Sackeim et al (SEE ARTICLE) compared the efficacy and cognitive side effects of right unilateral electroconvulsive therapy (ECT), given at 3 different stimulus intensities, and a "gold standard" form of bilateral ECT. High-dosage right unilateral ECT (administered at 6 times initial seizure threshold) was equivalent in efficacy to bilateral ECT, but had important advantages in short- and long-term cognitive side effects. Relapse following response to ECT did not differ among the treatment groups. Clinicians should consider greater use of right unilateral ECT, particularly at a high dosage relative to seizure threshold.
McCall et al (SEE ARTICLE) compared 2 common stimulus dosing strategies in the right unilateral electroconvulsive therapy treatment of depressed patients—a fixed, high-dose stimulus vs an individually tailored stimulus that was 2.25 times seizure threshold. The fixed, high-dose group had better immediate antidepressant results but more memory problems than the individually tailored stimulus. These differences were best explained by a dose-response relationship with stimulus dose expressed as a multiple of the seizure threshold, up through 12 times the seizure threshold.
A commentary by Abrams is included. (SEE ARTICLE)
Using magnetic resonance imaging, Gilbert et al (SEE ARTICLE) report that thalamic volumes were significantly greater in untreated patients with obsessive-compulsive disorder (OCD) than in healthy children but declined significantly after paroxetine monotherapy to levels comparable to those of controls. This study provides new evidence of thalamic abnormalities in childhood OCD and further suggests that paroxetine treatment may be associated with a reduction in thalamic volume.
Agras et al (SEE ARTICLE) report the findings of a multisite study comparing 2 treatments for bulimia nervosa. Cognitive-behavioral therapy was significantly superior to interpersonal therapy in reducing the primary symptoms at the end of treatment. However, at 8- to 12-month follow-up there were no significant differences between the 2 treatments. The results suggest that cognitive-behavioral therapy should continue to be the psychotherapy of choice for the treatment of bulimia nervosa because of its rapid action.
Sanfilipo et al (SEE ARTICLE) examined cerebral gray and white matter regional volumes in a large sample of schizophrenic patients and normal controls. In general, schizophrenic patients had widespread reductions in gray but not white matter in the prefrontal and temporal lobe regions. However, schizophrenic patients with more negative symptoms had decrements in prefrontal white matter. These results suggest that gray matter deficits may be a common structural abnormality of schizophrenia, whereas reductions in prefrontal white matter may be associated with negative symptoms.
Long-term outcomes are often poor in bipolar disorder despite treatment. Bowden et al (SEE ARTICLE) studied the effectiveness of divalproex and lithium compared with placebo in 1-year, randomized, double-blind treatment. Divalproex aided in avoiding the need for early termination for a new mood episode of mania or depression, relative to placebo. Time to development of a new mood episode did not differ significantly between either drug and placebo. Enrollment of mildly ill patients may have contributed to better than anticipated outcomes with placebo.
A commentary by Baldessarini, Tohen, and Tondo is included. (SEE ARTICLE)
In a Danish population cohort study, Brennan et al (SEE ARTICLE) report that men hospitalized with a diagnosis of organic psychosis and men and women hospitalized with a diagnosis of schizophrenia were found to have higher rates of arrests for violence than never-hospitalized comparison groups. These relationships remained significant despite controls for demographic factors and secondary diagnoses of personality disorders and substance abuse.
The mechanism(s) by which antidepressants treat clinical depression remain elusive. Harvey et al (SEE ARTICLE) present the first evidence in humans that the antidepressant venlafaxine sequentially blocks first serotonin and then norepinephrine uptake pumps over its clinically relevant dosing range. They used setraline and maprotiline, respectively, as positive controls for as serotonin and norepinephrine selective reuptake inhibition. Their results provide a mechanistic explanation for the difference in the dose-response curves for venlafaxine vs serotonin selective reuptake inhibitors in terms of both antidepressant efficacy and side effects.
