“Cases That Test Your Skills: Is it anxiety, depression, or bipolar disorder?” (Current Psychiatry, August 2006) succinctly captures a common problem found in clinical practice. The authors’ methodical and meticulous teasing out of the differential diagnosis was based on clinical findings rather than a hunch. Various tables and the authors’ method to clarify the diagnosis and treat the patient effectively were helpful.
I am curious why the authors did not consider whether clonazepam or other benzodiazepines—with or without buspirone—would have resolved the patient’s anxiety faster than buspirone alone. According to the article, clonazepam had not been tried during the patient’s previous treatments and she did not have a history of substance abuse.
Vasudev N. Makhija, MD
Linden, NJ
Dr. Singh responds
Besides my preference to use nonbenzodiazepine drugs as a first-line treatment for anxiety disorders, medications like clonazepam1,2 act as antianxiety and mood stabilizing agents. If the patient had responded to clonazepam, it would not have been clear whether bipolar disorder or anxiety disorder was the correct diagnosis. We decided to use buspirone because it is an antianxiety agent that does not affect mood.
Tanvir Singh, MD
Assistant professor of psychiatry
University of Toledo, Health Science Campus
Toledo, OH