This issue has a general theme: the use of "antipsychotic" agents in mood conditions. In the extensive special article on dopamine blockers (our preferred term for these agents, as described there) we try to walk readers through the scientific evidence as well as how and why to think outside of the boxes set by the pharmaceutical industry and the Food and Drug Administration (FDA). This is not to say that FDA indications don't matter. But clinicians need to know the science, first and foremost, and view all other factors, including government regulations and biological mechanisms, as secondary. The case of antipsychotics in bipolar depression is an excellent case example of the PL approach to psychiatry. Good clinical practice isn't as simple as just following FDA indications. We need to look at the scientific literature ourselves, and draw our own conclusions. That's what PL is here to help you to do.
The treatment of bipolar depression with agents that aren’t standard “antidepressants” requires attention to the meaning of depression. In this issue, we discuss the concept of “mixed depression”, or depression with psychomotor excitation and sometimes frank manic symptoms. This kind of depression doesn't seem to improve, and may worsen, with antidepressants, while it improves with antipsychotics and mood stabilizers. Understanding mixed states of depression is key to knowing when to use antidepressants versus antipsychotics; and it’s not all about whether bipolar illness is present or not.
If you are one of our inaugural subscribers, thank you for continuing this journey with us into a new psychiatry of the future. If you are newly joining us, we hope you find ideas that open new ways of thinking and practice for you.
Nassir Ghaemi MD, Editor
New truths begin as heresies and end as superstitions - T. H. Huxley