Session to Present High-Impact Psychopharmacology Studies

Four published studies from the American Journal of Psychiatry (AJP) that will have a significant impact on clinical practice will be presented at the symposium “Psychopharmacological Treatment of Depression and Anxiety” at this year’s annual meeting in New York.

The symposium will take place Monday, May 5, in Room 1E13 on Level 1 of the Javits Convention Center from 9 a.m. to noon.

AJP Editor-in-Chief Robert Freedman, M.D., who will chair the symposium, said the event has become a regular feature of the annual meeting designed to showcase research published in the journal that has a high impact on real-world psychiatric clinical practice. “We try to publish papers in AJP that inform our readers about issues for which new research data are likely to improve an aspect of their practice,” Freedman told Psychiatric News. “The goal of the symposium is to allow members to hear directly from the authors of four published papers that have had that kind of impact.”

This year’s papers are focused on psychopharmacology.

The four papers are “Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial” (October 1, 2013); “Evaluation of the FDA Warning Against Prescribing Citalopram at Doses Exceeding 40 mg” (June 1, 2013); “The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders” (November 1, 2013); and “A Double-Blind Randomized Controlled Trial of Augmentation and Switch Strategies for Refractory Social Anxiety Disorder” (January 1, 2014).

Sanjay Matthew, M.D., of Baylor College of Medicine, will present the paper on antidepressant efficacy of ketamine in depression. The glutamate N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has shown rapid antidepressant effects, but small sample sizes and inadequate control conditions in prior studies have precluded a definitive conclusion. Matthew and colleagues conducted a randomized, controlled trial in which patients with treatment-resistant major depression experiencing a major depressive episode were randomized to receive a single intravenous infusion of ketamine or midazolam in a 2:1 ratio. The ketamine group had greater improvement on the Montgomery-Asberg Depression Rating Scale score 24 hours after treatment compared with the midazolam group, and treatment with ketamine increased the likelihood of response at 24 hours compared with midazolam.

Eduard Vieta, M.D., Ph.D., of the University of Barcelona, will present the paper on the ISBD task force report. The task force integrated the evidence and experience of the task force members and developed a consensus on 12 statements about the use of antidepressants in bipolar disorder. Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants.

Mark Pollack, M.D., of Rush University Medical Center, will present findings on augmentation treatment of refractory social anxiety. Despite the availability of evidence-based treatments for anxiety disorders, many patients remain symptomatic after initial intervention. Pollack will review results from the first randomized, controlled trial to provide systematic, prospectively derived data on the relative benefits of “next-step” pharmacotherapies to improve outcome for individuals with generalized social anxiety disorder who remain symptomatic after initial treatment.

Kara Zivin, Ph.D., of the University of Michigan and the Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor will present new findings on the use of high-dose citalopram for depression. A recent FDA warning cautioned that citalopram dosages greater than 40 mg may cause abnormal heart rhythms including torsades de pointes. Zivin and colleagues conducted a cohort study using Veterans Health Administration data from 2004 to 2009 to assess relationships between citalopram use and ventricular arrhythmias and mortality in depressed patients prescribed citalopram or sertraline. The study found no increased risks of ventricular arrhythmia or mortality associated with citalopram dosages above 40 mg, raising questions regarding the continued merit of the FDA warning.

Freedman told Psychiatric News that the FDA ruling regarding high-dose citalopram has been highly controversial. “Many clinicians have found in their practice that higher doses are sometimes required,” he said. “So now there are two different datasets—Dr. Zivin’s report and the FDA’s—regarding the safety of high-dose citalopram. Dr. Zivin will present both sides of the controversy so that clinicians can decide for themselves when and under what circumstances to use this treatment strategy.” ■