From the Editor-in-Chief's Desk

The articles within contain valuable new insights that promise to change clinical practice for the better, smart investigations of treatment monitoring and effectiveness, and further results of the landmark Treatment of Severe Childhood Aggression (TOSCA) study.

The work of Gabbay et al. begins to confirm our clinical understanding of adolescent depression as a highly variable disorder that benefits from a dimensional approach. Specifically, the authors found that while both irritability and anhedonia are variable and manifest differently across depressed adolescents, it is only anhedonia that is tied to “overall illness severity, suicidality, and illness duration” in major depressive disorder.

While we wait for these conclusions to be tested and results replicated, I do not believe it is hasty to imagine how the field might change given this new information. As Gabbay et al. note, wisely, “irritability is highly prevalent in many pediatric and adult psychiatric disorders;” the prospect of identifying a more specific core symptom to aid identification and treatment is more than exciting. What's more, as the authors point out, their results “provide further support to the inclusion of dimensional analyses in psychiatric research.”

Gabbay et al.'s ultimate conclusion is sober but incredibly valuable: “Our findings suggest the significance of anhedonia, but not irritability, as a hallmark of adolescent depression. This further emphasizes the importance of closely monitoring highly anhedonic depressed adolescents.”

Elsewhere, we are pleased to publish three articles investigating the valuable data that has come out of the TOSCA study. Rundberg-Rivera et al. provide information on parent satisfaction with study regimen as well as methods of collection; Arnold et al. discuss comorbid anxiety in the study population; and Farmer et al. write on predicting response using patient characteristics. I encourage you to read these articles, as well as the introduction from Dr. Michael Aman.

Relatedly, I would like to point readers to Whitney et al.'s thorough meta-analysis of the appropriateness of therapeutic drug monitoring in children receiving atypical or second generation antipsychotic (SGA) treatments that are often prescribed off label and have not been tested in this population. Unsurprisingly, they report, the literature is not robust—but it is precisely this sort of investigation that may spur us to a better understanding of our often indispensable treatments for ill children. Whitney et al. also provide a sober but valuable conclusion: “Further research is required for establishing a sounder safety profile for SGA use in the pediatric population.”