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CBT for Insomnia

February 1, 2019
Chris Aiken, MDChris Aiken, MD. 
Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dear Dr. Aiken: The January 2019 issue mentioned cognitive behavioral therapy for insomnia (CBT-i) as a good alternative to sleep meds. It’s hard to find a therapist trained in CBT-i in my area. Are there any evidence-based self-help options that I can recommend to my patients?
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Does Mania Follow the Sun?

February 1, 2019

Chris Aiken, MDChris Aiken, MD. 
Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

If dark nights can treat mania, can too much sunshine destabilize it? Yes and no. Mania is linked to rapid changes in sunlight, but not to the amount of light itself. Mania peaks in early spring when there’s a steep rise in sunlight. By the time the longest day of the year comes along in late June, there’s no longer a detectable increase in mania (Parker G et al, J Affect Disord 2018;226:72–76).
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Prazosin for Alcohol Use Disorders

February 1, 2019
Michael Posternak, MD.
Michael Posternak, MD. Dr. Posternak has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Prazosin is often used as a second-line option for a broad array of psychiatric conditions, including anxiety, insomnia, nightmares, and post-traumatic stress dis¬order (PTSD). It is a high blood pressure medication that also modulates the stress-response system through noradrenergic effects, blocking alpha-1 receptors in the brain. Since stress is a common trigger for excessive drinking, this study set out to test whether prazosin could improve so¬briety in alcohol use disorders.
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An Opioid Combo Falls Short in Depression

February 1, 2019
Chris Aiken, MD

Chris Aiken, MDChris Aiken, MD. 
Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Opioids have a bad name these days. But let’s not forget that they were once consid­ered a first-line treatment for depression before the discovery of MAOIs and tricy­clics in the 1950s. That history has been revived recently by buprenorphine, a par­tial opioid agonist that was fast-tracked by the FDA for treatment-resistant depression.
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Prescription CBD Is Available, But Are We Ready to Use It?

January 1, 2019
Chris Aiken, MD
Chris Aiken, MDChris Aiken, MD Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Your patient comes in with a new medication on his list: CBD oil. He started taking it for anxiety and wants to know if it’s safe. You hedge, explaining that there is limited information available on unregulated products, but the patient is persistent. He says CBD oil is available as a prescription, and wonders if you could write one for it.
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Deprescribing Medication

January 1, 2019
Barbara Farrell, PharmD
Barbara Farrell, PharmDBarbara Farrell, PharmD

Assistant Professor, Department of Family Medicine, University of Ottawa and Adjunct Assistant Professor, School of Pharmacy, University of Waterloo. Co-founder of the Canadian Deprescribing Network. Dr. Farrell has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Deprescribing refers to lowering or stopping medications that might be causing harm or no longer providing benefit. It’s done in a planned, collaborative, and supervised way rather than simply the patient stopping the medications independently.
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Wellbutrin Augmentation: When Does It Work?

January 1, 2019
Chris Aiken, MD
Chris Aiken, MD Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dear Dr. Aiken: In the July/August 2018 issue, you wrote that ­bupropion (Wellbutrin) augmentation does not work in ­treatment-resistant depression (TRD). So why do we see it work so often in practice?
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Cannabidiol for Schizophrenia

January 1, 2019
Michael Posternak, MD.
Michael Posternak, MD. Dr. Posternak has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In this pilot study, investigators evaluated the benefits of cannabidiol (CBD), which is one of the two main active components of marijuana (the other being THC), for the treatment of ­schizophrenia.
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Is Ketamine Just Another Opiate?

January 1, 2019
Michael Posternak, MD.
Michael Posternak, MD. Dr. Posternak has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Ketamine’s rapid antidepressant effects have now been demonstrated in over two dozen double-blind, placebo-controlled trials, but how it works is less clear. For many years, NMDA receptor antagonism was thought responsible, but other NMDA antagonists have not worked well in depression.
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