From the Editor-in-Chief's Desk

This issue of the journal is notable for its many investigations of novel compounds and new pharmacotherapy approaches for unstudied populations.

Lin et al.'s study of the selective norepinephrine reuptake inhibitor edivoxetine in attention-deficit/hyperactivity disorder (ADHD) patients is encouraging for the large minority who respond poorly to stimulant medications. The authors' careful study suggests that edivoxetine is efficacious, uncovers side effects that should be the subject of monitoring—particularly blood pressure—and suggests new ways forward in understanding treatment response and developing new best practices for ADHD medication treatment.

Lin et al.'s approach is also notable for a design element shared with the next articles we will discuss, namely a positive control—OROS methylphenidate—that deepens the clinical picture. Atkinson et al. and Emslie et al. pursue parallel investigations of duloxetine in the pediatric major depressive disorder population, in 36-week trials of flexible- and fixed-dose regimens, respectively. The researchers chose to use fluoxetine in addition to placebo as a positive control, which in this case produced ambiguous results.

These studies benefited from size, design, and diversity of study subjects, but both were inconclusive as “neither the investigational drug nor the active control separated from placebo.” Still, these studies add to the literature on serotonin-norepinephrine reuptake inhibitors and illuminate hurdles to the conclusive success of ambitious study designs. For instance, as Emslie et al. write, “because of the need to blind multiple doses of two different drugs, all patients were required to take six capsules of study drug per day.” As the authors note, this simple fact is of no small importance when bringing pediatric patients into a clinical environment and expecting treatment adherence.

Finally, I would like to point out Park et al.'s contribution to the fast-developing field of treatment response in biological psychiatry. Data concerning stimulant and non-stimulant response in pediatric ADHD patients has been producing remarkable insights recently, and this research has been doing double duty. Not only does it reveal intricacies of general brain function and pathology; it also provides a model for sophisticated response research in other areas of psychopathology. Park et al. continue promising research into the glutamate system's role in ADHD and implicate a specific gene polymorphism that surely deserves further study.

I hope you find these articles as useful and forward-looking as I have.