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A Look at the Latest Antidepressant Meta-Analysis

June 1, 2018
Adam Strassberg, MD
Adam Strassberg, MD Psychiatrist in private practice in Palo Alto, CA. Contributing writer to the Carlat newsletters. Dr. Strassberg has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
You may have read about the meta-analysis published in Lancet earlier this year on the efficacy evidence for all antidepressants (Cipriani A et al, Lancet 2018;391(10128):1357–1366). It’s a complicated paper, and in this article, we’ll take a closer look at it and give you our take on the bottom line.
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EXPERT Q&A

Neurobiology Concepts for Psychiatrists

June 1, 2018
David M. Kaufman, MD
David M. Kaufman, MD Department of Neurology, Montefiore Medical Center, Bronx, NY. Co-author of Kaufman’s Clinical Neurology for Psychiatrists, 8th ed. (Elsevier). Dr. Kaufman has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
The most common cause of parkinsonism is Parkinson disease, but parkinsonism also can occur from the use of any medication that blocks the D2 (dopamine type 2) receptor. Those include antipsychotics but can also include non-psychiatric medicines, particularly metoclopramide (Reglan), an anti-nausea medicine.
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The Neuroscience Behind Addictions and SSRIs

June 1, 2018
Edmund S. Higgins, MD.
Edmund M. Higgins, MD Clinical associate professor, Psychiatry and Behavioral Sciences, Medical University of South Carolina. Co-author of The Neuroscience of Clinical Psychiatry: The Pathophysiology of Behavior and Mental Illness, 3rd ed. (Wolters Kluwer). Dr. Higgins has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
If we think of the molecules (the endorphins or the opioids) as “keys” and the receptors on the neurons as “locks,” then one needs the right key in the lock to get the reward—to turn on the good feelings.
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Dose Maintenance, Reduction With Antipsychotics

June 1, 2018
Adam Strassberg, MD.
Adam Strassberg, MD. Dr. Strassberg has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Once patients with schizophrenia are stabilized on an antipsychotic in the acute phase of their treatment, guidelines are unclear on how to continue dosing. Some guidelines recommend lowering the dose, others recommend maintaining the dose, and others give no firm recommendations whatsoever.
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Lithium Favored in Treatment Effectiveness Study

June 1, 2018
Adam Strassberg, MD.
Adam Strassberg, MD. Dr. Strassberg has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
A new study from Finland shows that lithium may be more effective than other treatments in reducing the risk of psychiatric rehospitalization in patients with bipolar disorder.
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Benzodiazepines for Anxiety: Where They Fit In

May 1, 2018
Michael Posternak, MD.
Michael Posternak, MD. Psychiatrist in private practice, Boston, MA Dr. Posternak has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Benzodiazepines (BZDs) are widely used, rarely studied, and much maligned. So where exactly do they fit in today’s medication arsenal for treating anxiety? This article discusses when BZDs are appropriate and when they are not, and how to choose among the various BZDs.
But before doing so, let’s first address the elephant that always seems to be lurking in the BZD room: their addictive potential.

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Anxious Distress: A New DSM Diagnosis

May 1, 2018
Mark Zimmerman, MD
Michael Posternak, MD.Mark Zimmerman, MD Director of the Partial Hospital Program and Adult Outpatient Psychiatry at Rhode Island Hospital Dr. Zimmerman has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

There’s a new diagnosis in the DSM-5 called anxious distress. But is this truly a new diagnosis, or just another way of defining depression? This month, we spoke with Mark Zimmerman, MD, a clinician and leading researcher on the topic of anxious distress, to get some answers.
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