Psychopharmacology of depression in the next millennium

Over the last half of the 20th century, there have been a series of psychopharmacologic strategies for treatment of depression. As we approach the next century, new therapies in varying stages of American release are being developed. This review will focus on information available for the following proposed antidepressants: 1) reboxetine, a norepinephrine selective reuptake inhibitor; 2) milnacipran, a combined serotonin/norepinephrine reuptake inhibitor; 3) a new enantiomer of fluoxetine, a selective serotonin reuptake inhibitor; 4) duloxetine, another combined serotonin/norepinephrine reuptake inhibitor; 5) sunepitron, a combined 5-HT1A agonist and a2 antagonist; and 6) MK-869, a substance P inhibitor. Finally, other possible developing directions will be reviewed, including corticotropin-releasing factor.     

Neuroscience and psychopharmacology into the next millennium

The end of the millennium provides an opportunity to review some of the common practices that were present in psychopharmacology during the 20th century. The author focuses on two approaches that have dominated research and guided the clinical application of psychopharmacologic therapeutics: the unitary clinically-based and single-lesion perspectives. The author expands upon these older formulations of neuropsychiatric disease pathogenesis and describes how the approach to psychopharmacologic research and therapeutics has changed in light of advances in the basic neurosciences. Relevant recent advances in the basic neurosciences that shed light on the pathophysiology of neuropsychiatric disease states and that guide psychopharmacologic practices are described. The use of atypical antipsychotic agents to treat schizophrenia is given as one example of the clinical applications of the approach to psychopharmacology in the next century.     

How knowledge of regional brain dysfunction in depression will enable new somatic treatments in the next millennium

New knowledge about the specific brain regions involved in depression is rapidly evolving due to advances in functional neuroimaging techniques. Several new regionally specific somatic interventions build on this modern neuroanatomic information. These latest methods promise to revolutionize the understanding and treatment of depression. This article reviews the past and current use of these techniques, with an eye toward where they are heading in the next century.     

Meeting the challenges in the delivery of child and adolescent mental health services in the next millennium: The continuous quality improvement approach

Managed care and concerns about the effectiveness of services are major pressures on mental health services. An approach to dealing with the challenges of providing high-quality, cost-effective services is continuous quality improvement or CQI. This article describes four major themes that motivate the CQI approach. However, we also describe the major obstacles in using an approach originally designed for manufacturing for human services. The need to accurately measure both treatment processes and outcomes is emphasized.     

Mental lexicon research in the new millennium

This article presents an overview of current research on the mental lexicon, as it is represented by articles in the spring 2002 Special Issue of Brain and Language. We examine current findings in terms of language, task, and population effects associated with how words are presented and processed in the mind. We discuss how such mental representations may be linked to neurological instantiations and address the issue of ecological validity in the field. These discussions are organized in order to both provide an overview of the issues and to enable the reader to locate specific articles that bear on these issues. Finally, we present an organizational framework for the characterization of mental lexicon research within which challenges for advancement are isolated.     

Thoughts on the eve of the millennium

Spiritually hungry is how I would characterize our society in this last part of the twentieth century in the United States. Jung's statement that the world is hanging by a slender thread, and that only consciousness can save it, seems appropriate here.