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REPLY

New Psychopharmacologic Treatment Strategies

right arrow Ira D. Glick, MD, and Charles DeBattista, MD

4 December 2001 | Volume 135 Issue 11 | Page 1008


IN RESPONSE:

We appreciate Dr. Stokes' positive comments about our update. Regarding his concerns, first, we agree that lithium has a "clear early response." Our point was that anticonvulsants, such as divalproex, may allow loading doses to be used, which may allow earlier onset of action (1). Second, although antidepressant effects may be seen in the first week, few clinical trials show a separation from placebo in the first week. Selective serotonin reuptake inhibitors start at full therapeutic dose, but there is likewise little evidence that they separate from placebo in the first week (2).


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Stanford University School of Medicine; Stanford, CA 94305


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1. Hirschfeld RM, Allen MH, McEvoy JP, Keck PE Jr, Russell JM. Safety and tolerability of oral loading divalproex sodium in acutely manic bipolar patients J Clin Psychiatry. 1999;60:815-8. [PMID: 10665626].[Medline]

2. Leon AC, Blier P, Culpepper L, Gorman JM, Hirschfeld RM, Nierenberg AA, et al. An ideal trial to test differential onset of antidepressant effect J Clin Psychiatry. 2001;62(Suppl 4):34-6. [PMID: 11229787].

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Related articles in Annals:

Updates from the Annual Session
Psychopharmacologic Treatment Strategies for Depression, Bipolar Disorder, and Schizophrenia
Ira D. Glick, Trisha Suppes, Charles DeBattista, Rona J. Hu, AND Stephen Marder
Annals 2001 134: 47-60. [ABSTRACT][Full Text]  

Letters
New Psychopharmacologic Treatment Strategies
Peter E. Stokes
Annals 2001 135: 1008. [Full Text]  




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