential negative consequences of the excessive use of stimulants. You’ve also studied the history of stimulant use, and have thought about how this can inform our decisions now.
We’ve all noticed the trend: children are increasingly being diagnosed with bipolar disorder. This issue is controversial, because psychiatrists are already accused of overmedicating children.
The STEP-BD study, an NIMH-funded study of bipolar disorder, has enrolled its last patient, and we have already begun to see the first results filtering through to the psychiatric journals.
The latest foray into the controversial issue of antidepressant-induced switching appeared in the February issue of The American Journal of Psychiatry (2006;163:232-239). The last time TCPR took up this topic (June 2005), we reviewed a meta-analysis of antidepressant use in bipolar disorder. That paper concluded that SSRIs cause the same rate of manic switching as placebo (Am J Psychiatry 2004;161:1537-1547). The authors of the newly published research would beg to differ.
Gary S. Sachs, MD
Associate Professor of Psychiatry, Harvard Medical School
Director, Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, Massachusetts
Dr. Sachs has disclosed that he is the recipient of research grants from Abbott, GlaxoSmithKline, Janssen, Repligen, Pfizer, and Wyeth; is a consultant for Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Janssen, JDS, Memory, Repligen, Pfizer, Solvay, and Wyeth; and is a member of the speakers bureaus of Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, and Eli Lilly. The editors of The Carlat Psychiatry Report have reviewed the content of Dr. Goddard’s interview and have resolved any financial conflicts of interest regarding this educational activity. The author has disclosed that inositol has not been approved by the U.S. Food and Drug Administration for use in the treatment of bipolar disorder.
Dr. Sachs, as the principal investigator of the STEP-BD study, can you walk us through how the study was hatched?