Clinical Psychiatry News' Top Stories of 2005

Article excerpt

A decrease in the number of antidepressants prescribed for children and adolescents by psychiatrists and primary care physicians kept the Food and Drug Administration's decision to require black box labeling on antidepressants as a top issue in 2005.

The year brought the approval of a new device aimed at treating severely depressed patients who have exhausted all other options for treatment.

Hurricane Katrina left its mark on thousands of survivors, many of whom will be trying to recover emotionally from this disaster for years to come.

Psychiatrists also defended their preference for using atypicals over conventional antipsychotics and emphasized a broad interpretation of the Clinical Antipsychotics Trials of Intervention Effectiveness (CATIE) results.

Finally, forecasters warned that the demand for psychiatrists--and other mental health professionals--in this country might soon surpass the supply.

In no particular order, CLINICAL PSYCHIATRY NEWS presents a review of some of the top news stories of 2005 affecting psychiatry. In some cases, members of the publication's editorial advisory board have offered their insights.

Antidepressant Prescriptions

Some psychiatrists were surprised by data showing that fewer psychiatrists were prescribing fewer antidepressants to children and adolescents in the wake of the FDA black box warning ("Dropoff Seen in Prescribing of Antidepressants," March 2005, p. 1).

The pharmacy benefit manager Medco Health Systems, which manages drug benefits for about 60 million Americans, said no difference in the drop-off rate in prescribing was seen by psychiatrists and their colleagues in primary care.

Antidepressant prescriptions fell about 19% in the third quarter and about 16% in the fourth quarter of 2004, from a year earlier.

Psychiatrists and and their colleagues in pediatrics suggested that the drop in prescriptions among primary care physicians is probably a physician-driven trend, and that the decline among patients of psychiatrists is more likely a result of parents' concern.

The story also noted anecdotal reports of companies increasing premiums for malpractice insurance if physicians say they prescribe antidepressants.

Those worries also were compounded by the difficulty of complying with the FDA's recommendations for monitoring patients on antidepressants when the current benefits given by most health insurers and managed behavioral health companies are not adequate enough to meet such requirements.

Vagus Nerve Stimulation for Depression

The FDA's approval of a vagus nerve stimulator as the first device for a psychiatric disorder since electroconvulsive therapy met with a mix of cautious optimism ("VNS Therapy Is Approved for Severe Depression," August 2005, p. 1).

Some experts raised concern about a lack of rigorous research into the device's efficacy.

A multicenter pivotal trial failed to show a difference between the device and sham stimulation. But when the device's manufacturer, Cyberonics Inc., argued that the treatment could take longer to have an effect, the FDA's Neurological Devices Advisory Panel voted to approve the device, based on long-term follow-up of the patients to 12 months.

No randomized, controlled trials have compared the device with other treatments for depression.

The device is approved as a long-term adjunctive treatment for patients with major depression who have failed at least four other treatments. Its label contains a black box warning about the risks associated with an implantable device.

Dr. Rodrigo A. Munoz points out that VNS should be used only in the rarest of cases.

"The rules are pretty precise--it's not a first-line treatment," said Dr. Munoz, clinical professor of psychiatry at the University of California, San Diego.

"You have to examine other treatments and see if they have been competently applied, and that should include all of the therapies we have, including ECT," he said. …