A year ago-- 4/4/07-- the NEJM published a study that said\ antidepressants did not provide additional benefit to mood stabilizers.  But my tin foil hat allowed me to see that the authors were abandoning antiepileptics and antidepressants; the future was in bipolar, and in antipsychotics.    We are now for monotherapy, and it is branded. 

I wrote about it then, received slightly more than the usual hate mail ("are you a psychiatrist or a scientologist?") had a drink and went to bed.  What else am I going to do?

Time passed.  Seroquel got an indication for bipolar depression; Abilify for adjunctive use in depression.  SSRIs are history, Cymbalta a last holdout due to an extra indication.  And I haven't seen a Depakote rep since, well, since a year ago.

If you're new to the game, it will be hard for you to believe that in 2001 Depakote was everywhere.  If you dared to start a "bipolar" on anything other than an antiepileptic, you were actually reprimanded by other doctors.  "What the hell is this nut doing over there?"    Back then if you said you were going to use Seroquel for... anything, they caned you. 

Now it's the top selling psych drug.

I briefly toyed with asking Calabrese, Bowden, Sachs, et al-- the Mafia of Psychopharm-- for a formal apology; or at least an admission that they were wrong, but now I see that that's impossible: not because they are hiding it, but because they actually believe they never said it.  They think they were always pro-antipsychotic monotherapy; that they never intended Depakote to be first line; that they never implied there was considerable evidence that Depakote should be a maintenance agent, when in fact there was none.  They don't realize how much a pawn in the academic-Pharma  game they are.

I fought a solitary battle against this thinking back then, and I'll say it was with some not inconsequential professional repercussions. 

Whatever; my point isn't to say I was right, but to show that they were wrong--and now pretend they never said it.  So that the next thing they say can be met with at least a little skepticism.

It's like Iraq-- first it was WMD, everywhere, all the time; now they don't talk about WMD, but worse, they pretend that they never really meant WMD.    

Difference is no one trusts Cheney anymore; but somehow, we still ask the Mafia of Psychopharm to lead us. 

I'd trust Cheney over any of them, any day.