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This paper reviews studies bearing on the validity of the bereavement exclusion for the diagnosis of major depression. It concludes that the exclusion is not supported by the best available data, and the authors propose revisions for Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. [ABSTRACT FROM AUTHOR]

There is neurobiologically based, theoretical support for the use of antipsychotic medications in the treatment of anxiety, and two firstgeneration neuroleptics are approved by the United States Food and Drug Administration for the treatment of nonpsychotic anxiety. However, neuroleptics are associated with a large side effect burden, which has limited their utility in the treatment of nonpsychotic disorders. Because of their somewhat improved safety profile, atypical antipsychotics are increasingly used for the treatment of nonpsychotic anxiety. The published literature describing the efficacy of atypical antipsychotics in randomized, controlled trials involving patients with anxiety disorders is briefly reviewed, and the safety of atypical antipsychotics in nonpsychotic disorders is discussed. There is moderately strong controlled evidence supporting the use of some atypical antipsychotics, either as adjunctive treatment or monotherapy, in the treatment of nonpsychotic anxiety; however, the side effect burden of some atypical antipsychotics probably outweighs their benefits for most patients with anxiety disorders. The evidence to date does not warrant the use of atypical antipsychotics as first-line monotherapy or as first- or secondline adjunctive therapy in the treatment of anxiety disorders. Rigorous, independently funded, longterm studies are needed to support the off-label use of atypical antipsychotics in the treatment of anxiety disorders. Nevertheless, some patients with highly refractory anxiety disorders may benefit from the judicious and carefully monitored use of adjunctive atypical antipsychotics. A careful risk-benefit assessment must be undertaken by the physician, on a case-by-case basis, with appropriate informed consent. [ABSTRACT FROM AUTHOR]

There is considerable controversy with respect to so-called Internet addiction and whether it ought to be reified as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The relationship between 'addiction' and various compulsive or impulsive behaviors is also a source of confusion. Some psychiatrists have argued that Internet addiction shows the features of excessive use, withdrawal phenomena, tolerance, and negative repercussions that characterize many substance use disorders; however, there are few physiological data bearing on these claims. It is not clear whether Internet addiction usually represents a manifestation of an underlying disorder, or is truly a discrete disease entity. The frequent appearance of Internet addiction in the context of numerous comorbid conditions raises complex questions of causality. In order to make nosological decisions regarding Internet addiction, we require a more general model of what counts as 'disease,' and as a specific disease. Based on a model emphasizing intrinsic suffering and incapacity, as well as data regarding course, prognosis, temporal stability, and response to treatment, it appears premature to consider Internet addiction as a discrete disease entity. However, growing research suggests that some individuals with Internet addiction are at significant risk and merit our professional care and treatment. Carefully controlled studies are required to settle these controversies. [ABSTRACT FROM AUTHOR]

Drug-induced depression has been the focus of intense scrutiny by the US Food and Drug Administration and has serious clinical and medicolegal implications. 'Gold standard' studies of drug-induced depression -- involving randomized, placebo-controlled design and direct assessment of depressive symptoms -- are lacking. Based on the available literature, our review suggests that only a few types of drugs are strongly linked with induction of depression. However, the potential for idiosyncratic reactions -- not necessarily detected in large-scale studies -- suggests that particular caution and careful monitoring are warranted with several types of drugs, including isotretinoin, rimonabant, and alpha interferons. [ABSTRACT FROM AUTHOR]

Presents a response by Dr. R. Pies to a letter to the editor about his article "Reclaiming Dionysus," published in a previous issue.