Dr. Sandson, you've just published the definitive casebook on drug interactions (1), and you obviously have thought long and hard about the issue. What do you think psychiatrists really need to know about drug-drug interactions?

The concept of drug-drug interactions in psychiatry surfaced surprisingly recently. In 1988, a small letter was published in the American Journal of Psychiatry by Dr. D. A. Vaughan, a psychiatrist in practice in Wichita, Kansas. Dr. Vaughan described two women he had been treating for depression with tricyclics.

Alan Ringold, M.D., is a psychiatrist in private practice in Palo Alto, California. He is particularly astute when it comes to drug interactions, and he clearly made the right call in the following situation.

Side effect expert Prakash Masand once observed that “the difference between a good clinician and a great clinician is that a great clinician is better at managing side effects.”

It has become more and more painful for us to prescribe SSRIs and SNRIs over the last few years. The reason? Sexual dysfunction.

Yes, side effects can be your (and your patients’) friend. Here are several common clinical scenarios, culled from conversations with astute clinicians and from reflections on my own practice.

Dr. Pies, as an expert psychopharmacologist you’ve seen a lot of patients experiencing both therapeutic effects and side effects of medications. What do you actually say to your patients to prepare them for SSRI side effects?

Perhaps the most dreaded side effect in all of psychiatry is the MAOI-cheese interaction. We now understand its mechanism fairly well, namely, that most cheeses contain high amounts of the amino acid tyramine, which has the effect of increasing the release of norepinephrine (NE) from nerve terminals.

Alicia Powell, M.D., is a psychiatrist in private practice in Jamaica Plain, Mass. Like many psychiatrists, she deals with sexual side effects of antidepressants on a daily basis.

There’s nothing like a close friend suffering psychiatric difficulties to motivate a psychiatrist to do some serious reading. Recently, your humble editor encountered this situation.