There is a strange disconnect between what we psychiatrists do in daily practice and what official antidepressant treatment guidelines recommend. Treatment guidelines typically say, essentially, that all antidepressants are equal in efficacy, but real psychiatrists have strong personal preferences, based on some combination of the scientific literature, the advice of experts, our clinical experience, and perhaps even the personalities of the last drug reps we saw in the office. In this article we review a range of evidence to come up with suggestions for which antidepressants to start with, as well as adding bonus material on how to start meds that many of us may have little experience with, namely the tricyclics and the MAOIs.
It’s easy to order labs—it’s the interpretation that’s difficult. In this article, we’ll review some of the more common labs you are likely to order as psychiatrists and give you some tips on interpreting them, as well as discussing what (if anything) you should do when a lab is abnormal.
A variety of psychotherapy techniques work well for eating disorders, particularly for bulimia nervosa and binge eating disorder. This article gives a brief summary of the evidence from controlled clinical trials.
Any discussion of psychiatric medications and breastfeeding must begin with the benefits of breastfeeding, which are substantial. While all psychotropic medications enter the breast milk, medication exposure for a nursing infant is much less than the exposure to a fetus during pregnancy. As is the case for pregnant women, it is important to work with breastfeeding women to find the lowest effective dose.
In this issue of TCPR, we focus on TMS (Transcranial Magnetic Stimulation), which has just been approved for treatment resistant depression. There are also other brain devices in various stages of research and development. Here is a quick run-down of four of them.
Let’s assume that you have already diagnosed a patient with Alzheimer’s Disease (AD). Your patient has received a full workup to rule out medical causes, has had a full battery of neuropsychological tests, and you have started a standard cocktail of whichever cholinesterase inhibitor you prefer.
Most of us who prescribe benzodiazepines (BZs) have a love-hate relationship with them. On the one hand, they work quickly and effectively for anxiety and agitation, but on the other hand, we worry about sedative side effects and the fact that they can be difficult to taper because of withdrawal symptoms.
Ronald C. Albucher, MD, is the director of counseling and psychological services and clinical assistant professor of psychiatry, Stanford University in Palo Alto, CA.
Steve Balt, MD is a psychiatrist in private practice in the San Francisco Bay area.
Richard Gardiner, MD, is a psychiatrist in private practice in Potter Valley, CA.
Alan D. Lyman, MD, is a child and adolescent psychiatrist in private practice in New York City, NY.
James Megna, MD, PhD, is the director of inpatient psychiatry and an associate professor of psychiatry and medicine at SUNY Upstate Medical University in Syracuse, NY.
Robert L. Mick, MD, is a contract physician in addiction medicine and military psychiatry in Bloomfield, NY.
Michael Posternak, MD, is a psychiatrist in private practice in Boston, MA.
Glen Spielmans, PhD, is an assistant professor of psychology at Metropolitan State University in St. Paul, MN.
Marcia L. Zuckerman, MD is director of Psychiatric Services at Walden Behavioral Care in Waltham, MA.
All editorial content is peer reviewed by the editorial board. Dr. Albucher, Dr. Balt, Dr. Gardiner, Dr. Goldberg, Dr. Lyman, Dr. Megna, Dr. Mick, Dr. Posternak, Dr. Spielmans, and Dr. Zuckerman have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity. Dr. Balt discloses that his spouse is employed as a sales representative for Otsuka America, Inc.