Although we tend to feel comfortable counseling patients to continue antidepressants during pregnancy, because most of them do not appear to cause congenital abnormalities, mood stabilizers are trickier.
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The STEP-BD study is an NIMH-funded study of patients with bipolar disorder, which has already yielded a number of intriguing findings, some of which we covered in an earlier issue (TCPR, Aug 2006). This study followed 293 patients with acute depression, most of whom received both mood stabilizers and antidepressants.
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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.
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On November 20, 2007, the FDA issued an “early communication” warning about possible dangerous side effects of Chantix (varenicline), a new smoking cessation agent that affects brain nicotine receptors. Several cases of new-onset depression, suicidal ideation, and aggressive or erratic behavior have been reported via the Medwatch program.
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Dr. Fink, recently you and your colleague, Michael Taylor, reviewed the latest studies of electroconvulsive therapy in patients with major depression in JAMA (Fink M and Taylor MA, JAMA 2007;298(3):330-332). I thought we might start by talking about ECT efficacy. How effective is it?
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The last time we took a close look at transcranial magnetic stimulation (TMS) was three years ago (TCPR, Jan 2005), and we concluded that it had promise as a treatment for major depression. In that article, we reported that the company making the device, Neuronetics, would apply for FDA approval as early as Fall of 2005, and that we could be passing magnetic coils over our patients’ heads as early as 2006.
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Many psychiatrists are already hearing from patients about “this new technique” of using EEG to predict whether a given antidepressant will work. How good is this technology? Is it even remotely ready for prime time?
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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