I emerge from the session and run into an acquaintance from New Jersey. I unwind with him over a burger in a sports bar. I'm back at my hotel by seven. I force myself to stay awake till 8:30. I'm asleep before my head hits the pillow.
Wednesday (again) - I arrive for a morning session on PTSD only to realize there is a session on treatment guidelines going on at the same time.
The APA's Depression Treatment Guidelines dates from 1999 and the Bipolar Guidelines from 2002. Revised Guidelines for both are in their second draft. A third draft is in the works, and both final versions are expected to be published in Spring, next year.
Robert Hirschfeld MD of the University of Texas, Galveston chairs the Bipolar Guidelines expert panel. He reveals that the trial evidence does not justify recommending Lamictal as a first choice for treating acute (initial) phase bipolar depression. The med has failed four trials in this phase of treatment, with only one finding that can be interpreted as a success.
On the other hand, Lamictal faired well in at least one long-term study.
Seroquel, on the other hand, has come up trumps in a number of short-term trials, and is a no-brainer for initial treatment. But side effects may make the med problematic for the long term.
There is also strong evidence for cognitive behavioral therapy and other short-term talking therapies with meds.
At an afternoon session, a four-or-five person panel is discussing the pros and cons of the 10-minutes meds check. I catch the first speaker, Charles Nemeroff MD, PhD of Emory University, who is very much opposed to this aspect of mangled care.
Time to head out. A Washington DC friend, Karen, picks me up at my hotel at four, and we visit the FDR Memorial. Karen senses that I have been indoors in dark rooms for way longer than is good for me. The fresh air and outdoor light come as a welcome tonic, not to mention the inspiration from being in the presence of a giant among me.
Karen's husband Alan joins us in a downtown pub, and later we check out the memorial of my other favorite President, Lincoln.
Then it's AMTRAK to Connecticut first thing in the morning.
More later ...
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