We often prescribe antidepressants to patients who are suicidal, and unfortunately, some people use these very medications to try to kill themselves. It’s been known for some time that tricyclic antidepressants are among the most toxic in overdose, so we embraced the SSRIs and later medications in part because they are considered to be safer. But how safe are they?

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As director of psychiatry at Hebrew SeniorLife for 18 years, Dr. Metzger has witnessed a number of changes in how we manage agitation and other elements of BPSD. In this article, he outlines current thinking about such symptoms, as well as the latest techniques—both pharmacologic and non-pharmacologic—for managing them.

There used to be this rule of thumb that you don’t need to worry about people who are worried about their memory; you need to worry about people who aren’t worried. And that might be true for people with dementia, where there is often a loss of insight. But if you want to pick up memory problems at the earlier, mild cognitive impairment stage, do an evaluation when someone is worried about memory loss.

We’ve all seen the ads from companies such as Lumosity implying that fun, computer-based learning games will help your mind work better. Such methods are called computerized cognitive training (CCT), and past systematic reviews have had weaknesses, such as combining CCT with other interventions or including studies that were not randomized controlled trials. These researchers performed a systematic review that was more rigorous.

Do antidepressants cause bipolar II patients to switch from depression to hypomania? It’s a controversial question, and you’ll find academic psychiatrists who will argue passionately that antidepressants are either safe or dangerous in these patients. The latest study appears to endorse the “safe” camp.

The post-test for this issue is available for one year after the publication date to subscribers only. By successfully completing the test you will be awarded a certificate for 1 CME credit.

After reading these articles, you should be able to…

The latest official statement on psychotherapies from the American Psychological Association more or less states that all techniques are equally effective, and it’s likely that the skills of individual therapists are as important as the specific technique they choose. This is all well and good, but meanwhile, in the real world, we need to make decisions about how to treat specific patients. If we wait for the definitive answers from research, we will be waiting for a very long time. This article details certain well-known techniques drawn from the broad umbrella of cognitive behavior therapy.

Insomnia is so ubiquitous and misunderstood with respect to its health consequences and “treatability.” At the core of this is the widespread misconception that insomnia is primarily a symptom of other things. Insomnia is also identified in DSM-5 as an independent disorder (780.52) which, when occurring with other DSM-5 disorders, is considered a comorbid disorder rather than a symptom.