December 2009

Iloperidone (Fanapt)
Iloperidone, an antipsychotic recently approved by the U.S. Food and Drug Administration (FDA), is comparable in efficacy to other second-generation agents.

Cholinesterase Inhibitors Cause Syncope
Cholinesterase inhibitors, such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon), which are used to treat Alzheimer's disease, may cause syncope.

In Brief
Cigarettes and Coffee May Elevate Risk of Suicidal Behavior in Patients with Bipolar Disorder; Depression and Anxiety Have Different Effects on Risk of Mortality

Antipsychotics Decrease Mortality
Treatment with antipsychotics increases life expectancy for patients with schizophrenia.

On to 2010!
Dr. Alan Gelenberg reviews biological interventions approved during the past year, including new antipsychotics and a device to deliver repeated transcranial magnetic stimulation (rTMS).

2009 Index

On to 2010!

December 2009

Hard as it is to believe, 2009 draws to a close. Over the past year, several biological interventions for psychiatric disorders received approval from the U.S. Food and Drug Administration: the antipsychotics iloperidone (Fanapt; see page 47, this issue) and asenapine (Saphris); the antidepressant milnacipran (Savella), which is labeled only for the treatment of the fibromyalgia syndrome (FMS); and a device to deliver repeated transcranial magnetic stimulation (rTMS). None is a "game changer." The two antipsychotics might extend treatment options for some patients who have responded insufficiently or cannot tolerate older medicines. Milnacipran is the fourth drug approved to treat FMS (BTP 2009;32:42) and might benefit some patients with this difficult condition. As we have written previously, it is unclear what role rTMS will play in the treatment of depression and where it fits in a treatment algorithm (BTP 2008;31:47). Discovering substantially new and better treatments for psychiatric disorders will require either great luck or a better understanding of the underlying neurobiology of mental disorders.

Last year at this time, I wrote of the crying need for health care reform in the United States. This past summer, we witnessed fear and confusion sown by people invested in our status quo non-system of care. We eagerly await true reform toward universal coverage and more rational and integrated care. Patients with psychiatric disorders are at a particular disadvantage in the current hodge-podge.

For me, 2009 has been another splendid year in the lovely community of Madison, Wisconsin. I thank my outstanding partners at Healthcare Technology Systems—James W. Jefferson, MD, John Greist, MD, and David Katzelnick, MD. They welcomed me into their midst and contribute regularly to the richness of BTP. I enjoy and appreciate the excellent Department of Psychiatry at the University of Wisconsin, where I have a faculty appointment.

My special thanks again to the wonderful BTP family: Heather Hopkins, Amy Boynton, Melissa Manas, and Susanne Austin. BTP would be impossible without them, and I value their contributions and camaraderie immensely. Thanks also to the staff at West Press, always professional and dedicated. Finally, I express my deep gratitude and love to my wife and children for their ongoing support.

I wish all of you and your families the best of holidays and a joyful and productive 2010. Undoubtedly there will be challenges ahead, but as dedicated professionals, you know how to keep your eyes and minds on the mission of patient care. You are needed, valued, and appreciated every day.