deprescribing | CARLAT PUBLISHING

Deprescribing Anti-anxiety Meds in Older Adults

March 25, 2024

Chris Aiken, MD and Kellie Newsome, PMHNP

All sorts of medications are prescribed for anxiety in older adults. Today, we look at when and how to discontinue them.

Clinical Update

Addressing Polypharmacy in Older Adults

January 1, 2024

Jose Antonio Ribas Roca, MD and Carolyn TK Tran, PhD

Jose Antonio Ribas Roca, MD. Associate Professor, Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Carolyn TK Tran, PhD. Instructor, Psychiatry and Behavioral Sciences Baylor College of Medicine, Houston, TX.

Dr. Ribas Roca and Dr. Tran have no financial relationships with companies related to this material.

Managing polypharmacy in older adults can be tricky, especially when multiple clinicians are involved. We offer tips on how to find the right medication and dose while avoiding prescribing cascades. We also discuss how to use shared decision-making to deprescribe.

Clinical Update

Tapering Antipsychotics

November 1, 2023

Charmi Patel Rao, MD, DFAACAP

Charmi Patel Rao, MD, DFAACAP. Director of Psychiatric Services, Positive Development; Health Sciences Assistant Clinical Professor, Department of Psychiatry, Child and Adolescent Psychiatry; UCSD, San Diego, CA.

Dr. Patel Rao has no financial relationships with companies related to this material.

Antipsychotics offer remarkable, even lifesaving treatment for children and adolescents, however, their side effects include metabolic and neurologic problems, including neurotoxicity. This clinical update guides you through a rational process for employing these powerful medications when necessary but also reducing and discontinuing them when possible.

Psychotherapy and Medication in Recurrent Depression

June 29, 2021

Giovanni Fava, MD

Giovanni Fava, MD

Clinical Professor of Psychiatry at the State University of New York at Buffalo. Editor-in-Chief of the journal Psychotherapy and Psychosomatics and author of over 500 scientific papers. His book, Discontinuing Antidepressant Medications, is due from Oxford University Press in 2021. Dr. Fava has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Antidepressants treat depression, but patients need something more to prevent future episodes. Giovanni Fava describes an evidence-based method that blends medication with psychotherapy in two phases: sequential treatment for prevention of depression.

How to Come Off a Psych Med Part 2: Antidepressants, Stimulants, and Benzos

March 11, 2021

Swapnil Gupta, MD

Swapnil Gupta, MD

Associate Professor at Icahn School of Medicine at Mount Sinai. Co-author of Deprescribing in Psychiatry (Oxford, 2019). Dr. Gupta has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

What do you do when a patient comes to you on a high dose of Adderall and Klonopin without any clear reason to be on them? Swapnil Gupta tackles this in part II of our interview on deprescribing, and describes how to fine-tune and microdose antidepressants and benzodiazepines to manage withdrawal symptoms.

Are SSRIs Associated With Increased Rates of Violence?

February 3, 2021

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.

SSRIs are often used to reduce irritability, but questions about they can cause violence have loomed over these antidepressants since the early 1990’s. This new study, with 700,000 patients followed over 7 years, suggests they can.

How to Switch Antipsychotics

February 3, 2021

Peter Smith, PsyD.

Peter Smith, PsyD. Dr. Smith has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Should you stop the old antipsychotic and start the new? Or gradually cross-taper them? This new meta-analysis compared three titration strategies to find the best way to switch from one antipsychotic to another in schizophrenia.

Rest Easy: Benzos, Z-Drugs, and Dementia

December 31, 2020

James Jenkins, MD.

James Jenkins, MD. Dr. Jenkins has disclosed that he has stock in Alkermes, Sage Therapeutics, Teva Pharmaceutical Industries, Trevena, and Viatris. Dr. Aiken has reviewed this article and has found no evidence of bias pertaining to this educational activity.

It may not be perfect, but this study has the best data yet on the controversial link between benzodiazepines and dementia.

The “Z-Drugs”: Safety Issues and Misuse Potential

June 10, 2020

Rehan Aziz, MD.

Rehan Aziz, MD. Associate Professor of Psychiatry and Neurology, Rutgers Robert Wood Johnson Medical School. Dr. Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Once heralded for their relative safety compared to benzodiazepines, the “Z-drugs” are now known to be one of the most common causes of adverse drug events. Here we review the risks of Z-drugs and highlight updated dosing recommendations for zolpidem.

EXPERT Q&A

Gabapentin Misuse and Diversion

June 10, 2020

Rachel Vickers-Smith, PhD, MPH

Rachel Vickers-Smith, PhD, MPH
Assistant Professor at University of Louisville, KY. Dr. Vickers-Smith has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Clinicians are increasingly turning to gabapentinoids as non-opioid alternatives for pain treatment. Yet we may be inadvertently introducing new risks in so doing. Dr. Vickers-Smith reviews current epidemiology of gabapentinoid use and offers some clues regarding how to turn the tide on gabapentin misuse.