Esther French

Out of sight, out of mind: If patients don't observe disease symptoms, they may think continuing treatment is unnecessary. Dr. Ethan A. Halm explains how physicians can understand and correct erroneous patient perceptions about chronic disease.

Out of sight, out of mind: If patients don't observe disease symptoms, they may think continuing treatment is unnecessary. Dr. Ethan A. Halm explains how physicians can understand and correct erroneous patient perceptions about chronic disease.

Out of sight, out of mind: If patients don't observe disease symptoms, they may think continuing treatment is unnecessary. Dr. Ethan A. Halm explains how physicians can understand and correct erroneous patient perceptions about chronic disease.

Women who have lost a baby in a miscarriage or stillbirth can experience persistent depression during a later pregnancy that continues even after the birth of a healthy baby.

In a study of 13,133 women who gave birth in the early 1990s in southwest England and 21% had experienced miscarriages or stillbirths, "previous prenatal loss showed a persisting prediction of depressive and anxiety symptoms well after what would conventionally be defined as the postnatal period," reported Emma Robertson Blackmore, Ph.D., of the University of Rochester Medical Center, New York, and her associates (Br. J. Psychiatry 2011 March 7 [doi:10.1192/bjp.bp.110.083105]).

The study builds on previous findings about increased anxiety and depression in pregnant women who had previously lost a baby in a miscarriage or stillbirth "by showing that the impact persists well past the subsequent pregnancy and despite the birth of a healthy child."

Because depression is very treatable, Dr. Blackmore emphasized in an interview the need for a heightened focus on identifying women with a previous prenatal loss and routinely screening them for depression.

The study, which drew its large sample from the Avon Longitudinal Study of Parents and Children (ALSPAC), measured data from six assessments, two prenatal (at 18 and 32 weeks) and four post partum (at 8 weeks and 8, 21, and 33 months). In the first assessment, the women self-reported any previous miscarriages and stillbirths. At each assessment stage, the women self-reported maternal anxiety using the Crown–Crisp Experiential Index (CCEI) and depression using the Edinburgh Postnatal Depression Scale (EPDS).

Covariates included "maternal age at initial interview, currently living with husband or partner, number of living children, education level, ethnicity, and use of tobacco and alcohol during the first 3 months of pregnancy," previous depressive episodes, birth weight and gestational age, and a household crowding index.

The investigators combined stillbirths and miscarriages after finding no significant difference in results.

They separated the number of "previous elective terminations" because they did not have data on the reason for each termination, Dr. Blackmore said.

Dr. Blackmore, who is in the department of psychiatry, said that she has done extensive work in postpartum depression, but she "was actually quite surprised by the findings" because it never crossed her mind before to ask women about previous loss. She had focused instead on factors such as any history of depression. "People are certainly uncomfortable talking about pregnancy loss," she said.

She explained how women who had a previous loss can "get incredibly anxious leading up to the gestational point" during which they lost the baby, which is when an ob.gyn. can step in and alleviate anxiety about physical symptoms.

The investigators did not report any relevant financial disclosures. The U.K. Medical Research Council, the Wellcome Trust, and the University of Bristol currently provide core support for ALSPAC. This particular study received funding from the National Institutes of Health.

Women who have lost a baby in a miscarriage or stillbirth can experience persistent depression during a later pregnancy that continues even after the birth of a healthy baby.

In a study of 13,133 women who gave birth in the early 1990s in southwest England and 21% had experienced miscarriages or stillbirths, "previous prenatal loss showed a persisting prediction of depressive and anxiety symptoms well after what would conventionally be defined as the postnatal period," reported Emma Robertson Blackmore, Ph.D., of the University of Rochester Medical Center, New York, and her associates (Br. J. Psychiatry 2011 March 7 [doi:10.1192/bjp.bp.110.083105]).

The study builds on previous findings about increased anxiety and depression in pregnant women who had previously lost a baby in a miscarriage or stillbirth "by showing that the impact persists well past the subsequent pregnancy and despite the birth of a healthy child."

Because depression is very treatable, Dr. Blackmore emphasized in an interview the need for a heightened focus on identifying women with a previous prenatal loss and routinely screening them for depression.

The study, which drew its large sample from the Avon Longitudinal Study of Parents and Children (ALSPAC), measured data from six assessments, two prenatal (at 18 and 32 weeks) and four post partum (at 8 weeks and 8, 21, and 33 months). In the first assessment, the women self-reported any previous miscarriages and stillbirths. At each assessment stage, the women self-reported maternal anxiety using the Crown–Crisp Experiential Index (CCEI) and depression using the Edinburgh Postnatal Depression Scale (EPDS).

Covariates included "maternal age at initial interview, currently living with husband or partner, number of living children, education level, ethnicity, and use of tobacco and alcohol during the first 3 months of pregnancy," previous depressive episodes, birth weight and gestational age, and a household crowding index.

The investigators combined stillbirths and miscarriages after finding no significant difference in results.

They separated the number of "previous elective terminations" because they did not have data on the reason for each termination, Dr. Blackmore said.

Dr. Blackmore, who is in the department of psychiatry, said that she has done extensive work in postpartum depression, but she "was actually quite surprised by the findings" because it never crossed her mind before to ask women about previous loss. She had focused instead on factors such as any history of depression. "People are certainly uncomfortable talking about pregnancy loss," she said.

She explained how women who had a previous loss can "get incredibly anxious leading up to the gestational point" during which they lost the baby, which is when an ob.gyn. can step in and alleviate anxiety about physical symptoms.

The investigators did not report any relevant financial disclosures. The U.K. Medical Research Council, the Wellcome Trust, and the University of Bristol currently provide core support for ALSPAC. This particular study received funding from the National Institutes of Health.

Women who have lost a baby in a miscarriage or stillbirth can experience persistent depression during a later pregnancy that continues even after the birth of a healthy baby.

In a study of 13,133 women who gave birth in the early 1990s in southwest England and 21% had experienced miscarriages or stillbirths, "previous prenatal loss showed a persisting prediction of depressive and anxiety symptoms well after what would conventionally be defined as the postnatal period," reported Emma Robertson Blackmore, Ph.D., of the University of Rochester Medical Center, New York, and her associates (Br. J. Psychiatry 2011 March 7 [doi:10.1192/bjp.bp.110.083105]).

The study builds on previous findings about increased anxiety and depression in pregnant women who had previously lost a baby in a miscarriage or stillbirth "by showing that the impact persists well past the subsequent pregnancy and despite the birth of a healthy child."

Because depression is very treatable, Dr. Blackmore emphasized in an interview the need for a heightened focus on identifying women with a previous prenatal loss and routinely screening them for depression.

The study, which drew its large sample from the Avon Longitudinal Study of Parents and Children (ALSPAC), measured data from six assessments, two prenatal (at 18 and 32 weeks) and four post partum (at 8 weeks and 8, 21, and 33 months). In the first assessment, the women self-reported any previous miscarriages and stillbirths. At each assessment stage, the women self-reported maternal anxiety using the Crown–Crisp Experiential Index (CCEI) and depression using the Edinburgh Postnatal Depression Scale (EPDS).

Covariates included "maternal age at initial interview, currently living with husband or partner, number of living children, education level, ethnicity, and use of tobacco and alcohol during the first 3 months of pregnancy," previous depressive episodes, birth weight and gestational age, and a household crowding index.

The investigators combined stillbirths and miscarriages after finding no significant difference in results.

They separated the number of "previous elective terminations" because they did not have data on the reason for each termination, Dr. Blackmore said.

Dr. Blackmore, who is in the department of psychiatry, said that she has done extensive work in postpartum depression, but she "was actually quite surprised by the findings" because it never crossed her mind before to ask women about previous loss. She had focused instead on factors such as any history of depression. "People are certainly uncomfortable talking about pregnancy loss," she said.

She explained how women who had a previous loss can "get incredibly anxious leading up to the gestational point" during which they lost the baby, which is when an ob.gyn. can step in and alleviate anxiety about physical symptoms.

The investigators did not report any relevant financial disclosures. The U.K. Medical Research Council, the Wellcome Trust, and the University of Bristol currently provide core support for ALSPAC. This particular study received funding from the National Institutes of Health.

Communicate to parents that their goal is to alleviate a child’s discomfort and monitor for signs of serious illness rather than simply lowering their child’s temperature, an American Academy of Pediatrics report published in the March issue of Pediatrics advised.

Although fever is normal and often beneficial to the immune system, "fever phobia" remains prevalent, and pediatricians must redirect overblown parental concerns about their child’s fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children’s Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but "our focus on gathering that information gives the message to parents that fever is bad," Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103°F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be "to improve the child’s overall comfort," not to lower temperature, and the report cited the lack of evidence that "reducing fever reduces morbidity or mortality from a febrile illness."

Although alternating or combining antipyretics is common, "questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point," according to the report.

"If we’re treating discomfort, one agent should be adequate," Dr. Sullivan said.

The report urged pediatricians to "advocate for a limited number of formulations of acetaminophen and ibuprofen." Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Communicate to parents that their goal is to alleviate a child’s discomfort and monitor for signs of serious illness rather than simply lowering their child’s temperature, an American Academy of Pediatrics report published in the March issue of Pediatrics advised.

Although fever is normal and often beneficial to the immune system, "fever phobia" remains prevalent, and pediatricians must redirect overblown parental concerns about their child’s fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children’s Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but "our focus on gathering that information gives the message to parents that fever is bad," Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103°F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be "to improve the child’s overall comfort," not to lower temperature, and the report cited the lack of evidence that "reducing fever reduces morbidity or mortality from a febrile illness."

Although alternating or combining antipyretics is common, "questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point," according to the report.

"If we’re treating discomfort, one agent should be adequate," Dr. Sullivan said.

The report urged pediatricians to "advocate for a limited number of formulations of acetaminophen and ibuprofen." Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Communicate to parents that their goal is to alleviate a child’s discomfort and monitor for signs of serious illness rather than simply lowering their child’s temperature, an American Academy of Pediatrics report published in the March issue of Pediatrics advised.

Although fever is normal and often beneficial to the immune system, "fever phobia" remains prevalent, and pediatricians must redirect overblown parental concerns about their child’s fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children’s Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but "our focus on gathering that information gives the message to parents that fever is bad," Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103°F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be "to improve the child’s overall comfort," not to lower temperature, and the report cited the lack of evidence that "reducing fever reduces morbidity or mortality from a febrile illness."

Although alternating or combining antipyretics is common, "questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point," according to the report.

"If we’re treating discomfort, one agent should be adequate," Dr. Sullivan said.

The report urged pediatricians to "advocate for a limited number of formulations of acetaminophen and ibuprofen." Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Communicate to parents that their goal is to alleviate a child’s discomfort and monitor for signs of serious illness rather than simply lowering their child’s temperature, an American Academy of Pediatrics report published in the March issue of Pediatrics advised.

Although fever is normal and often beneficial to the immune system, "fever phobia" remains prevalent, and pediatricians must redirect overblown parental concerns about their child’s fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children’s Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but "our focus on gathering that information gives the message to parents that fever is bad," Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103°F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be "to improve the child’s overall comfort," not to lower temperature, and the report cited the lack of evidence that "reducing fever reduces morbidity or mortality from a febrile illness."

Although alternating or combining antipyretics is common, "questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point," according to the report.

"If we’re treating discomfort, one agent should be adequate," Dr. Sullivan said.

The report urged pediatricians to "advocate for a limited number of formulations of acetaminophen and ibuprofen." Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Communicate to parents that their goal is to alleviate a child’s discomfort and monitor for signs of serious illness rather than simply lowering their child’s temperature, an American Academy of Pediatrics report published in the March issue of Pediatrics advised.

Although fever is normal and often beneficial to the immune system, "fever phobia" remains prevalent, and pediatricians must redirect overblown parental concerns about their child’s fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children’s Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but "our focus on gathering that information gives the message to parents that fever is bad," Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103°F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be "to improve the child’s overall comfort," not to lower temperature, and the report cited the lack of evidence that "reducing fever reduces morbidity or mortality from a febrile illness."

Although alternating or combining antipyretics is common, "questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point," according to the report.

"If we’re treating discomfort, one agent should be adequate," Dr. Sullivan said.

The report urged pediatricians to "advocate for a limited number of formulations of acetaminophen and ibuprofen." Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Communicate to parents that their goal is to alleviate a child’s discomfort and monitor for signs of serious illness rather than simply lowering their child’s temperature, an American Academy of Pediatrics report published in the March issue of Pediatrics advised.

Although fever is normal and often beneficial to the immune system, "fever phobia" remains prevalent, and pediatricians must redirect overblown parental concerns about their child’s fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children’s Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but "our focus on gathering that information gives the message to parents that fever is bad," Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103°F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be "to improve the child’s overall comfort," not to lower temperature, and the report cited the lack of evidence that "reducing fever reduces morbidity or mortality from a febrile illness."

Although alternating or combining antipyretics is common, "questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point," according to the report.

"If we’re treating discomfort, one agent should be adequate," Dr. Sullivan said.

The report urged pediatricians to "advocate for a limited number of formulations of acetaminophen and ibuprofen." Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Combining L-methylfolate with an SSRI or an SNRI proved more effective than monotherapy at treatment initiation in a study of 242 patients with major depressive disorder published in Innovations in Clinical Neuroscience.

When they added 7.5 mg or 15 mg of L-methylfolate to another antidepressant, Dr. Lawrence D. Ginsberg and his associates reported improvement in patients’ symptoms and a reduction in Clinical Global Impression-Severity (CGI-S) scores, in which 1 is "normal" and 7 is "extremely ill."

In the group of 95 patients on combination treatment, 18.5% saw at least a two-point reduction in CGI-S scores during a 60-day period. In contrast, only 7% saw the same reduction in the group of 147 patients on monotherapy of either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), reported Dr. Ginsberg, a Houston psychiatrist who is in private practice.

Patients on the L-methylfolate combo also improved more rapidly. Their median time to achieve at least a two-point reduction on the CGI-S scale was 177 days, compared with 231 days for those on the monotherapy group. The team did not find any side effects from the addition of L-methylfolate (Innov. Clin. Neurosci. 2011;8:19-28).

The patients were aged 18-70 years, and each one began with a CGI-S score of 4-5. Although the results built upon those of previous investigations on the effective use of folate when treating major depressive episodes, this single-site study limited itself to retrospective chart analysis. The team did not measure patients’ baseline folate levels.

In an interview, Dr. Ginsberg explained his reasoning in deciding who got the monotherapy and who received the L-methylfolate-antidepressant combination. "If I felt it was in the best interests of an individual patient, then I prescribed L-methylfolate," he said.

The use of L-methylfolate is part of a "paradigm shift" over the last 5 years toward initial combination therapy, said Dr. Stephen M. Stahl, adjunct psychiatry professor at the University of California, San Diego. He added, however, that psychiatrists have tried multiple therapies at treatment initiation for almost a decade now.

Dr. Stahl, whose work is cited in Dr. Ginsberg’s study, said that whereas the classical approach is to try adjunctive therapy after monotherapy fails, the norm in cancer and HIV/AIDS treatment is to begin with three or four drugs. "Depression is moving in that direction," he said in an interview. Dr. Stahl, who is also chairman of the Neuroscience Education Institute, expressed doubts about the Ginsberg study design. "This is more of an interesting hypothesis-generating study than a hypothesis-confirming study," he said. Because the study was neither randomized nor controlled, he said it was "not a completely objective comparison" of the test group and the control group.

Dr. Ginsberg’s study is by no means isolated. Dr. Maurizio Fava, psychiatry professor at Harvard Medical School, Boston, presented a similar study in a poster at the American College of Neuropsychopharmacology’s annual meeting in December, but these results have not yet been published in a peer-reviewed journal.

Dr. Stahl considers Dr. Fava’s results to be more convincing because of that study’s randomized controlled design. "Taken in the context of the Fava study, the Ginsberg study is more interesting," he said.

However, Dr. Stahl acknowledged that such a comparison is difficult because, although Dr. Fava tested the effectiveness of adding L-methylfolate to treatment with SSRIs, his study does not focus on treatment initiation.

The Ginsberg study received funding from Pamlab, which manufactures the medical food L-methylfolate under the brand name Deplin. Dr. Ginsberg also reported his work as a speaker for Pamlab and as a consultant for various other pharmaceutical companies. Dr. Stahl disclosed that he has done consulting for Pamlab. Dr. Fava also has consulted for and received funding from Pamlab.

Communicate to parents that their goal is to alleviate a child's discomfort and monitor for signs of serious illness rather than simply lowering their child's temperature, an American Academy of Pediatrics report.

Although fever is normal and often beneficial to the immune system, “fever phobia” remains prevalent, and pediatricians must redirect overblown parental concerns about their child's fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children's Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but “our focus on gathering that information gives the message to parents that fever is bad,” Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103° F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be “to improve the child's overall comfort,” not to lower temperature, and the report cited the lack of evidence that “reducing fever reduces morbidity or mortality from a febrile illness.” Although alternating or combining antipyretics is common, “questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point,” according to the report.

“If we're treating discomfort, one agent should be adequate,” Dr. Sullivan said.

The report urged pediatricians to “advocate for a limited number of formulations of acetaminophen and ibuprofen.” Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Communicate to parents that their goal is to alleviate a child's discomfort and monitor for signs of serious illness rather than simply lowering their child's temperature, an American Academy of Pediatrics report.

Although fever is normal and often beneficial to the immune system, “fever phobia” remains prevalent, and pediatricians must redirect overblown parental concerns about their child's fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children's Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but “our focus on gathering that information gives the message to parents that fever is bad,” Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103° F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be “to improve the child's overall comfort,” not to lower temperature, and the report cited the lack of evidence that “reducing fever reduces morbidity or mortality from a febrile illness.” Although alternating or combining antipyretics is common, “questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point,” according to the report.

“If we're treating discomfort, one agent should be adequate,” Dr. Sullivan said.

The report urged pediatricians to “advocate for a limited number of formulations of acetaminophen and ibuprofen.” Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

Communicate to parents that their goal is to alleviate a child's discomfort and monitor for signs of serious illness rather than simply lowering their child's temperature, an American Academy of Pediatrics report.

Although fever is normal and often beneficial to the immune system, “fever phobia” remains prevalent, and pediatricians must redirect overblown parental concerns about their child's fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children's Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).

Fever is a sign of illness, but “our focus on gathering that information gives the message to parents that fever is bad,” Dr. Sullivan said in an interview.

If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103° F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.

Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be “to improve the child's overall comfort,” not to lower temperature, and the report cited the lack of evidence that “reducing fever reduces morbidity or mortality from a febrile illness.” Although alternating or combining antipyretics is common, “questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point,” according to the report.

“If we're treating discomfort, one agent should be adequate,” Dr. Sullivan said.

The report urged pediatricians to “advocate for a limited number of formulations of acetaminophen and ibuprofen.” Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.

Dr. Sullivan reported no relevant financial disclosures.

A panel of experts at the annual meeting of American Association for the Advancement of Science discussed the potential of deep brain stimulation for treatment of certain psychiatric disorders such as obsessive compulsive disorder and depression. 

A panel of experts at the annual meeting of American Association for the Advancement of Science discussed the potential of deep brain stimulation for treatment of certain psychiatric disorders such as obsessive compulsive disorder and depression. 

A panel of experts at the annual meeting of American Association for the Advancement of Science discussed the potential of deep brain stimulation for treatment of certain psychiatric disorders such as obsessive compulsive disorder and depression. 

A panel of experts at the annual meeting of American Association for the Advancement of Science discussed the potential of deep brain stimulation for treatment of certain psychiatric disorders such as obsessive compulsive disorder and depression. 

A panel of experts at the annual meeting of American Association for the Advancement of Science discussed the potential of deep brain stimulation for treatment of certain psychiatric disorders such as obsessive compulsive disorder and depression. 

A panel of experts at the annual meeting of American Association for the Advancement of Science discussed the potential of deep brain stimulation for treatment of certain psychiatric disorders such as obsessive compulsive disorder and depression.