Roseann Gumina, M.D., is an obstetrician/gynecologist in private practice in Milwaukee, Wisconsin. Like most OB/GYNs, Dr. Gumina sees more pregnant women on antidepressants in a given year than most psychiatrists are likely to see in a lifetime, and her perspective is informative.

In 1956, a German company synthesized thalidomide (its brand name was “Contergan”) and launched it the next year in Europe as a sedative. Unlike sedatives available at the time, such as the barbiturates, thalidomide was apparently completely non-addictive and had few if any side effects.

There are now no fewer than 14 FDA-approved psychostimulants… and counting. This does not include the many generics, the new non-stimulant Straterra or the off-label ADHD meds Wellbutrin (bupropion) and desipramine.

The Eli Lilly reps are almost delirious about their new ADHD “miracle drug”, Straterra (atomoxetine). This is not surprising.

They have been flooding into your office: grown-ups who believe that they have ADHD.

Dr. Prince, you have done innumerable evaluations of children and adults with ADHD. These days, psychiatrists in the community are besieged by patients wanting treatment for ADHD, and the pressure is on to come up with a diagnosis and treatment during a single 45 minute session. Is this possible?

David Sorenson, M.D., is medical director of the Anna Jaques Hospital Child Psychiatry Inpatient Unit in Amesbury, Massachusetts. His experiences with patients misusing ADHD medications should give us pause.

The discovery that stimulants are helpful for behavioral problems in children was another of the serendipitous discoveries so common in psychiatry. Dr. Charles Bradley, in the 1930’s, was medical director of a small child psychiatric hospital.

Panic disorder is a much harder nut to crack than we give it credit for. We tend to get complacent about treating it, because so many patient appear to do well on the standard starting regimen of an SSRI with or without a benzodiazepine.

When it comes to cognitive behavior therapy (CBT) and most psychiatrists, a little knowledge is a troubling thing. We know that CBT is effective, but we don’t know how to practice it. We know that a lot of patients ask us about it, but we don’t know enough to confidently describe to them what it entails.