Featured Articles

Agitation in Dementia (Part 2)

By: jives | February 20th , 2020 | The Carlat Psychiatry Blog| 4 Comment

Families bring difficult questions when their loved one has dementia, and in this interview with Cathy Howard, RN, we’ll show you how to answer some of them. We also delve into the nonpharmacologic approaches to agitation in dementia to learn what they look like in real life. Published On: 2/20/20 Duration: 8 minutes, 9 seconds Article

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Agitation in Dementia (Part 1)

By: jives | February 17th , 2020 | The Carlat Psychiatry Blog| 1 Comment

Nuedexta. A 60 year old cough medicine gets approve for uncontrollable crying, but the drug company has its eyes on a bigger target: Agitation in dementia. Follow the trail of pseudoscience, bribery, and indictments, and learn a few clinical pearls about this dextromethorphan-quinidine combination along the way. Published On: 2/17/20 Duration: 15

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Inflammation and Depression: An Interview with Andrew Miller, MD

By: jives | February 10th , 2020 | The Carlat Psychiatry Blog| 0 Comment

30-50% of patients with depression have signs of inflammation, and some of those markers may help predict which medication they'll respond to. Andrew Miller, MD, of Emory University is one of the leading researchers in this field, and in this interview he tells us when to suspect inflammation and how to test for it. Published on: 2/10/20 Duratio

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Psilocybin, Ketamine, and the Spiritual Brain

By: jives | February 4th , 2020 | The Carlat Psychiatry Blog| 0 Comment

A new antidepressant is under development that could change the field even more than esketamine. And even if it doesn't, its novel effects on the mind reveals something that can help our patients today. This fascinating drug was commonly prescribed by psychiatrists in the 1950's until Richard Nixon tried to put it back in the bottle. Date Publish

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How And When To Come Off Medications

By: jives | January 27th , 2020 | The Carlat Psychiatry Blog| 0 Comment

Antipsychotics.  For some, long term use is best, for others, you need to keep it short. In this interview with Nassir Ghaemi we dig into the research to find some answers. Date Published: 1/27/20 Duration: 27 minutes, 1 second Article Referenced: "Antipsychotic Maintenance: How Long Is Enough?", The Carlat Psychiatry Report, January 2020

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ADHD and Life Expectancy with Russell Barkley, PhD

By: jives | January 23rd , 2020 | The Carlat Psychiatry Blog| 0 Comment

From a public health standpoint, ADHD is worse than the top five killers in the U.S. combined. Russell Barkley, PhD, is a Clinical Professor of Psychiatry at the Virginia Commonwealth University Medical Center (VCUMC), Richmond, VA. His research findings have lit a fire under the ADHD community. Listen to excerpts of his interview with the Dr. Josh

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What We Learned in 2019

By: jives | January 6th , 2020 | The Carlat Psychiatry Blog| 0 Comment

These are the articles from 2019 that changed our practice. Dark therapy for mania. CBD oil. Genetic testing. An antidepressant diet. Viagra and the brain. Sleep in PTSD. Antidotes for weight gain and nausea. Light therapy for depression. Date Published: 1/6/2020 Duration: 10 minutes, 48 seconds Take the Podcast Survey to help us launch a CM

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ADHD and Identity

By: jives | December 30th , 2019 | The Carlat Psychiatry Blog| 0 Comment

When a patient is diagnosed with ADHD for the first time in adulthood, they have a lot of baggage to overcome. Years of living with the symptoms has probably shaped their identity, and in part 2 of our interview with Scott Shapiro, MD, we learn how to address the core beliefs of shame and failure that can develop when ADHD goes untreated. Date Publis

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Cannabis and Kids

By: jives | December 16th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Child psychiatrists are grappling with the problem of pervasive use of marijuana in an age where legalization of use for adults has led to even greater use in teens. In this episode, Dr. Feder and Mara go over two recent interviews in The Carlat Child Psychiatry Report with Gabriella Gobbi, MD, PhD, of McGill University and Elizabeth D’Amico, P

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Micronutrients and Mental Health

By: jives | December 9th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Vitamins have dozens of positive studies in mental health, but is it better to give one single vitamin or a broad variety? Or should you just stick with a healthy diet? In this interview, Dr. Julia Rucklidge explains the difference, and how micronutrients can help people with ADHD, irritability, emotional dysregulation, and autism. Date Published

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Research Theme Park: Anxiety

By: jives | December 2nd , 2019 | The Carlat Psychiatry Blog| 0 Comment

A ride through recent studies on anxiety, highlighting the playful and the practical. Why anxious people prefer to worry than relax. City parks lift mood, and a bike helmet changes the perception of risk. Anxious triggers are less distracting as we get older, and for a select group of patients metformin may reduce anxiety and depression. Date Publish

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Hysteroid Dysphoria. Donald Klein's Lost Diagnosis.

By: jives | November 25th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Donald Klein was known as the father of psychopharmacology, and when he passed earlier this year he left behind a legacy that remains relevant to practice. We survey his ideas that lasted - panic disorder, atypical depression, antidepressant withdrawal - and pull one out of the dustbins that still has relevance today: A common disorder of mood and p

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Does Trintellix Treat Generalized Anxiety?

By: jives | November 11th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Trintellix looks like a natural fit for anxiety disorders, with a serotonergic mechanism that overlaps with buspirone (5HT1a agonism). But things are not always as they seem in psychiatry. In this second installment of our anxiety series we delve into the failure of Trintellix in generalized anxiety disorder, and uncover two other myths about this a

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A Scandalous History of Anxiety

By: jives | November 4th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Is Generalized Anxiety Disorder (GAD) an anxious temperament, a symptom of another disorder, or a valid disorder on its own? In Part One of our November series on anxiety, we trace the history of GAD from Sigmund Freud to DSM-5.  With over two dozen choices, it isn't easy to pick a medication for GAD. The forthcoming issue of The Carlat Psychiatry

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Informed Consent: An Ongoing Process for Focused Care

By: jives | October 28th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Informed consent is a foundation for good clinical practice and can provide legal protection. But informed consent is more than defensive medicine. It is a vehicle for framing good care. How often do people use the consent process? In this episode we go through the steps of good informed consent with some practical advice on how to go about doing it.

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Prescription Mental Health Apps

By: jives | October 21st , 2019 | The Carlat Psychiatry Blog| 0 Comment

Prescription apps are here, and in this interview Dr. John Torous will help you get ready for them. From a list of 250,000 health apps, we highlight the top 7, including video games that treat ADHD, medication reminders, and digital guides for CBT, mindfulness, and insomnia. Dr. Torous led the development of the APA guidelines on evaluating smartph

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Vyleesi: A Drug for What You Don't Feel

By: jives | October 14th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Vyleesi was just released for low sex drive in women, but it hasn't received a warm welcome. Kellie Newsome goes undercover to explore some bold marketing techniques for these kinds of drugs. After getting lost in the politics and business of low sex drive, she interviews sex therapist and Foreplay host Laurie Watson to learn about the real strugg

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Should You Consider TMS for Kids?

By: jives | October 7th , 2019 | The Carlat Psychiatry Blog| 0 Comment

With concerns about both safety and efficacy surrounding antidepressant use in children and adolescents, we are always looking for safe, effective treatments for our patients. Transcranial Stimulation (TMS) has been around for many years, and its use in youth is expanding. In this episode, we examine the evidence of efficacy and potential side effec

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Top Myths in Psychopharmacology

By: jives | September 30th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Nassir Ghaemi takes issue with some of psychiatry's cherished notions in this expert interview. From the practical to the philosophical, he considers symptomatic treatments, preventative medicine, and whether medications are best given in divided doses or once-a-day. Date Published: 9/30/19 Duration: 12 minutes 17 seconds Related Articles

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Remeron Runs out of Rocket Fuel

By: jives | September 23rd , 2019 | The Carlat Psychiatry Blog| 0 Comment

When a popular antidepressant combination is discredited, what do we do with it? Dr. Aiken sorts through the possibilities for mirtazapine (Remeron) augmentation, and pulls up a few more myths about this medicine. Date Published: 9/23/19 Duration: 9 minutes 11 seconds Article Referenced: "Mirtazapine Augmentation: Running Low on Rocket Fuel

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Should we trust the experts?

By: jives | September 16th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Why does the top-selling psychiatric textbook base its recommendations on the lowest grade of medical evidence? Psychiatric practice is often mislead by expert opinion, practice trends, and neurotransmitter theories. In the case of paroxetine (Paxil), venlafaxine (Effexor), and mirtazapine (Remeron), this misinformation has created some popular myth

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How to Address School Refusal

By: jives | August 31st , 2019 | The Carlat Psychiatry Blog| 0 Comment

School refusal is a common problem, affecting up to 5% of schoolchildren. This episode takes a look at the limited research on the subject and goes over work done by experts at the Yale Child Center to put together some useful advice on how to address this problem in your patients and families. Publication Date: 9/2/19 Runtime: 15 minutes, 28

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Brexanolone: A New Treatment for Postpartum Depression

By: jives | August 26th , 2019 | The Carlat Psychiatry Blog| 0 Comment

William S. Meyer is a clinical social worker and psychoanalytic psychotherapist who holds faculty positions at Duke in the Departments of Psychiatry and Ob/Gyn. He has spent 20 years working with postpartum depression at the Duke Medical Center. In this interview, he discusses the role of psychotherapy, community, family, and where medications and t

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Weight Gain on Psych Meds

By: jives | August 19th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Metformin is the top antidote for antipsychotic weight gain, but is it good for patient's health or just their looks? We explore how to use it, delve into its fabled anti-aging effects, and end with a new discovery that may help people lose weight while they sleep. Publication Date: 8/12/19 Runtime: 19 minutes, 51 seconds Article Reference

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Is Watching ‘13 Reasons Why’ Bad for Teens?

By: jives | August 12th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Join Josh Feder, MD, and Mara Goverman, LICW, for a special episode focused on child psychiatry, suicidality, and the popular Netflix series 13 Reasons Why. The show stirred controversy when it portrayed the bullying and suicide of a teenager. Although the program increased awareness of these issues, some clinicians argued that it glamorized the su

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The Choice: Deplin, Folate, or Folic acid

By: jives | August 5th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Folate, folic acid, l-methylfolate, Deplin, folinic acid… How do we choose among the many forms of this vitamin? All have proved useful as add-on therapies in depression, but they differ in important ways. Some may work in bipolar disorder, and there’s even one that might get in the way of a popular treatment for bipolar depression. Publicati

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The Carlat Report Goes to APA Part II

By: jives | July 29th , 2019 | The Carlat Psychiatry Blog| 0 Comment

More highlights from the American Psychiatric Association's 2019 meeting in the final installment of this two-part series. Expert interviews with Manpreet Singh on childhood mood disorders and Nikhil Rao on novel medications for sleep. Learn what to do when children get worse on antidepressants, and how to use clonidine for sleep in patients with

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Daniel in the Pharma Den

By: jives | July 22nd , 2019 | The Carlat Psychiatry Blog| 0 Comment

20 years ago, Danny Carlat signed up to speak for the pharmaceutical industry. Through closed-door meetings and lavish "faculty development programs," he learned how to present their product's data in the most convincing way. The only problem was that he couldn't convince himself, and his industry handlers started to worry that Dr. Carlat was unwell.

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How to use Lithium in the Elderly

By: jives | July 15th , 2019 | The Carlat Psychiatry Blog| 0 Comment

A new study suggests that lithium might work better in geriatric depression, but prescribing it safely in older patients takes skill. To start with, they require different blood levels. In this episode you'll learn how to manage lithium's risks in the elderly, as well as some newly discovered medical benefits that it carries in this population. Pu

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Podcast Episode #9: The Secret History of Ketamine

By: jives | July 8th , 2019 | The Carlat Psychiatry Blog| 0 Comment

In 1985 a Soviet psychiatrist began giving his patients ketamine in hopes to cure their alcoholism. The experiment backfired, but the results tell us something about how ketamine might treat depression. Long buried behind the Iron Curtain, this episode uncovers that early research and traces it back to modern PET-scans, the "default mode network," a

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Podcast Episode #8: SSRI Withdrawal

By: jives | July 1st , 2019 | The Carlat Psychiatry Blog| 0 Comment

Withdrawal problems rank among patients’ top concerns with antidepressants. They include insomnia, flu-like symptoms, irritability, distractibility, and unusual sensory experiences such as “brain zaps.” Earlier this year, a study examined clinical and biological research on tapers of serotonergic antidepressants. In this episode we discuss wha

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Podcast Episode #7: How to Use Amantadine

By: jives | June 24th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Rarely used but often studied, amantadine is a medicine that doesn't fit neatly into any boxes. It's thought to work in OCD, autism, depression, cognition, ADHD, weight loss, sexual dysfunction, and traumatic brain injury. But how good is that research, and when should you use it? Chris Aiken and Kellie Newsome guide you through in this edition.

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Podcast Episode #6: The Carlat Report Goes to the APA Part I

By: jives | June 17th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Follow our editor-in-chief Chris Aiken as he brings you practice-changing highlights from the American Psychiatric Association's 2019 meeting. Featuring an interview with Mark Rappaport on inflammation and depression. Learn about a biomarker that predicts antidepressant response, pharmacologic approaches cannabis and opioid abuse, and safe prescribi

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Podcast Episode #5: Ginger Ale and Normal Hallucinations

By: jives | June 10th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Does ginger ale really help nausea? Are hallucinations ever normal? Some of the answers may surprise as we bring you highlights from the June/July double issue of the Carlat Report. Included are practical tips on how to assess spectrum symptoms of mental illnesses, how to intervene in patients at risk for schizophrenia, and dosage and product recomm

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Podcast Episode #4: An Antidepressant Diet

By: jives | June 3rd , 2019 | The Carlat Psychiatry Blog| 0 Comment

A healthy diet is associated with an approximately 30% reduction in the risk for depression and a 40% improvement in cognition. That’s after controlling for education, income, other health behaviors, and body weight. This podcast discusses a recent interview with Felice Jacka, MD, Professor at Deakin University, Geelong, Victoria, Australia. She i

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Podcast Episode #3: Do Antipsychotics Improve Cognition?

By: jives | May 27th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Unlike the typical antipsychotics, atypicals improve both cognitive and psychotic symptoms of schizophrenia, so they must have procognitive effects of their own that can be harnessed in mood disorders, ADHD, and even dementia. The problem is that the data show the opposite. Publication Date: 5/27/19 Runtime: 8 mins, 35 seconds Article Reference

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Podcast Episode #2: Cash, Guns, and a Lap Dancing Drug Rep

By: jives | May 20th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Earlier this month, five Insys Therapeutics pharmaceutical executives were found guilty of racketeering for their attempts to bribe doctors to prescribe the company's Subsys fentanyl spray, which was approved as a pain reliever for cancer patients, to people who didn't even need it. Their scheme included strippers, guns, cash, and even a rap video i

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Podcast Episode #1: Sexual Side Effects of Psychiatric Medications

By: jives | May 13th , 2019 | The Carlat Psychiatry Blog| 0 Comment

Sexual side effects on SSRIs are so common that psychiatrist David Healy once argued these drugs more reliably lower libido than treat depression. Yet the problem isn’t limited to SSRIs, and it’s not unmanageable. In this episode Chris Aiken, MD, and Kellie Newsome, RN, discuss some useful strategies to manage sexual dysfunction on antidepressan

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