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.

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?

There is a need for rapid treatment in postpartum depression, as each month of this potentially severe condition can take a toll on infant development. That is why brexanolone (Zulresso), which was recently fast-tracked for approval by the FDA, is causing such a splash.

You may have noticed that a confusing array of new stimulants has been approved in the last few years. Since 2012, there have been five new amphetamines and two new methylphenidates. What are these preparations? Are any of them worth prescribing to your patients?

It’s nice when we can get our patients better with a single medication, but that’s not always possible. Sometimes the right combination of meds can do the trick, but studies of polypharmacy are scarce. In this article we dig through that research, small and limited as it is, to highlight a few useful combinations where the drug interaction can benefit your patient.

Akathisia is a sensation of inner restlessness so unpleasant that it independently elevates the risk of suicide. Among atypicals, quetiapine (Seroquel) has the lowest risk of akathisia, but that doesn’t mean it’s easy to take.

Probiotics, the so-called “good” bacteria in the gut flora, have become popular as a natural treatment for various disorders. They are taken as capsules or through food sources like yogurt, vinegar, and fermented foods.

We know that transcranial magnetic stimulation (TMS) works for treatment-resistant depression (TRD), but one disadvantage is the length of the treatment sessions.

In the May 2018 issue of TCPR, we wrote about using benzodiazepines for anxiety and other disorders, and we got some reader feedback that we did not provide a thorough enough review of medication risks. So, in a follow-up article this month, I will focus on two groups where benzos pose the greatest risks: opioid users and the elderly.