Dhwani Shah, MD

Printer-friendly version

Associate Clinical Faculty Member
University of Pennsylvania

Which Antidepressant to Choose?

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.

Tips When Reviewing Labs

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.

Psychotherapy for Eating Disorders: A Review of the Current Evidence

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.

Breast Feeding and Psychiatric Medications: An Overview

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.

The New Brain Devices in Psychiatry: A Brief Review

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.

Medications for Treating Alzheimer’s Dementia

The Diagnosis and Treatment of Dementia

While drug companies have been working hard to come up with new options for the treatment of dementia, there have been no new FDA approvals since memantine (Namenda) hit the scene in 2003.

Monitoring Dementia Symptoms: Which Scales are Practical for Clinicians?

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.

Actually, that was the easy part.

Alternative Treatments for Depression

No clinician wants to be a “pill-pusher,” and most of our patients do not want that kind of treatment. So what can we offer our depressed patients beyond medications?

Benzodiazepines: A Guide to Safe Prescribing

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.