LETTERS TO THE EDITOR Clinical Experience vs. Scientific Studies To the Editor: In regard to Biederman's comments on the cardiac effects of tricyclics (Biederman, 1991), I have treated well over 2,000 children with tricyclics, with doses seldom as high as 2 mg/kg and never above 3 mg/kg. By usual assays, the serum levels were usually not measurable. There has not been a single case of cardiac symptoms. These drugs often produce dramatic benefits, but we cannot predict which antidepressant a patient will respond to. These drugs are definitely not interchangeable. Their benefits are evident within an hour. If one antidepressant doesn't work, try another. The effective dose is usually one-third or less of the antidepression dosage.
psychiatry in your July 1991 issue. It is indeed disappointing that there is still relatively little contact between European and North American researchers and clinicians in our field. Despite widespread advertisement, American attendance at the Ninth Congress of the European Society for Child and Adolescent Psychiatry held in London in September 1991 was very low. Many Americans remain unfamiliar with the significant work going on in many different parts of Europe, not just in neuropsychiatry but, for example, in longitudinal studies, child protection, and nonorganic failure-to-thrive. I hope that many American child psychiatrists will read and contribute to a recently launched journal, European Child and Adolescent Psychiatry, and eventually find it as valuable as I find your own excellent journal. Philip Graham Hospital for Sick Children London
Hans R. Huessy, M.D. Professor Emeritus The University of Vermont
Down with Insensitive Editors!
REFERENCE
Biederman, J. (1991), Sudden death in children treated with a tricyclic antidepressant. J. Am. Acad. Child Adolesc. Psychiatry, 30:495498.
Dr. Biederman replies: I am encouraged to hear about the safety record of the wide use of tricyclic antidepressants (TCAs) in children by a single clinician. This is in keeping with our own safety record with thousands of patients. My experience regarding dosage is, however, discrepant with that of Dr. Huessy. Although low doses of TCAs may be initially effective to maintain a clinical response over time, higher doses than those suggested by the writer have been consistently necessary (Biederman et al., 1986, 1989a, b; Gastfriend et al., 1984). It will be very informative to the field for the writer to present his rich clinical experience in the scientific literature so that we may be able to evaluate the nature of these apparent discrepant clinical experiences. Joseph Biederman, M.D. Massachusetts General Hospital REFERENCES
Biederman, 1., Gastfriend, D. R., & Jellinek, M. S. (1986), Desipramine in the treatment of children with attention deficit disorder. J. Clin. Psychopharmacol., 6:359-363. - - Baldessarini, R., Wright, V., Knee, D. & Harmatz, J. (1989a), A double-blind placebo controlled study of desipramine in the treatment of attention deficit disorder: I. Efficacy. J. Am. Acad. Child Adolesc. Psychiatry, 28:777-784. - - - - - - - - - - Goldblatt, A. (1989b) A double-blind placebo controlled study of desipramine in the treatment of attention deficit disorder: II. Serum drug levels and cardiovascular findings. J. Am. Acad. Child Adolesc. Psychiatry, 28:903-911. Gastfriend, D. R., Biederman, J. & Jellinek, M. S. (1984), Desipramine in the treatment of adolescents with attention deficit disorder. Am. J. Psychiatry, 141:906-908.
European Child Psychiatry To the Editor: I was delighted to read Dr. Todd's account of his enjoyable attendance at a European child psychiatry meeting focused around neuro-
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To the Editor: We are very pleased to note the publication in your journal of several of our papers on the mental health of children and adolescents from the Dunedin longitudinal study. However, we wish to point out a consistent change that occurs from submitted manuscript to published version. This is the ruthless alteration of sentences commencing "We ..." as in "We decided to use ANOVA ..." and so on. This is sometimes replaced by the more impersonal "The authors decided . .." We would note that although some journals welcome the use of the active voice, others appear to be obsessed with its elimination. Our own belief is that the use of "we" or "I" in scientific articles fixes responsibility for what is said more firmly on the author. Although some may believe this is a trivial point, the use of the passive voice in the psychiatric literature is consistent with a writing style that promotes the idea of "acts without agents" (Lamb, 1991). This author has pointed out how linguistic style in the literature on violence toward women serves to reinforce a notion of acts arising in thin air, attributable to no one. The use of the passive voice reinforces a view of methodology without guiding agents. We see nothing wrong in promoting a more active view of researchers in the language of journals. Rob McGee Michael Feehan Sheila Williams University of Otago Dunedin, New Zealand REFERENCE
Lamb, S. (1991), Acts without agents: an analysis of linguistic avoidance in journal articles on men who batter women. Am. J. Orthopsychiatry, 61:250-258.
The Editor comments: The Journal pleads nolo contendere and will be guided by the wishes of its readers. The deciding factor should be readability rather than resolving any conflicts our valued authors (p. 50) may have over activity vs. passivity! Do you favor articles written in the first or third person? Or does it matter? Send replies to the Editor, JAACAP, or Fax to (808) 941-6707.
J. McD. J. Am. Acad. Child Adolesc. Psychiatry, 31: 1, January 1992
psychiatry in your July 1991 issue. It is indeed disappointing that there is still relatively little contact between European and North American researchers and clinicians in our field. Despite widespread advertisement, American attendance at the Ninth Congress of the European Society for Child and Adolescent Psychiatry held in London in September 1991 was very low. Many Americans remain unfamiliar with the significant work going on in many different parts of Europe, not just in neuropsychiatry but, for example, in longitudinal studies, child protection, and nonorganic failure-to-thrive. I hope that many American child psychiatrists will read and contribute to a recently launched journal, European Child and Adolescent Psychiatry, and eventually find it as valuable as I find your own excellent journal. Philip Graham Hospital for Sick Children London
Hans R. Huessy, M.D. Professor Emeritus The University of Vermont
Down with Insensitive Editors!
REFERENCE
Biederman, J. (1991), Sudden death in children treated with a tricyclic antidepressant. J. Am. Acad. Child Adolesc. Psychiatry, 30:495498.
Dr. Biederman replies: I am encouraged to hear about the safety record of the wide use of tricyclic antidepressants (TCAs) in children by a single clinician. This is in keeping with our own safety record with thousands of patients. My experience regarding dosage is, however, discrepant with that of Dr. Huessy. Although low doses of TCAs may be initially effective to maintain a clinical response over time, higher doses than those suggested by the writer have been consistently necessary (Biederman et al., 1986, 1989a, b; Gastfriend et al., 1984). It will be very informative to the field for the writer to present his rich clinical experience in the scientific literature so that we may be able to evaluate the nature of these apparent discrepant clinical experiences. Joseph Biederman, M.D. Massachusetts General Hospital REFERENCES
Biederman, 1., Gastfriend, D. R., & Jellinek, M. S. (1986), Desipramine in the treatment of children with attention deficit disorder. J. Clin. Psychopharmacol., 6:359-363. - - Baldessarini, R., Wright, V., Knee, D. & Harmatz, J. (1989a), A double-blind placebo controlled study of desipramine in the treatment of attention deficit disorder: I. Efficacy. J. Am. Acad. Child Adolesc. Psychiatry, 28:777-784. - - - - - - - - - - Goldblatt, A. (1989b) A double-blind placebo controlled study of desipramine in the treatment of attention deficit disorder: II. Serum drug levels and cardiovascular findings. J. Am. Acad. Child Adolesc. Psychiatry, 28:903-911. Gastfriend, D. R., Biederman, J. & Jellinek, M. S. (1984), Desipramine in the treatment of adolescents with attention deficit disorder. Am. J. Psychiatry, 141:906-908.
European Child Psychiatry To the Editor: I was delighted to read Dr. Todd's account of his enjoyable attendance at a European child psychiatry meeting focused around neuro-
170
To the Editor: We are very pleased to note the publication in your journal of several of our papers on the mental health of children and adolescents from the Dunedin longitudinal study. However, we wish to point out a consistent change that occurs from submitted manuscript to published version. This is the ruthless alteration of sentences commencing "We ..." as in "We decided to use ANOVA ..." and so on. This is sometimes replaced by the more impersonal "The authors decided . .." We would note that although some journals welcome the use of the active voice, others appear to be obsessed with its elimination. Our own belief is that the use of "we" or "I" in scientific articles fixes responsibility for what is said more firmly on the author. Although some may believe this is a trivial point, the use of the passive voice in the psychiatric literature is consistent with a writing style that promotes the idea of "acts without agents" (Lamb, 1991). This author has pointed out how linguistic style in the literature on violence toward women serves to reinforce a notion of acts arising in thin air, attributable to no one. The use of the passive voice reinforces a view of methodology without guiding agents. We see nothing wrong in promoting a more active view of researchers in the language of journals. Rob McGee Michael Feehan Sheila Williams University of Otago Dunedin, New Zealand REFERENCE
Lamb, S. (1991), Acts without agents: an analysis of linguistic avoidance in journal articles on men who batter women. Am. J. Orthopsychiatry, 61:250-258.
The Editor comments: The Journal pleads nolo contendere and will be guided by the wishes of its readers. The deciding factor should be readability rather than resolving any conflicts our valued authors (p. 50) may have over activity vs. passivity! Do you favor articles written in the first or third person? Or does it matter? Send replies to the Editor, JAACAP, or Fax to (808) 941-6707.
J. McD. J. Am. Acad. Child Adolesc. Psychiatry, 31: 1, January 1992
